TEST BANK for Pharmacology: Connections to Nursing Practice, 5th edition by ISBN-13: 9780137659166. by welldoneassistant

Pharmacology Connections To Nursing Practice 5th Edition Adams Urban Test Bank

Test Bank: Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 1 Introduction to Pharmacology: Concepts and Connections The nurse is teaching a pharmacology class to a group of student nurses. Which key events does the nurse include in the history of pharmacology? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Early researchers used themselves and animals as test subjects. Pharmacologists began to synthesize drugs in the laboratory in the 20th century. Modern pharmacology began in the mid-1600s. The first drugs included morphine, cocaine, and penicillin. The Dark Ages provided much useful information that we still use today. Answer: 1, 2 Explanation: Early researchers did use themselves and animals as test subjects. Pharmacologists did begin to synthesize drugs in the laboratory in the 20th century. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Relationship Centered Care: Learn cooperatively, facilitate the learning of others | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-1 Identify key events in the history of pharmacology. Although all areas of medicine, including pharmacology, have made great advances in the past century, the early roots of pharmacology still apply for the nurse and other health professionals. What were the early roots of pharmacology? Applying products to relieve human suffering Creating new drugs as quickly as possible Finding medicinal alternatives to plants Understanding how drugs cause their effects Answer: 1 Explanation: The early root of pharmacology was to relieve human suffering. Cognitive Level: Remembering 1

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Relationship Centered Care: Learn cooperatively, facilitate the learning of others | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-1 Identify key events in the history of pharmacology. Although many substances can be considered drugs, which drug definition is the most appropriate? Any substance that is found in nature or that normally occurs in the body Any substance that is synthesized and tested in the laboratory setting Any substance that is taken to prevent, cure, or reduce symptoms of a medical condition Any substance that can be isolated from substances found in nature Answer: 3 Explanation: A drug is considered to be any substance that is taken to prevent, cure, or reduce symptoms of a medical condition. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-2 Compare and contrast the terms drug, pharmacology, and pharmacotherapy. Pharmacotherapy is a critical intervention for many conditions, and a key part of nursing intervention. Which statement best describes pharmacotherapy? The study of medicine and drug therapy The application of natural substances to cure diseases The application of drugs for the prevention and treatment of disease and human suffering Understanding the difference between trade and generic medications Answer: 3 Explanation: Pharmacotherapy is the application of drugs for the prevention and treatment of diseases and human suffering. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated 2

Concepts: Nursing Process: Implementation Learning Outcome: 1-2 Compare and contrast the terms drug, pharmacology, and pharmacotherapy. Which principle best describes what the nurse is expected to understand when administering medication to a client? The pharmacotherapeutics for all of the medications The most common side effects of the drug's prototype The trade and generic names for all of the medications The cost of the drug therapy from different drug manufacturers Answer: 1 Explanation: The nurse should understand the pharmacotherapeutics for all medications that the client is receiving. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-3 Explain the importance of pharmacotherapy to clinical nursing practice. The Food and Drug Administration classifies drugs by category, and these categories and drugs are found in the "Orange Book." To find out which drugs treat hypertension, the nurse would look under which classification? Cardiac Pharmacologic Disease Therapeutic Answer: 4 Explanation: The nurse would look under the therapeutic category to find out what conditions a drug will treat. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-4 Using specific examples, explain the difference between the pharmacologic and therapeutic methods of classifying drugs.

The nurse is creating a teaching plan for a client on the cardiac unit and is researching the medications the client is currently taking to understand how each drug produces its effects in the body. To find this information, the nurse looks up which classification for each medication? Therapeutic Respiratory Disease Pharmacologic Answer: 4 Explanation: The nurse researches the pharmacologic classification to discover how a drug works in the body. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-4 Using specific examples, explain the difference between the pharmacologic and therapeutic methods of classifying drugs. A prototype drug is a single drug in a class and can be compared with all other medications in the class. By studying a prototype drug, the nurse would gain what knowledge for predicting the characteristics of other drugs in the same class? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. The drugs with the most favorable safety profile The drug's therapeutic indications The drug's actions and adverse effects The drug's specific clinical use Contraindications specific to any drug in that group Answer: 2, 3, 4 Explanation: Studying the therapeutic indications of a prototype drug may allow the nurse to predict the actions and adverse effects of other drugs in the same group. By studying the prototype, the nurse can predict the actions and adverse effects of other drugs in the same class. Studying the prototype drug may allow the nurse to predict the clinical use of another drug in the same class. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated 4

Concepts: Nursing Process: Assessment Learning Outcome: 1-5 Identify the advantages of using prototype drugs to study pharmacology. Chemical names are assigned to each drug. What are the major reasons for why nurses usuallydo not use the chemical names of drugs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. They are usually not brief or easy to remember. They are often difficult to pronounce. There is no standard for assigning names. They do not explain the nature of the drug. There is only one chemical name for each drug. Answer: 1, 2 Explanation: Chemical names are usually not brief or easy to remember. Chemical names are often difficult to pronounce. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-6 Classify drugs by their chemical, generic, and trade names. The trade name for a drug is usually selected to be short and easy to remember. What is the reason the nurse does not use the trade name for a drug? There are no trade names for combination drugs. A drug can have more than one trade name. The trade name will expire and no longer be used. A company might change the trade name for a drug. Answer: 2 Explanation: A drug can have more than one trade name. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-6 Classify drugs by their chemical, generic, and trade names. Nursing students must memorize the generic names of drugs. What is the primary reason that generic names are used by healthcare providers over chemical and trade names? 5

A drug can have more than one chemical and trade name. There is only one generic name for each drug. The trade names do not reflect the action of the drug as the generic name does. Nursing students should learn both the generic and trade names to avoid confusion with clients. Answer: 2 Explanation: Each drug does have only one generic name. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-6 Classify drugs by their chemical, generic, and trade names. Which is one of the main reasons a pharmaceutical company might be granted an exclusive period to market and distribute a new drug? It allows the company to recoup the cost of research and development. It allows consumers to learn the trade name of the drug. It allows all the adverse effects to be discovered. Without competition, consumer savings are significant. Answer: 1 Explanation: Exclusivity allows a pharmaceutical company a period of time to recoup the costs of research and development of a drug. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-7 Discuss the rationale for a pharmaceutical company receiving exclusivity for the marketing of a new drug. Bioavailability of a drug can be affected by many factors. Which factor does not affect the bioavailability of a drug? Inert ingredients Rate of absorption Safety margin Tablet compression Answer: 3 Explanation: Safety margin will not affect the bioavailability of a drug. Cognitive Level: Understanding 6

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-8 Analyze possible differences between generic drugs and their trade-name equivalents. Bioavailability can be different between the generic and trade versions of a drug. When is it not appropriate for a generic drug to be substituted for a trade version? The trade version costs the same as the generic. The time for onset of action is different between the generic and trade versions. The inert ingredients are different in the generic and trade versions. The drug is a critical care drug, or one with a narrow safety margin. Answer: 4 Explanation: The nurse should not substitute a generic drug for a trade version if the drug is a critical care drug or has a narrow safety margin. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-8 Analyze possible differences between generic drugs and their trade-name equivalents. Before administering a drug, what pertinent information must the nurse obtain from the client? Physical assessment, medical history, previous medications, and learning capabilities Medical history, growth and development level of client, and ability to pay for the medication Medical history, client's growth and development level, and potential adverse effects of the medication Medical history, physical assessment, disease process, and learning needs Answer: 1 Explanation: Physical assessment, medical history, previous medications, and learning capabilities are all important pieces of information the nurse should have prior to administering drugs to clients. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, 7

pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-10 Identify the responsibilities of the nurse in drug administration as part of an interprofessional team. When a drug is ordered for a client, what is the nurse responsible for knowing and understanding about the drug? Name, intended use, special considerations, and adverse effects Drug classification, contraindications, adverse effects, gender considerations, and cost of therapy Drug classification, contraindications, special considerations, and severity of adverse effects Name, intended use, effects, contraindications, special considerations, and adverse effects Answer: 4 Explanation: Name, intended use, effects, contraindications, special considerations, and adverse effects give the nurse the information needed to safely administer the drug as ordered. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-10 Identify the responsibilities of the nurse in drug administration as part of an interprofessional team. After successfully completing the pharmacology course, a student nurse tells the instructor thatshe is glad the course is finished. What is the best response from the nursing instructor? "It might be over, but now you will start your clinical courses and apply your knowledge." "If you think this course was hard, you should try the graduate level." "Learning is an ongoing process in pharmacology; we must continue to stay up to date." "Learning difficult material is always painful, but it is necessary." Answer: 3 Explanation: Learning is an ongoing process in pharmacology to stay current with drug therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.C.5 Value the need for continuous improvement in clinical practice based on new knowledge | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-10 Identify the responsibilities of the nurse in drug administration as part 8

of an interprofessional team. The client asks the charge nurse how the healthcare provider will decide which medication to prescribe. The nurses bases the response on which rationale regarding the "ideal drug"? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Effectively treats, prevents, or cures the client's condition Is not quickly eliminated by the body so that it can produce its effects over a prolonged period of time Produces minimal adverse effects Produces a rapid and predictable response Is inexpensive and easily accessible Answer: 1, 4, 5 Explanation: The goal of pharmacology is to select a drug that will effectively treat, prevent, or cure a condition. The goal of pharmacology is to select a drug that will produce a rapid, predictable response at relatively low doses. The ideal drug is affordable and easily accessible. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-3 Explain the importance of pharmacotherapy to clinical nursing practice. A client is taking a medication for a condition whose indication is not listed and asks the nurse why the healthcare provider would prescribe this drug. Which response by the nurse is the most appropriate? "Some medications may be used for conditions for which they have not been approved. This is called an 'off-label' indication." "Some medications may be used as a prototype drug for a specific condition and are not listed in the nursing drug handbook." "A medication can only be used for the specific condition for which it was approved." "This is a generic drug, and not all generic drugs are in the nursing drug handbook. Only trade name drugs are listed." Answer: 1 Explanation: When a drug is prescribed for a condition for which it has not been approved, this is called an "off-label" indication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, 9

medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-3 Explain the importance of pharmacotherapy to clinical nursing practice.

A client is admitted to the emergency department with high blood pressure. The healthcare provider orders a diuretic and tells the client this medication will lower the blood pressure by decreasing intravascular fluid volume. What does this description address? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. The drug's mechanism of action The drug's pharmacologic classification How the drug produces its effects in the body The drug's therapeutic classification What condition is being treated by the drug Answer: 1, 2, 3 Explanation: Mechanism of action describes how a drug produces its effects in the body—in this case, how it lowers blood pressure. The pharmacologic classification describes how a drug produces its effects in the body—in this case, how it lowers blood pressure. The diuretic lowers blood pressure by lowering fluid volume in the vasculature. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-4 Using specific examples, explain the difference between the pharmacologic and therapeutic methods of classifying drugs. A client who is admitted to the intensive care unit for monitoring notices the arthritis medication does not look like the one used at home and asks the nurse about the different appearance. Which response by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "This is a different brand from the one you use at home, but it will give you the same pain relief." "Your healthcare provider feels we can safely substitute this drug for the drug you use at home." "This generic drug is the one we have on formulary in the pharmacy. It has the same ingredientsas the one you use at home." "This is what we have in the pharmacy. Go ahead and take it for now and let me know if it doesn't relieve the pain." "The medications in the hospital often do not look like the ones you get from the pharmacy." Answer: 1, 2, 3 Explanation: Most trade-name drugs can be safely substituted with generic drugs. The exceptions to this rule are critical care drugs and drugs with a narrow margin of safety. Most trade-name drugs can be safely substituted with generic drugs. The exceptions to this rule are critical care drugs and drugs with a narrow margin of safety. Most trade-name drugs can be safely substituted with generic drugs. The exceptions to this rule are critical care drugs and drugs with a narrow margin of safety. 11

Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-8 Analyze possible differences between generic drugs and their trade-name equivalents. A client who received a refill for a medication returns to the pharmacy and says, "This medication is wrong! It doesn't look anything like my usual prescription." Which response by the pharmacist would be most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "Your usual prescription drug is too expensive, so I substituted it with a generic one." "There is no difference between this drug and the one you usually get." "Our state allows me to substitute a generic drug when the prescription calls for a trade-name drug." "Don't worry. Can you see that the generic ingredients are exactly the same?" "This medication is a generic form of your other medication. That is why it looks different. Butit has the same ingredients and should work the same way." Answer: 3, 5 Explanation: Some states allow the pharmacist to routinely substitute a generic drug for a trade-name drug. Other states prohibit this substitution and the pharmacist or client must request the substitution from the healthcare provider. There may be several forms of a generic medication. Although they may look different, the ingredients and mechanism of action are the same. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: II.A.2 Describe scopes of practice and roles of healthcare team members | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-8 Analyze possible differences between generic drugs and their trade-name equivalents.

The physician has written an order for a client for a new antihypertensive drug. Why is it important for the nurse to have an understanding of the drug's prototype? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Knowledge of the prototype allows the nurse to surmise important information about an unfamiliar drug in the same class. If the nurse knows the actions and adverse effects of the prototype drug, this information can be relevant to use of the unfamiliar drug. The safety profile for the prototype is the same as the safety profile for the unfamiliar drug. Knowledge of the prototype drug's therapeutic or pharmacologic classification can offer useful information about the unfamiliar drug. Traditional prototype drugs are often older and infrequently prescribed, and the information about them should not be used. Answer: 1, 2, 4 Explanation: Prototype drugs are the drugs to which all other drugs in the class are compared. Knowledge of the actions and effects of a prototype drug can be extended to an unfamiliar drug in the same class. Prototype drugs are the drugs to which all other drugs in the class are compared. Knowledge of the actions and adverse effects of a prototype drug can be extended to an unfamiliar drug in the same class. Prototype drugs are the drugs to which all other drugs in the class are compared. Knowing how the prototype drug works will reveal important information about the unfamiliar drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1-5 Identify the advantages of using prototype drugs to study pharmacology. A client says to the nurse, "I just don't understand why my prescription costs so much. I tried to get a generic one, but the doctor said there isn't one yet." Which rationales are most appropriate for the nurse to use when responding to this client's question? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. During the time of exclusivity, there is little competition, resulting in higher prices. During the time of exclusivity, there are generic versions of the drug, but the pharmacist has the right to sell only the trade-name drug. Once the time of exclusivity is over, other drug companies will be able to market generic drugs for less than the trade-name drug. When the generic equivalent is released, the physician may routinely substitute the trade-name version for the generic version. The period of exclusivity does not apply to internet pharmacies based in other countries. Answer: 1, 3, 4, 5 Explanation: During the time of exclusivity, the pharmaceutical company determines the cost of 13

the medication. To offset research and development costs, trade-name drugs are often expensive. Once the exclusive rights end, other pharmaceutical companies will be able to market the generic version at a lower cost. In some states, the physician may routinely substitute the trade-name drug for a generic drug. Other countries are not bound by U.S. drug laws, and clients may obtain trade-name drugs for a fraction of the price. However, these countries do not have the same quality control standards as the United States. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-7 Discuss the rationale for a pharmaceutical company receiving exclusivity for the marketing of a new drug. A client tells the nurse that the healthcare provider has prescribed a new medication that "has just come on the market." The nurse has not heard of this particular medication but is able to give the client important information based on its prototype drug because of which principles? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Knowing the prototype drug allows the nurse to predict the mechanism of action of the new medication. The information regarding the prototype drug can be extended to any drug in the same class. The prototype drug is the drug to which all drugs in a class are compared. Knowing the prototype drug's therapeutic or pharmacologic classification can reveal important information about other drugs in the same class. This is a new drug on the market. It may not have a prototype drug yet and its properties cannotbe predicted. Answer: 1, 2, 3, 4 Explanation: Knowledge about the prototype drug can help the nurse predict important information such as actions, side effects, mechanism of action, and contraindications for other drugs in the same class. Knowledge about the prototype drug can help the nurse predict important information such as actions, side effects, mechanism of action, and contraindications for other drugs in the same class. The prototype drug is chosen to be the representative medication in a particular classification. Just knowing a drug's therapeutic or pharmacologic classification can reveal important information about the drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: 14

Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 1-5 Identify the advantages of using prototype drugs to study pharmacology. The client is receiving a new and expensive medication. The client asks the nurse why the medication is so expensive compared with other medications. What is the nurse's best response? "The drug companies spend too much money on marketing, and the cost gets passed on to you." "It is expensive, but your insurance company will probably pay for it." "These drugs are very expensive to develop and bring to market." "I agree with you. You would think they could lower the cost of the drug." Answer: 3 Explanation: The cost for researching and developing new drugs is tremendous. The Food and Drug Administration provides a time of exclusivity in which the drug company can try to recoup these costs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-7 Discuss the rationale for a pharmaceutical company receiving exclusivity for the marketing of a new drug. Which statement best describes the difference between a biologic drug and a biosimilar drug? Biologic drugs are medications made by living cells. Biosimilar drugs are medications made by cells lysed by other cells. Biologic drugs are not approved by the FDA. Biosimilar drugs are more expensive than biologics. Answer: 1 Explanation: Biologic drugs are medicines made by living cells, such as bacteria or yeast. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-9 Explain how a biosimilar drug differs from its reference product.

Which statements are characteristics of biosimilar drugs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. They are FDA approved. They are less expensive. They are made of living cells. They are a duplicate copy of the reference product. They are considered a generic medication. Answer: 1, 2 Explanation: Biosimilar drugs have comparable effectiveness and safety to FDA-approved biologic products. Biosimilar drugs are not required to undergo the same rigorous preclinical and clinical testing as their reference products and are less expensive. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-9 Explain how a biosimilar drug differs from its reference product.

Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 2 Drug Regulations Which was the greatest problem with patent medicines in early America that led to drug legislation? They were only distributed in elixir formulation. They had dangerous or addictive substances. They smelled like medicine. They could only be made out of natural products. Answer: 2 Explanation: Many did contain dangerous or addictive substances such as morphine or cocaine. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Defining how sciences are developed, and by whom | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-1 Explain the role of patent medicines in the history of pharmacology and the legislation of drugs. 16

During the rise of patent medicines in America in the 1800s, there were few attempts to regulate drugs. Which statements accurately depict this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Patent medicines contained a trade name that clearly identified the product. Patent medicines claimed to cure just about any disease or condition. Patent medicines were often harmless and ineffective. Many patent medicines contained addictive substances. Patent medicines could not make false therapeutic claims. Answer: 1, 2, 3, 4 Explanation: Patent medicine did contain the trade name clearly identifying the product. Patent medicine claimed to cure everything from consumption to "all forms of weakness." Many patent medicines contained coloring and flavoring and were both harmless and ineffective. Some elixirs contained up to 50% morphine. In the late 1800s, Coca-Cola contained about 9 mg of cocaine per serving. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: NLN Competencies: Knowledge and Science: Defining how sciences are developed, and by whom | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-1 Explain the role of patent medicines in the history of pharmacology and the legislation of drugs. The student nurse taking a pharmacology class is studying the Food, Drug, and Cosmetic Act of 1938. What was important about this regulation? It prevented the sale of drugs that had not been tested before marketing. It gave the government the power to change the labeling content of medications. It helped to standardize the quality of prepared food, drugs, and cosmetics. It prohibited the sale of drugs labeled with false therapeutic claims to defraud the public. Answer: 1 Explanation: It did prevent the sale of drugs that had not been tested before marketing. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Policies and procedures | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-2 Outline the key U.S. drug regulations and explain how each has contributed to the safety and effectiveness of medications.

A client is talking to the nurse and is expressing doubt about whether to take a drug that is advertised on television. The client does not believe that commercials for drugs tell the truth. Which rationale will the nurse use when responding to the client? Advertisements are not legally binding and can be misleading. All drugs must be advertised in the media to inform the public. Manufacturers have some ability to change things when advertising drugs. False claims of a drug's therapeutic effect are prohibited by law. Answer: 4 Explanation: The Sherley Amendment of 1912 prohibits the sale of drugs labeled with false therapeutic claims. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Policies and procedures | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-2 Outline the key U.S. drug regulations and explain how each has contributed to the safety and effectiveness of medications.

The Pure Food and Drug Act (PFDA) of 1906 was significant in that it gave the government the power to prohibit drug labels from claiming false therapeutic benefits. However, the act still had several weaknesses. Which statements most accurately describe the weaknesses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. This law required drug manufacturers to prove that the drug was effective in its claims. This law prevented drugs from being marketed for any disease. This law required all drug labels to accurately describe their contents. This law required adequate testing for safety prior to marketing. This law encouraged the development of drugs for rare or unusual disorders. Answer: 1, 2, 4, 5 Explanation: The fact that manufacturers did not have to prove efficacy was a tremendous weakness in the regulation of drugs in the early 20th century. Another weakness of the PFDA of 1906 was that drugs could be still marketed for any disease. The PFDA did not require testing for safety prior to marketing. It was not until Congress passed the Food, Drug, and Cosmetic Act of 1938 that drugs had to be tested for safety prior to marketing. The PFDA did not encourage the development of drugs for rare or unusual disorders. The act that did so is called the Orphan Act. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Policies and procedures | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-2 Outline the key U.S. drug regulations and explain how each has contributed to the safety and effectiveness of medications.

One of the first standards used by pharmacists for preparation and potency of drugs was a formulary. What did early formularies contain? Names of patent medicines and natural drugs Lists of pharmaceutical products and drug recipes Lists of various drugs' strengths based on individual pharmacies Lists of various drugs' potency based on geographic region Answer: 2 Explanation: Early formularies did contain a list of pharmaceutical products and drug recipes. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Current best practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-3 Describe how the United States Pharmacopeia-National Formulary (USP-NF) controls drug purity and standards.

In the early 1800s, it became clear that the standardization of drug purity and strength was necessary. Which reasons reflected this need? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Strength and purity of products varied from region to region and batch to batch. Strength and purity of products depended on the pharmacist's experience. Strength and purity of products varied in size, taste, and nutritional value. Strength and purity were mostly guaranteed if products were produced locally, which caused a hardship for those outside the region. Strength and purity could be trusted when the product had gone through extensive local testing. Answer: 1, 2, 3 Explanation: The strength and purity of the products varied considerably because they were dependent on the experience of the pharmacist and the quality of the local ingredients, which could vary from region to region and batch to batch. The strength and purity of the products varied considerably because they were dependent on the experience of the pharmacist and the quality of the local ingredients, which could vary from region to region and batch to batch. The strength and purity of the products varied considerably because they were dependent on the experience of the pharmacist and the quality of the local ingredients, which could vary from region to region and batch to batch. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Current best practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-3 Describe how the United States Pharmacopeia-National Formulary (USP-NF) controls drug purity and standards.

A pharmaceutical representative comes to the primary care office and states that his company is marketing a new drug that does not need approval by the Food and Drug Administration (FDA). What is the best response of the nurse? "Is this a drug in clinical trials? Those are the only drugs that don't have to have FDA approval." "Is this an over-the-counter drug? Over-the-counter drugs do not need FDA approval." "Your company must be involved in academic research if the drug doesn't need FDA approval." "Any pharmaceutical company must have FDA approval before marketing a drug." Answer: 4 Explanation: All drugs marketed by pharmaceutical companies must have FDA approval. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.7 Explore ethical and legal implications of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Current best practice | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-4 Evaluate the role of the U.S. Food and Drug Administration in the drug approval process. Nursing students are studying which drug types must have Food and Drug Administration (FDA) approval before being marketed. The students know that which drugs must have approval from the FDA before being marketed? Biologics Cosmetics Herbal preparations Dietary supplements Answer: 1 Explanation: Biologics must have FDA approval before being marketed. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.7 Explore ethical and legal implications of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Current best practice | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-4 Evaluate the role of the U.S. Food and Drug Administration in the drug approval process.

Which statements regarding the role of the U.S. Food and Drug Administration (FDA) are true? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. The FDA is responsible for ensuring the security of human drugs. The FDA publishes a summary of the standards of drug purity and strength. The FDA ensures the availability of effective drugs. The FDA takes action against any supplement that is deemed to be unsafe. The FDA facilitates the availability of safe drugs. Answer: 1, 3, 4, 5 Explanation: The mission of the FDA is to protect public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biologic products, medical devices, the nation's food supply, cosmetics, and products that emit radiation. Ensuring the availability of effective drugs is one of the FDA's roles. It is the FDA's role to take action against any supplement that is deemed to be unsafe. It is the role of the FDA to facilitate the availability of safe drugs. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.7 Explore ethical and legal implications of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Current best practice | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-4 Evaluate the role of the U.S. Food and Drug Administration in the drug approval process. The nurse explains to the client that during the Food and Drug Administration (FDA) drug approval process, clinical investigators from many different medical specialties address concerns. What concerns are addressed? Whether a New Drug Application (NDA) must be filed The marketability of the drug What the cost of the drug should be Whether or not the drug is safe Answer: 4 Explanation: Safety is determined by the FDA during the Investigational New Drug application process. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.7 Explore ethical and legal implications of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Policies and procedures | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-5 Categorize the four stages of new drug approval. 24

The client receiving a newly released medication is experiencing adverse effects. Why does the nurse report these adverse effects as part of the postmarketing surveillance stage of the drug approval process? The clinical trials are continuing to collect new data. Individual client response is compared with the clinical trial data. The efficacy of the drug is determined for new drugs. Harmful effects in the larger population continue to be monitored. Answer: 4 Explanation: Some harmful effects are subtle, take longer to appear, and are not identified until the drug is prescribed to a large number of people; thus, postmarketing surveillance for harmful effects must be reported. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Policies and procedures | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-5 Categorize the four stages of new drug approval.

Which statements regarding the preclinical research stage of drug development are true? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Most drugs do not proceed past the preclinical stage because they are found to be too toxic or just ineffective. At the end of the preclinical research stage, client variability is determined and potential drug– drug interactions are examined. The preclinical stage of research involves extensive testing on animals in the laboratory to determine if the drug will cause harm to humans. Preclinical research results are always inconclusive. The Food and Drug Administration (FDA) is responsible for extensive testing for safety before the pharmaceutical company can begin the preclinical research stage of development. Answer: 1, 3, 4 Explanation: Most drugs do not proceed past the preclinical research stage of development because they are found to be either too toxic or just ineffective. The preclinical stage of development involves extensive testing on human and microbial cells and on animals to determine drug action and to predict whether the drug will cause harm to humans. Because lab tests cannot accurately predict human response to a drug, preclinical research results are always inconclusive. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Policies and procedures | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-5 Categorize the four stages of new drug approval.

Clients enrolled in a clinical drug trial are told that they might receive a placebo drug as part of a control group. A client asks the nurse what a placebo is. Which response by the nurse is the most appropriate? "A placebo is a substance that has no therapeutic effect." "A placebo is a similar drug that is safe." "A placebo is a drug that has been tested before." "A placebo is an over-the-counter drug." Answer: 1 Explanation: A placebo is an inert substance that has no therapeutic effect and is used as a control. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Current best practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-6 Explain the role of a placebo in new drug testing. The nursing student is studying how priority drugs receive accelerated approval by the Foodand Drug Administration (FDA) as part of the FDA modernization. Which conditions are the priority drugs used to treat? Diseases that previously were treated with older and less popular drugs Diseases that affect only a small percentage of the population Diseases for which the community raises money for treatment Serious and life-threatening conditions that lack effective treatments Answer: 4 Explanation: The accelerated approval process is for drugs used to treat serious and life-threatening conditions. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Policies and procedures | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-7 Discuss how changes to the approval process have increased the speed at which new drugs reach consumers.

The nurse is teaching a class about over-the-counter (OTC) medications at a senior citizen center. Which statement by a participant indicates the teaching was effective? "Over-the-counter medications are safe, as long as we don't take them at the same time as our prescription medications." "Over-the-counter medications are safe; otherwise, they would require a prescription." "We should not take any over-the-counter medications without first calling our primary healthcare provider because these medications can interact with other prescriptions or products." "We must read all the label directions before taking any over-the-counter medications." Answer: 3 Explanation: Older clients often take multiple medications and should consult with their healthcare provider before taking any OTC medication or supplement to ensure there are no risks for drug interactions. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Current best practice | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 2-8 Compare and contrast prescription and over-the-counter drugs. The client was taking a prescription medication that is now available over the counter. The client asks the nurse, "Why do some medications become available over the counter and other medications remain prescription drugs?" Which response by the nurse is the most appropriate? "Drugs with the least amount of side effects can become over-the-counter drugs." "Drugs that have a high safety margin may be reclassified to over-the-counter drugs." "The longer the drug is on the market, the better its chance of becoming an over-the-counter drug." "If the pharmaceutical company pays the FDA a large amount of money, it can have its drug reclassified." Answer: 2 Explanation: Drugs that have a high safety margin may be reclassified as OTC drugs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Current best practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-8 Compare and contrast prescription and over-the-counter drugs.

A client says to the admitting nurse, "Why do you need to know the names of all the over-the-counter supplements I take? They aren't drugs." Which responses by the nurse are the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "The admitting physician needs to know everything you are taking." "You're right. I'm not sure why the admitting paperwork asks for this information. Would you mind listing them anyway?" "The law requires us to keep a list of over-the-counter drugs and supplements that you are taking." "It is true that supplements are not considered drugs; however, some of these products can cause adverse effects with prescribed drugs." "We need to know if you are having an allergic reaction to one of them." Answer: 1, 4 Explanation: The healthcare providers involved in this client's care will need to know everything she is taking—both prescription and over the counter (OTC). Supplements are not subject to the same regulatory process as drugs, and some of these products can cause adverse effects and interact with medications. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Current best practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-8 Compare and contrast prescription and over-the-counter drugs.

The client says to the nurse, "I wonder if I am considered a drug addict. I went to pick up my medication from the drug store and the pharmacist told me that the drug was a controlled substance." Which response by the nurse is the most appropriate? "If you continue on this medication for a long time, you will become addicted to it." "You are not an addict, but the Drug Enforcement Agency (DEA) will be watching your prescription drug habits now." "Any drug that has a potential for abuse is considered a controlled substance and is restricted. This does not mean the pharmacist will think you are an addict." "Do you think that you are addicted to your medication?" Answer: 3 Explanation: The pharmacist recognizes that all drugs with the potential for abuse are considered controlled substances and carry restrictions but most likely will not think the client is a drug addict. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.7 Explore ethical and legal implications of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Policies and procedures | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-9 Explain how scheduled drugs are classified and regulated. The nurse is working in a cancer treatment center. A client diagnosed with terminal cancer has received a prescription for morphine (MS Contin), a Schedule II drug for pain control. After medication teaching, which statement by the client indicates appropriate understanding? "I should call the office three days before I need a refill called in to the pharmacy." "I will need to see the provider each time for my refill." "This is an addictive drug, so I should try not to take it." "After the first prescription, my doctor will be able to call in my prescription." Answer: 2 Explanation: The client will need to see the provider each time a refill is needed. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.7 Explore ethical and legal implications of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Policies and procedures | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-9 Explain how scheduled drugs are classified and regulated.

A nurse educator is preparing a lecture regarding prescriptive authority for advanced practice registered nurses (APRNs). Which statement is appropriate for the educator to include in the lecture regarding this topic? APRNs can only prescribe medications when under the supervision of a physician. APRNs prescribe medications based on federal regulations. APRNs prescribe medications based on state regulations. APRNs prescribe medications based on local regulations. Answer: 3 Explanation: APRNs prescribe medications based on state regulations. This is an appropriate statement to include in the lecture. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: II.A.2 Describe scopes of practice and roles of healthcare team members | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Teamwork: Scope of practice, roles, and responsibilities of healthcare team members, including overlaps | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2-10 Discuss the requirements and regulations needed for nurses to have the ability to prescribe drugs.

The nurse is teaching a client the importance that a placebo plays in drug research. Which items are appropriate for the nurse to include in the teaching session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. The research drug must be compared to an inert substance to determine effectiveness. The placebo will be given to a control group, and those results will be compared to the group taking the research drug. During the trials, neither group will know if they have the placebo drug or the research drug. The research drug will be considered for a New Drug Application (NDA) if it is found to be effective and safe when compared to the placebo drug. Before the clinical trials, the research drug will be tested on select clients against another standard drug used for the same condition. Answer: 1, 2, 3, 4 Explanation: The primary focus of a clinical trial is to provide information regarding the effectiveness of the research drug. The effectiveness of the research drug will be compared to an inert substance taken by a nontreatment group, called the control group. The primary focus of a clinical trial is to provide information regarding the effectiveness of the research drug. The effectiveness of the research drug will be compared to an inert substance taken by a nontreatment group, called the control group. Clients may have a perceived or actual improvement in a medical condition if they know they are taking the research drug. Clients may also feel there is no improvement if they know they are taking a drug that has inert properties. If the research drug continues to show that it is effective and safe, an NDA will be submitted to the Federal Drug Administration (FDA). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Current best practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-6 Explain the role of a placebo in new drug testing.

A nurse educator is discussing the prescriptive authority of healthcare providers to a group of new employees. Which healthcare providers are able to prescribe medications to clients? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Registered nurses Physicians Nurse practitioners Nurse managers Physical therapists Answer: 2, 3 Explanation: Physicians are able to prescribe medications. Nurse practitioners are able to prescribe medications. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: II.A.2 Describe scopes of practice and roles of healthcare team members | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Teamwork: Scope of practice, roles, and responsibilities of healthcare team members, including overlaps | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-10 Discuss the requirements and regulations needed for nurses to have the ability to prescribe drugs. Which is a reason that delayed approval by the Food and Drug Administration (FDA) of newer drugs prior to 1990? The FDA was using outdated guidelines. There was not enough money from the drug companies to support the testing. Drug companies identified a handful of drugs necessary for disease outbreaks. The drug approval process was not supported by the larger federal government sector. Answer: 1 Explanation: Delays in the FDA approval process were caused by outdated guidelines, poor communication, and not enough staff to handle the workload. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Policies and procedures | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-7 Discuss how changes to the approval process have increased the speed at which new drugs reach consumers. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 3 Pharmacokinetics What are the four phases of pharmacokinetics that a drug goes through? 33

Absorption, distribution, ionization, and metabolism Diffusion, bioavailability, metabolism, and excretion Absorption, distribution, metabolism, and excretion Active transport, ionization, diffusion, and excretion Answer: 3 Explanation: A drug undergoes the pharmacokinetics of absorption, diffusion, metabolism, and excretion. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3-1 Identify the four primary processes of pharmacokinetics.

The nurse is teaching a client the importance of taking the medication as prescribed. Client teaching is guided by the nurse's knowledge of which principles of pharmacokinetics? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A medication taken by injection must cross the membranes of the gastrointestinal tract to get to the bloodstream before it can be distributed throughout the body. A drug may be exposed to several physiologic processes while en route to target cells. Liver enzymes may chemically change the drug. Excretion organs such as kidneys and intestines must be healthy enough to eliminate the drug. Many processes to which drugs are exposed are destructive, thereby helping facilitate the drug's movement throughout the body. Answer: 2, 3, 4, 5 Explanation: Drugs taken orally are often exposed to physiologic processes such as stomach acid and digestive enzyme effects. Enzymes in the liver may chemically change some drugs. Drugs will continue to act on the body until they are either metabolized to an inactive form or are excreted. Pathologic states such as kidney disease can increase the drug's action on the body. Many destructive processes, such as when stomach acid breaks down food, can break down the drug molecule before it can reach the target cells. This will facilitate the drug's movement throughout the body. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-1 Identify the four primary processes of pharmacokinetics. When administering an intravenous (IV) medication to a client, the nurse understands that the medication has a high concentration in the blood and will move into areas of lower concentration by which action? Facilitated diffusion Active diffusion Absorption Simple diffusion Answer: 4 Explanation: The process of moving from an area of high concentration to low concentration is called simple diffusion or passive transport. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-2 Explain mechanisms by which drugs cross plasma membranes. 35

When the nurse administers a drug that must move from an area of low concentration to an areaof high concentration, what will the drug require? Simple diffusion Active transport An intravenous route A transdermal delivery system Answer: 2 Explanation: The movement from low to high concentration is against a gradient, and will require energy, via the process of active transport. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-2 Explain mechanisms by which drugs cross plasma membranes. The nurse is reviewing the role of diffusion in the distribution of medications. Drugs that cannotbe distributed by simple diffusion include those with which characteristics? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Large molecules Ionization Water-soluble agents Alcohol Urea Answer: 1, 2, 3 Explanation: Large molecules have difficulty crossing plasma membranes by simple diffusion. These molecules may require carrier, or transport, proteins to cross membranes. Ionized drugs have difficulty crossing plasma membranes by simple diffusion. These drugs may require carrier, or transport, proteins to cross membranes. Water-soluble agents have difficulty crossing plasma membranes by simple diffusion. These agents may require carrier, or transport, proteins to cross membranes. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 3-2 Explain mechanisms by which drugs cross plasma membranes.

The nurse is administering an albuterol (Ventolin) inhaler to a client with asthma. The absorption of the medication will occur in what manner? Very slowly Over a 2- to 3-hour period Over a 1- to 2-hour period Very rapidly Answer: 4 Explanation: Drugs given via inhalation produce a rapid response, since the membrane separating the drug from the bloodstream is very thin and absorption occurs readily. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-3 Discuss factors affecting drug absorption. The nurse has just administered a client's morning dose of medications following a high-fat breakfast. How will the absorption of the medication be affected? It will be blocked. It will be slowed. It will be accelerated. It will not be affected. Answer: 2 Explanation: Fatty foods in the stomach almost always slow drug absorption. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-3 Discuss factors affecting drug absorption.

The nurse recognizes that adding a vasoconstrictor to a local anesthetic agent will have which effect on absorption of the anesthetic agent? It will increase blood flow to the area. It will help to eliminate the drug sooner. It will produce a more localized effect. It will slow absorption of the agent. Answer: 4 Explanation: Vasoconstriction reduces blood flow to the site and slows absorption of the agent. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-3 Discuss factors affecting drug absorption. The nurse is preparing an intramuscular (IM) injection for a client with strep throat. Which principles of absorption may have guided the healthcare provider's decision to order the medication by IM route? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. IM drugs are rapidly absorbed. IM drugs bypass the gastrointestinal tract, resulting in increased absorption. IM drugs avoid drug–drug and food–drug interactions, which can decrease absorption. IM drugs have the ability to accumulate in the muscle and may remain in the body for an extended amount of time. IM drugs bypass the gastrointestinal tract and are delivered to the small intestine, where most medications are rapidly absorbed. Answer: 1, 2, 3 Explanation: Muscles have a high blood flow, which maximizes absorption. The thick mucous layer of the stomach decreases absorption. IM drugs bypass this obstacle, resulting in increased absorption. Oral medications and food can interfere with absorption of medications. Bypassing the gastrointestinal tract will remove this possibility. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-3 Discuss factors affecting drug absorption.

A client is receiving antibiotic treatment for a wound abscess. For the drug to be effective, what does the nurse recognize that drug distribution to this area requires? The drug to be lipid soluble Adequate blood perfusion to the area The drug to be bioavailable in an acidic environment Use of a topical antibiotic Answer: 2 Explanation: Antibiotics can have difficulty reaching areas of necrotic or abscessed tissues, unless they have an adequate blood supply available. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-4 Discuss how drugs are distributed throughout the body. The nurse is caring for a client with obesity who has received thiopental (Pentothal), a lipid-soluble drug, during surgery. Of which fact about the drug should the nurse be aware? It will need to be given at higher than normal doses. It will be stored in adipose tissue. It may have difficulty being distributed to body tissues. It is often ineffective. Answer: 2 Explanation: Thiopental is a lipid-soluble drug that has a higher affinity for bone marrow, teeth, eyes, and adipose tissue. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-4 Discuss how drugs are distributed throughout the body.

The nurse recognizes that when a client is receiving a lipid-soluble medication, higher concentrations will accumulate in which tissues? Cardiac muscle Liver Bone marrow Skeletal muscle Answer: 3 Explanation: Lipid-soluble drugs have a greater affinity for bone marrow, teeth, eyes, and adipose tissue. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-4 Discuss how drugs are distributed throughout the body. A client is admitted to the burn unit with 75% body surface area burns. Which orders would be appropriate for this client to control pain? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Morphine 10 mg IV every 2 to 4 hours as needed for pain Morphine 10 mg IM every 2 to 4 hours as needed for pain Morphine 10 mg transdermal patch every 2 to 4 hours as needed for pain Morphine 10 mg sublingual every 2 to 4 hours as needed for pain Morphine 10 mg subcutaneous every 2 to 4 hours as need for pain Answer: 1, 4 Explanation: Pain medication given by the intravenous (IV) route will be rapidly and completely absorbed. Sublingual morphine can be used as a rescue drug. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3-4 Discuss how drugs are distributed throughout the body.

When administering a drug-protein–bound drug to a client, what can the nurse expect? Duration of action will be prolonged. Drug excretion will be accelerated. Metabolism of the drug will be delayed. Onset of drug action will be prolonged. Answer: 1 Explanation: The portion of the drug that is protein bound is not available to the tissues, but as it is released, it becomes a free drug; a drug that is highly protein bound has a high percentage of bound or unavailable drug that will produce a longer duration of action. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-5 Describe how plasma proteins affect drug distribution. The nurse checks a newly ordered medication and finds it to be 92% protein bound. How much of the medication will be readily available to the client once the nurse administers the medication? 1. 100% 2. 8% 3. 50% 4. 92% Answer: 2 Explanation: The percentage of drug that is unbound is free and able to reach target tissue. If a drug is 92% protein bound, then 8% is free and available to tissues. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3-5 Describe how plasma proteins affect drug distribution.

A client who was recently started on the anticoagulant warfarin (Coumadin) asks about adverse reactions. The nurse explains that adverse effects may occur because the drug is highly bound with only % available to reach the target cells. Record your answer rounding to the nearest whole number. Answer: A Explanation: When giving a medication that is highly bound, the nurse should carefully monitor for adverse effects. The anticoagulant warfarin (Coumadin) is highly bound; 99% of the drug in the plasma exists in drug–protein complexes and only 1% exists as a free drug available to reach target cells. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3-5 Describe how plasma proteins affect drug distribution. A client has been started on diltiazem (Cardizem), a substrate of the cytochrome CYP3A4 isoenzyme system. The client also takes phenobarbital, an inducer of the CYP3A4 isoenzyme system, for seizures. What does the nurse recognize about diltiazem? It will not be able to cross the blood–brain barrier (BBB). It will be metabolized by the kidneys. It might be inactivated at a faster rate than normal. It might be excreted at a slower rate. Answer: 3 Explanation: When one drug induces an enzyme system, it accelerates the metabolism of other drugs using the same isoenzyme substrate—in this case, the CYP3A4 system, which causes early inactivation of the drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3-6 Explain the metabolism of drugs and its applications to pharmacotherapy.

A client receiving metoprolol (Lopressor), a substrate of the CYP2D6 system, is started on amiodarone (Cordarone), an inhibitor of the CYP2D6 system. What should the nurse plan to do? Monitor for signs of amiodarone toxicity. Administer both drugs on an empty stomach. Monitor for prolonged effects of the Lopressor. Administer the medications at least 2 hours apart. Answer: 3 Explanation: The CYP enzyme system determines the speed at which most drugs are metabolized in the liver. When one drug inhibits the action of the same isoenzyme system, other drugs being metabolized by this same system might not be inactivated as quickly, leading to prolonged effects of the drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3-6 Explain the metabolism of drugs and its applications to pharmacotherapy. What does the nurse anticipate about the medications ordered for a client with liver disease? They will be in lower doses than normal. They will be administered by the parenteral route. They will need to be divided evenly throughout the day. They will need to be given with an antacid. Answer: 1 Explanation: Liver function is decreased in cirrhosis, leading to a reduction in drug metabolism. Drugs given at normal doses could lead to toxicity. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3-6 Explain the metabolism of drugs and its applications to pharmacotherapy.

The nurse has administered a dose of codeine to a client for the management of postoperative pain. The nurse monitors for respiratory depression because % of codeine is metabolized and converted to morphine, which can cause respiratory depression in clients. Record your answer rounding to the nearest whole number. Answer: 10 Explanation: Chemical changes to drugs always result in functional changes. The products of drug metabolism, or metabolites, usually have less pharmacologic activity than the original molecule. On rare occasions a metabolite may have greater activity than the original drug. This is the case for codeine. Although 90% of codeine is changed to inactive metabolites by the liver, 10% is converted to morphine, which has significantly greater ability to relieve severe pain and has the potential to cause respiratory depression in clients. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3-6 Explain the metabolism of drugs and its applications to pharmacotherapy. A client is seen in the emergency department for an overdose of diazepam (Valium), a weakly basic drug. In order to enhance excretion of the drug, what does the nurse anticipate that the client will receive? High volumes of intravenous normal saline solution (NSS), a weakly basic solution Large doses of a proton pump inhibitor, in an acidic solution An intravenous solution containing sodium bicarbonate, which promotes alkaline urine An intravenous solution with ammonium chloride, which acidifies filtrate Answer: 4 Explanation: Ammonium chloride will provide acidic urine, in which the diazepam will be eliminated more quickly. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3-7 Identify major processes by which drugs are excreted.

The nurse determines that a client who is breastfeeding has understood teaching regarding medication use when the client makes which statement? "I will be sure to take medications just before breastfeeding." "I know it is safe to take over-the-counter meds, but not prescription meds." "I will check with my healthcare provider before taking any medication." "I will only use herbal supplements while breastfeeding." Answer: 3 Explanation: This reflects the safest way to determine if a drug can be taken while breastfeeding. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3-7 Identify major processes by which drugs are excreted. The nurse recognizes that medications can be excreted by which routes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Fecal Gastric Glandular Pulmonary Renal Answer: 1, 3, 4, 5 Explanation: Drugs can be excreted via feces. Drugs can be secreted glandularly. Drugs can be secreted via the lungs. Drugs can be excreted by the renal route. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-7 Identify major processes by which drugs are excreted.

A client asks the nurse why he experiences a metallic taste after taking certain medications. The nurse explains that a medication may cause glandular secretions that occur by which routes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Saliva Sweat Breast milk Urine Feces Answer: 1, 2, 3 Explanation: Water-soluble drugs may be secreted into the saliva, which can cause a "funny taste" after the administration of a medication. Water-soluble drugs may be secreted into the sweat, which may cause an odor to be omitted by the person who has taken a medication. Water-soluble drugs may be secreted into the breast milk. Breastfeeding mothers must use caution in regards to medications while lactating because medications can be passed to their infants via breast milk. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-7 Identify major processes by which drugs are excreted. The nurse reads that a drug undergoes enterohepatic recirculation. How would the nurse explain this process to a colleague? This drug must be given several times a day. The drug will have a very low therapeutic effect. The drug will be concentrated in the liver. The drug might have a prolonged activity in the body. Answer: 4 Explanation: Drugs secreted into the bile are sent back to the liver through enterohepatic recirculation and can be recirculated several times, thus prolonging their activity. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-8 Explain how enterohepatic recirculation affects drug activity.

A healthcare provider has discontinued the client's medication, digoxin (Lanoxin). Recalling that this drug undergoes enterohepatic recirculation, which statement does the nurse make to the client? "You might continue to have effects of the drug for a few weeks." "You might experience some toxic effects from the drug in the next few days." "Expect to experience some side effects until the drug is totally eliminated." "The drug will be totally out of your system in the next 48 hours." Answer: 1 Explanation: Since the drug is recirculated several times through enterohepatic recirculation, continued effects of the drug may be expected. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-8 Explain how enterohepatic recirculation affects drug activity. The nurse is caring for a client who is receiving medications from several different classifications for the treatment of multiple health problems. For which medications or classifications does the nurse anticipate prolonged activity due to enterohepatic recirculation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Mebendazole (Vermox) Digoxin (Lanoxin) Phenothiazines Topical steroids Topical anti-infectives Answer: 2, 3 Explanation: Some drugs may be recirculated numerous times with the bile, thus extending their stay in the body; biliary excretion is influential in prolonging the activity of digoxin (Lanoxin). Some drugs may be recirculated numerous times with the bile, thus extending their stay in the body; biliary excretion is influential in prolonging the activity of phenothiazines. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3-8 Explain how enterohepatic recirculation affects drug activity.

A client has been started on a medication for postoperative pain. When does the nurse anticipate the client will receive optimal pain relief? When the drug concentrates in the muscle tissue When the drug reaches a therapeutic range When the drug achieves a minimal effective concentration When the drug approaches a toxic concentration Answer: 2 Explanation: The goal of therapy is to reach and maintain a plasma level in the therapeutic range. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3-9 Explain how a drug reaches and maintains its therapeutic range in the plasma. A client is receiving an antibiotic with the potential for nephrotoxicity. Which item should the nurse should plan to monitor? Urinary concentration of the drug Route of drug administration Plasma levels of the drug Rate of intravenous administration Answer: 3 Explanation: Plasma levels of a drug are an indicator of whether a drug is at a therapeutic or toxic level, and they provide information as to whether a drug dosage needs adjustment. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3-9 Explain how a drug reaches and maintains its therapeutic range in the plasma.

The nurse is preparing to medicate a client for a migraine headache. The nurse should choosethe drug with which half-life? 10 to 20 hours 5 to 10 days 2 to 3 hours 1 to 3 minutes Answer: 3 Explanation: A drug with a half-life of 2 to 3 hours will be reduced by 50% in 2 to 3 hours, providing adequate time for the client to obtain pain relief. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3-10 Explain the applications of a drug's plasma half-life (t1/2) to pharmacotherapy. The nurse is reviewing the concept of a drug's half-life for a student nurse, explaining that it isthe time it takes for what to happen? One-half of the drug to be absorbed One-half of the drug to be eliminated by the body The drug to elicit a therapeutic response The drug to reach the target tissue Answer: 2 Explanation: A drug's half-life is the time it takes for one-half of the original dose to be eliminated by the body. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-10 Explain the applications of a drug's plasma half-life (t1/2) to pharmacotherapy.

The nurse is administering a drug with a half-life of 6 hours. The nurse understands the clientwill eliminate most of the drug in how many hours? 1. 36 2. 24 3. 6 4. 12 Answer: 2 Explanation: After four half-lives, 94% of the drug has been eliminated by the body. A drug with a half-life of 6 hours will go through four half-lives in 24 hours. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-10 Explain the applications of a drug's plasma half-life (t1/2) to pharmacotherapy. The nurse is preparing to administer felodipine to a hospitalized client. The nurse assesses the client for which disorders that may cause an increased risk for adverse effects associated with this medication due to its extended half-life? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Renal disease Liver disease Gastrointestinal disease Cardiac disease Pulmonary disease Answer: 1, 2 Explanation: As drugs stay in the body for prolonged periods, the risk for long-term adverse effects increases. This can become particularly serious for clients with significant renal impairment; diminished metabolism and excretion will cause the plasma half-life of a drug to increase, and the concentration may reach toxic levels. As drugs stay in the body for prolonged periods, the risk for long-term adverse effects increases. This can become particularly serious for clients with significant hepatic impairment; diminished metabolism and excretion will cause the plasma half-life of a drug to increase, and the concentration may reach toxic levels. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3-10 Explain the applications of a drug's plasma half-life (t1/2) to pharmacotherapy. 50

A client is prescribed a loading dose of a cardiac glycoside for an exacerbation of heart failure. When the client comments, "I usually take a much lower dose," which response by the nurse is the most appropriate? "Giving a large dose will reduce the incidence of side effects." "You are being given a large dose in order to increase blood levels of the drug quickly." "The healthcare provider ordered this dose, so I need to administer it." "Your usual dose is probably no longer effective for your condition, and you need to be on a higher dose now." Answer: 2 Explanation: Loading doses of medications are used to provide a more rapid increase in the blood level of the drug, resulting in a quicker therapeutic response. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-11 Differentiate between loading and maintenance doses. Following the administration of a loading dose of an antibiotic, the nurse anticipates that the client will receive which dosing schedule of additional antibiotic? A second loading dose Regularly intermittent doses of the antibiotic Alternating high and low doses of the antibiotic Daily bolus injections Answer: 2 Explanation: Following a loading dose, the usual maintenance dose of a drug is given in order to maintain a therapeutic blood level of the drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3-11 Differentiate between loading and maintenance doses.

The nurse is teaching a client about the loading dose of antibiotic that will be administered later in the day. The client demonstrates understanding by stating that the medication will reach a therapeutic dose in hour(s) versus the 48 hours that would be required for the routine medication dose. Record your answer rounding to the nearest whole number. Answer: 12 Explanation: It takes almost five doses (48 hours) before a therapeutic level is reached using a routine dosing schedule. With a loading dose, a therapeutic level is reached within 12 hours. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 3-11 Differentiate between loading and maintenance doses. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 4 Pharmacodynamics The client and his wife receive the same medication for hypertension. The wife asks the nurse why she is receiving a higher dose of the medication. Which response by the nurse is the most appropriate? "You have a greater percentage of body fat, so you need more medication." "Females have a higher metabolism, so you need more medication." "Your hormones are different from your husband's, so you need more medication." "Everyone is unique and responds differently to medication." Answer: 4 Explanation: Many variables influence how clients respond to medications; each client must be evaluated for response. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.5 Participate in the process of retrieval, appraisal and synthesis of evidence in collaboration with other members of the healthcare team to improve patient outcomes | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-1 Apply frequency distribution curves to explain interpatient variability in medication response. A client asks the nurse why his dose of an antihypertensive medication is different from his neighbor's dose, stating, "We both take the exact same drug, but I take 60 mg and he takes only 25 mg." Which response by the nurse is the most appropriate? "If your neighbor is a lot younger than you, his dose might be a lot lower." "Individuals often have widely different responses to the same medications and need different doses of the same medication." "If your neighbor takes a lot of other medications, he might need to take a lower dose of the 52

medication than you." "If you are taking a generic version of the medication, you will need a higher dose than you would of a trade name of the same medication." Answer: 2 Explanation: Genetic makeup and metabolism vary widely and account for the differences in response to drugs and the need for individualized doses. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.5 Participate in the process of retrieval, appraisal and synthesis of evidence in collaboration with other members of the healthcare team to improve patient outcomes | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-1 Apply frequency distribution curves to explain interpatient variability in medication response. The nursing instructor is teaching student nurses about how the median effective dose of a medication is related to clinical practice. Which statement reflects the correct understanding by the student? "About 50% of clients will experience severe side effects from the drug." "About 50% of clients will not experience any effect from the drug." "Some clients will respond differently, depending on their ethnic background." "Some clients will require more or less than the average dose of the drug." Answer: 4 Explanation: The median effective dose is the dose required to produce a specific therapeutic response in 50% of a group of clients. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 4-2 Explain the importance of the median effective dose (ED50) to clinical practice. A client looks up the drug he is taking in a drug guide and asks the nurse why the healthcare provider prescribed a medication that has a lethal dose measure. Which response by the nurse is the most appropriate? "Lethal dose just refers to what is done in research; it is not used by doctors to prescribe drugs." "The lethal dose is a value determined in research that helps to establish the safe dose." "All that means is that the drug could be lethal, but I will closely monitor you for side effects." "Don't worry about that. I will have your doctor explain it to you." Answer: 2 Explanation: The difference between the median effective dose and the median lethal dose is measured to determine the drug's safety margin as well as the safe effective dose. 53

Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-3 Compare and contrast median lethal dose (LD50) and median toxicity dose (TD50).

The nurse explains to a student nurse that the median lethal dose of a drug is often determined in laboratory preclinical trials. Which rationales best support why this is done? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. It would be unethical to determine these values in human participants. The safety of the medication must be determined prior to clinical trials. It is difficult to obtain sufficient participants for clinical trials. Clinical trials determine only the effective dose of a drug. It is too costly to conduct the studies during clinical trials. Answer: 1, 2 Explanation: Laboratory animals are used in clinical trials to determine the LD50, or the dose that kills 50% of the participants. It would be unethical to kill human participants. Before a drug is released for trials in human participants, its safety must be determined. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-3 Compare and contrast median lethal dose (LD50) and median toxicity dose (TD50). The nurse is educating a client who is participating in a drug study and describes the median toxicity dose as the dose that will produce toxicity in % of a group of clients. Record your answer rounding to the nearest whole number. Answer: 50 Explanation: The median toxicity dose (TD50) is the dose that will produce a given toxicity in 50% of a group of clients. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-3 Compare and contrast median lethal dose (LD50) and median toxicity dose (TD50).

The nurse is researching a drug recently released on the market to determine what the median lethal dose (LD50) was in preclinical trials. The nurse recognizes that this number reflects which fact? The dose at which 50% of the research animals died A measurement of the potency of the drug The value of relative safety of the drug The dose that produced signs of toxicity in 50% of lab animals Answer: 1 Explanation: The dose at which 50% of animals in the preclinical trials are killed is the median LD50 dose. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-3 Compare and contrast median lethal dose (LD50) and median toxicity dose (TD50). Prior to administering medications, the nurse reviews the therapeutic index. What is the therapeutic index used to identify? Whether the healthcare provider has prescribed the best drug for the client When a client will begin to experience toxic drug effects Interactions among the drugs the client is receiving Clients who will need to have serum blood levels monitored Answer: 4 Explanation: Drugs with a narrow therapeutic index have low margins of safety and need to be monitored through serum drug levels. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-4 Relate a drug's therapeutic index to its margin of safety.

The nurse checks the margin of safety (MOS) for a drug that will be administered to a client, knowing that the MOS is the amount of drug that is lethal to % of animals divided by the amount that produces a therapeutic effect in % of animals. Record your answer rounding to the nearest whole number. Answer: 1, 99 Explanation: The MOS is calculated as the amount of drug that is lethal to 1% of animals (LD1) divided by the amount of drug that produces a therapeutic effect in 99% of the animals (ED99). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-4 Relate a drug's therapeutic index to its margin of safety. The nurse is researching a drug that has a median effective dose (ED50) of 5 mg and a median lethal dose (LD50) of 20 mg. Which therapeutic index (TI) calculated by the nurse is correct? 1. 5 2. 4 3. 1 4. 10 Answer: 2 Explanation: The TI is calculated by dividing the median LD by the median ED. Twenty divided by 5 equals 4. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4-5 Identify the significance of the dose–response relationship to clinical practice.

The nurse is preparing to administer a medication to a client on a medical-surgical unit. The median lethal dose of the drug is 40 mg, and the median effective dose is 10 mg. The nurse calculates the therapeutic index to be . Answer: 4 Explanation: The therapeutic index is calculated by dividing the median lethal dose (LD50) by the median effective dose (ED50). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-4 Relate a drug's therapeutic index to its margin of safety. A client receiving antibiotics for a serious infection asks the nurse, "Why don't you just giveme more of that drug to cure the infection faster?" Which response by the nurse is the most appropriate? "I will check with the doctor to see if it is time to increase the medication." "You are at maximum dose; taking more will not help." "You are at a maximum dose; taking more will cause interactions with other medications." "You must stay on this drug for two more weeks before the dosage can be increased." Answer: 2 Explanation: When the plateau of a drug has been reached, administering more of the drug will not produce additional benefit. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-5 Identify the significance of the dose–response relationship to clinical practice.

The nurse is administering narcotics to surgical clients and understands that which characteristic is true? Codeine is less potent than morphine; it will not produce an allergic reaction. Codeine is less potent than morphine; it will not relieve pain as well. Morphine is more potent than codeine; it will produce more adverse effects. Morphine is more potent than codeine; a lower dose will be required. Answer: 4 Explanation: A drug that is more potent will produce a therapeutic effect at a lower dose. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-6 Compare and contrast the terms potency and efficacy. The nurse is discussing the difference between potency and efficacy with a client who has just received a prescription to treat congestive heart failure. Which statement by the client indicates that learning has occurred? "The best drug for me is the one with the greatest efficacy." "A drug with the greatest efficacy will produce the least side effects." "Low-potency drugs have efficacy and do not produce side effects." "The best drug for me is the one with the highest potency." Answer: 1 Explanation: Efficacy refers to the magnitude of maximal response that can be produced by a particular drug. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-6 Compare and contrast the terms potency and efficacy.

A client with hypertension is prescribed a potent antihypertensive without results. The client is concerned when the healthcare provider orders a new drug. Which explanation by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "The drug you took is very potent and a higher dose is needed." "The new drug has greater efficacy, so it will help reduce your blood pressure." "The prescriber must have made an error in the orders." "Efficacy in treating your hypertension is more important than potency." "You are correct. I think the prescriber meant to order both drugs." Answer: 2, 4 Explanation: Efficacy is more important than potency in providing blood pressure control. Efficacy is more important than potency in pharmacologic treatment. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4-6 Compare and contrast the terms potency and efficacy. The nurse administers a medication that binds to a beta receptor on the cardiac muscle, resulting in stimulation of the receptor. Which effect does the nurse anticipate when assessing theclient? A decrease in chest pain An increase in heart rate An increase in blood pressure A decrease in electrical conduction Answer: 2 Explanation: Stimulation of the beta receptors will cause an increase of sympathetic nervous system activity, resulting in an increased heart rate. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4-7 Describe the relationship between receptors and drug action.

The nurse is administering a medication that will bind to histamine-2 receptors in the stomachand block their action. The nurse explains to the client that this drug will cause which action? A reduction in abdominal cramping A decrease in stomach acidity A reduction in nausea An increase in stomach motility Answer: 2 Explanation: Blocking the histamine-2 receptors will help to reduce the stimulation of gastric acid. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-7 Describe the relationship between receptors and drug action. The nurse is reviewing the medication administration record for a group of clients and recognizes that which agents have nonspecific cellular responses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Ethyl alcohol General anesthetics Osmotic diuretics Calcium channel blockers Alpha-adrenergic antihypertensives Answer: 1, 2, 3 Explanation: Ethyl alcohol is an example of an agent that acts by nonspecific mechanisms, independently of cellular receptors. General anesthetics are an example of agents that act by nonspecific mechanisms, independently of cellular receptors. Osmotic diuretics are an example of agents that act by nonspecific mechanisms, independently of cellular receptors. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-7 Describe the relationship between receptors and drug action.

The nurse has taught a group of clients how their medications work in their bodies. Which comment by a client reflects correct understanding of the teaching? "The normal function of a cell is enhanced or blocked by medications." "Medications help the body produce new enzymes." "Body tissue functions are changed by medications." "Medications change the function of cells in the body." Answer: 1 Explanation: Many medications work by stimulating or enhancing the normal function of a cell or by blocking the normal function. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4-7 Describe the relationship between receptors and drug action. The healthcare provider has ordered naltrexone (ReVia), a narcotic antagonist, for a client in rehabilitation who is recovering from heroin addiction. The nurse explains that if heroin is used while taking the naltrexone, the client could experience which effect? Severe nausea and vomiting Lack of euphoria Anger and rage A severe craving for more heroin Answer: 2 Explanation: Euphoria will not occur. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-8 Distinguish between an agonist, partial agonist, and antagonist.

A client has been receiving haloperidol (Haldol), a dopamine antagonist. When the psychiatrist changes the order to aripiprazole (Abilify), a partial dopamine antagonist, the nurse anticipates the client will experience which effect? A greater reduction in symptoms Fewer side effects Greater adherence in taking the drug Greater efficacy from the new drug Answer: 2 Explanation: Partial blocking of dopamine results in fewer side effects than does complete blocking. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-8 Distinguish between an agonist, partial agonist, and antagonist. The student nurse has been reading about the Human Genome Project, and asks the nursing instructor how it will affect future pharmacologic therapies. Which response by the nurse is the most appropriate? "It will help prevent disease through gene manipulation, but will not impact drugs." "We will be able to alter genes, so we will not need drugs," "We will be able to standardize drug doses to make prescribing easier." "It will help to individualize drug therapy for people in a more effective way." Answer: 4 Explanation: The goal of pharmacogenetics is to help individualize drug therapy for people in a more effective way. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-9 Explain possible future developments in the field of pharmacogenetics.

A male client of African descent has been prescribed sulfamethoxazole with trimethoprim (Bactrim), a sulfonamide anti-infective, for a bacterial infection. When the client arrives in the emergency department, the nurse should place priority on which assessment? Urinary output Level of red blood cells (RBCs) Liver function tests Renal function tests Answer: 2 Explanation: Males of African descent are more likely to be deficient in the enzyme G6PD, an enzyme that is essential in carbohydrate metabolism. The use of sulfonamides in this group of clients can cause an acute hemolysis of red blood cells due to the breaking of chemical bonds in the hemoglobin molecule. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-9 Explain possible future developments in the field of pharmacogenetics. The nurse on a medical–surgical unit identifies several clients as being at risk for hemolytic symptoms after the administration of oxidative medications. Which clients does the nurse correctly identify as being at risk? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A male of Egyptian descent with no allergies A male immigrant from Morocco with hypertension An adolescent female from India with anemia A Latina female with an allergy to fava beans An older Native American male with diabetes Answer: 1, 2 Explanation: Males of Mediterranean and African descent are known to have a deficiency of the enzyme G6PD, which can lead to hemolysis of red blood cells after administration of oxidative medications. Males of Mediterranean and African descent are known to have a deficiency of the enzyme G6PD, which can lead to hemolysis of red blood cells after administration of oxidative medications. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4-9 Explain possible future developments in the field of pharmacogenetics. The nurse administered an antihypertensive medication to a client with high blood pressure. 64

The nurse assesses the blood pressure and notices that the blood pressure was reduced after administration of the blood pressure medication. Which pharmacologic response is the client experiencing? The therapeutic index The margin of safety The lethal dose The median effective dose Answer: 4 Explanation: The median effective dose is the dose required to produce a specific therapeutic response in 50% of a group of clients. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 4-2 Explain the importance of the median effective dose (ED50) to clinical practice. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 5 Adverse Drug Effects and Drug Interactions A client develops angioedema and difficulty swallowing after receiving an intravenous medication. The nurse recognizes this is what type of effect? A minor adverse effect A life-threatening adverse effect An unpredictable side effect A reaction secondary to urticaria Answer: 2 Explanation: Angioedema involves facial edema, which can lead to difficulty swallowing, and is considered a serious or life-threatening adverse effect. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-1 Differentiate between adverse effects and side effects. The nurse monitors a client on a newly prescribed antihypertensive drug. The nurse recognizes the symptom of hypotension would be indicative of which reaction? An allergic response to the drug A therapeutic drug effect An adverse drug effect An idiosyncratic drug reaction Answer: 3 65

Explanation: Hypotension with an antihypertensive drug would be considered an adverse effect of the drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-1 Differentiate between adverse effects and side effects.

The nurse explains to a student nurse that side effects differ from adverse events in which way? Adverse effects cause permanent damage. Side effects are usually more serious than adverse effects. Side effects are predictable at therapeutic levels. Adverse effects are only dose related. Answer: 3 Explanation: Side effects are types of effects that are predictable and can occur even at therapeutic doses. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-1 Differentiate between adverse effects and side effects. When teaching the client about a new medication, the nurse should include which information? Note: Credit will be given only is all correct choices and no incorrect choices are selected. Select all that apply. Adverse effects that can be expected Which adverse effect to report to the healthcare provider The drug's therapeutic action Chemical composition of the drug Name of the drug manufacturer Answer: 1, 2, 3 Explanation: To help the client identify and prevent adverse effects, the client should be taught the therapeutic action, adverse effects, and when to notify the healthcare provider of adverse effects. To help the client identify and prevent adverse effects, the client should be taught the therapeutic action, adverse effects, and when to notify the healthcare provider of adverse effects. To help the client identify and prevent adverse effects, the client should be taught the therapeutic action, adverse effects, and when to notify the healthcare provider of adverse effects. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-2 Create a plan to minimize or prevent adverse drug events in patients.

A client with a history of multiple allergies is prescribed a new anti-infective. At which time should the nurse plan to monitor the client for an anaphylactic reaction? Within 24 hours of receiving the first dose Immediately after receiving the first dose At any time while receiving the drug Within 1 hour of receiving the first dose Answer: 3 Explanation: Anaphylactic reactions can be unpredictable. They can occur immediately after a drug is taken or can be delayed. The nurse needs to be prepared for a reaction at any time. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-4 Describe the incidence and characteristics of drug allergies. Which clinical manifestation would the nurse identify as an allergic reaction? Urticaria Photosensitivity Abdominal cramping Complaints of diarrhea Answer: 1 Explanation: Urticaria, or hives, is indicative of an allergic response to a medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-4 Describe the incidence and characteristics of drug allergies.

A client with a documented allergy to penicillin is prescribed cephalosporin. The nurse will monitor the client for allergic responses, since cephalosporin can cause which reaction? A heightened drug reaction Pseudoallergy Cross-allergy A hyporesponsive reaction Answer: 3 Explanation: Drugs with similar structure can elicit an allergic response in a receptive client, which is called cross-allergy. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-4 Describe the incidence and characteristics of drug allergies. The nurse administers zolpidem (Ambien) to a client at 11 p.m. for sleep. The client awakens at3 a.m. and is wide awake and agitated. How will the nurse document this client's reaction to the medication in the medical record? Allergic response Side effect Adverse effect Idiosyncratic reaction Answer: 4 Explanation: The desired response of Ambien is sleep induction. An opposite or unexpected reaction would be an idiosyncratic reaction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-5 Explain how idiosyncratic reactions differ from other types of adverse effects.

The nurse determines that an idiosyncratic reaction to a drug has occurred when the client experiences drug effects that have which characteristic? Predictable Unexplained Irreversible Life threatening Answer: 2 Explanation: Idiosyncratic drug reactions are those that are unexpected or unexplained. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-5 Explain how idiosyncratic reactions differ from other types of adverse effects. A client is prescribed a medication and is concerned it might have teratogenic effects. Which response by the nurse is the most appropriate? "Let me check the pregnancy risk category of the drug." "Are you in your first trimester of pregnancy?" "If your healthcare provider ordered the medication, it should be okay." "You should avoid taking any medications while pregnant." Answer: 1 Explanation: The pregnancy risk category of a drug gauges the risk of birth defects or teratogenic effects. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-6 Explain why certain drugs with carcinogenic or teratogenic potential are used in pharmacotherapy.

A client is prescribed a chemotherapeutic drug for treatment of leukemia and asks the nurse why a drug that can also cause cancer is being used to treat cancer. Which response by the nurse isthe most appropriate? "The incidence of carcinogenic effects is really quite small, and you shouldn't be concerned about it." "Since you are receiving such potent drugs, they have to warn of you of every possible side effect." "The risk for causing another cancer is there, but sometimes the benefit of the treatment outweighs the risks." "The carcinogenic effects often do not show up for a few decades, and we want to cure this leukemia now." Answer: 3 Explanation: The benefits of treatment sometimes do outweigh the risks; this provides an honest answer to the client. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-6 Explain why certain drugs with carcinogenic or teratogenic potential are used in pharmacotherapy. The nurse determines that the client is most at risk for renal toxicity while receiving an aminoglycoside anti-infective when which diagnostic lab result is abnormal? Kidney function test White blood cell count Liver function test Platelet count Answer: 1 Explanation: Abnormal kidney function tests would indicate kidney impairment. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IV.1 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5-7 Report the characteristic signs, symptoms, and treatment for each of the following organ-specific adverse events: nephrotoxicity, neurotoxicity, hepatotoxicity, dermatologic toxicity, bone marrow toxicity, cardiotoxicity, and skeletal muscle and tendon toxicity.

A client on long-term therapy with itraconazole (Sporanox) for treatment of a nail fungus is admitted to the hospital with right upper quadrant pain, nausea, and abdominal pain. Which laboratory results found in the medical record would support the diagnosis of hepatotoxicity? Elevated liver function tests Elevated creatinine levels Decreased blood sugar Decreased prothrombin time Answer: 1 Explanation: Elevated liver function tests, which include the enzymes ALT and AST, are indicative of liver inflammation and/or impaired function of the liver. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IV.1 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-7 Report the characteristic signs, symptoms, and treatment for each of the following organ-specific adverse events: nephrotoxicity, neurotoxicity, hepatotoxicity, dermatologic toxicity, bone marrow toxicity, cardiotoxicity, and skeletal muscle and tendon toxicity. The nurse plans to monitor a client for dermatologic toxicities after administering which medication? Salicylates Antiseizure drugs Antithyroid drugs Loop diuretic Answer: 2 Explanation: Antiseizure drugs are associated with dermatologic toxicity. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IV.1 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-7 Report the characteristic signs, symptoms, and treatment for each of the following organ-specific adverse events: nephrotoxicity, neurotoxicity, hepatotoxicity, dermatologic toxicity, bone marrow toxicity, cardiotoxicity, and skeletal muscle and tendon toxicity.

When checking on the potential interactions of two drugs being administered at the same time,the nurse recognizes which principle? Drug–drug interactions are more serious than drug–food interactions. All drugs will have some type of interaction. Drug interactions should always be avoided. Some drug interactions can produce therapeutic effects. Answer: 4 Explanation: The combination of some drugs can produce a synergistic or additive effect, which often is therapeutic in nature. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-8 Use examples to explain the importance of drug interactions to pharmacotherapy. A client is receiving an antiviral drug that is a substrate of the CYP3A4 enzyme system. Whena drug that is an inhibitor of the 3A4 system is added to the client's regimen, the nurse should assess the client for which result? Toxicity of the antiviral drug No change in viral-related symptoms A decrease in the antiviral drug side effects An increase in viral load Answer: 1 Explanation: The drug inhibitor will interact with the antiviral drug and inhibit metabolism of it, resulting in accumulation of the drug with possible toxic effects. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-9 Describe the mechanisms of drug interactions that alter absorption, distribution, metabolism, or excretion.

A client is prescribed tetracycline for an infection. The nurse instructs the client to avoid which food to prevent a possible drug–food interaction? Citrus juices Dairy products Legumes Beef Answer: 2 Explanation: The calcium in dairy products can interfere with the absorption of tetracycline, and so should not be taken with the medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-11 Identify examples of drug–food interactions that may impact pharmacotherapeutic outcomes. A client is scheduled to receive a diuretic and a beta blocker. The nurse determines the combination of these drugs will have which effect on the client's blood pressure? Oppositional Synergistic Antagonistic Additive Answer: 4 Explanation: The two drugs together have an additive effect on blood pressure. The diuretic will reduce blood volume; the beta blocker will block vasoconstriction, causing a decrease in peripheral vascular resistance. These two different actions will both help to reduce blood pressure. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-10 Differentiate among additive, synergistic, and antagonistic drug interactions.

The nurse administers ciprofloxacin (Cipro), a fluoroquinolone, to a client. To prevent a food– drug interaction, the nurse should remove which item from the client's lunch tray? Orange juice Tomatoes Coffee Chocolate cake Answer: 3 Explanation: Cipro may increase the stimulatory effects of caffeine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-11 Identify examples of drug–food interactions that may impact pharmacotherapeutic outcomes. The nurse recognizes that which food on a client's tray could cause a drug–food interaction with warfarin (Coumadin)? Banana Toasted cheese sandwich Iced tea Spinach salad Answer: 4 Explanation: The vitamin K in the spinach can interfere with the action of warfarin (Coumadin) and prolong bleeding time. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-11 Identify examples of drug–food interactions that may impact pharmacotherapeutic outcomes.

The nurse is conducting medication teaching for a client recently prescribed a calcium channel blocker. Which food will the nurse caution the client to avoid when taking this medication? Grapefruit and grapefruit juice Coffee Dairy products Green, leafy vegetables Answer: 1 Explanation: Grapefruit can enhance the absorption of calcium channel blockers, leading to elevated drug levels. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-11 Identify examples of drug–food interactions that may impact pharmacotherapeutic outcomes. A nurse is preparing care for a newly admitted client with diabetic mellitus. Which information would be critical for the nurse to assess? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Medical history Current lab results Medication allergies Use of dietary supplements Number of previous hospitalizations Answer: 1, 2, 3, 4 Explanation: Medical history may reveal conditions that contraindicate the use of certain drugs. Current lab results may reveal important information about the health of organs, such as the kidneys and liver, which would be important to metabolism and excretion of drugs. Allergies to one drug may cross over to another drug and would need to be avoided. Some dietary supplements can interact with drugs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-2 Create a plan to minimize or prevent adverse drug events in patients.

A nurse is caring for a client diagnosed with acute asthma who is taking several medications.The nurse would suspect a common adverse drug effect when the client exhibits which symptoms? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Headache Nausea Vomiting Changes in blood pressure Loss of hearing Answer: 1, 2, 3, 4 Explanation: Headache is a common adverse effect of some medications. Nausea is a common adverse effect of some medications. Vomiting is a common adverse effect of some medications. Changes in blood pressure are a common adverse effect of some medications. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-2 Create a plan to minimize or prevent adverse drug events in patients.

A nurse is caring for a client who may be experiencing an allergic response to medication. The nurse bases the assessment on which information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Signs and symptoms of drug allergy range from minor to life threatening. Drug allergy symptoms may appear the same as common allergies to other substances, such as environmental triggers. It is important to determine the source of the allergy. Nausea and vomiting are the most common drug allergy symptoms. Drug allergies require previous exposure. Answer: 1, 2, 3, 5 Explanation: Symptoms of drug allergies may range from skin rash to difficulty breathing. The symptoms of drug allergies may appear the same as common allergic triggers. It is important to determine the source of the allergic response in an effort to avoid it in the future. Previous exposure to the allergic drug is required for a hyperimmune response. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-4 Describe the incidence and characteristics of drug allergies.

A nurse teaching a prenatal class is reinforcing precautions concerning the use of medications during pregnancy. The nurse determines the class understands when the students make which comments? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "There are some medications I cannot take because I am pregnant and they could hurt my baby." "I need to check with my doctor before I take any medication because some drugs can hurt my baby." "I should consider all drugs to be harmful to my baby unless my doctor tells me it is okay." "I have to be very careful to let all my health providers know that I am pregnant before they prescribe medications for me." "Once I am halfway through my pregnancy, I won't need to worry about taking over-the-counter medications because the baby will be more fully formed." Answer: 1, 2, 3, 4 Explanation: The pregnant client should consider all drugs are dangerous during pregnancy, unless her healthcare provider tells her otherwise. The pregnant client should always consult her healthcare provider before taking any medication. The pregnant client should consider all drugs to be dangerous during pregnancy unless her healthcare provider tells her otherwise. The pregnant client should consider all drugs to be dangerous during pregnancy unless her healthcare provider tells her otherwise. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-6 Explain why certain drugs with carcinogenic or teratogenic potential are used in pharmacotherapy.

The nurse is caring for a client who is taking a drug known to cause nephrotoxicity. Which interventions are appropriate to prevent drug-induced nephrotoxicity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Encouraging hydration Monitoring diagnostic lab tests for changes in kidney function Identifying drugs that affect the kidneys and discussing adjusting doses Determining whether the client has kidney impairment Providing proper nutrition Answer: 1, 2, 3, 4 Explanation: Encouraging proper hydration will help to protect the kidneys by improving excretion of drugs. It is important to monitor lab tests for any indication that a nephrotoxic drug is having an adverse effect on the kidneys. It is important to recognize drugs that affect the kidneys, monitor lab values, and adjust doses if needed. Identifying present kidney impairment will allow the provider to adjust any nephrotoxic drug doses, which will minimize the strain on the kidney. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IV.1 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-7 Report the characteristic signs, symptoms, and treatment for each of the following organ-specific adverse events: nephrotoxicity, neurotoxicity, hepatotoxicity, dermatologic toxicity, bone marrow toxicity, cardiotoxicity, and skeletal muscle and tendon toxicity.

A nurse caring for a client taking a drug that can cross the blood–brain barrier determines the client is experiencing possible neurotoxicity when which symptoms are observed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Visual changes Loss of balance Sedation Depression Nausea and vomiting Answer: 1, 2, 3, 4 Explanation: Symptoms of neurotoxicity may include visual changes. Symptoms of neurotoxicity may include loss of balance. Symptoms of neurotoxicity may include drowsiness. Symptoms of neurotoxicity may include depression. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IV.1 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-7 Report the characteristic signs, symptoms, and treatment for each of the following organ-specific adverse events: nephrotoxicity, neurotoxicity, hepatotoxicity, dermatologic toxicity, bone marrow toxicity, cardiotoxicity, and skeletal muscle and tendon toxicity.

A nurse is caring for a client recently prescribed an oral antibiotic who is exhibiting signs of dermatologic toxicity. Which assessment findings support dermatologic toxicity? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Rash Itching Urticaria Sunburn Photosensitivity Answer: 1, 2, 3, 4 Explanation: Rash is a common hypersensitivity response. Itching is a common hypersensitivity response. Hives are common in a hypersensitive response. Certain drugs can cause the skin to be sensitive to the sun, resulting in sunburn. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IV.1 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-7 Report the characteristic signs, symptoms, and treatment for each of the following organ-specific adverse events: nephrotoxicity, neurotoxicity, hepatotoxicity, dermatologic toxicity, bone marrow toxicity, cardiotoxicity, and skeletal muscle and tendon toxicity.

A nurse is planning care for a client taking a medication with the potential to cause bone marrow toxicity. Which interventions exemplify the nurse's role in preventing complications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Assess the client for signs and symptoms of infection. Assess the client for signs and symptoms of anemia. Monitor the client for signs and symptoms of fatigue. Monitor the client for evidence of bruising. Monitor the client for insomnia. Answer: 1, 2, 3, 4 Explanation: Bone marrow toxic drugs can affect the production of white blood cells. Bone marrow toxic drugs can affect the production of red blood cells. Bone marrow toxic drugs can affect the production of red blood cells. Bone marrow toxic drugs can affect the production of platelets. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IV.1 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-7 Report the characteristic signs, symptoms, and treatment for each of the following organ-specific adverse events: nephrotoxicity, neurotoxicity, hepatotoxicity, dermatologic toxicity, bone marrow toxicity, cardiotoxicity, and skeletal muscle and tendon toxicity.

The nurse is caring for a client who is prescribed laxatives. Which statements are most relevantto the absorption of medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Drugs that increase peristalsis may decrease absorption. Drugs that decrease peristalsis may increase absorption. The presence of food will usually decrease absorption. Drug–drug interactions that affect absorption may be prevented by taking the drugs 2 hours apart. Increasing fluid intake will increase absorption. Answer: 1, 2, 3, 4 Explanation: The less time drugs stay in the stomach or small intestine, the less the time of absorption. The longer the drug is exposed to the stomach lining and small intestine, the greater the time of absorption. Absorption is increased when the stomach is empty. Many drug–drug interactions that cause decreased absorption can be avoided by separating the drugs by 2 to 3 hours. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-9 Describe the mechanisms of drug interactions that alter absorption, distribution, metabolism, or excretion.

The nurse is caring for a client who has been admitted for uncontrolled hypertension. When the healthcare provider orders a second antihypertensive drug for the client, the client asks the nurse why the healthcare provider ordered another drug instead of increasing the first drug. The nurse's response is based on which principles? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A second drug from the same class is added to prevent the dose of the first drug from being increased. Adding a second drug may allow both drugs to be used at a lower dose. The effect of two drugs from different classes may have a greater effect than two drugs from the same class. Adding the second drug will result in the diminished response of the first drug, which will increase the effects. It is important to counteract the increased dose with another drug to decrease the potential for adverse effects. Answer: 1, 2, 3 Explanation: Keeping both doses low and taking advantage of an additive effect reduces the potential for adverse effects. Keeping both doses low and taking advantage of an additive effect reduces the potential for adverse effects. The two drugs will affect different receptor sites to achieve the same goal, resulting in a greater response but at lower doses. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-10 Differentiate among additive, synergistic, and antagonistic drug interactions.

A nurse is reinforcing discharge instructions concerning food–drug interactions. Which statements by the client indicate correct understanding of the discharge instructions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "I should take my medications with water to avoid any problems with my medications being absorbed." "I cannot take one of my medications with grapefruit juice because it will decrease the absorption of the medication." "I need to be sure to read the prescription label because the pharmacist will indicate if I need to take my medication with food or without food." "I should take my daily vitamin 2 hours after my medication so they do not affect each other." "If I take my medication with hot tea, it will not affect absorption." Answer: 1, 2, 3, 4 Explanation: The safest fluid to take with medications is water. Grapefruit juice can increase absorption of certain drugs and should be avoided. The pharmacist will indicate on the medication label if the medication should be taken with or without food. Herbal supplements and vitamins can cause adverse effects when taken with medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-11 Identify examples of drug–food interactions that may impact pharmacotherapeutic outcomes.

A client reports an adverse effect to the Adverse Event Reporting System. The nurse recognizes that if a potential safety concern is identified, the Food and Drug Administration (FDA)may take which actions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Determine the extent of the safety concern by conducting additional studies. Require changes be made to the product's labeling information. Recall the product. Restrict the product's use in certain populations. Continue to log in public concerns regarding the safety of the product before taking further action. Answer: 1, 2, 3, 4 Explanation: The FDA will conduct additional epidemiologic studies to determine the validity or extent of the concern. The FDA will require the pharmaceutical company to change the product's label to reflect this concern. The FDA will recall a product that may have performance concerns. The FDA will restrict the product's use in certain populations. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IV.1 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-3 Explain the advantages and disadvantages of the FDA Adverse Event Reporting System.

The nurse is planning care for a client newly diagnosed with emphysema who complains thatthe medication is causing a "shaky" feeling. What does the nurse recognize this to be? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A predictable side effect of the medication An annoying side effect of the medication A dose-dependent side effect of the medication An allergic response to the medication A serious adverse effect of the medication Answer: 1, 2, 3 Explanation: Many drugs used for emphysema cause nervousness, which may result in the client feeling unsteady. Many drugs used for emphysema cause annoying sides effects such as nervousness, which may result in the client feeling unsteady. Many drugs used for emphysema cause side effects such as nervousness, resulting in the client feeling unsteady. This side effect is often dose dependent. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-1 Differentiate between adverse effects and side effects. A client is prescribed tetracycline for acne. Which foods should the nurse ask the client to avoid while taking this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Milk Almonds Ice cream Hamburgers Grapefruit juice Answer: 1, 3 Explanation: Milk products contain calcium, which will decrease absorption. Milk products contain calcium, which will decrease absorption. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-11 Identify examples of drug–food interactions that may impact pharmacotherapeutic outcomes. 88

A client returns to the clinic for follow-up after taking a newly prescribed medication for a month. The nurse recognizes medication teaching was successful when the client makes which statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "I've been taking my medication on an empty stomach, like the prescription label said to do." "I always take my medication with a full glass of water." "I'm not drinking any alcohol close to the time that I take my medication." "I switched all my medications to one pharmacy, like you suggested." "I was glad I could take my medications and supplements together. I don't really like to take a lotof pills during the day." Answer: 1, 2, 3, 4 Explanation: Some medications must be taken on an empty stomach. It is important to know if the medication should be taken with food or on an empty stomach. Taking medications with water will decrease the chance of an interaction that can occur with other juices or fluids. Alcohol can cause adverse interactions with medications. Filling all prescriptions at the same pharmacy will assist the pharmacist in comparing current and new medications for interactions. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5-11 Identify examples of drug–food interactions that may impact pharmacotherapeutic outcomes.

A nurse is caring for a client who is exhibiting signs of an adverse reaction to warfarin (Coumadin). Which statements made by the client would lead the nurse to suspect that this is the case? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "I'm from the South, and we have buttermilk almost every meal." "I was suffering so much from hot flashes until my friend told me to try an herb called St. John's wort. I don't seem to have as many symptoms as before." "My husband makes me put garlic in everything! He heard it helps keep our blood pressure normal." "I heard ginkgo was really good for improving memory so I started taking it a couple of months ago." "I was having difficulty sleeping a couple months ago, and my neighbor recommended I try kava. It seems to calm my nerves." Answer: 2, 3, 4 Explanation: St. John's wort may increase the risk for bleeding when taken with warfarin. Garlic may increase the risk for bleeding when taken with warfarin. Ginkgo may increase the risk for bleeding when taken with warfarin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-11 Identify examples of drug–food interactions that may impact pharmacotherapeutic outcomes.

A client is admitted to the emergency department in a hypertensive crisis. The client's spouse said the client ate food containing tyramine. The nurse immediately rules out which types of drugs as the cause of the client's hypertensive crisis? Tetracycline Warfarin (Coumadin) Calcium channel blockers Monoamine oxidase inhibitors (MAOIs) Answer: 4 Explanation: Foods with tyramine can cause hypertensive crisis when taken with MAOIs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-11 Identify examples of drug–food interactions that may impact pharmacotherapeutic outcomes. A nurse in the emergency department is preparing to care for a client suspected of an opiate overdose. The nurse is preparing to give the client a medication called naloxone (Narcan). Which rationales support the use of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. It reverses the effects of the overdose. It is an antagonist. It has an additive effect. It has a synergistic effect. It causes CNS depression. Answer: 1, 2 Explanation: Narcan is an antagonist that will reverse the effects of an opiate overdose. Narcan is an antagonist. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 5-10 Differentiate among additive, synergistic, and antagonistic drug interactions.

The nurse would anticipate an alteration in drug excretion in clients with which conditions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Kidney disease Heart disease Diarrhea Asthma Alzheimer's disease Answer: 1, 2 Explanation: Any condition that decreases or impairs glomerular filtration rate will decrease excretion of drugs from the body. Glomerular filtration rate is directly related to cardiac output. Any heart disease that decreases cardiac output will decrease excretion of drugs from the body. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-9 Describe the mechanisms of drug interactions that alter absorption, distribution, metabolism, or excretion. The nurse would anticipate an alteration in drug absorption in clients with which conditions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Vomiting Diabetes Diarrhea Asthma Alzheimer's disease Answer: 1, 3, 4 Explanation: The drug cannot be absorbed if it is vomited. The quick transit of medication through the small intestines may alter absorption. Bronchoconstriction could alter inhaled medications. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-9 Describe the mechanisms of drug interactions that alter absorption, distribution, metabolism, or excretion.

A nurse educator explaining drug interactions to students includes which statement in the teaching? "Drug interactions occur with very small amounts of drug." "The symptoms of drug interactions are related to the pharmacologic actions of the drug." "Drug interactions require a previous exposure to the drug." "The severity of the drug reaction is directly related to the dose of the drug." Answer: 2 Explanation: The symptoms of drug interactions are related to the pharmacologic actions of the drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-8 Use examples to explain the importance of drug interactions to pharmacotherapy. Which is a disadvantage of the FDA Adverse Event Reporting System (FAERS)? Reports received from the manufacturers are forwarded to the FDA to be added to its computerized database. The reporting system can restrict the use of a drug in specific populations if found unsafe. Reported adverse effects can remove the product from the market. The nurse should examine the incidence of adverse effects that occur over and above that causedby a placebo. Answer: 4 Explanation: A disadvantage of the FAERS is the need for the constant review of medication safety of the placebo reports by the nurse, which requires a nurse to be vigilant on medication knowledge. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IV.1 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-3 Explain the advantages and disadvantages of the FDA Adverse Event Reporting System. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 6 Medication Errors and Risk Reduction The nursing instructor teaches the students how medication errors can occur. Which common causes of errors will the instructor discuss? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 93

The nurse does not validate a written order with the healthcare provider. The nurse administers the incorrect drug. The nurse miscalculates the medication dose. The nurse misinterprets a healthcare provider's order. The nurse does not check the client's identification band. Answer: 2, 3, 4, 5 Explanation: Medication errors can be related to misadministration. Medication errors can be related to miscalculations. Medication errors can be related to misinterpretations. Not correctly identifying a client may lead to giving the wrong client the medication. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-1 Critique the following statement: "All medication errors can be prevented."

Drug administration is a complex process that involves more than one person. The potential fora medication error can occur during any step in that process. Which individual would not be involved in the process? Pharmacist Healthcare provider Client Nurse manager Answer: 4 Explanation: The nurse manager would only be involved in the process if there were a problem on the unit with medication administration. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-1 Critique the following statement: "All medication errors can be prevented."

The nurse makes a medication error, but the client is not harmed. The client's family asks the nurse manager what constitutes a medication error. Which are potential responses by the nurse manager? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Failure to follow healthcare provider's orders Failure to give the right medication Failure to give a medication at the ordered time Failure to call the pharmacy and report that the medication has been given Failure to give the right dose of the medication Answer: 1, 2, 3, 5 Explanation: In this medication error, the client does not receive the drug as the healthcare provider intended it to be given. In this medication error, the client does not receive the drug the healthcare provider intended to be given. In this medication error, the client does not receive the drug at the time the healthcare provider intended it to be given. In this medication error, the client does not receive the dose of the drug the healthcare provider intended to be given. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-3 Using specific examples, analyze major types of medication errors and how they can be prevented. The nurse in the emergency department miscalculates, and administers the wrong dosage of an antibiotic to a 9-month-old baby. As a result, the baby suffers permanent brain damage. Which factor most likely contributed to the error? Lack of adequate oral or written communication Name confusion involving similar-sounding drugs Mislabeled products Human factors Answer: 4 Explanation: This was a human factor. The dosage was miscalculated. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-3 Using specific examples, analyze major types of medication errors and how they can be prevented. 96

The FDA uses the information reported to it on specific types and incidences of medication errors to determine contributing factors. Which factor would be included on this list? Never taking a verbal or phone order without receiving a written order before administering the drug Performing an agency system check Failure to account for client variables Following the rights of drug administration Answer: 3 Explanation: Variables such as age, body size, and renal and hepatic function must be assessed and taken into account when administering medications. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-3 Using specific examples, analyze major types of medication errors and how they can be prevented. The FDA uses the information reported to it on specific types and incidences of medication errors to determine contributing factors. What is a common factor involving the client or caregiver? Taking medications as the practitioner has ordered Never trading drugs with anyone Taking drugs prescribed by more than one practitioner Filling prescriptions at several pharmacies Answer: 4 Explanation: Pharmacists are the key members of the healthcare team who can recognize potential drug interactions and adverse effects. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-3 Using specific examples, analyze major types of medication errors and how they can be prevented.

The nurse administers an evening medication to the client in the morning. The medication didgo to the correct client. What is the nurse's best course of action at this time? Notify the healthcare provider to ask if any further action needs to be taken. Notify the healthcare provider about the error, and complete an incident report. Tell the evening nurse to hold the evening dose just for tonight. Change the medication administration time to the morning. Answer: 2 Explanation: The healthcare provider must be notified of the medication error and an incident report must be completed. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: IV.1 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-4 Describe procedures for reporting and documenting medication errors and incidents. The nurse commits a medication error. The nurse documents the error in the client's record and completes the incident report. What does the nurse recognize as the primary reason for this action? To protect the nurse from liability To verify that the client's safety was protected To protect the client from further harm To protect the healthcare facility from litigation Answer: 2 Explanation: Documentation in the client's medical record and completion of an incident report verify that the client's safety was protected. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: IV.1 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-4 Describe procedures for reporting and documenting medication errors and incidents.

The nurse assesses an adverse effect of a medication that has been administered. No medication error was committed. To which federal database would the nurse report the adverse effect? The Food and Drug Administration's (FDA) Safe Medicine The Food and Drug Administration's (FDA) MedWatch The Food and Drug Administration's (FDA) Institute for Safe Medication Practices (ISMP) The Centers for Disease Control and Prevention (CDC) Answer: 2 Explanation: Adverse events with medication should be reported to the FDA's Safety Information and Adverse Event Reporting Program, known as MedWatch. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: IV.1 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-4 Describe procedures for reporting and documenting medication errors and incidents. The nurse recognizes that agency system checks are in place to decrease medication errors. Who commonly collaborates with the nurse on checking the accuracy of the medication prior to administration? The nursing supervisor The pharmacist The healthcare provider The nursing unit manager Answer: 2 Explanation: Pharmacists and nurses must collaborate on checking the accuracy and appropriateness of drug orders prior to client administration. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.5 Participate in quality and patient safety initiatives, recognizing that these are complex system issues, which involve individuals, families, groups, communities, populations and other members of the healthcare team | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-5 Explain how rules, policies, and procedures can help prevent medication errors.

The nurse was very busy and unfamiliar with a new medication, but administered it anyway. Later the nurse looked up the medication. How would the nurse manager evaluate this behavior? An error did occur because the nurse could have administered the medication via the incorrect route. This was acceptable as long as the nurse looked up the action and side effects of the drug at some point. The nurse manager was partially at fault because the nursing unit was understaffed and the nurse was too busy. An error could have occurred because the nurse was unfamiliar with the medication. Answer: 4 Explanation: An error did not occur, but could have because the nurse was not familiar with the medication. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.9 Apply quality improvement processes to effectively implement patient safety initiatives and monitor performance measures, including nurse-sensitive indicators in the microsystem of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-6 Develop a list of strategies that the nurse can implement in practice to reduce medication errors. The nurse is preparing medications for a group of clients. Another nurse begins telling the nurse about her recent engagement. What is the best plan of action by the first nurse? Tell the second nurse that the conversation is distracting and must cease while medications are being prepared. Ask the second nurse to help with administering medications so they can have more time to talk. Continue to prepare the medications for administration and pretend to listen to the first nurse. Stop preparing medications until the first nurse has finished talking about her engagement. Answer: 1 Explanation: When preparing medications, the nurse must focus entirely on the task at hand, and instruct others who are talking to stop. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.9 Apply quality improvement processes to effectively implement patient safety initiatives and monitor performance measures, including nurse-sensitive indicators in the microsystem of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-6 Develop a list of strategies that the nurse can implement in practice to reduce medication errors.

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The nurse is working hard to prevent medication errors. Which plans will assist the nurse in preventing most errors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Plan to validate all orders with another nurse prior to administration of medications. Plan to assess for patient variables such as age, weight, and diagnostic lab studies prior to administration. Plan to tell healthcare providers that verbal orders will not be accepted. Plan to always check the client's identification band prior to administration of medications. Plan to record the medication on the medication administration record (MAR) immediately prior to administration. Answer: 2, 3, 4 Explanation: Nurses should always account for patient variables such as age, weight, and any diagnostic studies that may impact the administration of medication. Requiring a written medication order also reduces the possibility of an error related to similar-sounding drug names. This is one of the five rights of drug administration to prevent errors. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.9 Apply quality improvement processes to effectively implement patient safety initiatives and monitor performance measures, including nurse-sensitive indicators in the microsystem of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 6-6 Develop a list of strategies that the nurse can implement in practice to reduce medication errors.

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The nurse is working hard to prevent medication errors. Which intervention would assist the nurse in preventing most errors using the assessment step of the nursing process? Be aware of stressful situations and distractions during medication administration. Assess the client for expected outcomes and determine if any adverse side effects have occurred. Ask the client about food or medication allergies, including OTC medications and herbal supplements. Avoid using abbreviations that could be misunderstood. Answer: 3 Explanation: This is part of the assessment step of the nursing process. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.9 Apply quality improvement processes to effectively implement patient safety initiatives and monitor performance measures, including nurse-sensitive indicators in the microsystem of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 6-6 Develop a list of strategies that the nurse can implement in practice to reduce medication errors. It is common for older clients to receive multiple prescriptions that might have conflicting pharmacologic actions. What is the term for keeping track of the client's medications as the client moves through the healthcare system? Assessment Medication transition Pharmacologic evaluation Medication reconciliation Answer: 4 Explanation: Medication reconciliation is the process of tracking clients' medications as they progress through the healthcare system. Cognitive Level: Remembering Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IV.3 Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-7 Explain how medication reconciliation can lead to a reduction in medication errors.

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The nurse is instructing a client about how to help prevent medication errors while in the hospital. What is a priority question for the nurse to ask the client? "Do you know what your illness is, and if you will need surgery?" "Do you have a friend to verify that you are receiving the correct medication?" "Do you trust your healthcare provider to order the correct medication?" "Do you know the names of all the medications you take?" Answer: 4 Explanation: Knowing the names of all the medications the client is taking can help reduce medication errors when the client is admitted to the hospital. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-8 Design patient teaching information that can be used to reduce medication errors. The nurse is instructing a client about how to prevent medication errors after discharge fromthe hospital. What is a priority recommendation the nurse should make? Ask questions about drug safety. Healthcare providers should be partners in maintaining safe medication principles. Remember that OTC and herbal supplements are not considered medications. They cannot cause any harm. It is okay to use household measuring devices to measure medications. These devices yield the same measurements that are used by professionals. Do not question the medications received from the pharmacist. The pharmacist is a professional and should not be questioned. Answer: 1 Explanation: This recommendation will help to reduce medication errors. Working together to understand information is an important process in medication reconciliation. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-8 Design patient teaching information that can be used to reduce medication errors.

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The nurse is discharging a client from the hospital. Which is a priority intervention for the nurse at this time? On discharge from the facility, the nurse should provide the client with a complete list of medications to be taken, as well as instructions on how to take any newly prescribed medications. The nurse should consult the client's pharmacy and inform the pharmacist that the client is being discharged. The nurse should call a friend to come before giving discharge instructions to the client. The nurse should inform the client's primary healthcare provider that the client is being discharged. Answer: 1 Explanation: This intervention will help to reduce medication errors because the client is better informed about the medications. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-8 Design patient teaching information that can be used to reduce medication errors. The nurse is working in the risk management department to examine risks and minimize the number of medication errors. Which intervention can the nurse put in place to prevent errors? Make sure there is an overstock of all medications to ensure availability. Remove outdated reference books. Store all medication in well-lighted areas. Transfer all small amounts of medications into smaller containers to save space. Answer: 2 Explanation: Current reference books ensure current information, reducing medication errors. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.11 Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in the development and initiation of effective plans for the microsystem and/or system-wide practice improvements that will improve the quality of healthcare delivery | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-9 Identify strategies that healthcare agencies use to prevent medication errors.

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The nurse is on a committee to reduce medication errors in a large healthcare facility. Which strategy can the nurse recommend that is being adopted in many healthcare facilities? Use robots to prepare all medications for administration by the nurse. Use automated, computerized cabinets on all nursing units. Designate nurses whose only function is to administer medication. Train medication technicians to administer medications. Answer: 2 Explanation: Healthcare agencies are using automated, computerized cabinets to reduce medication errors. Cognitive Level: Remembering Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.11 Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in the development and initiation of effective plans for the microsystem and/or system-wide practice improvements that will improve the quality of healthcare delivery | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 6-9 Identify strategies that healthcare agencies use to prevent medication errors.

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A nurse on the medical–surgical unit is caring for several very ill clients. One client says, "I was supposed to get my medications an hour ago." The nurse recognizes that medication errors can have what repercussions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Medication errors can potentially extend the client's length of hospital stay. Medication errors can result in expensive legal costs to the facility. Medication errors can damage the facility's reputation. Medication errors can be physically devastating to nurse and client. Medication errors cause preventable deaths during hospitalizations. Answer: 1, 2, 3, 5 Explanation: Medication errors can cause harm, which can extend the client's length of stay. If a medication error causes harm to a client, it can result in expensive legal fees for hospital defense. If the incidence of medication errors is publicized, it can cause the facility to be seen as unsafe or to be delivering substandard care. Medication errors are the most common cause of morbidity and preventable death within hospitals. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: II.A.2 Describe scopes of practice and roles of healthcare team members | AACN Essential Competencies: II.2 Demonstrate leadership and communication skills to effectively implement patient safety and quality improvement initiatives within the context of the interprofessional team | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-2 Describe the potential impact of a medication error on all aspects of healthcare delivery, including patients, nurses, and healthcare agencies.

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A new nurse on the orthopedic unit makes a medication error. Which statements by the nurse manager foster a safe environment in which nurses will report medication errors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "Many of us have made a medication error in our careers. The most important issue is to identify why the error occurred." "I know you could not feel any worse than you already do. We need to discuss how this error happened and how we can prevent it from happening again." "It's really good that your patient is okay and did not suffer any harmful effects of this error. We should discuss why this error occurred and how it can be prevented in the future." "Because you are a new nurse, we should sit down and discuss the procedure you followed to see what you could have done to prevent this error." "We need to sit down as soon as possible and write up an incident report describing everything you did incorrectly that caused this error." Answer: 1, 2, 3, 4 Explanation: All errors should be investigated with the goal of identifying why they occurred. This investigation should be done in a manner that is not punitive and will encourage staff to report errors without fear of punishment. All errors should be investigated with the goal of identifying why they occurred. This investigation should be done in a manner that is not punitive and will encourage staff to report errors without fear of punishment. All errors should be investigated with the goal of identifying why they occurred. This investigation should be done in a manner that is not punitive and will encourage staff to report errors without fear of punishment. All errors should be investigated with the goal of identifying why they occurred. This investigation should be done in a manner that is not punitive and will encourage staff to report errors without fear of punishment. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-3 Using specific examples, analyze major types of medication errors and how they can be prevented.

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A community health nurse is preparing a teaching plan regarding medications and safety for a new parent class. Which topics should be addressed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Parents should maintain a list of current medications for each child. Parents should be aware of each child's medication allergies. Parents should know what the child's prescribed medication is for, how it should be administered, and when to expect the child to feel better. Parents should be aware that any leftover medication should be appropriately disposed of, not saved for future use. Parents should read the drug label for any foods the child should avoid while taking the medication and for possible adverse effects to watch out for. Answer: 1, 2, 3, 4 Explanation: Parents should make a complete list of all prescribed medications, over-the-counter drugs, and any vitamins the child takes. It is very important for parents to be aware of a child's allergies in order to prevent an unnecessary allergic response. Parents should know what condition the child's medication is prescribed for, and how, when, and how much to administer. It is also important for parents to know when to expect the child to feel better so a follow-up visit can be made if the child is not feeling better. Parents should be aware that it is not safe to self-diagnose and treat with leftover medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-8 Design patient teaching information that can be used to reduce medication errors.

108

A community health nurse working with a group of migrant workers is reinforcing instruction on how to avoid medication errors. What should the nurse encourage clients to do in order to avoid medication errors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Have all medications filled at the same pharmacy. Let the healthcare provider know if they have difficulty acquiring their medications. Ask questions about how and when to take medications if they are unsure. Take all the medication as directed, and not to save the medication for a future illness. Ask friends or family if they have any of the same medication and are willing to share it with the client. Answer: 1, 2, 3, 4 Explanation: The pharmacist can recognize possible drug interactions if all medications are filled at one pharmacy. Many indigent clients do not have the means to fill prescriptions and may be embarrassed to tell the healthcare provider. Taking the wrong amount of medication at the wrong time is a very common medication error. The nurse should emphasize the importance of taking all the prescribed medication as directed. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-8 Design patient teaching information that can be used to reduce medication errors.

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The nurse is preparing a teaching plan for an older adult client who is taking multiple medications. Which principles should the nurse keep in mind during the planning phase? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. The client should use only one pharmacy to fill prescriptions. The client should keep a list of all medications for easy accessibility. Polypharmacy is a common cause of medication errors in older clients. Polypharmacy is unique to older clients and is the most common cause of medication errors. The client should be aware of each prescribed medication, the dose, and possible side effects. Answer: 1, 2, 3, 5 Explanation: It is common for older clients to have medical conditions requiring the use of multiple medications that could have possible interactions. Using one pharmacy will ensure the pharmacist will discover any problematic interactions between multiple drugs. Keeping a list available is important for unexpected trips to a healthcare facility. The use of multiple drugs for multiple chronic conditions is a common cause for medication errors in older clients. Knowing the names, dose, and possible side effects of medications will reduce the risk for medication errors. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 6-8 Design patient teaching information that can be used to reduce medication errors.

110

During a staff meeting, a nurse asks how risk management reduces medication errors in the facility. Which statements by the director of the risk management department accurately describe its functions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "We examine each reported incident to determine risks that could have contributed to the error." "We investigate each incident report to determine strategies that may be helpful to decrease the risk for medication errors." "We use data from reported incidences to identify common themes that may increase the risk for medication errors." "We use data to make changes in policies and procedures that may prevent medication errors." "We track data to determine if specific nurses are making errors so we can notify the nursing board." Answer: 1, 2, 3, 4 Explanation: Risk management personnel investigate reported incidents to determine the cause or causes for medication errors. Risk management personnel use data from incident reports to recommend strategies that may decrease medication errors. Risk management personnel use the information from incident reports to identify common factors that increase the risk for medication errors. Risk management personnel recommend strategies to decrease medication errors based on information gained during the investigation. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.11 Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in the development and initiation of effective plans for the microsystem and/or system-wide practice improvements that will improve the quality of healthcare delivery | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-9 Identify strategies that healthcare agencies use to prevent medication errors.

111

A new nurse on the pediatric unit is very nervous about making a medication error. Which statements by a more experienced nurse are accurate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "One of the main causes of medication errors is the human factor. So, just be sure you ask for help if you are not sure about a dosage calculation." "If you are not sure you are reading an order correctly, always call the provider and ask. This will keep you from misinterpreting an order." "Our facility has a list of drugs that have similar names that have contributed to medication errors in the past. You might want to take a look at the list so you will be aware of them." "You really don't have to look at the diagnostic lab work from yesterday. It has been charted in the nurse's notes." "As long as two nurses take a phone order, it does not have to be written by the healthcare provider." Answer: 1, 2, 3 Explanation: It is important to double-check any calculations that the nurse may be unsure about with another nurse or the pharmacist. The nurse must always call the healthcare provider to confirm or clarify any orders that may be in question. Medications with similar names are a common cause for medication errors. If the facility has a list, it would be good for the new nurse to study that list. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.9 Apply quality improvement processes to effectively implement patient safety initiatives and monitor performance measures, including nurse-sensitive indicators in the microsystem of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-6 Develop a list of strategies that the nurse can implement in practice to reduce medication errors.

112

A nurse preparing to give medications to clients in the emergency department avoids making medication errors by following drug administration rights. Which "rights" did the nurse use? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Evaluating the client following drug administration Assessing the client prior to administering any drug Documenting all medications immediately following administration Educating the client regarding medications Administering prescribed medication even if the client refuses it Answer: 1, 2, 3, 4 Explanation: Right evaluation following drug administration is 1 of the 10 rights of drug administration. Right assessment prior to drug administration is 1 of the 10 rights of drug administration. Right documentation is 1 of the 10 rights of drug administration. Right client education is 1 of the 10 rights of drug administration. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.9 Apply quality improvement processes to effectively implement patient safety initiatives and monitor performance measures, including nurse-sensitive indicators in the microsystem of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-6 Develop a list of strategies that the nurse can implement in practice to reduce medication errors.

113

The nurse makes a medication error. The nurse manager determines the error was based on a common misinterpretation of which abbreviation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. IU SQ Q.O.D. U mcg Answer: 1, 2, 3, 4 Explanation: This is the abbreviation for international unit but can be mistaken for IV or 10. The prescriber should write out "international unit." This is the abbreviation for subcutaneous but can be mistaken for 5q or 5 every. The prescriber should write out "subcutaneous." This is the abbreviation for every other day but can be mistaken for every day or four times a day. The prescriber should write out "every other day." This is the abbreviation for unit but can be mistaken for 4. The prescriber should write out "unit." Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.9 Apply quality improvement processes to effectively implement patient safety initiatives and monitor performance measures, including nurse-sensitive indicators in the microsystem of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-6 Develop a list of strategies that the nurse can implement in practice to reduce medication errors.

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The nurse has returned from an in-service in which "high-alert" drugs were discussed. For which drugs should the nurse be particularly alert? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. IV epinephrine Heparin Digoxin IV morphine Oral propranolol Answer: 1, 2, 3, 4 Explanation: An incorrect dose of IV epinephrine can result in a dangerous dysrhythmia. An incorrect dose of heparin can cause a client to hemorrhage. Digoxin has a narrow therapeutic range and is considered a high-alert drug. An incorrect dose of IV morphine can stop a client's respirations, resulting in death. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.11 Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in the development and initiation of effective plans for the microsystem and/or system-wide practice improvements that will improve the quality of healthcare delivery | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-9 Identify strategies that healthcare agencies use to prevent medication errors.

115

A client newly diagnosed with diabetes mellitus is being prepared for discharge. The nurse knows discharge teaching on how to reduce the risk of at-home medication errors is successful when the client makes which statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "I know all about my new medications, including their names, what they do, and how to take them." "I know what side effects need to be reported immediately to my doctor." "I have a list of all my medications right here in my wallet." "I know I can call any time I have a question about any of my medications." "First thing in the morning, I will take all my prescriptions to the pharmacy to make sure they are safe for me to take." Answer: 1, 2, 3, 4 Explanation: Clients should know each medication's name, what it is for, what it does, and how to take it. It is important for clients to know what adverse effects need to be immediately reported. Clients should carry a list of all medications for quick reference or in case of an unexpected hospital or clinic visit. Clients should be encouraged to call and ask any questions. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-8 Design patient teaching information that can be used to reduce medication errors.

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The nurse prepares to administer medications to clients on the orthopedic unit. Which outcomes will result from following the unit's rules, policies, and procedures? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Minimizing medication errors Positively verifying client identification prior to medication administration Guiding accurate documentation Holding nurses accountable for medication errors Determining which medication errors are preventable Answer: 1, 2, 3 Explanation: Facility rules, policies, and procedures are in place to minimize medication errors. Facility rules, policies, and procedures are in place to ensure that positive client identification occurs prior to medication administration. Facility rules, policies, and procedures ensure accurate documentation. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.5 Participate in quality and patient safety initiatives, recognizing that these are complex system issues, which involve individuals, families, groups, communities, populations and other members of the healthcare team | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-5 Explain how rules, policies, and procedures can help prevent medication errors. The nurse receives a verbal order for subcutaneous insulin but gives the insulin IV instead to a client in the intensive care unit (ICU). Which medication errors have been committed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Medication based on verbal order Wrong route for medication Stressful workplace Illegible medication order Failure to review diagnostic lab work Answer: 1, 2 Explanation: Medication orders must be written prior to administration. The wrong route was used because the verbal order was misunderstood. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-3 Using specific examples, analyze major types of medication errors and how they can be prevented. 117

The nurse in the emergency department administers an adult dose of an antibiotic to a 3-month-old baby. As a result, the baby suffers permanent brain damage. What are the likely ramifications of this error? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. The reputation of the healthcare facility will suffer. The healthcare facility may pay high legal fees and a large settlement. The morale of the staff will be adversely affected. The nurse will lose the professional license to practice and can never practice again. The healthcare facility will lose its accreditation and may be closed. Answer: 1, 2, 3 Explanation: If this error is made public, the reputation of the facility may suffer. If the family sues, the facility's legal fees and settlement conditions could be significant. An error of this nature may result in self-doubt and loss of morale. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: II.A.2 Describe scopes of practice and roles of healthcare team members | AACN Essential Competencies: II.2 Demonstrate leadership and communication skills to effectively implement patient safety and quality improvement initiatives within the context of the interprofessional team | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-2 Describe the potential impact of a medication error on all aspects of healthcare delivery, including patients, nurses, and healthcare agencies.

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A nurse is preparing to discharge a client from an acute care setting. The nurse reviews withthe client the list of medications the client was receiving during the hospitalization and those the client was taking prior to the hospitalization. The client asks the nurse why this is necessary. Which is the nurse's best response? "The hospital requires all nurses to review medications with the clients near the end of the hospitalization." "The discussion ensures that the client is aware of medications received during the hospitalization." "The process helps to identify any duplicate medication or incorrect dosages prior to the client being discharged." "Registered nurses are mandated by law to review all medications administered for insurance coverage." Answer: 3 Explanation: The process supports managing medication information for the client after an encounter. Information regarding medications that have been discontinued, doses that have been changed, or new medications that have been added are communicated with the client. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IV.3 Apply safeguards and decision making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-7 Explain how medication reconciliation can lead to a reduction in medication errors. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 7 The Role of Complementary and Alternative Therapies in Pharmacotherapy Which activity would support the client's use of mind–body interventions and require privacy? Reading Praying Practicing aromatherapy Meditation Answer: 4 Explanation: Meditation is considered a mind–body intervention, as are massage, yoga, and biofeedback. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing 119

Process: Implementation Learning Outcome: 7-1 Identify specific types of complementary and alternative therapies that are used by patients to promote wellness. Which is an advantage to the use of complementary and alternative medicine (CAM) therapies for clients? They can reduce the need for medications. They are less expensive. They are as effective as allopathic drugs. They have fewer side effects. Answer: 1 Explanation: From a pharmacologic perspective, an advantage of CAM therapy is its ability to reduce the need for medications. Reduction of drug dosages leads to fewer adverse effects. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-1 Identify specific types of complementary and alternative therapies that are used by patients to promote wellness.

120

The nurse in a long-term care facility begins giving clients evening massages. Using complementary and alternative medicine (CAM) in this manner would have which pharmacologic benefit for the clients? A possible decreased need for antianxiety medication Fewer drug interactions Improved nurse–client communication Consistent time for client to go to sleep Answer: 1 Explanation: From the perspective of pharmacology, the value of CAM therapies is their ability to reduce the need for medications. CAM has been shown to assist with a variety of client symptoms, including anxiety. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-1 Identify specific types of complementary and alternative therapies that are used by patients to promote wellness. The nurse has noticed that more clients are asking about the use of herbal supplements to treat their symptoms. The nurse is aware that this could be related to which factor? Aggressive marketing by the herbal industry The greater safety of herbal remedies over prescription medications An increase in acute illnesses The lower cost of herbal remedies Answer: 1 Explanation: Factors contributing to the increasing popularity of herbal products include the increased availability of herbal products, aggressive marketing by the herbal industry, and renewed interest in preventive medicine and natural alternatives. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 7-2 Analyze why dietary supplements have steadily increased in popularity.

121

A healthcare provider suggests that a client drink a glass of wine each evening to help prevent heart disease. The client's religious beliefs prohibit the consumption of alcohol in any form, but the client is willing to try an herbal supplement. What formulation should the nurse suggest the client avoid? Teas Decoctions Tinctures Infusions Answer: 3 Explanation: A tincture is prepared by soaking an herb in alcohol. Alcohol remains in the final product. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-3 Explain why it is important to standardize herbal products based on specific active ingredients. Which pharmacologic information about plants is most important for a client who plans to collect plants for herbal therapy? The active chemicals are found in the roots only. The active chemicals could be in one part or all parts of the plant. Most herbal plants contain only one active chemical. The strength of the active chemicals in a given plant is standard throughout the country. Answer: 2 Explanation: The pharmacologically active chemicals in an herbal product could be produced in only one specific part of the plant or in all of its parts. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-3 Explain why it is important to standardize herbal products based on specific active ingredients.

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A client interested in herbal supplements expresses concern that they could be dangerous. The nurse explains that herbal products are regulated by the Dietary Supplement Health and Education Act (DSHEA). What is a major strength of this legislation? The manufacturer is required to prove the product is safe for the general public. The Food and Drug Administration (FDA) has the power to remove any product from the market that poses a threat to the public. Herbal products must be tested prior to manufacturing. Manufacturers must prove the efficacy of each product. Answer: 2 Explanation: The DSHEA gives the FDA the authority to remove any product from the market that poses a significant or unreasonable risk to the public. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: V.1 Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-4 Describe legislation that governs the use of dietary supplements. What is a legal requirement of the Dietary Supplement Health and Education Act (DSHEA)? The herbal product must contain only one active ingredient, which is displayed on the bottle. Dietary supplements must state that the product is not intended to diagnose, treat, cure, or prevent any disease. Efficacy must be demonstrated by the manufacturer by randomized clinical trials. The product must contain the ingredients listed in the amounts claimed. Answer: 2 Explanation: These statements are required on the label of dietary supplements. Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: V.1 Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 7-4 Describe legislation that governs the use of dietary supplements.

123

The Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2007 represented an update of the Dietary Supplement Health and Education Act (DSHEA) of 1994. What was required in the marketing of dietary supplements as a result of this act? Testing the safety of the supplements Notifying the FDA of serious adverse events reported by consumers Stating which conditions the product is designed to treat Carrying a USP verification mark on labels Answer: 2 Explanation: Companies must report to the FDA serious adverse events resulting in death, life-threatening experience, disability, birth defect, or hospital admission. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: V.1 Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-4 Describe legislation that governs the use of dietary supplements. A client with a history of depression is taking cyclosporine to prevent organ rejection. However, recent tests indicate the medication is losing effectiveness. The nurse should ask if theclient is taking which herbal supplement? Flaxseed Saw palmetto St. John's wort Black cohosh Answer: 3 Explanation: St. John's wort is commonly used to treat depression. It can decrease cyclosporine levels, resulting in decreased protection for the transplanted organ. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 7-6 Distinguish between an herbal product and a specialty supplement.

124

The nurse obtains information during the admission interview that a client is taking herbal product. What implications does this information have for the client's treatment? This is not important, because herbal products are natural and pose little risk to the client. The nurse must observe the client for allergic reactions. The herbal products could interact with prescribed medications and affect drug action. These products are a welcome adjunct to conventional treatment. Answer: 3 Explanation: Some herbal products contain ingredients that can serve as agonists or antagonists to prescription drugs and should not be taken without discussion with the healthcare provider. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 7-5 Describe drug interactions and adverse effects that may be caused by dietary supplements. A client is admitted with abnormal liver enzymes. Included in the client's medication list are amiodarone and echinacea. Which nursing action takes the highest priority? Prepare the client for a liver biopsy. Document the findings. Notify the healthcare provider. Palpate for hepatomegaly. Answer: 3 Explanation: The combination of amiodarone and echinacea can cause severe hepatotoxicity. The most appropriate action for the nurse would be to notify the healthcare provider so that appropriate assessment and treatment can be initiated. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-5 Describe drug interactions and adverse effects that may be caused by dietary supplements.

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What is a benefit of adding dietary supplements to an older adult's treatment plan? Increased effectiveness of prescribed drugs An inexpensive alternative to traditional medicines Possible prevention of nutritional deficits Prevention of Alzheimer's disease Answer: 3 Explanation: Nutritional deficiencies greatly increase with age, and supplements help to prevent or eliminate these deficiencies. Some research has shown that older adults who have low levels of folate and vitamin B12 have an increased risk of developing Alzheimer's disease. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-7 Discuss the role of the nurse in teaching patients about complementary and alternative therapies. The nurse is advising a client about the proper use of herbal and dietary supplements. What isthe responsibility of the nurse in recommending herbal products? The nurse should advise the client to seek information on herbal products from a practitioner of alternative medicine rather than a healthcare provider, because the healthcare provider has no knowledge of these products. The nurse should be aware of the latest medical information on herbal products, including interactions and side effects. The nurse should seek to dissuade the client from using them, because they are not "scientific." The nurse should say that clients can trust the labeling on herbal products because the U.S. government tests them rigorously before they are marketed. Answer: 2 Explanation: Nurses need to be informed about the advantages and limitations of using herbal products in order to educate their clients, who then can make informed decisions regarding their usage. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-7 Discuss the role of the nurse in teaching patients about complementary and alternative therapies.

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A male client states that he has been using the herbal product saw palmetto. Which assessment finding would indicate that the product is helpful? A decrease in the frequency of headaches Less burning and pain with urination The ability to fall asleep quickly Less difficulty initiating urination Answer: 4 Explanation: Saw palmetto is used to relieve urinary problems related to prostate enlargement. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 7-7 Discuss the role of the nurse in teaching patients about complementary and alternative therapies. A client receiving warfarin (Coumadin) therapy is also using the herb feverfew. For what doesthe nurse assesses? Kidney dysfunction Increased coagulation Liver toxicity Increased bleeding potential Answer: 4 Explanation: Feverfew interacts with aspirin, heparin, NSAIDs, and warfarin and can cause increased bleeding. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 7-5 Describe drug interactions and adverse effects that may be caused by dietary supplements.

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A client with Parkinson's disease is admitted to the emergency department with increased tremors and muscle rigidity. Which herbal supplement would the nurse expect to find on the client's medication list? Saw palmetto Garlic Kava kava Ginkgo Answer: 3 Explanation: Kava kava can worsen Parkinson's symptoms. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 7-5 Describe drug interactions and adverse effects that may be caused by dietary supplements. Although attempts are being made to standardize the flavones in ginkgo, the nurse is aware this product can still be particularly dangerous for which clients? Those using a generic brand of the herbal product Those who are taking anticoagulant drugs Clients who have never taken the herb Clients who are of African American ethnicity Answer: 2 Explanation: Ginkgo can cause increased bleeding time in clients, increasing the risk of hemorrhage. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 7-5 Describe drug interactions and adverse effects that may be caused by dietary supplements.

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The client states that an herbal supplement is "better" because it is standardized. What is the nurse's best response regarding standardization? It determines which products were tested for their efficacy. It shows which supplements underwent clinical trials. It allows for a comparison of potency among herbal products. It indicates which products are FDA approved. Answer: 3 Explanation: Standardization uses a marker substance, such as a percentage of an herb's active ingredient, to quantify a product's potency. This can allow for strength comparisons among available products, but it does not address efficacy or safety. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: V.1 Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-3 Explain why it is important to standardize herbal products based on specific active ingredients. The client asks the nurse how to compare the strengths of different brands of an herbal supplement. Which response by the nurse is the most appropriate? "Look for a label with an NSF or United States Pharmacopoeia (USP) certification, which indicates that the strength of the herb has been quantified." "There is no way to compare the strengths of any herbal products in the United States." "If the supplement is standardized, you can compare the amount of active ingredient in different products." "There is no need to check strengths. All products in the United States are standardized." Answer: 3 Explanation: The active ingredient in some herbal supplements is standardized. Standardization uses a marker substance, such as a percentage of an herb's active ingredient, to quantify a product's potency. This can allow for strength comparisons among available products. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: V.1 Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-4 Describe legislation that governs the use of dietary supplements.

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A client experiencing occasional minor digestive problems asks the nurse about herbal therapy. Which herbs would the nurse recommend? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Turmeric Green tea Ginger Grape seed Stevia Answer: 1, 2, 3 Explanation: Turmeric is used to reduce indigestion and dyspepsia. Green tea is used to decrease nausea and vomiting. Ginger is used to decrease nausea. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-7 Discuss the role of the nurse in teaching patients about complementary and alternative therapies. A postmenopausal client with a history of stroke is told she cannot take female hormones because of the risk for future thromboembolic events. The client asks about other ways to manage her symptoms. Which herbs would be appropriate for the nurse to recommend to this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Soy Black cohosh Evening primrose Saw palmetto Acai Answer: 1, 2, 3 Explanation: Soy is used to alleviate postmenopausal symptoms. Black cohosh is used to alleviate postmenopausal symptoms. Evening primrose is used to alleviate postmenopausal symptoms. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-7 Discuss the role of the nurse in teaching patients about complementary and alternative therapies. 130

A client with a family history of heart disease asks the nurse to recommend herbs that decreasethe risk for heart disease. The nurse suggests the client discuss which herbs with the healthcare provider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Flaxseed Green tea Soy Milk thistle Acai Answer: 1, 2, 3 Explanation: Flaxseed is believed to reduce the risk of heart disease. Green tea is believed to increase LDL and cholesterol, which may reduce the risk for heart disease. Soy is believed to help prevent cardiovascular disease. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-7 Discuss the role of the nurse in teaching patients about complementary and alternative therapies.

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A client with inflammatory arthritis asks about adding an anti-inflammatory herb to the medication regimen to decrease the use of prescription drugs. The nurse suggests the client discuss the efficacy of which herbs with the healthcare provider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Turmeric St. John's wort Ginger Ginseng Bilberry Answer: 1, 2, 3 Explanation: Turmeric is used to reduce inflammation. St John's wort is believed to reduce inflammation. Ginger is thought to reduce inflammation. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-7 Discuss the role of the nurse in teaching patients about complementary and alternative therapies.

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A client who is considering taking a dietary supplement recommended by the nurse asks howto determine whether the supplement is safe. Which requirements of the Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2007 will the nurse educate the client about? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Include their contact information on the label so consumers can report adverse effects. Notify the Food and Drug Administration (FDA) within 15 days of receiving a report of an adverse effect. Keep records of adverse effects for at least 6 years and make these records available for inspection by the Food and Drug Administration (FDA). Demonstrate product effectiveness prior to release of the product to the public. State which conditions the product is intended to cure or prevent. Answer: 1, 2, 3 Explanation: This legislation requires that the marketing company's contact information be listed on the label. The marketing company must notify the FDA of any reported adverse effects within 15 days. The marketing company must keep records of reported adverse effects for at least 6 years and make those records available to the FDA for inspection. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: V.1 Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-4 Describe legislation that governs the use of dietary supplements.

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The nurse is teaching clients in a senior center about complementary and alternative therapies. Which statements by a client indicate understanding of the information the nurse has presented? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "I see now that 'natural' doesn't really mean 'safe,' and I should ask my healthcare provider about any supplements I want to take." "I didn't realize that some herbal supplements may be just as strong as a prescription drug. I will need to discuss any supplements I want to try with my doctor." "I understand now that when I choose to use a natural product over a prescription medication, I could be delaying my recovery." "It's good to know that herbs contain ingredients that are as powerful as a prescribed medication and are an option for safe and effective therapy." "I'm allergic to many foods. It's good to know that because herbal products are natural, I don't have to worry about an allergic reaction." Answer: 1, 2, 3 Explanation: Many herbal products are not standardized and may contain dozens of active chemicals, many of which have not been identified and studied, making these products potentially unsafe. Some herbs contain active chemicals that are just as powerful as approved prescription medications. Anytime a client chooses to use an unproven alternative therapy instead of an established, effective medical treatment, healing may be delayed. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-7 Discuss the role of the nurse in teaching patients about complementary and alternative therapies.

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A client's spouse brings the client to the urgent care facility. The spouse is worried because the client has been very drowsy recently. After taking the client's history, the nurse determines that the combination of prescribed benzodiazepine and which herbs may be causing the drowsiness? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. St. John's wort Kava Valerian Ginkgo Soy Answer: 1, 2, 3 Explanation: St. John's wort causes relaxation and may result in excessive sedation if taken with a benzodiazepine. Kava causes relaxation and may result in excessive sedation if taken with a benzodiazepine. Valerian causes relaxation and may result in excessive sedation if taken with a benzodiazepine. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 7-5 Describe drug interactions and adverse effects that may be caused by dietary supplements.

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A client is taking warfarin (Coumadin) after experiencing a stroke. Which herbs must the nurse caution the client to avoid? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Green tea St. John's wort Soy Feverfew Ginger Answer: 1, 2, 3 Explanation: Green tea can decrease the anticoagulant effects of warfarin, increasing the risk for thromboembolic events. St. John's wort can decrease the anticoagulant effects of warfarin, increasing the risk for thrombolytic events. Soy can decrease the anticoagulant effects of warfarin, increasing the risk for thrombolytic events. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-7 Discuss the role of the nurse in teaching patients about complementary and alternative therapies.

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The discharge nurse gives a list of dangerous herb–drug interactions to a new client with diabetes who has been prescribed oral hypoglycemic drugs. Which herbal supplements should be included on this list? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Garlic Ginseng Green tea Kava Ginkgo Answer: 1, 2 Explanation: Garlic can increase the effects of medications for hypoglycemia. Ginseng can increase the effects of medications for hypoglycemia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-5 Describe drug interactions and adverse effects that may be caused by dietary supplements. The nurse is providing care to a client who would like to begin using a specialty supplement to help treat chronic insomnia. Which supplement would be appropriate to recommend to this client? Melatonin Chromium Black cohosh Evening primrose Answer: 1 Explanation: Melatonin is a specialty supplement that can be taken to reduce sleeplessness. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-6 Distinguish between an herbal product and a specialty supplement.

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The nurse has noticed that "baby boomer" clients are asking about the use of herbal supplements to treat their symptoms. The nurse is aware that this could be related to which factor? A lack of forceful marketing by the herbal industry A renewed interest in natural alternatives Confusion regarding herbal effectiveness The safety and lower cost of herbal remedies Answer: 2 Explanation: One contributing factor to the increasing popularity of herbal products by baby boomers is a renewed interest in preventive medicine and natural alternatives. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 7-2 Analyze why dietary supplements have steadily increased in popularity. The client asks the nurse the difference between a specialty supplement and an herbal supplement. Which is the nurse's best response? "A specialty supplement complements a specific function of the body." "Herbal supplements cure chronic conditions." "Herbal supplements are used to target acute conditions." "A specialty supplement is for general use." Answer: 1 Explanation: A specialty supplement enhances or complements a specific function of the body. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Practice: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7-6 Distinguish between an herbal product and a specialty supplement. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 8 Pharmacotherapy During Pregnancy and Lactation When possible, drug therapy is postponed until after pregnancy and lactation. Which acute and chronic conditions must be managed during pregnancy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Epilepsy Serious cystic acne Sexually transmitted infections Gestational diabetes Hypertension 138

Answer: 1, 3, 4, 5 Explanation: Epilepsy is a preexisting disease. It would not be wise to discontinue therapy during pregnancy and lactation. Sexually transmitted infections can harm the fetus. Gestational diabetes is a complication related to pregnancy that must be treated for the safety of both the mother and growing fetus. If hypertension is present prior to pregnancy, it would be unwise to discontinue therapy during pregnancy and lactation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.6 Use information and communication technologies in preventive care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-1 Discuss the rationale for using drugs during pregnancy and lactation. A pregnant client tells the nurse that her prescribed medication is not as effective as it was before her pregnancy. Which response by the nurse is the most appropriate? "This is because your blood volume has increased." "This is because high estrogen levels increase stomach acid, which may decrease absorption." "Maybe the medication has expired; check the label." "Tell me how you have been taking your medication." Answer: 2 Explanation: High estrogen levels can increase hydrochloric acid in the stomach, which can affect the absorption of some medications. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.11 Provide nursing care based on evidence that contributes to safe and high quality patient outcomes within healthcare Microsystems | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-2 Describe physiologic changes during pregnancy that may affect the absorption, distribution, metabolism, and excretion of drugs. The nurse knows that pregnancy affects the absorption, distribution, metabolism, and excretionof drugs. Which one is the least affected by pregnancy? Distribution Metabolism Excretion Absorption Answer: 2 Explanation: Metabolism is the least affected by pregnancy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and 139

processes | AACN Essential Competencies: IX.11 Provide nursing care based on evidence that contributes to safe and high quality patient outcomes within healthcare Microsystems | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-2 Describe physiologic changes during pregnancy that may affect the absorption, distribution, metabolism, and excretion of drugs. During a class about the use of medications during pregnancy, the nurse determines that additional information is required when a client makes which statement? "Exposure to some medications can result in my baby's death or in malformations." "The baby can only be harmed by medication during the first trimester." "If I breastfeed my baby, drugs can come through my breast milk." "It is important not to take over-the-counter (OTC) drugs during my pregnancy." Answer: 2 Explanation: Teratogens can affect different body systems at different times during the pregnancy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 8-3 Describe the placental transfer of drugs from mother to infant.

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The nurse educator is explaining the factors that impact the transfer of medications across the placenta. Which factor would be responsible for higher concentrations of a drug being transferred to the fetus through the placenta? Low degree of metabolic activity of the placenta Increased blood flow to the placenta Plasma drug level in the mother Increased blood volume of the mother Answer: 3 Explanation: Higher concentrations of drugs in the maternal blood lead to higher levels of circulating drug to the placenta. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-3 Describe the placental transfer of drugs from mother to infant. Student nurses are learning about the Food and Drug Administration (FDA) pregnancy categories. What is the best information for the nurse educator to include in the lecture? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. FDA pregnancy categories for individual drugs seldom change once they are established. FDA pregnancy categories are based on clinical human studies. FDA pregnancy categories provide a framework for safe use of drugs in pregnant women. FDA pregnancy category X has been associated with teratogenic effects. FDA pregnancy category C is safe to use during pregnancy. Answer: 3, 4 Explanation: FDA pregnancy categories provide a guideline for prescribers to help them choose the least teratogenic drug possible. FDA pregnancy category X medications should never be given during pregnancy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: V.7 Examine the roles and responsibilities of the regulatory agencies and their effect on patient care quality, workplace safety and the scope of nursing and other health professionals' practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-4 Differentiate among the U.S. Food and Drug Administration pregnancy risk categories.

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What should the nurse educator teach as a common reason for difficulty in assessing for side effects of medications during pregnancy? The mother is so uncomfortable with the pregnancy that she chooses to ignore the adverse effects. Adverse effects of medications are not experienced as often with pregnant women. Adverse effects of medications are often similar to common discomforts of pregnancy. The mother has increased blood volume, so the drugs are not strong enough to produce side effects. Answer: 3 Explanation: Nausea, vomiting, abdominal cramps, flushed skin, and diaphoresis are also normal symptoms in pregnancy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-8 Outline important points in patient and family education regarding drug use during pregnancy and lactation. The nurse is teaching a prenatal class for mothers with a past history of drug abuse. Which factor would the nurse need to emphasize about the first trimester of pregnancy? There is very little chance of the fetus being affected by teratogens during this phase. Teratogenic agents taken during this phase can lead to structural malformation and spontaneous abortion. This is the preconceptional period of the pregnancy. Teratogenic agents during this phase do not cause severe malformations in the fetus. Answer: 2 Explanation: In this phase, all the body systems form. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-5 Explain how drugs administered during the different stages of fetal development affect the potential for teratogenic effects.

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The nurse tells the expectant mothers during their last prenatal class that their fetus might receive a larger dose of a drug in the later period of their pregnancy. Which processes in the mother's body systems are responsible for this action? Blood flow to placenta increases, and placental vascular membranes become thicker. Blood flow to placenta decreases, and placental vascular membranes become thicker. Blood flow to placenta increases, and placental vascular membranes become thinner. Blood flow to placenta decreases, and placental vascular membranes become thinner. Answer: 3 Explanation: Blood flow to the placenta increases, and placental vascular membranes become thinner, allowing for more substances to be transferred through the placenta. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-5 Explain how drugs administered during the different stages of fetal development affect the potential for teratogenic effects. The pregnant client plans to breastfeed her baby. She asks the nurse about the use of herbal products during breastfeeding. Which response by the nurse is the most appropriate? "That should be fine as long as at least 12 hours pass between the time you use the product and when you breastfeed." "Most drugs can be transferred to the infant during breastfeeding, so this is not recommended." "Herbal products are considered natural, so it should be fine to use them during breastfeeding." "Be sure to check the label to see whether the herbal product can be used during breastfeeding." Answer: 2 Explanation: The majority of drugs are secreted into breast milk to some extent. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-6 Identify factors that influence the transfer of drugs into breast milk.

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The nurse teaching a parenting class would stress what information about adverse drug reactions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Common drug effects seen in breastfeeding infants include diarrhea and irritability. The concentration of drugs in breast milk is very high. Effects on the infant can be very serious. There is rarely any effect on the infant. The concentration of drugs in breast milk is very low but may still result in adverse drug effectsin an infant. Answer: 1, 3, 5 Explanation: Common drug effects in breastfed infants include diarrhea, constipation, sedation, and irritability. The effects can be very serious depending on the drug ingested. Even a low drug concentration in breast milk can cause very serious effects to the infant. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-7 Describe signs of adverse drug reactions in the breastfeeding infant. The nurse is teaching a prenatal class for mothers with a past history of drug abuse. Which fact about the use of drugs with a breastfeeding infant would the nurse need to emphasize? The infant might experience withdrawal symptoms and test positive for the drug for several hours following exposure. The infant will not experience withdrawal symptoms and will not test positive for the drug following exposure. The infant might experience withdrawal symptoms and test positive for the drug for several days following exposure. The infant might experience withdrawal symptoms and test positive for the drug for several weeks to months following exposure. Answer: 4 Explanation: The infant could experience withdrawal symptoms and test positive for the drug for several weeks to months following exposure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-8 Outline important points in patient and family education regarding drug use during pregnancy and lactation. 144

The nurse is preparing a teaching plan for an adolescent postpartum mother. Which topic willthe nurse include in the teaching plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Most medications are secreted into breast milk. The new mother's insulin will not be secreted into her breast milk. Over-the-counter (OTC) drugs and herbal products are secreted into breast milk and have the potential to cause harm to the infant. Topical medications must be avoided as these also are secreted into breast milk. Most drugs are safe to take right after breastfeeding because they have not reached the bloodstream yet. Answer: 1, 2, 3 Explanation: The majority of drugs are secreted into breast milk. Insulin molecules are too large to be secreted into breast milk. OTC drugs and herbal products can be secreted into breast milk and have the potential to harm the infant. All products should be approved by the provider prior to use. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-8 Outline important points in patient and family education regarding drug use during pregnancy and lactation.

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The nurse is planning care for a pregnant client prone to substance abuse. When the client states, "My baby isn't getting my drugs; I am," which response by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "Most illicit drugs will cross the placenta and hurt the baby." "Even drugs that do not cross the placenta can hurt your baby by preventing nutrients from getting across the placenta." "Research shows taking drugs can cause your baby to be born too early." "You are correct. You are far enough along in your pregnancy that drugs will not harm your baby." "If you continue to take drugs, it will make you have a very irritable infant." Answer: 1, 2, 3 Explanation: Most illicit drugs cross the placenta and can cause premature birth, low birth weight, birth defects, and withdrawal symptoms. Certain drugs can cause constriction of placental blood vessels, resulting in decreased nutrient exchange. Most illicit drugs cross the placenta and can cause premature birth, low birth weight, birth defects, and withdrawal symptoms. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-6 Identify factors that influence the transfer of drugs into breast milk.

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A pregnant client suspected of drug abuse is admitted to the emergency department. The nurse plans to teach the client about which complications associated with drug use during pregnancy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Preterm birth Low birth weight Birth defects Allergies to narcotics Increased labor Answer: 1, 2, 3 Explanation: Many illicit drugs can cause preterm birth. Many illicit drugs can cause low birth weight. Many illicit drugs can cause birth defects. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-8 Outline important points in patient and family education regarding drug use during pregnancy and lactation. For which client would the nurse expect the healthcare provider to continue prescribed medications during pregnancy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. The client recently diagnosed with gonorrhea The client with a history of frequent asthma attacks The client with hypertension The client with frequent insomnia The client with a family history of stroke Answer: 1, 2, 3 Explanation: Sexually transmitted infections are treated during pregnancy. Asthma is treated during pregnancy. Hypertension is treated during pregnancy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.6 Use information and communication technologies in preventive care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-1 Discuss the rationale for using drugs during pregnancy and lactation. The clinic nurse will immediately alert the healthcare provider when which category X drugs 147

are identified on a recently diagnosed pregnant client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Tetracycline ACE inhibitor antihypertensive medication Methotrexate Isotretinoin (Accutane) Oral contraceptives Answer: 3, 4, 5 Explanation: Methotrexate is in category X and should be avoided during pregnancy. Isotretinoin is in category X and should be avoided during pregnancy. Oral contraceptives are in category X and should be avoided during pregnancy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: V.7 Examine the roles and responsibilities of the regulatory agencies and their effect on patient care quality, workplace safety and the scope of nursing and other health professionals' practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 8-4 Differentiate among the U.S. Food and Drug Administration pregnancy risk categories.

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A client admitted to the emergency department for vaginal bleeding is surprised to find she isin the third trimester of pregnancy. An ultrasound determines the fetus is not viable. The nurse recognizes that which drug could be responsible for the fetal demise? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Selective serotonin reuptake inhibitors (SSRIs) Fluoroquinolone Acetaminophen Nonsteroidal anti-inflammatory drugs (NSAIDs) Angiotensin-converting enzyme (ACE) inhibitor Answer: 4, 5 Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause fetal demise in the third trimester. ACE inhibitors are category D and can cause fetal demise. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: V.7 Examine the roles and responsibilities of the regulatory agencies and their effect on patient care quality, workplace safety and the scope of nursing and other health professionals' practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-4 Differentiate among the U.S. Food and Drug Administration pregnancy risk categories. The nurse recognizes that which physiologic change during pregnancy can alter absorption of medication? Decreased levels of progesterone cause a decrease in gastric tone and intestinal motility. High estrogen levels cause decreased hydrochloric acid production, which may affect the absorption of certain acid-labile drugs. An enlarging uterus presses against the stomach, resulting in increased gastric emptying. Increased levels of progesterone increase pulmonary blood flow, resulting in higher serum levels for respiratory drugs. Answer: 4 Explanation: Increased levels of progesterone increase pulmonary blood flow, resulting in higher serum levels for respiratory drugs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.11 Provide nursing care based on evidence that contributes to safe and high quality patient outcomes within healthcare Microsystems | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-2 Describe physiologic changes during pregnancy that may affect the absorption, distribution, metabolism, and excretion of drugs.

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The nurse teaching a parenting class would stress what information about adverse drug reactions in the breastfeeding infant? Common drug effects seen in breastfeeding infants include diarrhea and irritability. Topical medications are safe to use during lactation. Occasional alcohol use by the mother is safe for the breastfed infant. Sedation is rarely a drug effect in breastfed infants. Answer: 2 Explanation: Generally, topical medications are safe to use during lactation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8-7 Describe signs of adverse drug reactions in the breastfeeding infant. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 9 Pharmacotherapy of the Pediatric Patient In 1997, the Food and Drug Administration Modernization Act was passed. What was the rationale for this legislation? To prove that all adult medications are safe for children To improve testing and labeling of pediatric drugs To encourage the production of more pediatric drugs To generate higher profits for pharmaceutical companies marketing pediatric drugs Answer: 2 Explanation: The Food and Drug Administration Modernization Act was passed to improve testing and labeling of pediatric drugs. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: V.1 Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-1 Identify the purposes of the Food and Drug Administration Modernization Act of 1997, the Best Pharmaceuticals for Children Act of 2002, and the Pediatric Research Equity Act of 2003. The FDA Modernization Act contained several flaws, which led to the passage of the Best Pharmaceuticals for Children Act in 2002. What was the major flaw in the modernization act? Profits for studying off-patent drugs were higher. Congress controlled the choice of drugs that the pharmaceutical companies were allowed to study. Drugs were chosen for research based on their potential value for children. Drugs were chosen for research based on their financial benefits to the pharmaceutical 150

companies. Answer: 4 Explanation: Most of the drugs studied were in adult drug classes. The main rationale for the pharmaceutical companies' choice of drugs for the studies was financial. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: V.1 Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-1 Identify the purposes of the Food and Drug Administration Modernization Act of 1997, the Best Pharmaceuticals for Children Act of 2002, and the Pediatric Research Equity Act of 2003. Which factor would lead to the dilution of the drug furosemide (Lasix) in the newborn? The higher proportion of fat to water dilutes water-soluble drugs. There is no dilution of the drug in pediatric clients. The lower proportion of water to fat dilutes water-soluble drugs. The higher proportion of water to fat dilutes water-soluble drugs. Answer: 4 Explanation: The newborn's weight is 80% water. The high proportion of water to fat dilutes water-soluble drugs. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 9-2 Explain how differences in pharmacokinetic variables can impact drug response in pediatric patients. An infant recently prescribed the anti-infective gentamicin is brought to the emergency department with oliguria, hematuria, cloudy urine, and fever. Which diagnosis would the nurse anticipate for this infant based on the assessment findings? Respiratory distress syndrome Gasping syndrome Nephrotoxicity Neurotoxicity Answer: 3 Explanation: Nephrotoxicity is the diagnosis the nurse would anticipate because of the infant's immature renal system and inability to excrete drugs adequately. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and 151

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The nurse plans to teach a safety class to parents of toddlers about household exposure to medications. Which information would be included in an effective teaching plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Poisoning is extremely common during the toddler years. Vitamins are not medications and, therefore, are not toxic. All medications should be locked up or stored out of reach of the toddler. Prescription drugs for children come in flavored elixirs and can be mistaken for candy. Toddlers put everything in their mouths, including topical medications. Answer: 1, 3, 4, 5 Explanation: Toddlers are curious; they explore and want to try new things. All medications and toxic substances should be locked up or stored out of reach of the child. Parents should never refer to medication as candy, to prevent toddlers from ingesting the medication on their own. Topical medications can be poisonous if ingested and should be kept out of the child's reach. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 9-3 Discuss the nursing and pharmacologic implications associated with each of the pediatric developmental age groups. The nurse plans to administer medication to a preschool-age child. Which approach indicates the nurse has an understanding of growth and development? The child will be more cooperative if the parent is not in the room. A brief explanation, followed by quick administration of the medication, is best. There should be no need to restrain a child this age. The child will do better with verbal instruction than play instruction. Answer: 2 Explanation: Children this age have a limited ability to reason to understand the relationship of health to medicines. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-3 Discuss the nursing and pharmacologic implications associated with each of the pediatric developmental age groups.

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The nurse plans to administer medication to a 6-month-old infant based on which understanding? The gluteal site is the preferred site for intramuscular (IM) administration of medication. The dosage should be based on milligrams per kilogram weight per day. Oral medications are the preferred route due to fewer side effects. Medications should be calculated based on the infant's age. Answer: 2 Explanation: The dosage should be based on milligrams per kilogram weight per day. This is one of the most accurate methods of calculating medication dosages at this age. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.1 Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as, work-arounds and dangerous abbreviations) | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-4 Describe safe methods and techniques appropriate for administering medications to pediatric patients. It is important that the nurse understand that the safety and effectiveness of a medication regimen depend on which factors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Proper procurement Proper administration of the drug Protection of the healthcare provider from liability Proper storage of the medication Protection of the nurse from liability Answer: 1, 2, 4 Explanation: The correct medication and dosage must be obtained. Proper administration of the drug is the last step in the process, and the whole process contributes to this step. Proper storage is very important. Medications react to the environment. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.1 Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as, work-arounds and dangerous abbreviations) | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-4 Describe safe methods and techniques appropriate for administering medications to pediatric patients.

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The nurse is following the guidelines established by the American Academy of Pediatrics (2007) when administering medications to pediatric patients. Which nursing action is included inthe guidelines? Confirm the client's identity before administering the first dose of the shift. Remember that all medication ordering and dispensing systems are the same in all facilities. Check medication calculations with another professional. Verify drug orders after medication administration. Answer: 3 Explanation: The nurse should always have another professional check calculations. Anyone can make a mathematical error. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.1 Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as, work-arounds and dangerous abbreviations) | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-4 Describe safe methods and techniques appropriate for administering medications to pediatric patients. The nurse is calculating the medication dose for a 4-year-old child by plotting the child's height and weight on a nomogram, then drawing a line between the two points. The point at which the line intersects the surface area line is the child's BSA. The dose is calculated using the BSA. What does this calculation represent? Body weight method Age–weight method Pharmacokinetic method Body surface area method Answer: 4 Explanation: The body surface area is the correct formula. It accounts for the pharmacokinetic differences in pediatric medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-5 Explain several methods for accurately calculating drug doses in pediatric patients.

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The pediatric nurse is aware that a child might experience the same adverse effects to a medication as an adult. For what class of medication could this reaction occur, and what reaction would the nurse anticipate? Antianxiety; diarrhea Antidepressants; diarrhea Antipsychotics; CNS depression Antibiotics; CNS depression Answer: 3 Explanation: CNS depression is the typical adverse reaction to antipsychotics. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-6 Describe nursing interventions for minimizing adverse effects during pediatric pharmacotherapy. The nurse is providing discharge instructions to a child and the family. To promote medication adherence, the nurse facilitates which conditions? Minimal nursing guidance Minimal adverse effects from the medications A complex, expensive medication regimen Low expectations for a successful outcome Answer: 2 Explanation: Minimal adverse effects from the medications are always the desired outcome. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-7 Propose appropriate teaching strategies to enhance medication adherence in pediatric patients.

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The emergency department nurse is preparing for the arrival of a 3-year-old with suspected drug overdose. Which medications are most likely to be the cause of the overdose? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Analgesics Cough syrup Topical ointments Vitamins Oral antibiotics Answer: 1, 2, 3, 4 Explanation: Analgesics are among the most common poisonous drugs children younger than 6 years are exposed to. Cough and cold preparations are among the most common poisonous drugs children younger than 6 years are exposed to. Topical ointments are among the most common poisonous drugs children younger than 6 years are exposed to. Vitamins are among the most common poisonous drugs children younger than 6 years are exposed to. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 9-3 Discuss the nursing and pharmacologic implications associated with each of the pediatric developmental age groups.

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The nurse is teaching the mother of an infant how to properly administer medication. Which teaching points are important for this age group? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Cuddle the infant while administering medications. Deposit oral medication into the cheek area of the infant's mouth. Hold the buttocks closed for 5 to 10 minutes after administering a rectal suppository. Administer oral medications as quickly as possible before the infant can resist. Use a household teaspoon for oral medications. Answer: 1, 2, 3 Explanation: Cuddling the child will encourage the infant to take the medication. Directing oral medication to the inner cheek of the mouth will decrease the risk of aspiration. Holding the buttocks closed helps prevent expulsion of the drug before absorption occurs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-3 Discuss the nursing and pharmacologic implications associated with each of the pediatric developmental age groups. The nurse is teaching a toddler's mother strategies for administering prescribed oral antibiotics. Which strategies will be discussed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Mix unpleasant-tasting medications in appetizing food such as jam or syrup. Ask the pharmacist to put the medication into sweet syrup, if possible. Physically comfort or praise the toddler following medication administration. Put any liquid medication into the toddler's milk bottle to ensure it will be completely consumed. Give the child a detailed explanation regarding the need for the medication. Answer: 1, 2, 3 Explanation: Mixing unpleasant-tasting medications in appetizing foods may disguise the taste. Many pediatric medications are formulated for sweet syrups. Physical comfort and praise are important when administering medications to this age group. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-3 Discuss the nursing and pharmacologic implications associated with each of the pediatric developmental age groups. The nurse would determine that which pediatric client is experiencing an adverse effect from a 158

medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A child taking ibuprofen (Advil) for a sports injury who frequently has an upset stomach A child taking an ototoxic antibiotic who does not respond when spoken to A child taking amoxicillin for an ear infection who has diarrhea A pregnant teen taking ferrous sulfate (Feosol) who experiences headaches A teenager taking minocycline (Minocin) for acne who has a rash Answer: 1, 2, 3 Explanation: Ibuprofen can cause upset stomach if taken on an empty stomach. Several antibiotics can be toxic to the organs responsible for hearing, which may result in hearing loss. Amoxicillin can cause diarrhea. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 9-6 Describe nursing interventions for minimizing adverse effects during pediatric pharmacotherapy.

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The nurse in a pediatric clinic is preparing to give a toddler and a preschooler intramuscular (IM) antibiotics. The nurse chooses the injection sites for each child based on which considerations? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. The vastus lateralis muscle is the preferred site for IM injections in toddlers. After the child has been walking for a year, the ventrogluteal site is used for IM injections. Use of the dorsogluteal site should be avoided. The vastus lateralis muscle is the preferred site for IM injections in preschoolers. The dorsogluteal site is the preferred site for IM injections. Answer: 1, 2, 3 Explanation: The vastus lateralis muscle is the preferred site for IM injections in toddlers because there are few nerves and the muscle is well developed. After the child has been walking for a year, the ventrogluteal site is used for IM injections because it causes less pain than the vastus lateralis. Use of the dorsogluteal site has declined due to the risk of affecting the sciatic nerve. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-3 Discuss the nursing and pharmacologic implications associated with each of the pediatric developmental age groups.

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A clinic nurse is discussing an acne medication regimen with an adolescent client. Which statements by the adolescent represent common problems with adherence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "I was taking the medicine for a while, but it didn't seem to be working." "I took it the first month but my mom got busy and kept forgetting to get my refill." "I felt nauseous whenever I took the medicine." "The nurse explained everything to me so that I could understand." "I only have to take the medication once a day." Answer: 1, 2, 3 Explanation: High expectations of a successful outcome will help clients adhere to a medication regimen. If the medication does not meet these expectations, the client may stop taking it. Clients are more likely to follow a medication regimen if they have supportive family members. Clients are more likely to adhere to a medication regimen if there are minimal adverse effects. Teaching the client to take this medication with food may decrease the nausea and improve adherence. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 9-3 Discuss the nursing and pharmacologic implications associated with each of the pediatric developmental age groups.

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The nurse is providing discharge instructions to an adolescent and the family. To increase the likelihood of adherence, which questions would the nurse ask? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "This particular prescription has to be taken three times a day. Will that be difficult for you to do?" "Are you worried about the fact that you will need to take this medication while you are at school?" "This medication may give you dry mouth. Will you be allowed to suck on hard candy in schoolto help with the dry mouth?" "Because you will be on the medication for such a long time, can you make an appointment for1 year?" "Do you think your parents should watch you take the medication every day to make sure you take it as prescribed?" Answer: 1, 2, 3 Explanation: The client and the parents should be asked directly if they feel they may have difficulty adhering to the medication regimen. Taking medication may make the adolescent feel different from peers. Approaching the subject may help the adolescent discuss these fears. Discussing possible adverse effects and suggesting strategies to deal with them may increase adherence. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-7 Propose appropriate teaching strategies to enhance medication adherence in pediatric patients.

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The nurse has been assigned to the pediatric floor. Which nursing interventions indicate this nurse understands pharmacokinetic variables in children? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Monitoring diagnostic lab work for therapeutic levels of phenobarbital in a premature infant Monitoring blood sugars for hyperglycemia in an infant with eczema requiring frequent applications of topical corticosteroid cream Monitoring a 5-month-old infant taking propranolol (Inderal) for a heart defect for symptoms of toxicity Monitoring a 6-year-old taking salicylates for pain for hepatic toxicity Monitoring a 2-week-old infant taking gentamicin for severe infection for decreased blood urea nitrogen (BUN) Answer: 1, 2, 3 Explanation: Low gastric acid production may slow the absorption of weak acids such as phenobarbital. The skin of infants is thin and very permeable, allowing topical drugs to be absorbed at a rapid rate. Frequent applications of topical corticosteroid cream can cause a systemic effect of hyperglycemia. Prior to 6 months, the child's liver function is immature and produces very small amounts of plasma proteins. This could lead to toxicity with drugs requiring high levels of protein binding such as propranolol (Inderal). Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-2 Explain how differences in pharmacokinetic variables can impact drug response in pediatric patients.

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Which classification(s) of drugs is/are more commonly prescribed for children due to their high incidence of infectious diseases? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Respiratory drugs Systemic antibiotics Dermatologic drugs Cardiovascular drugs Musculoskeletal system drugs Answer: 1, 2, 3 Explanation: Respiratory drugs such as nasal preparations, cold and cough preparations, and antihistamines are frequently used in children. Anti-infective drugs are frequently used in children for conditions such as otitis media and upper respiratory infections. Commonly used dermatologic drugs used for children include antifungal medications, emollients for dry skin, and corticosteroids for eczema. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: V.1 Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-2 Explain how differences in pharmacokinetic variables can impact drug response in pediatric patients.

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Which factors does the nurse recognize potentially influence oral absorption of drugs in the pediatric client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Increased gastric pH Delayed gastric emptying Immature hepatic cytochrome P450 enzyme system Immaturity of the kidneys High water-to-fat proportion Answer: 1, 2 Explanation: Increased gastric pH may enhance the absorption of acid-labile drugs such as ampicillin and penicillin and slow the absorption of weak acids such as phenobarbital. Delayed gastric emptying may keep a drug in the stomach longer, increasing the absorption across the stomach mucosa but slowing the rate of drug absorption for drugs designed to be absorbed in the intestine. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 9-2 Explain how differences in pharmacokinetic variables can impact drug response in pediatric patients. The nurse is calculating the medication dose for a 4-year-old child by use of the body weight method. Which is a disadvantage of this type of drug dosage? It does not account for metabolism and elimination. It uses calculation of milligrams of drug and child's weight. It utilizes the serum concentration of the drug and the proportion of the body weight. It is not as easy to calculate as the body surface area method. Answer: 1 Explanation: It does not account for the pharmacokinetic differences in pediatric medication such as metabolism and elimination. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-5 Explain several methods for accurately calculating drug doses in pediatric patients. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 10 Pharmacotherapy of the Geriatric Patient Why is polypharmacy so prevalent in the older adult population? 165

Multiple medical problems can usually be treated with a single drug. Clients rarely see more than one prescriber. Clients might be taking multiple medications for their comorbidities. Use of over-the-counter medications is uncommon in this age group. Answer: 3 Explanation: Many comorbidities increase the likelihood of polypharmacy. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: VII.3 Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities and populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-1 Describe factors that lead to polypharmacy in older adults. Why should the nurse ask the client about all medications the client takes, including over-the-counter and herbal medications? Minimizing the cost of medications is the highest priority. They might interact with each other or with prescribed medications. Clients should not use over-the-counter or herbal medications. Use of these agents must be reported to the Food and Drug Administration. Answer: 2 Explanation: Interactions with other medications can occur with over-the-counter or herbal medications. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: VII.3 Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities and populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-1 Describe factors that lead to polypharmacy in older adults.

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A healthcare provider in a clinic writes several prescriptions for an older client. The nurse notices several medications are in the same class as drugs listed on the client's intake form. What should the nurse do next? Set the prescriptions to the side and follow up on the issue at a later date. Ask the primary healthcare provider if he was aware his client had been prescribed medicationsin the same drug class as those prescribed by the cardiologist. Throw the prescriptions away. Give them to the client. Answer: 2 Explanation: Duplication in therapy appears to be present; this needs to be clarified with the prescriber. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: VII.3 Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities and populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-1 Describe factors that lead to polypharmacy in older adults. Which of these is an age-related physiologic change that occurs in older adults? Brain mass increases. GI motility increases. The kidneys filter better and function more efficiently as a client ages. Blood flow to the liver decreases. Answer: 4 Explanation: Liver blood flow typically decreases with advancing age. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-2 Identify age-related physiologic changes in the older adult.

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A nurse notices that an older adult client has not urinated all day, despite drinking 3 liters of water. Which physiologic change is the most likely cause for this issue? Reduction in plasma protein levels Increased glomerular filtration rate Increase in body fat Renal function impairment Answer: 4 Explanation: A decline in renal function, especially if acute, would best explain why the client has not urinated. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-2 Identify age-related physiologic changes in the older adult. Why can a reduction in albumin synthesis that may occur with aging result in exaggerating the effects of a medication? Blood flow to the liver decreases. More unbound drug will be present. Pharmacodynamics will be altered. Renal elimination of the drug will be decreased. Answer: 2 Explanation: If the drug is protein bound, a decrease in albumin will result in higher concentrations of free drug and increased pharmacologic effects. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-3 Explain how age-related physiologic changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

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What is the definition of pharmacodynamics? The mechanisms by which drugs affect the body Complying with one's medication regimen as prescribed Taking multiple medications The mechanisms by which the body handles the drug Answer: 1 Explanation: Pharmacodynamics deals with how a drug affects body systems. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-3 Explain how age-related physiologic changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults. A nurse who works at a nursing home notices that a client's hearing has diminished significantly over the past couple of days. The client has been receiving gentamicin IV for an infection. Which action by the nurse is the most appropriate? Continue gentamicin IV and check the peak level in a week. Suggest checking the client's peak gentamicin level and immediately report the loss in hearing in the chart and to the healthcare provider. Tell the client that she is going to need a hearing aid. Continue gentamicin IV and suggest adding vancomycin IV to improve the ototoxicity. Answer: 2 Explanation: Gentamicin is a narrow-therapeutic-window drug that can cause ototoxicity and nephrotoxicity. A peak level can help determine the likelihood that it is the drug causing the hearing loss. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-6 Identify specific drugs that are particularly hazardous for use in older patients.

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Which strategy can nurses implement to improve drug therapy adherence in older adult clients? Discourage the use of check-off calendars because older clients do not have adequate eyesight to use them properly. Suggest the client forgo obtaining medications that are too expensive. Suggest the client use a daily or weekly pill counter. Suggest stopping any medications that do not seem to be having an effect. Answer: 3 Explanation: Daily or weekly pill counters are an effective, inexpensive way to promote adherence. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-4 Explain strategies that the nurse may implement to improve adherence with drug therapy in geriatric patients. Which evidence-based client-level factor affects nonadherence? Management of instructions by the healthcare provider Simplification of the regimen Identification of the client's social support network Belief that the treatment will be effective Answer: 4 Explanation: Belief that the treatment will be effective is a client-level factor likely to improve adherence. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-4 Explain strategies that the nurse may implement to improve adherence with drug therapy in geriatric patients.

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Why are older adults more prone to adverse drug reactions and interactions than younger adults? Presence of fewer chronic disease states More predictable pharmacokinetics and pharmacodynamics Use of fewer chronic medications Physiologic changes in body composition Answer: 4 Explanation: Physiologic changes in body composition can affect drug pharmacokinetics, increasing the risk of adverse drug reactions and interactions. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-5 Explain why older adults are more likely to experience adverse drug reactions and interactions. Which group of medications should be used cautiously, if at all, in older adult clients? Beers list Polypharmacy Washington Manual Physicians' Desk Reference Answer: 1 Explanation: Beers list or Beers criteria is the correct name for this group of medications that are usually poor choices for older clients. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-6 Identify specific drugs that are particularly hazardous for use in older patients.

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A nurse working at a clinic notices that a client is having problems reading the prescription bottles. Sometimes the client takes medications incorrectly because of difficulty reading the small print. Which suggestion by the nurse can alleviate this problem? Put the medication in a zip-top bag with the instructions written on it in large print. Ask the pharmacist to provide easy-open caps. Stop taking the medications, as they are more likely to cause problems than to help if not taken correctly. Ask the pharmacist to provide labels with large print that explain how to take the medication. Answer: 4 Explanation: Large-print labels will make the instructions easier for the client to read. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-5 Explain why older adults are more likely to experience adverse drug reactions and interactions. An older adult client comes to the emergency department with complaints of confusion. Which recently prescribed medication is most likely responsible for this assessment finding? Lansoprazole (Prevacid) Atorvastatin (Lipitor) Hydroxyzine (Atarax) Amlodipine (Norvasc) Answer: 3 Explanation: Hydroxyzine is a sedating antihistamine with significant anticholinergic effects. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-6 Identify specific drugs that are particularly hazardous for use in older patients.

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An older adult client comes in to the office with severe sunburn. When reviewing the client's medication list, which is the likely cause of the client's sunburn? Phenytoin (Dilantin) Cyclobenzaprine (Flexeril) Naproxen (Aleve) Alprazolam (Xanax) Answer: 3 Explanation: Naproxen (Aleve) can cause an increase in sensitivity to sunlight. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-6 Identify specific drugs that are particularly hazardous for use in older patients. An older adult client recently started digoxin (Lanoxin) and is in the office for a routine checkup. Lab tests show a decline in the client's renal function. Which is a priority concern for thenurse based on the lab results? Digoxin causing the decrease in renal function Digoxin interfering with the lab test, making it appear that the client's renal function has worsened Increased likelihood of toxicity due to the inability to excrete digoxin Diminished response to digoxin due to alterations in pharmacodynamics Answer: 3 Explanation: Digoxin is largely eliminated by the kidneys. Serious toxicity can occur if the dose is not adjusted after a decline in renal function. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-7 Differentiate medication responses that result from age-related alterations in specific body systems from those that occur in younger individuals.

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Which is the best description of the anatomic and physiologic changes that occur as a result of aging? They result from pathologic changes. They are reversible. They are normal and predictable. They are a potential target for drug therapy. Answer: 3 Explanation: The anatomic and physiologic changes are a normal and predictable part of aging. Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-2 Identify age-related physiologic changes in the older adult. What is the age-related change in the gastrointestinal tract that can affect medication administration? Decreased motility Reduced intestinal transit time Increased absorption of medications and nutrients Increased gastric acid production Answer: 1 Explanation: Decreased motility of the GI tract is a common change seen with aging. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 10-2 Identify age-related physiologic changes in the older adult.

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Which rationale explains why anticonvulsants and antidepressants have an exaggerated effectin older adult clients? Increased binding to plasma proteins such as albumin Increased rate of hepatic metabolism Reduced intestinal transit time Declining efficiency of the blood–brain barrier Answer: 4 Explanation: Declining efficiency of the blood–brain barrier could explain an increase in the effects of drugs that work in the brain such as anticonvulsants or antidepressants. Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 10-7 Differentiate medication responses that result from age-related alterations in specific body systems from those that occur in younger individuals. An older client asks the nurse how to avoid potential drug interactions. Which response by the nurse is the most appropriate? "Take over-the-counter medications rather than prescription ones whenever possible." "Obtain all medications from one pharmacy when possible." "Ask for free drug samples rather than getting prescriptions filled at a pharmacy." "Use memory aids such as pill reminders." Answer: 2 Explanation: Obtaining all medications from one pharmacy ensures that that pharmacy has a record of all medications. This could make it easier to catch potential interactions. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-8 Develop nursing interventions that maximize pharmacotherapeutic outcomes in older adults.

175

While providing medication education to an older adult client, which instruction by the nurseis the most appropriate? Vary the time of day that each medication is taken so that the long-term effectiveness will be preserved. Obtain information about every possible adverse effect that could possibly occur. Changes in mental status, weight, or bowel function should be reported to the prescriber. Avoid keeping a list of medication names and doses, and their purposes, because the list couldbe lost, resulting in a loss of privacy. Answer: 3 Explanation: Changes in mental status, weight, or bowel function are common signs of an adverse drug reaction in older clients. These should be promptly reported so the possibility of an adverse reaction can be evaluated. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Identify personal, professional and environmental risks that impact personal and professional choices and behaviors | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-9 Generate key points for family and patient education regarding drug pharmacotherapy for older adults. The nurse planning discharge teaching for an older client with multiple prescriptions for multiple chronic illnesses may discuss which strategies to avoid medication errors at home? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. When possible, take medications at the same time each day. Keep a written record of medications taken, including the name, dose, date, and time. Use a pill holder as a memory aid. Plan to have a family member remind the client each day to take medication. Request easy-to-open bottles so the client will not have difficulty opening the bottles. Answer: 1, 2, 3 Explanation: Setting a schedule whereby medications are taken at the same time each day may prevent clients from forgetting to take medications or forgetting if they did take their medication. Keeping a written record will help clients remember to take medications and to remember if medication has been taken. Pill holders have compartments for each day of the week and time of day. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Identify personal, professional and environmental risks that impact personal and professional choices and behaviors | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 10-9 Generate key points for family and patient education regarding drug pharmacotherapy for older adults. 176

The nurse is not surprised when a healthcare provider orders a lower than normal dose of a drug excreted by the kidneys for an older adult client because certain effects of aging cause the body to retain drugs and other substances for longer periods. Which normal effects of the aging process decrease the ability to excrete drugs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Decrease in renal blood flow Decrease in the number of functioning nephrons Decrease in the ability to excrete waste products effectively Decrease in gastric pH, causing delayed absorption Decrease of fat storage, causing delayed absorption Answer: 1, 2, 3 Explanation: Older adults have a decrease in blood flow to kidneys. This may affect excretion of drugs. Older adults have a decreased number of nephrons, resulting in a decreased number of functioning nephrons. This may affect excretion of drugs. Because of age-related changes to the kidneys, the older adult may have difficulty excreting waste products, which may affect excretion of drugs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-3 Explain how age-related physiologic changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

177

An older adult client complains to the nurse that a medication is causing significant nausea and vomiting. Which responses by the nurse are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "A normal consequence of aging is decreased blood flow to the stomach. This could result in the medication staying in your stomach longer, causing nausea and vomiting." "A normal consequence of aging is slowed emptying of stomach contents. This can cause nausea and vomiting." "A normal consequence of aging is slower absorption of medications, resulting in nausea and vomiting." "A normal consequence of aging is an increase in liver size, which can result in nausea and vomiting." "A normal consequence of aging is decreased carbohydrate metabolism, which can result in nausea and vomiting." Answer: 1, 2, 3 Explanation: Decreased blood flow to and from the stomach may delay absorption, resulting in nausea and vomiting. Slowed emptying of stomach contents may allow drugs to remain longer in the gastrointestinal tract, resulting in nausea and vomiting. When absorption time is decreased, drugs may remain longer in the stomach, resulting in nausea and vomiting. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-3 Explain how age-related physiologic changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

178

Which interventions would the nurse perform before administering the next dose of gentamicin to an older adult client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Monitor for peak and trough for toxicity. Check the healthcare provider's orders for periodic lab draws. Contact the healthcare provider if serum concentration is not within therapeutic range. Check that this drug is prescribed with short intervals between doses. Assess client for reduced cognitive function or confusion. Answer: 1, 2, 3 Explanation: Age-related changes result in a decrease in total body water in the older adult. Because gentamicin is water soluble, this could result in a higher concentration of the drug, causing toxicity. To prevent toxicity of gentamicin, periodic lab work for peak and trough must be checked. If the serum concentration is not within therapeutic range, the dose may need to be adjusted. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-3 Explain how age-related physiologic changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

179

An older adult client brought to the emergency department for bloody stools has been taking warfarin (Coumadin) post stroke. Initial diagnostic lab work reveals warfarin to be within therapeutic range. The daughter asks why the client has bloody stools if the lab work is normal. Which responses by the nurse are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "Liver function declines during the aging process." "Decreased liver function results in decreased plasma proteins." "Decreased plasma proteins result in more free drug circulating." "Decreased plasma proteins lead to more binding sites, resulting in lower concentrations of drugs such as this one." "Higher levels of this drug are able to cross the blood–brain barrier, resulting in the toxic effectsof bleeding." Answer: 1, 2, 3 Explanation: Liver function declines during the aging process. As liver function declines, so does the production of plasma proteins. As the production of plasma proteins declines, an increase in highly protein-bound drugs results in higher concentrations of free drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-3 Explain how age-related physiologic changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

180

Which clients would the nurse consider high risk for adverse drug effects related to an inefficient blood–brain barrier? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Older adult taking benzodiazepines for anxiety Older adult with a current history of seizures Older adult with a history of difficulty sleeping Older adult taking high doses of antibiotics for pneumonia Older adult with a history of emphysema Answer: 1, 2, 3 Explanation: Drugs such as benzodiazepines, antipsychotic agents, antiseizure agents, and tranquilizers can cross the blood–brain barrier in higher concentrations, resulting in adverse effects. Drugs such as benzodiazepines, antipsychotic agents, antiseizure agents, and tranquilizers can cross the blood–brain barrier in higher concentrations, resulting in adverse effects. Drugs such as benzodiazepines, antipsychotic agents, antiseizure agents, and tranquilizers can cross the blood–brain barrier in higher concentrations, resulting in adverse effects. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-3 Explain how age-related physiologic changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

181

The nurse is caring for an older adult client prescribed acetaminophen (Tylenol), as needed, for frequent headaches. What can the nurse expect? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. The client may not ask for the medication as often as younger clients. This drug may be prescribed with a longer dosing interval than normally prescribed. The healthcare provider may order a lower than normal dose. The healthcare provider will order diagnostic lab work to check creatinine clearance. The healthcare provider will need to prescribe nausea medication. Answer: 1, 2, 3 Explanation: Reduced metabolism will result in extended duration of the drug. Acetaminophen (Tylenol) has a long half-life and remains in tissues longer, resulting in toxicity. The healthcare provider may prescribe longer dosing intervals. Acetaminophen (Tylenol) has a long half-life and remains in tissues longer resulting in toxicity. The healthcare provider may prescribe a lower dose. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-3 Explain how age-related physiologic changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

182

The nurse is discharging an older adult client with a new medication. Which statements shouldbe included in discharge teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "You will be started on the lowest effective dose; it will gradually increase." "You will need to come back to the clinic in 3 to 5 days for follow-up." "Call if there are any changes in physical or emotional behavior." "It is very important that you do not get overhydrated, since that would increase the effects of the medication." "This would be a good time to commit to a low-protein diet in an effort to lose weight." Answer: 1, 2, 3 Explanation: Starting the older adult on the lowest effective dose and titrating upward will decrease the risk for toxicity. Drug accumulation in older adults often occurs 3 to 5 days after the new drug has been initiated. Consider any change in physical or emotional behavior as a possible sign of toxicity. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.7 Identify personal, professional and environmental risks that impact personal and professional choices and behaviors | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-9 Generate key points for family and patient education regarding drug pharmacotherapy for older adults.

183

Which questions would the case manager ask the older adult client to assess for risk for nonadherence to a medication regimen? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "How do you feel about the possible side effects your medication may cause?" "If we set you up with a pill holder, do you think you will be able to remember to take the medication?" "I have put large labels on the bottles; can you see the print?" "Do you feel you can afford the cost of the medication after your insurance pays its part?" "Can your daughter visit every day to give you the medication?" Answer: 1, 2, 3, 4 Explanation: Unpleasant side effects increase risk for nonadherence. Forgetfulness is a cause for nonadherence. Physical impairment such as poor vision can lead to nonadherence. Inability to purchase is a risk for nonadherence. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-8 Develop nursing interventions that maximize pharmacotherapeutic outcomes in older adults.

184

An urgent care nurse is triaging clients. Which client statements may indicate that medicationsare being misused? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "I was feeling really great so I stopped taking my antibiotic and now I feel feverish." "My retirement check didn't come in over the holiday weekend so I didn't have the money to get my antihypertension medication refilled. I just took one every other day instead of every day." "I really thought I would get better quicker if I took the medication four times a day instead of two times a day. Now, I have diarrhea." "The schedule is pretty complicated but my daughter-in-law got me a pill dispenser and that helps to keep me on schedule." "I've had to borrow the money from my daughter to get my medication, but I always seem to finda way to get it." Answer: 1, 2, 3 Explanation: Erratic use can be attributed to clients taking their medication when they feel sick and stopping the medication when feeling well. Uninsured or underinsured clients may try to make medications last longer by skipping doses or by splitting pills in half. Some clients believe taking extra doses of medication will speed recovery. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10-8 Develop nursing interventions that maximize pharmacotherapeutic outcomes in older adults.

185

The nurse is educating an older adult client on ways to decrease the risk of adverse drug reactions. Which statements will the nurse include in the teaching session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. When possible, decrease the number of prescriptions. Take medication only when necessary. Take medication as long as possible to ensure therapeutic response. Follow up as requested by the healthcare provider. Adjust doses of medication in clients with renal or hepatic impairment. Answer: 1, 2, 4, 5 Explanation: The risk of an adverse effect increases with the number of drugs taken. Take medications only when they are needed. Following up as requested by the healthcare provider will alert the provider to early symptoms of adverse effects. Doses of most drugs must be adjusted for clients with age-related renal or hepatic impairment. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-8 Develop nursing interventions that maximize pharmacotherapeutic outcomes in older adults.

186

An older adult client is being discharged with multiple new prescriptions. Which strategies could the home health nurse employ to encourage adherence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Communicate the purpose the new medications serve toward treatment of the condition. Ensure the medication is dispensed in containers that are easily opened. Make sure all drugs are clearly labeled with instructions. Place daily follow-up phone calls to high-risk older clients. Simplify the regimen to twice-a-day dosing and reduce the number of medications the older client must take. Answer: 1, 2, 3 Explanation: It is important that older clients understand the purpose of medications and their importance to the treatment plan. It is important for older clients to be able to easily access the medication. Clearly labeled instructions may encourage the client to take the medication as directed. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-4 Explain strategies that the nurse may implement to improve adherence with drug therapy in geriatric patients.

187

A nurse who provides care to older adult clients must be aware that which factors may increasethe risk for adverse drug reactions in this population? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Longevity results in increased risk for illnesses, which may require multiple medications. Many older clients will use over-the-counter medications to treat common symptoms such as constipation or joint pain in addition to prescription drugs. Older clients may see several healthcare specialists. The rate of absorption in older clients is unpredictable. Increased volume of total body water results in an increase in concentrations of drugs in the blood. Answer: 1, 2, 3 Explanation: Longevity inevitably leads to increased illnesses, which in turn necessitate the use of multiple medications, which may result in adverse reactions. When a client takes over-the-counter drugs in conjunction with prescribed medications, polypharmacy may occur, resulting in adverse reactions. Adverse reactions may occur when multiple health providers prescribe medications. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-5 Explain why older adults are more likely to experience adverse drug reactions and interactions.

188

The nurse recognizes that which physiologic changes may have what effects on medication responses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Decreased production of serum albumin may result in toxic levels of highly protein-bound drugs. Declining efficiency of the blood–brain barrier may result in increased central nervous system symptoms. Decreased contractility of the heart may result in decreased distribution of drugs. Decreased gastric pH may result in decreased absorption. Decreased body fat may result in decreased absorption of fat-soluble drugs. Answer: 1, 2, 3 Explanation: Decreased production of serum albumin in the older client may produce toxic levels of highly protein-bound drugs. Declining efficiency of the blood–brain barrier may result in more substances crossing the blood– brain barrier, resulting in increased central nervous system symptoms. Decreased contractility of the heart may decrease the distribution of drugs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10-7 Differentiate medication responses that result from age-related alterations in specific body systems from those that occur in younger individuals. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 11 Individual Variations in Drug Responses The nurse is performing a holistic assessment on a client prior to administering antihypertensive medication. Which factors would be included in the holistic assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Blood pressure Belief in a higher power Level of education The symptoms of the hypertension only Mood Answer: 1, 2, 3, 5 Explanation: Holistic healthcare incorporates the whole client to include the biologic dimension. Holistic healthcare incorporates the whole client to include the spiritual dimension. Holistic healthcare incorporates the whole client to include the sociocultural dimension. Holistic healthcare incorporates the whole client to include the psychologic dimension. 189

Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 11-1 Describe the fundamental concepts underlying a holistic approach to patient care and their importance to pharmacotherapy.

190

The nurse is conducting a holistic assessment of a client diagnosed with alcoholism. Which priority questions should the nurse include in the assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "Did you see your parents drink alcohol when you were growing up?" "How old were you when you started drinking?" "Have you ever attended Alcoholic Anonymous meetings?" "Have you been treated with any medications that are designed to discourage consumption of alcohol?" "Have any of your blood relatives been addicted to alcohol?" Answer: 1, 2, 3, 5 Explanation: Environmental questions are valid questions to ask during a holistic assessment. This question helps to determine the length of time alcohol has been a problem for this client. Participation in Alcoholic Anonymous assesses nonpharmacologic measures the client may have pursued and is relevant to a holistic assessment. Biologic questions are valid questions to ask during a holistic assessment. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 11-1 Describe the fundamental concepts underlying a holistic approach to patient care and their importance to pharmacotherapy. An African American adult client is prescribed a sulfonamide drug to treat an infection. Why would the nurse question this prescribed medication order? The client has a history of a penicillin allergy. The client may exhibit slow acetylation, which can impact the effect of the medication. The client has a history of hypertension. The client may not metabolize the medication due to CYP2D6. Answer: 2 Explanation: African American clients may not be able to metabolize this mediation effectively because of the slow acetylation that can occur when taking sulfa-based medications. This can increase the risk of toxicity. The nurse should question this medication order. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 11-6 Explain how pharmacogenomics may lead to customized drug therapy.

191

A healthcare provider recommends chemotherapy for a client diagnosed with cancer. The client tells the nurse, "This is a punishment from God for the sins I have committed. Some of the women at my church say so." Which intervention will best meet the client's spiritual needs? Plan to involve a hospital minister to discuss the client's perspective about cancer. Plan to meet with family members to discuss their feeling about the cancer and prognosis. Plan to contact the client's minister to make a visit. Plan to bring the case before the hospital's board of ethics. Answer: 3 Explanation: Strong religious beliefs can affect the outcome of illness. The nurse should involve the client's religious leader when possible. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.18 Develop an awareness of patients' as well as healthcare professionals' spiritual beliefs and values and how those beliefs and values impact healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11-2 Identify psychosocial and spiritual factors that can affect pharmacotherapeutics. A Native American client is admitted to receive chemotherapy. At any given time, five family members are in the client's private room. The nurse tells the client that according to hospital policy, only two visitors at a time are allowed. What is the nurse manager's analysis of the situation? The nurse should allow the client to have as many family members visiting as desired. The nurse followed protocol by informing the client about hospital policy. The nurse should have called the healthcare provider and obtained an order allowing additional family members to be present. The nurse should have assessed the client's preference about the number of family members present. Answer: 4 Explanation: Many hospital rules, such as how many visitors are allowed, are flexible, and do not have to be strictly interpreted; this client is in a private room. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.18 Develop an awareness of patients' as well as healthcare professionals' spiritual beliefs and values and how those beliefs and values impact healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 11-2 Identify psychosocial and spiritual factors that can affect pharmacotherapeutics.

192

A Caucasian nurse is caring for an African American client who has a history of myocardial infarction and is receiving atorvastatin (Lipitor). The nurse assesses the client's diet to be very high in fat. Which teaching plan would be most effective at improving the client's diet and possibly reducing the need for additional medications? Plan to ask an African American nurse to speak to the client about low-fat diets. Discuss the client's diet with whomever prepares meals for the family. Give the client a printout about low-fat diets specific to African Americans. Ask the healthcare provider for a consult by dietary services so a dietitian can teach the client about low-fat diets. Answer: 2 Explanation: Every culture has culture-specific diets; the nurse must include the person in the family who prepares meals if a different diet is to be successful. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11-3 Explain how ethnicity can affect pharmacotherapeutic outcomes. The nurse is caring for an Asian American client diagnosed with terminal cancer. Which factor should the nurse consider to achieve adequate pain control for the client? All ethnic groups respond to medications in the same manner. The only variation in drug metabolism occurs among African Americans. Asians respond differently to antidepressants only. Opioids are metabolized differently in individuals of Asian and Native American descent. Answer: 4 Explanation: Opioids are metabolized differently by clients of Asian descent. The nurse must understand how the drug is metabolized to ensure that the correct dose is being given. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11-3 Explain how ethnicity can affect pharmacotherapeutic outcomes.

193

An adolescent Hispanic male with attention-deficit/hyperactivity disorder (ADHD) is taking methylphenidate (Ritalin). The adolescent will not go to the school nurse at noon for his medication. Which statement best describes the likely result of the nurse's assessment? The adolescent really does not need an additional dose of methylphenidate (Ritalin) at school. The adolescent is embarrassed about having to take medicine at school; it is a social stigma. The adolescent is fearful that this drug might be a "gateway drug" and he will abuse other substances. The adolescent has developed alternative coping mechanisms to increase his focus during classes. Answer: 2 Explanation: Some clients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Clients can also perceive this as a social stigma. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 11-4 Identify examples of how cultural values and beliefs can influence pharmacotherapeutic outcomes. A woman from an Arab culture is in labor. Her husband insists he must stay with her and will not allow her to receive any analgesia. Which action by the nurse is the most appropriate? Inform the husband that he must sign a release of responsibility to avoid future litigation against the hospital. Allow this request, and be available in the event the request changes. Inform the husband that it is his wife's choice whether to receive analgesia. Allow the request, but inform the husband that the primary healthcare provider will make the final decision regarding analgesia. Answer: 2 Explanation: Nurses must allow and support cultural differences. The husband's decisions must be respected as long as the client's safety is not jeopardized. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11-4 Identify examples of how cultural values and beliefs can influence pharmacotherapeutic outcomes.

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The nurse is providing education about warfarin (Coumadin) to a group of Asian American and African American clients who have experienced strokes. The nurse determines that learninghas occurred when the clients make which statement? "We might need to have more frequent blood tests." "We might need less medication than other ethnic groups." "We might need to have less frequent blood tests." "We might need more medication than other ethnic groups." Answer: 2 Explanation: Asian Americans and African Americans have reduced metabolism rates of warfarin (Coumadin), so they often require lower doses to prevent toxicity. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 11-5 Convey how genetic polymorphisms can influence pharmacotherapy. The primary healthcare provider has prescribed isoniazid (INH) for a client of Japanese descent diagnosed with tuberculosis. What factor must be considered in regard to the therapeutic effectiveness of this drug? People of Japanese descent are known as rapid acetylators. People of Japanese descent are usually allergic to isoniazid. People of Japanese descent do not need medication to treat their tuberculosis. People of Japanese descent are known as slow acetylators. Answer: 1 Explanation: Rapid acetylators inactivate the drug so quickly that it will not produce a therapeutic effect. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 11-5 Convey how genetic polymorphisms can influence pharmacotherapy.

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A male client comes to the emergency department with chest pain. Upon assessment the nurse notes that his blood pressure is 210/100 mmHg. The client's wife says to the nurse, "He has not been taking his blood pressure medication, and we can afford it." What should the nurse's plan of action include? Plan to assess the client for any cultural concerns about the medication. Plan to teach the client the importance of taking his medication. Plan to assess the client for sexual side effects such as erection difficulty. Plan to design a teaching plan about medication that includes the client's wife. Answer: 3 Explanation: A common side effect of antihypertensive medication in males is sexual difficulty, such as erection problems. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 11-7 Explain how gender can influence the actions of certain drugs. The nurse is teaching a mixed-gender class how to prevent heart attacks. What important factor related to gender will the nurse include in the teaching plan? Heart disease affects men and women equally. All medications used to prevent heart attacks affect men and women the same. Certain medications, such as aspirin, are more effective in preventing heart attacks in women than in men. Certain medications, such as aspirin, are more effective in preventing heart attacks in men thanin women. Answer: 4 Explanation: Aspirin is more effective in preventing heart attacks in men than in women. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11-7 Explain how gender can influence the actions of certain drugs.

196

The nurse is assessing several clients. For which client does assessment reveal a psychosocial history that may affect the client's outcome? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Older adult who recently suffered a stroke, has an unsteady gait, and lives in a two-story home Middle-aged client with Down syndrome living in a group home Recently divorced mother of three children with breast cancer Sixteen-year-old requesting birth control without parental consent Seven-year-old with asthma in a foster care home Answer: 1, 2, 3 Explanation: This client may not be able to return to a home that requires climbing stairs. A client with Down syndrome needs additional care to ensure that treatment outcome is successful. This client may be the family's sole provider and may have financial concerns. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.18 Develop an awareness of patients' as well as healthcare professionals' spiritual beliefs and values and how those beliefs and values impact healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 11-2 Identify psychosocial and spiritual factors that can affect pharmacotherapeutics.

197

The nurse in charge of a clinical study welcomes the participants in an open forum. One clientis surprised that there are men and women from several ethnic groups. The nurse tells the group that in the past, ethnic variables were largely unknown or ignored for which reasons? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Clinical trials failed to include ethnically diverse subjects. Clinical trials comprised mostly Caucasian males. Little attention was focused on identifying the different effects drugs had on various ethnic groups. Research proved there were no differences among ethnic groups. The large majority of clinical trials included Caucasian females. Answer: 1, 2, 3 Explanation: There was a lack of ethnic diversity in early clinical trials. Until recently, clinical trials comprised mostly Caucasian males. Little attention was focused on identifying the differences in pharmacologic effects in diverse ethnic groups. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.18 Develop an awareness of patients' as well as healthcare professionals' spiritual beliefs and values and how those beliefs and values impact healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11-2 Identify psychosocial and spiritual factors that can affect pharmacotherapeutics.

198

The nurse in the emergency department is caring for several clients from diverse cultures. Which statements show the nurse's ability to provide culturally competent care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "I understand your religion prohibits blood transfusions. Would you consider nonblood alternatives?" "I just want to make sure you and your spouse understand the risks as you consider the options." "I don't really understand why you are afraid to take the medication. Do you have any questionsI can answer to alleviate your fear?" "I really don't understand why you won't consider an abortion. Your admission papers say you are an atheist." "I'm not quite sure why the healthcare provider is giving you these prescriptions. You didn't get them filled the last time you were here." Answer: 1, 2, 3 Explanation: This statement shows the nurse is respectful of religious beliefs and open to offering alternative treatment. This statement shows the nurse is accepting of clients' beliefs. This statement may encourage the client to open up to the nurse about fears. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 11-4 Identify examples of how cultural values and beliefs can influence pharmacotherapeutic outcomes.

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A home health nurse's client caseload is ethnically diverse. Which interventions show understanding of cultural variables? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Discussing cultural preferences for herbs and spices and possible alternatives when drug interactions are possible Assessing the client's response to acupuncture for pain Discussing the client's beliefs regarding treatment Notifying the healthcare provider of the client's intentions to consult with a medicine man for spiritual guidance Removing the client's collection of herbs to decrease the risk of an adverse effect when taken with Western medicine Answer: 1, 2, 3 Explanation: It is important to assess the cultural use of herbs and spices and determine if there may be any interactions with prescribed medications. The nurse can assess the client's response to acupuncture and interpret the effects on prescribed treatment with respect for the client's culture. Cultures view health and wellness in different ways. An understanding of the client's cultural beliefs allows the nurse to provide better support and guidance. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11-4 Identify examples of how cultural values and beliefs can influence pharmacotherapeutic outcomes.

200

A client asks the nurse why a medication prescribed by the provider "didn't do anything at all." Which statement by the nurse accurately describes how genetics influence drug action? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. "Genetic differences can result in significant differences in how each client's body handles the same medication." "Genetic differences can cause mutations in enzymes, changing the way they function. This can alter how the body metabolizes and excretes drugs." "Because of genetic differences, medication may accumulate to toxic levels in one client whilein another client may be inactivated before it can have a therapeutic effect." "Genetic differences can be expressed as an alteration in the structure of an enzyme, which can cause a defective receptor and an allergic response to drugs." "Genetic differences in clients who are biracial result in an allergic response to medications." Answer: 1, 2, 3 Explanation: 99.8% of human DNA sequences are identical. The remaining 0.2% can account for significant differences in people's ability to handle medications. The structure of an enzyme is closely related to its function. A mutation can cause a change in the structure of the enzyme, resulting in a change in its function. When enzymes are functionally changed by genetics, metabolism and excretion can be altered, resulting in the drug either accumulating or being inactivated. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11-5 Convey how genetic polymorphisms can influence pharmacotherapy.

201

A nurse administering medications to a variety of clients on a medical–surgical floor recognizes which clients may need additional education about medication adherence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Fifty-year-old recently remarried male taking antihypertensive medication Thirty-four-year-old female with family history of blood clots taking an estrogen oral contraceptive Sixty-eight-year-old male recently started on antidepressants known to cause gynecomastia Twenty-eight-year-old female started on acne medication known to cause male-patterned hair growth Seventy-eight-year-old male taking estrogen as therapy for prostate cancer Answer: 1, 2, 4 Explanation: Antihypertensive medications can cause erectile dysfunction. This client will need additional education about this possible side effect. Estrogen can cause an increased risk for thrombolytic events, especially in clients who have a positive family history. Some acne medications cause increased hair growth in a male pattern, such as on the face. While controlling acne is a goal, the client may not want the extra hair growth. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 11-7 Explain how gender can influence the actions of certain drugs.

202

A client overhears the healthcare team talking about pharmacogenomics. The client asks the nurse what that means. Which statement provides the best example of pharmacogenomics? "The study of individuals' history of a penicillin allergy and the use of gene transplants to change the allergy." "The study of individuals' genetic background and how it affects their response to drug therapy." "The study of individuals' genetic history and how it affects their genetic polymorphisms." "The study of individuals' ability to determine their genetic predisposition and prevent chronic diseases." Answer: 2 Explanation: Pharmacogenomics is a term referring to the network of genes that govern a patient's response to drug therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 11-6 Explain how pharmacogenomics may lead to customized drug therapy. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 12 Review of Neurotransmitters and the Autonomic Nervous System Which clinical manifestations indicate a central nervous system dysfunction? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. Lack of movement in the left upper extremity Decreased secretion of gastric acid Increased thirst Decreased memory Increased blood pressure and heart rate when threatened Answer: 1, 3, 4 Explanation: The nervous system is the master controller of most activities occurring within the body alerting the brain to internal and external environment changes, determining appropriate responses to these changes, and producing an action or response. The nervous system is the master controller of most activities occurring within the body, alerting the brain to internal and external environment changes, determining appropriate responses to these changes, and producing an action or response. The nervous system is the master controller of most activities occurring within the body, alerting the brain to internal and external environment changes, determining appropriate responses to these changes, and producing an action or response. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment 203

Learning Outcome: 12-1 Distinguish between the functions of the central and peripheral nervous systems.

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What are the components of the nervous system? A sensory division and a motor division Nerves that carry impulses to the brain Nerves that deliver messages to vital organs The central nervous system and the peripheral nervous system Answer: 4 Explanation: The parts of the nervous system are the central nervous system and the peripheral nervous system. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-1 Distinguish between the functions of the central and peripheral nervous systems. Which system is comprised of the somatic and autonomic nervous systems? Sensory nervous system Motor nervous system Central nervous system Peripheral nervous system Answer: 4 Explanation: The two divisions of the peripheral nervous system are the somatic and autonomic. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-2 Compare and contrast the two divisions of the peripheral nervous system.

205

Which is an example of an autonomic function? Contraction of cardiac muscles Movement of skeletal muscles Organization of thought Awareness of position Answer: 1 Explanation: Contraction of cardiac muscles is a function of the autonomic nervous system. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-2 Compare and contrast the two divisions of the peripheral nervous system. Given the main functions of the autonomic nervous system (ANS), which nursing action wouldbe a priority consideration in providing care for clients with an autonomic dysfunction? Providing information for urodynamic testing Monitoring cardiac rhythms Performing a mental status assessment Administering antacids Answer: 2 Explanation: The three main functions of the ANS are contraction of the bronchi, blood vessels, GI tract, eye, and genitourinary tract; contraction of cardiac muscle; and secretion of salivary, sweat, gastric, and bronchial glands. The potential for cardiac arrhythmias in clients with autonomic dysfunction warrants close monitoring. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-2 Compare and contrast the two divisions of the peripheral nervous system.

206

The client presents to the emergency department after a motor vehicle crash. Vital signs on admission are heart rate 56, respiratory rate 16, blood pressure 150/90, and temperature 97°F. Which vital sign finding indicates a sympathetic nervous system response? Respiratory rate Temperature Blood pressure Heart rate Answer: 3 Explanation: Elevated blood pressure is a response of the sympathetic nervous system's fight-or-flight response. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-3 Compare and contrast the actions of the sympathetic and parasympathetic divisions of the autonomic nervous system. Which laboratory value indicates a response to the sympathetic nervous system? Urinalysis +5 WBC Hemoglobin 13.5 mg/dL Blood glucose 180 mg/dL Blood urea nitrogen 8 mg/dL Answer: 3 Explanation: An elevated blood glucose level is a metabolic effect of the sympathetic nervous system. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-3 Compare and contrast the actions of the sympathetic and parasympathetic divisions of the autonomic nervous system.

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Which assessment finding is reflective of the parasympathetic nervous system? Frequent bowel movements Elevated liver enzymes Pupils 8 mm and equal Decreased urine output Answer: 1 Explanation: Increased peristalsis causing frequent bowel movements is a response of the parasympathetic nervous system. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-3 Compare and contrast the actions of the sympathetic and parasympathetic divisions of the autonomic nervous system. How is the process of synaptic transmission best described? The conduction of action potentials that move rapidly from one neuron across the synapse to its target tissue When the nerve impulse reaches the terminal axon and enters the synaptic cleft The communication of the message from one cell to another utilizing neurotransmitters When a neurotransmitter is synthesized within a cell body, causing a contraction Answer: 3 Explanation: The communication of the message from one cell to another utilizing neurotransmitters is the best description of the process of synaptic transmission. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-4 Explain the process of synaptic transmission.

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The nurse is explaining the process of synaptic transmission to the client who is taking medication that will affect it. Which client statement would indicate the need for further instruction? "The two primary neurotransmitters of the autonomic nervous system are epinephrine and dopamine." "The ganglia contain the neuron cell body of the postganglionic neuron." "The more neurotransmitter released into the synapse, the greater the response." "After the neurotransmitter binds with a receptor, the message is conveyed to the target tissue." Answer: 1 Explanation: This is false, indicating that the client needs further teaching. The two primary neurotransmitters of the autonomic nervous system are norepinephrine and acetylcholine. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-4 Explain the process of synaptic transmission. Which factor is primarily responsible for the difference between the speed of somatic transmission and autonomic transmission of nerve impulses? Abundance of ganglia Presence of myelin Absence of acetylcholine Availability of neuronal tissue Answer: 2 Explanation: The presence of myelin allows for movement of impulses more quickly than autonomic transmission. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-4 Explain the process of synaptic transmission.

209

Which statement explains how autonomic drugs affect synaptic transmission? Drugs are frequently given to correct autonomic dysfunction. Drugs used to prevent the normal destruction of the neurotransmitter cause the neurotransmitterto remain in the synapse for a longer period of time. Drugs influence the release of neurotransmitters at the postganglionic site. Drugs that decrease the degree of neurotransmitter synthesis stimulate autonomic responses. Answer: 2 Explanation: This is true; these drugs stimulate autonomic responses. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-5 Explain mechanisms by which drugs affect synaptic transmission. Which type of medication inhibits autonomic responses at target organs or glands? Drugs that prevent neurotransmitter reuptake Drugs that prevent neurotransmitter storage Drugs that increase neurotransmitter synthesis Drugs that promote neurotransmitter release Answer: 2 Explanation: Drugs that prevent the storage of neurotransmitters inhibit autonomic actions. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-5 Explain mechanisms by which drugs affect synaptic transmission.

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A client is prescribed an autonomic medication and asks the nurse how it works. Which response by the nurse is the most appropriate? "The drug acts to stop the symptoms you are experiencing." "The drug will help you with your day-to-day activities." "The drug you are taking pretends to mimic the substance you are missing." "The drug works by targeting the organ affected and producing an expected response." Answer: 4 Explanation: This is the most comprehensive explanation given in layman's terminology. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-5 Explain mechanisms by which drugs affect synaptic transmission. Which response is produced by nicotinic receptors containing acetylcholine? 1. Decreased heart rate 2. Increased blood pressure 3. Increased peristalsis 4. Decreased sweat production Answer: 2 Explanation: Activation of acetylcholine receptors causes hypertension. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-6 Describe the actions of acetylcholine at cholinergic synapses.

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Which response is produced by muscarinic receptors containing acetylcholine? 1. Decreased peristalsis 2. Increased sweat production 3. Decreased heart rate 4. Increased blood pressure Answer: 3 Explanation: A decrease in heart rate—known as bradycardia—is a muscarinic response. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-6 Describe the actions of acetylcholine at cholinergic synapses. The main action of acetylcholine (ACh) at cholinergic synapses in the peripheral nervous system results in which act? 1. Inhibition of optic muscles 2. Stimulation of cardiac muscle 3. Contraction of skeletal muscle 4. Relaxation of smooth muscle Answer: 3 Explanation: The main action of ACh is contraction of skeletal muscles. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-6 Describe the actions of acetylcholine at cholinergic synapses.

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Which statement best describes the action of norepinephrine? 1. An enzymatic substance released at receptors at the end of postganglionic nerves 2. The neurotransmitter that binds to adrenergic receptors to produce a physiologic response 3. The activation of beta receptors to constrict coronary blood vessels 4. The stimulation of alpha receptors to decrease blood pressure Answer: 2 Explanation: This best describes the action of norepinephrine. Norepinephrine binds to adrenergic receptors to produce a physiologic response. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-7 Describe the actions of norepinephrine at adrenergic synapses. The termination of norepinephrine (NE) occurs through the process of reuptake. Which phrase best describes this phenomenon? 1. Movement of NE to the adrenergic receptor sites 2. Release of NE into the bloodstream 3. Storage of NE in preganglionic nerves for future use 4. Destruction of NE by the enzyme catechol-O-methyltransferase (COMT) Answer: 3 Explanation: Reuptake is the process of storing NE for future use. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-7 Describe the actions of norepinephrine at adrenergic synapses.

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Adrenergic synapses containing alpha receptors are primarily responsible for which function? 1. Release of intracellular calcium 2. Inhibiting vasoconstriction of the bronchioles 3. Constriction of arterioles in the kidneys 4. Increasing the strength of contraction in the coronary arteries Answer: 1 Explanation: Release of intracellular calcium is an alpha response. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-7 Describe the actions of norepinephrine at adrenergic synapses. Which action of the adrenal medulla directly affects the sympathetic nervous system? 1. Arousal and wakefulness 2. Fight-or-flight response 3. Sensations of pain and touch 4. Ability to walk and speak Answer: 2 Explanation: The fight-or-flight response is directly related to the release of catecholamines—such as epinephrine and norepinephrine—from the adrenal medulla. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-8 Compare the actions of the adrenal medulla with those of other sympathetic effector organs.

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What is the difference between the release of catecholamines from the adrenal medulla and the postganglionic sympathetic neurons in the autonomic nervous system (ANS)? 1. The postganglionic sympathetic neurons of the ANS release catecholamines into the systemic circulation, while the adrenal medulla releases catecholamines that affect certain body cells innervated by the ANS. 2. The postganglionic sympathetic neurons of the ANS release catecholamines that are deactivated by the kidneys, while the catecholamines released from the adrenal medulla are deactivated by adrenergic enzymes. 3. The release of catecholamines from the adrenal medulla is longer lasting than that produced by the postganglionic sympathetic neurons of the ANS. 4. The concentrations of catecholamines are shortened when released from the adrenal medulla, reducing their effect on body cells, as opposed to the postganglionic sympathetic neurons of the ANS, which have long-lasting effects. Answer: 3 Explanation: The major difference is that the release of catecholamines from the adrenal medulla is longer lasting than that produced by the postganglionic sympathetic neurons of the ANS. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-8 Compare the actions of the adrenal medulla with those of other sympathetic effector organs. Which percentage estimate is indicative of the adrenal medulla's effect on the sympathetic nervous system? 1. 60–70% 2. 75–100% 3. 25–50% 4. 10–20% Answer: 3 Explanation: 25-50% of all sympathetic responses are due to circulating hormones from the adrenal medulla. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-8 Compare the actions of the adrenal medulla with those of other sympathetic effector organs.

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Which client responses are considered involuntary responses to autonomic nervous system control? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Becoming angry 2. Tripping over a chair 3. Complaining of nausea 4. Feeling depressed 5. Being happy Answer: 1, 4, 5 Explanation: Becoming angry is considered an involuntary response that is a signal from higher centers in the brain to the autonomic nervous system. Feeling depressed is considered an involuntary response that is a signal from higher centers in the brain to the autonomic nervous system. Being happy is considered an involuntary response that is a signal from higher centers in the brain to the autonomic nervous system. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-9 Explain how higher centers in the brain can influence autonomic function. What is the autonomic nervous system's (ANS) main integration center? 1. Spinal cord 2. Hypothalamus 3. Cerebellum 4. Cerebral cortex Answer: 2 Explanation: The hypothalamus is the main integration center of the ANS. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-9 Explain how higher centers in the brain can influence autonomic function.

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The hypothalamus sends messages through the brainstem and spinal cord to the autonomic nervous system, causing which sympathetic effects? 1. Decreased blood pressure 2. Decreased temperature 3. Increased heart rate 4. Increased peristalsis Answer: 3 Explanation: An increase in heart rate is a sympathetic response. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-9 Explain how higher centers in the brain can influence autonomic function. Which is the primary method for studying the classification of autonomic drugs? 1. Defining which receptor sites are stimulated 2. Contrasting nicotinic agonists with muscarinic agonists 3. Comparing two groups of drugs: the adrenergics and cholinergics 4. The stimulation and inhibition of the sympathetic nervous system and parasympathetic nervous system Answer: 4 Explanation: The primary method for studying the classification of autonomic drugs is knowing that drugs either stimulate or inhibit the sympathetic or parasympathetic nervous system. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-10 Design a method for classifying autonomic drugs based on which receptors are affected.

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Which strategy is the most comprehensive way to study autonomic nervous system (ANS) pharmacology? 1. Mastering the terminology of autonomic drugs 2. Studying the adrenergic agonist responses 3. Memorizing the parasympatholytic or muscarinic antagonist response 4. Comparing the drugs to the same or opposite effect of the fight-or-flight response Answer: 4 Explanation: The first group of drugs will provide logical extensions for the remaining three groups. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-10 Design a method for classifying autonomic drugs based on which receptors are affected. Sympathomimetic drugs can be considered similar to which type of medications? 1. Anticholinergics 2. Muscarinic agonists 3. Parasympathomimetics 4. Adrenergic antagonists Answer: 1 Explanation: Anticholinergic drugs inhibit the parasympathetic nervous system, producing similar responses to those produced by sympathomimetics. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-10 Design a method for classifying autonomic drugs based on which receptors are affected.

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A client has sustained a large blood loss. During the assessment, the nurse realizes that which findings are controlled by the nervous system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Heart rate 2. Blood pressure 3. Pupil size 4. Bowel sounds 5. Fluid volume Answer: 1, 2, 3, 4 Explanation: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as heart rate. The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as blood pressure. The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as pupil size. The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as intestinal motility. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-1 Distinguish between the functions of the central and peripheral nervous systems.

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The nurse is caring for a client with multisystem organ failure. Which client assessment findings are under the control of the sympathetic nervous system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Blood glucose level 210 mg/dL 2. Blood pressure 180/90 mmHg 3. Total cholesterol level 300 mg/dL 4. Respiratory rate 14 and regular 5. Hyperactive bowel sounds Answer: 1, 2, 3 Explanation: Metabolic effects such as an increase in blood glucose are a sympathetic nervous system function. The constriction and relaxation of arterioles are controlled entirely by the sympathetic nervous system. Metabolic effects such as the mobilization of lipids for energy are a sympathetic nervous system function. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-3 Compare and contrast the actions of the sympathetic and parasympathetic divisions of the autonomic nervous system.

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A student nurse is learning about a medication that affects the autonomic nervous system. When instructing the student about the effects of this medication, the nurse will begin by explaining which basic units of this system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The preganglionic neuron 2. The postganglionic neuron 3. The synaptic cleft 4. Norepinephrine 5. Dopamine Answer: 1, 2, 3 Explanation: The basic unit of the autonomic nervous system is a two-neuron chain. The first neuron, called the preganglionic neuron, originates in the central nervous system. The preganglionic neuron connects with the second nerve in the autonomic nervous system two-neuron chain through the ganglia, which contains the postganglionic neuron. Autonomic messages must cross the synaptic cleft. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-4 Explain the process of synaptic transmission. The nurse educator is reviewing the process of synaptic transmission across the neuroeffector junction with a student. In which order will the nurse explain the steps of synaptic transmission? Answer: Response 1. Synthesis of the neurotransmitter Response 2. Storage of the neurotransmitter Response 3. Release of the neurotransmitter Response 4. Binding to the receptor Response 5. Termination of neurotransmitter action Explanation: 1. This is the first step of synaptic transmission across the neuroeffector junction. 2. This is the second step of synaptic transmission across the neuroeffector junction. 3. This is the third step of synaptic transmission across the neuroeffector junction. 4. This is the fourth step of synaptic transmission across the neuroeffector junction. 5. This is the fifth step of synaptic transmission across the neuroeffector junction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-4 Explain the process of synaptic transmission.

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The nurse is providing a medication to a client that will decrease autonomic responses. Usingthis medication will result in which actions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Decrease neurotransmitter synthesis. 2. Prevent neurotransmitter storage. 3. Prevent neurotransmitter release. 4. Prevent neurotransmitter binding. 5. Prevent the reuptake of neurotransmitter. Answer: 1, 2, 3, 4 Explanation: Drugs that decrease neurotransmitter synthesis inhibit autonomic responses. Medications that prevent neurotransmitter storage inhibit autonomic actions. Medications that prevent neurotransmitter release inhibit autonomic responses. Medications that attach to the postganglionic cell and prevent the neurotransmitter from reaching its receptions will inhibit autonomic actions. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-5 Explain mechanisms by which drugs affect synaptic transmission. A client is prescribed a medication that will block muscarinic receptors. The nurse realizes thatthis medication has implications for which body systems? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Eyes 2. Respiratory 3. Cardiac 4. Endocrine 5. Metabolic Answer: 1, 2, 3 Explanation: Medications that block muscarinic receptors are used during ophthalmic procedures. Medications that block muscarinic receptors are used in the pharmacologic treatment of asthma. Medications that block muscarinic receptors are used in the pharmacologic treatment of bradycardia. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-6 Describe the actions of acetylcholine at cholinergic synapses. 222

The nurse is providing a client with a medication that is a beta1 and beta2 blocker. Which effects will the nurse expect to assess from this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Decreased heart rate 2. Reduced blood pressure 3. Increased blood pressure 4. Dilated pupils 5. Reduced anxiety Answer: 1, 2 Explanation: A beta1 blocker will decrease heart rate. A beta1 blocker will reduce the release of renin, decreasing the blood pressure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-7 Describe the actions of norepinephrine at adrenergic synapses. A client received an injection of norepinephrine as part of medical treatment. This neurotransmitter will be destroyed by which body organs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Kidney 2. Liver 3. Stomach 4. Bladder 5. Pancreas Answer: 1, 2 Explanation: Norepinephrine that enters circulation as a medication is destroyed by the enzyme catechol-O-methyltransferase in kidney cells. Norepinephrine that enters circulation as a medication is destroyed by the enzyme catechol-O-methyltransferase in liver cells. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 12-7 Describe the actions of norepinephrine at adrenergic synapses.

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A client is prescribed a medication that will affect the autonomic nervous system. The nurse knows that the body's response to this medication will begin in the hypothalamus and travel to which structures? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Medulla oblongata 2. Brainstem 3. Spinal cord 4. Spleen 5. Small intestines Answer: 1, 2, 3 Explanation: Messages from the hypothalamus travel along the medulla oblongata. Messages from the hypothalamus travel along the brainstem. Messages from the hypothalamus travel along the spinal cord. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-9 Explain how higher centers in the brain can influence autonomic function.

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The nurse is providing a medication to a client that will stimulate the sympathetic nervous system. This medication will cause which effects to the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increased heart rate 2. Increased blood pressure 3. Increased respirations 4. Dilated pupils 5. Decreased body temperature Answer: 1, 2, 3, 4 Explanation: Sympathomimetics will produce the classic symptoms of the fight-or-flight response, including an increase in heart rate. Sympathomimetics will produce the classic symptoms of the fight-or-flight response, including an increase in blood pressure. Sympathomimetics will produce the classic symptoms of the fight-or-flight response, including an increase in respirations. Sympathomimetics will produce the classic symptoms of the fight-or-flight response, including dilated pupils. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-10 Design a method for classifying autonomic drugs based on which receptors are affected.

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A client is prescribed a medication that will inhibit the parasympathetic nervous system. The nurse will refer to which drug classifications for this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Anticholinergics 2. Parasympatholytics 3. Muscarinic blockers 4. Adrenergic antagonists 5. Muscarinic agonists Answer: 1, 2, 3 Explanation: Drugs that inhibit the parasympathetic nervous system are called anticholinergics. Drugs that inhibit the parasympathetic nervous system are called parasympatholytics. Drugs that inhibit the parasympathetic nervous system are called muscarinic blockers. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-10 Design a method for classifying autonomic drugs based on which receptors are affected. A client is prescribed a medication that replaces serotonin. The nurse realizes this medicationis used to treat which health problems? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Anxiety 2. Depression 3. Nausea and vomiting 4. Cocaine abuse 5. Seizures Answer: 1, 2, 3 Explanation: A clinical application for serotonin is to treat anxiety. A clinical application for serotonin is to treat depression. A clinical application for serotonin is to treat nausea and vomiting. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-4 Explain the process of synaptic transmission.

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The nurse is caring for a client diagnosed with glaucoma. Which types of medications will be prescribed for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Alpha-adrenergic blockers 2. Beta-adrenergic blockers 3. Cholinergic agents 4. Beta-adrenergic agonists 5. Alpha-adrenergic agonists Answer: 1, 2, 3 Explanation: Alpha-adrenergic blockers are indicated in the treatment of glaucoma. Beta-adrenergic blockers are indicated in the treatment of glaucoma. Cholinergic agents are indicated in the treatment of glaucoma. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-10 Design a method for classifying autonomic drugs based on which receptors are affected. The client develops paralysis of the lower extremities after a skiing accident. Which part of the nervous system is responsible for the client's change in functioning? 1. Autonomic nervous system 2. Somatic nervous system 3. Sympathetic nervous system 4. Parasympathetic nervous system Answer: 2 Explanation: The somatic nervous system consists of nerves that provide for the voluntary control of skeletal muscle. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-2 Compare and contrast the two divisions of the peripheral nervous system. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 13 Cholinergic Agonists 1) Cholinergic drugs are most often indicated in which situation? 1. Preventing excess salivation and sweating 2. Treating a client with bradycardia 227

3. Lowering intraocular pressure in clients with glaucoma 4. Inhibiting muscular contractions in the bladder Answer: 3 Explanation: Cholinergic drugs are most often indicated to lower intraocular pressure in clients with glaucoma. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-1 Compare and contrast the mechanisms of action for direct- and indirect-acting cholinergic agonists. 2) What is the most significant difference between neostigmine and pyridostigmine? 1. Neostigmine has no adverse effects. 2. Neostigmine has a longer duration of action. 3. Neostigmine has a shorter duration of action. 4. Neostigmine cannot counteract a neuromuscular blocking effect. Answer: 3 Explanation: Neostigmine has a shorter duration of action than pyridostigmine. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-1 Compare and contrast the mechanisms of action for direct- and indirect-acting cholinergic agonists.

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3) Which side effect from an anticholinergic agent such as atropine is unexpected? 1. Dry mouth 2. Diarrhea 3. Urinary retention 4. Dilated pupils Answer: 2 Explanation: Diarrhea is not a side effect of anticholinergic agents. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-1 Compare and contrast the mechanisms of action for direct- and indirect-acting cholinergic agonists. 4) A client has received a dose of atropine to counteract the effects of a cholinergic medication prior to having surgery. On the way to the operating room (OR), the client complains of a sudden feeling of warmth. The client's skin is flushed, warm, and dry. Which nursing action is the most appropriate? 1. Assess the vital signs and advise the OR that surgery must be delayed for 1 hour. 2. Assess the client's mental status and vital signs. If normal, document finding and proceed to operating room. 3. Notify the surgeon of the client's vital signs. 4. Explain the side effects of atropine to the client. Answer: 2 Explanation: Assess the client's mental status and vital signs. If normal, document the finding, proceed to the operating room, and report the finding to the surgeon and anesthesiologist. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-1 Compare and contrast the mechanisms of action for direct- and indirect-acting cholinergic agonists.

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5) Which action is the most appropriate description for cholinesterase inhibitors? 1. Intensify transmission at neuromuscular junctions only. 2. Prevent transmission at neuromuscular junctions only. 3. Prevent transmission at muscarinic, ganglionic, and neuromuscular junctions. 4. Intensify transmission at muscarinic, ganglionic, and neuromuscular junctions. Answer: 4 Explanation: They can act on all three sites. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-2 Identify the actions of muscarinic agonists and their pharmacologic uses. 6) A client is prescribed bethanechol (Urecholine) 10 mg PO tid. What will the nurse determine as an adverse effect of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Nausea and vomiting 2. Blurred vision 3. Orthostatic hypotension 4. Increased peristalsis 5. Slow respiratory rate Answer: 1, 2, 3 Explanation: Nausea and vomiting are an adverse effect of a direct cholinergic agonist such as bethanechol. Blurred vision is an adverse effect of a direct cholinergic agonist such as bethanechol. Orthostatic hypotension is an adverse effect of a direct cholinergic agonist such as bethanechol. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 13-2 Identify the actions of muscarinic agonists and their pharmacologic uses.

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7) A client is prescribed donepezil (Aricept) for treatment of Alzheimer's disease. What will the nurse instruct the client about this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. This medication will improve memory. 2. This medication will improve thinking. 3. This medication slows the progression of the disease. 4. This medication will cure the disease. 5. This medication causes a long-term improvement in the progression of the disease. Answer: 1, 2 Explanation: This medication increases the amount of acetylcholine in cholinergic synapses in the brain, which improves memory. This medication increases the amount of acetylcholine in cholinergic synapses in the brain, which improves cognitive functioning. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-2 Identify the actions of muscarinic agonists and their pharmacologic uses.

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8) Prior to administering a prescribed muscarinic agonist, the nurse reviews the client's medical history and decides to withhold the medication until contacting the healthcare provider. Which findings in the medical history support withholding the medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client's bowel sounds are absent. 2. The client is currently being treated for asthma. 3. The client has ventricular dysrhythmia. 4. The client has a diagnosis of arthritis. 5. The client has spinal stenosis. Answer: 1, 2, 3 Explanation: Muscarinic agonists should not be provided when an obstruction of the gastrointestinal tract is suspected because the medication increases peristalsis and could cause a bowel rupture. Muscarinic agonists should not be given to those with respiratory disease because the medication causes bronchoconstriction. Muscarinic agonists should not be given to those with serious cardiac disease because of the risk for reflex tachycardia. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-2 Identify the actions of muscarinic agonists and their pharmacologic uses. 9) A client with myasthenia gravis is prescribed neostigmine. The client telephones to report severe abdominal pain for the last 4 hours. Which response by the nurse is the most appropriate? 1. "Increase your evening dose of medication. This should resolve your pain." 2. "This is a common side effect that should resolve when you have a bowel movement." 3. "You need to be evaluated immediately for a bowel obstruction." 4. "You are probably constipated. Take a laxative and return to the office in the morning." Answer: 3 Explanation: Advise the client to be evaluated immediately for a bowel obstruction. Clients with obstructive disorders of the gastrointestinal and urinary tract should not receive this drug because the increased smooth muscle contractions could worsen the condition. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-3 Describe the pharmacotherapy of myasthenia gravis. 232

10) While assessing a client before administering neostigmine for myasthenia gravis management, the nurse documents that the client has increased muscle strength compared with the last assessment over an hour ago. Which interpretation of this data by the nurse is the most accurate? 1. Toxicity from the medication is imminent. 2. The client's dose should be increased. 3. The medication appears to be effective. 4. The next dose of the medication should not be given. Answer: 3 Explanation: This is the expected outcome. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 13-3 Describe the pharmacotherapy of myasthenia gravis. 11) A client who is suspected of having myasthenia gravis is given a small dose of postoperative medication. The client subsequently develops increased muscle weakness. Which medication should the nurse anticipate administering immediately? 1. A dopamine agonist 2. A calcium channel blocker 3. A cholinesterase inhibitor 4. A sympathetic stimulant Answer: 3 Explanation: This would increase muscle strength. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 13-3 Describe the pharmacotherapy of myasthenia gravis.

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12) A client entering the hospital for a prostatectomy questions whether he should take his normal medications for myasthenia gravis prior to coming to the hospital. In particular, he needs to know when to take his ambenonium (Mytelase). Which action by the nurse is the most appropriate? 1. Advise him to hold the medication. 2. Advise him to take his medication as scheduled. 3. Ask if he is able to empty his bladder prior to taking his medication. 4. Consult with the urologist performing the case. Answer: 2 Explanation: The client should take his medication, so muscle strength and contractility during the surgery will not be compromised. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-3 Describe the pharmacotherapy of myasthenia gravis. 13) A client with myasthenia gravis is receiving pyridostigmine (Mestinon). Which medications should the nurse question prior to administering to this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Decadron 2. Ibuprofen 3. Warfarin 4. NPH insulin 5. Lidocaine Answer: 1, 2, 5 Explanation: Cholinergic drugs increase gastric acid secretion and should be used with caution with corticosteroids such as Decadron. Cholinergic drugs increase gastric acid secretion and should be used with caution with nonsteroidal anti-inflammatory drugs such as ibuprofen. Drugs that interfere with neuromuscular transmission such as lidocaine should be used with caution in the client with myasthenia gravis because severe muscular weakness may result. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 13-3 Describe the pharmacotherapy of myasthenia gravis.

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14) The nurse differentiates between a cholinergic crisis and a myasthenic crisis by taking which action? 1. Assessing the neuromuscular status of the client 2. Asking the client about family and occupational history 3. Assessing serum levels of the cholinesterase inhibitor 4. Administering edrophonium and monitoring the client's response Answer: 4 Explanation: This is a diagnostic test for myasthenic crisis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-4 Differentiate between the treatment of cholinergic crisis and myasthenic crisis. 15) A client with Alzheimer's disease is admitted for an overdose of donepezil (Aricept). What will the nurse most likely assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Tachycardia 2. Vomiting 3. Muscle twitching 4. Abdominal cramping 5. Urinary retention Answer: 1, 2, 3, 4 Explanation: Tachycardia is a sign of progressing cholinergic crisis. Vomiting is a sign of intense parasympathetic stimulation associated with a cholinergic crisis. Muscle twitching is a sign of intense parasympathetic stimulation associated with a cholinergic crisis. Abdominal cramping is a sign of intense parasympathetic stimulation associated with a cholinergic crisis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-4 Differentiate between the treatment of cholinergic crisis and myasthenic crisis.

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16) A client with myasthenia gravis is demonstrating weakness 4 hours after taking the last dose of pyridostigmine (Mestinon). What may be the cause of the client's weakness? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client needs a higher dose of the medication. 2. The client is developing drug resistance. 3. The client needs a lower dose of the medication. 4. The client's autonomic nervous system is rejecting the medication. 5. The client should have received the medication with atropine. Answer: 1, 2 Explanation: Weakness that occurs 3 or more hours after drug administration without muscarinic overstimulation is more likely due to myasthenic crisis caused by underdosing and is treated with more intensive therapy. Weakness that occurs 3 or more hours after drug administration without muscarinic overstimulation is more likely due to myasthenic crisis caused by drug resistance and is treated with more intensive therapy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-4 Differentiate between the treatment of cholinergic crisis and myasthenic crisis.

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17) The nurse is administering a transdermal patch of tobacco to a client. What effects will the nurse most likely assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increased alertness 2. Increased heart rate 3. Increased blood pressure 4. Nausea 5. Muscle pain Answer: 1, 2, 3, 4 Explanation: Nicotine causes both parasympathetic and sympathetic responses. Activation of the central nervous system increases alertness. Nicotine causes an increase in heart rate. Nicotine causes an increase in blood pressure. The emetic center in the central nervous system is triggered with nicotine, causing a feeling of nausea. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-5 Explain the actions and pharmacologic applications of nicotine. 18) In the postoperative client, the nurse recognizes that bethanechol (Urecholine) might be given to treat which condition? 1. Respiratory atelectasis 2. Postoperative hypotension 3. Ischemic colitis 4. Urinary atony Answer: 4 Explanation: Bethanechol (Urecholine) might be given to treat a urinary atony in a postoperative client. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 13-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 237

19) Which are common side effects of bethanechol? 1. Abdominal cramping 2. Hypertension 3. Constipation 4. Tachycardia Answer: 1 Explanation: Abdominal cramping is a common side effect of bethanechol. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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20) The nurse is preparing to administer pyridostigmine to a client with myasthenia gravis. What will the nurse identify as characteristics of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. It affects nicotinic acetylcholine synapses in skeletal muscle. 2. It is the prototype drug. 3. It does not cross the placenta. 4. It decreases peristalsis and causes bronchodilation. 5. It must be used with caution in heart failure. Answer: 1, 2, 5 Explanation: Pyridostigmine is used to treat myasthenia gravis and affects the nicotinic acetylcholine synapses in skeletal muscle. Pyridostigmine is a prototype drug. Pyridostigmine can cause bradycardia and should be used cautiously in clients with heart failure. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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21) The nurse is concerned that a client receiving pyridostigmine (Mestinon) is experiencing adverse effects. Which assessment findings indicate an adverse effect? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Muscle twitching 2. Nausea 3. Drooling 4. Increased peristalsis 5. Low blood pressure Answer: 1, 2, 3 Explanation: Muscle twitching is a common adverse effect of pyridostigmine (Mestinon). Nausea is a common adverse effect of pyridostigmine (Mestinon). Increased salivation is a common adverse effect of pyridostigmine (Mestinon). Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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22) A client is prescribed cevimeline (Evoxac) for treatment of xerostomia. What potential side effects should the nurse discuss with the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Excessive sweating 2. Diarrhea 3. Rhinorrhea 4. Muscle pain 5. Respiratory infections Answer: 1, 2, 3 Explanation: Excessive sweating is the most common adverse effect of this medication. Diarrhea is a possible adverse effect of this medication. Rhinorrhea, or runny nose, is a possible adverse effect of this medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 23) Caution should be used in administering cholinergic drugs to clients with a history of which condition? 1. Leg cramps 2. Glaucoma 3. Benign prostatic hypertrophy 4. Heartburn Answer: 3 Explanation: Cholinergic drugs might increase bladder tone, which would cause the client to have difficulty with urination. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-7 Apply the nursing process to care for patients receiving pharmacotherapy with cholinergic agonists. 241

24) What is a priority nursing diagnosis for the client receiving anticholinergic drugs? 1. Injury, Risk for related to CNS changes related to medications 2. Knowledge, Deficient related to new medications 3. Gas Exchange, Impaired related to respiratory secretions 4. Urinary Retention related to loss of bladder tone Answer: 3 Explanation: Impaired gas exchange related to respiratory secretions is the most critical priority to address. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 13-7 Apply the nursing process to care for patients receiving pharmacotherapy with cholinergic agonists. 25) A migrant worker presents to the emergency department with signs of an acute, recent organophosphate poisoning exposure. Which treatment plan should the nurse expect? 1. Treat the symptoms with echothiophate. 2. Keep the client relaxed and quiet; administer no medications. 3. Administer a stat dose of pralidoxime as an immediate antidote. 4. Give neostigmine as the antidote. Answer: 3 Explanation: The nurse should expect to administer a stat dose of pralidoxime or atropine as an immediate antidote. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-7 Apply the nursing process to care for patients receiving pharmacotherapy with cholinergic agonists.

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26) The nurse is preparing discharge instructions for a client who is prescribed neostigmine (Prostigmin). What should be included in this client's discharge teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Practice home safety measures. 2. Take the medication with food, milk, or a small snack. 3. Notify the healthcare provider if experiencing tremors, dizziness, or urinary retention. 4. Report to the healthcare provider any changes in muscle weakness that occur 1 or 3 hours after taking. 5. Stop taking the medication if shortness of breath occurs. Answer: 1, 2, 3, 4 Explanation: Home safety measures need to be reviewed with the client who is prescribed neostigmine (Prostigmin). The client could experience muscle fatigue and orthostatic hypotension, which could precipitate falls. Administering the medication with food helps to minimize adverse effects. These are signs of excessive autonomic nervous system stimulation and could indicate an overdose. Muscle weakness within 1 hour of a dose may indicate overdosing, and muscle weakness within 3 hours of a dose may indicate underdosing. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 13-7 Apply the nursing process to care for patients receiving pharmacotherapy with cholinergic agonists.

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27) The nurse is evaluating instruction provided to a client who is prescribed pyridostigmine (Mestinon). Which client statements indicate teaching has been effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I am taking this medication for muscle weakness." 2. "I am to take a total of ten 60-mg tablets spaced throughout the day." 3. "I should use nightlights at home for safety when walking." 4. "I should keep all appointments with my healthcare provider because I will need blood work." 5. "Black tarry stools are an expected effect of this medication." Answer: 1, 2, 3, 4 Explanation: Stating the correct reason for the medication is an indication that instruction has been effective. Stating the correct dosing schedule is an indication that instruction has been effective. Stating applicable safety precautions when taking this medication is an indication that instruction has been effective. The client will need follow-up laboratory studies on liver function. This is an indication that instruction has been effective. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-7 Apply the nursing process to care for patients receiving pharmacotherapy with cholinergic agonists.

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28) The nurse is discussing nicotine replacement therapy (NRT) with a client who wants to stop smoking but is afraid of the withdrawal symptoms. Which are symptoms of nicotine withdrawal? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increased alertness 2. Difficulty sleeping 3. Depression 4. Nausea 5. Headaches Answer: 2, 3, 5 Explanation: Symptoms of nicotine withdrawal include difficulty sleeping, lack of concentration, depression, headaches, and food cravings. Symptoms of nicotine withdrawal include difficulty sleeping, lack of concentration, depression, headaches, and food cravings Symptoms of nicotine withdrawal include difficulty sleeping, lack of concentration, depression, headaches, and food cravings. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-5 Explain the actions and pharmacologic applications of nicotine. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 14 Cholinergic Antagonists 1) While a client is paralyzed with neuromuscular blockers, which assessment finding would the nurse expect? 1. Conscious 2. Stuporous but can be aroused 3. Heavily sedated but conscious 4. Unconscious Answer: 1 Explanation: The client receiving a neuromuscular blocking agent should remain at a baseline level of consciousness. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14-5 Compare and contrast the actions of the depolarizing and nondepolarizing neuromuscular blockers. 2) Which assessment finding indicates that a neuromuscular blocking agent has not produced the 245

expected effect? 1. Consciousness 2. Hypotension 3. Restlessness 4. Drowsiness Answer: 3 Explanation: Restlessness indicates that the neuromuscular blocking agent has not resulted in muscle paralysis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14-5 Compare and contrast the actions of the depolarizing and nondepolarizing neuromuscular blockers.

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3) Which statement is accurate regarding the difference between succinylcholine, which is the only depolarizing neuromuscular blocker, and a nondepolarizing neuromuscular blocker? 1. Succinylcholine produces paralysis that is preceded by a brief period of muscle contraction. 2. Succinylcholine produces a state of flaccid paralysis. 3. Succinylcholine will produce sedation-like effects. 4. Succinylcholine produces a more prolonged state of paralysis. Answer: 1 Explanation: Succinylcholine produces paralysis that is preceded by a brief period of muscle contraction. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 4) A client concurrently receiving which medication would be at risk for an intensified succinylcholine reaction? 1. Acetaminophen 2. Aminoglycosides 3. Ibuprofen 4. Opioids Answer: 2 Explanation: Aminoglycosides can attach to the same binding site, causing an intensified reaction. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 14-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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5) The nurse counsels a client who has received the ganglionic-blocking agent mecamylamine (Vecamyl) about side effects. Which side effect will the nurse include in the teaching session? 1. Sweating 2. Diarrhea 3. Urinary incontinence 4. Blurred vision Answer: 4 Explanation: Blurred vision is a common effect associated with this drug's use in ophthalmic procedures. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 14-4 Identify indications for ganglionic blockers. 6) The nurse is caring for a client who is prescribed mecamylamine for hypertension. Which teaching point should the nurse emphasize with this client? 1. Take the drug with food. 2. Take the drug early in the morning. 3. Expect diarrhea as the major side effect. 4. Change positions slowly. Answer: 4 Explanation: Mecamylamine can cause orthostatic hypotension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 14-4 Identify indications for ganglionic blockers.

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7) When a long-acting, nondepolarizing neuromuscular blocker is given, the nurse can expect prolonged muscle relaxation in clients with which condition? 1. Hepatitis 2. Heart failure 3. Renal insufficiency 4. Chronic obstructive pulmonary disease Answer: 3 Explanation: Renal insufficiency will increase the time required to clear this drug from the body, leading to a prolonged drug effect. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 14-5 Compare and contrast the actions of the depolarizing and nondepolarizing neuromuscular blockers. 8) Before a procedure in which a neuromuscular blocking agent is used, the nurse will evaluate a client's electrolyte levels. Which abnormality would provoke the most concern? 1. Hypomagnesemia 2. Hyperkalemia 3. Hyponatremia 4. Hypercalcemia Answer: 2 Explanation: Hyperkalemia could cause cardiac arrest when a neuromuscular blocking agent is used. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 14-5 Compare and contrast the actions of the depolarizing and nondepolarizing neuromuscular blockers.

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9) When tubocurarine is administered, the nurse will first see paralysis of which muscles? 1. The levator muscles of the eyelid and muscles of mastication 2. The muscles in the lower extremities 3. The muscles controlling sphincters 4. The muscles of respiration and the diaphragm Answer: 1 Explanation: Paralysis of the levator muscles of the eyelid and muscles of mastication occurs first. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14-5 Compare and contrast the actions of the depolarizing and nondepolarizing neuromuscular blockers. 10) A client prescribed an anticholinergic treatment for Parkinson's disease reports he has benign prostatic hyperplasia (BPH) with urinary retention. Which intervention by the nurse is the most appropriate? 1. Instruct the client that the medication will not have an effect on BPH symptoms. 2. Instruct the client to drink less caffeine. 3. Instruct the client to drink more water. 4. Notify the healthcare provider about the client's report of BPH. Answer: 4 Explanation: It is important for the healthcare provider to know about a history of BPH, since an anticholinergic agent would be likely to worsen BPH symptoms. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 14-6 Compare and contrast the indications for drugs that block nicotinic receptors at the ganglia versus those that block nicotinic receptors at the neuromuscular junction.

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11) The nurse is preparing discharge teaching for a client prescribed an anticholinergic drug. Which teaching topic is most appropriate for the nurse to include? 1. Decrease caffeine intake. 2. Drink warm fluids to assist with symptoms of dry mouth. 3. Increase dietary intake of high-fiber foods. 4. Take a daily laxative. Answer: 3 Explanation: Constipation is common. Clients should increase intake of high-fiber foods. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 14-3 Identify symptoms of anticholinergic syndrome. 12) A client receives succinylcholine for paralysis during an endoscopy. During the procedure, the client's muscles become rigid, and the skin feels hot to the touch. Which effect will the nurse document in the medical record once the client is stabilized? 1. Septicemia 2. Esophageal perforation 3. Hyperthyroid storm 4. Malignant hyperthermia Answer: 4 Explanation: Rigid muscles and hot skin represent a common presentation of malignant hyperthermia, a life-threatening adverse effect of succinylcholine. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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13) The nurse prepares a client for a diagnostic procedure where succinylcholine will be administered. Which information should be given to the client? 1. Succinylcholine is not associated with any side effects. 2. Transient muscle pain is common after receiving succinylcholine. 3. Nerve damage can occur after receiving succinylcholine. 4. There is a high risk of arrhythmias with administration of succinylcholine. Answer: 2 Explanation: It is common for succinylcholine to cause transient muscle pain due to muscle contraction prior to paralysis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 14-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 14) Which assessment findings does the nurse expect in a client who received a medication that is a muscarinic antagonist? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Dilated pupils 2. Increased heart rate 3. Hypoactive bowel sounds 4. Deep rapid respirations 5. Excessive salivation Answer: 1, 2, 3, 4 Explanation: Dilated pupils are an expected response from a muscarinic antagonist. Increased heart rate is an expected response from a muscarinic antagonist. Hypoactive bowel sounds are an expected response from a muscarinic antagonist. Deep rapid respirations are an expected response from a muscarinic antagonist. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14-1 Describe how the therapeutic actions and adverse effects of the cholinergic antagonists can be explained by their blockade of muscarinic or nicotinic receptors. 252

15) A client is admitted with an exacerbation of chronic obstructive pulmonary disease (COPD). Which medications would help with this client's symptoms? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Ipratropium (Atrovent) 2. Tiotropium (Spiriva) 3. Oxybutynin (Ditropan) 4. Benztropine (Cogentin) 5. Glycopyrrolate (Robinul) Answer: 1, 2 Explanation: The muscarinic antagonist ipratropium (Atrovent) is useful in treating chronic obstructive pulmonary disease because it will dilate the bronchi. The muscarinic antagonist tiotropium (Spiriva) is useful in treating chronic obstructive pulmonary disease because it will dilate the bronchi. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 14-2 Identify indications for muscarinic antagonists. 16) A client is receiving titrated doses of mecamylamine (Vecamyl). Which assessment findings indicate this client is experiencing adverse effects from this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Orthostatic hypotension 2. Nausea 3. Dry mouth 4. Facial flushing 5. Body rash Answer: 1, 2, 3 Explanation: Orthostatic hypotension is an adverse effect of this medication. Nausea is an adverse effect of this medication. Dry mouth is an adverse effect of this medication. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14-4 Identify indications for ganglionic blockers.

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17) A client admitted with exacerbation of asthma reports using ipratropium (Atrovent) up to 24 inhalations each day. Which assessment findings indicate the client is experiencing anticholinergic syndrome? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Photophobia 2. Difficulty swallowing 3. Agitation 4. Blurred vision 5. Excessive salivation Answer: 1, 2, 3, 4 Explanation: Photophobia is a symptom of anticholinergic syndrome. Difficulty swallowing is a symptom of anticholinergic syndrome. Agitation is a symptom of anticholinergic syndrome. Blurred vision is a symptom of anticholinergic syndrome. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14-3 Identify symptoms of anticholinergic syndrome.

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18) During a surgical procedure, a client begins to demonstrate respiratory depression and hypotension after receiving a nondepolarizing blocker. Which treatments are indicated for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Neostigmine (Prostigmin) 2. An antihistamine 3. Succinylcholine (Anectine) 4. A diuretic 5. Quinidine Answer: 1, 2 Explanation: The adverse effects of a nondepolarizing blocker can be treated by administering an acetylcholinesterase inhibitor such as neostigmine (Prostigmin). Hypotension can result after the administration of a nondepolarizing blocker, which is treated with an antihistamine-to-block histamine release. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 14-5 Compare and contrast the actions of the depolarizing and nondepolarizing neuromuscular blockers.

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19) A client is being prepared to receive succinylcholine (Anectine). For which types of procedures is this neuromuscular blocker indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Intubation 2. Electroconvulsive therapy 3. Total hip replacement 4. Craniotomy 5. Mitral valve replacement Answer: 1, 2 Explanation: Succinylcholine (Anectine) is indicated for very short procedures such as intubation. Succinylcholine (Anectine) is indicated for very short procedures such as electroconvulsive therapy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 14-6 Compare and contrast the indications for drugs that block nicotinic receptors at the ganglia versus those that block nicotinic receptors at the neuromuscular junction.

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20) A client is scheduled for surgery to repair an abdominal aortic aneurysm. Which neuromuscular blocking agents will be the best choice for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Tubocurarine 2. Pancuronium (Pavulon) 3. Vecuronium (Norcuron) 4. Succinylcholine (Anectine) Answer: 1, 2, 3 Explanation: Tubocurarine is used as an adjunct to anesthesia to cause complete skeletal muscle relaxation of the abdominal muscles during operative procedures. This is an intermediate-acting nondepolarizing neuromuscular blocking agent that can be used for this surgical procedure. This is an intermediate-acting nondepolarizing neuromuscular blocking agent that can be used for this surgical procedure. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 14-6 Compare and contrast the indications for drugs that block nicotinic receptors at the ganglia versus those that block nicotinic receptors at the neuromuscular junction. 21) For intubation, a client received 0.5 mg/kg of succinylcholine (Anectine) with a repeat dose of 0.7 mg/kg. The client weighs 154 lb. How many milligrams of the medication did the client receive for both doses? Record your answer rounding to the nearest whole number. Answer: 84 Explanation: The client weighs 154 lb or 70 kg. For the initial dose, the client received 0.5 mg/70 kg or 35 mg of the medication. For the repeat dose, the client received 0.7 mg × 70 kg or 49 mg of the medication. The client received a total of 84 mg of the medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 14-8 Apply the nursing process to care for patients receiving pharmacotherapy with cholinergic antagonists.

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22) The nurse is preparing discharge instructions for a client prescribed an anticholinergic medication. What should be included in this teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Report palpitations to the healthcare provider. 2. Report shortness of breath to the healthcare provider. 3. Expect to be dizzy with this medication. 4. Difficulty swallowing is an expected effect of this medication. 5. Fainting might occur. Answer: 1, 2 Explanation: The client should be instructed to report palpitations to the healthcare provider. The client should be instructed to report shortness of breath to the healthcare provider. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 14-8 Apply the nursing process to care for patients receiving pharmacotherapy with cholinergic antagonists. 23) What will the nurse most likely assess in the client with Parkinson's disease who is prescribed a muscarinic antagonist? 1. Diarrhea 2. Reduced tremors and rigidity 3. Increased urine output 4. Rhinorrhea Answer: 2 Explanation: Muscarinic antagonists are prescribed to reduce the muscular tremor and rigidity associated with Parkinson's disease. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14-1 Describe how the therapeutic actions and adverse effects of the cholinergic antagonists can be explained by their blockade of muscarinic or nicotinic receptors.

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24) A client is receiving tiotropium. Which element in the client's history would be a contraindication for this medication? 1. Bronchospasm 2. Hypertension 3. Type 2 diabetes mellitus 4. Constipation Answer: 1 Explanation: Muscarinic antagonists can cause worsening of sinusitis, paradoxical bronchospasm, and oropharyngeal candidiasis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14-1 Describe how the therapeutic actions and adverse effects of the cholinergic antagonists can be explained by their blockade of muscarinic or nicotinic receptors. 25) Which is the primary effect of a ganglionic blocker such as mecamylamine? 1. Lowers intraocular pressure (IOP) 2. Improves motor response 3. Lowers blood pressure 4. Elevates mood Answer: 3 Explanation: Ganglionic blockers cause vasodilation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14-4 Identify indications for ganglionic blockers.

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26) The nurse is caring for a client who is prescribed a muscarinic antagonist. When teaching a client about the medication, what is important to include? 1. "Muscarinic antagonists are referred to as anticholinergics." 2. "Nicotinic antagonists block the muscarinic synapses." 3. "Parasympatholytics are used to assist with cardiac rhythm disorders." 4. "The central nervous system is not affected by the muscarinic antagonists." Answer: 1 Explanation: Muscarinic antagonists are often referred to as anticholinergics. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14-2 Identify indications for muscarinic antagonists. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 15 Adrenergic Agonists 1) A client diagnosed with asthma asks the nurse why an albuterol (Proventil) inhaler is better than isoproterenol (Isuprel). The nurse's response should be based on the physiologic concept that isoproterenol primarily affects which receptors? 1. Alpha1 receptors 2. Beta1 and beta2 receptors 3. Alpha2 receptors 4. All of the receptors Answer: 2 Explanation: Isoproterenol affects beta1 and beta2 receptors. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-1 Identify the physiologic responses produced when a drug activates adrenergic receptors.

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2) Phenylephrine is to be used for a client to reverse hypotension caused by spinal anesthesia. For which symptoms should the nurse assess the client as contraindications to this drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Angina 2. Parkinson's disease 3. Closed-angle glaucoma 4. Asthma 5. Severe hypertension Answer: 1, 3, 5 Explanation: Phenylephrine causes vasoconstriction, which can lead to angina. Because of its effects on the eye, phenylephrine should not be used in clients with closed-angle glaucoma. Phenylephrine is contraindicated in clients with severe hypertension, because it can raise blood pressure to dangerous levels. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 3) One of the reasons epinephrine causes an intense fight-or-flight response throughout the body is because it stimulates which receptors? 1. The alpha receptors only 2. All four types of adrenergic receptors 3. The beta2 receptors only 4. The beta1 receptors only Answer: 2 Explanation: Epinephrine stimulates all four types of receptors, and hence causes an intense fight-or-flight response, the effects of which are seen all over the body. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-1 Identify the physiologic responses produced when a drug activates adrenergic receptors. 261

4) A client receives epinephrine for anaphylactic shock. The nurse should be aware of which mechanism by which epinephrine acts? 1. Inhibiting reuptake of norepinephrine from the synaptic cleft 2. Indirectly, by promoting release of norepinephrine 3. Directly, by stimulating adrenergic receptors 4. Inhibiting destruction of norepinephrine by enzyme MAO Answer: 3 Explanation: Epinephrine acts directly by stimulating adrenergic receptors. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 15-2 Explain the direct and indirect mechanisms by which adrenergic agonists act. 5) A client with Parkinson's disease who is receiving entacapone (Comtan) is to be given epinephrine for cardiopulmonary resuscitation. The nurse should be aware that entacapone (Comtan) causes an increased effect of epinephrine on the heart due to which action? 1. Stimulation of the enzyme COMT in the synaptic cleft 2. Inhibition of the enzyme COMT in the synaptic cleft 3. Increased reuptake of the enzyme COMT from the synaptic cleft 4. Excessive secretion of the enzyme COMT from the synaptic vesicles Answer: 2 Explanation: Entacapone (Comtan) causes inhibition of COMT in the synaptic cleft. This causes an increased effect of epinephrine on the heart and blood pressure. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-2 Explain the direct and indirect mechanisms by which adrenergic agonists act.

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6) A low-dose dopamine infusion is to be started for a client diagnosed with hypovolemic shock. Which assessment finding indicates the drug is having the desired therapeutic effect? 1. Nausea 2. Increased urine output 3. Increased blood pressure 4. Ventricular tachycardia Answer: 2 Explanation: At low doses, dopamine selectively stimulates dopaminergic receptors, especially in the kidneys, causing increased urine output. At higher doses, dopamine stimulates beta1-adrenergic receptors, causing the heart to beat more forcefully, thus increasing cardiac output. Also, at higher doses, dopamine stimulates alpha1-adrenergic receptors, causing vasoconstriction and increased blood pressure. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-3 Compare and contrast the characteristics of catecholamines and noncatecholamines. 7) A client taking an MAO inhibitor for hypertension asks the nurse for medication to relieve nasal congestion. The nurse should know that phenylephrine will be a poor choice for this client because it might cause which condition? 1. Tinnitus 2. Hypokalemia 3. Dizziness 4. Hypertension Answer: 4 Explanation: Phenylephrine should not be administered within 21 days of an MAO inhibitor, or a hypertensive crisis could occur. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 15-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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8) Why are adrenergic agonists such as epinephrine given parenterally or by inhalation instead of orally? 1. They are not easily digested in the gastrointestinal tract. 2. They produce toxic by-products in the blood. 3. They are rapidly absorbed by the blood. 4. They are metabolized by the enzyme COMT in the intestinal tract. Answer: 4 Explanation: Epinephrine is metabolized by the enzymes MAO and COMT in the liver and in most tissues; hence, it is not absorbed orally. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-3 Compare and contrast the characteristics of catecholamines and noncatecholamines. 9) A client diagnosed with narcolepsy is prescribed ephedrine, and asks the nurse how this medication will improve the problem. The nurse's response will be based on which physiologic concept? 1. Ephedrine will prevent any attacks of epilepsy. 2. Ephedrine can be easily destroyed by the enzymes in the synaptic cleft. 3. Ephedrine can easily cross the blood–brain barrier. 4. Ephedrine cannot be easily absorbed through the intestinal tract. Answer: 3 Explanation: Ephedrine is a noncatecholamine. Noncatecholamines are less polar than are catecholamines; hence, they are able to cross the blood–brain barrier, cause stimulation of the brain cells, and keep the client awake and alert. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-3 Compare and contrast the characteristics of catecholamines and noncatecholamines.

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10) A client is prescribed tetrahydrozoline (Tyzine) for redness of the eye. Which rationale supports the use of this medication? 1. Constriction of the pupil 2. Absorption of fluid in the conjunctival sac 3. Vasoconstriction of the arterioles in the eye 4. Relaxation of the radial muscles of the iris Answer: 3 Explanation: Because of alpha1-receptor activation, tetrahydrozoline (Tyzine) causes vasoconstriction of the vessels in the eye, reducing the conjunctival congestion and redness. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-4 Identify indications for pharmacotherapy with adrenergic agonists. 11) A client who was stung by a bee is treated with an epinephrine auto-injection. Which assessment finding indicates that the drug is working? 1. Increased blood pressure 2. Constriction of the pupils 3. Increased urinary output 4. Spasm of the bronchus Answer: 1 Explanation: Immediately after injection, blood pressure increases due to stimulation of alpha1 receptors. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 15-4 Identify indications for pharmacotherapy with adrenergic agonists.

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12) A client is prescribed albuterol (Proventil) oral tablets for asthma. What should the nurse include when teaching the client about this medication? 1. "The dosage for this drug should be doubled if no effect is seen in a short time." 2. "This drug is very effective in treating acute attacks." 3. "This drug can be taken every 5 minutes for maximal effect." 4. "This drug must be taken 15 minutes before exercise." Answer: 4 Explanation: Albuterol can be used for prophylaxis of exercise-induced bronchospasm by administering it 15 minutes before exercise. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 15-4 Identify indications for pharmacotherapy with adrenergic agonists. 13) A client is prescribed a high-dose dopamine infusion. The nurse would expect to see an increase in blood pressure because of dopamine's effect on which receptors? 1. Alpha1-adrenergic receptors 2. Dopaminergic receptors 3. Beta2-adrenergic receptors 4. Beta1-adrenergic receptors Answer: 1 Explanation: Stimulation of alpha1-adrenergic receptors by high doses of dopamine causes vasoconstriction and increased blood pressure. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 15-5 Compare and contrast the types of responses that occur when a drug activates alpha1-, alpha2-, beta1-, or beta2-adrenergic receptors.

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14) Isoproterenol is an effective bronchodilator. It also produces adverse cardiovascular effects because of its effect on which receptors? 1. Alpha2 receptors 2. Beta1 receptors 3. Alpha1 receptors 4. Dopamine receptors Answer: 2 Explanation: Isoproterenol activates beta1 receptors to increase the strength of myocardial contraction and improve cardiac output. This increases its potential for causing serious side effects. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 15-5 Compare and contrast the types of responses that occur when a drug activates alpha1-, alpha2-, beta1-, or beta2-adrenergic receptors. 15) A client is prescribed salmeterol (Serevent) by inhalation for asthma. The client asks the nurse how the medication can help. The nurse's response should be based on the fact that salmeterol (Serevent) is which type of agonist? 1. Nonselective adrenergic agonist 2. Selective beta2 agonist 3. Selective alpha1 agonist 4. Selective beta1 agonist Answer: 2 Explanation: Salmeterol (Serevent) is a selective beta2 agonist with fewer cardiac side effects and a longer onset of action. Its effects are delayed, but persist for up to 12 hours. Hence it can be used as pharmacotherapy for chronic asthma and not for relieving acute bronchospasm. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-5 Compare and contrast the types of responses that occur when a drug activates alpha1-, alpha2-, beta1-, or beta2-adrenergic receptors.

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16) A client is prescribed oxymetazoline (OcuClear) ophthalmic solution for redness of the eye and eye irritation. Which statements are appropriate for the nurse to include in this client's teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Transient stinging can occur. 2. Expect some dizziness. 3. Blurred vision is possible. 4. Headache or brow pain can occur. 5. Vomiting is a common occurrence with this drug. Answer: 1, 3, 4 Explanation: Oxymetazoline (OcuClear) is an alpha1-adrenergic agonist. Activation of these receptors in the arterioles of the eye causes vasoconstriction and stinging. Oxymetazoline (OcuClear) is an alpha1-adrenergic agonist. Activation of these receptors in the arterioles of the eye causes blurred vision and sensitivity to light. Oxymetazoline (OcuClear) is an alpha1-adrenergic agonist. Headache or brow pain is a frequent side effect early on. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 15-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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17) The nurse is getting ready to use an epinephrine auto-injector (EpiPen) for a client who was bitten by a wasp. In order for the EpiPen to be fully effective, where will the nurse educate the client to store it? 1. On the counter 2. In the refrigerator 3. At a warm temperature 4. In a dark place Answer: 4 Explanation: An EpiPen is sensitive to light, so it should be kept in a cool, dark place. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 18) The nurse is starting a high-dose dopamine infusion for a client diagnosed with shock. The nurse should monitor the client for which side effect of this drug? 1. Angina 2. Ventricular tachycardia 3. Bronchospasm 4. Urinary retention Answer: 2 Explanation: High doses of dopamine stimulate beta1 receptors, causing the heart to beat more rapidly, hence causing ventricular tachycardia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 15-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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19) A client is given ephedrine (Efedron) for bronchial asthma. The nurse should ask the client to report which effect of this drug? 1. Drowsiness 2. Palpitations 3. Excessive vomiting 4. Increased appetite Answer: 2 Explanation: Ephedrine can be used in bronchial asthma because of beta2-receptor stimulation. It also stimulates beta1 and alpha receptors, which causes cardiac side effects. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 15-7 Apply the nursing process to care for patients receiving pharmacotherapy with adrenergic agonists. 20) The nurse is teaching a client about the use of phenylephrine (Neo-Synephrine) nasal spray. Which statement by the nurse is the most appropriate to include in the teaching plan? Note: Credit will be given only if all corrected choices and no incorrect choices are selected. Select all that apply. 1. "Avoid caffeine-containing beverages while taking this drug." 2. "You must use this spray for a period of 10 days continually for maximal effects." 3. "You can use this spray for treating other members in the family." 4. "Report symptoms of excessive use of this drug, such as palpitations and nervousness." 5. "Do not use this drug if you have heart disease." Answer: 1, 4, 5 Explanation: Caffeine-containing beverages should be avoided because they can cause excessive nervousness and tremors if taken with phenylephrine (Neo-Synephrine). Palpitations and nervousness are serious side effects of this drug and must be reported. Phenylephrine (Neo-Synephrine) cannot be used by a person with cardiovascular disease unless prescribed by the healthcare provider. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 15-7 Apply the nursing process to care for patients receiving pharmacotherapy with adrenergic agonists. 270

21) A client is prescribed isoproterenol for ventricular dysrhythmia. Which concurrent medication order would cause the nurse to question the order for isoproterenol? 1. Analgesic 2. MAO inhibitor 3. Cardiac glycoside 4. Anti-inflammatory drug Answer: 2 Explanation: Isoproterenol is metabolized by COMT and MAO in the liver; hence MAO inhibitors should be discontinued 2 weeks prior to isoproterenol therapy to prevent hypertensive crisis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-7 Apply the nursing process to care for patients receiving pharmacotherapy with adrenergic agonists. 22) The nurse is concerned that a client receiving epinephrine is experiencing autonomic nervous system adverse effects when which items are found on assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Tachycardia 2. Ventricular dysrhythmia 3. Elevated blood pressure 4. Elevated blood glucose level 5. Flaccid paralysis Answer: 1, 2, 3, 4 Explanation: Tachycardia is an autonomic nervous system adverse effect of epinephrine. Ventricular dysrhythmia is an autonomic nervous system adverse effect of epinephrine. Hypertension is an autonomic nervous system adverse effect of epinephrine. Hyperglycemia is an autonomic nervous system adverse effect of epinephrine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-1 Identify the physiologic responses produced when a drug activates adrenergic receptors. 271

23) A client is being treated for cocaine and amphetamine abuse. The nurse realizes that the client's symptoms are caused by which actions of these substances on the central nervous system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Stimulate the release of norepinephrine on the presynaptic neuron. 2. Inhibit the reuptake of norepinephrine from the synaptic cleft back to the presynaptic neuron. 3. Inhibit the destruction of norepinephrine by the enzyme monoamine oxidase. 4. Inhibit alpha1 receptors. 5. Stimulate beta2 receptors. Answer: 1, 2 Explanation: This is a mechanism of action for amphetamines. This is a mechanism of action for cocaine. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15-2 Explain the direct and indirect mechanisms by which adrenergic agonists act. 24) A client is prescribed a medication that is a catecholamine. The nurse will expect the pharmacy to prepare the medication to be administered through which routes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Intravenous 2. Inhalation 3. Oral 4. Topical 5. Subcutaneous Answer: 1, 2, 4, 5 Explanation: One route of catecholamine administration is parenteral. One route of catecholamine administration is inhalation. Catecholamines can be administered through the topical route. Catecholamines can be administered through the subcutaneous route. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 15-3 Compare and contrast the characteristics of catecholamines and noncatecholamines. 25) A client is diagnosed with hypertension. The nurse should prepare to instruct the client about 272

which alpha2 agonists? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Methyldopa (Aldomet) 2. Clonidine (Catapres) 3. Tetrahydrozoline (Tyzine) 4. Midodrine (ProAmatine) 5. Pirbuterol (Maxair) Answer: 1, 2 Explanation: Methyldopa (Aldomet) is an alpha2 agonist. It decreases blood pressure; the primary therapeutic application is the treatment of hypertension. Clonidine (Catapres) is an alpha2 agonist. It decreases blood pressure; the primary therapeutic application is the treatment of hypertension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 15-4 Identify indications for pharmacotherapy with adrenergic agonists. 26) A client is having difficulty managing symptoms of acute bronchospasm. Which medications would be indicated for this client's symptoms? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Albuterol (Proventil) 2. Levalbuterol (Xopenex) 3. Pirbuterol (Maxair) 4. Arformoterol (Brovana) 5. Formoterol (Foradil) Answer: 1, 2, 3 Explanation: Albuterol (Proventil) is a short-acting beta-adrenergic agonist given by inhalation to terminate acute bronchospasm. Levalbuterol (Xopenex) is a short-acting beta-adrenergic agonist given by inhalation to terminate acute bronchospasm. Pirbuterol (Maxair) is a short-acting beta-adrenergic agonist given by inhalation to terminate acute bronchospasm. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 15-4 Identify indications for pharmacotherapy with adrenergic agonists. 273

27) A client with heart failure is started on a beta1-agonist medication to improve cardiac output. The nurse would explain that this medication performs which action? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increases cardiac output. 2. Increases the strength of myocardial contractions. 3. Relaxes bronchial smooth muscle. 4. Prevents low blood pressure. 5. Treats high blood pressure. Answer: 1, 2 Explanation: Drugs used for their beta1-agonist actions are sometimes called cardiotonic drugs because they increase cardiac output. Drugs used for their beta1-agonist actions are sometimes called inotropic drugs because they increase the strength of myocardial contraction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 15-5 Compare and contrast the types of responses that occur when a drug activates alpha1-, alpha2-, beta1-, or beta2-adrenergic receptors.

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28) A client with cardiac disease is prescribed isoproterenol (Isuprel). Which medications, if also prescribed to the client, would cause the nurse to question this order? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Potassium-wasting diuretic 2. Cardiotonic 3. Anticoagulant 4. Antihyperglycemic 5. Antibiotic Answer: 1, 2 Explanation: Isoproterenol (Isuprel) should not be concurrently administered with potassium-wasting diuretics because hypokalemia may result. Isoproterenol (Isuprel) may lower serum levels of digoxin and induce dysrhythmias. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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29) A client is receiving an infusion of an adrenergic agonist. Which actions should the nurse take when monitoring this infusion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use an infusion pump. 2. Frequently assess the infusion site. 3. Stop the infusion with signs of extravasation. 4. Raise the head of the bed. 5. Report signs of urinary retention. Answer: 1, 2, 3, 5 Explanation: All intravenous adrenergic infusions should be administered with an infusion pump. The site should be frequently assessed for extravasation. The intravenous infusion should be immediately stopped if signs of extravasation occur. Urinary retention should be reported immediately. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15-7 Apply the nursing process to care for patients receiving pharmacotherapy with adrenergic agonists.

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30) A client is prescribed an ophthalmic adrenergic agonist medication. What should the nurse include when instructing the client about this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Wear sunglasses when going out of doors. 2. Talk with the healthcare provider before using soft contact lenses. 3. Wear sunglasses when exposed to bright indoor lights. 4. Stinging will occur temporarily after instilling. 5. Eye irritation will continue for a week after discontinuing the medication. Answer: 1, 2, 3, 4 Explanation: This medication causes photosensitivity, and sunglasses may be needed for outdoor activities. Soft contact lens users should check with the healthcare provider before using because some preparations may stain lenses. This medication causes photosensitivity, and sunglasses may be needed in bright indoor light. Stinging will occur for a brief period after instilling. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 15-7 Apply the nursing process to care for patients receiving pharmacotherapy with adrenergic agonists. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 16 Adrenergic Antagonists 1) Which symptom is the client who is prescribed alpha1-antagonist therapy likely to complain of within the first 24 hours? 1. Difficulty swallowing 2. Blurring of vision 3. Decreased urinary frequency 4. Attacks of dizziness and faintness Answer: 4 Explanation: The first-dose phenomenon causes syncope due to reduced blood flow to the brain, and so attacks of dizziness and faintness can occur. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment 277

Learning Outcome: 16-1 Identify the physiologic responses produced when a drug blocks alpha1-, alpha2-, beta1-, and beta2-adrenergic receptors. 2) A client is prescribed alfuzosin (Uroxatral) for benign prostatic hyperplasia (BPH). The nurse should anticipate which intended effect of this drug? 1. Increased formation of residual urine in the bladder 2. Increased reabsorption of sodium in the kidney tubules 3. Excessive excretion of sodium in the urine 4. Increased frequency of urinary excretion Answer: 4 Explanation: Alfuzosin (Uroxatral) is an alpha1-antagonist drug that causes increased urinary frequency due to more active smooth muscle contractions in the urinary tract. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16-2 Identify indications for pharmacotherapy with alpha1- and alpha2-adrenergic antagonists.

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3) A client is given tamsulosin (Flomax) for benign prostatic hyperplasia (BPH). The nurse knows that the action of this drug is due to selective blockade of which receptor? 1. Alpha1 2. Alpha2 3. Beta2 4. Beta1 Answer: 1 Explanation: Alpha1 receptors in the smooth muscle in the trigone and sphincter muscles at the base of the urinary bladder and in the prostate are blocked by this drug, causing relaxation of these muscles and an increase in the urine flow in clients who have difficulty voiding. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16-2 Identify indications for pharmacotherapy with alpha1- and alpha2-adrenergic antagonists. 4) Phentolamine is an antidote used for treating hypertensive emergencies caused by catecholamine overdose because it blocks which type of receptors? 1. Alpha1 receptors 2. Alpha2 receptors 3. Both beta1 and beta2 receptors 4. Both alpha1 and alpha2 receptors Answer: 4 Explanation: Phentolamine is nonselective, blocks both alpha1 and alpha2 receptors, and can be used to treat or prevent hypertensive crises caused by catecholamine overdose. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-2 Identify indications for pharmacotherapy with alpha1- and alpha2-adrenergic antagonists.

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5) A client diagnosed with hypertension is prescribed carvedilol (Coreg) and complains of dizziness and faintness immediately after taking this medication. The nurse knows that this effect is due to the action of which receptors? 1. Beta2 receptors only 2. Beta1 and beta2 receptors 3. Beta1 receptors only 4. Alpha1, beta1, and beta2 receptors Answer: 4 Explanation: Carvedilol (Coreg) is classified as a nonselective beta blocker, blocking both the beta1 and beta2 receptors as well as the alpha1 receptors. The dizziness and faintness are due to its effect on all of these receptors. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 16-3 Identify indications for pharmacotherapy with nonselective beta-adrenergic antagonists. 6) A client is prescribed sotalol (Betapace) for a cardiac dysrhythmia. The nurse knows that sotalol (Betapace) is used in this client because it performs which action? 1. Increases secretion of renin from the kidneys. 2. Decreases sympathetic output from the vasomotor center in the brain. 3. Slows the travel of impulses across the myocardium. 4. Diminishes myocardial contractility. Answer: 3 Explanation: Sotalol (Betapace) is a nonselective beta blocker used exclusively as an antidysrhythmic because it slows the action potential crossing the myocardium, allowing the heart to regain normal rhythm. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-3 Identify indications for pharmacotherapy with nonselective beta-adrenergic antagonists.

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7) The nurse should question an order for propranolol (Inderal) in treatment of hypertension when the client has which associated disorders? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Angina pectoris 2. Dysrhythmias 3. Hyperlipidemia 4. Asthma 5. Liver failure Answer: 3, 4 Explanation: Propranolol increases serum triglycerides and decreases high-density lipoproteins. Patients with preexisting hyperlipidemia should have their lipid profiles monitored periodically to prevent hyperlipidemia. Propranolol is a nonselective beta blocker and can block the beta2 receptors in the lung, which can be dangerous in cases of asthma. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-3 Identify indications for pharmacotherapy with nonselective beta-adrenergic antagonists.

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8) A client is to be treated for an overdose of propranolol (Inderal). Which medications should the nurse anticipate being used? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Prazosin 2. Isoproterenol 3. Atropine 4. Metoprolol 5. Digoxin Answer: 2, 3, 5 Explanation: Isoproterenol is an adrenergic agonist that is used to treat overdose of propranolol to reverse the bronchoconstriction. Atropine is an anticholinergic drug that is used to treat overdose of propranolol to reverse the severe bradycardia. Cardiac failure caused by beta-antagonist overdose can be treated by administering digoxin (Lanoxin) or diuretics. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-3 Identify indications for pharmacotherapy with nonselective beta-adrenergic antagonists. 9) For which symptoms should the nurse teach the client to monitor when taking doxazosin (Cardura)? 1. Dizziness and headache 2. Difficulty in breathing 3. Decreased urinary frequency 4. Constipation Answer: 1 Explanation: The most common side effects of doxazosin (Cardura) include dizziness, drowsiness, fatigue, and weakness. Also, first-dose syncope can occur 30 to 90 minutes following the initial dose, so the nurse should teach the client to be cautious. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-4 Identify indications for pharmacotherapy with selective beta1-adrenergic antagonists.

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10) An older client who is prescribed terazosin (Hytrin) for treatment of benign prostatic hyperplasia (BPH) asks the nurse the reason why this drug should initially be taken at bedtime. On which rationale will the nurse base the response to the client? 1. It can cause a sudden fall in blood pressure. 2. It can depress the vasomotor center in the brain. 3. It can decrease the blood supply to the kidneys. 4. It can reduce the formation of urine at bedtime. Answer: 1 Explanation: Terazosin (Hytrin) can cause a sudden fall in blood pressure. First-dose syncope generally occurs 30 to 90 minutes after an initial dose of 2 mg or more, which causes a sudden fall in blood pressure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-4 Identify indications for pharmacotherapy with selective beta1-adrenergic antagonists. 11) Prazosin (Minipress) is prescribed for a hypertensive client. Which measure should be used by the nurse to prevent the first-dose phenomenon? 1. Give the dosage early in the morning before breakfast. 2. Give initial low doses at bedtime. 3. Give the dosage with meals. 4. Give an initial high dosage and then lower gradually. Answer: 2 Explanation: First-dose syncope with sudden loss of consciousness generally occurs 30 to 90 minutes after an initial dose of 2 mg or more. This can cause a sudden fall in blood pressure, so the initial low doses of 1 mg must be given at bedtime. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 16-4 Identify indications for pharmacotherapy with selective beta1-adrenergic antagonists.

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12) A client diagnosed with hypertension is prescribed atenolol (Tenormin). The nurse knows that this medication is a selective beta1 blocker and can be safely used for clients with which concurrent diagnosis? 1. Asthma 2. Diabetes 3. Heart failure 4. Hepatic disease Answer: 1 Explanation: Atenolol is a selective beta1-adrenergic blocker that blocks beta1 receptors in the cardiac tissue only. Since it does not affect the receptors in the lungs, there is less possibility of bronchospasm. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-5 Explain the advantages of selective beta antagonists versus nonselective beta antagonists. 13) Which medication should the nurse anticipate to be prescribed for a client with asthma and hypertension? 1. Metoprolol (Lopressor) 2. Propranolol (Inderal) 3. Sotalol (Betapace) 4. Nadolol (Corgard) Answer: 1 Explanation: Metoprolol is a selective beta1-adrenergic blocker that blocks beta1 receptors in the cardiac tissue only. Since it does not affect the receptors in the lungs, there is less possibility of bronchospasm. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 16-5 Explain the advantages of selective beta antagonists versus nonselective beta antagonists.

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14) Which instruction should the nurse include in the discharge teaching plan of a client being treated with propranolol (Inderal) for angina? 1. "Salt and salt substitutes can be used with this medication." 2. "Take a double dose if you miss a dose." 3. "Do not stop taking this medication without talking to your healthcare provider." 4. "Use an OTC medication if you develop nasal allergies." Answer: 3 Explanation: Propranolol (Inderal) must not be abruptly discontinued because abrupt discontinuation can cause tremors, sweating, palpitation, malaise, headache, rebound HTN, and life-threatening dysrhythmias (in patients with angina pectoris or MI). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 15) A client prescribed propranolol (Inderal) for angina asks the nurse why this drug should not be abruptly discontinued. The nurse would be correct in telling the client that abrupt withdrawal could lead to which result? 1. Extreme weight loss 2. Increase in blood glucose levels 3. Rebound chest pain or heart attack 4. Insomnia Answer: 3 Explanation: Beta blockers should be withdrawn gradually over several weeks. If withdrawn abruptly, the heart displays hypersensitivity to catecholamines, and sweating, palpitations, headache, and tremulousness can occur. This phenomenon is called rebound cardiac excitation. Clients with coronary artery disease might experience a worsening of angina symptoms, and MIs have been recorded in some clients. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 16) The nurse is preparing a care plan for an older adult client diagnosed with hypertension who is prescribed prazosin (Minipress) 1 mg 2 times a day. Which instructions should the nurse include in 285

the care plan for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. This drug decreases urinary output and causes urinary retention. 2. The first dose should be given at bedtime. 3. Monitor for drug-related side effects such as dizziness, fatigue, and weakness. 4. Client must be recumbent for 3 to 4 hours if the first dose is given during the daytime. 5. This drug can cause severe constipation, so a high-fiber diet is advisable. Answer: 2, 3, 4 Explanation: Administer the initial dose of prazosin (Minipress) at bedtime to minimize adverse effects, such as postural hypotension and syncope. The most common side effects of prazosin include dizziness, drowsiness, fatigue, weakness, palpitations, orthostatic hypotension, and headache, since this drug is an alpha1-adrenergic blocker that causes a rapid decrease in peripheral resistance that reduces blood pressure. If the initial dose of prazosin (Minipress) must be taken during the day, advise the client to remain recumbent for at least 3 to 4 hours and not to perform hazardous activities during that time. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 16-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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17) An older adult client who is taking doxazosin (Cardura) for hypertension is given a prescription of sildenafil (Viagra) for erectile dysfunction. The nurse should caution the client about which effect? 1. Sildenafil causes rapid elimination of doxazosin through the kidneys. 2. Sildenafil will potentiate the hypotensive effects of doxazosin. 3. Sildenafil blocks the absorption of doxazosin from the gastrointestinal tract. 4. Sildenafil causes hypertension, counteracting the effect. Answer: 2 Explanation: Use of doxazosin (Cardura) with erectile dysfunction agents such as sildenafil (Viagra) can cause increased hypotension, since both these drugs relax the smooth muscles of the vessels. Using both together can cause added hypotension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 18) A client is seen in the clinic for migraine headaches. The nurse anticipates that which medication might be prescribed as a prophylaxis for migraines? 1. Propranolol (Inderal) 2. Acebutolol 3. Carvedilol (Coreg) 4. Metoprolol (Lopressor) Answer: 1 Explanation: Propranolol is a nonselective beta-adrenergic antagonist, blocking both beta1 and beta2 receptors all over the body, so it is used in the prophylaxis of migraine headache. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 16-7 Apply the nursing process to care for patients receiving pharmacotherapy with adrenergic antagonists.

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19) In preparing a teaching plan for a client who is on acebutolol (Sectral), the nurse should include which instructions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Take the radial pulse before each dose and report any irregular pulse. 2. Report cold, painful, or tender feet or hands to your healthcare provider. 3. If a dose is missed, take a double dose next time. 4. Stop the medication completely if dizziness or headache occurs. 5. This drug must not be stopped abruptly but must be taken regularly. Answer: 1, 2, 5 Explanation: Acebutolol is an oral cardioselective beta1 antagonist similar to metoprolol that is used for HTN and recurrent ventricular dysrhythmias; high doses can produce hypotension and bradycardia. Take the radial pulse before each dose and report an irregular pulse or if pulse drops below the parameter recommended by the healthcare provider. Cold, painful, or tender feet or hands, or other symptoms of Raynaud's disease, such as cyanosis, intermittent pallor, redness, or paresthesias, can occur as a side effect of this drug and should be reported. The healthcare provider might prescribe a vasodilator. Acebutolol must be discontinued slowly over a period of 1 to 2 weeks. Sudden withdrawal can result in anginal attacks and MIs in clients diagnosed with angina pectoris, or in thyroid storm in clients diagnosed with hyperthyroidism. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 16-7 Apply the nursing process to care for patients receiving pharmacotherapy with adrenergic antagonists.

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20) The nurse is evaluating a client's response to a newly prescribed adrenergic agonist. Which assessment findings does the nurse anticipate this client will exhibit? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increased peristalsis 2. Dilated pupils 3. Increased salivation 4. Deep respirations 5. Decreased heart rate Answer: 1, 3, 5 Explanation: Increased peristalsis is a reaction consistent with the rest-and-digest response. Increased salivation is a reaction consistent with the rest-and-digest response. Decreased heart rate is a reaction consistent with the rest-and-digest response. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 16-1 Identify the physiologic responses produced when a drug blocks alpha1-, alpha2-, beta1-, and beta2-adrenergic receptors. 21) A client is prescribed an alpha1 antagonist for blood pressure control. When instructing the client, the nurse will include that this medication performs which action? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Blocks alpha1 receptors on arterial smooth muscle. 2. Dilates veins. 3. Blocks alpha2 receptors on arterial smooth muscle. 4. Reduces the heart rate. 5. Decrease the force of myocardial contraction. Answer: 1, 2 Explanation: Alpha1 antagonists block alpha1 receptors on arterial smooth muscle, which directly lowers blood pressure. Alpha1 antagonists dilate veins, which indirectly lowers the blood pressure by decreasing venous return to the heart. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 16-2 Identify indications for pharmacotherapy with alpha1- and alpha2-adrenergic antagonists. 289

22) A client with hypertension is prescribed a beta blocker. The effects that this medication will have on the client's blood pressure are due to which factors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Reduced myocardial contractility 2. Reduced release of renin 3. Relaxed arteriole smooth muscle 4. Reduced sympathetic output from the brain 5. Reduced lipolysis Answer: 1, 2, 3, 4 Explanation: Diminished myocardial contractility decreases cardiac output. The release of renin by the kidney, which is normally stimulated by catecholamines, is prevented. The nonselective adrenergic antagonists block alpha1-adrenergic receptors, relaxing arteriolar smooth muscle. Central actions reduce sympathetic output from the vasomotor center in the brain. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 16-2 Identify indications for pharmacotherapy with alpha1- and alpha2-adrenergic antagonists.

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23) The nurse learns that a client has been taking a beta-adrenergic antagonist but does not know why. For which disease processes should the nurse focus assessment with this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Angina pectoris 2. Dysrhythmias 3. Glaucoma 4. Hypertension 5. Chronic obstructive pulmonary disease Answer: 1, 2, 3, 4 Explanation: Beta-adrenergic antagonists decrease cardiac workload and oxygen demands and ease acute chest pain associated with angina pectoris. Beta-adrenergic antagonists slow cardiac conduction, which is helpful in the treatment of some dysrhythmias. Some beta-adrenergic antagonists reduce intraocular pressure, which is used in the treatment of glaucoma. Beta-adrenergic antagonists are used in the treatment of hypertension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16-3 Identify indications for pharmacotherapy with nonselective beta-adrenergic antagonists.

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24) A client reports feeling lightheaded and dizzy with palpitations after being instructed to increase the dose of a prescribed beta-adrenergic antagonist. How should the nurse respond to this client's symptoms? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "This is first-dose phenomenon." 2. "If the dose is increased again, take the medication at bedtime." 3. "This will go away in time." 4. "Maybe you have another health problem that needs to be examined." 5. "You may have taken too much medication." Answer: 1, 2 Explanation: First-dose phenomenon is the onset of orthostatic hypotension when beginning or changing the dose of a beta-adrenergic antagonist. Taking the medication at bedtime will reduce the onset of first-dose phenomenon. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16-4 Identify indications for pharmacotherapy with selective beta1-adrenergic antagonists.

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25) The nurse is concerned that a client who received a dose of phentolamine (Regitine) is experiencing adverse effects. Which assessment findings support this? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Hypotension 2. Tachycardia 3. Nausea 4. Vomiting 5. Headache Answer: 1, 2, 3, 4 Explanation: Phentolamine (Regitine) is a nonselective medication that activates both alpha1 and alpha2 receptors, which can cause the adverse effect of hypotension. Phentolamine (Regitine) is a nonselective medication that activates both alpha1 and alpha2 receptors, which can cause the adverse effect of tachycardia. Phentolamine (Regitine) is a nonselective medication that activates both alpha1 and alpha2 receptors, which can cause the adverse effect of nausea. Phentolamine (Regitine) is a nonselective medication that activates both alpha1 and alpha2 receptors, which can cause the adverse effect of vomiting. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16-5 Explain the advantages of selective beta antagonists versus nonselective beta antagonists.

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26) A client asks the nurse, "What would happen if I stop taking propranolol (Inderal)?" Which response by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You could start sweating and have palpitations." 2. "You could get a headache." 3. "You could develop nausea and vomiting." 4. "Nothing will occur." 5. "The medication will not work if prescribed again." Answer: 1, 2 Explanation: If beta blockers are withdrawn abruptly, the client could develop sweating and palpitations because of the sensitivity of the heart to catecholamines. If beta blockers are withdrawn abruptly, the client could develop a headache because of the sensitivity of the heart to catecholamines. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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27) Prior to administering a newly prescribed order for metoprolol (Toprol), the nurse reviews the client's medications and decides to question the order for which reason? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client is also prescribed a calcium channel blocker. 2. The client is already taking an antihypertensive medication. 3. The client is using cimetidine. 4. The client is taking oral contraceptives. 5. The client is taking aspirin. Answer: 1, 2, 3, 4 Explanation: Concurrent use of a beta1 blocker with a calcium channel blocker can cause bradycardia or heart block. Concurrent use of a beta1 blocker with an antihypertensive can cause additive hypotension. Concurrent use of a beta1 blocker with cimetidine can cause additive hypotension. Concurrent use of a beta1 blocker with oral contraceptives can cause additive hypotension. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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28) The nurse is preparing discharge instructions for a client who is prescribed an adrenergic antagonist. What should be included in this teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Weighing self daily, at the same time each day 2. How to measure blood pressure 3. How to measure pulse 4. Notifying the healthcare provider about a weight gain or loss of 2 lb in one day 5. Stopping taking the medication if dizziness occurs Answer: 1, 2, 3, 4 Explanation: The nurse should instruct the client to perform a daily weight at the same time of day. The nurse should instruct the client on blood pressure monitoring since this measurement should be recorded every day. The nurse should instruct the client on measuring the pulse since this measurement should be recorded every day. The nurse should instruct the client on the importance of reporting a weight gain or loss of 2 lb in a 24-hour period. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 16-7 Apply the nursing process to care for patients receiving pharmacotherapy with adrenergic antagonists. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 17 Review of the Central Nervous System 1) A client, prescribed an antidepressant for symptoms of depression, is expressing feelings of hopelessness and thoughts of suicide. The nurse's response will be based on which conclusion? 1. There is great variability in individual responses to drugs that affect the CNS. 2. The client has not been taking the antidepressant. 3. The antidepressant needs to be taken for several months in order to eliminate suicidal ideations. 4. Drug levels should be obtained to see if the dose needs to be increased. Answer: 1 Explanation: There is great client variability in symptoms and disease progression with conditions such as depression. Without a complete understanding of the etiology and pathophysiology of mental disorders, pharmacotherapy of these conditions and the development of new drug therapies for CNS disorders will remain challenging. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, 296

practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 17-1 Identify disorders for which central nervous system medications are prescribed. 2) A client is prescribed medication to treat bipolar disorder. Which statement indicates the client understands the medication regimen? 1. "This medication is going to cure me." 2. "I will take this medication when I remember to." 3. "This medication may help my symptoms." 4. "This is the only medication that I can take for my illness." Answer: 3 Explanation: This statement indicates the client understands the purpose of the medication regimen. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-1 Identify disorders for which central nervous system medications are prescribed.

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3) A client with Parkinson's disease is prescribed a medication that affects a particular central nervous system neurotransmitter. Which neurotransmitter is the medication acting on to treat the symptoms of Parkinson's disease? 1. Acetylcholine 2. Norepinephrine 3. An endorphin 4. Gamma aminobutyric acid (GABA) Answer: 1 Explanation: Cholinergic synapses utilize acetylcholine as the neurotransmitter. Cholinergic synapses are especially important in the pathophysiology of Parkinson's disease and Alzheimer's disease. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 17-3 Identify the major neurotransmitters in the central nervous system and their functions. 4) A client tells the nurse about taking a medication that affects the central nervous system but cannot recall the name of the drug. When assessing the client, it would be appropriate for the nurse to ask about which possible symptoms? 1. Weight loss despite an increase in appetite, inability to sleep, feeling fidgety, palpitations, intolerance to heat 2. Weight loss despite an increase in appetite and food consumption, extreme thirst, drinking more fluids, and increase in urination 3. Moodiness, crying, or feelings of anxiety 4. More than usual shortness of breath, or tightness in the chest with physical activity, and sweating Answer: 3 Explanation: Moodiness, crying, or feelings of anxiety can be associated with disorders such as bipolar disorder, anxiety, and panic disorders. Some central nervous system medications would be prescribed for these symptoms. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-4 Describe the major structural regions of the brain and their primary functions.

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5) The nurse recognizes the action of psychotherapeutic medications is mediated by which processes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Some neurotransmitters are stimulatory. 2. The electrical impulse causes the release of an inhibitory neurotransmitter. 3. Some neurotransmitters are inhibitory. 4. The electrical impulse inhibits the neurotransmitter from being released. 5. The electrical impulse at the synapse activates a receptor. Answer: 1, 2, 3, 4 Explanation: Some neurotransmitters, such as glutamate, are primarily stimulatory. In some cases, the electrical impulse causes the release of an inhibitory neurotransmitter that suppresses neuronal conduction. Some neurotransmitters, such as gamma aminobutyric acid (GABA), inhibit neuronal activity. In some cases, the electrical impulse inhibits the neurotransmitter from being released. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 17-3 Identify the major neurotransmitters in the central nervous system and their functions.

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6) Which statements describe the function of the central nervous system synapse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Suppression, or inhibition, of the firing of neurons 2. Inhibition of the release of a neurotransmitter 3. Release of an inhibitory neurotransmitter that suppresses conduction 4. Simulation, or activation, of the firing of neurons 5. Serving as the primary functioning cell within the nervous system Answer: 1, 2, 3, 4 Explanation: In some cases, the firing of neurons is inhibited. Synapses within the CNS operate by an electrical impulse releasing a neurotransmitter to activate a receptor neuron on the opposite side. In some cases, the electrical impulse inhibits the release of the neurotransmitter. In some cases, an inhibitory neurotransmitter is released that suppresses neuronal conduction. The neuron is the primary functional cell for communicating messages through conduction of an action potential. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-2 Illustrate the major components of a synapse within the central nervous system. 7) A client is treated in the emergency department for an overdose of cocaine. The nurse monitors the client based on the knowledge that cocaine affects which item? 1. Cholinergic synapses 2. Adrenergic synapses 3. Dopamine receptors 4. Glutamate Answer: 3 Explanation: Cocaine and amphetamines produce their stimulatory actions by affecting dopamine receptors. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-3 Identify the major neurotransmitters in the central nervous system and their functions.

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8) A client newly diagnosed with depression is given a prescription for an antidepressant. The nurse understands that the medication prescribed affects which neurotransmitter that is associated with anxiety, impulsive behavior, and suicidal ideation? 1. Glutamate 2. Serotonin 3. Dopamine 4. Acetylcholine Answer: 2 Explanation: Low serotonin levels in the CNS are associated with anxiety and impulsive behavior, including suicidal ideation. Serotonergic receptors play an important role in the mechanism of action of antidepressant drugs. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-3 Identify the major neurotransmitters in the central nervous system and their functions. 9) The client is receiving a medication that alters the utilization of glutamate, therefore risking an increase in glutamate levels in the CNS. The nurse should evaluate for which manifestation of high glutamate levels? 1. Blurred vision and dry mouth 2. Signs of neurotoxicity 3. Ataxia 4. Tremors Answer: 2 Explanation: High amounts of glutamate can cause death of neurons, and can be the mechanism responsible for certain types of neurotoxicity. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 17-3 Identify the major neurotransmitters in the central nervous system and their functions.

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10) A client recovering from a recent stroke is having difficulty with speech, memory, and movement of the extremities on the left side of the body. The nurse explains to the family that which area of the CNS has most likely been affected by the stroke? 1. Limbic system 2. Cerebrum 3. Cerebellum 4. Thalamus Answer: 2 Explanation: The cerebrum is the "thinking" part of the brain responsible for perception, speech, conscious motor movement, movement of skeletal muscles, memory, and smell. Focal abnormalities, often the result of stroke, occur in specific regions and can affect a single brain function. Generalized disorders of the cerebrum affect widespread areas or multiple regions. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17-4 Describe the major structural regions of the brain and their primary functions. 11) A client admitted to the hospital with a possible brain tumor has symptoms of increased thirst and hunger, despite an increase in weight, and complains of feeling cold all the time. Which region of the CNS system most likely has been affected? 1. Thalamus 2. Hypothalamus 3. Cerebellum 4. Limbic system Answer: 2 Explanation: The regulation of hunger, thirst, water balance, and body temperature is the function of the hypothalamus. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 17-4 Describe the major structural regions of the brain and their primary functions.

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12) The nurse is instructing a client on the characteristics of central nervous system medications. Which characteristic should be included in this teaching? 1. Ability of the medications to cross the blood–brain barrier 2. Neurotransmitters 3. Function of a neuron 4. Location of synapses Answer: 1 Explanation: CNS drugs must be designed with the ability to penetrate the blood–brain barrier to produce their effects. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17-4 Describe the major structural regions of the brain and their primary functions. 13) The nurse is taking care of a client who has been in the intensive care unit (ICU) for 10 days. Which nursing action would cause a decrease in stimulation of the reticular activating system (RAS)? 1. Keeping the door closed and the lights dim 2. Assisting with bathing and activities for elimination 3. Allowing family members, including children, to visit 4. Turning on the television Answer: 1 Explanation: Stimulation of the reticular formation causes heightened alertness and arousal of the brain as a whole. Inhibition causes general drowsiness and the induction of sleep. The RAS is responsible for sleeping and wakefulness, and it performs an alerting function for the cerebral cortex. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17-5 Explain the major functional systems of the brain and their primary functions.

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14) The nurse is concerned that a client taking an antipsychotic medication is experiencing extrapyramidal side effects. For which effects should the nurse notify the healthcare provider? 1. Complaints of slight drowsiness 2. Urinary hesitancy 3. Muscular spasms of the head and neck 4. Dry mouth Answer: 3 Explanation: Adverse extrapyramidal symptoms include jerking motions; muscular spasms of the head, face, and neck; and akathisia. They can cause nerve damage if allowed to continue. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17-5 Explain the major functional systems of the brain and their primary functions. 15) The family of a client who has a tumor deep in the brain is concerned about the client's demonstration of aggression and anger over the past few months. Which response by the nurse is the most appropriate? 1. "I will inform the healthcare provider about the client's anger and aggression." 2. "I will request a referral for anger management." 3. "The tumor might affect areas of the brain responsible for emotional expression." 4. "This is an abnormal response to the diagnosis." Answer: 3 Explanation: The limbic system is a group of structures deep in the brain responsible for emotional expression, learning, and memory. Emotional states associated with this system include anxiety, fear, anger, aggression, remorse, depression, sexual drive, and euphoria. Signals routed through the limbic system ultimately connect with the hypothalamus. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17-5 Explain the major functional systems of the brain and their primary functions.

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16) A client with depression and a sleep disorder is prescribed a central nervous system medication. The nurse will expect to assess which effects of this medication in the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Improved mood 2. Improved sleep pattern 3. Activation of the fight-or-flight response 4. Onset of seizures 5. Increased pain levels Answer: 1, 2 Explanation: An improved mood is an effect of some central nervous system medications. An improvement in sleep patterns is an effect of some central nervous system medications. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-1 Identify disorders for which central nervous system medications are prescribed. 17) The nurse is instructing a client on the effects of a medication on the neurons and synapses within the nervous system. What should the nurse teach about the characteristics of a synapse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Synapses are junctions between two neurons. 2. Synapses are junctions between a neuron and a muscle. 3. The function of the synapse is to communicate messages through an action potential. 4. Synapses respond only to acetylcholine and norepinephrine. 5. Synapses stimulate an emotional response. Answer: 1, 2 Explanation: Synapses are junctions between two neurons. Synapses are junctions between a neuron and a muscle. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17-2 Illustrate the major components of a synapse within the central nervous system.

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18) A client is found to have a reduction in the amount of the neurotransmitter acetylcholine. The nurse realizes this client is prone to developing which health problems? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Myasthenia gravis 2. Alzheimer's disease 3. Parkinson's disease 4. Seizure disorders 5. Anxiety Answer: 1, 2 Explanation: The neurotransmitter acetylcholine plays a role in myasthenia gravis. The neurotransmitter acetylcholine plays a role in Alzheimer's disease. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-3 Identify the major neurotransmitters in the central nervous system and their functions. 19) A client is prescribed a serotonin supplement. For which disorder(s) is this neurotransmitter replacement indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Anxiety 2. Bipolar disorder 3. Depression 4. Panic attacks 5. Psychosis Answer: 1, 2, 3 Explanation: One clinical use of serotonin is in the treatment of anxiety. One clinical use of serotonin is in the treatment of bipolar disorder. One clinical use of serotonin is in the treatment of depression. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-3 Identify the major neurotransmitters in the central nervous system and their functions.

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20) A client is admitted with a spinal cord injury. Which clinical manifestations does the nurse anticipate upon assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Paresthesia 2. Paralysis 3. Jerky body movements 4. Obsessive-compulsive disorder 5. Drowsiness Answer: 1, 2 Explanation: The spinal cord is essentially a conduction pathway to and from the brain. Disruptions of these pathways will prevent transmission of nerve impulses and cause loss of sensory function (paresthesia). The spinal cord is essentially a conduction pathway to and from the brain. Disruptions of these pathways will prevent transmission of nerve impulses and cause loss of motor function (paralysis). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-4 Describe the major structural regions of the brain and their primary functions.

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21) A client is demonstrating a disorder involving the limbic system. Which physiologic findings associated with this disorder does the nurse anticipate upon assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Rapid heart rate 2. High blood pressure 3. Peptic ulcer disease 4. Increased peristalsis 5. Slow respirations Answer: 1, 2, 3 Explanation: Through its connection with the hypothalamus, autonomic actions such as rapid heart rate are associated with intense emotional states. Through its connection with the hypothalamus, autonomic actions such as high blood pressure are associated with intense emotional states. Through its connection with the hypothalamus, autonomic actions such as peptic ulcers are associated with intense emotional states. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17-5 Explain the major functional systems of the brain and their primary functions.

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22) A client is believed to have a disorder that affects the basal ganglia. What should the nurse instruct the client about this structure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. It helps regulate skeletal muscle movement. 2. It helps with memory. 3. It is needed for learning. 4. It is useful for being attentive. 5. Disorders can cause myasthenia gravis. Answer: 1, 2, 3, 4 Explanation: The basal ganglia are a cluster of neurons in the brain that help regulate the initiation and termination of skeletal muscle movement. The basal ganglia help initiate and terminate the cognitive function of memory. The basal ganglia help initiate and terminate the cognitive function of learning. The basal ganglia help initiate and terminate the cognitive function of attention. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17-5 Explain the major functional systems of the brain and their primary functions. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 18 Pharmacotherapy of Anxiety and Sleep Disorders 1) It is important for the nurse to obtain a thorough history from a client who is experiencing anxiety. What can the nurse distinguish through the history? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The best method of pharmacotherapy 2. Whether the client might benefit from individual or group therapy 3. The category of anxiety disorder 4. The region of the brain that is causing the anxiety disorder 5. Substances that might worsen anxiety Answer: 1, 2, 5 Explanation: The healthcare provider must accurately diagnose the anxiety disorder, because treatment differs among the various types of anxiety disorders. Some anxiety disorders are debilitating and require effective pharmacotherapy. Some clients benefit from individual or group psychotherapy, which can help them identify and overcome the root causes of their worry and fear. When obtaining a comprehensive medication history during the initial client assessment, the nurse should observe any substances the client is taking that might worsen or cause anxiety symptoms. Sometimes discontinuing or substituting an alternate drug for these "anxiety-promoting" medications can lessen client symptoms. Cognitive Level: Analyzing 309

Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IV.1 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18-1 Explain why it is important to obtain an accurate diagnosis of anxiety.

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2) A client comes to the emergency department with shortness of breath, difficulty breathing, pressure in the chest, and a feeling of impending doom. After diagnostic tests and an electrocardiogram, the findings are not consistent with an acute myocardial infarction. What should the nurse do next? 1. Assess the gastrointestinal system. 2. Obtain a history of recent events that might trigger anxiety or that might indicate drug abuse. 3. Ask the healthcare provider to prescribe pain medication. 4. Prepare discharge forms for the client. Answer: 2 Explanation: It is appropriate for the nurse to investigate a more in-depth history on the client to find out if the symptoms could be related to a panic attack or drug abuse. This is necessary to decipher the best course of action. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IV.1 Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 18-1 Explain why it is important to obtain an accurate diagnosis of anxiety. 3) A client, who experienced shortness of breath, tachycardia, profuse diaphoresis, and trembling learns that all cardiac diagnostic tests are negative for an acute myocardial infarction. During the assessment, the nurse is told about a major problem that has caused the client great concern over the past 2 months. The nurse interprets this information as being consistent with which anxiety disorder? 1. Social 2. Generalized 3. Panic 4. Obsessive-compulsive Answer: 3 Explanation: Panic disorder is a type of anxiety characterized by intense feelings of immediate apprehension, fearfulness, terror, or impending doom, accompanied by increased autonomic nervous system activity such as sweating, racing heart rate, shortness of breath, and trembling. The client must experience at least 1 month of ongoing concern or worry. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 18-2 Compare and contrast the five major categories of anxiety disorders.

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4) A client who recently returned from duty in Iraq is diagnosed with post-traumatic stress disorder (PTSD). The client's family questions what this means. How should the nurse respond to the family? 1. "The client might experience sweating, increased heart rate, and blushing when asked to speak to an audience." 2. "Whenever in an enclosed, small space, the client might experience an attack of sweating, racing heart, shortness of breath, and trembling." 3. "The client might experience nightmares, hallucinations, or flashbacks, accompanied by a racing heart, sweating, shortness of breath, and trembling." 4. "It might be common for the client to repetitively wash his hands over and over without apparent reason." Answer: 3 Explanation: Post-traumatic stress disorder is a type of situational anxiety that develops in response to reexperiencing a previous life event. The reexperience may take the form of nightmares, hallucinations, flashbacks, and panic attacks. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 18-2 Compare and contrast the five major categories of anxiety disorders. 5) The client is diagnosed with post-traumatic stress disorder (PTSD). What will the nurse assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Tachycardia 2. Extreme nervousness or panic attacks 3. A fear of crowds 4. A fear of exposure to germs 5. Hallucinations, nightmares, or flashbacks Answer: 1, 2, 5 Explanation: Tachycardia is a symptom of post-traumatic stress disorder. Extreme nervousness and panic attacks are symptoms of post-traumatic stress disorder. In post-traumatic stress disorder, the person reexperiences traumatic events, which can take the form of nightmares, hallucinations, or flashbacks. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18-2 Compare and contrast the five major categories of anxiety disorders. 312

6) Signals routed through the amygdala ultimately connect with the hypothalamus, an important center responsible for modulating the fight-or-flight response of the autonomic nervous system. Which are emotional states associated with this connection? Note: Credit will be given only if all choices and no incorrect choices are selected. Select all that apply. 1. Euphoria 2. Aggression 3. Anger 4. Sexual drive 5. Fatigue Answer: 1, 2, 3, 4 Explanation: Emotional states associated with this connection include euphoria. Emotional states associated with this connection include aggression. Emotional states associated with this connection include anger. Emotional states associated with this connection include sexual drive. Cognitive Level: Understanding Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18-3 Identify the regions and systems of the brain associated with anxiety, sleep, and wakefulness. 7) The spouse of a client tells the nurse about the client's twitching and jerking shortly after lying down and says it stops after the client goes into a deep sleep. Which response is the most appropriate from the nurse? 1. Suggest the client see a sleep specialist to obtain medication for restless leg syndrome. 2. Reassure the spouse that this might be a part of the normal sleep cycle. 3. Explain that the client should not drink caffeinated beverages immediately before bedtime. 4. Suggest the client take measures to assist sleepiness, such as sleep in a dark, quiet room. Answer: 2 Explanation: During stage 1 of NREM sleep, muscle twitches and jerks are normal. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 18-4 Describe the normal stages of sleep and explain how they are affected by anxiety and stress.

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8) A client has been in the intensive care unit for a week receiving various procedures throughout the day and night. Currently the client, though physiologically stable, is irritable and paranoid and complains of vivid dreams when dozing off to sleep. What are the best actions for the nurse to take at this time? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Check the client's oxygen status. 2. Request an order for sleep medication. 3. Assess the client's vital signs. 4. Turn down the lights at night and reduce noise to a minimum. 5. Schedule all tests and procedures before 9 p.m. or after 7 a.m. Answer: 2, 4, 5 Explanation: Since it is important for the client to get rest, an order for sleep medication would be appropriate. When deprived of REM sleep, people experience a sleep debt and become frightened, irritable, paranoid, and even emotionally disturbed. It is speculated that to make up for their lack of dreaming, these persons experience far more daydreaming and fantasizing throughout the day. It is important to institute measures that promote restful sleep. When deprived of REM sleep, people experience a sleep debt and become frightened, irritable, paranoid, and even emotionally disturbed. It is important to institute measures that promote restful sleep, which would include scheduling tests and procedures so as to not disturb the client's sleep. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18-4 Describe the normal stages of sleep and explain how they are affected by anxiety and stress.

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9) A client is complaining of irritability, difficulty with memory, constant fatigue, and an inability to fall asleep. The client averages 3 hours of sleep each night, has been following a restricted-calorie evening meal as part of a weight loss plan, and exercises every evening. Instead of food, the client drinks no-calorie caffeinated sodas. What should the nurse suggest to this client? 1. Eating a larger meal later in the evening will facilitate better sleep and relieve the symptoms. 2. An MRI might be necessary to determine the factors causing the symptoms. 3. Dieting is a common cause for difficulty sleeping. 4. Changes in hormones due to exercising late in the evening and late intake of caffeine might be disrupting the NREM sleep phase, causing the stated symptoms. Answer: 4 Explanation: Decreases in neurotransmitters signal the change from wakefulness to nonrapid eye movement (NREM) sleep. Late exercise increases adrenaline, and caffeine is a stimulant. Both of these factors could interrupt NREM sleep. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 18-4 Describe the normal stages of sleep and explain how they are affected by anxiety and stress. 10) A client diagnosed with narcolepsy, sleepwalking, and cataplexy is prescribed a selective serotonin reuptake inhibitor (SSRI). Which explanation regarding this medication is the most accurate? 1. It lowers levels of serotonin, thereby increasing serotonin and elevating energy levels. 2. It helps with sleepwalking because the increase in serotonin allows the client a deeper sleep. 3. It decreases sleepiness, because SSRIs are stimulants, which will help the client maintain wakefulness. 4. It decreases episodes of slurred speech, sagging of the jaw, and head nodding. Answer: 4 Explanation: Cataplexy is a sudden loss of muscle strength manifesting as slurred speech, sagging of the jaw, head nodding, or even complete collapse of the body. Stimulants such as modafinil are not effective for cataplexy symptoms. Older therapies for cataplexy include antidepressants, such as TCAs or SSRIs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 18-5 Identify sleep disorders that may benefit from pharmacotherapy.

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11) A client complains of frequent awakenings during the night with an inability to return to sleep. The client does not have difficulty falling asleep initially. Which medication would the nurse anticipate preparing? 1. Eszopiclone (Lunesta) 2. Estazolam (ProSom) 3. Temazepam (Restoril) 4. Ramelteon (Rozerem) Answer: 1 Explanation: Eszopiclone (Lunesta) has a long elimination half-life, which might give it an advantage in maintaining sleep and decreasing early morning awakening. Therefore, it might be the best option. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 18-5 Identify sleep disorders that may benefit from pharmacotherapy. 12) A client diagnosed with insomnia, triggered by anxiety, is prescribed paroxetine (Paxil). When the client asks the nurse why an antidepressant has been prescribed, which response by the nurse is the most appropriate? 1. "Paxil is a sedative–hypnotic that will enhance sleep." 2. "There is a link between insomnia and anxiety. Many antidepressants that are effective for treating anxiety are also given to treat insomnia." 3. "Antidepressant medications are safer than other medications used to induce sleep." 4. "Antidepressants act immediately, allowing for faster relief from insomnia." Answer: 2 Explanation: There is a pathophysiologic link between sleep and anxiety, and many of the drugs used to treat anxiety also are effective for treating insomnia. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 18-6 Explain the association between insomnia and anxiety.

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13) A client is taking verapamil for hypertension, Glucotrol for management of type 2 diabetes, and melatonin for sleep. Which question should the nurse ask about these medications? 1. "How is the melatonin helping you with sleep?" 2. "How long have you been taking the verapamil for blood pressure control?" 3. "What was the result of your last hemoglobin A1C level?" 4. "What was your blood pressure before you began taking the verapamil?" Answer: 1 Explanation: There is evidence that melatonin helps older adults fall asleep faster and helps insomnia related to disrupted circadian rhythm cycles. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: VII.4 Contribute the unique nursing perspective to interprofessional teams to optimize patient outcomes | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18-7 Describe nonpharmacologic methods for managing anxiety and sleep disorders. 14) A client whose spouse recently died is having difficulty falling asleep and does not want to take any prescription medications to induce sleep. Which response by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Walking 2 to 3 miles or engaging in some other exercise every morning can enhance sleep." 2. "There are alternative methods to treat insomnia, such as yoga, meditation, and massage therapy." 3. "Eating a large meal at bedtime will help induce sleep." 4. "Avoid caffeinated beverages, nicotine, and alcohol immediately prior to bedtime." 5. "Count sheep after lying down in order to enhance sleep." Answer: 1, 2, 4 Explanation: Exercise therapy (except just prior to sleeping), nutrition therapy, and deep breathing are alternative treatments for insomnia. Acupuncture, aromatherapy, yoga, prayer, massage, meditation, biofeedback therapy, hypnosis, guided imagery, and music therapy are alternative treatments for anxiety and insomnia. Amphetamines, cocaine, caffeinated beverages, corticosteroids, sympathomimetics, antidepressants, alcohol use, nicotine, and tobacco use are secondary causes of insomnia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: VII.4 Contribute the unique nursing perspective to interprofessional teams to optimize patient outcomes | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 18-7 Describe nonpharmacologic methods for managing anxiety and sleep disorders. 317

15) A client who recently experienced the loss of a spouse asks the nurse if there are any over-the-counter herbs or nonprescription medications that can be used to improve insomnia. Which response by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Ginger root is commonly taken to improve sleep." 2. "Ginkgo is an herb commonly taken to improve sleep." 3. "Diphenhydramine (Benadryl) and doxylamine are over-the-counter meds sometimes taken to produce drowsiness." 4. "Valerian and melatonin are herbs commonly taken to improve sleep." 5. "Kava is an herb taken to improve sleep." Answer: 3, 4 Explanation: Diphenhydramine and doxylamine are two antihistamines frequently used to produce drowsiness. An herbal product with demonstrated efficacy in promoting relaxation is valerian root. Supplemental melatonin, 0.5 to 3.0 mg at bedtime, is alleged to decrease the time required to fall asleep and to produce a deep and restful sleep. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: VII.4 Contribute the unique nursing perspective to interprofessional teams to optimize patient outcomes | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 18-7 Describe nonpharmacologic methods for managing anxiety and sleep disorders. 16) The nurse distinguishes medications used in general surgery as either hypnotic or sedative, or sedative–hypnotic. The nurse can anticipate the anesthesiologist using which sedative–hypnotic for induction of anesthesia? 1. Clorazepate (Tranxene) 2. Alprazolam (Xanax) 3. Thiopental sodium (Pentobarbital) 4. Temazepam (Restoril) Answer: 3 Explanation: Thiopental sodium (Pentobarbital) is a sedative–hypnotic that produces anesthesia at high doses. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 18-8 Identify the major classes of medications used to treat anxiety and sleep disorders. 318

17) A client diagnosed with generalized anxiety disorder is prescribed a tricyclic antidepressant, Doxepin (Sinequan). Which statement indicates that the client understands the actions of this medication? 1. "I'm glad to have a medication that will take away my anxiety right away." 2. "I'm glad the healthcare provider has ordered a medication that won't produce side effects." 3. "I need to be careful not to take Sinequan for a long period, due to the possibility of drug dependency." 4. "I might need to suck on sugar-free hard candy for my dry mouth." Answer: 4 Explanation: Dry mouth is a common anticholinergic effect that is treated with increased fluid intake and sucking on sugar-free hard candy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 18-8 Identify the major classes of medications used to treat anxiety and sleep disorders. 18) A client who is complaining of anxiety and difficulty sleeping has asked what prescription medications would assist in getting to sleep. What would be appropriate responses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Diphenhydramine (Benadryl) 2. Valerian root 3. Ramelteon (Rozerem) 4. Flurazepam (Dalmane) 5. Zolpidem (Ambien) Answer: 3, 4, 5 Explanation: Ramelteon (Rozerem) is a newer, nonbenzodiazepine hypnotic approved to treat chronic insomnia in people who have problems falling asleep. Benzodiazepines are drugs of choice for generalized anxiety disorder and the short-term therapy of insomnia. Flurazepam (Dalmane) should be taken at bedtime because it quickly produces significant drowsiness. Zolpidem (Ambien) is a sedative–hypnotic approved for short-term treatment of insomnia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18-8 Identify the major classes of medications used to treat anxiety and sleep disorders. 319

19) A client with anxiety and insomnia has been taking alprazolam (Xanax) for 5 days. What is the priority for the nurse to assess in this client? 1. Stopping the use of birth control pills 2. Thoughts of suicide 3. Taking the medication with grapefruit juice 4. Drowsiness after taking the medication Answer: 2 Explanation: Examples of such behaviors that should be reported to the healthcare provider immediately include aggressiveness, hallucinations, suicidal thinking, and unusual extroversion or depersonalization. This could indicate a serious underlying psychiatric or medical condition that requires further assessment. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18-9 Describe the nurse's role in the pharmacologic and nonpharmacologic management of anxiety and sleep disorders. 20) A client is being assessed for complaints of difficulty getting to and staying asleep, chronic fatigue, and difficulty staying awake during daytime hours. A sleep study has been ordered. Which medication should the nurse teach the client to avoid prior to the sleep study? 1. Fosinopril (Monopril), 10 mg p.o. q.d., an ACE inhibitor 2. Verapamil (Calan SR), 120 mg p.o. q.d., a calcium channel blocker 3. Folic acid, 1 mg p.o., a vitamin 4. Buspirone (BuSpar), 10 mg p.o. b.i.d., a nonbenzodiazepine anxiolytic Answer: 4 Explanation: Drowsiness is a common side effect of buspirone (BuSpar). This could affect the results of a sleep study. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 18-9 Describe the nurse's role in the pharmacologic and nonpharmacologic management of anxiety and sleep disorders.

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21) The nurse is providing discharge instructions to a client who has been started on a monoamine oxidase inhibitor (MAOI). Which statement indicates that the client needs further teaching? 1. "I might need to monitor my blood sugars more closely." 2. "I'm not sure how I am going to wake up without my morning coffee." 3. "I sure would like to stop for a pizza on my way home from the hospital." 4. "I will try to get out of bed more slowly." Answer: 3 Explanation: Clients must strictly avoid foods containing tyramine. Cheese and yeast, common ingredients in pizza, contain tyramine and must be avoided. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 18-9 Describe the nurse's role in the pharmacologic and nonpharmacologic management of anxiety and sleep disorders. 22) The nurse is preparing to administer intravenous lorazepam (Ativan) to a client. Which nursing intervention is a priority following the parenteral administration of this medication? 1. Assess for drug interactions with other medications. 2. Instruct client to change positions slowly, especially from lying to standing. 3. Monitor for changes in respirations. 4. Assess for seizure activity. Answer: 3 Explanation: When providing this medication through the parenteral route, the client should be monitored for respiratory depression. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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23) Lorazepam (Ativan) is ordered to be given through the intravenous route for a client with status epilepticus. The client currently has an intravenous infusion of dextrose 5% and 0.9% normal saline at the rate of 125 mL/h. Which action demonstrates the correct administration of this medication by the nurse? 1. Administering lorazepam (Ativan) by slow IV injection over a 2- to 4-minute period 2. Injecting the lorazepam (Ativan) quickly via IV push 3. Discontinuing the intravenous infusion prior to administering the medication 4. Mixing the lorazepam (Ativan) in a 50-mL bag of NS and administering piggyback over 30 minutes Answer: 1 Explanation: Lorazepam (Ativan) should be administered over a 2- to 4-minute period when given via IV push. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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24) A client recovering from surgery is prescribed zolpidem (Ambien) for sleep. The client is scheduled for physical therapy at 8 p.m. What should the nurse do when providing the client with this medication? 1. Crush the medication in a small amount of food. 2. Provide the medication with food. 3. Administer the medication prior to attending physical therapy because it takes 30 to 60 minutes to produce effects. 4. Administer the medication immediately prior to expected sleep. Answer: 4 Explanation: Zolpidem (Ambien) has a very rapid onset and should be taken immediately before bedtime. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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25) A client receiving phenobarbital for seizure control has a temperature of 102°F, periorbital and oral edema, and an erythematous rash over the entire body. Which action by the nurse is the priority? 1. Give the phenobarbital as ordered. 2. Hold the phenobarbital and notify the healthcare provider of the client's condition. 3. Hold the phenobarbital and inquire of family members if these symptoms have been present previous to hospitalization. 4. Give the phenobarbital and notify the healthcare provider of the client's condition. Answer: 2 Explanation: Many adverse effects are reported with phenobarbital. Serious ones include Stevens–Johnson syndrome, so the medication would need to be held and the healthcare provider notified immediately. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18-11 Develop a plan of care for patients receiving pharmacotherapy for anxiety and sleep disorders. 26) Since long-term use of phenobarbital can lead to osteomalacia, a client is instructed to consume foods high in vitamin D, vitamin K, and folic acid. Which statement indicates the client understands these instructions? 1. "I need to eat more broiled poultry, turnip greens, and nuts." 2. "I need to eat more fish, green vegetables, and milk." 3. "I need to eat more fruits, beef, and milk." 4. "I need to eat more dried fruits, cantaloupe, and dairy products." Answer: 2 Explanation: Eating fish, green vegetables, and milk would be the best answer, because those foods provide vitamin D, vitamin K, and folic acid. Fish, cereals, and milk are high in vitamin D. Green vegetables, green tea, milk, and yogurt are high in vitamin K. Folic acid is high in vegetables, fruits, and organ meats like liver. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 18-11 Develop a plan of care for patients receiving pharmacotherapy for anxiety and sleep disorders. 324

27) A client experiencing hyperventilation, diaphoresis, and difficulty breathing with chest tightness was diagnosed with panic attacks after a negative cardiac workup. What action should the nurse implement first? 1. Perform a 12-lead EKG. 2. Administer oxygen via nasal cannula at 2 to 4 L/min. 3. Move the client from the waiting area to a private ED cubicle. 4. Prepare to administer lorazepam (Ativan). Answer: 3 Explanation: This is the most important intervention. The client needs to be removed from a busy area to help decrease the anxiety associated with the attack. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18-11 Develop a plan of care for patients receiving pharmacotherapy for anxiety and sleep disorders. 28) During a health history, a client expresses concern to the nurse about finances and the health of older parents. What will the nurse assess to determine whether this client is experiencing generalized anxiety disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Restlessness 2. Elevated blood pressure 3. Urinary urgency 4. Blushing 5. Repeating the numbers 1 through 13 Answer: 1, 2, 3 Explanation: Restlessness is a symptom of generalized anxiety disorder. Elevated blood pressure is a sign of sympathetic nervous system activation that accompanies generalized anxiety disorder. Urinary urgency is a parasympathetic response that accompanies generalized anxiety disorder. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18-2 Compare and contrast the five major categories of anxiety disorders. 325

29) A client is prescribed a medication for anxiety that will affect the limbic system. When instructing the client, the nurse explains that this medication will affect which areas? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Emotions 2. Behavior 3. Long-term memory 4. Secretion of corticotropin-releasing factor 5. Production of melatonin Answer: 1, 2, 3 Explanation: The limbic system is responsible for emotions. The limbic system is responsible for behavior. The limbic system is responsible for long-term memory. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 18-3 Identify the regions and systems of the brain associated with anxiety, sleep, and wakefulness. 30) A client is prescribed a medication that will inhibit the function of the reticular activating system. What will the nurse assess as effects of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Drowsiness 2. Sleeping 3. Alertness 4. Dilated pupils 5. Elevated blood pressure Answer: 1, 2 Explanation: Drugs that inhibit the reticular activating system will cause general drowsiness. Drugs that inhibit the reticular activating system will cause sleep. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18-3 Identify the regions and systems of the brain associated with anxiety, sleep, and wakefulness.

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31) A client with anxiety reports difficulty sleeping and waking up several times throughout the night. The nurse is concerned that the client can develop imbalances in which neurotransmitters? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Acetylcholine 2. Serotonin 3. Norepinephrine 4. Dopamine 5. Gamma-aminobutyric acid Answer: 1, 2, 3 Explanation: When moving from non-REM to REM sleep, there is an increase of acetylcholine. If either sleep stage is interrupted, an imbalance in the amount of acetylcholine could occur. In REM sleep, the body increases the levels of serotonin. In the absence of REM sleep, an imbalance in the amount of serotonin may occur. In REM sleep, the body increases the levels of norepinephrine. In the absence of REM sleep, an imbalance in the amount of norepinephrine may occur. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18-4 Describe the normal stages of sleep and explain how they are affected by anxiety and stress.

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32) During a medical history, a client tells the nurse about waiting several hours before falling asleep and waking up repeatedly during the night only to wait again to fall asleep. The nurse would document this client's symptoms as being which types of insomnia? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Sleep-onset 2. Sleep-maintenance 3. Sleep-offset 4. Nonrestorative sleep 5. Parasomnia Answer: 1, 2 Explanation: Sleep-onset insomnia is the inability to fall asleep within a reasonable time, usually within 30 minutes. Sleep-maintenance insomnia is frequent awakenings during the night or the inability to fall back asleep. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 18-5 Identify sleep disorders that may benefit from pharmacotherapy.

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33) A hospitalized client who is not prescribed medication for sleep tells the nurse about using a sedative to sleep "for years." What will the nurse most likely assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Sleeplessness 2. Anxiety 3. Daytime drowsiness 4. Dizziness 5. Blurred vision Answer: 1, 2, 3 Explanation: Rebound insomnia can occur when sedatives are abruptly withdrawn after being used long term for sleep. One symptom of rebound insomnia is sleeplessness. Rebound insomnia can occur when sedatives are abruptly withdrawn after being used long term for sleep. One symptom of rebound insomnia is anxiety. Rebound insomnia can occur when sedatives are abruptly withdrawn after being used long term for sleep. One symptom of rebound insomnia is daytime drowsiness. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18-6 Explain the association between insomnia and anxiety.

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34) A client being treated for an anxiety disorder is prescribed medication for sleep to be provided every evening. Why is the client prescribed sleeping medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. There is a link between anxiety and sleep. 2. Improving sleep will help with the anxiety disorder. 3. Less antianxiety medication will be needed during the day. 4. It will prevent rebound insomnia. 5. It will stop the client from worrying about not getting enough sleep. Answer: 1, 2, 5 Explanation: There is a pathophysiologic link between sleep and anxiety. Insomnia therapy is more than just a nighttime problem. Anxiety and insomnia need to be treated together. Providing a sleeping medication may prevent the client from worrying about getting enough sleep and reduce the anxiety associated with sleeplessness. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18-6 Explain the association between insomnia and anxiety. 35) The nurse is coaching a client on nonpharmacologic interventions to improve sleep. What would be included in these instructions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Meditation 2. Guided imagery 3. Deep breathing 4. Drinking chamomile tea 5. Keeping a light on Answer: 1, 2, 3, 4 Explanation: Meditation is one alternative therapy that has been used to improve sleep. Guided imagery is one alternative therapy that has been used to improve sleep. Deep breathing is one alternative therapy that has been used to improve sleep. Chamomile is an herb that has been used as alternative therapy to improve sleep. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: VII.4 Contribute the unique nursing perspective to interprofessional teams to optimize patient outcomes | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 18-7 Describe nonpharmacologic methods for managing anxiety and sleep disorders. 330

36) A client is prescribed duloxetine (Cymbalta) for fibromyalgia. When teaching the client about this medication, the nurse will include which adverse or side effects? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Constipation is an adverse effect. 2. Weight loss can occur when taking this medication. 3. Headaches are an adverse effect. 4. An increase in sexual desire may occur. 5. Symptoms of social anxiety disorder may decrease while taking this medication. Answer: 1, 2, 3 Explanation: Constipation is an adverse effect of this medication. Weight loss is an adverse effect of this medication. Headaches are an adverse effect of this medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 18-8 Identify the major classes of medications used to treat anxiety and sleep disorders. 37) The nurse withholds a scheduled dose of secobarbital (Seconal) to a client and notifies the healthcare provider when what was assessed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Respiratory rate of 8 breaths/min 2. Heart rate of 58 beats/min 3. Blood pressure 124/88 mmHg 4. Temperature 99.8ºF 5. Pain level 5 on numeric pain scale Answer: 1, 2 Explanation: Respiratory depression is a serious adverse effect of this medication. Bradycardia is a serious adverse effect of this medication. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18-9 Describe the nurse's role in the pharmacologic and nonpharmacologic management of anxiety and sleep disorders. 331

38) The nurse notes that a client is prescribed zolpidem (Ambien) at a dose smaller than is recommended. What would the nurse review to determine the reason for the reduced dose? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Client's age 2. Blood-urea-nitrogen level 3. Creatinine level 4. Liver function studies 5. White blood cell count Answer: 1, 2, 3, 4 Explanation: This medication should be used cautiously in older clients. The dose may be lower because of impaired kidney function, which can increase serum drug levels. The dose may be lower because of impaired kidney function, which can increase serum drug levels. The dose may be lower because of impaired liver function, which can increase serum drug levels. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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39) The nurse's client is prescribed medication for anxiety and sleep, and the nurse is providing instruction on lifestyle changes. What would be included in this teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Avoid caffeine. 2. Avoid smoking. 3. Limit alcohol intake. 4. Exercise before bedtime. 5. Limit the intake of green leafy vegetables. Answer: 1, 2, 3 Explanation: Caffeine may decrease the effectiveness of prescribed medications. Nicotine may decrease the effectiveness of prescribed medications. Alcohol may increase the adverse effects of prescribed medications. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 18-11 Develop a plan of care for patients receiving pharmacotherapy for anxiety and sleep disorders. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 19 Pharmacotherapy of Mood Disorders 1) The client tells the nurse, "I thought I was just depressed, but my doctor says I have bipolar disorder. What is that?" Which response by the nurse is the most appropriate? 1. "Bipolar disorder just means that your mood alternates with the seasons, and it becomes worse in the winter." 2. "Bipolar disorder means you have cycles of depression as well as hyperactivity, or mania." 3. "Bipolar disorder is just another type of depression, except your depression occurs in cycles." 4. "Bipolar disorder is a type of depression that includes attention-deficit disorder symptoms." Answer: 2 Explanation: Clients with bipolar disorder can shift from emotions of extreme depression to extreme rage and agitation. Mania can include grandiosity, decreased need for sleep, pressured speech, racing thoughts, buying sprees, and sexual indiscretions. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 19-1 Compare and contrast the major categories of mood disorders and their symptoms. 333

2) Mood disorders are emotional disorders characterized by changes in mood, and they range from mania to depression. Which symptoms characterize major depressive disorder? 1. Fatigue and decreased appetite 2. Anxiety and elevated mood 3. Low mood and increased activity 4. Psychosis and euphoria Answer: 1 Explanation: Major depressive disorder can be associated with fatigue and decreased appetite. Cognitive Level: Remembering Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19-1 Compare and contrast the major categories of mood disorders and their symptoms.

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3) Mood disorders are closely associated with which part of the brain? 1. Limbic 2. Hippocampus 3. Hypothalamus 4. Brainstem Answer: 1 Explanation: The limbic system is associated with mood disorders. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19-2 Explain the pathophysiology of major depression and bipolar disorder. 4) A client with depression is to begin treatment with an antidepressant medication. In performing the initial assessment, what is the most important question for the nurse to ask? 1. "Are you allergic to any medications?" 2. "How long have you been depressed?" 3. "Have you had any thoughts about killing yourself?" 4. "How much alcohol do you consume during the week?" Answer: 3 Explanation: The nurse should always assess for suicidal ideation in any depressed client who is about to begin antidepressant treatment. The medication takes several weeks before the full benefit is obtained. This is a safety issue. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: VI.1 Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education and licensure requirements) | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19-3 Discuss the nurse's role in the assessment of patients with mood disorders.

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5) A client with bipolar disorder in the manic phase is started on lithium (Eskalith). The client's current lithium level is 0.4 mEq/L. What will the nurse expect to assess in this client? 1. A return to baseline behavior: calm and rational 2. Signs and symptoms of depression 3. Hyperactivity and pressured speech 4. A decrease in manic behavior Answer: 3 Explanation: At the start of therapy, the lithium level should be maintained within the range of 0.8 to 1.4 mEq/L. Since this client's level is low, behaviors will indicate mania—i.e., hyperactivity and pressured speech. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: VI.1 Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education and licensure requirements) | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19-3 Discuss the nurse's role in the assessment of patients with mood disorders.

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6) The client asks the nurse why she needs to continue using table salt, because her prescribed lithium (Eskalith) is a salt. What is the best response by the nurse? 1. "You must continue to use salt to avoid lithium (Eskalith) toxicity. If you use sea salt, you don't need as much." 2. "You must use table salt or your kidneys will retain lithium (Eskalith), and you will become toxic." 3. "Salt is very important to avoid lithium (Eskalith) toxicity, but not as important as drinking 1 to 1.5 L of water per day." 4. "The amount is not important; just increase your table salt if you notice signs of lithium (Eskalith) toxicity." Answer: 2 Explanation: The kidneys are responsible for maintaining normal sodium levels. If there is sodium depletion, the kidneys will conserve any salt—in this case, lithium (Eskalith). This will lead to lithium (Eskalith) toxicity. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 19-5 Describe the nurse's role in the pharmacologic and nonpharmacologic management of mood disorders. 7) The nurse is caring for a client receiving electroconvulsive therapy (ECT). What is the priority assessment for this client? 1. Orientation 2. Level of consciousness 3. Airway 4. Vital signs Answer: 3 Explanation: The client who undergoes ECT receives anesthesia and is intubated while receiving ECT. Immediately following treatment, the client is extubated; therefore, airway is the first priority. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19-5 Describe the nurse's role in the pharmacologic and nonpharmacologic management of mood disorders.

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8) A client, prescribed sertraline (Zoloft) for anxiety and depression, reports experiencing delayed ejaculation since being on this medication. Which response by the nurse is the most appropriate? 1. "I am concerned that you will become suicidal if you stop the medication." 2. "Keep taking the medicine, as this usually goes away after a few months." 3. "I will let your doctor know." 4. "This does happen, but treating your depression is a bigger priority." Answer: 3 Explanation: One of the most common side effects of the selective serotonin reuptake inhibitors (SSRIs) relates to sexual dysfunction; up to 70% of men and women experience this. In men, delayed ejaculation and impotence can occur. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 19-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 9) A client diagnosed with depression has been placed on imipramine (Tofranil). What would the nurse most likely assess if the client experiences adverse effects of this medication? 1. Various anemias accompanied by bradycardia 2. Hypertension with severe emesis 3. Dizziness accompanied by possible photosensitivity 4. Polyuria with gross proteinuria Answer: 3 Explanation: The most common adverse effects of imipramine include dizziness and, to a lesser extent, photosensitivity. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 338

10) Which medication, when administered with lithium, increases the risk of toxicity? 1. Lomefloxacin 2. Sodium bicarbonate 3. Calcium iodine 4. Furosemide Answer: 4 Explanation: Lithium, when combined with a diuretic such as furosemide, increases the potential for sodium depletion, thereby increasing therapeutic blood levels of lithium to the toxic range. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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11) The nurse is conducting a group education session for clients who have been diagnosed with depression. The nurse evaluates the education as effective when a client makes which comments about the cause of depression? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Depression results from parents who are cold and distant and don't really care about their children." 2. "Depression results from unresolved conflicts in your childhood." 3. "We really don't know what causes depression; it has not been studied very much." 4. "Depression can be an inherited illness." 5. "Depression has many causes; they could include environmental as well as brain-based disorders." Answer: 4, 5 Explanation: Depression has many causes; it is a brain-based disorder that is exacerbated by environmental influences. Depression runs in families, supporting a genetic link. Depression has many causes; it is a brain-based disorder that is exacerbated by environmental influences. Depression runs in families, supporting a genetic link. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 19-2 Explain the pathophysiology of major depression and bipolar disorder. 12) A client taking amitriptyline (Elavil) for 2 weeks tells the nurse that the medication "isn't working" because feelings of depression continue. Which response by the nurse is the most appropriate? 1. "This might not be the best medicine for you; I'll call your doctor." 2. "You might still feel depressed, but you are looking much better." 3. "It is working, but it can take several months to have an effect." 4. "It is working, but it can take several weeks to have an effect." Answer: 4 Explanation: The therapeutic effects of tricyclic antidepressants can take 2 to 6 weeks to appear. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 19-7 Apply the nursing process to care for patients receiving pharmacotherapy for mood disorders. 340

13) The nurse has completed medication education for a client about to begin therapy with phenelzine (Nardil). The nurse evaluates the education as effective when the client makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I can't eat fried chicken and gravy." 2. "I'll have to give up my beer at the football games." 3. "I really shouldn't eat at a restaurant; too many foods are on my restricted list." 4. "I am not supposed to have processed meats or cheese." 5. "I am really going to miss my morning coffee and sweet roll." Answer: 2, 4 Explanation: Beer is high in tyramine. Combining tyramine-rich foods with a monoamine oxidase inhibitor (MAOI) can result in a hypertensive crisis. Processed meats and cheese are high in tyramine. Combining tyramine-rich foods with a monoamine oxidase inhibitor (MAOI) can result in a hypertensive crisis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 19-7 Apply the nursing process to care for patients receiving pharmacotherapy for mood disorders.

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14) The nurse is concerned that a client is moving into the manic phase of bipolar disorder when what is assessed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Not sleeping 2. Losing weight 3. Sluggish activity 4. Complaints of muscle pain 5. Constant talking Answer: 1, 2, 5 Explanation: Decreased need for sleep is a symptom of the manic phase of bipolar disorder. Decreased need for food is a symptom of the manic phase of bipolar disorder. Increased talkativeness is a symptom of the manic phase of bipolar disorder. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19-1 Compare and contrast the major categories of mood disorders and their symptoms. 15) The nurse is instructing a client on the cause of bipolar disorder. Which neurotransmitters will the nurse describe as contributing to the manic phase of this disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Excessive glutamate 2. Excessive norepinephrine 3. Deficiency of gamma aminobutyric acid 4. Deficiency of dopamine 5. Excessive serotonin Answer: 1, 2, 3 Explanation: Mania may involve an excess of excitatory neurotransmitters such as glutamate. Mania may involve an excess of excitatory neurotransmitters such as norepinephrine. Mania may involve a deficiency of inhibitory neurotransmitters such as gamma aminobutyric acid (GABA). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 19-2 Explain the pathophysiology of major depression and bipolar disorder.

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16) During a health history, the nurse wants to include an assessment of depression for an older adult client. Which statements will the nurse use to conduct this assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "How often do you go out to socialize with friends?" 2. "Explain your self-care activities." 3. "How much alcohol do you consume every day?" 4. "How is living with your oldest daughter and her family working out for you?" 5. "Are you feeling depressed?" Answer: 1, 2, 3, 4 Explanation: This question would assess if the client were to be reluctant to leave the home, which can indicate depression in the older adult. Older clients are reluctant to admit depression because it is seen as an inability to continue to care for themselves. In some cases, the older client may overuse alcohol or combine it with other medications that are depressants, which can further impact depression. Factors that contribute to depression in the older client include the need to move in with other family members because of health status or finances. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: VI.1 Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education and licensure requirements) | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19-4 Identify the relationship between suicide and depression.

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17) During a health history, the nurse is concerned that a client with depression is at risk for suicide. Which assessment findings support this concern? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. States that "suicide is always an option." 2. Describes a previous unsuccessful attempt at suicide by aspirin overdose. 3. States that the prescribed medication is not working and that feelings of depression are worse. 4. Requests prescriptions for pain medication and a sleeping aid. 5. Expresses interest in meeting with friends more often. Answer: 1, 2, 3, 4 Explanation: If a person verbalizes about committing suicide, the talk must be taken seriously. A client who has had a previous suicide attempt is at higher risk for suicide and must be monitored carefully. Worsening symptoms of depression must be reported immediately because these may indicate that the drug is not working or that the client is not compliant with pharmacotherapy. All prescription drugs must be monitored because suicidal clients often take overdoses. Therapy with multiple central nervous system depressants is discouraged because these drugs produce additive sedation. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 19-4 Identify the relationship between suicide and depression.

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18) A client who has been taking antidepressant medication for several months and is demonstrating an improvement in symptoms tells the nurse that counseling sessions might be helpful. Which types of therapies will the nurse review with the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Behavioral therapy 2. Interpersonal therapy 3. Cognitive–behavioral therapy 4. Psychodynamic therapy 5. Crisis therapy Answer: 1, 2, 3, 4 Explanation: Behavioral therapies help clients unlearn the behavioral patterns that contribute to or result from their depression. Interpersonal therapy focuses on a client's disturbed personal relationships that both cause and exacerbate depression. Cognitive–behavioral therapies help clients change negative styles of thought and behavior that are often associated with depression. Psychodynamic therapies focus on resolving the client's internal conflicts by looking at the influence of past experiences on current behavior and how behavior is influenced by emotional factors. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 19-5 Describe the nurse's role in the pharmacologic and nonpharmacologic management of mood disorders.

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19) A client with depression does not want to take prescribed medication because of the side effects. What can the nurse suggest to help with medication adherence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use ice chips to help alleviate dry mouth. 2. Chew gum or use hard candy to help alleviate dry mouth. 3. Avoid alcohol-based mouthwash to help alleviate dry mouth. 4. Use "dry eye" drops to help with eye dryness. 5. Take alcoholic beverages several times a week to help with unpleasant side effects. Answer: 1, 2, 3, 4 Explanation: Using ice chips helps to alleviate dry mouth associated with these medications. Chewing gum or sucking on hard candy helps to alleviate dry mouth associated with these medications. Alcohol-based mouthwash can increase the feeling of dry mouth associated with these medications. "Dry eye" drops help alleviate eye dryness associated with these medications. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 19-7 Apply the nursing process to care for patients receiving pharmacotherapy for mood disorders. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 20 Pharmacotherapy of Psychoses 1) A client is treated in the emergency department for injuries received after running through thick brush in the woods. The client relates being followed by a large man in dark clothing. A witness to this event claims there was no one chasing the client into the woods. Which item should the nurse further assess this client for based on the information provided? 1. A list of current prescription medications 2. Symptoms of depression 3. Family members' interpretation of the event 4. Whether the client might require restraints Answer: 1 Explanation: Reviewing a list of current medications might help to determine whether the client is being treated for a psychosis. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: 346

Nursing Process: Assessment Learning Outcome: 20-1 Describe the general symptoms of psychosis. 2) An adolescent client diagnosed with a psychosis is having difficulty maintaining friendships at school. Which behavior does the nurse suspect is the cause of the client's difficulty with peer relationships? 1. Laughing inappropriately at sad events 2. Tremors and contraction of the extremities, drooling, and eyes rolling back in the head 3. Tremors, palpitations, diaphoresis, and tachycardia 4. Lack of energy, sleepiness, inability to concentrate, and inability to perform activities of daily living Answer: 1 Explanation: Laughing inappropriately at sad events is a symptom of a psychotic episode. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-1 Describe the general symptoms of psychosis.

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3) A young adult client is demonstrating a lack of interest in personal hygiene and routine social activities, a sudden drop in school grades, and a recent unwillingness to get out of bed to go to school. The nurse will assess for which health problem? 1. Depression and positive symptoms of schizophrenia 2. Depression and post-traumatic stress syndrome 3. Depression and insomnia 4. Depression and negative symptoms of schizophrenia Answer: 4 Explanation: The client has symptoms suggestive of depression and the negative symptoms of schizophrenia. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-2 Compare and contrast the positive and negative symptoms of schizophrenia. 4) The nurse suspects a client is demonstrating negative symptoms of schizophrenia and will be a challenge to treat because of which barriers? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client feels that the symptoms are normal. 2. Family members feel the client is going through a period of depression. 3. The client is suspicious of the motives of the healthcare provider. 4. Family members have labeled the client as lazy. 5. The client is indifferent to obtaining help. Answer: 2, 4, 5 Explanation: Negative symptoms of schizophrenia are often mistaken for depression. Negative symptoms of schizophrenia are often mistaken for laziness. Negative symptoms are characteristic of the indifferent personality typical of many clients with schizophrenia. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-2 Compare and contrast the positive and negative symptoms of schizophrenia.

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5) The nurse is performing the initial assessment on a client admitted to the psychiatric unit. The client hears voices saying to cut the client's arms with razor blades until they bleed. What should the nurse assess this client for based on these initial findings? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Family history of first-degree relative with schizophrenia 2. Use of illegal substances 3. Recent episodes of anxiety 4. Family history of heart disease 5. History of a dysfunctional family Answer: 1, 2, 5 Explanation: A person has a 5 to 10 times greater risk of getting schizophrenia if a first-degree relative has the disorder. Use of drugs such as cocaine can produce hallucinations or paranoia. Family dynamics can affect coping skills, which can influence the onset of schizophrenia. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-3 Explain theories for the etiology of schizophrenia. 6) A client is prescribed aripiprazole (Abilify) to treat both the positive and negative symptoms of schizophrenia. What will the nurse explain as the medication's mechanism of action? 1. Increasing norepinephrine activity by blocking its synaptic reuptake 2. Partial agonist activity at dopamine type 2 (D2 and D3) and serotonin type 2 3. Inhibiting the reuptake of serotonin at the synapse 4. Binding to the GABA receptor Answer: 2 Explanation: By blocking D2 receptors, antipsychotic drugs reduce the symptoms of schizophrenia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 349

7) A client in the emergency department tells the nurse about being chased by a "serial killer." The client is currently paranoid and is aggressively fighting against any treatment. Which medication does the nurse anticipate will be prescribed for this client? 1. Clozapine (Clozaril) in intramuscular (IM) form 2. Risperidone (Risperdal) IM 3. Loxapine (Loxitane) IM 4. Lorazepam (Ativan) IM Answer: 4 Explanation: Benzodiazepines such as lorazepam (Ativan) may be administered intramuscularly during the initial treatment period; they provide sedation for agitated clients. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-4 Describe the initial treatment and maintenance pharmacotherapy of schizophrenia. 8) A client was prescribed olanzapine (Zyprexa) 4 weeks ago to treat symptoms of schizophrenia. The client's family has noted only a small improvement in symptoms and asks about changing to another treatment. Which response by the nurse is the most appropriate? 1. "The client will need to see a psychotherapist in conjunction with the medication for there to be a major improvement in symptoms." 2. "It might take 6 to 8 weeks to see definite improvement in most symptoms." 3. "It might take 8 to 12 weeks to begin seeing improvement on this therapy." 4. "There should have been improvement within 1 to 2 weeks." Answer: 2 Explanation: By 6 to 8 weeks, definite improvement should be noted in most symptoms. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-4 Describe the initial treatment and maintenance pharmacotherapy of schizophrenia.

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9) The nurse is providing discharge instructions to a client who is prescribed ziprasidone (Geodon) for acute mania associated with bipolar disorder. Which statement by the client indicates the need for further education regarding this medication? 1. "I need to report severe muscle spasms, especially of the neck, back, tongue, or face." 2. "I sure hate it that I can't have a beer with my buddies anymore." 3. "I hope that I can discontinue this medicine after I go back to see my doctor." 4. "I need to let the doctor know immediately if I begin to have dizziness, lightheadedness, or shortness of breath with an irregular heartbeat." Answer: 3 Explanation: The majority of clients must maintain drug therapy for a lifetime, or symptoms will return. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 20-4 Describe the initial treatment and maintenance pharmacotherapy of schizophrenia.

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10) A client with a history of suicidal behavior and schizophrenia stopped taking clozapine (Clozaril) after 4 weeks of therapy. The client is currently experiencing a return of hallucinations. What might the nurse assess when determining the reason the client stopped taking the medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Feeling sedated all the time 2. Significant weight gain 3. Agitation 4. Fatigue and headache 5. Lack of desire to consume alcohol Answer: 1, 2, 3, 4 Explanation: Clients do not like the side effect of being sedated all the time. Substantial weight gain has been reported in some clients taking this medication. This is a reason some stop taking the medication. Agitation may be an extrapyramidal symptom of treatment with this medication and is an unwanted adverse effect. Fatigue and headache are possible side effects of this medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-5 Explain the importance of patient drug adherence in the pharmacotherapy of psychoses. 11) The nurse is preparing discharge instructions for a client being treated with medication and psychotherapy for schizophrenia. What should the nurse address with the client prior to discharge? 1. The client smokes 1 to 3 cigarettes per day. 2. The client drinks 1 to 3 beers before bedtime per day. 3. The client likes to eat grapefruit for breakfast. 4. The client drinks 1 to 3 caffeinated sodas per day. Answer: 2 Explanation: Alcohol taken with antipsychotic medications can cause additive CNS depression, which could be fatal. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-5 Explain the importance of patient drug adherence in the pharmacotherapy of psychoses. 352

12) A client's medication regimen is being determined by the healthcare provider. Currently, the medications haloperidol (Haldol), a high-potency drug, and chlorpromazine, a low-potency drug, are being considered. Which doses of the medications does the nurse anticipate for this client? 1. 2 mg of chlorpromazine and 2 mg of haloperidol (Haldol) 2. 100 mg of chlorpromazine and 2 mg of haloperidol (Haldol) 3. 100 mg of chlorpromazine and 100 mg of haloperidol (Haldol) 4. 2 mg of chlorpromazine and 100 mg of haloperidol (Haldol) Answer: 2 Explanation: Low-potency drugs are those that require higher doses, and high-potency drugs are those that are able to control symptoms with low doses. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-6 Explain how antipsychotic drugs are classified. 13) A client prescribed haloperidol (Haldol) is not demonstrating an improvement of psychotic behavior after taking the medication for 5 days. The nurse would anticipate which dose change for the medication? 1. No changes are necessary, as it might take 2 to 4 weeks for significant improvement to be noted. 2. The dose of haloperidol (Haldol) might be increased. 3. The order for haloperidol (Haldol) might be discontinued. 4. Xanax might be added to improve the symptoms of psychotic behavior. Answer: 1 Explanation: The pharmacotherapy of psychosis is a long-term process, with symptoms resolving gradually. It could take 2 to 4 weeks before a significant change in behavior is noted. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-6 Explain how antipsychotic drugs are classified.

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14) A client with a history of benign prostatic hyperplasia is beginning treatment for schizophrenia. Which medication might be contraindicated for this client? 1. Fluphenazine 2. Chlorpromazine 3. Aripiprazole (Abilify) 4. Risperidone (Risperdal) Answer: 2 Explanation: Chlorpromazine should be used with caution in clients with benign prostatic hyperplasia because it can cause urinary retention. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-7 Discuss the rationale for selecting a specific antipsychotic drug for the treatment of schizophrenia. 15) The nurse is caring for a client with severe cardiovascular disease and schizophrenia. Which antipsychotic medication would be the safest treatment for this client? 1. Ziprasidone (Geodon) 2. Paliperidone (Invega) 3. Risperidone (Risperdal) 4. Aripiprazole (Abilify) Answer: 3 Explanation: Risperidone (Risperdal) should be used with caution in dysrhythmias but is not specifically listed as a risk in cardiovascular disease. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-7 Discuss the rationale for selecting a specific antipsychotic drug for the treatment of schizophrenia.

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16) A client is prescribed fluphenazine (Prolixin) and is experiencing muscle spasms of the neck. The client is grimacing and having difficulty speaking. Which action should the nurse take? 1. Call the healthcare provider and prepare to give chlorpromazine (Thorazine) IM. 2. Distract the client to confirm the client is not faking a muscle spasm. 3. Call the healthcare provider and prepare to give diphenhydramine (Benadryl). 4. Engage the client in open-ended conversation to find out why the client is having difficulty speaking. Answer: 3 Explanation: Signs of acute dystonia associated with fluphenazine include severe muscle spasms of the back, neck, tongue, and face. It can be so severe as to cause laryngospasm. When treated with diphenhydramine (Benadryl), it can be reversed within minutes. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-8 Identify the extrapyramidal adverse effects of antipsychotic drugs. 17) A client who was prescribed trifluoperazine (Stelazine) 2 days ago presents with muscle spasms of the tongue. The healthcare provider orders diphenhydramine (Benadryl) 50 mg IV. What is the rationale for this medication? 1. To decrease saliva and mucous secretions 2. To reverse the acute dystonia 3. To prevent anaphylaxis 4. To sedate the client Answer: 2 Explanation: Diphenhydramine (Benadryl) is used to reverse the acute dystonia before the client has respiratory distress caused by laryngospasms. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-8 Identify the extrapyramidal adverse effects of antipsychotic drugs.

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18) A client is prescribed haloperidol decanoate (Haldol LA) IM to be administered once a month for treatment of schizophrenia. The nurse will instruct the client to notify the healthcare provider for which manifestation? 1. Involuntary, unusual tongue and face movements, such as lip smacking or rapid eye blinking 2. Nausea, sometimes accompanied with vomiting 3. Weight gain of 5 lb or more in 2 weeks 4. Constipation and dry mouth Answer: 1 Explanation: Unusual tongue and face movements are signs of tardive dyskinesia, and if the medication is not discontinued immediately, the symptoms could persist for months or years. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-8 Identify the extrapyramidal adverse effects of antipsychotic drugs. 19) The nurse is assessing a female client who is prescribed chlorpromazine for schizophrenia. Based on this information, what will the nurse include in the client assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Perform an eye exam and ask if there have been changes in vision. 2. Draw blood to check a lipid profile. 3. Ask the client questions regarding amount of alcohol intake. 4. Determine the date of her last menstrual period. 5. Draw blood to check thyroid function. Answer: 1, 3, 4 Explanation: Chlorpromazine accumulates in the eye, and there is a risk of phototoxicity, blurred vision, dry eyes, and glaucoma. It is important to assess for alcohol use, as this could cause excessive drowsiness. It is important to assess for pregnancy as this drug is pregnancy category C. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-9 Describe the nurse's role in the pharmacologic management of schizophrenia. 20) A client prescribed clozapine (Clozaril) for treatment of schizophrenia is complaining of 356

drowsiness after the first 2 weeks of therapy. Which response by the nurse is the most appropriate for this situation? 1. "Take the medication exactly as prescribed, and do not discontinue it without the healthcare provider's approval." 2. "Tell the healthcare provider that you cannot tolerate the drowsiness caused by the medication." 3. "It may take 6 to 8 weeks for the drowsiness to subside." 4. "Try taking the medication at bedtime." Answer: 4 Explanation: This is the best answer when the client has only taken the medication for 2 weeks. Taking the medication at bedtime should reduce drowsiness. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-9 Describe the nurse's role in the pharmacologic management of schizophrenia. 21) A client prescribed an atypical antipsychotic medication for bipolar disorder reports difficulty sleeping. What might the nurse want to discuss with the client? 1. Using alcohol to aid with sleep 2. Increasing fluid intake 3. Trying St. John's wort to help with sleeping 4. Avoiding the use of valerian Answer: 4 Explanation: Increased central nervous system depression may occur if used with valerian. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-9 Describe the nurse's role in the pharmacologic management of schizophrenia.

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22) A client prescribed olanzapine (Zyprexa) for mania associated with bipolar disorder is being discharged. Which client statement indicates more teaching is necessary about this medication? 1. "I take St. John's wort at bedtime to help me go to sleep." 2. "I'm going to weigh myself weekly to check for weight gain." 3. "I need to report symptoms of extreme thirst, insatiable hunger with weight loss, and increased urination." 4. "I might need to increase my intake of fiber and fluids." Answer: 1 Explanation: Increased central nervous system depression can occur if atypical antipsychotics are taken with St. John's wort or valerian. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 20-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 23) Treatment with an antipsychotic medication is being considered for an older adult client with dementia-related psychosis. Which medication would not be appropriate for this client? 1. Olanzapine (Zyprexa) 2. Clozapine (Clozaril) 3. Loxapine (Loxitane) 4. Aripiprazole (Abilify) Answer: 4 Explanation: Older adult clients with dementia-related psychosis have an increased risk of death due to stroke and other cardiovascular disorders when taking aripiprazole (Abilify). Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 358

24) The nurse is instructing a client on the medication risperidone (Risperdal). What should be included in this teaching? 1. Do not use alcohol while on this medication. 2. Watch for abnormal bruising, bleeding of the gums, blood in the feces, or any other abnormal bleeding. 3. Do not eat grapefruit or take grapefruit juice while on this medication. 4. Monitor for extreme thirst, hunger with weight loss, and increased urination. Answer: 1 Explanation: The use of alcohol can cause additive CNS depression. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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25) A client prescribed aripiprazole (Abilify) for schizophrenia is experiencing signs of hypotension with certain activities since starting this medication. What should the nurse teach the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Avoid being outside in the heat of the day. 2. Avoid hot baths or hot showers. 3. Avoid caffeine-containing preparations. 4. Change positions slowly, especially from lying or sitting to standing. 5. Take frequent naps during the day. Answer: 1, 2, 4 Explanation: The client should avoid any situation that might cause overheating, especially in hot weather, to reduce the risk of hypotension. Hot baths and hot showers should be avoided to decrease the chance of hypotension. Changing positions slowly will help reduce orthostatic hypotension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-11 Apply the nursing process to care for patients receiving pharmacotherapy for psychosis.

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26) A client has been experiencing fever, diaphoresis, muscle rigidity, and tachycardia for 4 hours. Current medications include aripiprazole (Abilify), enalapril (Vasotec), and atenolol (Tenormin). What will the nurse prepare to administer to this client? 1. Antipyretics, electrolytes, and muscle relaxants 2. Antipyretics, intravenous fluids, and lorazepam (Ativan) 3. Antipyretics, electrolytes, and a cooling blanket 4. Antipyretics, intravenous fluids, and atropine Answer: 1 Explanation: Quick, aggressive treatment is required for symptoms of neuroleptic malignant syndrome with antipyretics, electrolytes, and muscle relaxants. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-11 Apply the nursing process to care for patients receiving pharmacotherapy for psychosis. 27) A client with acute symptoms of schizophrenia is prescribed ziprasidone (Geodon) IM. Which rhythm will the nurse assess this client for prior to administering the medication? 1. Normal sinus rhythm 2. Sinus irregularity 3. Increase in QT interval 4. Premature atrial contractions Answer: 3 Explanation: Ziprasidone (Geodon) has the possibility of prolonging the QT interval, causing potentially fatal dysrhythmias. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-11 Apply the nursing process to care for patients receiving pharmacotherapy for psychosis.

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28) During an assessment, the nurse determines a client is demonstrating symptoms of a psychosis. Which clinical manifestations did the nurse find during the assessment of this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client says, "The servants need to be disciplined." 2. The client says, "The voice told me to cut myself." 3. The client laughs when asked about the health of a family member hospitalized for cancer treatment. 4. The client asks to close the room door so "that man can't get to me." 5. The client says, "I have not been able to get any sleep for months." Answer: 1, 2, 3, 4 Explanation: This statement is an example of a grandiose delusion. This statement is an example of an auditory hallucination. During a psychotic episode, the client's mood and affect may vary widely and be inappropriate, such as laughing at sad events. This statement is an example of a delusion in which someone is trying to harm the client. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-1 Describe the general symptoms of psychosis.

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29) While conducting a health history, the nurse notes that the client is demonstrating positive signs of schizophrenia. Which clinical manifestations did the nurse find during the assessment of this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Disorganized sentence structure 2. Kicking the nurse 3. Not responding to questions 4. Difficulty following instructions 5. Stating that God wants the client to go home Answer: 1, 2, 5 Explanation: Disorganized speech is a positive symptom of schizophrenia. Combativeness is a positive symptom of schizophrenia. A delusion is a positive symptom of schizophrenia. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-2 Compare and contrast the positive and negative symptoms of schizophrenia. 30) The family of a client diagnosed with schizophrenia asks why medications are needed to help control the client's symptoms. Which responses by the nurse are appropriate in this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Medications for schizophrenia work on the basal ganglia of the brain." 2. "Most antipsychotic drugs block dopamine receptors to reduce the symptoms of the disorder." 3. "They help correct the genetic component of the disorder." 4. "They are really sedatives to stop the client from causing harm." 5. "They stimulate dopamine receptors to reduce the symptoms of the disorder." Answer: 1, 2 Explanation: There is a theory that overactive dopaminergic pathways in the basal ganglia are associated with the symptoms of schizophrenia. Most antipsychotic drugs act by entering dopaminergic synapses and competing with dopamine. By blocking dopamine receptors, antipsychotic drugs reduce the symptoms of schizophrenia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-3 Explain theories for the etiology of schizophrenia. 363

31) A client prescribed antipsychotic medication for chronic schizophrenia abruptly stops taking the medication and is in the emergency department. Which findings does the nurse anticipate when assessing this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Nausea 2. Sweating 3. Vomiting 4. Salivation 5. Paralysis Answer: 1, 2, 3, 4 Explanation: Abrupt cessation of some antipsychotic medication can cause serious withdrawal symptoms, including nausea. Abrupt cessation of some antipsychotic medication can cause serious withdrawal symptoms, including sweating. Abrupt cessation of some antipsychotic medication can cause serious withdrawal symptoms, including vomiting. Abrupt cessation of some antipsychotic medication can cause serious withdrawal symptoms, including salivation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-4 Describe the initial treatment and maintenance pharmacotherapy of schizophrenia.

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32) A client being treated for schizophrenia admits to occasionally skipping medication doses. Based on this information, what will the nurse include in the client assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use of alcohol 2. Intensity of side effects 3. Understanding of the health problem 4. Belief that the medication is poison 5. Cost of the medication Answer: 1, 2, 3, 4 Explanation: A factor in nonadherence with antipsychotic medication is the desire to drink alcohol. Even motivated clients may have difficulty tolerating the side effects of antipsychotic medications. A lack of insight into the illness may cause some clients to believe their behavior is normal and does not need to be treated with medication. Clients with paranoia may feel that drug therapy is a plot to poison them. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-5 Explain the importance of patient drug adherence in the pharmacotherapy of psychoses.

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33) A client being treated with antipsychotic medication for schizophrenia is overheard telling family that the problem has improved because the new medication is given at a low dose. How should the nurse respond to this client's comment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The new medication has a higher potency, and a lower dose is needed." 2. "The symptoms can be controlled with a lower dose." 3. "The other medication was not working." 4. "It is always better to start a new medication with a lower dose." 5. "The other medication was too much for you since your symptoms are almost gone." Answer: 1, 2 Explanation: High-potency drugs control symptoms at lower doses. High-potency drugs are able to control symptoms with a lower dose. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-6 Explain how antipsychotic drugs are classified. 34) The family of a client being treated for schizophrenia asks the nurse why the client's medication was changed to a new type just out on the market. Which responses by the nurse are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The newer medications have fewer adverse effects." 2. "Many clients prefer the new medication." 3. "The newer medications cost less." 4. "The newer medications are easier to get from the pharmacy." 5. "The client's healthcare provider likes to try new medications." Answer: 1, 2 Explanation: The second-generation atypical antipsychotic medications have a lower incidence of serious adverse effects. The second-generation atypical antipsychotic medications have become the drugs of choice for many clients. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-7 Discuss the rationale for selecting a specific antipsychotic drug for the treatment of schizophrenia. 366

35) A client being treated for chronic schizophrenia develops tardive dyskinesia. Which interventions will the nurse prepare to perform for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Administering a prescribed lower dose of the antipsychotic medication 2. Administering a benzodiazepine as prescribed 3. Administering tapered doses of the antipsychotic medication 4. Administering a newly prescribed atypical antipsychotic medication 5. Administering a higher dose of the currently prescribed antipsychotic medication Answer: 1, 2, 3, 4 Explanation: For some clients, decreased doses of the antipsychotic medication help with the symptoms of tardive dyskinesia. For some clients, a benzodiazepine helps with the symptoms of tardive dyskinesia. For some clients, a gradual withdrawal of the antipsychotic medication helps with the symptoms of tardive dyskinesia. For some clients, switching to an atypical antipsychotic medication helps with the symptoms of tardive dyskinesia. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-8 Identify the extrapyramidal adverse effects of antipsychotic drugs.

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36) The nurse is concerned that a client being treated with antipsychotic medication for schizophrenia is developing extrapyramidal symptoms. Which assessment findings support the nurse's concern? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Neck spasms 2. Fidgeting and rocking back and forth in the chair 3. Shuffling gait 4. Lip smacking and rapid eye blinking 5. Diaphoresis and muscle rigidity Answer: 1, 2, 3, 4 Explanation: Acute dystonia involves severe muscle spasms of the neck. Akathisia, the inability to rest or relax, is a common extrapyramidal symptom. Parkinsonism induced by antipsychotic medications may include a shuffling gait. Tardive dyskinesia is characterized by involuntary lip smacking and rapid eye blinking. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-9 Describe the nurse's role in the pharmacologic management of schizophrenia.

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37) A client is being evaluated for appropriate medication treatment for a new onset of psychosis. Which information in the history would indicate that haloperidol (Haldol) is contraindicated for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Current treatment for Parkinson's disease 2. History of seizure disorder 3. Malnourished 4. Currently prescribed lithium 5. Drinks a six pack of beer every day Answer: 1, 2, 4, 5 Explanation: This medication is contraindicated in those with Parkinson's disease. This medication is contraindicated in those with a seizure disorder. Because this medication and lithium have been implicated in brain damage in a few clients, the two medications should not be taken together. This medication should not be taken by clients with a history of alcoholism. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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38) The nurse is instructing a client on the importance of having routine blood work performed while taking a prescribed antipsychotic medication. Which symptoms would warrant having the client notify the healthcare provider immediately? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Abdominal pain 2. Change in stool color 3. Increased thirst and urination 4. Frequent infections 5. Dry mouth Answer: 1, 2, 3, 4 Explanation: Antipsychotic drugs can cause hepatotoxicity as an adverse effect. Antipsychotic drugs can cause hepatotoxicity as an adverse effect. Antipsychotic drugs can cause increased glucose levels. Increased thirst and urination could be symptoms of hyperglycemia. Antipsychotic drugs can cause bone marrow depression, which could affect the client's white and red blood cell counts. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-11 Apply the nursing process to care for patients receiving pharmacotherapy for psychosis. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 21 Pharmacotherapy of Degenerative Diseases of the Central Nervous System 1) The nurse is planning a presentation on degenerative diseases. Which two most common degenerative diseases will the nurse include in the presentation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Amyotrophic lateral sclerosis 2. Multiple sclerosis 3. Alzheimer's disease 4. Huntington's chorea 5. Parkinson's disease Answer: 3, 5 Explanation: Alzheimer's disease and Parkinson's disease are the two most common degenerative diseases of the central nervous system. Alzheimer's disease and Parkinson's disease are the two most common degenerative diseases of the central nervous system. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential 370

Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 21-1 Identify the most common degenerative diseases of the central nervous system. 2) When teaching a community course on health problems that the older adult client might encounter, the nurse describes a disorder that is characterized by progressive memory loss, confusion, and the inability to think clearly. Which disease process is the nurse describing? 1. Alzheimer's disease 2. Parkinson's disease 3. Schizophrenia 4. Huntington's chorea Answer: 1 Explanation: Alzheimer's disease is a degenerative disorder characterized by progressive memory loss, confusion, and inability to think or communicate clearly and effectively. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-1 Identify the most common degenerative diseases of the central nervous system. 3) A client with memory loss and difficulty completing routine tasks questions if these symptoms are related to Alzheimer's disease. For what additional symptoms will the nurse assess to determine if the client is experiencing Alzheimer's disease? 1. Muscle weakness and vision changes 2. Tremors, muscle rigidity, and abnormal gait 3. Confusion and difficulty with communication 4. Involuntary muscle spasms and confusion Answer: 3 Explanation: Alzheimer's disease is a degenerative disorder characterized by progressive memory loss, confusion, and inability to think or communicate effectively. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-1 Identify the most common degenerative diseases of the central nervous system. 371

4) The nurse is determining if a client is experiencing symptoms of Alzheimer's disease or Huntington's chorea. Which assessment finding would indicate the client might have Huntington's chorea rather than Alzheimer's disease? 1. Confusion 2. Difficulty completing tasks 3. Involuntary muscle spasm 4. Memory loss Answer: 3 Explanation: Huntington's chorea is a disorder characterized by involuntary muscle spasms and rigidity plus progressive dementia. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-1 Identify the most common degenerative diseases of the central nervous system.

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5) Which assessment finding would indicate to the nurse that a client might have secondary Parkinson's disease? 1. Confusion and difficulty performing activities of daily living 2. Nonintentional tremor and history of a brain injury 3. Progressive memory loss and history of fatigue 4. Involuntary muscle spasm and history of a motor vehicle crash Answer: 2 Explanation: History of a brain injury and nonintentional tremor are classic signs associated with secondary Parkinson's disease. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-2 Distinguish between idiopathic Parkinson's disease and secondary Parkinson's disease. 6) The nurse is concerned that a client is experiencing symptoms of Parkinson's disease. Which assessment findings would indicate the client might have idiopathic or primary Parkinson's disease? 1. Tremors and bradykinesia 2. Ocular diplopia and ptosis 3. Progression and severity of fatigue 4. Spasticity and paresis Answer: 1 Explanation: Tremors and bradykinesia are present with idiopathic or primary Parkinson's disease. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-2 Distinguish between idiopathic Parkinson's disease and secondary Parkinson's disease.

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7) A client is diagnosed with secondary Parkinson's disease. What is associated with the development of this type of Parkinson's disease? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Traumatic brain injury 2. Family history of the disorder 3. Brain tumor 4. Toxins 5. Encephalitis Answer: 1, 3, 4, 5 Explanation: Traumatic brain injury is a finding associated with development of secondary Parkinson's disease. Brain tumor is a finding associated with development of secondary Parkinson's disease. Exposure to toxins is a finding associated with development of secondary Parkinson's disease. A brain infection is a finding associated with development of secondary Parkinson's disease. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-2 Distinguish between idiopathic Parkinson's disease and secondary Parkinson's disease. 8) The nurse suspects a client is developing Parkinson's disease. Which early sign did the nurse most likely assess in this client? 1. Rigid posture 2. Shuffling gait 3. Masklike face 4. Tremors Answer: 4 Explanation: Tremors are usually the first sign of Parkinson's disease, along with fatigue and moving more slowly. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-3 Describe symptoms of Parkinson's disease.

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9) When assessing a client for the typical signs and symptoms of Parkinson's disease, which clinical manifestations would the nurse expect to find? 1. Tremors, a masklike facial expression, and a rigid posture 2. Shuffling gait, confusion, and postural instability 3. Tremors and hyperkinesia 4. A masklike expression and generalized muscle weakness Answer: 1 Explanation: The classic symptoms of Parkinson's disease are tremors, muscle rigidity, bradykinesia, and postural instability. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-3 Describe symptoms of Parkinson's disease. 10) During the nurse's assessment of a client with known Parkinson's disease, the onset of which finding would be cause for concern? 1. Masklike expression 2. "Pill-rolling" motion of the fingers 3. Confusion 4. Frequent falls Answer: 3 Explanation: Confusion is not a sign typically seen in clients with Parkinson's disease and would alert the nurse that further investigation into the cause of the confusion is warranted. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-3 Describe symptoms of Parkinson's disease.

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11) When explaining the pathophysiology of Parkinson's disease to a client, the nurse would explain that it is a degenerative disorder of the nervous system caused by the death of neurons that produce which substance? 1. Acetylcholine 2. Serotonin 3. Norepinephrine 4. Dopamine Answer: 4 Explanation: Symptoms of Parkinson's disease develop due to the destruction of the dopamine-producing neurons located in the substantia nigra. These neurons supply dopamine to the corpus striatum, the region of the brain that controls unconscious muscle movement. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-4 Explain the neurochemical basis for Parkinson's disease, focusing on the roles of dopamine and acetylcholine in the brain. 12) The nurse is explaining to a client the imbalance of neurotransmitters in Parkinson's disease. How will the nurse describe the relationship between acetylcholine and dopamine in the area of the brain that affects balance, posture, and involuntary muscle movement? 1. Dopamine stimulates while acetylcholine inhibits this region. 2. Both dopamine and acetylcholine inhibit this region of the brain. 3. Both dopamine and acetylcholine stimulate this region of the brain. 4. Dopamine inhibits and acetylcholine stimulates this region. Answer: 4 Explanation: Dopamine is supplied to the corpus striatum by dopamine-producing neurons in the substantia nigra. Control of unconscious muscle movement depends on the balance between dopamine and acetylcholine in the corpus striatum. Persons with Parkinson's disease have decreased levels of inhibitory dopamine and increased levels of stimulating acetylcholine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-4 Explain the neurochemical basis for Parkinson's disease, focusing on the roles of dopamine and acetylcholine in the brain.

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13) A client with Parkinson's disease asks the nurse why dopamine is not given as a neurotransmitter replacement. Which response by the nurse is the most appropriate? 1. "The risk for hypertension is too high with dopamine; therefore, more frequent cardiac monitoring would be required." 2. "Exogenous dopamine cannot cross the blood–brain barrier and would be of little use." 3. "Exogenous dopamine must be administered via intravenous infusion, which usually requires a central line and continuous cardiac monitoring." 4. "In older clients, the effects of dopamine on urinary function can pose an unacceptable risk for renal failure." Answer: 2 Explanation: Dopamine does not cross the blood–brain barrier. Levodopa is the precursor of dopamine and does cross the blood–brain barrier, where the enzyme dopa decarboxylase converts it to dopamine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-4 Explain the neurochemical basis for Parkinson's disease, focusing on the roles of dopamine and acetylcholine in the brain.

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14) What will the nurse include when teaching a caregivers' support group about Alzheimer's disease? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Glutamatergic inhibitors are the most common class of drugs for treating Alzheimer's disease. 2. Depression and aggressive behavior are common with the disease. 3. Memory difficulties are an early symptom of the disease. 4. Chronic inflammation of the brain can be a cause of the disease. 5. Pharmacologic therapies are given to help improve memory in Alzheimer's disease. Answer: 2, 3, 4, 5 Explanation: Depression and aggressive behavior are common symptoms of the disease. Memory difficulties are an early symptom of Alzheimer's disease. It is suspected that chronic inflammation and excess free radicals can cause neuron damage and contribute to the disease. The acetylcholinesterase inhibitors are the most widely used class of drugs for treating the disease. These drugs work by increasing the availability of acetylcholine. Acetylcholine is involved in cognition, memory, and learning. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 21-5 Describe symptoms of Alzheimer's disease and explain theories about why these symptoms develop. 15) The nurse explains to the family of a client with Alzheimer's disease that memory loss and confusion occur because of the disease's effect on which neurotransmitter? 1. Serotonin 2. Acetylcholine 3. Dopamine 4. Gamma aminobutyric acid (GABA) Answer: 2 Explanation: Clients with Alzheimer's disease experience a dramatic loss of their ability to perform tasks that require acetylcholine as a neurotransmitter. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-5 Describe symptoms of Alzheimer's disease and explain theories about why these symptoms develop.

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16) Which assessment finding in a client with Alzheimer's disease would the nurse directly attribute to the disease's effect on acetylcholine? 1. Darkened urine 2. Inability to retain new information 3. Muscle cramps 4. Vomiting and diarrhea Answer: 2 Explanation: Acetylcholine functions within the hippocampus (an area of the brain responsible for learning and memory) and in other portions of the cerebral cortex. The inability to recall information is among the early symptoms of the disease. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-5 Describe symptoms of Alzheimer's disease and explain theories about why these symptoms develop. 17) The spouse of a client with Parkinson's disease asks how taking medication will help with symptoms. What is the nurse's best response? 1. "Medication will balance serotonin and acetylcholine in your spouse's brain." 2. "Medication will prevent muscle wasting in your spouse." 3. "Medication will boost your spouse's energy and appetite." 4. "The medication will facilitate your spouse's ability to walk, dress, and eat." Answer: 4 Explanation: The goal of pharmacotherapy for Parkinson's disease is to increase an individual's ability to perform activities of daily living, such as walking, dressing, eating, and bathing. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-6 Describe the nurse's role in the pharmacologic management of Parkinson's disease and Alzheimer's disease.

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18) A client has been diagnosed with Alzheimer's disease. What is the most accurate medication education the nurse can give to the client's spouse? 1. "Symptoms should begin to improve in a few days." 2. "The medication has side effects that require periodic breaks from treatment." 3. "There is no cure. The medication might help with symptoms for a period of time." 4. "Symptoms will improve as long as the medication is taken daily at the same time." Answer: 3 Explanation: Medications can slow the progression of the disease, but there is no cure. Improvement with medication usually lasts only a matter of months, and it takes 1 to 4 weeks to observe medication effectiveness. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-6 Describe the nurse's role in the pharmacologic management of Parkinson's disease and Alzheimer's disease. 19) The family member of a client with Parkinson's disease notifies the nurse that the client is demonstrating extrapyramidal symptoms. Which instruction by the nurse to the family is the most appropriate? 1. Increase the dosage of the antiparkinson drugs. 2. Transport the client to the emergency department immediately. 3. Make an appointment when convenient for the client and healthcare provider for an evaluation. 4. Give diphenhydramine (Benadryl) 25 mg immediately by mouth. Answer: 2 Explanation: Extrapyramidal symptoms can be life threatening without intervention. The client should be transported immediately to the emergency department. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-6 Describe the nurse's role in the pharmacologic management of Parkinson's disease and Alzheimer's disease.

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20) A client is prescribed a dopaminergic agent for management of symptoms related to Parkinson's disease. When teaching the client and family about medication management, which time frame will the nurse include regarding when the medication's results should be observable? 1. Within 1 week 2. Within 2 to 3 days 3. Within 24 hours 4. Within 2 to 3 weeks Answer: 4 Explanation: It can take up to 2 or 3 weeks to observe results in the client. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-6 Describe the nurse's role in the pharmacologic management of Parkinson's disease and Alzheimer's disease. 21) The nurse is teaching a class for caregivers of clients with Alzheimer's disease. The nurse determines that learning has occurred when a caregiver makes which statement? 1. "There are effective drugs, but they cannot be used over a long period of time." 2. "There are drugs that will help to decrease the symptoms for a period of time." 3. "There aren't any drugs that are effective in treating this disease." 4. "There are drugs that can control the symptoms for many years." Answer: 2 Explanation: Current medications will only decrease symptoms for a short period of time. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 21-7 Discuss the pharmacologic goals for the management of Parkinson's disease, Alzheimer's disease, and other neurodegenerative disorders.

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22) A client with Parkinson's disease develops depression. What education would the nurse provide to the client's family? 1. "Depression is a common problem with Parkinson's disease." 2. "Depression is very easy to treat, and a wide variety of medications are available." 3. "Eventually anyone who has a brain disease will develop depression." 4. "The depression is most likely a side effect of the medications taken to treat the symptoms." Answer: 1 Explanation: Over half of the clients with Parkinson's disease present with clinical depression. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-7 Discuss the pharmacologic goals for the management of Parkinson's disease, Alzheimer's disease, and other neurodegenerative disorders. 23) The nurse provides instruction to a client who is prescribed levodopa/carbidopa (Parcopa). Which client statement indicates that learning has occurred? 1. "I need to increase my daily intake of protein." 2. "I must avoid eating leafy green vegetables in my diet." 3. "I need to check my pulse before I take this medication." 4. "I must avoid foods such as beef, whole-grain cereals, and multivitamins." Answer: 4 Explanation: The client should be instructed to avoid foods high in pyridoxine such as beef, whole-grain cereals, and multivitamins because they will decrease the effects of the medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 21-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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24) Prior to administering benztropine (Cogentin) to a client, the nurse assesses adverse effects of previous doses and decides to withhold the current dose. Which clinical manifestation would warrant the nurse withholding the dose of the medication? 1. A respiratory rate of 14 2. A blood pressure reading of 88/60 mmHg 3. A temperature of 100.2°F 4. Distant bowel sounds Answer: 4 Explanation: Paralytic ileus is the only identified life-threatening adverse reaction with this medication. Distant bowel sounds could be an indication of developing paralytic ileus. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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25) A client takes an aspirin, a multivitamin, and an antihistamine every day. What is the most important instruction by the nurse when the client is prescribed levodopa/carbidopa (Parcopa)? 1. "You should not take the multivitamin with your levodopa/carbidopa (Parcopa)." 2. "You should not take the antihistamine with your levodopa/carbidopa (Parcopa)." 3. "You should not take the aspirin with your levodopa/carbidopa (Parcopa)." 4. "These medications are safe to take with levodopa/carbidopa (Parcopa)." Answer: 1 Explanation: Vitamin B6 will decrease the effects of levodopa/carbidopa (Parcopa), so a multivitamin should not be taken with the medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 26) The nurse is planning care for a client with Parkinson's disease. What intervention is important for the nurse to include? 1. Monitor the client's ability to chew and eat. 2. Teach the client to limit exercise to decrease the risk for fractures. 3. Assess peripheral circulation for presence of thrombophlebitis. 4. Monitor the client for development of psychotic symptoms. Answer: 1 Explanation: In Parkinson's disease, muscle function is lost, and the client's ability to chew and swallow is impaired, increasing the risk of aspiration. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 21-9 Apply the nursing process to care for patients receiving pharmacotherapy for degenerative diseases of the central nervous system.

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27) A client who is prescribed benztropine (Cogentin) tells the nurse about plans for a Caribbean cruise. What should the nurse include during client teaching? 1. "Take a multivitamin every day to keep you healthy." 2. "If you miss a dose, take the next dose at its regularly scheduled time." 3. "Limit your activity while on the cruise." 4. "Avoid alcohol." Answer: 4 Explanation: Benztropine (Cogentin) interacts with alcohol and has an additive sedative effect. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-9 Apply the nursing process to care for patients receiving pharmacotherapy for degenerative diseases of the central nervous system. 28) An older client is receiving levodopa/carbidopa (Parcopa). Which side effect of the medication would cause the nurse the most concern? 1. Hypertension 2. Dark urine 3. Urinary retention 4. Diarrhea Answer: 3 Explanation: Urinary retention is related to the anticholinergic effects of the medication and must be reported to the healthcare provider. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-9 Apply the nursing process to care for patients receiving pharmacotherapy for degenerative diseases of the central nervous system.

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29) A client is diagnosed with multiple sclerosis. Which symptoms will the nurse most likely assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Muscle weakness 2. Difficulty maintaining balance 3. Atrophy of the hands and legs 4. Slow shuffling gait 5. Progressive chorea Answer: 1, 2 Explanation: Muscle weakness is a manifestation of multiple sclerosis. Difficulty maintaining balance is a manifestation of multiple sclerosis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-1 Identify the most common degenerative diseases of the central nervous system. 30) After taking a health history, the nurse becomes concerned that a client is at risk for developing secondary Parkinson's disease because of which information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client has a history of concussions. 2. The client was treated for meningitis while in college. 3. The client worked as a crop duster after the war. 4. The client waited tables at a local restaurant. 5. The client scuba dives during vacations. Answer: 1, 2, 3 Explanation: Head trauma is a cause of secondary Parkinson's disease. Brain infections are a cause of secondary Parkinson's disease. Exposure to neurotoxins is a cause of secondary Parkinson's disease. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-2 Distinguish between idiopathic Parkinson's disease and secondary Parkinson's disease.

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31) The nurse observes a client with Parkinson's disease having difficulty controlling hand movements. What did the nurse observe in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Pill rolling 2. Tremor 3. Stooped posture 4. Lack of arm swing 5. Difficulty bending the arms Answer: 1, 2 Explanation: Pill rolling is a common behavior in progressive Parkinson's disease in which the client rubs the thumb and forefinger together in a circular motion resembling the motion of rolling a tablet between two fingers. The hands develop a palsy-like continuous motion or shaking when at rest. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-3 Describe symptoms of Parkinson's disease. 32) A client with Parkinson's disease is experiencing an increase in bradykinesia. What will the client demonstrate with this manifestation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Slow speech 2. Difficulty chewing 3. Shuffling the feet when walking 4. Stooped posture 5. Lack of facial expression Answer: 1, 2, 3 Explanation: Slow speech is a manifestation of bradykinesia. Difficulty chewing is a manifestation of bradykinesia. Shuffling the feet when walking is a manifestation of bradykinesia. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-3 Describe symptoms of Parkinson's disease.

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33) The nurse is explaining to a client with Parkinson's disease the steps in which the neurotransmitter dopamine functions to impact motor movement. In which order will the nurse explain these steps? Response 1. The substantia nigra produces dopamine. Response 2. Dopamine travels to the corpus striatum. Response 3. The dopamine is released. Response 4. The dopamine finds receptors. Response 5. The dopamine slows impulses down spinal neurons. Response 6. Coordinated unconscious muscle movement occurs. Answer: 1, 2, 3, 4, 5, 6 Explanation: 1. The substantia nigra, a dark band of gray matter in the midbrain, is a primary producer of the neurotransmitter dopamine. 2. The dopamine travels through axons along the nigrostriatal pathway to the corpus striatum. 3. When dopamine reaches the nigrostriatal pathways, it is released. 4. In the corpus striatum, dopamine encounters its receptors and produces multiple actions. 5. Dopamine serves an inhibitory function, slowing the flow of impulses down spinal neurons. 6. When dopamine is present, the normal flow of motor impulses from the corpus striatum helps to produce coordinated unconscious muscle movement. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-1 Describe the exchange of fluids that occurs among the different fluid compartments in the body.

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34) The nurse is caring for a client in the middle phase of Alzheimer's disease. Which symptoms is the client most likely to demonstrate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Inability to remember eating breakfast 2. Stating that the year is 1950 3. Staring at bath basin and not sure what to do with a washcloth 4. Weight loss 5. Inability to walk Answer: 1, 2, 3 Explanation: In the middle phase of the disease, recent memory loss occurs. In the middle phase of the disease, loss of orientation to time can occur. In the middle phase of the disease, changes in personal habits and increasing difficulty with self-care can occur. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-5 Describe symptoms of Alzheimer's disease and explain theories about why these symptoms develop.

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35) The spouse of a client with Alzheimer's disease tells the nurse that the healthcare provider said that a cause of the disorder is brain damage. The spouse wants to know what type of brain damage could have occurred to the client. What possible causes of brain damage can the nurse explain to the spouse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Environmental exposure 2. Nutritional imbalances 3. Exposure to viruses 4. Acetylcholine deficiency 5. Defect in chromosome 14 Answer: 1, 2, 3 Explanation: Environmental exposure is considered a possible source of brain damage in the client with Alzheimer's disease. Nutritional factors are considered a possible source of brain damage in the client with Alzheimer's disease. Viruses are considered a possible source of brain damage in the client with Alzheimer's disease. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-5 Describe symptoms of Alzheimer's disease and explain theories about why these symptoms develop.

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36) A client tells the nurse about using "different" drugs to treat the symptoms associated with mild Alzheimer's disease. For which drugs should the nurse assess the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Vitamins 2. NSAIDs 3. Ginkgo biloba 4. Estrogen 5. Antihistamines Answer: 1, 2, 3, 4 Explanation: Several agents, including vitamins, have been investigated for their possible benefit in delaying the progression of Alzheimer's disease. Several agents, including NSAIDs, have been investigated for their possible benefit in delaying the progression of Alzheimer's disease. Several agents, including ginkgo biloba, have been investigated for their possible benefit in delaying the progression of Alzheimer's disease. Several agents, including estrogen, have been investigated for their possible benefit in delaying the progression of Alzheimer's disease. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-6 Describe the nurse's role in the pharmacologic management of Parkinson's disease and Alzheimer's disease.

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37) The nurse is providing care to a client who is diagnosed with multiple sclerosis. When teaching the client about the medication therapy, which goals will the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Modifying the progression of the disease 2. Treating acute exacerbations 3. Managing symptoms 4. Curing the disease 5. Remyelinating nerve fibers Answer: 1, 2, 3 Explanation: This is a goal of pharmacologic therapy for multiple sclerosis. This is a goal of pharmacologic therapy for multiple sclerosis. This is a goal of pharmacologic therapy for multiple sclerosis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 21-7 Discuss the pharmacologic goals for the management of Parkinson's disease, Alzheimer's disease, and other neurodegenerative disorders.

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38) A client with amyotrophic lateral sclerosis is prescribed riluzole (Rilutek). What will the nurse instruct the client about this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. It reduces the degeneration of neurons. 2. It should be taken every 12 hours on an empty stomach. 3. The client should avoid high-fat meals before and after taking the medication. 4. Headache and dizziness are common reactions to this medication. 5. Paralytic ileus is a life-threatening adverse effect of this medication. Answer: 1, 2, 3, 4 Explanation: This medication has been proven to extend survival by reducing the degeneration of neurons. It is a tablet that should be taken every 12 hours on an empty stomach. The client should avoid high-fat meals before and after taking the medication because fat interferes with medication absorption. Common adverse effects include headache and dizziness. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-7 Discuss the pharmacologic goals for the management of Parkinson's disease, Alzheimer's disease, and other neurodegenerative disorders.

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39) Prior to administering donepezil (Aricept) to a client diagnosed with Alzheimer's disease, the nurse notes that the client is prescribed medications that will react with this drug. Which medications interact with donepezil (Aricept)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Phenytoin (Dilantin) 2. Rifampin 3. Quinidine 4. Penicillin 5. Aspirin Answer: 1, 2, 3 Explanation: Decreased effects of donepezil (Aricept) will occur with concurrent administration of phenytoin (Dilantin). Decreased effects of donepezil (Aricept) will occur with concurrent administration of rifampin. Metabolism of donepezil (Aricept) may be inhibited by quinidine. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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40) Prior to administering galantamine (Reminyl) to a client with Alzheimer's disease, the nurse reviews the client's medical history for which disease processes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Respiratory disorders 2. Liver dysfunction 3. Kidney failure 4. Atrial fibrillation 5. Arthritis Answer: 1, 2, 3, 4 Explanation: This medication should be used cautiously in those with respiratory disease. This medication is not recommended for use in those with hepatic dysfunction. This medication is not recommended for use in those with renal dysfunction. This medication is to be used cautiously in those with cardiac conduction disorders. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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41) Which strategies can the nurse teach the family of a client with Alzheimer's disease to ensure an adequate nutritional and fluid intake? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Weigh the client once a week. 2. Assist the client with eating. 3. Offer fluids on a regular basis. 4. Permit the client to feed self. 5. Provide finger foods. Answer: 1, 2, 3 Explanation: Weekly weights are one strategy to ensure an adequate nutritional intake. Helping the client with meals and eating is a strategy to ensure an adequate nutritional intake. Offering fluids is one way to ensure an adequate fluid intake. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-9 Apply the nursing process to care for patients receiving pharmacotherapy for degenerative diseases of the central nervous system. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 22 Pharmacotherapy of Seizures 1) A parent tells the nurse, "The doctor says my son has epilepsy, but he has never had a convulsion. How can that be?" Which response by the nurse to the parent is the most appropriate? 1. "He will probably develop convulsions as he gets older." 2. "Some people with epilepsy do not have seizures." 3. "Convulsions are not part of all epileptic conditions." 4. "The convulsions common in young boys are usually silent." Answer: 3 Explanation: Some epileptic conditions manifest seizure activity that does not include the tonic– clonic convulsion. An example of this type of seizure is the absence seizure, which is most often seen in children. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 22-1 Understand the causes of epilepsy.

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2) The nurse is teaching a class for clients who recently have been diagnosed with epilepsy. The nurse determines that learning has occurred when the clients make which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Epilepsy can be caused by a head injury." 2. "With some cases of epilepsy, the cause is never determined." 3. "Excessive stress levels cause disruptions in how the brain receives oxygen, leading to epilepsy." 4. "Eating disorders like anorexia nervosa increase the risk for developing epilepsy." 5. "A stroke, or brain attack, could increase the risk for developing epilepsy." Answer: 1, 2, 5 Explanation: Head trauma is a known cause of seizures. Epilepsy is a disorder where seizures occur on a chronic basis. In some cases, the exact etiology cannot be identified. Changes in cerebral perfusion such as hypotension, strokes or brain attacks, and shock can be causes of seizures. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 22-2 Differentiate among the following terms: epilepsy, seizures, and convulsions. 3) A preschool-age client is diagnosed with epilepsy. The child's mother is crying as she tells the nurse, "I know that this is my fault. I did drugs before I knew I was pregnant." Which response by the nurse is the most appropriate? 1. "That is most likely not the reason your child has epilepsy." 2. "The most important thing now is getting good care for your child." 3. "Women who take drugs during pregnancy have to realize they are possibly hurting their baby." 4. "Medical testing can tell when the damage occurred." Answer: 2 Explanation: The reason the child has epilepsy is not as important as obtaining appropriate care for the child today. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 22-2 Differentiate among the following terms: epilepsy, seizures, and convulsions. 4) The client who is prescribed valproic acid (Depakote) for seizure control would like to have a 397

baby. Which statements should the nurse include in a discussion with this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Since your epilepsy may flare up during pregnancy, your doctor will likely have you take a second antiepileptic medication." 2. "Thankfully, most modern antiepileptic medications will not interfere with your getting pregnant." 3. "Your current antiepileptic medication should not be used when you are pregnant." 4. "Folic acid supplementation is important for you." 5. "You should consider adopting a baby instead since there are so many problems associated with epilepsy and pregnancy." Answer: 3, 4 Explanation: Valproic acid (Depakote) is pregnancy category D. Folic acid supplementation is important for all women who are, or wish to become, pregnant. This is especially true of women who are epileptic because many antiepileptic medications cause folic acid deficiency. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 22-3 Describe how the presentation and pharmacotherapy of epilepsy change throughout the lifespan.

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5) A parent says to the nurse, "The doctor prescribed ethosuximide (Zarontin) for my child, who has absence seizures. What does this mean?" Which response by the nurse is the most appropriate? 1. "Absence seizures are basically the same kind of seizures as grand mal, but they are less frequent." 2. "Your child's seizures manifest as a staring into space for a few seconds. Ethosuximide (Zarontin) is a good medication for this type of seizure." 3. "Explaining the types of seizure activity is complicated. Have you spoken to your doctor about it?" 4. "Are you sure your doctor prescribed ethosuximide (Zarontin)? Phenobarbital is used more frequently with children." Answer: 2 Explanation: Absence seizures, formerly known as petit mal, last a few seconds and are seen most often in children. Ethosuximide (Zarontin) is a drug of choice for this type of seizure disorder. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 22-4 Differentiate the signs, symptoms, and treatment of the different types of seizure disorders.

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6) An emergency department (ED) client's wife says, "I couldn't wake my husband up this morning. He was snoring so loudly. Why, he was so asleep he urinated in the bed. He has never done anything like this before and he is okay now." Which question is the priority for the nurse to ask the client's wife? 1. "Does your husband have diabetes?" 2. "Was your husband especially active yesterday?" 3. "Has your husband ever had a seizure?" 4. "What kind of street drugs did your husband take last night?" Answer: 3 Explanation: Being difficult to awaken and sonorous respirations are findings associated with the postictal state common after seizure activity. Persons experiencing seizures may be incontinent of urine or stool. When the postictal state passes, the client may appear normal or "okay." Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 22-4 Differentiate the signs, symptoms, and treatment of the different types of seizure disorders.

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7) The nurse completes education to the parents of a child newly diagnosed with tonic–clonic seizures. Which comments made by the parents would the nurse evaluate as indicating the need for further education? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Some of the times when I thought he was ignoring me may have actually been seizure activity." 2. "He just needs to focus more to prevent these attacks." 3. "I know he will outgrow these seizures with time." 4. "I hope we can help our son identify his seizure aura." 5. "We will watch for the development of status epilepticus." Answer: 1, 2, 3 Explanation: Behavior that manifests as the child ignoring outside stimuli is most likely absence seizure, which is different from tonic–clonic seizure. The client who suffers seizure disorder cannot prevent seizure occurrence by focusing harder. The client with tonic–clonic seizure disorder is less likely to outgrow seizures than the client with absence seizure disorder. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 22-4 Differentiate the signs, symptoms, and treatment of the different types of seizure disorders.

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8) A mother phones the clinic and tells the nurse, "My 5-year-old son had a fever seizure this morning." She adds that this is the child's first seizure experience. The nurse responds by asking the mother to bring the child in to be seen today. What other information should the nurse offer? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Febrile seizures are uncommon in boys." 2. "High temperatures generally induce seizures." 3. "Five-year-olds are too old for febrile seizures." 4. "Febrile seizures occur in up to 5% of children." 5. "Seizure medications are usually not necessary for febrile seizures." Answer: 4, 5 Explanation: Up to 5% of children experience seizure activity related to temperature elevation. The best course of action for febrile seizures is prevention by using acetaminophen to prevent onset of fever. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 22-1 Understand the causes of epilepsy. 9) The client says to the nurse, "My doctor said that I will always have to take medicine to control the seizures from my epilepsy. Is that so?" What is the best response by the nurse? 1. "You will need to take medication on a continuous basis to control the seizures." 2. "You will have to take the medication until your seizures are cured." 3. "You will need to take the medication unless you are willing to make some very difficult lifestyle changes." 4. "After you have been seizure free for 1 year, you can stop taking medication." Answer: 1 Explanation: Epilepsy is a disease where seizures occur on a chronic basis. Even after seizures are controlled, clients are continued indefinitely on the antiseizure drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 22-3 Describe how the presentation and pharmacotherapy of epilepsy change throughout the lifespan.

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10) The client tells the nurse that she has been prescribed phenytoin (Dilantin) for 2 years and is still having too many side effects. She wants to stop taking it. What is the best response by the nurse? 1. "This is the best medication for you; we can add another medication to decrease the side effects associated with phenytoin (Dilantin)." 2. "Please do not stop the medication abruptly, as you will have withdrawal seizures." 3. "You have probably been on the medication long enough; I'll let your doctor know you are stopping it." 4. "Side effects are a problem, but they are not as bad as the seizures you were having." Answer: 2 Explanation: Seizures are likely to occur with abrupt withdrawal of antiseizure medication. The medication must be withdrawn over a period of 6 to 12 weeks. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 22-6 Identify factors that influence the selection of a specific antiseizure drug by the healthcare provider. 11) The healthcare provider has ordered intravenous (IV) diazepam (Valium) for the client in status epilepticus. During administration, it is most important for the nurse to assess for which result from this drug? 1. Tachycardia 2. Level of consciousness 3. Hypotension 4. Respiratory depression Answer: 4 Explanation: Respiratory depression is common when diazepam is given intravenously (IV). Respiratory assessment is the priority. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 22-6 Identify factors that influence the selection of a specific antiseizure drug by the healthcare provider.

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12) The healthcare provider has prescribed 5 mg of intravenous diazepam (Valium) to treat the client in status epilepticus. The client's IV bag is labeled "1000 mL D5NS with 20,000 units heparin." Which nursing interventions are necessary to safely administer this diazepam (Valium)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use a large-bore needle to access the IV port. 2. Flush the intravenous (IV) line with saline. 3. Administer the diazepam (Valium) directly into a vein in the client's hand. 4. Dilute the diazepam (Valium) with Xylocaine prior to administration. 5. Observe the IV tubing for cloudiness while administering the diazepam (Valium). Answer: 2, 5 Explanation: The IV line should be well flushed with saline to remove any residual heparin, which will precipitate with the diazepam (Valium). Diazepam (Valium) precipitates with many drugs. The nurse should watch the IV tubing just above the injection site for cloudiness or development of precipitate during administration and should discontinue the administration if this situation occurs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 22-6 Identify factors that influence the selection of a specific antiseizure drug by the healthcare provider.

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13) The client is prescribed phenobarbital for seizure control. The client asks the nurse how this little pill can stop seizures. What response by the nurse is the most appropriate? 1. "The pill helps to decrease the calcium in your brain, which is responsible for your seizures." 2. "This medication increases a chemical called GABA that calms down the excitability in your brain that causes your seizures." 3. "Phenobarbital increases a chemical called glutamate, which calms down the excitability in your brain that causes your seizures." 4. "It helps by decreasing the sodium in your brain, which is responsible for the seizures." Answer: 2 Explanation: Phenobarbital acts biochemically in the brain by enhancing the action of the neurotransmitter GABA, which is responsible for suppressing abnormal neuronal discharges that can cause epilepsy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 22-7 Describe the nurse's role in the pharmacologic management of seizures. 14) The client is receiving carbamazepine (Tegretol) for control of seizures. The client tells the nurse she plans to become pregnant. Which response by the nurse is the most appropriate? 1. "Please talk to your doctor; this drug is contraindicated in the pregnancy." 2. "Your medication dose will need to be decreased during your pregnancy." 3. "Your medication dose will need to be increased during your pregnancy." 4. "Please talk to your doctor; you will need a safer drug like valproic acid (Depakene)." Answer: 1 Explanation: Carbamazepine (Tegretol) falls under pregnancy category D and is contraindicated in pregnancy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 22-7 Describe the nurse's role in the pharmacologic management of seizures.

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15) The client has epilepsy and is prescribed phenytoin (Dilantin). The client has been seizure free and asks the nurse why he still needs blood tests when he is not having seizures. Which response by the nurse is the most appropriate? 1. "Dilantin can cause blood thinning in some people." 2. "There is a narrow range between a helpful dose of this medication and a dose that could make you feel sicker." 3. "Dilantin tends to lower blood levels of potassium." 4. "This medication can cause a severe skin reaction called Stevens–Johnson syndrome if doses are too high." Answer: 2 Explanation: Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose; blood levels must be monitored to ensure a therapeutic level and to prevent toxicity. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 22-7 Describe the nurse's role in the pharmacologic management of seizures.

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16) The nurse is speaking before a group of elementary school teachers on the topic of seizure control medications. Which behaviors should the nurse advise the teachers to watch for in children who are taking levetiracetam (Keppra)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Sleepiness after lunch 2. Fighting at recess 3. Inability to sit still 4. Depression 5. Difficulty in seeing the blackboard Answer: 2, 3, 4 Explanation: Levetiracetam (Keppra) can cause hostility in some children and may manifest as an inability to get along with others. Hyperkinesis is a common side effect of levetiracetam (Keppra). Depression is a common side effect of levetiracetam (Keppra). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 22-7 Describe the nurse's role in the pharmacologic management of seizures.

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17) The nurse is talking with a client who was just prescribed zonisamide (Zonegran). Which client statement should the nurse immediately discuss with the client's healthcare provider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Did I mention that I used to take phenobarbital for my seizures?" 2. "I forgot to tell the doctor that I am allergic to sulfa drugs." 3. "I have lactose intolerance, so I can't drink milk." 4. "My husband and I plan to have a baby in a couple of years." 5. "My husband and I are leading a 20-mile bicycle tour next weekend for the company we have just started." Answer: 2, 5 Explanation: Zonisamide (Zonegran) is an oral sulfonamide. The most common adverse effects of zonisamide (Zonegran) include dizziness, ataxia, and fatigue. These effects may be problematic for the owner of a company that promotes bicycle touring. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 22-7 Describe the nurse's role in the pharmacologic management of seizures.

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18) The older adult client is prescribed phenobarbital for seizure control. What is the most important intervention for the nurse to add to the client's care plan? 1. Monitor for signs of electrolyte imbalance. 2. Assess respiratory rate and depth every hour. 3. Track nutritional intake. 4. Measure and record all fluid intake and output. Answer: 2 Explanation: Older adult clients are at risk for cumulative effects of barbiturates due to diminished hepatic and renal function. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 22-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 19) The parents of a pediatric client diagnosed with epilepsy have decided to try a ketogenic diet to control their child's epilepsy. Which food should the nurse teach these parents to include in their child's diet? 1. Mashed potatoes with gravy 2. Baked chicken 3. Salad with vinegar and oil dressing 4. Roast beef Answer: 3 Explanation: Salad is low in calories, and the oil dressing is high fat. The ketogenic diet carefully controls calories, but is a high-fat diet. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 22-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 409

20) The nurse is planning educational sessions for a client regarding the use of a newly prescribed antiepileptic drug (AED). Which topics should be included in these sessions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client should take the medication at the same time every day. 2. If the client forgets a dose of medication, wait until the next dose is due and take both doses together. 3. The client should take an additional dose of medication upon experiencing a seizure aura. 4. If the client experiences side effects of the medication, the client should skip the next dose to see if the side effects lessen. 5. The client should avoid using dietary supplements containing kava when on this medication. Answer: 1, 5 Explanation: Stable blood levels of medication are important in the control of seizure activity. To achieve this stability, the medication should be taken at the same time every day. Kava interferes with many AEDs, often adding to their sedative effects. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 22-9 Apply the nursing process to care for patients receiving pharmacotherapy for seizures.

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21) The client states, "I can't swallow those capsules," so the nurse plans to open the carbamazepine (Carbatrol) for administration. Which foods found on the client's lunch tray are appropriate for the nurse to use for administration of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A hamburger patty 2. Citrus salad 3. Applesauce 4. Mashed potatoes 5. Green beans Answer: 3, 4 Explanation: Applesauce is soft and can be swallowed without chewing. Mashed potatoes are soft and can be swallowed without chewing. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 22-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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22) The client is prescribed valproic acid (Depakene) for treatment of seizures. The client has also been taking a daily 81-mg aspirin tablet prophylactically for a cardiac condition. Because of the use of these two drugs, the nurse closely observes the client for which occurrence? 1. Increase in seizure activity 2. Migraine headaches and generalized irritability 3. Bleeding from the gums and bruising of the skin 4. Stevens–Johnson syndrome Answer: 3 Explanation: Valproic acid (Depakene) can prolong bleeding time; concomitant aspirin use can cause severe bleeding. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 22-9 Apply the nursing process to care for patients receiving pharmacotherapy for seizures. 23) Which are included in the category of generalized seizures? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Tonic–clonic 2. Absence 3. Focal 4. Complex partial 5. Atonic Answer: 1, 2, 5 Explanation: The four primary types of generalized seizures are tonic–clonic, absence, atonic, and myoclonic seizures. The four primary types of generalized seizures are tonic–clonic, absence, atonic, and myoclonic seizures. The four primary types of generalized seizures are tonic–clonic, absence, atonic, and myoclonic seizures. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 22-5 Compare and contrast the pharmacotherapy of generalized and partial seizures. 412

24) A nurse is caring for a client started on an antiseizure medication. The client starts to stare off at the wall with eyelids fluttering. After a few seconds, the client is responsive to the nurse. Which type of seizure does the nurse document along with the assessment? 1. Tonic–clonic 2. Absence 3. Focal 4. Myoclonic Answer: 2 Explanation: Absence seizures involve a reduction of normal brain activity with staring and transient loss of responsiveness, eyelid fluttering, or muscular jerking movements. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 22-5 Compare and contrast the pharmacotherapy of generalized and partial seizures. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 23 Pharmacotherapy of Muscle Spasms and Spasticity 1) The nurse is providing care to a client who is diagnosed with muscle spasticity. The client wants to know the difference between muscle spasticity and muscle spasm. Which response by the nurse is most appropriate? 1. "A muscle spasm causes certain muscle groups to remain in a continuous state of contraction." 2. "Muscle spasms include scissoring movements of the lower extremities." 3. "Muscle spasticity causes pain that is more intense than muscle spasm and produces greater impairment of mobility." 4. "Muscle spasticity is a chronic neurologic disorder that is characterized by involuntary muscle contraction that forces body parts into abnormal, painful movements or postures." Answer: 3 Explanation: Muscle spasticity causes pain that is more intense than muscle spasm and produces greater impairment of mobility. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-1 Compare and contrast the etiology and pathophysiology of muscle spasm and muscle spasticity. 2) The nurse's neighbor says, "My son has been waking up with bad cramps in his calf for the last two nights. He has been working out with his football team, and it has been so hot." Which additional statement would indicate to the nurse that the neighbor needs more information 413

concerning muscle spasms? 1. "I have my son take a multivitamin every day to help replenish calcium and other minerals." 2. "I think I will give him one of my muscle relaxers before practice today." 3. "I've told my son to point his toes upward and gently massage the calf muscle." 4. "I send three 64-ounce bottles of Gatorade and water with my son to practice every day." Answer: 2 Explanation: Muscle relaxers can cause drowsiness and would be inappropriate in this situation. Sharing prescription medications is not a good idea. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 23-1 Compare and contrast the etiology and pathophysiology of muscle spasm and muscle spasticity.

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3) The nurse is providing discharge instructions for a client who has experienced pulled muscles in the back after lifting a heavy item at work. Which statement by the client indicates the need for further instruction? 1. "I should apply heat for 10 minutes, followed by cold for 10 minutes." 2. "I may sit in a warm whirlpool tub to help relax the back muscles." 3. "I may take 2 to 3 ibuprofen, 200 mg each, every 6 hours by mouth." 4. "I am to go home and stay on bed rest for the next 2 to 3 days." Answer: 4 Explanation: The client should perform gentle range-of-motion exercises to the point of physical discomfort, but not pain, several times each day. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 23-2 Describe the nonpharmacologic management of muscle spasms and muscle spasticity. 4) A client who suffers from frequent calf muscle cramping asks the nurse about using nonprescription capsaicin for pain relief. What information should the nurse provide this client? 1. Capsaicin is seldom effective in the treatment of cramping in calf muscles. 2. The client should plan to use the medication two times each day. 3. This medication should be taken with a full glass of water. 4. The client should wear gloves when handling this medication. Answer: 4 Explanation: The medication can cause irritation to the tissues of the hands, so gloves should be worn. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-2 Describe the nonpharmacologic management of muscle spasms and muscle spasticity.

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5) A client is seen for muscle spasms in the upper thigh. The nurse anticipates instructing the client on the use of which medication? 1. Nonsteroidal anti-inflammatory drugs 2. Muscle relaxants 3. Both nonsteroidal anti-inflammatory drugs and muscle relaxants 4. Nonsteroidal anti-inflammatory drugs, muscle relaxants, and narcotic pain relievers Answer: 3 Explanation: When skeletal muscle relaxants are used in combination with nonsteroidal anti-inflammatories, pain relief is greater than when either agent is used alone. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 23-3 Identify drug classes used to treat muscle spasms and spasticity. 6) A client tells the nurse, "I have been reading about using castor oil as a treatment for muscle cramping. Do you know anything about that?" How should the nurse respond to this question? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Why don't you ask the doctor about whether or not it works?" 2. "I think you take a tablespoon twice a day." 3. "The castor oil should be warmed before use." 4. "Soak a flannel cloth with the castor oil and apply it to your muscle." 5. "You must wear gloves when handling castor oil." Answer: 3, 4 Explanation: Warming the castor oil has the added benefit of warming the muscle tissue, which helps to relieve discomfort. The flannel cloth absorbs the castor oil and holds it on the skin. The flannel also holds in the warmth of the oil. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-2 Describe the nonpharmacologic management of muscle spasms and muscle spasticity.

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7) The parents of a toddler client who has cerebral palsy are only now beginning to accept that their child will have permanent disability. The nurse has been instructing the parents about the treatment for the spasticity their child is experiencing. Which statements by the parents indicate that the nurse should plan additional teaching sessions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "At some point, our child may require surgery to correct this spasticity." 2. "As long as we continue our child's medications, the spasticity can be controlled." 3. "Our physical therapy sessions should focus on flexing our child's muscles." 4. "We should repeat the exercises several times with each muscle group." 5. "It is best to give our child a rest from physical therapy by skipping 1 week a month." Answer: 2, 3, 5 Explanation: Medication alone is generally not enough to control spasticity in these children. The parents need additional teaching. The physical therapy sessions for spasticity focus on muscle stretching, not flexion. The parents need additional teaching. Physical therapy should be routine and consistent in order to reduce or control spasticity. These parents need additional teaching. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 23-2 Describe the nonpharmacologic management of muscle spasms and muscle spasticity.

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8) A client scheduled for surgery has a family history of malignant hyperthermia. The circulating nurse will be responsible for seeing that which medication is immediately available for administration? 1. Dantrolene sodium (Dantrium) 2. Baclofen (Lioresal) 3. Tizanidine (Zanaflex) 4. Orphenadrine (Myophen) Answer: 1 Explanation: Dantrolene is a direct-acting skeletal muscle relaxant that interferes with the release of calcium ions that produce hypermetabolism and intense muscle rigidity in malignant hyperthermia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-4 Compare and contrast the actions of the centrally acting and direct-acting skeletal muscle relaxants. 9) A client who has cerebral palsy is beginning to experience spasticity of the muscles in the upper arm. Which medications would the nurse question if prescribed for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Metaxalone (Skelaxin) dosed three times a day 2. Chlorzoxazone (Parafon Forte) dosed four times a day 3. Carisoprodol (Soma) dosed three times a day 4. Intrathecal baclofen (Lioresal) 5. Tizanidine (Zanaflex) dosed twice a day Answer: 1, 2, 5 Explanation: Metaxalone (Skelaxin) is ineffective in the treatment of spasticity-related neurologic disorders. Chlorzoxazone (Parafon Forte) is ineffective in the treatment of spasticity related to neurodegenerative disorders. Tizanidine (Zanaflex) is used for muscle spasticity but has a short half-life and must be dosed every 6 to 8 hours. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-3 Identify drug classes used to treat muscle spasms and spasticity.

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10) The nurse is caring for a client who is prescribed cyclobenzaprine (Flexeril) for lower back pain following a work injury. The client has been quite drowsy, and dozes off and on throughout the day while taking the cyclobenzaprine. Which action by the nurse is the most appropriate for this client? 1. Notifying the healthcare provider that the client is experiencing extreme drowsiness 2. Providing the client caffeinated beverages to help the client stay awake 3. Holding the cyclobenzaprine until the client can be further evaluated 4. Continuing the medication as ordered Answer: 4 Explanation: Continue the medication as ordered. Centrally acting muscle relaxants work through their sedating effects. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-4 Compare and contrast the actions of the centrally acting and direct-acting skeletal muscle relaxants. 11) A client is going to physical therapy to reduce muscle spasms related to a bulging disc L4-L5. The client is prescribed methocarbamol (Robaxin) for the muscle spasms prior to each physical therapy session. Which instruction should the nurse review with the client? 1. Long-term use can lead to dependence. 2. Do not take the medication with grapefruit juice or grapefruit. 3. The medication can lead to gastric ulcers. 4. Plan on getting a driver for the physical therapy sessions. Answer: 4 Explanation: The client should not drive until the effects of the medication are known. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-5 Explain the role of skeletal muscle relaxants as surgical adjuncts.

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12) A client who was discontinued from using an MAOI 1 week ago has injured his back and is in pain from severe muscle spasms. The client is prescribed cyclobenzaprine (Flexeril) for the muscle spasms. Which nursing action is the most important? 1. Inform the client to watch for added CNS depression. 2. Warn the client not to operate a motorized vehicle until the effects of the medication are known. 3. Hold the cyclobenzaprine (Flexeril) and notify the healthcare provider. 4. Give the cyclobenzaprine (Flexeril) as prescribed. Answer: 3 Explanation: A potentially fatal hypertensive crisis could occur if cyclobenzaprine is used within 14 days of an MAOI. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-5 Explain the role of skeletal muscle relaxants as surgical adjuncts. 13) A client is admitted to the unit from surgery for insertion of pins for traction due to a compound fracture to the left femur. The client has a Foley catheter for gravity drainage. Chlorzoxazone (Parafon Forte) is ordered for the client. The next day, it is noted that the urine has a reddish-orange discoloration. How should the nurse respond to this development? 1. Call the healthcare provider for an order for a urinalysis. 2. Check the urine for bacteria with a urine chemstick. 3. Continue to monitor I&O. 4. Notify the healthcare provider about the discoloration in the urine. Answer: 3 Explanation: Red-orange urine is an adverse effect of chlorzoxazone, so the nurse should continue to monitor I&O. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-5 Explain the role of skeletal muscle relaxants as surgical adjuncts.

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14) A client who is taking baclofen (Lioresal) for muscle spasms due to a spinal cord injury that occurred 5 years ago is hospitalized with pyelonephritis. The client is receiving ciprofloxacin IV for the infection and phenazopyridine (Pyridium) for the bladder discomfort. None of the medications the client takes at home have been continued during the hospitalization. The nurse should monitor this client for which condition? 1. Contractures of the hands and feet 2. Irritable tendon reflexes and scissoring movement of the lower extremities 3. Diminished kidney function 4. Fever and seizures, or hallucinations Answer: 4 Explanation: Abrupt discontinuation following prolonged therapy with baclofen can cause high fever, seizures, severe rebound muscle spasticity, and hallucinations. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 23-6 Describe the nurse's role in the pharmacologic management of muscle spasms and muscle spasticity. 15) An adult client who prescribed the anticholinergic oxybutynin (Ditropan) for urinary incontinence is admitted to the unit with acute muscle spasms after twisting her back in a fall. Which medication used for muscle spasm relaxation would cause the nurse the most concern? 1. Ibuprofen 600 mg 2. Cyclobenzaprine (Flexeril) 3. Tizanidine (Zanaflex) 4. Chlorzoxazone (Parafon Forte) Answer: 2 Explanation: Cyclobenzaprine will enhance anticholinergic side effects and is contraindicated with anticholinergics. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-6 Describe the nurse's role in the pharmacologic management of muscle spasms and muscle spasticity.

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16) The operating room (OR) nurse is scheduled as the circulator in a case that involves a client with a family history of malignant hyperthermia. The nurse checks to see that dantrolene is readily available. What other medication should the nurse check for availability in case dantrolene must be administered? 1. Phenytoin (Dilantin) 2. Romazicon (Flumazenil) 3. Phentolamine (Regitine) 4. Enoxaparin (Lovenox) Answer: 3 Explanation: Phentolamine (Regitine) should be available in the event of extravasation of dantrolene. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 23-6 Describe the nurse's role in the pharmacologic management of muscle spasms and muscle spasticity.

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17) The client's healthcare provider prescribed dantrolene sodium (Dantrium) 25 mg daily for the treatment of neck spasms secondary to spinal cord injury. The client reports that the medication is "not working," even though it has been 45 days since the medication was started. What changes in this client's plan of care would the nurse anticipate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increase the dosage frequency to twice a day. 2. Discontinue the medication. 3. Increase the frequency of hepatic function tests. 4. Change to a different medication. 5. Add succinylcholine (Anectine) to the client's medications. Answer: 2, 4 Explanation: If there has been no therapeutic effect from the dantrolene after 45 days of therapy, the medication should be discontinued. Since there have been no therapeutic effects from this medication, a different medication is indicated. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 23-6 Describe the nurse's role in the pharmacologic management of muscle spasms and muscle spasticity.

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18) The nurse is discharging an older adult client who was hospitalized after a muscle strain injury to his back. One of the discharge prescriptions for this client is cyclobenzaprine (Flexeril) 10 mg three times per day with food. The prescription is written for 90 tablets and there are three refills available. Which information from this situation would alert the nurse for the need to collaborate with the client's healthcare provider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The dosage amount is too low for the type of injury this client sustained. 2. Cyclobenzaprine should be used with great caution in those over age 65. 3. If taken as directed, the client would be able to take the medication for 120 days. 4. Cyclobenzaprine is not effective for back pain. 5. Cyclobenzaprine should not be taken with food. Answer: 2, 3 Explanation: The adverse reactions from cyclobenzaprine include confusion, hallucinations, and cardiac events, which are more common in clients over age 65. The manufacturer recommends that treatment not extend beyond 3 weeks or 21 days. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-8 Apply the nursing process to care for patients receiving pharmacotherapy for muscle spasms and spasticity.

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19) A 45-year-old female client is prescribed dantrolene sodium ((Dantrium) for spasms related to progression of multiple sclerosis. Which intervention is most important for the nurse to include in this client's care plan? 1. Teach the client the importance of using sunscreen when taking this medication. 2. Assess the client for pain using a pain scale and range of motion. 3. Monitor the client for sedation. 4. Monitor liver function tests. Answer: 4 Explanation: The risk of dantrolene-induced hepatotoxicity is greatest in women over the age of 35, so it should be administered cautiously in these clients. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 23-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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20) The client is prescribed collagenase (Xiaflex) for Dupuytren's contracture. When developing this client's care plan, which statement by the patient would concern the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I do not like the way my hand looks." 2. "I am so tired all the time." 3. "I'm surprised my hand is not painful at times." 4. "I feel confident in my balance and walking." 5. "One of my hands is swollen at times." Answer: 1, 5 Explanation: Dupuytren's contracture causes malformation of the hand. A possible adverse effect of injection of collagenase is swelling of the affected hand. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 23-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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21) The client tells the nurse, "The doctor is going to start me on Botox for the muscle spasms in my neck. I've always wanted to try that. It will make me look younger." Which information should the nurse provide to this client regarding onabotulinumtoxinA (Botox)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Once you start on the medication, it may take a week or so before you notice a change in your skin." 2. "Be certain you take the medication with a full glass of water because it can be hard on your kidneys." 3. "There are many different uses for that drug, depending on how it is administered." 4. "You may have to have additional treatments with the medication in a few months." 5. "You should be aware that side effects of the medication can occur hours or weeks after your treatment." Answer: 3, 4, 5 Explanation: OnabotulinumtoxinA (Botox) has many clinical indications. Action depends on the area where the medication is administered. The effects of onabotulinumtoxinA (Botox) generally last from 3 to 6 months. Side effects of onabotulinumtoxinA (Botox) may not occur immediately upon administration, and the client should watch for their development for several hours to weeks later. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 23-8 Apply the nursing process to care for patients receiving pharmacotherapy for muscle spasms and spasticity. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 24 Central Nervous System Stimulants and Drugs for Attention-Deficit/Hyperactivity Disorder 1) The mother of a school-age client tells the school nurse, "My son is so hyperactive. I can't see any harm in putting him on medication, especially since the stimulants have so few side effects." Which response by the nurse is the most appropriate? 1. "Stimulants can cause the side effect of excessive excitation." 2. "Have you made an appointment for your son to see the healthcare provider?" 3. "Stimulants can be helpful in hyperactivity disorders." 4. "What actions lead you to think your son is hyperactive?" Answer: 1 Explanation: A side effect of stimulants is excessive excitation. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, 427

practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-1 Describe the general actions and pharmacotherapeutic applications of central nervous system stimulants. 2) A mother tells the school nurse that she is concerned over her daughter's use of an inhaler for asthmatic episodes. The daughter is taking amphetamine and dextroamphetamine (Adderall XR) for ADHD. The mother states that since beginning the Adderall, every time the daughter uses her inhaler, she gets very agitated, jittery, and anxious. Which response by the nurse is the most appropriate? 1. "Your daughter needs to see her primary care provider to have her asthmatic medication changed to another medication." 2. "Your daughter will need to discontinue her treatment for ADHD, because it is contraindicated with medications use to treat asthma." 3. "The Adderall should be discontinued during times of asthma exacerbation." 4. "Inhalers used for asthma tend to cause central nervous system stimulation, just as medications for ADHD do. Her symptoms are likely due to the additive effect of having both medications." Answer: 4 Explanation: Inhalers used for asthma can cause nervousness, tremors, and anxiety. The effects wear off quickly. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-1 Describe the general actions and pharmacotherapeutic applications of central nervous system stimulants. 3) A mother expresses concern that her school-age child may need to be started on medication for ADHD. When asked to describe the child's behaviors that led to this concern, the mother makes these statements. Which would the nurse interpret as a potential indicator of ADHD? 1. "When I ask him to do his chores, he finishes his game before he starts." 2. "His teacher says that he isn't able to complete assignments that require him to sit and write for 5 to10 minutes at a time. He doodles on his paper or badgers others in the classroom instead of working on his assignment." 3. "In the last month, he has twice forgotten to ask me to give him his lunch money for the day." 4. "When I tell him to clean the house, he doesn't clean under furniture or under the rim of the toilet. He only dusts some of the furniture, but not all of it." Answer: 2 Explanation: Clients with ADHD avoid tasks that require mental effort for a long period of time and fail to finish schoolwork; they have trouble keeping attention on a task. Cognitive Level: Evaluating Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and 428

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5) Atomoxetine (Strattera) has been prescribed for a school-age client newly diagnosed with ADHD. Which comment by the mother would indicate that the nurse should provide more teaching about this medication? 1. "I will keep this medication in a secure place, because it is popular as a recreationally abused drug." 2. "I will monitor my child's appetite and watch for excessive weight loss." 3. "I will monitor my child for a persistent cough that does not go away." 4. "I must look for signs of suicidal ideation." Answer: 1 Explanation: Atomoxetine (Strattera) is a nonstimulant used for the treatment of ADHD and does not appear to have abuse potential. It is not classified as a controlled substance. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 24-3 Compare and contrast the central nervous system stimulants and nonstimulants in treating attention-deficit/hyperactivity disorder. 6) A school-age client comes to the clinic for routine follow-up after being placed on amphetamine sulfate (Adderall) 2 weeks ago for a diagnosis of ADHD. The client weighed 15 lb over normal for height prior to the start of the Adderall. The mother states concern that the client is no longer snacking, barely finishes meals, and "will lose too much weight." What is the nurse's best response to this concern? 1. "Make an appointment each week for us to monitor against too much weight loss." 2. "It is normal for clients to lose weight when taking Adderall." 3. "Over time, the diminished appetite might be reduced. Begin by offering small, frequent meals, and monitor for excessive weight loss." 4. "The Adderall will help the client to return to normal weight for his height." Answer: 3 Explanation: Offering small, frequent meals and monitoring for weight loss are the most appropriate actions. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-3 Compare and contrast the central nervous system stimulants and nonstimulants in treating attention-deficit/hyperactivity disorder.

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7) A client with a history of benign prostatic hyperplasia (BPH), gout, hyperlipidemia, and palpitations is being seen for symptoms of narcolepsy. Before starting on methylphenidate (Concerta) for treatment of narcolepsy, which testing would the nurse anticipate? 1. A PSA and digital prostate exam 2. A 12-lead EKG and further cardiac workup pending results 3. Urinalysis and lab tests to determine control of gout 4. Labs for cholesterol and triglyceride levels Answer: 2 Explanation: Clients should be screened for preexisting cardiac disease before starting this medication, because sudden unexplained cardiac death has occurred in some people taking this medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 24-4 Compare and contrast the different pharmacotherapies available for narcolepsy. 8) An older adult client with Parkinson's disease is seen because the daughter states the client cannot stay awake in the daytime. The client is sleeping most of the day, and is having trouble sleeping at night. The client has no history of cardiac events or psychiatric disorders. Vital signs, electrolytes, and liver and renal test results are within normal limits. The client is slightly underweight for height. The nurse would anticipate a prescription for which medication? 1. Sodium oxybate (gamma hydroxybutyrate, Xyrem) 2. Modafinil (Provigil, Alertec) 3. Methylphenidate (Ritalin) 4. Selegiline (Eldepryl) Answer: 2 Explanation: Modafinil is approved for treatment of fatigue related to Parkinson's disease and circadian rhythm disruption, and it does not appear to suppress appetite or promote weight gain. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 24-4 Compare and contrast the different pharmacotherapies available for narcolepsy.

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9) During a routine dressing change, the nurse notes a vesicular rash across the abdomen of a client who is 2 days postop after hysterectomy. The client's a.m. meds, including modafinil (Provigil), ibuprofen, and a multivitamin with iron, are due in 30 minutes. What nursing action is essential? 1. Culture the drainage from the rash. 2. Give the a.m. medications and plan to show the rash to the healthcare provider on morning rounds. 3. Hold the ibuprofen until the nurse can check the client's medical record for drug allergies. 4. Hold the modafinil and talk to the healthcare provider about the rash. Answer: 4 Explanation: Modafinil should not be given, and the healthcare provider should be made aware of the rash. A possible adverse effect of modafinil is Stevens–Johnson syndrome, which is an exfoliating skin response. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-5 Describe the nurse's role in the pharmacologic management of attention-deficit/hyperactivity disorder and narcolepsy. 10) A school-age client who is taking amphetamine sulfate (Adderall) for treatment of ADHD is seen in the clinic for routine follow-up. The nurse will automatically perform which functions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Measure the client's height and weight. 2. Assess vital signs, especially heart rate and BP. 3. Obtain labs to assess cardiovascular status. 4. Obtain a fasting blood glucose. 5. Instruct the parent and child on how to obtain a 24-hour urine collection for proteinuria. Answer: 1, 2 Explanation: Placing children on amphetamines for ADHD can stunt their growth. Height and weight should be checked regularly. Amphetamines can increase BP and heart rate. Both should be monitored. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-5 Describe the nurse's role in the pharmacologic management of attention-deficit/hyperactivity disorder and narcolepsy. 11) Which client comment would alert the nurse that atomoxetine (Strattera) should be held and the healthcare provider notified? 432

1. "I get lightheaded when I get out of bed in the mornings." 2. "Sometimes I have difficulty going to sleep." 3. "I always feel like I have such a dry mouth." 4. "Sometimes I feel like I'd be better off if I were dead." Answer: 4 Explanation: Suicidal ideation is a serious adverse effect of atomoxetine (Strattera). The medication should be held, and the healthcare provider notified immediately. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-5 Describe the nurse's role in the pharmacologic management of attention-deficit/hyperactivity disorder and narcolepsy. 12) An adult client who is seen by the primary care provider for complaints of inability to focus and concentrate on college studies is prescribed atomoxetine (Strattera). Which client comment indicates that the nurse should provide additional information about the drug? 1. "I'll wait until I've taken the medication a few days before driving." 2. "I'll call the doctor immediately if I become jaundiced." 3. "It would be nice if my appetite were decreased with this medication, because I want to shed a few pounds." 4. "I'll continue to take melatonin at bedtime, as I have difficulty falling asleep at night." Answer: 4 Explanation: It is recommended that the client not take any herbal products while on atomoxetine. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-6 For each class shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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13) A client is brought to the emergency department with severe hypertension, nervousness, tremors, tachycardia, and postseizure. According to the paramedics, the client was found lying next to an open bottle of amphetamine and dextroamphetamine (Adderall). The client is not coherent, but admits to taking the Adderall. The nurse should prepare to administer which treatments? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Chlorpromazine IV 2. Sodium bicarbonate 3. Flumazenil (Romazicon) IV 4. Gastric lavage 5. Phentolamine IV Answer: 1, 4, 5 Explanation: Chlorpromazine IV is administered to counteract the effects of amphetamine. The treatment of overdose with amphetamine includes gastric lavage. Phentolamine IV would be administered if the client developed severe hypertension. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 24-6 For each class shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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14) An adolescent client who has been taking amphetamine sulfate (Adderall) since age 7 now presents with new-onset type 1 diabetes mellitus. What should be of highest priority in the nurse's education regarding the diabetes for this client? 1. This medication may be changed. 2. Immediately report signs of a dry mouth. 3. Monitor height and weight very closely. 4. Report any increase in irritability and nervousness. Answer: 1 Explanation: The healthcare provider might change treatment to a nonamphetamine because Adderall is contraindicated in clients with diabetes. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-6 For each class shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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15) A client recently prescribed methylphenidate (Ritalin) for treatment of ADHD complains of an inability to go to sleep at night. Which nursing actions are indicated? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Assess for caffeine intake, especially late in the afternoon or evening hours. 2. Assess for time of day that methylphenidate (Ritalin) is taken. 3. Assess for nonpharmacologic measures taken to induce sleep. 4. Inform the healthcare provider that the client is unable to fall asleep while taking methylphenidate (Ritalin). 5. Suggest taking melatonin to assist in nighttime drowsiness. Answer: 1, 2, 3 Explanation: Caffeine intake will cause additive CNS stimulant effects when taken concurrently with methylphenidate (Ritalin). Methylphenidate (Ritalin) should be taken no later than 6 p.m., and should be taken earlier if interference with sleep occurs. An assessment should be made of what measures the client has tried to help with sleep before contacting the healthcare provider (for example, meditation, quiet activities at bedtime, reduced lighting). Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-7 Apply the nursing process to care for patients receiving pharmacotherapy with central nervous system stimulants.

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16) An adolescent female is brought to the emergency department after experiencing a panic attack while at school. She had forgotten to study for a biology test. The mother indicates that her daughter is easily distracted, often forgets schoolwork, and has difficulty completing assignments and following instructions. She asks if her daughter should be on medication for ADHD. What is the nurse's best response? 1. "Many medications given for treatment of ADHD can worsen anxiety, which is a major component of panic attacks." 2. "Medication might help with the ADHD." 3. "Have you tried behavioral therapy for treatment of the ADHD?" 4. "It is better to change the diet first as treatment for the ADHD." Answer: 1 Explanation: Amphetamines and amphetamine-like medications are contraindicated in severe anxiety, because these medications can cause the anxiety to worsen. Cognitive Level: Evaluating Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-7 Apply the nursing process to care for patients receiving pharmacotherapy with central nervous system stimulants.

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17) A pregnant client says, "There is a strong history of ADHD in my husband's family. What can I do to help my baby avoid developing it?" How should the nurse respond? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "There is really little you can do to prevent your baby from developing ADHD, but you can watch for symptoms and get help early." 2. "Do not smoke while you are pregnant and avoid secondhand smoke." 3. "You should breastfeed your baby." 4. "Avoid situations that would expose your baby to lead or lead paint." 5. "Keep your baby's intake of sugar very low for the first 3 years of life." Answer: 2, 4 Explanation: Cigarette smoking by the mother during pregnancy may contribute to the development of ADHD. Exposure to lead can contribute to the development of ADHD. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-2 Identify the signs and symptoms of attention-deficit/hyperactivity disorder and narcolepsy.

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18) The nurse provides information regarding methylphenidate (Concerta) to the parents of a school-age client. Which statements indicate that the parents have a good understanding of the information? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I will talk with the school nurse about administering a dose at about noon each day." 2. "We should fold the patch with the medication side facing in before it is thrown in the garbage." 3. "We should not expect physical dependence at the low dose given for ADHD." 4. "We can expect that the healthcare provider will occasionally tell us to stop giving the medication for a few days." 5. "If our child experiences loss of appetite, we should immediately contact the healthcare provider." Answer: 3, 4 Explanation: Physical dependence is uncommon at therapeutic dosages. The use of drug-free periods is common when therapy with Concerta is prolonged. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 24-6 For each class shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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19) The mother of a pediatric client prescribed clonidine (Kapvay) for treatment of ADHD makes these remarks. Which statements indicate that the nurse should provide additional information about the drug? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I'm so glad that the doctor chose a medication that won't make my child sleepy." 2. "I think my dad takes that for his high blood pressure." 3. "I can expect that the doctor will take my child off this medication for a few days every 6 months or so." 4. "I must warn my parents that Dad's clonidine cannot be substituted for the Kapvay." 5. "At least my child will not become addicted to this medication." Answer: 1, 3 Explanation: Clonidine (Kapvay) can cause sedation and fatigue. Drug holidays are not used with clonidine (Kapvay). If the medication is discontinued abruptly, rebound hypotension can occur. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 24-6 For each class shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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20) An infant in the neonatal intensive care unit is prescribed caffeine (Cafcit) IV as treatment for apnea. Which medical orders should the nurse plan for, based on the addition of this medication? Note: Credit will be awarded only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Blood glucose measurements every 2 hours 2. Bilirubin measurement daily 3. Seizure precautions 4. Deep tendon reflex monitoring every 4 hours 5. Skin assessment every 4 hours Answer: 2, 3 Explanation: One of the serious adverse effects of using caffeine (Cafcit)in newborns is the development of kernicterus. Increasing bilirubin measurements indicate potential for development of kernicterus. One of the serious adverse effects of using caffeine (Cafcit)in newborns is the development of seizures. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 24-6 For each class shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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21) A mother tells the nurse, "My son has ADHD and so does my sister's daughter. They are the same age, but they are on two different drugs. Why is that?" Which information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "All the drugs used to treat ADHD are basically the same." 2. "Children often have severe reactions to ADHD drugs and have their therapy changed." 3. "The choice of drug can be guided by different dosing schedules." 4. "Some children just do better on one drug or the other." 5. "Girls don't respond to medications as well as boys." Answer: 3, 4 Explanation: This is a true statement and may be the reason these two children are on different medications. This is a true statement. Children react differently to the drugs and may try more than one drug before their symptoms are controlled. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-7 Apply the nursing process to care for patients receiving pharmacotherapy with central nervous system stimulants.

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22) What should the nurse teach a client about obtaining prescribed central nervous system stimulant medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Have the healthcare provider call the prescription in to a pharmacy that knows your health history. 2. The prescription can be filled only at a pharmacy especially licensed to dispense these drugs. 3. A new prescription must be written each time additional medication is needed. 4. Ask the pharmacy to precertify the number of refills indicated on the prescription form. 5. Extra rules apply to these drugs because of their abuse potential. Answer: 3, 5 Explanation: This is a true statement of the laws concerning these medications. This is a true statement regarding these medications. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-5 Describe the nurse's role in the pharmacologic management of attention-deficit/hyperactivity disorder and narcolepsy.

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23) A pediatric client diagnosed with ADHD is being treated with dexmethylphenidate (Focalin XR). The client's mother reports that the child has started saying "huh" very loudly several times each day. What should the nurse tell the mother about this finding? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. This sound may represent a vocal tic. 2. Children with ADHD often make such sounds to call attention to themselves. 3. The dexmethylphenidate (Focalin XR) may need to be discontinued. 4. Dexmethylphenidate (Focalin XR) causes an inhibition of growth in many children. 5. Many illicit drugs cause this type of behavior. Answer: 1, 3 Explanation: Vocal tics are loud and sometimes inappropriate sounds made at inappropriate or unexpected times. Vocal and motor tics are an adverse effect of dexmethylphenidate (Focalin XR) and often result in the drug being discontinued. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 24-6 For each class shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 25 Pharmacotherapy of Severe Pain and Migraines 1) To increase the awareness of pain treatment among healthcare professionals, the American Pain Society coined which phrase? 1. "Pain: Assess daily" 2. "Pain: Optimum pain relief" 3. "Pain: The fifth vital sign" 4. "Pain: Obtain relief" Answer: 1 Explanation: "Pain: Assess daily" was not the coined phrase. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.21 Engage in caring and healing techniques that promote a therapeutic nurse–patient relationship | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-1 Identify key principles of pain management. 444

2) When clients are aware that healthcare providers are actively engaged in pain management, research shows that the clients often respond in which manner? 1. They report a decrease in chronic pain. 2. They experience less anxiety. 3. There is no change in pain levels. 4. They report less acute pain. Answer: 2 Explanation: When healthcare workers are engaged in pain management, clients have less anxiety with pain. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.21 Engage in caring and healing techniques that promote a therapeutic nurse–patient relationship | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-1 Identify key principles of pain management.

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3) How is acute pain defined? 1. Pain associated with chronic illness 2. Pain associated with an injury or surgery 3. Pain associated with malignant pain 4. Pain associated with nerve injury Answer: 2 Explanation: Pain associated with an injury, surgery, or childbirth is acute pain. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-2 Describe the assessment and classification of pain. 4) Nociceptor pain responds well to which type of drug therapy? 1. Analgesic drugs 2. Serotonin receptor blockers 3. Antidepressant medications 4. Nonanalgesic drugs Answer: 1 Explanation: Nociceptor pain responds best to analgesic drugs that relieve pain. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-2 Describe the assessment and classification of pain. 5) Somatic pain is a type of nociceptor pain that is usually experienced in which area? 1. Internal organs 2. Cancer or tumors 3. Muscles and joints 4. The nerves Answer: 3 Explanation: Somatic pain is usually experienced in the muscles and joints. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-2 Describe the assessment and classification of pain. 446

6) Clients and healthcare providers often have beliefs about pain that can interfere with successful pain management. What is a common myth related to pain? 1. Clients in pain do not necessarily look and act as if they are in pain. 2. Clients can sleep even when experiencing pain. 3. Vital signs are reliable indicators of pain. 4. Clients rarely become addicted to pain medication. Answer: 3 Explanation: This is an inaccurate belief. Vital signs can be an unreliable indicator of pain; they return to normal as the body adapts to pain. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-3 Refute the common pain myths, using objective evidence. 7) Pain transduction begins when which event occurs? 1. Pain travels on the nociceptor to the spinal cord. 2. The pain impulse reaches the spinal cord to pass messages to neurons. 3. Local tissue injury causes release of chemical mediators of inflammation. 4. The pain impulse reaches the brain, which responds with a variety of actions. Answer: 3 Explanation: When local tissue injury occurs, pain transduction begins in the nociceptor nerve endings. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-4 Explain the phases of pain physiology: transduction, transmission, perception, and modulation.

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8) Gate control therapy proposes a mechanism to explain which phenomenon? 1. Pain modulation 2. Pain transmission 3. Pain perception 4. Pain transduction Answer: 2 Explanation: The gate control theory explains pain transmission in the spinal cord. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-4 Explain the phases of pain physiology: transduction, transmission, perception, and modulation. 9) How is pain perception best defined? 1. Pain perception is based on the client's culture and previous experience with pain. 2. Pain perception is the conscious experience of pain that occurs in the brain. 3. Pain perception is the unconscious experience of pain that occurs in the brain. 4. Pain perception is the pain score rating for a client before drug therapy begins. Answer: 2 Explanation: Pain perception is the conscious experience of pain that occurs in the brain. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-4 Explain the phases of pain physiology: transduction, transmission, perception, and modulation.

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10) What is one of the benefits of the use of nonpharmacologic interventions in pain management? 1. Nonpharmacologic interventions allow for pain medication to be given on an as-needed basis only. 2. Nonpharmacologic interventions provide adequate pain relief without the use of medication. 3. Nonpharmacologic interventions do not require additional training of the healthcare team. 4. Nonpharmacologic interventions allow for lower doses and fewer drug-related adverse effects of pain medications. Answer: 4 Explanation: Nonpharmacologic interventions allow pain medication to be given at a lower dose for fewer adverse side effects. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-5 Describe pharmacologic and nonpharmacologic therapies used in pain management. 11) The client is experiencing pain after orthopedic surgery, and is prescribed opioid analgesic medication. The client complains to the nurse that the surgical joint is still uncomfortable, despite around-the-clock medication. What is the nurse's best response? 1. "You just had your medication; you will have to tolerate the pain for a little while." 2. "Let's try a cold pack on the area to help control the pain." 3. "I will call your provider to increase your dose of medication." 4. "I wonder if you are starting to get addicted to your medication." Answer: 2 Explanation: Offering nonpharmacologic intervention can serve as an adjunct to medication. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-5 Describe pharmacologic and nonpharmacologic therapies used in pain management.

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12) A client who is being treated for cancer tells the nurse that she is still having trouble getting to the toilet without experiencing significant pain. The nurse plans care for this client based on which goal? 1. Eliminating all pain in clients with chronic pain 2. Allowing the client to perform activities of daily living 3. Preventing the client from becoming addicted to the medication 4. Allowing the nurse to assess if the treatment is successful Answer: 2 Explanation: The goal for clients with chronic pain is to be able to perform activities of daily living comfortably. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 25-6 Describe the types of opioid receptors in the central nervous system. 13) Which objective method should the nurse use to assess the client's pain level? 1. Ask the client to describe the pain sensation. 2. Assess pain only when the client complains of pain. 3. Observe whether the client appears to be in pain or appears comfortable. 4. Use a pain rating scale such as the numeric rating scale. Answer: 4 Explanation: The most objective tool for assessment of pain is a pain scale. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-6 Describe the types of opioid receptors in the central nervous system.

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14) The client is experiencing mild pain secondary to a minor ankle sprain. Which is the drug class of choice for the client's pain? 1. Nonopioid analgesics 2. Opioid analgesics 3. Adjuvant analgesics 4. Patient-controlled analgesics Answer: 1 Explanation: Nonopioid analgesics are the drug of choice for mild pain. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-7 Identify the classes of drugs used for minor, moderate, and severe pain. 15) The client is being treated for severe pain with opioid analgesics. The pain has neuropathic qualities. The nurse chooses a prn order for which type of analgesic to aid the client's pain management? 1. Adjuvant analgesics 2. Nonopioid analgesics 3. Parenteral opioids 4. Patient-controlled analgesics Answer: 1 Explanation: Adjuvant analgesics will help to address the neuropathic nature of the pain. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-7 Identify the classes of drugs used for minor, moderate, and severe pain.

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16) The client asks the nurse why he is receiving combination therapy of opioid and nonopioid drugs to manage his pain. The nurse should explain which benefit of combination therapy? 1. Combination therapy prevents addiction to the opioid drug. 2. Using combination therapy helps to relieve pain synergistically and decreases the risk of side effects. 3. Combination therapy eliminates the need for follow-up laboratory monitoring. 4. Combination therapy is standard therapy for all pain management clients. Answer: 2 Explanation: Combination therapy does help to relieve pain synergistically, uses a smaller dose of opioid drugs, and decreases related side effects. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-9 Describe the use of nonopioids and adjuvant analgesics in the treatment of pain. 17) What is the mechanism of action that differentiates opioid agonists from opioid agonist-antagonists? 1. Opioid agonists block two receptors; opioid agonist-antagonists have no effect on any receptors. 2. Opioid agonists activate two receptors; opioid agonist-antagonists occupy only one receptor. 3. Opioid agonists activate one receptor; opioid agonist-antagonists activate both receptors. 4. Opioid agonists block one receptor; opioid agonist-antagonists block both receptors. Answer: 2 Explanation: Opioid agonists activate both mu and kappa receptors, and opioid agonist-antagonists occupy only one receptor and block the other. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 25-8 Compare and contrast the actions of opioid agonists, mixed opioid agonists-antagonists, and opioid antagonists.

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18) When administering opioid drugs, the nurse should have an opioid antagonist readily available in case the client experiences which effects? 1. Nausea and vomiting 2. Hyperventilation 3. Hypoventilation 4. Hypovolemia Answer: 3 Explanation: Opioid antagonists are used in the treatment of hypoventilation or toxicity of opioid drugs. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-8 Compare and contrast the actions of opioid agonists, mixed opioid agonists-antagonists, and opioid antagonists. 19) A client is prescribed an opioid–nonopioid drug combination. The nurse explains that the drug is composed of hydrocodone and acetaminophen. The client says, "Why am I getting this? I don't have a fever, and I don't think that will be enough for my pain." Which is the best response from the nurse? 1. "I am not really sure; it really can't hurt you." 2. "You still might run a fever; this will prevent it." 3. "Why, are you allergic to acetaminophen?" 4. "The two drugs work together to relieve your pain." Answer: 4 Explanation: The two drugs work together synergistically to relieve pain. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-9 Describe the use of nonopioids and adjuvant analgesics in the treatment of pain.

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20) A client who has neuropathy of the lower extremities is prescribed an opioid analgesic for pain. The provider adds a tricyclic antidepressant (TCA) medication for pain management. The client asks the nurse, "Why am I getting this new drug? I am not depressed, my feet just burn." What is the best response from the nurse? 1. "This drug will also help with the nerve pain you are having in your feet." 2. "It is to help you sleep at night instead of using the opioid." 3. "Sometimes people get depressed with chronic pain." 4. "Maybe this is a mistake if you are not depressed." Answer: 1 Explanation: TCAs are often added as an adjuvant medication in neuropathic pain management, as with this client. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-9 Describe the use of nonopioids and adjuvant analgesics in the treatment of pain. 21) The nurse plans care for the client receiving nonopioid analgesic drugs based on which benefit these drugs have over opioids? 1. Lower risk of dependency 2. Few or no GI side effects 3. Cost effectiveness 4. No risk of dizziness or hallucinations Answer: 1 Explanation: Nonopioid drugs have a lower risk of dependency than do opioid drugs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 25-14 Apply the nursing process to care for patients receiving pharmacotherapy for pain and for migraines.

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22) The nurse is performing medication teaching for a client after surgery. The nurse explains that the client will go home on tramadol, a nonopioid analgesic, for pain management. The client states, "I can't take that, I'm allergic to NSAIDs." How should the nurse respond? 1. "Tramadol is an NSAID that doesn't cause GI bleeds, so you should be OK." 2. "Are you sure? I don't see that allergy listed." 3. "Not all nonopioids are NSAIDs. Tramadol is not an NSAID." 4. "Then you will probably have to stay on a low dose of your opioid analgesic." Answer: 3 Explanation: Not all nonopioids are NSAIDs. Tramadol is not an NSAID, and the client will be able to take the drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-10 Compare and contrast the actions and adverse effects of the opioids and nonopioids for analgesia. 23) The nurse is interviewing the client before minor surgery. The client is worried about pain management: "I have a history of addiction; I have to be careful what I get for pain." What is the best response from the nurse? 1. "Maybe you should put off having surgery until you don't have the urge to abuse drugs." 2. "We will have to use only complementary therapies for you. I am afraid you may still have some pain." 3. "We can use nonopioid drugs, which have a very low risk of dependency." 4. "How long have you been drug-free? If it has been more than 2 years, we can use opioids." Answer: 3 Explanation: Nonopioid analgesics have a very low rate of dependency, and might be the ideal drug choice for this client. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 25-10 Compare and contrast the actions and adverse effects of the opioids and nonopioids for analgesia.

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24) The nurse is teaching an older adult client about morphine sulfate drug therapy. Important safety teaching for this client should include which instruction? 1. Do not take the drug with food or milk. 2. Take the drug only when absolutely necessary. 3. Always have someone stand by while using the toilet. 4. Change positions slowly to avoid dizziness and fainting. Answer: 4 Explanation: Morphine sulfate can cause hypotensive effects. Clients should take care when changing positions to avoid dizziness or fainting. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-13 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 25) The nurse monitoring a client receiving morphine therapy would be watchful for which common adverse side effects? 1. Hypertension, diarrhea, and sedation 2. Hypertension, respiratory depression, and constipation 3. Hypotension, diarrhea, and insomnia 4. Hypotension, respiratory depression, and constipation Answer: 4 Explanation: The most common adverse effects of morphine sulfate therapy are hypotension, respiratory depression, and constipation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-13 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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26) The nurse should question an order for tramadol (Ultram) for which client? 1. An 18-year-old female with a femur fracture 2. A 65-year-old male with prostate cancer 3. A 59-year-old male with COPD 4. A 60-year-old female with hypertension Answer: 3 Explanation: Tramadol can cause respiratory depression; it should be used cautiously in clients with COPD. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-13 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 27) An adult client with a history of obesity, asthma, peripheral vascular disease, and migraine headaches tells the nurse she saw an advertisement in a magazine for a drug for migraine headaches: "The drug was Imitrex; it looked very effective, and I wonder why my provider hasn't talked to me about using it for my headaches." What is the nurse's best response to this question about sumatriptan (Imitrex)? 1. "Your peripheral vascular disease is a contraindication for the drug." 2. "You have asthma, so you cannot use the drug." 3. "I think it will be good for you. Bring in the ad." 4. "Once you lose some weight, the drug will be perfect for you." Answer: 1 Explanation: Sumatriptan (Imitrex) is contraindicated in clients with peripheral vascular disease, CAD, and cerebrovascular disease due to the risk of myocardial infarction. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-12 Compare the types of drugs used for preventing migraines to those for terminating migraines.

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28) The nurse is teaching a group of student nurses the role of naloxone in treating opioid toxicity. How should the nurse explain the mechanism of action? 1. Naloxone blocks the pain transmission sites. 2. Naloxone competes with the opioid at the receptor sites. 3. Naloxone binds with the opioid to prevent the action of the opioid. 4. Naloxone blocks the pain perception of the client. Answer: 2 Explanation: Naloxone competes with the opioid at the mu and kappa receptor sites. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-11 Explain the role of opioid antagonists in the diagnosis and treatment of acute opioid toxicity. 29) A client arrives unconscious in the emergency department in respiratory depression from an unknown drug overdose. To help diagnose the overdose, the client is given small doses of naloxone (Narcan). What is the purpose of this action? 1. To help wake up the client to obtain the name of the drug 2. To help diagnose if the overdose was an opioid drug 3. To prevent vomiting while the client is unconscious 4. To reduce the psychoactive effects of the drug overdose Answer: 2 Explanation: If the drug was opioid in nature, naloxone will quickly reverse the respiratory depression, helping with identification of the drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-11 Explain the role of opioid antagonists in the diagnosis and treatment of acute opioid toxicity.

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30) An adult client with a history of migraine headaches tells the nurse that in the past 6 months, she has needed to use her medication to abort headaches on the average of five to six times a month, despite avoiding her migraine triggers. The nurse explains that the next step in her therapy might be to take which action? 1. Review her migraine triggers and look for new ones. 2. Try a different drug to abort the headaches. 3. Try a drug to prevent the headaches. 4. Take a drug holiday to clear out her system. Answer: 3 Explanation: If a client is having more than three migraine headaches a month, she might require preventive rather than abortive treatment. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 25-12 Compare the types of drugs used for preventing migraines to those for terminating migraines. 31) A client is being switched from abortive therapy for migraines to preventive therapy. The client asks the nurse to explain the difference between the two types of therapy. What is the nurse's best response? 1. "Preventive therapy will allow you to get pregnant while on medication." 2. "Preventive therapy will help you have less pain with each headache." 3. "Preventive therapy will help prevent headaches, rather than treating them when you get them." 4. "Preventive therapy will prevent drug side effects, which are worse with abortive therapy." Answer: 3 Explanation: Preventive therapy does help prevent headaches, rather than stopping the headaches once they start. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 25-12 Compare the types of drugs used for preventing migraines to those for terminating migraines.

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32) The nurse is teaching the client how to use sumatriptan (Imitrex) to treat migraine headaches. Which common side effects should the nurse include in this teaching? 1. Dizziness and nausea 2. Hypotension and irritability 3. Constipation and sedation 4. Anxiety and agitation Answer: 1 Explanation: Sumatriptan can cause dizziness and nausea. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-13 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 33) The nurse is teaching a client who is prescribed sumatriptan therapy for treatment of migraine headaches. The nurse instructs the client to take the drug at which time? 1. At the first sign of aura or headache 2. First thing in the morning if expecting a headache 3. When the client can lie down for 1 hour after taking the drug 4. About 30 minutes after the start of the headache Answer: 1 Explanation: The client should take the medication at the first sign of aura or headache for it to be most effective. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-14 Apply the nursing process to care for patients receiving pharmacotherapy for pain and for migraines.

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34) For which client should the nurse question an order for tramadol? 1. A 35-year-old female with migraine headaches 2. A 60-year-old female with osteoarthritis 3. A 55-year-old male with a history of anxiety disorder 4. A 50-year-old male with a seizure disorder Answer: 4 Explanation: Tramadol can lower the seizure threshold. It must be used with caution in clients with a history of seizure disorder. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-13 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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35) The nurse is teaching a client who is being discharged from the hospital. The client will be going home on morphine sulfate therapy. The client tells the nurse that at home, the client was using St. John's wort as a natural treatment for depression, and asks if it is all right to continue taking this herb. What is the nurse's best response? 1. "If it is a natural substance, it should be OK, and you should not have to worry about any drug interactions." 2. "Why are you using an herb? You could treat your depression better with conventional medication." 3. "St. John's wort can decrease the analgesic effect of morphine sulfate. You might want to wait until you no longer need pain management." 4. "As long as you don't take them at the same time, you should be OK. Just space them about 2 hours apart." Answer: 3 Explanation: St. John's wort can decrease the analgesic effects of morphine sulfate. The client should wait until morphine sulfate therapy is discontinued before restarting the herb. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-13 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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36) The nurse has just taken a job in a hospital that cares for an ethnically diverse population and is concerned about being culturally sensitive. How should the nurse plan to manage caring for clients in pain? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Treat all clients alike. 2. Listen carefully as the client's comments about pain are translated. 3. Show respect for the client's preferences even if they are very different from the nurse's. 4. Ask questions about the client's beliefs and customs regarding pain management. 5. Watch how other nurses provide care to their clients. Answer: 2, 3, 4 Explanation: Even if the nurse has to use the services of a translator, careful listening is an important step in providing culturally sensitive care. Showing respect is important in providing culturally sensitive care in all areas, including pain management. The nurse cannot practice what the nurse does not know. Asking questions is the method used to gain information to facilitate sensitive care. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.21 Engage in caring and healing techniques that promote a therapeutic nurse–patient relationship | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-1 Identify key principles of pain management.

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37) The client has advanced cancer and is experiencing malignant pain. How should the nurse plan to manage this pain? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use the intravenous route for pain medication administration. 2. Set up a dosing schedule that provides for round-the-clock doses. 3. Encourage the client to wait 10 minutes after pain medication is required to ask for a dose. 4. Augment the client's regimen with other pharmaceutical and nonpharmaceutical pain relief measures for breakthrough pain. 5. Counsel the client that it is not possible to eliminate all the pain of cancer and that some must be tolerated. Answer: 2, 4 Explanation: Often the problem in controlling pain of any type is that the client "gets behind" the pain rather than medicating for it before it gets severe. Round-the-clock dosing helps to prevent "playing catch-up" to the pain. Breakthrough pain is expected and may require additional pharmaceutical or nonpharmaceutical measures. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 25-2 Describe the assessment and classification of pain.

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38) The client rings the nurse call button and requests pain medication. Upon assessment, the nurse finds the client sitting up in a chair, watching television with a friend. Vital signs are normal and the client's skin is warm and dry. Which nursing actions are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Ask the client to rate his pain on the pain scale. 2. Tell the client that he does not look as if he is in pain. 3. Have the client go back to bed and ask the visitor to leave. 4. Check to see when the client last received pain medication. 5. Have another nurse assess the client. Answer: 1, 4 Explanation: When the client complains of pain, the nurse should always ask for a pain rating. The nurse should check to see when the client last had pain medication, what drug was given, what dose was given, and by what route it was administered. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-3 Refute the common pain myths, using objective evidence.

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39) The home hospice nurse is completing the initial assessment of a client who has terminal heart failure. The client frequently has pain with breathing. Which questions should the nurse ask? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "How much pain are you willing to tolerate?" 2. "What do you like to do throughout the day?" 3. "Have you ever been addicted to a pain medication?" 4. "Are there any pain medications you would like to avoid?" 5. "What things besides drugs help with your pain?" Answer: 1, 2, 4, 5 Explanation: It is sometimes impossible to eliminate all pain and all adverse medication effects. The nurse needs to know how much pain and how many of the effects the client is willing to tolerate. Knowing what the client likes to do and when it is important for the client to be most awake and alert helps the nurse create a pain management plan. Some clients cannot tolerate the side effects of some medications. It is important for the nurse to assess for these preferences. Nonpharmacologic pain relief strategies should also be investigated. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-14 Apply the nursing process to care for patients receiving pharmacotherapy for pain and for migraines.

466

40) The client is prescribed morphine sulfate (MS Contin) for chronic back pain resulting from inoperable disk degeneration. What nursing actions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use the prn order of docusate (Dulcolax) routinely every night. 2. Ask the dietary department to add bran cereal to the client's breakfast trays. 3. Ask the healthcare provider to write an order for an indwelling urinary catheter. 4. Review the trending of the client's hemoglobin and hematocrit levels. 5. Check the medical record for a prn order for an antiemetic. Answer: 1, 2, 4, 5 Explanation: One of the adverse effects of morphine therapy is constipation. The nurse should be proactive by giving the docusate every night. Intake of additional fiber, as long as sufficient fluid is taken, is useful in preventing the constipation that is common with the use of morphine. Morphine should not be administered to those who are hypovolemic due to the risk of hypotension. Nausea and vomiting are adverse effects of the use of morphine. Until the client becomes tolerant of this effect, an antiemetic may be necessary. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-14 Apply the nursing process to care for patients receiving pharmacotherapy for pain and for migraines.

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41) The nurse receives a medication order for fentanyl patches (Duragesic) for a new home health client. What should the nurse check before ordering these patches from the pharmacy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Is the client allergic to amitriptyline (Elavil)? 2. Was the client's morphine discontinued? 3. Has the client ever taken opioids? 4. Can the client manage changing the patch every morning? 5. Has the client had adverse reactions to morphine? Answer: 3, 5 Explanation: Giving fentanyl formulations to clients who are opioid naïve can result in serious or fatal respiratory depression. Fentanyl has the same actions and adverse effects as morphine. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-13 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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42) A client who is allergic to morphine has been receiving meperidine (Demerol) 75 to 100 mg IM every 6 hours for the last 3 days. Five hours after the last dose, the client calls the nursing desk and says, "I need some pain medication. I am hurting so badly that I am shaking." What should the nurse do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Administer the 100-mg dose. 2. Administer the 75-mg dose. 3. Administer 50 mg of meperidine. 4. Collaborate with the client's healthcare provider regarding the medication and schedule. 5. Ask the client when the shaking first began. Answer: 4, 5 Explanation: Meperidine can become toxic at doses greater than 400 to 600 mg/day or if given over 48 hours. One of the symptoms of toxicity is tremors and seizures. The nurse should discuss the symptoms with the healthcare provider, who should change the medication. Before contacting the healthcare provider, the nurse should complete additional assessment regarding the shaking and the pain. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-13 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

469

43) The client has been prescribed duloxetine (Cymbalta) for the treatment of diabetic neuropathic pain. What information should the nurse provide to this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The prescription is for a small number of capsules because the medication will be discontinued if it doesn't work in a week." 2. "This is a corticosteroid, so you may notice an increased thirst." 3. "Your dose is lower than your wife's because her prescription is for a different reason." 4. "You may feel relief in as few as 5 days." 5. "This drug is a narcotic, so be certain to keep it in a safe place." Answer: 1, 3, 4 Explanation: If improvement in pain relief is not noted in 1 week, the drug is discontinued. Duloxetine is also given as an antidepressant, and that dose is generally higher. The effects of the drug usually occur in 5 to 7 days. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-13 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

470

44) The client has been keeping a "headache diary" of her migraines. Upon review of this diary, the nurse notes that the headaches are described as mild and have happened four times in the last 3 months. The client reports that she "generally just lies down until they pass" but that her new job will not allow that time. She is requesting information about pain medication. What medications would the nurse expect to be prescribed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Ibuprofen 2. Acetaminophen and caffeine 3. Sumatriptan (Imitrex) 4. Ergotamine (Ergostat) 5. Amitriptyline (Elavil) Answer: 1, 2 Explanation: NSAIDs are often effective for the mild migraines this client experiences. Acetaminophen and caffeine together are used for treatment of mild migraines. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 25-12 Compare the types of drugs used for preventing migraines to those for terminating migraines.

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45) A client with a history of migraine headache has decided to augment drug therapy with lifestyle changes to prevent migraine attacks. Which information should the nurse include in teaching for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You should consider wearing sunglasses when in bright light." 2. "In some people, pickles will trigger migraines." 3. "Some people find it is helpful to drink hot coffee, tea, or chocolate when they first experience a migraine aura." 4. "Try drinking a glass of wine before bed each evening." 5. "Try to modify the way you deal with the stress in your life." Answer: 1, 2, 5 Explanation: Bright or flickering lights can be triggers for migraines. Pickled foods are migraine triggers in some people. Stress and heightened emotion can serve as migraine triggers. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-14 Apply the nursing process to care for patients receiving pharmacotherapy for pain and for migraines.

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46) The nurse and the client have established this goal: "The client will verbalize safety considerations for use of tramadol (Ultram) before being dismissed from the hospital." Which client statements would support evaluation that this goal has been achieved? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I will not drive until I know how I am going to react to the tramadol." 2. "I will limit my alcohol intake to a couple of glasses of wine with dinner." 3. "I will avoid taking my regular dose of kava while I am on this drug." 4. "I will not eat aged cheese while taking tramadol." 5. "I will work with my healthcare provider to taper off the dose of this medication when it is no longer needed." Answer: 1, 3, 5 Explanation: Symptoms such as confusion and visual impairment can occur with tramadol use. Caution should be observed when using herbs such as kava that may have an additive CNS depressant effect. If tramadol is abruptly discontinued, symptoms of opioid withdrawal may occur. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 25-14 Apply the nursing process to care for patients receiving pharmacotherapy for pain and for migraines.

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47) A client has been treated for a migraine headache, been given a prescription for sumatriptan (Imitrex), and is being dismissed from the clinic. Which client statements would the nurse evaluate as meeting the goal that, prior to dismissal, the client will verbalize symptoms that indicate the need to contact the healthcare professional? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I should report any tightness in my chest." 2. "I should expect some dizziness and blurred vision until I get acclimated to this drug, so that should not be reported." 3. "If I get a headache after drinking alcoholic beverages, I should notify my healthcare provider." 4. "If I get a really bad headache, I should report it." 5. "If I notice a rash when I have a headache, I should report it." Answer: 1, 4, 5 Explanation: Triptans and ergot alkaloids cause vasoconstriction. Persons at risk for cardiovascular disease need close monitoring. Changes in severity, character, or duration of headaches should be reported because they may not be migraines. Fever, rash, or stiff neck may indicate meningitis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 25-14 Apply the nursing process to care for patients receiving pharmacotherapy for pain and for migraines. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 26 Anesthetics and Anesthesia Adjuncts 1) For which client would the nurse anticipate the use of a local anesthetic? 1. A client with an umbilical hernia 2. A client scheduled for a laparoscopic cholecystectomy 3. A client scheduled for a repeat cesarean section 4. A client with a scalp laceration Answer: 4 Explanation: Local anesthesia is applied to the skin or mucous membranes, resulting in loss of sensation to the immediate area. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning 474

Learning Outcome: 26-1 Compare and contrast the four basic types of anesthesia. 2) A nurse assisting the healthcare provider with chest tube placement prepares lidocaine for which type of anesthesia administration near the insertion site? 1. A regional nerve block 2. Spinal 3. Epidural 4. Infiltration Answer: 4 Explanation: The injection of a local anesthetic deep into tissue surrounding a surgical site is called infiltration anesthesia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 26-1 Compare and contrast the four basic types of anesthesia.

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3) A pregnant woman has a lesion on her leg and will need surgery. She expresses concern about anesthesia. What is the best response by the nurse? 1. "You will most likely have local anesthesia; this will not affect the baby." 2. "You may choose to have an epidural or a spinal block, which will not affect your baby." 3. "There are newer general anesthetics that do not pose a risk to your baby." 4. "Inhalation anesthetics will be used, as they are safest for your baby." Answer: 1 Explanation: Local anesthetics are most commonly used to remove lesions. Local anesthetics stay in the treatment area and will not impact a fetus. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 26-1 Compare and contrast the four basic types of anesthesia. 4) The client asks the nurse during preoperative teaching why he has to "receive so many drugs for such a simple procedure." How should the nurse explain the goal of using multiple agents to achieve general anesthesia? 1. This method decreases the dosages required for the various anesthetic agents. 2. Temporary amnesia can be produced in order for the client not to remember the procedure. 3. Use of multiple drugs reduces the pain the client feels postoperatively. 4. This method maintains a deep state of anesthesia during the procedure. Answer: 4 Explanation: Multiple medications are used to achieve rapid induction of anesthesia, maintain deep anesthesia, and promote muscle relaxation. While the client will not remember the surgery or experience pain, these are secondary goals. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 26-2 Explain the five general purposes of balanced anesthesia.

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5) Which statement by the nurse would be part of a "best plan" to teach a client about anesthesia? 1. "An inhaled agent is used to induce sleep, followed by an intravenous agent to promote relaxation." 2. "An inhaled agent needs to be followed by an intravenous agent if the inhaled agent is not adequate." 3. "An intravenous agent will be used first to induce sleep; then an inhaled agent will be used." 4. "An intravenous agent to induce sleep is usually all that is required." Answer: 3 Explanation: Intravenous agents are usually administered first because they act rapidly, within a few seconds. After the client loses consciousness, inhaled agents are used to maintain anesthesia. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 26-2 Explain the five general purposes of balanced anesthesia. 6) Midazolam (Versed) may be administered as part of surgical anesthesia. This drug is recognized as having which effects? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Producing effects consistent with those observed in administering other benzodiazepines 2. Reducing anxiety and stress associated with surgery 3. Producing central nervous system depression and skeletal muscle relaxation 4. Maintaining stable cardiac and respiratory activity 5. Preventing cardiac dysrhythmias Answer: 1, 2, 3 Explanation: Midazolam (Versed) can produce serious cardiovascular side effects, including hypotension, tachycardia, and cardiovascular collapse. Midazolam (Versed) can produce laryngospasm. Midazolam (Versed) reduces anxiety and stress associated with surgery. Midazolam (Versed) produces central nervous system depression and skeletal muscle relaxation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 26-2 Explain the five general purposes of balanced anesthesia.

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7) Balanced anesthesia is the use of a combination of medications to produce general anesthesia. Which drugs may be used in combination? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Benzodiazepines 2. Neuromuscular blockers 3. Inhaled anesthetics 4. Proton-pump inhibitors 5. Intravenous anesthetics Answer: 1, 2, 3, 5 Explanation: Benzodiazepines reduce anxiety, produce central nervous system depression, and relax skeletal muscle. Neuromuscular blockers provide skeletal muscle relaxation, which is an important component of general anesthesia. Inhaled agents are used to maintain an anesthetized state. Intravenous anesthetics relax muscles, diminish pain, and produce sleep. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 26-4 Identify drug classes used to produce general anesthesia. 8) The client is in stage 3 of general anesthesia, known as surgical anesthesia. The nurse anticipates which findings in this client's assessment? 1. Relaxation, stable respiration, and slow eye movements are present. 2. Breathing ceases. 3. Heart rate and breathing become irregular. 4. General sensation is lost. Answer: 1 Explanation: In stage 3, or surgical anesthesia, the skeletal muscles become relaxed, cardiovascular and breathing activities stabilize, and eye movements slow. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 26-3 Compare and contrast the four stages of general anesthesia.

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9) The client is in stage 2 of general anesthesia. What is the priority nursing intervention? 1. Insert a urinary catheter. 2. Maintain a quiet and calm environment in the operating room suite. 3. Administer a surgical scrub to the operative site. 4. Assist the anesthesiologist in positioning the client on the operating room table. Answer: 2 Explanation: The client is hyperexcitable in stage 2. Therefore, the environment must be kept quiet to minimize stimulation. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 26-3 Compare and contrast the four stages of general anesthesia. 10) Which assessment would indicate that surgical anesthesia has not been achieved for the client undergoing surgery with a general anesthetic? 1. Muscle rigidity 2. A reduction in heart rate 3. Slowed eye movements 4. Loss of consciousness Answer: 1 Explanation: Surgical anesthesia produces muscle paralysis. Muscle rigidity or muscle spasms would indicate that surgical anesthesia has not been achieved. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 26-3 Compare and contrast the four stages of general anesthesia.

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11) The nursing instructor is explaining the drug lidocaine (Xylocaine) to nursing students who are about to enter their surgical rotation. Which information should be included? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Amides block sodium from entering the cell. 2. Lidocaine has a longer duration of action than many of the esters. 3. Amides have fewer side effects than do esters. 4. Lidocaine is a calcium blocker. 5. Lidocaine and cocaine are from the same drug class. Answer: 1, 2, 3 Explanation: Amides decrease the sodium flux into the neuron, thus inhibiting the initial depolarization and conduction of the nerve impulse. Lidocaine is an amide-type local anesthetic, which has a longer duration of action than esters. Amides such as lidocaine have largely replaced the administration of agents from the ester class, because they produce fewer side effects. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 26-4 Identify drug classes used to produce general anesthesia.

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12) The surgical nurse is preparing a novice nurse for the first day in the operating suite. Which comment by the surgical nurse best explains what can be expected when the client is given succinylcholine (Anectine)? 1. "We don't have to worry too much about the client's cardiovascular status on this drug." 2. "The client will rapidly lose consciousness with drug administration." 3. "The client will need assistance with breathing, because succinylcholine paralyzes the muscles of respiration." 4. "We'll see that the effects of succinylcholine administration are much like those of atropine." Answer: 3 Explanation: Succinylcholine (Anectine) is a neuromuscular blocker that paralyzes muscles, including those of respiration. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 26-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 13) Which client effect would the nurse expect when nitrous oxide is administered? 1. Stage 3 anesthesia 2. Suppression of the pain mechanism 3. Total relaxation of skeletal muscles 4. A state of unconsciousness Answer: 2 Explanation: One of the major advantages of nitrous oxide is that it has strong analgesic properties. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 26-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 481

14) Which is a priority outcome goal for a client who has received local anesthesia related to treatment of a musculoskeletal injury? 1. The client will describe the postoperative course of recovery prior to discharge. 2. The client will maintain adequate nutrition to promote wound healing. 3. The client will have a return of gag reflex prior to ingesting food or fluids. 4. The client will verbalize the need to refrain from activity that could cause injury due to paresthesia. Answer: 4 Explanation: Local anesthesia results in paresthesia of varying lengths. The paresthesia places the client at risk for injury of the tissues with diminished sensation. Preventing this injury is a priority goal. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 26-8 Apply the nursing process to care for patients receiving local or general anesthesia. 15) A nurse who works in the operating room monitors clients for a number of effects of inhalation anesthesia. Which is the most dangerous of these effects? 1. Malignant hypertension 2. An increase in intracranial pressure 3. Malignant hyperthermia 4. Ventricular tachycardia Answer: 3 Explanation: Malignant hyperthermia is a rare adverse effect but is difficult to treat and often has an outcome that is fatal or debilitating. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 26-5 Describe the nursing care associated with the administration of regional and general anesthesia.

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16) Preoperative adjunct medications are used for which reasons? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. To reduce anxiety and facilitate sedation 2. To facilitate a faster recovery 3. To reduce the risk of aspiration pneumonia 4. To reduce the risk of a postoperative ileus 5. To manage pain Answer: 1, 3, 5 Explanation: Benzodiazepines or short-acting barbiturates are used to reduce anxiety and facilitate sedation. Preoperative adjunct medications such as histamine-2 receptor agonists or anticholinergics are used to reduce the risk of aspiration pneumonia. If the pain level is moderate or mild, nonsteroidal anti-inflammatory drugs are administered because they cause fewer serious adverse reactions than opioids. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 26-6 Explain the rationale for using adjunct agents during general anesthesia. 17) The anesthesiologist has listed succinylcholine (Anectine) as part of a client's anesthesia plan. Noting this, the nurse plans which as a priority assessment for this client? 1. Respiratory paralysis 2. Spontaneous bleeding 3. Anaphylactic shock 4. Emergence delirium Answer: 1 Explanation: Succinylcholine (Anectine) is a neuromuscular blocker that paralyzes muscles, including those of respiration. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 26-8 Apply the nursing process to care for patients receiving local or general anesthesia.

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18) A client has received local anesthesia of lidocaine (Xylocaine) with epinephrine for repair of a laceration. The nurse plans care based on the knowledge of which action of the epinephrine? 1. Constrict the blood vessels in the area to dramatically reduce bleeding, thus enhancing the operative field. 2. Constrict the blood vessels to extend the duration of the drug in the operative area. 3. Constrict the blood vessels to make the wound less distressing to the client and to promote relaxation. 4. Constrict the blood vessels in the area to reduce the transmission of pain signals to the central nervous system. Answer: 2 Explanation: Epinephrine is a common additive to local anesthetics that is used to constrict the blood vessels and to extend the duration of the drug. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 26-8 Apply the nursing process to care for patients receiving local or general anesthesia. 19) A client reports that the last time he received nitrous oxide for a procedure he had what felt like a "hangover" for days afterward. Which intervention should the nurse plan to help avoid this effect? 1. Prehydrate the client with intravenous normal saline. 2. Report this comment to the anesthesiologist so he will change the agent used. 3. Provide the client with caffeine-containing beverages immediately after the procedure. 4. Have the client breathe 100% oxygen for several minutes following the nitrous oxide. Answer: 4 Explanation: Having the client breathe 100% oxygen for several minutes following nitrous oxide use has been shown to prevent alveolar hypoxia. It is the alveolar hypoxia that produces the "hangover" effect. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 26-8 Apply the nursing process to care for patients receiving local or general anesthesia. 484

20) A nurse is interviewing a client who is scheduled for a surgical procedure using nitrous oxide. Which statement by the client is most important for the nurse to communicate to the surgeon? 1. "I've never had any type of surgery before this." 2. "The last surgery I had was done under spinal anesthesia." 3. "I take St. John's wort daily to decrease my tendency toward depression." 4. "I have a fear of enclosed spaces." Answer: 3 Explanation: St. John's wort should be discontinued 2 to 3 weeks prior to administration of general anesthesia due to possible hypotension risk. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 26-8 Apply the nursing process to care for patients receiving local or general anesthesia. 21) Which nursing action would be best to help a client clear nitrous oxide anesthesia from the system? 1. Run intravenous fluids at 125 mL/h for several hours after the procedure. 2. Keep the client NPO for at least 2 hours after the procedure. 3. Have the client deep breathe several times each hour for several hours after the procedure. 4. Monitor urine output every hour for at least 4 hours after the procedure. Answer: 3 Explanation: Nitrous oxide is cleared through the respiratory system, and deep breathing will help in this process. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 26-5 Describe the nursing care associated with the administration of regional and general anesthesia.

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22) A nurse is assessing a postoperative client who has a family history of malignant hyperthermia. Which findings would be of most concern to the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Mild spasms of the client's jaw muscles 2. Dark urine 3 hours after surgery 3. Tachycardia in the first hour after surgery 4. Temperature elevation 3 hours after the procedure 5. Respiratory rate increase to 18 breaths/min 2 hours after the procedure Answer: 1, 2, 3 Explanation: Mild jaw spasms often herald the development of malignant hyperthermia. Darkened urine may signify rhabdomyolysis, which occurs with malignant hyperthermia. Tachycardia is a potential herald of malignant hyperthermia. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 26-5 Describe the nursing care associated with the administration of regional and general anesthesia. 23) A client is scheduled to have a procedure under anxiolysis sedation. Which assessment findings would the nurse evaluate as indicating this level of sedation has been reached? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Client needs airway support. 2. Respiratory effort is adequate. 3. Client can only be aroused with painful stimulation. 4. Cardiovascular function requires support. 5. Client remains responsive. Answer: 2, 5 Explanation: Respiratory effort is not diminished in anxiolysis sedation. Clients in the anxiolysis level of sedation remain responsive. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 26-1 Compare and contrast the four basic types of anesthesia.

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24) Moderate sedation is planned for a client who will undergo a procedure. Which statements by the nurse would help the client understand this level of sedation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You will be able to respond to us when we tap you on the shoulder." 2. "You will have a breathing tube inserted in your throat through your mouth." 3. "We will keep stimulating you to breathe." 4. "This level of sedation shouldn't have any effect on your heart." 5. "You will definitely be able to respond to us when we call your name." Answer: 1, 4 Explanation: Minimally sedated clients are able to respond to light tactile stimulation. Minimally sedated clients generally do not need any cardiovascular support. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 26-1 Compare and contrast the four basic types of anesthesia. 25) A client has just been visited by the anesthesiologist who will provide anesthesia during the client's abdominal surgery the next day. The client says, "I think I heard the doctor say something about hypnosis. I don't believe in all of that." How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Hypnosis is a standard method of relaxing the client before anesthesia is started." 2. "That just means the drugs are going to make you unaware of what is happening." 3. "The doctor needs to block all of your reflexes so the surgeon can do the surgery." 4. "This is not the same as the kind of hypnosis you might see on television." 5. "The doctors do not want you to remember the pain of your procedure." Answer: 2, 4 Explanation: This statement is a good description of hypnosis as it applies to general anesthesia. This is a true statement. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 26-2 Explain the five general purposes of balanced anesthesia.

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26) A novice nurse says, "We want to keep our clients in stage 4 anesthesia during their surgery." How should the supervising nurse interpret this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The novice nurse has made an error in this statement. 2. Stage 4 anesthesia is avoided. 3. This is a good description of the goal of anesthesia. 4. The novice nurse should have said stage 3 anesthesia. 5. A more accurate statement would be that the client is maintained in anxiolysis anesthesia. Answer: 1, 2, 4 Explanation: Stage 4 is not the goal for anesthesia. In stage 4, the medulla is paralyzed and breathing and circulation could stop. This stage is avoided. The goal of anesthesia is rapid induction through stages 1 and 2 with the client remaining in stage 3 until the end of the procedure. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 26-2 Explain the five general purposes of balanced anesthesia. 27) The client will be given intravenous remifentanil (Ultiva) for a procedure. The nurse expects that after the drug is discontinued, recovery from anesthesia will occur within minutes. Record your answer rounding to the nearest whole number. Answer: 10 Explanation: Remifentanil (Ultiva) is used because it is rapidly metabolized, with recovery occurring 5 to 10 minutes after discontinuation of the drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 26-8 Apply the nursing process to care for patients receiving local or general anesthesia.

488

28) Which clients would the nurse evaluate as unsuitable for the administration of fentanyl as anesthesia? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A 60-year-old with a history of emphysema 2. A 17-year-old who sustained a head injury in a motor vehicle crash 3. A breastfeeding mother 4. A 58-year-old with type 2 diabetes mellitus 5. A 70-year-old with a history of ulcerative colitis Answer: 1, 2, 3 Explanation: Any client with a history of respiratory impairment should be administered fentanyl only with great caution. Clients who have sustained a head injury should not receive fentanyl. Fentanyl is secreted in breast milk and should not be given to breastfeeding mothers. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 26-8 Apply the nursing process to care for patients receiving local or general anesthesia.

489

29) A nurse is admitting a client scheduled for a late afternoon procedure for which midazolam (Versed) will be administered. Which client statements should be reported to the anesthesiologist? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I was afraid I would be nervous and not be able to sleep last night, so I took one of my melatonin capsules." 2. "The doctor said I could have a light breakfast. I hope a grapefruit and dry toast is light enough." 3. "I didn't put my glaucoma drops in my eyes this morning." 4. "When I had my last surgery, they gave me nitrous oxide." 5. "I am allergic to eggs." Answer: 1, 2, 3 Explanation: Melatonin should be avoided because it may increase the actions of benzodiazepines. Grapefruit and grapefruit juice may increase the serum concentration of midazolam. Clients who have acute, closed-angle glaucoma should not be administered midazolam. Cognitive Level: Evaluating Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 26-8 Apply the nursing process to care for patients receiving local or general anesthesia.

490

30) During the admission assessment for a procedure in which propofol (Diprivan) will be administered, the client reports multiple food and drug allergies. Which allergies would be of greatest concern to the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Eggs 2. Milk 3. Wheat 4. Soybeans 5. Pineapple Answer: 1, 4 Explanation: Propofol emulsion contains egg products. Propofol emulsion contains soybean products. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 26-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

491

31) A client has had an unexpected reaction to propofol (Diprivan) and may be developing propofol infusion syndrome (PIF). What assessment findings are important for the nurse to relay to the client's healthcare provider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client's urinary output has fallen to almost nothing over the past 4 hours. 2. The client's urine is cola colored. 3. The client's serum potassium level drawn an hour ago is low normal. 4. The client is complaining of right upper quadrant pain. 5. The client has a fever. Answer: 1, 2, 4 Explanation: This could be a sign of renal failure, which is a sign of PIF. This can be a sign of liver problems or rhabdomyolysis, which are both associated with PIF. Pain in the right upper quadrant may be pain from the liver. Liver enlargement is associated with PIF. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 26-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

492

32) Isoflurane (Forane) was administered as anesthesia for a client who had abdominal surgery. During postanesthesia recovery, the client begins to shiver. What should the nurse do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Check the client's temperature. 2. Notify the anesthesiologist immediately. 3. Put warm blankets on the client. 4. Assure the client that shivering is common. 5. Administer prn pain medication. Answer: 3, 4 Explanation: Warm blankets may be applied for client comfort. Shivering is common after receiving isoflurane. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 26-5 Describe the nursing care associated with the administration of regional and general anesthesia. 33) During review of postoperative medical orders, the nurse notes an order for ondansetron (Zofran) prn. When would the nurse expect to administer this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. If the client has temperature elevation 2. If the client complains of nausea 3. Approximately 30 minutes before the end of the procedure 4. If the client reports breakthrough pain between regular pain medication administration 5. Just before the first dressing change Answer: 2, 3 Explanation: Ondansetron (Zofran) is used as an antiemetic. If administered approximately 30 minutes before the end of the procedure, acute nausea and vomiting may be avoided. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 26-6 Explain the rationale for using adjunct agents during general anesthesia. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 27 Pharmacology of Substance Abuse 493

1) The nurse is managing care for a group of substance abusers. The clients have completed group education about the disease of addiction. The nurse determines that learning has occurred when the clients make which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "A heroin addict can die from heroin withdrawal." 2. "Addiction includes a compulsion to use a mood-altering substance." 3. "Most addicts became addicted from pain medication in a hospital." 4. "Substance abuse depends on complex variables." 5. "There is most likely a genetic component to addiction." Answer: 2, 4, 5 Explanation: Addiction is an overwhelming compulsion that drives someone to repetitive drug-taking behavior, despite serious health and social consequences. Substance abuse depends on multiple, complex, interacting variables. Substance abuse depends on multiple, complex, interacting variables, including a genetic component. Children of alcoholic parents, for example, are four times more likely to become alcoholics than are children of nonalcoholic parents. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 27-4 Identify factors contributing to addiction.

494

2) The nurse is caring for a client who is one day postsurgery for an abdominal hysterectomy. The client is requesting morphine sulfate intravenous (IV), which is prescribed. The client rates her pain as 8 out of 10, with 10 being the most intense. The nurse says to another nurse on the unit, "She really doesn't look like she is in pain. Maybe she is an addict." Which is the best response by the other nurse? 1. "Maybe you could tell her to do some distraction techniques first." 2. "You could call the doctor and get an order for an oral medication." 3. "I would give the morphine; pain is subjective, and we don't know her history." 4. "I would hold the medication until she looks like she is in pain." Answer: 3 Explanation: The response to pain varies among individuals; a client is not an addict just because she "does not look like she is in pain." Pain is subjective; the client should be believed. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-4 Identify factors contributing to addiction. 3) The adolescent client is in a drug rehabilitation program. The mother of this client says to the nurse, "The healthcare provider said my son has a physical addiction to alcohol. What does this mean?" Which response by the nurse is the most appropriate? 1. "He will have feelings of depression when stopping alcohol; we need to monitor him for suicide." 2. "His body is used to alcohol; he will have specific withdrawal symptoms when it is stopped." 3. "His brain remembers the euphoria he had with alcohol, and he has a craving to return to it." 4. "He will have an intense craving for alcohol; this is best managed in group therapy." Answer: 2 Explanation: Over time, the body's cells become accustomed to the presence of the unnatural substance. Specific physical withdrawal symptoms will occur; the client needs to be medically withdrawn from the substance. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-5 Compare and contrast physical and psychologic dependence. 495

4) The client comes to the emergency department and tells the nurse, "I have been off my drugs for 3 days." The nurse assesses the client for withdrawal symptoms associated with the category of drug used. Withdrawal from which drug, if taken by the client, should cause the nurse the most concern? 1. Cocaine 2. Marijuana 3. Heroin 4. Secobarbital Answer: 4 Explanation: Secobarbital is a barbiturate. This drug, which is a central nervous system (CNS) depressant, will likely lead to the most life-threatening withdrawal symptoms in a client who has stopped taking it. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 27-6 Compare and contrast withdrawal syndromes for the different classes of abused substances.

496

5) The client is withdrawing from opioids. Which symptoms best describe the results of the nurse's assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Abdominal cramping and pain 2. Dilated pupils 3. Pinpoint pupils 4. Diaphoresis 5. Hypotension Answer: 1, 2, 4 Explanation: Signs of opioid withdrawal include abdominal cramps and pain. The pupils will be dilated during opioid withdrawal, but will appear pinpoint when the client is using opioids. Signs of opioid withdrawal include diaphoresis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 27-6 Compare and contrast withdrawal syndromes for the different classes of abused substances.

497

6) A client with an extensive history of alcoholism is having coronary bypass surgery. While administering anesthesia, the certified nurse anesthetist notes that the client requires greater than usual amounts of the drug. The nurse correctly evaluates this response as which phenomenon? 1. The client has developed a resistance to the anesthesia, so it will not work very well. 2. The client has developed a paradoxical reaction to the anesthesia and will require a different drug. 3. The nurse anesthetist most likely did not calculate the correct amount of anesthesia for this client. 4. The client had developed cross-tolerance to the anesthesia and will require greater amounts. Answer: 4 Explanation: With chronic alcohol use, the liver adapts and metabolizes alcohol at a faster rate. More of the substance is required to achieve the same effect. This is a phenomenon known as cross-tolerance. This client has a tolerance to alcohol, so he will require additional anesthesia for surgery, since both drugs are CNS depressants. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-7 Discuss the significance of drug tolerance to pharmacology.

498

7) The mother of an adolescent client says to the nurse, "I think my son is staying up too late studying, and I see him using Visine eyedrops all the time for his red eyes. Should I have his vision checked?" Which response by the nurse is the most appropriate? 1. "It sounds like he could be smoking marijuana, and I would talk to him." 2. "Yes, that is a great idea, he might need some glasses." 3. "Sounds like he is using cocaine; I have seen this before." 4. "He might be depressed; insomnia is common with depression." Answer: 1 Explanation: One hallmark symptom of marijuana use is red or bloodshot eyes, caused by dilation of blood vessels. Visine constricts the blood vessels of the eyes, reducing the redness. It is important for the parent to discuss this with the adolescent. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-8 Explain the major characteristics of abuse, dependence, and tolerance resulting from use of the following substances: sedatives, opioids, alcohol, marijuana, hallucinogens, club drugs, amphetamines, methylphenidate, cocaine, caffeine, nicotine, inhalants, and anabolic steroids.

499

8) The client has been abusing alcohol for several years and tells the nurse, "I used to drink a pint of whiskey every day. Now I get sick and pass out after just two drinks." What does the nurse correctly recognize about this client? 1. The client has brain damage from the alcohol and cannot remember how much he consumes. 2. The client is in denial and most likely is misrepresenting the amount of alcohol he consumes. 3. The client could have liver damage, resulting in an inability to metabolize large amounts of alcohol. 4. The client's symptoms are related to hyperglycemia; he might have pancreatic damage. Answer: 3 Explanation: Alcoholism is a common cause of cirrhosis, a debilitating—and often fatal—failure of the liver to perform its vital functions, such as metabolism of alcohol. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-8 Explain the major characteristics of abuse, dependence, and tolerance resulting from use of the following substances: sedatives, opioids, alcohol, marijuana, hallucinogens, club drugs, amphetamines, methylphenidate, cocaine, caffeine, nicotine, inhalants, and anabolic steroids.

500

9) The client is admitted to the inpatient substance abuse unit. She tells the nurse she has been buying "yellow jackets" (pentobarbital, or Nembutal) on the street, but has not had any for a few days. Which plan, by the nurse, is the most appropriate at this time? 1. Prepare to do frequent room searches, because the client's friends will most likely bring drugs in for her. 2. Prepare to manage the depression and suicidal thoughts the client will have. 3. Prepare to manage a withdrawal that will likely be minimal. 4. Prepare to manage a withdrawal that could be life threatening. Answer: 4 Explanation: Barbiturates are central nervous depressant (CNS) drugs. Withdrawal symptoms resemble those of alcohol withdrawal, and can be life threatening. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 27-6 Compare and contrast withdrawal syndromes for the different classes of abused substances. 10) The client had been abusing cocaine for several years. Recently, the client snorted cocaine that was much purer than was thought, resulting in an overdose. The client died in the emergency department. What does the nurse recognize as the most likely cause of death? 1. Impurities in the cocaine 2. Bowel ischemia 3. Rhabdomyolysis 4. Respiratory arrest Answer: 4 Explanation: Overdose of cocaine can result in dysrhythmias, convulsions, stroke, or death due to respiratory arrest. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.C.1 Value seeing healthcare situations "through patients' eyes" | AACN Essential Competencies: VI.1 Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education and licensure requirements) | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 27-9 Identify the role of the nurse in recognizing, preventing, and treating substance abuse.

501

11) The client has smoked a pack of cigarettes per day for 20 years. The client also takes oral contraceptives. In implementing a teaching plan, what is the most important information for the nurse to include? 1. "You are at a greater risk for emphysema than are nonsmokers." 2. "You are at a greater risk for developing diabetes than are smokers who do not use birth control pills." 3. "You are at a greater risk for a heart attack than are nonsmokers." 4. "The nicotine will decrease the effectiveness of your birth control pills." Answer: 3 Explanation: Cardiovascular effects can be particularly serious in clients taking oral contraceptives if they also smoke. The risk of a fatal heart attack is five times greater in smokers who also use oral contraceptives than in nonsmokers. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-8 Explain the major characteristics of abuse, dependence, and tolerance resulting from use of the following substances: sedatives, opioids, alcohol, marijuana, hallucinogens, club drugs, amphetamines, methylphenidate, cocaine, caffeine, nicotine, inhalants, and anabolic steroids.

502

12) The client tells the nurse that her 12-year-old child asks to use her nail polish remover several times a day. When her friends come to visit, this seems to occur more frequently. Which response by the nurse is the most appropriate? 1. "Your daughter might be 'huffing'; that is really scary." 2. "Your daughter might be 'huffing,' or inhaling the remover." 3. "Your daughter might be 'huffing,' or drinking small amounts of the remover." 4. "Your daughter might be 'huffing,' or rubbing the remover on her skin." Answer: 2 Explanation: Inhaling volatile chemicals, known as "huffing," is most prevalent in the 10- to 12-year-old group. Virtually any organic compound can be huffed, including nail polish remover, spray paint, household glue, and gasoline. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-8 Explain the major characteristics of abuse, dependence, and tolerance resulting from use of the following substances: sedatives, opioids, alcohol, marijuana, hallucinogens, club drugs, amphetamines, methylphenidate, cocaine, caffeine, nicotine, inhalants, and anabolic steroids. 13) Which is a priority outcome for the client who is diagnosed with chronic alcoholism and liver damage? 1. The client will switch to a safer drug, such as a benzodiazepine. 2. The client will become involved in Alcoholics Anonymous (AA). 3. The client will learn to drink more responsibly. 4. The client will keep all appointments with the doctor who is treating the liver damage. Answer: 2 Explanation: Long-term management for alcohol abuse includes behavioral counseling and self-help groups, such as Alcoholics Anonymous (AA). Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.C.1 Value seeing healthcare situations "through patients' eyes" | AACN Essential Competencies: VI.1 Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education and licensure requirements) | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 27-9 Identify the role of the nurse in recognizing, preventing, and treating substance abuse.

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14) A 10-year-old child is admitted to the emergency department after "huffing" gasoline. The healthcare provider suspects mild brain damage. Which clinical manifestations will the nurse teach the parents to observe for after they take the child home? 1. Irregular pulse, fainting, and anger 2. Slurred speech, memory loss, and personality changes 3. Nausea, vomiting, and dizziness 4. Depression, cold extremities, and dyspnea Answer: 2 Explanation: Children can die after a single episode of "huffing" a volatile chemical, or they might suffer brain damage. Brain damage can manifest as slurred or slow speech, memory loss, or personality changes. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.C.1 Value seeing healthcare situations "through patients' eyes" | AACN Essential Competencies: VI.1 Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education and licensure requirements) | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-9 Identify the role of the nurse in recognizing, preventing, and treating substance abuse. 15) A nurse is assessing a group of clients for the complications of long-term abuse of anabolic steroids. Which clients would the nurse focus the assessment on due to their history? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A 23-year-old personal trainer 2. A 17-year-old senior high school baseball player 3. A 35-year-old weightlifter 4. A 32-year-old professional football player 5. A 21-year-old downhill skier preparing for the Olympics Answer: 1, 2, 3 Explanation: Some abusers use anabolic steroids to enhance their appearance. It should not be surprising to find steroid abuse in this client. High school students are not tested for anabolic steroid use, so it would not be surprising to find steroid abuse in this client. If this weightlifter in not competing in a professional organization, it would not be surprising to find steroid abuse in this client. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.3 Promote the image of nursing by modeling the values and articulating the knowledge, skills, and attitudes of the nursing profession | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-1 Describe the types of substances abused by individuals. 504

16) A nurse preparing a teaching plan for a group of high school athletes on anabolic steroid use and abuse would include which key points in the presentation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Although anabolic steroids do enhance performance, their use can also produce serious side effects such as liver disease and stroke. 2. Anabolic steroids can cause infertility, impotence, and breast enlargement in men. 3. Anabolic steroids can cause women to develop masculine traits such as increased body hair, deepening voice, and shrinking breasts. 4. Anabolic steroids can cause personality changes such as aggression, violent behavior, depression, and insomnia. 5. Anabolic steroids can be taken safely if the "pyramiding" method is used. Answer: 1, 2, 3, 4 Explanation: Liver disease, elevated cholesterol, myocardial infarction, and stroke are serious side effects of anabolic steroid abuse. Infertility, impotence, and breast enlargement are symptoms found in men who abuse anabolic steroids. Women who abuse anabolic steroids can develop masculine traits such as increased body hair, deepening voice, and shrinking breasts. Abuse of steroids can cause personality changes such as aggression, violent behavior, depression, insomnia, anorexia, and decreased libido. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.C.1 Value seeing healthcare situations "through patients' eyes" | AACN Essential Competencies: VI.1 Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education and licensure requirements) | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-9 Identify the role of the nurse in recognizing, preventing, and treating substance abuse.

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17) A nurse is preparing to admit a client suspected of overdose. Which drugs will the nurse monitor for because of their high potential for abuse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Oxycodone (OxyContin) 2. Nicotine 3. Marijuana 4. Amobarbital (Amytal) 5. Secobarbital (Seconal) Answer: 1, 2, 3 Explanation: Legally prescribed drugs such as oxycodone (OxyContin) have become frequent drugs of abuse. Nicotine is one of the most commonly abused drugs. Marijuana is the most frequently abused drug, although it is legal in some states. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.3 Promote the image of nursing by modeling the values and articulating the knowledge, skills, and attitudes of the nursing profession | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-1 Describe the types of substances abused by individuals. 18) The nurse is preparing care for a client diagnosed with substance abuse of a Schedule I drug. Which drugs are Schedule I drugs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Heroin 2. Marijuana 3. LSD 4. Cocaine 5. Diazepam (Valium) Answer: 1, 2, 3 Explanation: Heroin is a Schedule I drug. Marijuana is a Schedule I drug. LSD is a Schedule I drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-2 Identify the five drug schedules of controlled substances and give examples of drugs in each schedule.

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19) The nurse is preparing discharge instructions for a client admitted for drug overdose of an illegal substance. The client asks the nurse why some drugs are illegal, while others are not. Which response by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Some drugs are restricted or regulated because they have the potential for abuse." 2. "The government is committed to making sure drug dealers do not have the means to acquire drugs to sell to the public." 3. "Some drugs are restricted because they can cause significant harm to the user and the public." 4. "There are five schedules of drugs the government considers dangerous. Schedule V drugs have the highest potential for abuse, while some Schedule I drugs do not need a prescription." 5. "Some drugs have a strong potential for abuse but also have therapeutic value. These drugs will be restricted to medical necessity." Answer: 1, 3, 5 Explanation: Drugs with abuse potential are restricted. Some substances can cause significant harm to the user or to anyone near the user when memory or performance becomes impaired. Some substances have a strong potential for abuse but have therapeutic applications important enough to approve them for use under restricted guidelines. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: V.7 Examine the roles and responsibilities of the regulatory agencies and their effect on patient care quality, workplace safety and the scope of nursing and other health professionals' practice | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-3 Explain major legislation regulating controlled substances in the United States.

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20) The nurse is reinforcing factors that contribute to addiction to a group of clients recovering from addiction and their family members. Which statement made by a client or family member would indicate the need for additional teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I'm not likely to have any more problems with addiction since neither of my parents had a problem with addiction." 2. "I can still see my friends as long as I stay away from alcohol." 3. "I don't want to become addicted like my husband did. I'm never going to take any kind of drug unless I absolutely have to." 4. "I realize now that I was just looking for ways to help me feel good about myself." 5. "After a while, it just seemed even though I was not in pain, I would still want to take the pain pills." Answer: 1, 2, 3 Explanation: Addiction depends on multiple and complex variables. Genetics plays a part but many other factors also contribute to addiction. Counselors encourage users to stop associating with social contacts who shared the substance abuse to lessen the possibility for relapse. The therapeutic use of drugs rarely causes addiction when used according to accepted medical protocols. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 27-4 Identify factors contributing to addiction.

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21) A client is abusing an antianxiety medication. Which assessment by the nurse would confirm a psychologic dependence instead of physical dependence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client's history reveals the long-term use of high doses of an antianxiety medication. 2. The client describes the "need" to use the antianxiety medication despite not feeling anxious. 3. The client describes feeling nauseous with abdominal cramping. 4. The client tells you her family has "disowned" her because of her need for the antianxiety medication. 5. The client complains she has not slept in days, feels anxious, and tired. Answer: 1, 2, 4 Explanation: Psychologic dependence usually requires the use of relatively high doses of antianxiety medication over a prolonged period of time. Psychologic dependence is the "need" or desire to continue taking a drug when there is a lack of physical symptoms. In this case, the client does not feel anxious but still has the desire to take the antianxiety medication. To continue the use of the antianxiety drug at the risk of jeopardizing relationships is indicative of psychologic dependence. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 27-5 Compare and contrast physical and psychologic dependence.

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22) The nurse is preparing care for a client diagnosed with substance abuse of a Schedule III drug. Which drugs are Schedule III drugs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Heroin 2. Marijuana 3. Hydrocodone 4. Anabolic steroids 5. Diazepam (Valium) Answer: 3, 4 Explanation: Hydrocodone is a Schedule III drug. Anabolic steroids are a Schedule III drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-2 Identify the five drug schedules of controlled substances and give examples of drugs in each schedule. 23) The nurse is preparing discharge instructions for a client who was being seen in the emergency department. The client shows the nurse a few pills that they have been using for the pain and states that they have really helped with their pain. Which response by the nurse is the most appropriate? 1. "I am going to let the prescriber know about these pills so you can get a prescription for them." 2. "Can you give me more information about your pain?" 3. "Some drugs are restricted because they can cause significant harm to the user and the public." 4. "I think that you have been sharing medications with others. You will need to leave." Answer: 2 Explanation: The nurse's best response is to attempt to assess for additional information. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: V.7 Examine the roles and responsibilities of the regulatory agencies and their effect on patient care quality, workplace safety and the scope of nursing and other health professionals' practice | NLN Competencies: Knowledge & Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-3 Explain major legislation regulating controlled substances in the United States.

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24) A nurse is interviewing a client and asks about tobacco use. The client denies tobacco use. The nurse asks about alcohol consumption. The client wonders why the nurse is asking about tobacco and alcohol use. Which is the nurse's best reply to the client? 1. "The hospital maintains records of this information on all clients admitted." 2. "This information assists the healthcare team to adjust medications based on usage of these products." 3. "I am required by the nurse practice act to complete all components of the nursing assessment." 4. "I want to provide excellent nursing care and this information will assist me to determine the right medications." Answer: 2 Explanation: The information obtained in the nursing assessment helps all providers to understand about all medication use including tobacco and alcohol use and to assist with prescribing appropriate medications based on that use and adjust for tolerance if overuse is occurring frequently. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transition and continuity | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-7 Discuss the significance of drug tolerance to pharmacology. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 28 Review of the Cardiovascular System 1) The nurse educator is describing the major structures of the cardiovascular system to a group of nursing students. How many major components will the educator teach the students about during the lecture? 1. One 2. Two 3. Three 4. Four Answer: 3 Explanation: There are three major components to the cardiovascular system. They are the blood, heart, and blood vessels. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 28-1 Describe the major structures of the cardiovascular system. 511

2) After a stressful event, a client's blood pressure and heart rate rise. Which system is most likely responsible for this physiologic change? 1. The respiratory system 2. The parasympathetic nervous system 3. The acid–base buffer system 4. The autonomic nervous system Answer: 4 Explanation: The autonomic nervous system controls the heart rate and blood vessel diameter. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-1 Describe the major structures of the cardiovascular system.

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3) Body cells require oxygen-rich blood for aerobic metabolism. The nurse explains that which organs bring oxygen to the blood and remove carbon dioxide from it? 1. The lungs 2. The parathyroid glands 3. The bronchioles 4. The kidneys Answer: 1 Explanation: The respiratory system brings oxygen to the blood and removes carbon dioxide from it. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-1 Describe the major structures of the cardiovascular system. 4) A nurse educator is teaching a group of students about the functions of the cardiovascular system. The nurse educator knows the students have grasped the information when they are able to state which as functions of the cardiovascular system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Transport of nutrients and wastes 2. Storage of blood 3. Regulation of blood pressure 4. Regulation of acid–base balance 5. Regulation of fluid balance Answer: 1, 3, 4, 5 Explanation: The functions of the cardiovascular system are diverse and include the transport of nutrients and wastes. The functions of the cardiovascular system are diverse and include the regulation of blood pressure. The functions of the cardiovascular system are diverse and include the regulation of acid–base balance. The functions of the cardiovascular system are diverse and include the regulation of fluid balance. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-1 Describe the major structures of the cardiovascular system.

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5) A client is in acute renal failure. During this period, the client's erythrocyte count might drop. The nurse understands that this might be due to a deficiency of which substance? 1. Renin 2. Angiotensin 3. Erythropoietin 4. Aldosterone Answer: 3 Explanation: Erythrocyte homeostasis is controlled by erythropoietin, a hormone secreted by the kidney in response to low oxygen levels in the blood. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 28-2 Identify the components of blood and their functions. 6) A client with leukopenia is placed in a private room, and visitors are limited. Why are these precautions taken for this client? 1. To keep the client in isolation 2. To protect visitors from infectious respiratory particles 3. To allow for undisturbed rest 4. To protect the client from potential infection Answer: 4 Explanation: Too few leukocytes, or leukopenia, will make the client susceptible to infection. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 28-2 Identify the components of blood and their functions.

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7) A group of nursing students is discussing the components of blood. One student is naming the formed components of blood. Which are considered to be the formed components of blood? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Erythrocytes 2. Leukocytes 3. Platelets 4. Erythropoietin 5. Hemoglobin Answer: 1, 2, 3 Explanation: Erythrocytes are solid, formed elements of blood. Leukocytes are solid, formed elements of blood. Platelets are solid, formed elements of blood. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-2 Identify the components of blood and their functions. 8) During morning rounds, the nurse is told one of the clients will need a platelet transfusion. From this information, the nurse infers that which should be removed from a client's room? 1. Visitors 2. Magazines 3. Fresh flowers 4. Shaving razors Answer: 4 Explanation: This client might have a decreased ability to clot at this time. Shaving razors should be avoided. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 28-3 Construct a flowchart diagramming the primary steps of hemostasis.

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9) A client with cirrhosis is due to have a liver biopsy performed. What will the nurse monitor this client for at the bedside following the procedure? 1. Dyspnea 2. Fever 3. Bleeding 4. Airway obstruction Answer: 3 Explanation: Several clotting factors are made by the liver. The client should be monitored for bleeding. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 28-3 Construct a flowchart diagramming the primary steps of hemostasis. 10) The nurse understands that which vitamin is essential in the process of coagulation? 1. Vitamin A 2. Vitamin K 3. Vitamin C 4. Vitamin D Answer: 2 Explanation: Vitamin K is required for the liver to make four of the clotting factors. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-3 Construct a flowchart diagramming the primary steps of hemostasis.

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11) The nurse knows that the process of hemostasis is complex and involves different clotting factors that contribute to the stoppage of blood flow. Record your answer rounding to the nearest whole number. Answer: 13 Explanation: The process of hemostasis is complex and involves 13 different clotting factors that contribute to the stoppage of blood flow. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-3 Construct a flowchart diagramming the primary steps of hemostasis. 12) A nurse educator is reviewing the clotting cascade with a group of students. The educator knows that the student has grasped the information when the student states that normal blood clotting occurs in about _ minutes. Record your answer rounding to the nearest whole number. Answer: 6 Explanation: Normal blood clotting occurs in about 6 minutes. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 28-3 Construct a flowchart diagramming the primary steps of hemostasis.

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13) At a community health fair, a nurse stresses the importance of a cardiac-prudent diet and exercise routine in order to help prevent coronary artery disease. Which is the correct rationale for this teaching? 1. Diet and exercise always reduce coronary artery disease. 2. Coronary arteries supply the myocardium with nutrients. 3. Diet and exercise are more effective treatment modalities in the prevention of coronary artery disease than are medications. 4. Coronary arteries spasm in response to exercise, which enhances myocardial perfusion. Answer: 2 Explanation: Patent coronary arteries are needed to supply the heart muscle with nutrients. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 28-4 Describe the structure of the heart and the function of the myocardium. 14) The nurse educator is describing the structure and function of the myocardium to a group of students working with cardiac clients. What does the nurse educator say is most likely to occur if the myocardium is deprived of oxygen? 1. Sinus rhythm 2. Decreased urine output 3. Hepatosplenomegaly 4. Heart failure Answer: 4 Explanation: Heart failure can occur if the myocardium is deprived of oxygen. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 28-4 Describe the structure of the heart and the function of the myocardium.

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15) A nurse educator is discussing what happens when cardiac cells die. Which consequences are appropriate for the educator to include in the discussion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fibrotic scar tissue formation 2. Impaired cardiac function 3. Extensive branching 4. Impaired cardiac contraction 5. Left ventricular hypertrophy Answer: 1, 2, 4, 5 Explanation: If a large area of the myocardium becomes deprived of oxygen and undergoes necrosis, the cells are replaced by fibrotic scar tissue. If a large area of the myocardium becomes deprived of oxygen and undergoes necrosis, impaired cardiac function can occur. If a large area becomes deprived of oxygen and undergoes necrosis, the different regions of the heart may not contract in a coordinated manner because conduction of the electrical potential may skip over spots on the myocardium where no conduction occurs. During heart failure, the size of the left ventricle and the thickness of the myocardial layer in this chamber can increase in size in clients, which is a condition known as left ventricular hypertrophy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-4 Describe the structure of the heart and the function of the myocardium.

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16) A client diagnosed with angina asks the nurse why she experiences chest pain while walking up stairs. The nurse explains that which item has likely occurred in this client? 1. Narrowing of the coronary arteries 2. Addisonian crisis 3. An infection of the floor of the mouth 4. A buildup of lactic acid in the calves Answer: 1 Explanation: Coronary artery narrowing results in chest pain upon exertion, a condition known as angina pectoris. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 28-5 Describe the role of the coronary arteries in supplying the myocardium with oxygen. 17) A client having a stress test exhibits an increased heart rate and stronger cardiac contraction but no chest pain. What is occurring to this client's coronary arteries? 1. Constriction 2. Dilation 3. Vasospasm 4. No change is occurring. Answer: 2 Explanation: An increased heart rate and stronger cardiac contraction indicate that dilation is occurring. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 28-5 Describe the role of the coronary arteries in supplying the myocardium with oxygen.

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18) A client asks the nurse which blood vessels supply blood to the heart muscle. Which response by the nurse is the most appropriate? 1. "The jugular veins." 2. "The carotid arteries." 3. "The coronary arteries." 4. "The saphenous veins." Answer: 3 Explanation: The coronary arteries bring essential nutrients to the myocardium. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-5 Describe the role of the coronary arteries in supplying the myocardium with oxygen. 19) The heart requires a bountiful supply of oxygen and other nutrients. Where does the heart obtain oxygen and nutrients? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Right coronary artery 2. Left coronary artery 3. Coronary artery branches 4. Brachial artery 5. Saphenous vein Answer: 1, 2, 3 Explanation: The right coronary artery supplies oxygen and other nutrients to the heart. The left coronary artery supplies oxygen and other nutrients to the heart. The coronary artery branches supply oxygen and other nutrients to the heart. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-5 Describe the role of the coronary arteries in supplying the myocardium with oxygen.

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20) A client suffers a myocardial infarction of the right atrium. The nurse notices that the client is in an irregular heart rhythm. From this information, the nurse infers there is a disturbance of which node of the cardiac conduction system? 1. Internodal pathway 2. Sinoatrial (SA) node 3. Atrioventricular (AV) node 4. Bundle of His Answer: 2 Explanation: The SA node is located in the tissue of the wall of the right atrium. Its function can be impaired after a right atrial infarction. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 28-6 Illustrate the flow of electrical impulses through the normal heart. 21) A cardiovascular nurse is orienting a new nurse to the unit. The new nurse questions the steps of the normal cardiac conduction system. The senior nurse explains that action potentials in the myocardium follow which sequence? 1. Sinoatrial (SA) node, internodal pathway, atrioventricular (AV) node, bundle of His, and Purkinje fibers 2. Internodal pathway, sinoatrial (SA) node, atrioventricular (AV) node, and Purkinje fibers 3. Atrioventricular (AV) node, sinoatrial (SA) node, bundle of His, and internodal pathway 4. Purkinje fibers, bundle of His, atrioventricular (AV) node, internodal pathway, and sinoatrial (SA) node Answer: 1 Explanation: This is the normal conduction pathway through the myocardium. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 28-6 Illustrate the flow of electrical impulses through the normal heart.

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22) A client has a heart rate of 78 beats/min. Which node is most likely to produce this heart rate? 1. Atrioventricular (AV) node 2. Internodal pathway 3. Sinoatrial (SA) node 4. Purkinje fibers Answer: 3 Explanation: The SA node generates a new action potential approximately 75 times per minute. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 28-6 Illustrate the flow of electrical impulses through the normal heart. 23) The nurse knows that the SA node generates a new action potential approximately times per minute under resting conditions. Record your answer rounding to the nearest whole number. Answer: 75 Explanation: The SA node generates a new action potential approximately 75 times per minute under resting conditions. This is known as a normal sinus rhythm. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-6 Illustrate the flow of electrical impulses through the normal heart.

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24) A nurse is reading a client's medical record and notes that the client's cardiac output (CO) is listed as 5 L/min. Which calculation was used to determine the CO? 1. Heart rate (beats/min) / stroke volume (mL/beat). 2. Systolic blood pressure × heart rate (beats/min). 3. Systolic blood pressure – diastolic blood pressure. 4. Stroke volume (mL/beat) × heart rate (beats/min). Answer: 4 Explanation: CO = stroke volume (mL/beat) × heart rate (beats/min). Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 28-7 Explain the major factors affecting cardiac output. 25) A nurse is preparing to administer a medication known to increase preload. Which is the expected outcome for this client? 1. A reduced stroke volume 2. An increase in cardiac output 3. Decreased venous return to the heart 4. Increased resistance against the left ventricle Answer: 2 Explanation: Drugs that increase preload generally increase cardiac output. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 28-7 Explain the major factors affecting cardiac output.

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26) A client has severe atherosclerosis and hypertension. Which statement about cardiac output will be true? 1. Afterload will be low. 2. Cardiac output will be unaffected. 3. Cardiac output will be low. 4. Preload will be high. Answer: 3 Explanation: Cardiac output likely will be low in the face of elevated afterload. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 28-7 Explain the major factors affecting cardiac output. 27) The nurse is caring for a client with a stroke volume of 54 mL/beat and a heart rate of 72 beats/min. The nurse calculates that the client's cardiac output is _ L/min. Record your answer rounding to the nearest whole number. Answer: 3.9 Explanation: A client's cardiac output is calculated by stroke volume × heart rate. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 28-7 Explain the major factors affecting cardiac output.

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28) The nurse asks a group of nursing students to name examples of positive inotropic agents. The nurse knows the students understand this concept when they name which agents? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Epinephrine 2. Norepinephrine 3. Dopamine 4. Quinidine 5. Propranolol Answer: 1, 2, 3 Explanation: Epinephrine is an example of a positive inotropic agent. Norepinephrine is an example of a positive inotropic agent. Dopamine is an example of a positive inotropic agent. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-7 Explain the major factors affecting cardiac output. 29) A client recently diagnosed with hypertension asks the nurse, "What did it mean when the doctor told me I have peripheral resistance?" Which response by the nurse is the most appropriate? 1. "The friction that the blood encounters in the arteries is called peripheral resistance." 2. "The resistance in the veins of your arms and legs is called peripheral resistance." 3. "It is the resistance on the heart by the pulmonary artery." 4. "I will ask the healthcare provider to come back and explain it to you." Answer: 1 Explanation: Peripheral resistance is defined as the friction that the blood encounters in the arteries. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 28-8 Explain the effects of cardiac output, peripheral resistance, and blood volume on hemodynamics.

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30) A nurse is preparing to administer a medication that will cause constriction of the arteries. The nurse expects that which vital sign parameter will be monitored most closely after administration of this medication? 1. Respiratory rate 2. Blood pressure 3. Temperature 4. Pulse rate Answer: 2 Explanation: If arteries constrict, their inside diameter will become smaller, and create more resistance and higher blood pressure. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 28-8 Explain the effects of cardiac output, peripheral resistance, and blood volume on hemodynamics. 31) A dehydrated client quickly receives a liter of intravenous fluid infusion to increase circulating blood volume. The nurse would expect which changes in the client's vital signs? 1. A decrease in respiratory rate from 20 to 12 breaths/min 2. A blood pressure decrease from 180/100 to 90/60 mmHg 3. A pulse increase from 75 to 120 beats/min 4. A blood pressure increase from 90/60 to 120/78 mmHg Answer: 4 Explanation: Infusion of intravenous fluids quickly increases blood volume and raises blood pressure. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 28-8 Explain the effects of cardiac output, peripheral resistance, and blood volume on hemodynamics.

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32) The nurse educator is teaching a group of students about factors that regulate arterial blood pressure. The educator knows the students have understood the lesson when they are able to name factors that regulate arterial blood pressure. Record your answer rounding to the nearest whole number. Answer: 3 Explanation: Three factors regulate arterial blood pressure: cardiac output, peripheral resistance, and blood volume. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-8 Explain the effects of cardiac output, peripheral resistance, and blood volume on hemodynamics. 33) The vasomotor center of the brain raises or lowers blood pressure based on information from which items? 1. Baroreceptors and chemoreceptors 2. Anterior and posterior pituitary 3. Adrenal medulla and adrenal cortex 4. Medulla oblongata and chemoreceptor trigger zone Answer: 1 Explanation: The vasomotor center reacts to information from baroreceptors and chemoreceptors. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-9 Discuss how the vasomotor center, baroreceptors, chemoreceptors, and hormones regulate blood pressure.

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34) A client with an exacerbation of heart failure is experiencing fluid volume overload. The nurse understands that which regulator of blood pressure will most likely be secreted during this exacerbation? 1. Renin 2. Atrial natriuretic peptide (ANP) 3. Antidiuretic hormone (ADH) 4. Aldosterone Answer: 2 Explanation: ANP is secreted by specialized cells in the right atrium when large increases in blood volume produce excessive stretch on the atrial wall. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 28-9 Discuss how the vasomotor center, baroreceptors, chemoreceptors, and hormones regulate blood pressure. 35) The nurse knows that which items are recognized by chemoreceptors in the large vessels as a regulatory mechanism of blood pressure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Pressure 2. Oxygen 3. Carbon dioxide 4. pH 5. Water Answer: 2, 3, 4 Explanation: Oxygen in the large vessels is detected by chemoreceptors in the regulation of blood pressure. Carbon dioxide in the large vessels is detected by chemoreceptors in the regulation of blood pressure. pH in the large vessels is detected by chemoreceptors in the regulation of blood pressure. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-9 Discuss how the vasomotor center, baroreceptors, chemoreceptors, and hormones regulate blood pressure.

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36) The nurse knows that which hormones play a role in regulating blood pressure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Estrogen 2. Antidiuretic hormone (ADH) 3. Testosterone 4. Renin 5. Atrial natriuretic peptide (ANP) Answer: 2, 4, 5 Explanation: Antidiuretic hormone (ADH) plays an important role in regulating blood pressure. ADH, also known as vasopressin, is a potent peripheral vasoconstrictor that quickly increases blood pressure. The renin-angiotensin-aldosterone system (RAAS) plays an important role in regulating blood pressure. As blood pressure falls, the enzyme renin is released by the kidneys. Through a two-step pathway, angiotensin II is formed, which subsequently increases CO and constricts arterioles to return blood pressure to original levels. Atrial natriuretic peptide (ANP) plays an important role in regulating blood pressure. ANP has multiple effects, all of which attempt to return blood pressure to original levels. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-9 Discuss how the vasomotor center, baroreceptors, chemoreceptors, and hormones regulate blood pressure.

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37) A nurse administers an IV antihypertensive medication, causing an immediate reduction in blood pressure. The baroreceptors respond by attempting to return blood pressure back to normal by accelerating the heart rate. Which term will the nurse use when documenting this phenomenon? 1. Reflex tachycardia 2. Ventricular tachycardia 3. Reentry tachycardia 4. Supraventricular tachycardia Answer: 1 Explanation: Reflex tachycardia is an accelerated heart rate in response to a sudden drop in blood pressure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 28-9 Discuss how the vasomotor center, baroreceptors, chemoreceptors, and hormones regulate blood pressure. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 29 Pharmacotherapy of Hyperlipidemia 1) The nurse is caring for a client diagnosed with coronary artery disease. When examining the results of laboratory tests, the nurse notes that which findings are consistent with this diagnosis? 1. Decreased total serum cholesterol and LDL, and elevated HDL 2. Elevated total serum cholesterol, LDL, and HDL 3. Elevated total serum cholesterol and LDL, and decreased HDL 4. Decreased total serum cholesterol, LDL, and HDL Answer: 3 Explanation: Elevated total serum cholesterol is consistent with coronary artery disease. Increased LDL is consistent with coronary artery disease because LDL reflects the amount of cholesterol that is being transported from the liver to peripheral tissue. A decrease in HDL is consistent with coronary artery disease because this value reflects how much cholesterol is being carried from the peripheral tissue to the liver for metabolism and excretion. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 29-1 Summarize the link between high blood cholesterol, low-density lipoprotein levels, and atherosclerosis. 2) The nurse is teaching a client about reducing the risk for coronary artery disease. An elevation in which laboratory value is most directly associated with atherosclerosis, leading to coronary artery disease? 531

1. Total cholesterol 2. Very low-density lipoprotein (VLDL) 3. Low-density lipoprotein (LDL) 4. High-density lipoprotein (HDL) Answer: 3 Explanation: The strength of the association between LDL cholesterol and atherosclerosis is demonstrated by the direct relationship between reduction in LDL cholesterol and acute coronary syndrome risk. LDL cholesterol contains lipoprotein (a), which is highly associated with atherosclerotic plaque. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 29-1 Summarize the link between high blood cholesterol, low-density lipoprotein levels, and atherosclerosis. 3) An elevation in low-density lipoprotein (LDL) most likely would be related to which comorbid condition? 1. Diabetes mellitus 2. Renal insufficiency 3. Iron deficiency anemia 4. Hyperthyroidism Answer: 1 Explanation: Clients with diabetes mellitus require more aggressive therapy to reduce the risk of atherosclerosis. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 29-1 Summarize the link between high blood cholesterol, low-density lipoprotein levels, and atherosclerosis. 4) The nurse is teaching a community group about the role that cholesterol plays in the development of high blood pressure and atherosclerosis. To decrease this risk, the nurse recommends that clients maintain a total cholesterol level of less than mg/dL. Record your answer rounding to the nearest whole number. Answer: 200 Explanation: It is recommended that the total cholesterol level be less than 200 mg/dL. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and 532

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5) The nurse is evaluating a client's response to teaching about managing dyslipidemia. Which statement by this client indicates that additional teaching is needed? 1. "I will read labels carefully so my daily cholesterol intake is no more than 200 mg." 2. "I will include several servings of soybeans in what I eat each week, since they provide lecithin." 3. "I will switch to using olive oil for cooking." 4. "I will decrease my intake of both cholesterol and saturated fat." Answer: 2 Explanation: Once promoted as a natural treatment for high cholesterol levels, controlled studies have not shown lecithin (which is found in soybeans) to be of benefit for high cholesterol. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 29-2 Explain the different types of lipids and how they are transported through the body. 6) The nurse is reviewing a client's laboratory results. Which finding is of most concern? 1. HDL cholesterol 62 mg/dL 2. Triglycerides 349 mg/dL 3. LDL cholesterol 92 mg/dL 4. Total cholesterol 202 mg/dL Answer: 2 Explanation: This value indicates that the client has a very high risk for coronary artery disease. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 29-2 Explain the different types of lipids and how they are transported through the body.

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7) A nurse educator is reviewing the different types of lipids with a group of nursing students. The educator is discussing the importance of triglycerides and states that triglycerides account for % of the total lipids in the body. Record your answer rounding to the nearest whole number. Answer: 90 Explanation: Triglycerides account for 90% of the total lipids in the body. Triglycerides are the major storage form of fat in the body and the only type of lipid that serves as an important energy source. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 29-2 Explain the different types of lipids and how they are transported through the body. 8) A nursing student is preparing a presentation on the different types of lipids. The student will include which classification of lipids in the presentation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Triglycerides 2. Phospholipids 3. Steroids 4. Lecithins 5. Bile acids Answer: 1, 2, 3 Explanation: Triglycerides are the most common classifications of lipids. Phospholipids are a class of lipids essential to building plasma membranes. Steroids are a diverse classification of lipids. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 29-2 Explain the different types of lipids and how they are transported through the body.

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9) Cholesterol, triglycerides, and phospholipids travel between the liver and peripheral tissues through which mechanism? 1. Bound to apoproteins 2. As unbound free molecules 3. Bound to albumin 4. Bound separately in molecule complexes Answer: 1 Explanation: Apoproteins are specific for cholesterol, triglycerides, and phospholipids, and they act as carrier molecules for transporting these lipids through the blood. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 29-3 Illustrate how lipids are transported through the blood. 10) A student is discussing lipid transport through the blood with a nursing instructor. The student asks the educator which apoproteins are important to lipid transport. Which responses by the educator are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A-I 2. A-II 3. A-III 4. A-IV 5. B-100 Answer: 1, 2, 4, 5 Explanation: A-I is an apoprotein important to lipid transport. A-II is an apoprotein important to lipid transport. A-IV is an apoprotein important to lipid transport. B-100 is an apoprotein important to lipid transport. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 29-3 Illustrate how lipids are transported through the blood.

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11) The nurse is teaching a client with elevated LDL cholesterol and decreased HDL cholesterol about strategies to manage this disorder. The client asks the nurse why there is a difference in the direction of change in the goals for altering HDL versus LDL cholesterol. Which response by the nurse is the most appropriate? 1. "It is most important to increase HDL cholesterol, and if we can reduce LDL cholesterol also, that might be of some help." 2. "We want to reduce HDL cholesterol and increase LDL cholesterol because these changes will protect you against atherosclerosis." 3. "We want to increase HDL cholesterol, which helps rid the body of excess cholesterol, and to decrease LDL cholesterol, which carries excess cholesterol to the body tissue to be stored." 4. "I think you have misunderstood what I have told you, since we want both values to be reduced." Answer: 3 Explanation: An elevation in HDL cholesterol and a decrease in LDL cholesterol maintain an optimal balance between storage of cholesterol in tissues and removal of cholesterol by the liver. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 29-4 Compare and contrast the clinical importance of the different types of lipoproteins. 12) The nurse is teaching a client who has been prescribed medication to manage HDL cholesterol. Which statement by the client indicates that the teaching has been understood? 1. "Treatment of HDL cholesterol will also decrease my LDL cholesterol level." 2. "Treatment of HDL cholesterol will also raise my LDL cholesterol level." 3. "If I can increase my HDL level, I will be less likely to have a heart attack." 4. "If I can decrease my HDL level, I will be less likely to have a heart attack." Answer: 3 Explanation: An increase of HDL cholesterol has the strongest association with a reduced risk of acute coronary syndromes. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 29-4 Compare and contrast the clinical importance of the different types of lipoproteins.

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13) An adult client is 75 lb over the ideal weight, eats a diet high in carbohydrates, and drinks three to four alcoholic beverages daily. Which pattern of dyslipidemia most likely fits all the findings and behaviors demonstrated by this client? 1. Elevated VLDL, triglycerides, and cholesterol; glucose intolerance 2. Elevated chylomicrons, normal cholesterol, triglycerides more than three times normal 3. Elevated LDL, VLDL, total cholesterol, chylomicrons; triglycerides more than three times normal 4. Elevated LDL and total cholesterol, normal VLDL and triglycerides Answer: 1 Explanation: These alterations represent endogenous dyslipidemia (Type IV), which is common in middle-aged adults and associated with obesity and with high alcohol and carbohydrate intake. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 29-4 Compare and contrast the clinical importance of the different types of lipoproteins. 14) A nursing instructor explains to a group of students that LDL is often called "bad" cholesterol because this lipoprotein contributes significantly to plaque deposits and coronary artery disease (CAD). The instructor asks the students what percentage of cholesterol is circulating in LDLs. The correct range is 60 to %. Record your answer rounding to the nearest whole number. Answer: 70 Explanation: Of the cholesterol circulating in the blood, 60 to 70% is found in LDLs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 29-4 Compare and contrast the clinical importance of the different types of lipoproteins.

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15) The nurse planning care for a client newly diagnosed with slightly elevated serum cholesterol, triglycerides, and LDL initiates a dietary consult for which reason? 1. This particular pattern of dyslipidemia is not amenable to pharmacologic agents. 2. Nonpharmacologic approaches to dyslipidemia should be initiated before pharmacologic agents are prescribed. 3. These levels are sufficiently elevated that pharmacologic intervention alone is unlikely to be successful. 4. Dietary modifications can be useful for lipid disorders, but only as an adjunct intervention after pharmacologic therapy for clients has been initiated. Answer: 2 Explanation: The alterations in laboratory values for this client are in the range of slightly elevated, and pharmacologic agents for lipid disorders carry a risk of adverse effects and potential adverse drug interactions. Therefore, nonpharmacologic approaches should be used before initiating drug therapy. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 29-5 Give examples of how cholesterol and low-density lipoprotein levels can be controlled with nonpharmacologic means. 16) The nurse is teaching a client with a lipid disorder about dietary modifications to manage the condition. Which statement by the client indicates an appropriate understanding of the rationale underlying a recommendation to increase the intake of plant sterols? 1. "I will eat oatmeal or cold oat cereal for breakfast every morning." 2. "I will try to increase the amount of lettuce I eat." 3. "I will snack on toasted pumpkin seeds." 4. "If I eat enough spinach and other green vegetables, I can stop taking my cholesterol-lowering medicine." Answer: 1 Explanation: Oats are a recommended source of plant sterols. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 29-5 Give examples of how cholesterol and low-density lipoprotein levels can be controlled with nonpharmacologic means.

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17) Which goal is appropriate for a person attempting to control cholesterol and low-density lipoprotein levels? 1. Limit cholesterol intake to less than 200 mg daily. 2. Limit saturated fat intake to less than 15% of total calories. 3. Limit dietary fat to less than 50% of total calories. 4. Increase plant sterol intake to 1 to 2 grams daily. Answer: 1 Explanation: Cholesterol intake should be less than 200 mg daily. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 29-5 Give examples of how cholesterol and low-density lipoprotein levels can be controlled with nonpharmacologic means. 18) The nurse is teaching a client regarding therapeutic lifestyle changes that can be implemented to control cholesterol levels in the blood. Which statements made by the client indicate an appropriate understanding of the teaching session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I will maintain an optimal weight." 2. "I will implement a medically supervised exercise plan." 3. "I will increase intake of dietary saturated fats and cholesterol." 4. "I will decrease soluble fiber in my diet." 5. "I will eliminate tobacco use." Answer: 1, 2, 5 Explanation: Maintaining an optimal weight is a nonpharmacologic therapeutic lifestyle change that can help control cholesterol levels in the blood. Following a medically supervised exercise plan is a nonpharmacologic therapeutic lifestyle change that can help control cholesterol levels in the blood. Eliminating tobacco use is a nonpharmacologic therapeutic lifestyle change that can help decrease cholesterol levels in the blood. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 29-5 Give examples of how cholesterol and low-density lipoprotein levels can be controlled with nonpharmacologic means. 19) The nurse is providing teaching to a client who has been placed on oral cholestyramine for management of a lipid disorder. Which statement by this client indicates the need for further 540

teaching about this drug? 1. "I should take my warfarin at least 1 hour before I take my cholestyramine." 2. "Before I take this medicine, I should mix it in 2 ounces of water, then add another 2 to 4 ounces before I swallow it." 3. "I should stop taking a daily multivitamin pill." 4. "I should keep all appointments for monitoring my warfarin therapy, since I might need to decrease the dose of this drug." Answer: 4 Explanation: The interaction between cholestyramine and warfarin produces an increased risk of bleeding by lowering vitamin K levels, so the dose of warfarin the client is taking might need to be lowered. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 29-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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20) Which statement indicates that a client understands teaching about atorvastatin (Lipitor)? 1. "I should always take this drug on an empty stomach." 2. "I should stop taking this drug if I decide to try to become pregnant." 3. "I might have to increase my dose of digoxin." 4. "I should take this drug with breakfast." Answer: 2 Explanation: Atorvastatin is a pregnancy category X drug, and should be avoided by women of childbearing age who might become pregnant. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 29-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 21) A client who takes atorvastatin (Lipitor) daily has been prescribed erythromycin for sinusitis. To prevent consequences of an adverse effect of this combination of drugs, it is most important for the nurse to monitor this client for which clinical manifestation? 1. Lack of expected response to erythromycin 2. New onset of muscle pain 3. Abdominal pain and cramping 4. Bleeding from the oral cavity and bruising Answer: 2 Explanation: Muscle pain may be a sign of rhabdomyolysis, which is a life-threatening condition. The risk of rhabdomyolysis is increased for clients taking a macrolide drug such as erythromycin, because macrolides significantly increase blood levels of atorvastatin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 29-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 542

22) The nurse is reviewing the adverse effects associated with statins with a client who is prescribed this classification of medication to reduce blood cholesterol levels. The nurse knows the client has understood the teaching when the client states which serious adverse effects associated with statins? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Headache 2. Abdominal pain 3. Myopathy 4. Muscle or joint pain 5. Rhabdomyolysis Answer: 3, 5 Explanation: Severe myopathy is a rare but serious adverse effect associated with statins. Rhabdomyolysis is an example of a rare but serious adverse effect associated with statins. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 29-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 23) Niacin and aspirin have been prescribed for a client diagnosed with hyperlipidemia. Which statement regarding why this drug combination is prescribed is the most accurate? 1. "A common side effect of niacin therapy is joint pain." 2. "Taking niacin and aspirin together increases the therapeutic effect of niacin." 3. "Aspirin can decrease discomfort associated with niacin therapy." 4. "Severe headaches are common during the early weeks of niacin therapy." Answer: 3 Explanation: One aspirin tablet administered 30 minutes before a dose of niacin might minimize the frequent side effect of flushing associated with niacin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 29-6 Categorize antihyperlipidemic drugs based on their classification and mechanism of action. 543

24) The nurse educator is teaching a group of students about HMG-CoA reductase medications. The nurse knows the students understood the lesson when they state which drugs as examples of this classification? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Lipitor 2. Lescol 3. Questran 4. Mevacor 5. Welchol Answer: 1, 2, 4 Explanation: Lipitor is an example of an HMG-CoA reductase medication and would indicate that the students understood the lesson. Lescol is an example of an HMG-CoA reductase medication and would indicate that the students understood the lesson. Mevacor is an example of an HMG-CoA reductase medication and would indicate that the students understood the lesson. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 29-6 Categorize antihyperlipidemic drugs based on their classification and mechanism of action.

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25) A seasoned nurse is reviewing the different classifications of medications that are used to decrease blood cholesterol levels with a new nurse on a medical–surgical unit. The seasoned nurse knows the new nurse has comprehended the information when she states which medications as fibric acid agents? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Atromid-S 2. Zetia 3. Lopid 4. Colestid 5. Zocor Answer: 1, 3 Explanation: Atromid-S is a fibric acid agent used to decrease blood cholesterol levels. Lopid is a fibric acid agent used to decrease blood cholesterol levels. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 29-6 Categorize antihyperlipidemic drugs based on their classification and mechanism of action. 26) The nurse is caring for a client taking both gemfibrozil (Lopid) and warfarin (Coumadin). To maintain safety relative to the interaction of these drugs, the nurse should monitor the client closely for which clinical manifestation? 1. Myolysis 2. Clot formation 3. Bleeding 4. Hyperlipidemia Answer: 3 Explanation: The client is at increased risk for bleeding because gemfibrozil competes with warfarin for plasma protein receptors, with the consequence of increasing the anticoagulant effect of an increased amount of free warfarin. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: VI.1 Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education and licensure requirements) | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 29-7 Explain the nurse's role in the safe administration of drugs for lipid disorders.

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27) The nurse is assigned to care for a client who is prescribed cholestyramine (Questran). To maintain safety for this client relative to the potential effects of this drug, the nurse should monitor which laboratory test? 1. Serum glucose 2. Serum transaminases 3. Neutrophil count 4. Serum potassium level Answer: 2 Explanation: Unlike statin drugs, bile acid sequestrants do not carry a risk of hepatic injury. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: VI.1 Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education and licensure requirements) | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 29-7 Explain the nurse's role in the safe administration of drugs for lipid disorders. 28) A client taking gemfibrozil (Lopid) and rosuvastatin (Crestor) reports muscle and joint pain. The nurse's response is based on an interpretation that this complaint might indicate which manifestation? 1. Hepatic injury 2. Peripheral neuropathy 3. Myopathy 4. An inflammatory response Answer: 3 Explanation: The risk of myopathy is increased in clients taking both a fibrate and a statin drug for hyperlipidemia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: VI.1 Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education and licensure requirements) | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 29-7 Explain the nurse's role in the safe administration of drugs for lipid disorders.

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29) The nurse is preparing to discharge a client from a medical–surgical unit. The client is going home on niacin therapy to decrease blood cholesterol levels. In educating the client on medication safety, the nurse should instruct the client to report which adverse effects to the healthcare provider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Nausea 2. Vomiting 3. Stomach pain 4. Joint pain 5. Jaundice Answer: 3, 4, 5 Explanation: Stomach pain is an adverse effect that should be reported to the healthcare provider when a client is taking niacin for the reduction of blood cholesterol levels. Joint pain is an adverse effect that should be reported to the healthcare provider when a client is taking niacin for the reduction of blood cholesterol levels. Jaundice is an adverse effect that should be reported to the healthcare provider when a client is taking niacin for the reduction of blood cholesterol levels. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: VI.1 Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e. scope of discipline, education and licensure requirements) | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 29-7 Explain the nurse's role in the safe administration of drugs for lipid disorders.

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30) Which statement indicates that a client has understood instructions about cholestyramine? 1. "I will take this drug when I wake up in the morning." 2. "I should take this drug at least 1 hour before taking any other drugs." 3. "I will drink plenty of fluids while I am taking this drug." 4. "I should report to my doctor any increase in swelling of my ankles." Answer: 3 Explanation: An adequate fluid intake is necessary to prevent constipation in clients taking cholestyramine. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 29-9 Apply the nursing process to care for patients receiving pharmacotherapy for lipid disorders. 31) A nurse is evaluating outcomes of teaching for a client with a new prescription for atorvastatin (Lipitor). Which response indicates that the client has understood teaching about this drug? 1. "I will avoid taking this drug with meals." 2. "I might need to increase my dose of digoxin while I am taking this drug." 3. "I will stop taking this drug if I am trying to get pregnant." 4. "I should always take this drug right before breakfast." Answer: 3 Explanation: Atorvastatin is a pregnancy category X drug, and should be avoided by women of childbearing age who might become pregnant. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 29-9 Apply the nursing process to care for patients receiving pharmacotherapy for lipid disorders.

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32) A client is being discharged after a hospital admission for chest pain with a multidrug regimen that includes a new prescription for cholestyramine (Questran). Which information is the most important for the nurse to include in discharge teaching about this drug? 1. "You must carefully follow instructions for mixing this drug with liquid." 2. "If you experience bloating or constipation, you should stop taking this drug." 3. "We will monitor your kidney function while you are taking this drug." 4. "Do not take vitamin supplements while taking cholestyramine." Answer: 1 Explanation: Failure to mix the powdered form of this drug adequately can cause gastrointestinal tract obstruction. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 29-9 Apply the nursing process to care for patients receiving pharmacotherapy for lipid disorders.

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33) The nurse is planning care for a client who is receiving drug therapy for a lipid disorder. What outcomes depict that the client is experiencing the therapeutic effects of the medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Lowered total cholesterol 2. Lowered LDL 3. Increased HDL 4. Elevated liver enzymes 5. Decreased BUN and creatinine Answer: 1, 2, 3 Explanation: A lowered total cholesterol level is an expected therapeutic effect to receiving drug therapy for lipid disorders. A lowered LDL cholesterol level is an expected therapeutic effect to receiving drug therapy for lipid disorders. An increase in HDL cholesterol level is an expected therapeutic effect to receiving drug therapy for lipid disorders. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 29-9 Apply the nursing process to care for patients receiving pharmacotherapy for lipid disorders. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 30 Pharmacotherapy with Calcium Channel Blockers 1) The nurse is teaching a client about the role of calcium in hypertension, and explains that a high concentration of calcium in arterial smooth muscle cells leads to which clinical manifestation? 1. Elevated blood pressure 2. Hypercalcemia 3. Decreased blood pressure 4. Hypocalcemia Answer: 1 Explanation: Blood pressure is increased by the increase in contractility of vascular smooth muscle when intracellular calcium is increased. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 30-1 Describe the role of calcium ions in the contraction of smooth and 550

cardiac muscle.

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2) A nursing instructor is explaining the role of calcium in the contraction of the cardiac muscle. The instructor asks the students to state, in order, the events that allow the cardiac muscle to contract. Response 1. An action potential occurs. Response 2. Depolarization occurs. Response 3. Voltage-gated channels in the sarcolemma open. Response 4. Ions enter and leave the muscle cell. Response 5. Muscle contraction occurs. Answer: 1, 2, 3, 4, 5 Explanation: 1. An action potential is the first step that must occur for the cardiac muscle to contract. 2. Depolarization is the second step that must occur for the cardiac muscle to contract. 3. The third step that occurs in the contraction of the cardiac muscle is the opening of the voltage-gated channels in the sarcolemma. 4. The fourth step that occurs in the contraction of the cardiac muscle is ions entering and leaving the muscle cell. 5. The last step that occurs is the actual contraction of the cardiac muscle. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 30-1 Describe the role of calcium ions in the contraction of smooth and cardiac muscle.

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3) The nurse preparing to administer both a calcium channel blocker and a beta1-adrenergic blocker to a client with hypertension plans to monitor the client's response based on which understanding of these drugs? 1. They promote calcium influx into vascular smooth muscle. 2. They block sympathetic impulses in sarcolemma membranes. 3. They prevent calcium influx into vascular smooth muscle. 4. They promote urinary excretion of sodium. Answer: 3 Explanation: Beta1-adrenergic blockers cause calcium ion channels to close by preventing sympathetic stimulation of membrane depolarization, and calcium channel blockers cause a change in calcium channel shape that prevents calcium influx into smooth muscle cells. Both mechanisms of drug action decrease intracellular calcium and prevent vascular smooth muscle contraction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 30-2 Explain why the actions of the beta1-adrenergic antagonists are similar to those of the calcium channel blockers. 4) The nurse is preparing to administer medications, including verapamil (Verelan), a calcium channel blocker, and metoprolol (Lopressor), a beta1-adrenergic blocker, to a client with hypertension. An entry in the client's medical record indicates he has developed AV block. Which action by the nurse is the most appropriate? 1. Administer both metoprolol (Lopressor) and verapamil (Verelan). 2. Hold both metoprolol (Lopressor) and verapamil (Verelan), and notify the prescriber. 3. Hold metoprolol (Lopressor), administer verapamil (Verelan), and notify the prescriber. 4. Hold verapamil (Verelan), administer metoprolol (Lopressor), and notify the prescriber. Answer: 2 Explanation: Both drugs reduce conduction through the AV node and should be administered with caution to this client. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 30-2 Explain why the actions of the beta1-adrenergic antagonists are similar to those of the calcium channel blockers.

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5) A beta1-adrenergic antagonist drug has been added to the regimen of a client with angina pectoris who is taking amlodipine (Norvasc). The nurse identifies which assessment finding as representing a goal of therapy related to a common mechanism of action of both drugs? 1. Peripheral edema 2. Decreased blood pressure 3. Flushing 4. Constipation Answer: 2 Explanation: Both drugs have a therapeutic effect of decreasing calcium influx into vascular smooth muscle and lowering blood pressure. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 30-2 Explain why the actions of the beta1-adrenergic antagonists are similar to those of the calcium channel blockers. 6) A nurse educator is discussing how calcium channel blockers interact with the L-type calcium channel. The educator knows the students have understood the discussion when they state that L-type calcium channels are located where? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The cardiovascular system 2. Neurons 3. Endocrine cells 4. Sensory cells 5. The gastrointestinal system Answer: 1, 2, 3, 4 Explanation: L-type calcium channels are widespread in the cardiovascular system. L-type calcium channels are located in neurons. L-type calcium channels are located in endocrine cells. L-type calcium channels are located in sensory cells. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 30-3 Describe how calcium channel blockers interact with the L-type calcium channel.

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7) A calcium channel blocker has been prescribed for a client with hypertension. The nurse explains that this drug affects the function of the L-type calcium channel by which action? 1. Enhancing the action potential along the cell membrane 2. Changing the shape of the L-type calcium channel 3. Blocking sympathetic input to the cell membrane 4. Competing for calcium receptors on the L-type calcium channel Answer: 2 Explanation: By altering the shape of the calcium channel, calcium channel blockers prevent entry of calcium into cells. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 30-3 Describe how calcium channel blockers interact with the L-type calcium channel. 8) The nurse is assessing a client taking both verapamil and digoxin. Which finding indicates an adverse interaction of this drug combination? 1. Pulse rate 51 beats/min 2. Respiratory rate 42 breaths/min 3. Blood pressure 184/96 mmHg 4. Serum potassium 5.6 mEq/L Answer: 1 Explanation: Risk of bradycardia is greater with this drug combination, since both drugs slow conduction through the AV node. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 30-4 Identify the physiologic effects of calcium channel blockers on arterial smooth muscle and cardiac muscle.

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9) The nurse is reviewing the medication administration record of a patient beginning therapy with verapamil (Verelan) who also takes carbamazepine (Tegretol) to manage a seizure disorder. The nurse is concerned because this drug combination can result in an increased risk of which disorder? 1. Seizures 2. Confusion 3. Ataxia 4. Hypotension Answer: 3 Explanation: The interaction of these drugs causes an increase in serum concentration of carbamazepine (Tegretol) and could lead to falls associated with ataxia, which is an adverse effect of carbamazepine (Tegretol). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 30-4 Identify the physiologic effects of calcium channel blockers on arterial smooth muscle and cardiac muscle. 10) Most calcium channel blockers reduce the force of myocardial contractions. The nurse knows which drugs have this negative chronotropic effect at a therapeutic dose? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Verapamil 2. Diltiazem 3. Amlodipine 4. Felodipine 5. Nicardipine Answer: 1, 2 Explanation: Verapamil has a negative chronotropic effect on the myocardium at a therapeutic dose. Diltiazem has a negative chronotropic effect on the myocardium at a therapeutic dose. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 30-4 Identify the physiologic effects of calcium channel blockers on arterial smooth muscle and cardiac muscle.

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11) The nurse observes that a client admitted for orthopedic surgery also has a diagnosis of atrial fibrillation. Which drug can achieve a therapeutic effect relative to the client's diagnosis of atrial fibrillation? 1. Isradipine (DynaCirc) 2. Nifedipine (Procardia) 3. Nicardipine (Cardene) 4. Diltiazem (Cardizem) Answer: 4 Explanation: Diltiazem is a nondihydropyridine drug used to manage atrial fibrillation because it slows conduction through the SA node. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 30-5 Explain the classification of calcium channel blockers. 12) Calcium channel blockers are classified by their chemical structure. The nurse knows that which calcium channel blockers are dihydropyridines? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Amlodipine (Norvasc) 2. Felodipine (Plendil) 3. Nicardipine (Cardene) 4. Diltiazem (Cardizem) 5. Verapamil (Verelan, Calan) Answer: 1, 2, 3 Explanation: Amlodipine (Norvasc) is a dihydropyridine calcium channel blocker. Felodipine (Plendil) is a dihydropyridine calcium channel blocker. Nicardipine (Cardene) is a dihydropyridine calcium channel blocker. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 30-5 Explain the classification of calcium channel blockers.

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13) The nurse is explaining the effects of calcium channel blockers on the cardiovascular system to a client. The nurse is aware that all dihydropyridine calcium channel blockers are equivalent in effectiveness for treating which disorders? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Hypertension 2. Angina 3. Cerebrovascular disease 4. Deep vein thrombosis 5. Pulmonary embolism Answer: 1, 2 Explanation: All dihydropyridine calcium channel blockers are equivalent in effectiveness for treating hypertension. All dihydropyridine calcium channel blockers are equivalent in effectiveness for treating angina. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 30-5 Explain the classification of calcium channel blockers. 14) A client's history includes hypertension and chronic stable angina pectoris. Which drug can manage both conditions? 1. Felodipine (Plendil) 2. Nimodipine (Nimotop) 3. Amlodipine (Norvasc) 4. Nicardipine (Cardene) Answer: 3 Explanation: Amlodipine is approved to treat both hypertension and coronary artery disease. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 30-6 Compare and contrast the actions of dihydropyridine versus nondihydropyridine calcium channel blockers.

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15) Which drug can be used to treat cardiac dysrhythmias? 1. Nifedipine (Procardia) 2. Verapamil (Calan) 3. Nisoldipine (Nisocor) 4. Amlodipine (Norvasc) Answer: 2 Explanation: Verapamil is a nondihydropyridine drug that suppresses abnormal cardiac dysrhythmias. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 30-6 Compare and contrast the actions of dihydropyridine versus nondihydropyridine calcium channel blockers. 16) A client prescribed verapamil (Calan) to treat hypertension has gained 6 lb in the past 3 days and is complaining of shortness of breath, constipation, ankle swelling, flushing, and dizziness. The client has been switched from verapamil to nifedipine (Procardia). The nurse understands the rationale for this change is that nifedipine (Procardia) will not cause which adverse effect? 1. Flushing 2. Dizziness 3. Heart failure 4. Constipation Answer: 3 Explanation: Shortness of breath and dependent edema are symptoms and signs of possible heart failure. The cardiovascular effects of nifedipine (Procardia) are limited to vascular smooth muscle. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 30-6 Compare and contrast the actions of dihydropyridine versus nondihydropyridine calcium channel blockers.

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17) A client is prescribed verapamil to treat hypertension and chronic stable angina. Which assessment finding is of greatest concern relative to potential adverse effects of verapamil for this client? 1. Facial flushing 2. Respiratory rate 22 breaths/min 3. Pedal edema 1+ 4. Heart rate 132 beats/min Answer: 4 Explanation: This finding represents reflex tachycardia, a potential adverse effect of verapamil. Reflex tachycardia can lead to myocardial ischemia by increasing cardiac workload in a client with chronic stable angina. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 30-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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18) The nurse is caring for a client who is prescribed digoxin (Lanoxin) and diltiazem (Cardizem). The nurse recognizes which finding as representing an adverse interaction of this combination of drugs? 1. Peripheral edema 2. Headache 3. Hypertension 4. Bradycardia Answer: 4 Explanation: An adverse effect of the combination of diltiazem (Cardizem) and digoxin (Lanoxin) is a rise in serum digoxin concentration and risk of digoxin toxicity. Bradycardia is one sign of digoxin toxicity. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 30-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 19) The nurse advises a client taking nifedipine (Procardia) to avoid alcohol while taking this drug because this combination increases the risk of which adverse effect? 1. Liver damage 2. Peptic ulcer 3. Headache 4. Fainting Answer: 4 Explanation: The combination of alcohol and nifedipine (Procardia) could cause a sudden drop in blood pressure and fainting due to additive peripheral vasodilation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 30-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 561

20) The nurse is teaching a client about the prototype calcium channel blocker nifedipine. During the teaching session, the nurse tells the client he will begin to feel the effects of the extended release tablet in _ hours. Record your answer rounding to the nearest whole number. Answer: 6 Explanation: The onset of action for the prototype calcium channel blocker nifedipine is 6 hours. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 30-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 21) The nurse is preparing to administer an intravenous dose of verapamil (Calan) to a client. Prior to administering this drug, which action by the nurse is the most appropriate? 1. Ask the client to sit in a chair. 2. Obtain emergency resuscitation equipment. 3. Attach a pulse oximeter monitor. 4. Administer oxygen by nasal cannula. Answer: 2 Explanation: The client receiving IV verapamil might experience cardiac dysrhythmias and cardiac arrest. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 30-8 Apply the nursing process to care for patients receiving pharmacotherapy with calcium channel blockers.

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22) A client is prescribed verapamil (Calan) and simvastatin (Zocor). To detect a potential adverse effect of this drug combination, the nurse should instruct the client to call her healthcare provider if which adverse effect is experienced? 1. Tachycardia 2. Muscle pain 3. Dizziness 4. Headache Answer: 2 Explanation: Muscle pain might indicate myopathy, an adverse effect of simvastatin (Zocor), which is a statin drug. The risk of myopathy is increased when a client takes both a statin drug and verapamil (Calan). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 30-8 Apply the nursing process to care for patients receiving pharmacotherapy with calcium channel blockers. 23) The nurse is caring for a client who is admitted to the hospital following rupture of an intracranial aneurysm. Nimodipine (Nimotop) is prescribed. Which assessment is most significant based on an understanding of the therapeutic effect of this drug for this client? 1. Measure blood pressure every 4 hours. 2. Auscultate cardiac rate and rhythm. 3. Observe for dependent edema. 4. Conduct frequent neurologic checks. Answer: 4 Explanation: Nimodipine (Nimotop) is given to reduce brain cell injury following rupture of a brain aneurysm. Frequent monitoring of neurologic deficits is necessary to assess the therapeutic response to this drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 30-8 Apply the nursing process to care for patients receiving pharmacotherapy with calcium channel blockers.

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24) The nurse is caring for a client diagnosed with hypertension. The client is currently taking a calcium channel blocker. Which adverse reactions should the nurse monitor for while the client is taking this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Myalgia 2. Facial edema 3. Decreased angina 4. Increased blood pressure 5. Significant constipation Answer: 1, 2, 5 Explanation: Myalgia is an adverse effect of taking calcium channel blockers that must be reported immediately to the healthcare provider. Facial edema is an adverse effect of taking calcium channel blockers that must be reported immediately to the healthcare provider. Significant constipation is an adverse effect of taking calcium channel blockers that must be reported immediately to the healthcare provider. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 30-8 Apply the nursing process to care for patients receiving pharmacotherapy with calcium channel blockers. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 31 Drugs Affecting the Renin-Angiotensin-Aldosterone System 1) Which peptide circulating in the blood can cause profound vasoconstriction? 1. Fibrogen 2. Sodium 3. Kinase 4. Angiotensin II Answer: 4 Explanation: Angiotensin is a peptide that causes vasoconstriction. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-1 Illustrate the steps in the renin-angiotensin-aldosterone pathway. 564

2) Angiotensinogen is a protein that is continuously circulating in the bloodstream. Where is it synthesized in the body? 1. The lungs 2. The liver 3. The gallbladder 4. The kidneys Answer: 2 Explanation: The liver synthesizes the protein angiotensinogen. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-1 Illustrate the steps in the renin-angiotensin-aldosterone pathway.

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3) Which organ has the primary responsibility for converting angiotensin I to angiotensin II? 1. The lungs 2. The kidneys 3. The heart 4. The liver Answer: 1 Explanation: The lungs are responsible for the conversion of angiotensin I to angiotensin II because they possess a large number of capillaries. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-1 Illustrate the steps in the renin-angiotensin-aldosterone pathway. 4) The nurse knows there are key enzymatic steps in the renin-angiotensin-aldosterone system. Record your answer rounding to the nearest whole number. Answer: 2 Explanation: There are two key enzymatic steps in the renin-angiotensin-aldosterone system. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 31-1 Illustrate the steps in the renin-angiotensin-aldosterone pathway. 5) The secretion, storage, and synthesizing of renin are controlled in which cells of the kidney? 1. The distal loop 2. The baroreceptors 3. Henle's loop 4. The juxtaglomerular cells Answer: 4 Explanation: The juxtaglomerular (JG) cells are responsible for the secretion, storage, and synthesizing of renin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-2 Identify the primary physiologic factors that control renin secretion. 566

6) The kidneys respond to which occurrences in the body by releasing renin? 1. Lowered blood pressure; dehydration 2. Lowered blood pressure; decreased cardiac output 3. Increased blood pressure; increased peripheral resistance 4. Increased blood pressure; stress, anxiety Answer: 1 Explanation: Lowered blood pressure causes the kidney to release renin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-2 Identify the primary physiologic factors that control renin secretion. 7) Which group of cells in the kidneys makes up the apparatus that helps control renin secretion? 1. The red blood cells and slit pores 2. The nephron and Bowman's capsule 3. The juxtaglomerular (JG) cells and the macula densa 4. The tubular filtrate and the glomerulus Answer: 3 Explanation: The JG cells and the macula densa are the cells that help control renin secretion. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-2 Identify the primary physiologic factors that control renin secretion.

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8) The nurse knows that the secretion of renin is controlled by which items? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Juxtaglomerular (JG) cells 2. Macula densa 3. Sympathetic nervous system 4. Parasympathetic nervous system 5. Cardiovascular system Answer: 1, 2, 3 Explanation: Renin is an enzyme that is synthesized, stored, and secreted by specialized cells in the kidney known as juxtaglomerular (JG) cells. The macula densa recognizes a slow flow rate (and less sodium) and sends a chemical message to the JG cells to release more renin. The activation of the sympathetic nervous system controls the release of renin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 31-2 Identify the primary physiologic factors that control renin secretion. 9) The angiotensin-converting enzyme (ACE) converts angiotensin I almost instantly to which substance? 1. Angiotensin II 2. Aldosterone 3. Angiotensinogen 4. Renin Answer: 1 Explanation: ACE converts angiotensin I to angiotensin II. This happens almost immediately because ACE lies on the membranes of the blood vessels. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-3 Explain the two primary functions of angiotensin-converting enzyme.

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10) Angiotensin-converting enzyme (ACE) inhibitor drugs prevent ACE from breaking down which substances, resulting in some of the serious adverse effects of the ACE inhibitors? 1. Aldosterone 2. Bradykinin 3. Renin 4. RAAS Answer: 2 Explanation: ACE, with several other enzymes, breaks down bradykinin, which, if it accumulates, can cause cough and angioedema. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-3 Explain the two primary functions of angiotensin-converting enzyme. 11) The nurse is reviewing the primary functions of the angiotensin-converting enzyme (ACE). The nurse knows that which is the primary function of this enzyme? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Forming angiotensin I 2. Forming angiotensin II 3. Breaking down bradykinin 4. Breaking down histamine 5. Forming kininase Answer: 2, 3 Explanation: ACE is responsible for the formation of angiotensin II. ACE is responsible for breaking down bradykinin. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 31-3 Explain the two primary functions of angiotensin-converting enzyme.

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12) The arterioles of which organ are most sensitive to the vasopressin action of angiotensin II? 1. The lungs 2. The liver 3. The kidneys 4. The heart Answer: 3 Explanation: The arterioles of the kidneys are the most sensitive to the vasopressin action of angiotensin II. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-4 Describe multiple mechanisms by which angiotensin II raises blood pressure. 13) Which clinical manifestations occur as the result of the cardiac remodeling caused by angiotensin II? 1. Hypotrophy of myocyte cells 2. A breakdown of fatty plaque deposits 3. Hypotension and dehydration 4. Myocardial infarction and cerebrovascular accident Answer: 4 Explanation: Angiotensin II causes cardiac remodeling of hypertrophy of myocardial cells and promotes collagen deposits, which increase the risk of myocardial infarction and cerebrovascular accident. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-4 Describe multiple mechanisms by which angiotensin II raises blood pressure.

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14) A seasoned nurse is explaining the multiple mechanisms by which angiotensin II raises blood pressure to a novice nurse. What should the seasoned nurse include in the explanation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Direct vasoconstriction 2. Increased sympathetic nervous system activity 3. Cardiac remodeling 4. Direct effect on the kidneys 5. Direct increase on the reabsorption of sodium Answer: 1, 2, 3, 5 Explanation: Angiotensin II causes direct vasoconstriction, which increases blood pressure. Angiotensin II causes increased sympathetic nervous system activity, which increases blood pressure. Angiotensin II causes cardiac remodeling, which increases blood pressure. Angiotensin II increases the reabsorption of sodium, which increases blood pressure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 31-4 Describe multiple mechanisms by which angiotensin II raises blood pressure. 15) How do additional amounts of aldosterone secreted by the kidneys raise blood pressure? 1. By excreting sodium and chloride to retain water 2. By excreting potassium and hydrogen to retain water 3. By decreasing sodium absorption, which increases blood volume 4. By enhancing sodium reabsorption, which increases blood volume Answer: 4 Explanation: By enhancing sodium reabsorption, the body retains water, which increases blood volume and raises blood pressure. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-5 Explain how the actions of aldosterone can lead to high blood pressure.

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16) A nursing student asks the nurse educator why the actions of aldosterone lead to high blood pressure. Which of the educator's responses explain this phenomenon? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Aldosterone increases sodium reabsorption and the excretion of potassium and hydrogen by acting on the distal tubules." 2. "Aldosterone increases sodium reabsorption and the excretion of potassium and hydrogen by acting on the collecting tubules." 3. "Aldosterone increases sodium reabsorption and the excretion of potassium and hydrogen by acting on Bowman's capsule." 4. "Aldosterone increases sodium reabsorption and the excretion of potassium and hydrogen by acting on the glomerulus." 5. "Aldosterone increases sodium reabsorption and the excretion of potassium and hydrogen by acting on the loop of Henle." Answer: 1, 2 Explanation: Aldosterone acts on the distal tubules of the nephron to increase Na+ reabsorption and K+ and H+ excretion. The enhanced sodium reabsorption from both direct and indirect actions of angiotensin II causes the body to retain water, thus increasing blood volume and raising blood pressure. Aldosterone acts on the collecting tubules of the nephron to increase Na+ reabsorption and K+ and H+ excretion. The enhanced sodium reabsorption from both direct and indirect actions of angiotensin II causes the body to retain water, thus increasing blood volume and raising blood pressure. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 31-5 Explain how the actions of aldosterone can lead to high blood pressure.

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17) Angiotensin-converting enzyme (ACE) inhibitor drugs function in the control of blood pressure by which mechanism of action? 1. Blocking the effects of angiotensin II 2. Blocking the conversion of angiotensin I to angiotensin II 3. Blocking the conversion of angiotensin II to angiotensinogen 4. Directly inhibiting renin Answer: 2 Explanation: ACE inhibitors prevent conversion of angiotensin I to angiotensin II, which controls blood pressure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-6 Identify the specific steps in the renin-angiotensin-aldosterone system that can be blocked by medications. 18) Angiotensin receptor blockers (ARBs) work in the body to lower blood pressure by which mechanism of action? 1. Inhibiting the stimulation of aldosterone secretion 2. Blocking the conversion of angiotensin I to angiotensin II 3. Blocking AT1 receptors, which prevent angiotensin from raising blood pressure 4. Blocking the formation of renin in the RAAS system Answer: 3 Explanation: By blocking the AT1 receptors, the ARBs prevent angiotensin from raising blood pressure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-6 Identify the specific steps in the renin-angiotensin-aldosterone system that can be blocked by medications.

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19) Aldosterone antagonist drugs work to lower blood pressure by which mechanism of action? 1. Blocking the formation of renin in the RAAS pathway 2. Blocking receptors for aldosterone in the kidneys 3. Blocking receptors for aldosterone in the adrenal glands 4. Blocking the AT1 receptors in the RAAS pathway Answer: 2 Explanation: Aldosterone antagonists block aldosterone receptors in the kidneys, which lowers blood pressure. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-6 Identify the specific steps in the renin-angiotensin-aldosterone system that can be blocked by medications. 20) The nurse is reviewing a list of medications that decrease blood pressure. Which medications decrease blood pressure by blocking the receptors for aldosterone in the kidneys? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Benazepril (Lotensin) 2. Azilsartan (Edarbi) 3. Eplerenone (Inspra) 4. Aliskiren (Tekturna) 5. Spironolactone (Aldactone) Answer: 3, 5 Explanation: Eplerenone (Inspra) is an aldosterone antagonist. Spironolactone (Aldactone) is an aldosterone antagonist. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 31-6 Identify the specific steps in the renin-angiotensin-aldosterone system that can be blocked by medications.

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21) An adult client is prescribed lisinopril therapy for hypertension. Why is it important to rule out pregnancy prior to starting this medication? 1. Lisinopril is pregnancy category C and D. 2. Lisinopril can cause hyperkalemia in pregnant women. 3. Lisinopril is pregnancy category B. 4. Lisinopril can cause hypotension in late pregnancy. Answer: 1 Explanation: Lisinopril is pregnancy category C in the first trimester and category D in the second and third trimesters. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 22) Which are the most common adverse effects of lisinopril therapy? 1. Hypotension, cough, and rash 2. Rash, hypokalemia, and constipation 3. Hypertension, hypokalemia, and productive cough 4. Hypotension, hyperkalemia, and urinary frequency Answer: 1 Explanation: Lisinopril can cause hypotension, cough, and a rash. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 31-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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23) The major difference in adverse effect profile between ACE inhibitors and ARBs is that ARBs do not cause which clinical manifestation? 1. Headache 2. Dizziness 3. Angioedema 4. Cough Answer: 4 Explanation: Since ARBs do not promote accumulation of bradykinin, they do not cause a cough. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 24) A nurse educator is teaching a group of students about the prototype medication lisinopril. The nurse tells the students that hyperkalemia is a common adverse reaction that occurs in 2% to % of clients taking the medication. Record your answer rounding to the nearest whole number. Answer: 4 Explanation: Of the clients that are taking lisinopril, 2% to 4% often experience the adverse effect of hyperkalemia. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 31-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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25) The client is starting on lisinopril therapy for hypertension and heart failure. The nurse instructs the client to return for laboratory monitoring because of the risk of which adverse effect? 1. Hyperkalemia 2. Hyponatremia 3. Hypernatremia 4. Hypokalemia Answer: 1 Explanation: Lisinopril therapy can increase the risk of hyperkalemia because it is a potassium-sparing drug. Clients with heart failure are at higher risk. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-8 Apply the nursing process to care for patients receiving pharmacotherapy with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. 26) A client who is prescribed losartan for hypertension is instructed to avoid using alcohol because of the risk of which adverse reaction? 1. Alcohol intoxication 2. Angioedema 3. Lowered blood pressure 4. Increased blood pressure Answer: 3 Explanation: Combining alcohol with losartan causes lowered blood pressure, which can lead to dizziness and faintness. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-8 Apply the nursing process to care for patients receiving pharmacotherapy with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.

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27) The nurse is reviewing the diet history of a client prescribed lisinopril therapy for hypertension. Which part of the client's current dietary intake must be altered while on lisinopril therapy? 1. Use of fish oil supplements 2. Use of calcium supplements 3. Use of potassium supplements 4. Use of multiple vitamins Answer: 3 Explanation: Use of potassium supplements is contraindicated with lisinopril therapy because of the risk of hyperkalemia. Lisinopril is a potassium-sparing drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-8 Apply the nursing process to care for patients receiving pharmacotherapy with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.

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28) The nurse knows it is essential to monitor which laboratory values while a client is being treated with ACE inhibitors and ARBs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Electrolyte levels 2. Liver function 3. BUN and creatinine levels 4. Lipid profiles 5. ECG Answer: 1, 2, 4 Explanation: Electrolyte levels, especially potassium, need to be monitored while a client is taking ACE inhibitors. Liver function needs to be monitored while a client is taking ACE inhibitors and ARBs. It is important to monitor a client's lipid profile while taking ACE inhibitors and ARBs. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 31-8 Apply the nursing process to care for patients receiving pharmacotherapy with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 32 Diuretic Therapy and the Pharmacotherapy of Chronic Kidney Disease 1) A client has severe protein malnutrition and is taking a drug that is 99% bound to albumin. Which alteration of drug concentration in the urinary filtrate will occur? 1. An increase in the amount of drug actively secreted across the walls of the renal tubule 2. A decrease in the amount of drug reabsorbed across the walls of the renal tubule 3. An increase in the amount of drug filtered into Bowman's capsule 4. An increase in the amount of drug passively secreted across the walls of the renal tubule Answer: 3 Explanation: A decrease in albumin concentration increases the proportion of free drug in the plasma available to be filtered into Bowman's capsule. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 32-1 Explain the role of the urinary system in maintaining fluid, electrolyte, and acid–base homeostasis. 579

2) A client with cancer is secreting excessive amounts of antidiuretic hormone. The nurse will monitor the client for which consequence of excess antidiuretic hormone secretion? 1. Fluid volume excess 2. Hyperkalemia 3. Hypernatremia 4. Dehydration Answer: 1 Explanation: Antidiuretic hormone increases renal tubular permeability and water retention. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-1 Explain the role of the urinary system in maintaining fluid, electrolyte, and acid–base homeostasis.

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3) A client is diagnosed with chronic renal failure and is receiving hydrochlorothiazide (HCTZ). The nurse has taught the client about the importance of kidney function and evaluates that learning has occurred when the client makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The kidneys help my heart by balancing potassium." 2. "The kidneys help decrease infections by excreting bacteria." 3. "The kidneys keep blood pressure from getting too low." 4. "The kidneys balance the fluid and electrolytes in my body." 5. "The kidneys help regulate the oxygen levels in my blood." Answer: 1, 3, 4 Explanation: The kidneys are the primary organs for regulating potassium balance. The kidneys secrete renin, which helps to maintain blood pressure. The kidneys are the primary organs for regulating fluid and electrolyte balance. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 32-1 Explain the role of the urinary system in maintaining fluid, electrolyte, and acid–base homeostasis.

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4) The nurse is caring for a client who is experiencing acute renal failure. The nurse knows that this client may experience problems regulating which items? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fluid balance 2. Electrolyte composition 3. The pH of body fluids 4. Heart rate 5. Blood pressure Answer: 1, 2, 3, 5 Explanation: The kidneys are the primary organs for regulating fluid balance through filtration and urine output. The kidneys are the primary organs for regulating electrolyte composition through filtration and urine output. The kidneys are the primary organ for regulating the pH of body fluids through filtration and urine output. The kidneys play a role in regulating blood pressure through the secretion of renin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 32-1 Explain the role of the urinary system in maintaining fluid, electrolyte, and acid–base homeostasis. 5) The formation of urine begins at which structure? 1. Glomerulus 2. Ureter 3. Collecting duct 4. Henle's loop Answer: 1 Explanation: The glomerulus is the site where filtration and production of urine begin. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-2 Explain the physiologic processes that change the composition of filtrate as it travels through the nephrons.

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6) Which substances enter the filtrate by active secretion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Hydrogen 2. Potassium 3. Phosphate 4. Chloride 5. Sodium Answer: 1, 2, 3 Explanation: Hydrogen is pumped into filtrate by molecular pumps. Potassium is pumped into filtrate by molecular pumps. Phosphate is pumped into filtrate by molecular pumps. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 32-2 Explain the physiologic processes that change the composition of filtrate as it travels through the nephrons. 7) The nurse is reviewing results of a routine urinalysis that indicate the presence of protein in the urine. How does the nurse interpret this finding? 1. The client probably has kidney damage. 2. The results are probably insignificant if the amount of protein is very small. 3. There is likely a mistake with the results, and the client should have another test done. 4. The client is in acute renal failure and should be hospitalized. Answer: 1 Explanation: Protein is always an abnormal finding on urinalysis; it indicates damage to the glomerular membrane. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 32-2 Explain the physiologic processes that change the composition of filtrate as it travels through the nephrons.

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8) The nurse is caring for a client with chronic renal failure and is assessing the client's urine output for the shift. In calculating the expected urine output, the nurse knows that the body produces mL of urine per minute. Record your answer rounding to the nearest whole number. Answer: 1 Explanation: The kidneys produce approximately 1 mL of urine each minute. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 32-2 Explain the physiologic processes that change the composition of filtrate as it travels through the nephrons. 9) The nurse caring for a client with renal failure will question the use of a usual dose of which medication? 1. Digoxin (Lanoxin) 2. Cholestyramine (Questran) 3. Fluvastatin (Lescol) 4. Benzylpenicillin (penicillin G) Answer: 1 Explanation: Digoxin has a narrow therapeutic index and is renally excreted. The dose should be reduced. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-3 Explain how pharmacotherapy is modified in patients with chronic kidney disease.

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10) The nurse is managing care for a client diagnosed with acute renal failure. What does the nurse recognize as the most important safety precaution with regard to medication administration? 1. Review the client's medication regimen to identify any nephrotoxic drugs. 2. Ensure that the client's fluid intake and output are measured precisely. 3. Review the client's medication regimen to identify any drugs that increase fluid retention. 4. Plan to administer less-than-average doses of all medications prescribed for the client. Answer: 1 Explanation: Persons in acute renal failure are at significantly increased risk of injury from nephrotoxic drugs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 32-3 Explain how pharmacotherapy is modified in patients with chronic kidney disease. 11) The nurse caring for a client in renal failure should question an order for which drug? 1. Ibuprofen (Advil) 800 mg three times daily 2. Erythromycin (E-Mycin) 500 mg four times daily 3. Aluminum hydroxide gel 30 mL every 4 hours as needed 4. Acetylsalicylic acid (aspirin) 162 mg daily Answer: 1 Explanation: Ibuprofen, an NSAID, is a nephrotoxic drug. Clients in renal failure have increased vulnerability to injury from nephrotoxic drugs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-3 Explain how pharmacotherapy is modified in patients with chronic kidney disease.

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12) The nurse is caring for a client admitted to the medical–surgical unit with hypervolemia that has resulted from renal failure. Which medications does the nurse anticipate will be prescribed for this client based on the diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Furosemide (Lasix) 2. Hydrochlorothiazide (Microzide) 3. Epoetin alfa (Procrit) 4. Polystyrene sulfate (Kayexalate) 5. Sodium bicarbonate Answer: 1, 2 Explanation: Loop diuretics are often given to treat the hypervolemia that accompanies renal failure. Thiazide diuretics are often given to treat the hypervolemia that accompanies renal failure. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 32-3 Explain how pharmacotherapy is modified in patients with chronic kidney disease. 13) The nurse is caring for clients on a renal failure unit and recognizes which are indications for diuretic therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Confusion and ataxia 2. Visual and auditory hallucinations 3. Blood pressure of 200/98 mmHg 4. Generalized edema and decreased urine output 5. Pinpoint pupils and extreme paranoia Answer: 3, 4 Explanation: Hypertension is an indication for diuretic therapy. Generalized edema and decreased urine output are signs of renal failure and edema, which are indications for diuretic therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 32-4 Identify indications for diuretics.

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14) Spironolactone (Aldactone) is prescribed for a client diagnosed with hypertension. The nurse recognizes which information as providing the most support for the use of this drug? 1. Diagnosis of hepatic failure 2. Insufficient therapeutic response to hydrochlorothiazide 3. Insufficient therapeutic response to furosemide (Lasix) 4. Diagnosis of renal failure Answer: 1 Explanation: Hepatic failure is accompanied by increased production of aldosterone, which increases reabsorption of sodium and water in the distal tubule and collecting ducts. Spironolactone (Aldactone) achieves a diuretic effect by blocking the effects of aldosterone. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 32-4 Identify indications for diuretics. 15) The nurse is caring for four clients on a renal failure unit and recognizes which drug as safe to administer to a client with hypokalemia? 1. Amiloride (Midamor) 2. Chlorothiazide (Diuril) 3. Bumetanide (Bumex) 4. Ethacrynic acid (Edecrin) Answer: 1 Explanation: Amiloride is a potassium-sparing diuretic. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-4 Identify indications for diuretics.

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16) The nurse is caring for a client with sodium retention that has resulted in hypervolemia. The nurse knows that even a 1% increase in sodium is equivalent to lb of fluid weight gain. Record your answer rounding to the nearest whole number. Answer: 4 Explanation: A 1% increase in sodium reabsorption (retention) could potentially cause a 1.8-L net gain of water each day, which is equivalent to 4 lb of body weight. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 32-4 Identify indications for diuretics. 17) A client prescribed bumetanide (Bumex) asks the nurse, "What is all this about 'loops' in my medicine?" Which response by the nurse is the most appropriate? 1. "This medication reabsorbs potassium in Henle's loop in your kidney." 2. "This medication blocks sodium reabsorption in what is known as Bowman's capsule." 3. "This is a loop diuretic, which refers to the location where it acts in your kidneys." 4. "This is a loop diuretic, which means it works in the proximal tubule of your kidney." Answer: 3 Explanation: Bumetanide (Bumex) promotes sodium loss at Henle's loop, which leads to diuresis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-5 Compare and contrast the loop, thiazide, potassium-sparing, osmotic, and carbonic anhydrase inhibitor diuretics.

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18) The nurse is teaching a client about spironolactone (Aldactone), and recognizes which statement as an indication that the client needs further teaching about this drug? 1. "I am really happy that I can have my cranberry juice." 2. "I am relieved that I do not have to give up my cabbage and mushrooms." 3. "Thank goodness I can still have my orange juice and bananas for breakfast." 4. "I need an apple a day to stay regular. I am glad I can still have this." Answer: 3 Explanation: Orange juice and bananas are rich in potassium and should be avoided by persons taking spironolactone (Aldactone), which is a potassium-sparing diuretic. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 32-5 Compare and contrast the loop, thiazide, potassium-sparing, osmotic, and carbonic anhydrase inhibitor diuretics. 19) The nurse is caring for a client with a brain tumor who is prescribed mannitol (Osmitrol) IV. Which laboratory finding represents a potential adverse effect of this drug? 1. Serum cholesterol 300 mg/dL 2. Serum albumin 29 mg/dL 3. Serum sodium 104 mEq/L 4. Serum amylase 820 mg/dL Answer: 3 Explanation: Hyponatremia is a common adverse effect of mannitol (Osmitrol). Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 32-5 Compare and contrast the loop, thiazide, potassium-sparing, osmotic, and carbonic anhydrase inhibitor diuretics.

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20) The nurse is instructing a client on the importance of eating foods rich in potassium while taking a diuretic that causes hypokalemia. Which diuretics do not require potassium supplements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Furosemide (Lasix) 2. Chlorothiazide (Diuril) 3. Amiloride (Midamor) 4. Mannitol (Osmitrol) 5. Spironolactone (Aldactone) Answer: 3, 5 Explanation: Amiloride (Midamor) is a potassium-sparing diuretic; therefore, clients do not need to eat foods high in potassium or take a potassium supplement while on this medication. Spironolactone (Aldactone) is a potassium-sparing diuretic. Clients on this medication are not required to eat foods high in potassium or take a potassium supplement. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-5 Compare and contrast the loop, thiazide, potassium-sparing, osmotic, and carbonic anhydrase inhibitor diuretics. 21) A client diagnosed with chronic renal failure has gained 4 lb in the past 24 hours. The nurse anticipates that the client will receive which diuretic? 1. Triamterene (Dyrenium) 2. Ethacrynic acid (Edecrin) 3. Mannitol (Osmitrol) 4. Hydrochlorothiazide (HCTZ) Answer: 2 Explanation: As a loop diuretic, ethacrynic acid can produce significant diuresis in the presence of renal failure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 32-6 Describe the nurse's role in the pharmacologic management of chronic kidney disease and in diuretic therapy.

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22) The nurse is preparing to administer furosemide (Lasix) 40 mg IV to a client on complete bedrest who has renal failure and pulmonary edema. Which action is most appropriate prior to administering furosemide (Lasix) to this client? 1. Measure the client's urine output. 2. Monitor apical heart rate and rhythm. 3. Auscultate bowel sounds. 4. Lower the head of the bed. Answer: 2 Explanation: Furosemide (Lasix) can cause a decrease in serum potassium and precipitate cardiac dysrhythmias. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-6 Describe the nurse's role in the pharmacologic management of chronic kidney disease and in diuretic therapy. 23) An older adult reports ringing in the ears while the nurse is administering a dose of ethacrynic acid (Edecrin) intravenously. Which intervention is the priority for the nurse? 1. Schedule a hearing test. 2. Stop infusion of the drug and notify the prescriber. 3. Question the client about recent history of hearing loss. 4. Review the client's fluid intake and assess fluid status. Answer: 2 Explanation: Tinnitus can be an early sign of hearing loss as an adverse effect of potassium-sparing drugs, which is more common with IV administration of ethacrynic acid (Edecrin). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-6 Describe the nurse's role in the pharmacologic management of chronic kidney disease and in diuretic therapy.

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24) The nurse is preparing to discharge a client who is prescribed a loop diuretic for the treatment of congestive heart failure. Which foods should the nurse encourage the client to consume to prevent serious adverse effects associated with the medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Bananas 2. Red meat 3. Oranges 4. Dried dates 5. Green leafy vegetables Answer: 1, 3, 4 Explanation: Bananas are a potassium-rich food. Clients on loop diuretics should eat foods rich in potassium. Citrus fruits are a good source of potassium. Clients on loop diuretics should eat foods rich in potassium. Dried dates are a good source of potassium. Clients on loop diuretics should eat foods rich in potassium. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-6 Describe the nurse's role in the pharmacologic management of chronic kidney disease and in diuretic therapy.

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25) The healthcare provider prescribes hydrochlorothiazide (HCTZ) for a client in chronic renal failure. The nurse suspects the client is experiencing an ineffective response to the medication. Which clinical manifestation would be the most significant? 1. Hyponatremia 2. Excessive skin moisture 3. Rales 4. Hypertension Answer: 3 Explanation: Rales can represent pulmonary edema, which is a life-threatening complication of chronic renal failure and fluid retention. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 32-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 26) A client is prescribed acetazolamide (Diamox). Which finding indicates that the next dose of this drug should be withheld? 1. Elevated serum pH 2. Decreased serum potassium 3. Increased seizure frequency 4. Nausea and dizziness Answer: 2 Explanation: Hypokalemia is a serious adverse effect of acetazolamide (Diamox), a carbonic anhydrase inhibitor. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 32-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 593

27) Mannitol (Osmitrol) IV is prescribed to a client. The nurse will question the order for this drug if which manifestation is noted upon assessment? 1. Mental confusion and elevated blood pressure 2. Fatigue and dizziness 3. Urinary output of 68 mL over 2 hours following administration of a test dose of mannitol (Osmitrol) 4. Urinary output of 45 mL over the previous 24 hours Answer: 4 Explanation: Mannitol (Osmitrol) is contraindicated in the presence of anuria. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 32-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 28) The nurse is administering furosemide (Lasix) IV to a client with congestive heart failure. The nurse knows that the anticipated onset of action is within minutes. Record your answer rounding to the nearest whole number. Answer: 5 Explanation: Furosemide is frequently used in the treatment of acute edema associated with liver cirrhosis, renal impairment, or congestive heart failure because it has the ability to remove large amounts of edema fluid from the client in a short time. When given IV, diuresis begins within 5 minutes, providing clients quick relief from their symptoms. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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29) The nurse planning teaching for a client taking acetazolamide (Diamox) will include which instruction? 1. "Limit intake of foods high in potassium, such as peaches." 2. "Drink 1 to 2.5 quarts of fluids daily." 3. "Report signs of hypokalemia, such as vomiting and diarrhea." 4. "Weigh yourself daily, and report a weight gain of 1 pound or more in 24 hours." Answer: 2 Explanation: An adequate fluid intake is necessary to prevent formation of renal calculi, which are an adverse effect of acetazolamide (Diamox). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-8 Apply the nursing process to care for patients who are receiving pharmacotherapy with diuretics. 30) A client diagnosed with chronic renal failure is prescribed hydrochlorothiazide (HCTZ). The client asks the nurse which is the best fluid to drink to avoid dehydration. Which is the best response by the nurse? 1. "Iced tea or coffee is good." 2. "You may drink alcohol in moderation." 3. "Plain water is best." 4. "Electrolyte-replacement fluids like Gatorade are excellent." Answer: 3 Explanation: Plain water is the preferred fluid for avoiding dehydration. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-8 Apply the nursing process to care for patients who are receiving pharmacotherapy with diuretics.

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31) The nurse administers an oral dose of hydrochlorothiazide (HCTZ) to a client who needs assistance walking. When does the nurse plan to assist the client to the bathroom? 1. 1 hour after administration 2. 2 hours after administration 3. 6 hours after administration 4. 30 minutes after administration Answer: 2 Explanation: Two hours is the time following administration of the drug when the onset of action occurs, and this client likely will need assistance to the bathroom. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 32-8 Apply the nursing process to care for patients who are receiving pharmacotherapy with diuretics. 32) The nurse is assessing a client prior to the administration of a diuretic. The nurse knows it is essential to assess which vital signs at this time? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Temperature 2. Pulse 3. Respirations 4. Blood pressure 5. Pain Answer: 2, 4 Explanation: The nurse must assess the client's pulse prior to administering a diuretic. The nurse must assess the client's blood pressure prior to administering a diuretic. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-8 Apply the nursing process to care for patients who are receiving pharmacotherapy with diuretics.

596

33) A client is taking a diuretic for the treatment of congestive heart failure. The nurse teaches the client the importance of daily weights and knows the client understands the instruction when he states, "I will report a weight gain or loss of pounds in a 24-hour period." Record your answer rounding to the nearest tenth place. Answer: 2.2 Explanation: The client should report a weight gain or loss of over 1 kg (2.2 lb) in a 24-hour period. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 32-8 Apply the nursing process to care for patients who are receiving pharmacotherapy with diuretics. 34) A home care nurse is instructing a client diagnosed with congestive heart failure on daily self-monitoring between home care visits. The nurse should instruct the client to monitor and record which items? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Weight 2. Pulse 3. Temperature 4. Blood pressure 5. Respiratory rate Answer: 1, 2, 4 Explanation: It is essential that the client measure and record weight daily to monitor for fluid loss or retention. It is essential that the client measure and record the pulse daily to determine the effectiveness of the medication therapy. It is essential that the client measure and record daily blood pressure to determine the effectiveness of the medication therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-8 Apply the nursing process to care for patients who are receiving pharmacotherapy with diuretics. 597

35) The nurse is instructing a client who is going home on diuretic therapy for the treatment of fluid retention caused by hypertension. The nurse instructs the client to stop the medication and notify a healthcare provider if the blood pressure falls below 90/ mmHg. Record your answer rounding to the nearest whole number. Answer: 60 Explanation: The nurse instructs the client to stop taking the medication if blood pressure is 90/60 mmHg or below, or is below the parameters set by the healthcare provider, and promptly notify the provider. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-8 Apply the nursing process to care for patients who are receiving pharmacotherapy with diuretics. 36) The nurse is caring for a client prescribed chlorothiazide (Diuril). Which assessment findings indicate that the client is experiencing side effects of this medication? 1. Ataxia and diarrhea 2. Serum potassium 3.0 mEq/L and blood pressure 88/60 mmHg 3. Serum sodium 170 mEq/L and headaches 4. Mental confusion and dependent edema Answer: 2 Explanation: Chlorothiazide (Diuril) causes side effects of hypokalemia and hypotension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 32-8 Apply the nursing process to care for patients who are receiving pharmacotherapy with diuretics.

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37) Which instruction will the nurse include when teaching a client newly prescribed chlorothiazide (Diuril)? 1. "It is all right to have a glass of wine with this medication." 2. "Avoid foods high in potassium while you are taking this medication." 3. "Be sure to include lots of salt in your diet." 4. "Take the medication early in the morning." Answer: 4 Explanation: Older adults are at risk for falls that might be associated with nocturia caused by taking diuretics in the evening. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 32-8 Apply the nursing process to care for patients who are receiving pharmacotherapy with diuretics. 38) The nurse is assessing a client prescribed chlorothiazide (Diuril). Which clinical manifestation found upon assessment is an indication of hypokalemia? 1. Confusion and decreased urine output 2. General irritability and increased urine output 3. Muscle weakness or cramps 4. Diarrhea and projectile vomiting Answer: 3 Explanation: Muscle weakness and cramps are indicators of hypokalemia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 32-8 Apply the nursing process to care for patients who are receiving pharmacotherapy with diuretics. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 33 Pharmacotherapy of Fluid Imbalance, Electrolyte, and Acid–Base Disorders 1) The nurse is aware that body fluids are exchanged between which compartments? 1. Intravascular and interstitial 2. Intravascular and extracellular 3. Interstitial and extracellular 599

4. Intracellular and extracellular Answer: 4 Explanation: Body fluids are exchanged between intracellular and extracellular compartments. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 33-1 Describe the exchange of fluids that occurs among the different fluid compartments in the body. 2) A client is prescribed a transfusion of fresh frozen plasma (FFP). The nurse plans care based on the knowledge that the transfusion will complete which process? 1. Replace multifactor deficiency states. 2. Rehydrate cells. 3. Dehydrate cells. 4. Cause fluid to shift out of the intravascular space. Answer: 1 Explanation: Transfusing FFP will replace multifactor deficiency states when specific factors are not available. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-1 Describe the exchange of fluids that occurs among the different fluid compartments in the body.

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3) A client has a severe fluid and electrolyte imbalance. The nurse is aware that in order for the body to move large molecules and molecules with electrical charges, which two processes are required? 1. Active transport and tonicity 2. Osmosis and active transport 3. Diffusion and active transport 4. Osmosis and diffusion Answer: 3 Explanation: The processes of diffusion and active transport govern the movement of large molecules and those with electrical charges. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 33-1 Describe the exchange of fluids that occurs among the different fluid compartments in the body. 4) The nurse is caring for a client who was admitted to the hospital for the treatment of dehydration. The nurse is discussing the difference between intracellular fluid and extracellular fluid and states that intracellular fluid accounts for of the total amount of water in the body. Record your answer as a fraction. Answer: 2/3 Explanation: The intracellular fluid (ICF) compartment, which contains water that is inside cells, accounts for about two thirds of the total body water. The remaining one third of body fluid resides outside cells in the extracellular fluid (ECF) compartment. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-1 Describe the exchange of fluids that occurs among the different fluid compartments in the body.

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5) A nurse is evaluating a client's serum osmolality. Which solute is not factored into this value? 1. Sodium 2. Glucose 3. Urea 4. Water Answer: 4 Explanation: Water is not a solute. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 33-2 Identify conditions for which intravenous fluid therapy may be indicated. 6) When planning care, the nurse anticipates that which client will most likely require intravenous fluid replacement? 1. A client with a minor burn to the left arm 2. A client diagnosed with heart failure 3. A client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) 4. A client diagnosed with shock Answer: 4 Explanation: A client in shock will require intravenous fluid replacement secondary to hypotension and fluid shifting. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 33-2 Identify conditions for which intravenous fluid therapy may be indicated.

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7) When treating fluid imbalances, which is the ultimate goal of care? 1. To diagnose and correct the underlying cause of the disorder 2. To maintain normal vital signs 3. To keep clients normothermic 4. To administer intravenous fluids Answer: 1 Explanation: When treating fluid imbalances, the ultimate goal of the healthcare team is to diagnose and correct the underlying cause of the disorder. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 33-2 Identify conditions for which intravenous fluid therapy may be indicated. 8) The nurse is caring for a group of clients on a medical–surgical unit. For which clients would the nurse anticipate the need for intravenous fluid therapy to correct fluid depletion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A client suffering from constipation 2. A client exhibiting nausea and vomiting following a surgical procedure 3. A client with a severe burn 4. A client with heart failure with edema to the lower extremities and rales 5. A client with uncontrolled diabetic ketoacidosis Answer: 2, 3, 5 Explanation: A client exhibiting nausea and vomiting may require intravenous fluid to avoid dehydration. A client with a severe burn will often require intravenous fluid due to fluid depletion that occurs from fluid shifts. A client with uncontrolled diabetic ketoacidosis often requires intravenous fluid administration for fluid depletion. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 33-2 Identify conditions for which intravenous fluid therapy may be indicated.

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9) A client is prescribed a hypertonic intravenous solution. Administration of this solution will most likely cause which manifestation to occur? 1. A shift of fluid from the vascular space to the interstitial space 2. No fluid shift 3. The plasma to have more solutes than the interstitial fluid 4. The plasma to have fewer solutes than the interstitial fluid Answer: 3 Explanation: If a hypertonic solution is administered, the plasma gains more solutes than does the interstitial fluid. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-3 Explain how changes in the osmolality or tonicity of a fluid can cause water to move to a different compartment. 10) When a nurse administers a hypotonic intravenous solution to a client, how will the water move? 1. By osmosis from the plasma compartment to the interstitial compartment 2. By diffusion from the plasma compartment to the interstitial compartment 3. By diffusion from the interstitial compartment to the plasma compartment 4. By osmosis from the interstitial compartment to the plasma compartment Answer: 1 Explanation: Water will move from the plasma compartment to the interstitial compartment, by osmosis, in response to administration of hypotonic intravenous solutions. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-3 Explain how changes in the osmolality or tonicity of a fluid can cause water to move to a different compartment.

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11) The nurse is reviewing a client's lab values, which indicate normal serum osmolality. Which intravenous solutions will not cause a fluid shift in this client? 1. Colloids 2. Isotonic solutions 3. Hypertonic solutions 4. Hypotonic solutions Answer: 2 Explanation: Isotonic solutions will likely cause no fluid shift in this client. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 33-3 Explain how changes in the osmolality or tonicity of a fluid can cause water to move to a different compartment. 12) A seasoned nurse is caring for a client receiving intravenous fluid therapy for dehydration. The nurse knows that the osmolarity or tonicity of a fluid causes water to move to a different compartment. The nurse is caring for a client who weighs 40 kg. The osmolality of the body fluids for this client is between 11,000 and milliosmoles. Record your answer rounding to the nearest whole number. Answer: 11,800 Explanation: The normal osmolality of body fluids ranges from 275 to 295 milliosmoles per kilogram (mOsm/kg). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-3 Explain how changes in the osmolality or tonicity of a fluid can cause water to move to a different compartment.

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13) A client with long-standing hepatic cirrhosis might receive which intravenous solution to correct hypoproteinemia? 1. Dextrose 5% 2. Packed red cells 3. Whole blood 4. Albumin Answer: 4 Explanation: Normal serum albumin is the preferred treatment for hypoproteinemia in a client with hepatic cirrhosis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-4 Compare and contrast the use of blood products, crystalloids, and colloids in intravenous therapy. 14) A client diagnosed with diabetes insipidus is suffering from severe hypernatremia. The nurse anticipates the use of which type of intravenous solution? 1. A hypertonic crystalloid 2. A hypotonic crystalloid 3. An isotonic crystalloid 4. Albumin Answer: 2 Explanation: Hypotonic crystalloids are indicated for clients with hypernatremia and cellular dehydration. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 33-4 Compare and contrast the use of blood products, crystalloids, and colloids in intravenous therapy.

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15) A client has vomited several times and continues to be nauseated. To correct mild hypovolemia, the nurse plans to complete which intervention? 1. Ask the client to drink 8 ounces of water every hour. 2. Administer an isotonic crystalloid. 3. Administer a hypotonic crystalloid. 4. Ask the client to drink 8 ounces of an electrolyte solution every 30 minutes for 4 hours. Answer: 2 Explanation: Isotonic solutions are often used to tread fluid loss due to vomiting. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 33-4 Compare and contrast the use of blood products, crystalloids, and colloids in intravenous therapy. 16) The nurse is caring for a client in the emergency department who has experienced a below-the-knee traumatic amputation. The nurse anticipates the use of a whole blood transfusion because the client has lost % of the total blood volume in the accident. Record your answer rounding to the nearest whole number. Answer: 30 Explanation: Blood loss can be treated with a number of different intravenous fluids. The nurse knows that whole blood will be used when the client loses 30% or more of the total blood volume. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 33-4 Compare and contrast the use of blood products, crystalloids, and colloids in intravenous therapy.

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17) The nurse is reviewing the tonicity of the different intravenous fluids on the medical–surgical unit in preparation for an in-service presentation. Which fluids are considered to be isotonic and appropriate in the treatment of fluid loss due to a surgical procedure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. 5% dextrose in lactated Ringer's 2. 0.9% sodium chloride (NS) 3. 0.45% sodium chloride 4. Lactated Ringer's 5. 5% dextrose in water Answer: 2, 4, 5 Explanation: This is an isotonic solution and is appropriate for the treatment of fluid loss due to a surgical procedure. This is an isotonic solution and is appropriate to treat fluid loss caused by a surgical procedure. This is an isotonic solution and is appropriate to treat fluid loss caused by a surgical procedure. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 33-4 Compare and contrast the use of blood products, crystalloids, and colloids in intravenous therapy. 18) A client prescribed 100 mL of 3% normal saline solution received 1,000 mL of 3% normal saline. Which is the priority assessment for this client? 1. Skin integrity 2. Blood pressure 3. Capillary refill 4. Coagulation profile Answer: 2 Explanation: Overtreatment with hypertonic crystalloids such as 3% normal saline can lead to excessive expansion of the intravascular compartment, fluid overload, and hypertension. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-5 Explain the importance of electrolyte balance in the body.

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19) A client has a serum sodium level of 157 mEq/L. Which area of assessment is the priority? 1. Muscle pain 2. Daily weight 3. Thirst level 4. Level of consciousness Answer: 4 Explanation: Hypernatremia can cause increased intracranial pressure. This should be reported to the healthcare provider immediately. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-5 Explain the importance of electrolyte balance in the body. 20) A nurse is caring for a client with a serum potassium level of 6.9 mEq/L. When planning care, which body system will be most profoundly affected by this value? 1. The respiratory system 2. The cardiovascular system 3. The hematologic system 4. The genitourinary system Answer: 2 Explanation: This value represents hyperkalemia. Both hyperkalemia and hypokalemia are associated with fatal dysrhythmias and serious neuromuscular disorders. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-5 Explain the importance of electrolyte balance in the body.

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21) The nurse is caring for a client with severe electrolyte imbalances that have occurred as a result of kidney failure. The nurse knows that this client is at risk for which disorders as a result of this electrolyte imbalance? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fluid retention 2. Muscle spasms 3. Fractures 4. High cholesterol 5. Depression Answer: 1, 2, 3 Explanation: Electrolytes are responsible for membrane permeability and water balance. An electrolyte imbalance, especially too much sodium, can result in fluid retention. Electrolytes are essential for muscle contractions. An imbalance in electrolytes can result in muscle spasms. Electrolytes are essential for bone growth and remodeling and may place a client at risk for fractures, especially when there is an imbalance of calcium. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 33-5 Explain the importance of electrolyte balance in the body. 22) A client has a serum potassium of 2.5 mEq/L. While reviewing the client's medical administration record, the nurse suspects that which medication might have contributed to this imbalance? 1. Metoprolol 2. Hydrochlorothiazide 3. Aspirin 4. Acetaminophen Answer: 2 Explanation: The most frequent cause of hypokalemia is pharmacotherapy with loop and thiazide diuretics. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 33-6 Explain the pharmacotherapy of sodium and potassium imbalances.

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23) A nursing instructor asks a student at what point it is appropriate to treat hyponatremia. Which response by the student is accurate? 1. "When serum levels fall below 130 mEq/L." 2. "When serum levels fall below 140 mEq/L." 3. "When serum levels fall below 145 mEq/L." 4. "When serum levels fall below 155 mEq/L." Answer: 1 Explanation: Sodium chloride is administered for hyponatremia when serum levels fall below 130 mEq/L. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 33-6 Explain the pharmacotherapy of sodium and potassium imbalances. 24) When infusing 3% NaCl solutions, which clinical manifestation will the nurse continuously check for? 1. Signs of pulmonary edema 2. Hyponatremia 3. Signs of thirst 4. Signs of depression Answer: 1 Explanation: Solutions of 3% NaCl can cause increased intravascular fluid volume, which can lead to pulmonary edema. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-6 Explain the pharmacotherapy of sodium and potassium imbalances.

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25) The nurse is caring for a client with a serum sodium level of 110 mEq/L. The nurse anticipates that the client will require an infusion of % sodium chloride solution. Record your answer rounding to the nearest whole number. Answer: 3 Explanation: Normal saline consists of 0.9% NaCl and is used to treat mild hyponatremia. When serum sodium falls below 115 mEq/L, a highly concentrated 3% NaCl solution may be infused. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-6 Explain the pharmacotherapy of sodium and potassium imbalances. 26) A nurse is providing care to several postsurgical clients. Which prescription would the nurse question? 1. Infuse potassium chloride 40 mEq, IV push over 1 minute, once. 2. Infuse potassium chloride 40 mEq in 250 mL NaCl, over 4 hours, once. 3. Administer potassium chloride 20 mEq, by mouth, once. 4. Administer potassium chloride, 20 mEq diluted in 90 mL juice, by mouth, once. Answer: 1 Explanation: Never give potassium as an IV push or in concentrated amounts by any route. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-7 Discuss medications used to treat acidosis and alkalosis.

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27) A client being treated long term with oral sodium bicarbonate should be monitored for which acid–base imbalance? 1. Metabolic acidosis 2. Respiratory acidosis 3. Respiratory alkalosis 4. Metabolic alkalosis Answer: 4 Explanation: Overdose or long-term use of sodium bicarbonate results in metabolic alkalosis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 33-7 Discuss medications used to treat acidosis and alkalosis. 28) Nurses must administer sodium bicarbonate with caution to clients with hypertension to avoid which adverse effect? 1. Respiratory acidosis 2. Metabolic acidosis 3. Retention of fluid 4. Unexpected diuresis Answer: 3 Explanation: Administer sodium bicarbonate with caution to clients with hypertension, because this drug will promote retention of fluids. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-7 Discuss medications used to treat acidosis and alkalosis.

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29) The nurse is caring for a client with a pH of 7.32. Which medications would be appropriate to administer to a client with this condition? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Oral bicarbonate 2. Sodium chloride 3. Citrate salts 4. Potassium chloride 5. Ammonium chloride Answer: 1, 3 Explanation: Oral bicarbonate is an agent used to treat acidosis. Citrate salts are an agent used to treat acidosis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-7 Discuss medications used to treat acidosis and alkalosis. 30) A client is prescribed ammonium chloride. Which statement indicates an appropriate understanding after medication teaching? 1. "I will report sleepiness right away." 2. "It's okay if this medication makes me a little shaky." 3. "Confusion will be normal for a day or so." 4. "The IV infusion is going to be painful." Answer: 1 Explanation: Symptoms of excessive drowsiness or confusion should be reported immediately because they are signs of overdose. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 33-8 Describe the nurse's role in the pharmacologic management of fluid imbalance, electrolyte, and acid–base disorders.

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31) A nurse is scheduled to administer a potassium supplement to a client. Which action should the nurse take prior to administering the drug? 1. Check the client's potassium level from the morning labs. 2. Tell the client that the infusion will burn. 3. Place the client in a low Fowler's position. 4. Ask the client why the medication is ordered. Answer: 1 Explanation: Serial serum potassium levels should be monitored before and during therapy. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-8 Describe the nurse's role in the pharmacologic management of fluid imbalance, electrolyte, and acid–base disorders. 32) A client is receiving an infusion of magnesium sulfate. The healthcare provider should be notified immediately if which response is observed? 1. A pulse rate of 99 beats/min 2. A blood pressure of 90/60 mmHg 3. Pain at the IV site 4. A respiratory rate of 9 breaths/min Answer: 4 Explanation: A respiratory rate below 12 breaths/min should be reported to the healthcare provider immediately. This can indicate magnesium toxicity. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-8 Describe the nurse's role in the pharmacologic management of fluid imbalance, electrolyte, and acid–base disorders.

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33) The nurse is preparing to administer magnesium sulfate to a pregnant client with preeclampsia. Which conditions must the nurse assess this client for while administering this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Level of consciousness 2. Deep tendon reflexes 3. Urine output 4. Neuromuscular depression 5. Magnesium level Answer: 1, 2, 3, 5 Explanation: The nurse must monitor the client's level of consciousness while administering magnesium to determine the presence of adverse effects. The nurse must monitor the client's deep tendon reflexes while administering magnesium to determine the presence of adverse effects. The nurse must monitor the client's urine output while administering magnesium to determine the presence of adverse effects. The nurse would monitor the client's magnesium level in order to assess for toxicity. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 33-8 Describe the nurse's role in the pharmacologic management of fluid imbalance, electrolyte, and acid–base disorders.

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34) The nurse would question administering sodium bicarbonate to which client? 1. A client taking methotrexate 2. A client in chronic renal failure 3. A client on continuous nasogastric suctioning 4. A client diagnosed with metabolic acidosis Answer: 3 Explanation: A client on continuous nasogastric suctioning might experience base excess secondary to loss of stomach acid, which predisposes the client to metabolic alkalosis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 35) The nurse would be most concerned about administering which blood product to a client? 1. Fresh frozen plasma 2. Albumin 3. Whole blood 4. Packed red cells Answer: 3 Explanation: The administration of whole blood is uncommon due to potential adverse reactions and the small possibility of transmitting infectious disease. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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36) Which is not an indication for the use of potassium chloride? 1. Prevention of hypokalemia 2. Treatment of hypokalemia 3. Treatment of peptic ulcer disease 4. Treatment of mild alkalosis Answer: 3 Explanation: Potassium chloride supplements can cause peptic ulcers. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 37) The nurse is preparing to administer normal serum albumin (Plasbumin) to a client with an albumin level of 3.2 g/dL. Which are appropriate classifications of Plasbumin? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Blood product 2. Colloid 3. Crystalloid 4. Vitamin 5. Electrolyte Answer: 1, 2 Explanation: Plasbumin is an albumin product. Albumin is considered a blood product. Plasbumin is an albumin product. Albumin is considered a colloid. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 33-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 618

38) The nurse is reviewing the client's medical record in preparation to administer 5% dextrose solution. Which findings would indicate a contraindication for this intravenous fluid? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Heart failure 2. Hypoglycemia 3. Increased intracranial pressure 4. Hypernatremia 5. Hypercalcemia Answer: 1, 3 Explanation: Heart failure is a contraindication for the administration of 5% dextrose solution. Increased intracranial pressure is a contraindication for the administration of 5% dextrose solution. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 33-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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39) The nurse is preparing to administer a 5% dextrose in water (D5W) infusion to a client. Which explanation as to why the infusion is ordered is the most accurate? 1. "This is a colloid, and will increase the client's blood pressure." 2. "This medication is isotonic in its container, but when infused, the solution becomes hypotonic." 3. "This medication is hypotonic and will cause fluid to shift from the intravascular space into the interstitial and intracellular spaces." 4. "This medication is hypertonic and will cause fluid to shift from the extravascular space into the vascular space." Answer: 2 Explanation: D5W is isotonic in the container. When infused, the dextrose is quickly metabolized in the body, leaving only water, and the solution becomes hypotonic. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-10 Apply the nursing process to care for patients receiving pharmacotherapy for fluid imbalance, electrolyte, and acid–base disorders. 40) The nurse is assessing a client being treated with 3% normal saline solution. Which assessment finding should be reported to the healthcare provider immediately? 1. Temperature of 100.1°F 2. Blood pressure of 146/92 mmHg 3. Presence of auscultated crackles 4. Presence of auscultated rhonchi Answer: 3 Explanation: Crackles are a sign of pulmonary edema, which can occur with the use of 3% normal saline solution. This assessment finding should be reported to the healthcare provider immediately. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 33-10 Apply the nursing process to care for patients receiving pharmacotherapy for fluid imbalance, electrolyte, and acid–base disorders.

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41) A nurse is providing medication teaching to a client who is prescribed potassium tablets. Which information should be included? 1. Allow potassium tablets to dissolve completely in the mouth. 2. Licorice helps alleviate the bad taste of the potassium tablets. 3. Avoid salt substitutes. 4. Add lots of potassium-rich foods to your diet. Answer: 3 Explanation: Salt substitutes contain potassium and electrolytes other than sodium, and they could cause hyperkalemia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 33-10 Apply the nursing process to care for patients receiving pharmacotherapy for fluid imbalance, electrolyte, and acid–base disorders. 42) A client is scheduled receive a parenteral dose of magnesium sulfate. The nurse tests patellar reflexes and determines them to be absent. Which action by the nurse is the most appropriate? 1. Administer the drug as ordered, because this is a normal finding. 2. Hold the medication for 1 hour, then reassess. 3. Hold the medication and notify the healthcare provider. 4. Administer the drug after placing the client on a cardiac monitor. Answer: 3 Explanation: Depression or absence of reflexes can indicate early magnesium intoxication. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 33-10 Apply the nursing process to care for patients receiving pharmacotherapy for fluid imbalance, electrolyte, and acid–base disorders.

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43) The nurse is caring for a client diagnosed with hyperkalemia. Which interventions are appropriate to include in the client's plan of care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A calcium supplement 2. A potassium supplement 3. Hypotonic fluids 4. Buffering agents 5. Citrus fruits in the diet Answer: 3, 4 Explanation: Hypotonic fluids are often used in the treatment of hyperkalemia. Buffering agents are often used in the treatment of hyperkalemia. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 33-10 Apply the nursing process to care for patients receiving pharmacotherapy for fluid imbalance, electrolyte, and acid–base disorders. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 34 Pharmacotherapy of Hypertension 1) The nurse is providing care to a client recently diagnosed with hypertension. The client's sustained blood pressure is 144/90 mmHg and the client has expressed concern about possible effects on the body. When educating this client, which conditions affected by hypertension are appropriate to discuss? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Stroke 2. Kidney damage 3. Heart failure 4. Blindness 5. Liver failure Answer: 1, 2, 3, 4 Explanation: Hypertension increases the risk of both hemorrhagic and thrombotic stroke by weakening arteries and promoting atherosclerosis. Hypertension damages the arteries of the glomerulus, leading to kidney disease. Hypertension increases the risk of heart failure due to the strain of increased peripheral vascular resistance. By damaging the retinal arteries, hypertension can lead to blindness. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and 622

processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 34-1 Summarize the long-term consequences of untreated hypertension. 2) The healthcare provider asks the nurse to monitor a client with hypertension for signs of kidney damage. Which clinical manifestation would indicate kidney damage? 1. Urine output of 30 mL/h 2. Proteinuria 3. Dysuria 4. Estimated glomerular filtration rate (GFR) of 105 Answer: 2 Explanation: Proteinuria is a very common sign of kidney damage due to hypertension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 34-1 Summarize the long-term consequences of untreated hypertension. 3) The nurse is caring for a client with a history of uncontrolled hypertension. The client's family asks the nurse the consequences of this condition. Which conditions will the nurse include in the teaching session regarding the consequences of uncontrolled hypertension? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Stroke 2. Heart failure 3. Myocardial infarction 4. Depression 5. Hyperbilirubinemia Answer: 1, 2, 3 Explanation: Uncontrolled hypertension places the client at an increased risk for stroke. Uncontrolled hypertension places the client at an increased risk for heart failure. Uncontrolled hypertension places the client at an increased risk for a heart attack. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 34-1 Summarize the long-term consequences of untreated hypertension.

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4) The nurse is discussing the long-term consequences of uncontrolled hypertension with a group of clients. Place in order the pathologic changes that occur as a result of uncontrolled hypertension. Response 1. Damage to the blood vessels occurs, particularly the small arteries and arterioles. Response 2. Damage to the blood vessels continues with thickening of the arterial walls. Response 3. The blood vessels become inflamed. Response 4. The lumen of the arteries narrows. Response 5. Blood flow to the vital organs decreases. Answer: 1, 2, 3, 4, 5 Explanation: 1. The damage from untreated hypertension begins in the blood vessels, particularly the small arteries and arterioles. 2. The second consequence of uncontrolled hypertension is a thickening of the arterial walls. 3. The third consequence of uncontrolled hypertension is the blood vessels becoming inflamed. 4. The fourth consequence of uncontrolled hypertension is the narrowing of the lumen of the arteries. 5. The fifth consequence of uncontrolled hypertension is decreased blood flow to the vital organs. This can lead to strokes, heart failure, and myocardial infarction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 34-1 Summarize the long-term consequences of untreated hypertension.

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5) The client recently diagnosed with hypertension presents with the following assessment data: weight, 200 lb; height, 54; diet, mostly starches; alcohol intake, three beers/week; stressors, works 60 hours/week. In planning care with this client, what is the priority outcome? 1. The client will eliminate alcohol from the diet. 2. The client will decrease stress by limiting work to 40 hours/week. 3. The client will achieve and maintain optimum weight. 4. The client will balance diet according to the food pyramid. Answer: 3 Explanation: Achieving and maintaining optimum weight is of greatest importance when a client has hypertension. For clients with obesity, a 10- to 20-lb weight loss can produce a measurable change in blood pressure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 34-2 Compare and contrast the roles of nonpharmacologic and pharmacologic methods in the management of hypertension. 6) The nurse is teaching a client diagnosed with hypertension about lifestyle modifications. The nurse determines that teaching has been effective when the client makes which statement? 1. "My father had hypertension, did nothing, and lived to be 90 years old." 2. "I won't be able to run the marathon anymore." 3. "I need to get started on my medications right away." 4. "I know I need to give up my cigarettes and alcohol." Answer: 4 Explanation: Limiting intake of alcohol and discontinuing the use of tobacco products are important nonpharmacologic methods for controlling hypertension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 34-2 Compare and contrast the roles of nonpharmacologic and pharmacologic methods in the management of hypertension.

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7) The nurse is teaching the client about lifestyle modifications to help manage hypertension. The nurse determines that teaching has been effective when the client makes which statement? 1. "Lifestyle changes always get blood pressure down to normal levels." 2. "Lifestyle changes are just a way to make you feel like you're doing something." 3. "As long as I take my medications, I don't need to make any lifestyle changes." 4. "I will probably need to change my lifestyle and take medications." Answer: 4 Explanation: Most clients with hypertension do best with a combination of drug therapy and lifestyle changes. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 34-2 Compare and contrast the roles of nonpharmacologic and pharmacologic methods in the management of hypertension. 8) The nurse is educating a client with hypertension on the importance of maintaining an optimal weight. The client asks the nurse how much weight loss is needed. The nurse's response is based on the knowledge that a weight loss of 11 to _ lb produces a measurable decrease in blood pressure. Record your answer rounding to the nearest whole number. Answer: 20 Explanation: Therapeutic lifestyle changes should be recommended for all clients with prehypertension or HTN. Of greatest importance is maintaining optimum weight, since obesity is closely associated with dyslipidemia (abnormal serum lipid levels) and HTN. A 5- to 9-kg (11- to 20-lb) weight loss often produces a measurable decrease in blood pressure, even in clients who are obese. Combining a medically supervised weight loss program with proper nutrition can delay the progression from prehypertension to HTN. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 34-2 Compare and contrast the roles of nonpharmacologic and pharmacologic methods in the management of hypertension.

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9) The nurse is educating a client whose blood pressure is 140/90 mmHg on ways to lower blood pressure. Which lifestyle choices may eliminate the need for pharmacotherapy in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increasing intake of wine 2. Restricting salt intake 3. Increasing intake of red meat 4. Increasing activity 5. Stopping smoking Answer: 2, 4, 5 Explanation: Restricting sodium intake is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. Increased activity, especially aerobic activity, is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. Eliminating tobacco products is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 34-2 Compare and contrast the roles of nonpharmacologic and pharmacologic methods in the management of hypertension. 10) A client does not want to take hypertension medication, and asks why it is needed, as the client feels fine. Which response by the nurse is the most appropriate? 1. "You're right; there is no need for these medications." 2. "The medications can prevent worsening of the hypertension." 3. "If the hypertension is severe, symptoms could arise." 4. "The medications can prevent complications from hypertension." Answer: 4 Explanation: The primary goal of hypertension treatment is to prevent complications of hypertension, such as stroke and blindness. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 34-3 Describe general principles guiding the pharmacotherapy of hypertension.

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11) The nurse is caring for a client with a new diagnosis of hypertension and no other conditions. Which medication prescription should the nurse anticipate as the first treatment option? 1. A calcium channel blocker 2. A thiazide-type diuretic 3. An ACE inhibitor 4. A beta blocker Answer: 2 Explanation: JNC VI recommends a thiazide-type diuretic as the preferred drug for clients without other underlying conditions. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 34-3 Describe general principles guiding the pharmacotherapy of hypertension. 12) The nurse is educating a client diagnosed with hypertension and explains that which criteria will be used to determine medication management for the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Risk factors 2. Comorbid medical conditions 3. Age 4. Degree of blood pressure elevation 5. Occupational status Answer: 1, 2, 4 Explanation: The client's risk factors guide the pharmacotherapy of hypertension. The client's comorbid medical conditions guide the pharmacotherapy of hypertension. The client's degree of hypertension guides the pharmacotherapy of hypertension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 34-3 Describe general principles guiding the pharmacotherapy of hypertension.

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13) The nurse is caring for an African American man recently diagnosed with hypertension. The nurse anticipates that this client will be started on which medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A thiazide diuretic 2. A calcium channel blocker 3. An ACE inhibitor 4. A beta-adrenergic antagonist 5. An angiotensin II receptor blocker Answer: 1, 2 Explanation: Thiazide diuretics seem to provide the greatest blood pressure reduction in this population. Calcium channel blockers seem to provide the greatest blood pressure reduction in this population. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 34-3 Describe general principles guiding the pharmacotherapy of hypertension. 14) A client with hypertension is also diagnosed with type 2 diabetes mellitus. The client asks why the healthcare provider has prescribed an ACE inhibitor. Which response by the nurse is the most appropriate? 1. "It protects the kidneys." 2. "It protects the eyes." 3. "It protects the heart." 4. "It protects the nerves." Answer: 1 Explanation: ACE inhibitors protect the kidneys in clients with diabetes. By treating the client with an ACE inhibitor, the healthcare provider is dealing with the hypertension and diabetes at the same time. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 34-4 Identify first- and second-line drug classes used in the management of hypertension.

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15) A client is newly diagnosed with hypertension and diabetes. Which classes of drugs are likely to be prescribed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. ACE inhibitors 2. Beta blockers 3. Thiazide diuretics 4. Calcium channel blockers 5. Angiotensin receptor blockers (ARBs) Answer: 1, 5 Explanation: ACE inhibitors protect the kidneys in clients with diabetes. JNC VI recommends that clients with other compelling factors be given an antihypertensive that also treats the "other" factors. ARBs protect the kidneys in clients with diabetes. JNC VI recommends that clients with other compelling factors be given an antihypertensive that also treats the "other" factors. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 34-4 Identify first- and second-line drug classes used in the management of hypertension. 16) A client with a history of heart disease has been diagnosed with hypertension. Which class of drugs is likely to be prescribed? 1. Calcium channel blockers 2. Thiazide diuretics 3. ACE inhibitors 4. Beta blockers Answer: 4 Explanation: Beta blockers are typically given to clients with heart disease to protect the heart. JNC VI recommends that clients with other compelling factors be given an antihypertensive that also treats the "other" factors. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 34-4 Identify first- and second-line drug classes used in the management of hypertension.

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17) The nurse is caring for a client recently diagnosed with hypertension. The client asks what medications may be used to treat the condition. The nurse begins by discussing the primary antihypertensive agents, which include which medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Diuretics 2. Angiotensin II receptor blockers (ARBs) 3. Beta-adrenergic antagonists 4. Direct-acting vasodilators 5. Peripheral adrenergic antagonists Answer: 1, 2 Explanation: Diuretics are considered a primary antihypertensive agent and should be discussed with this client. ARBs are considered a primary antihypertensive agent and should be discussed with this client. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 34-4 Identify first- and second-line drug classes used in the management of hypertension. 18) A client is treated in the emergency department for hypertensive emergency. The nurse anticipates treatment with which drug? 1. Metoprolol 2. Lisinopril 3. Clonidine 4. Nitroprusside Answer: 4 Explanation: Nitroprusside is a direct vasodilator, and is typically used to lower blood pressure immediately during hypertensive emergencies. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 34-5 Describe the pharmacologic management of hypertensive emergencies.

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19) A client presents with a blood pressure of 210/124 mmHg. The nurse documents this finding in which way? 1. Prehypertension 2. Stage 1 hypertension 3. Stage 2 hypertension 4. Hypertensive crisis Answer: 4 Explanation: Hypertensive emergencies are characterized by diastolic readings greater than 120 mmHg. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 34-5 Describe the pharmacologic management of hypertensive emergencies. 20) When reviewing the medical record of a client admitted for hypertensive emergency, the nurse realizes the client's actual admitting diagnosis should have been hypertensive crisis, because the diastolic blood pressure was greater than mmHg and the client was experiencing oliguria. Record your answer rounding to the nearest whole number. Answer: 120 Explanation: A hypertensive emergency (HTN-E), also called hypertensive crisis, is defined as a diastolic pressure greater than 120 mmHg, with evidence of target-organ system damage. This client should have been diagnosed with hypertensive crisis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 34-5 Describe the pharmacologic management of hypertensive emergencies.

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21) A client comes to the emergency department with a blood pressure of 200/120 mmHg. The healthcare provider orders hydralazine (Apresoline) IV. What will the nurse's priority assessment include? 1. Hypotension and bradycardia 2. Hypotension and tachypnea 3. Hypotension and hyperthermia 4. Hypotension and tachycardia Answer: 4 Explanation: Direct vasodilators produce reflex tachycardia, a compensatory response to the sudden decrease in blood pressure caused by the drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 34-5 Describe the pharmacologic management of hypertensive emergencies. 22) The client is prescribed doxazosin (Cardura) for hypertension and asks the nurse how the medication works. Which response by the nurse is the most appropriate? 1. "It works by making your blood vessels expand." 2. "It works by causing your kidneys to excrete more urine." 3. "It works by decreasing the release of stress hormones." 4. "It works by making your heart work more efficiently." Answer: 1 Explanation: Doxazosin (Cardura) is selective for blocking alpha1 receptors in vascular smooth muscle, which results in dilation of arteries and veins. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 34-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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23) The nurse completes medication education with a client prescribed hydrochlorothiazide. The nurse determines that teaching has been effective when the client makes which statement? 1. "I take my medication early in the morning." 2. "I really need to avoid grapefruit juice when I take this medication." 3. "If I develop a cough, I should call my doctor." 4. "I need to avoid salt substitutes and potassium-rich foods." Answer: 1 Explanation: Taking hydrochlorothiazide early in the day will help prevent nocturia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 34-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 24) Which is a priority nursing intervention for a client who is prescribed enalapril (Vasotec) for antihypertensive treatment? 1. Monitor the client for headaches. 2. Take the client's blood pressure. 3. Review the client's lab results for hypokalemia. 4. Order a sodium-restricted diet for the client. Answer: 2 Explanation: Enalapril (Vasotec) might produce a first-dose phenomenon, resulting in profound hypotension, which could result in syncope. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 34-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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25) The nurse is administering nitroprusside sodium in the treatment of a hypertensive crisis. The nurse will assess the client for which signs and symptoms of thiocyanate poisoning? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Hypotension 2. Blurred vision 3. Flushing of the skin 4. Metabolic acidosis 5. Dizziness Answer: 1, 2, 4 Explanation: Hypotension is a symptom of thiocyanate toxicity that may manifest with extended therapy. Blurred vision is a symptom of thiocyanate toxicity that may manifest with extended therapy. Metabolic acidosis is a symptom of thiocyanate toxicity that may manifest with extended therapy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 34-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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26) The nurse is caring for a client who is prescribed hydralazine for the treatment of high blood pressure. Which medication should the client avoid taking because of the risk of severe hypotension? 1. Beta blockers 2. Monoamine oxidase inhibitors (MAOIs) 3. Acetaminophen 4. Potassium supplements Answer: 2 Explanation: MAOIs should not be administered with hydralazine because the combination can cause severe hypotension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 34-7 Apply the nursing process to care for patients receiving antihypertensive drugs. 27) A client with hypertension has experienced heart failure. The nurse notes that the client is receiving nifedipine (Procardia). Which is a priority assessment for the nurse? 1. Auscultate breath sounds for crackles. 2. Assess level of orientation. 3. Review recent lab results for hypokalemia. 4. Assess urinary output. Answer: 1 Explanation: Some calcium channel blockers can reduce myocardial contractility and can worsen heart failure. Crackles in the lungs can indicate pulmonary edema, which could indicate heart failure. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 34-7 Apply the nursing process to care for patients receiving antihypertensive drugs.

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28) The client begins taking enalapril (Vasotec) for hypertension. Which adverse effect should the nurse teach the client to expect while taking this medication? 1. Persistent cough 2. Rebound hypertension 3. Hyperkalemia 4. Hyperglycemia Answer: 1 Explanation: Adverse effects of ACE inhibitors are usually minor and include a persistent cough, particularly following the first few doses of the drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 34-7 Apply the nursing process to care for patients receiving antihypertensive drugs. 29) The nurse is taking the initial history of a client admitted to the hospital for hypertension. The healthcare provider has ordered a beta-adrenergic blocker. Which statement by the client does the nurse recognize as most significant? 1. "I don't handle stress well; I have a lot of diarrhea." 2. "I have always had problems with my asthma." 3. "When I have a migraine headache, I need to have the room darkened." 4. "My father died of a heart attack when he was 48 years old." Answer: 2 Explanation: With increased doses, beta-adrenergic blockers can slow the heart rate and cause bronchoconstriction. They should be used with caution in clients with asthma. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 34-7 Apply the nursing process to care for patients receiving antihypertensive drugs.

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30) The nurse is administering nitroprusside in the treatment of a hypertensive crisis. The nurse will assess the client's blood pressure after 1 to minutes to assess for the therapeutic effects of the medication. Record your answer rounding to the nearest whole number. Answer: 2 Explanation: The onset of action for this medication is 1 to 2 minutes. The nurse would assess the client for the therapeutic effects of the medication at this time. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 34-7 Apply the nursing process to care for patients receiving antihypertensive drugs. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 35 Pharmacotherapy of Angina Pectoris and Myocardial Infarction 1) The nurse is caring for a client with heart failure and knows that an increase in myocardial oxygen demand is likely the result of which finding? 1. Temperature 98.6ºF 2. Respirations 26 breaths/min 3. Blood pressure 154/98 mmHg 4. Heart rate 95 beats/min Answer: 3 Explanation: High blood pressure requires a higher force of contraction, increasing the heart's myocardial demand. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 35-1 Describe factors that affect myocardial oxygen supply and demand. 2) A client asks which conditions will cause the heart to need more oxygen. Which responses by the nurse are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Increased physical activity." 2. "Watching a television show." 3. "Emotional stress." 4. "Eating a meal." 638

5. "Listening to music." Answer: 1, 3 Explanation: Increased physical activity requires more cardiac output, increasing the work of the heart and increasing myocardial oxygen demand. Emotional stress causes epinephrine release, increasing heart rate and contractility and increasing myocardial oxygen demand. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 35-1 Describe factors that affect myocardial oxygen supply and demand.

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3) The nurse caring for a client who is at risk for experiencing a myocardial infarction knows that which hemodynamic factors can affect the supply of myocardial oxygen? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Atrial fibrillation 2. Hemorrhage 3. Anemia 4. Blood pressure 5. Coronary artery disease (CAD) Answer: 2, 3, 4 Explanation: Hemorrhage is a hemodynamic factor that affects the supply of myocardial oxygen. Anemia is a hemodynamic factor that affects the supply of myocardial oxygen. Blood pressure is the most important hemodynamic factor that affects the supply of myocardial oxygen. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 35-1 Describe factors that affect myocardial oxygen supply and demand. 4) The nurse realizes that client teaching regarding the cause of anginal pain was effective when the client makes which statement? 1. "The pain is related to remodeling of the heart muscle caused by narrowed arteries." 2. "The heart is not pumping enough blood out with each beat because of narrowed arteries." 3. "The pain is from a lack of oxygen getting to the heart, which is caused by narrowed arteries." 4. "The pain comes from the heart beating irregularly because of narrowed arteries." Answer: 3 Explanation: Angina pectoris is acute chest pain caused by the coronary arteries' inability to maintain adequate oxygenation to meet the metabolic demands of the myocardium. This is usually caused by a narrowing of the coronary vessels. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 35-2 Explain the relationship between atherosclerosis and coronary artery disease.

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5) The nurse anticipates that which is a goal of antianginal therapy? 1. Increase blood flow to the peripheral blood vessels. 2. Increase myocardial contractility. 3. Increase the oxygen consumption of the heart. 4. Reduce the frequency of angina episodes. Answer: 4 Explanation: A primary goal of pharmacotherapy for angina is to reduce the frequency and intensity of angina episodes. Additionally, successful pharmacotherapy should improve exercise tolerance and allow the client to actively participate in activities of daily living. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 35-2 Explain the relationship between atherosclerosis and coronary artery disease. 6) The nurse uses which statement to best describe the link between atherosclerosis and coronary artery disease? 1. "Coronary artery disease results when atherosclerotic plaques break off and cause ischemia." 2. "Coronary artery disease results when atherosclerotic plaques block the inside of the blood vessels." 3. "Coronary artery disease results when atherosclerotic plaques grow large enough to rupture the coronary blood vessels." 4. "Coronary artery disease results when there are spasms around the atherosclerotic areas." Answer: 2 Explanation: Coronary artery disease is the progressive buildup of atherosclerotic plaque that could eventually occlude the artery. The plaque also can rupture, leading to a myocardial infarction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 35-2 Explain the relationship between atherosclerosis and coronary artery disease.

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7) The client is admitted with a diagnosis of angina. The chest pain occurred while at rest. Which term will the nurse use when documenting this client's angina? 1. Classic angina 2. Stable angina 3. Silent angina 4. Unstable angina Answer: 4 Explanation: Unstable angina is chest pain that occurs at rest or does not resolve with nitroglycerin treatment. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 35-3 Explain the pathophysiology of angina pectoris and myocardial infarction. 8) The nurse teaches the client that which is the major difference between stable angina and the pain associated with myocardial infarction (MI)? 1. Angina can be fatal. 2. Angina is relieved with nitroglycerin and rest. 3. MI pain cannot be treated. 4. MI pain always radiates to the left arm or jaw. Answer: 2 Explanation: Stable angina usually is relieved immediately by nitroglycerin or by rest. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 35-3 Explain the pathophysiology of angina pectoris and myocardial infarction.

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9) The client is admitted with a diagnosis of angina. The client's angiogram shows no sign of coronary artery disease. Which type of angina does the nurse document in the medical record for this client? 1. Unstable angina 2. Classic angina 3. Vasospastic angina 4. Stable angina Answer: 3 Explanation: Vasospastic angina is caused by intermittent spasm of the coronary arteries, resulting in severe vasoconstriction, which causes angina. It is usually diagnosed by ruling out stable and unstable angina. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 35-3 Explain the pathophysiology of angina pectoris and myocardial infarction. 10) A client is diagnosed with coronary artery disease. What will the nurse teach the client in regards to alcohol consumption? 1. Drink as much as the client prefers. 2. Completely refrain from alcohol. 3. Limit alcohol to two drinks per day. 4. Limit alcohol to one drink per day. Answer: 4 Explanation: Moderate consumption of alcohol, especially one glass of red wine per day, can have a beneficial effect on coronary artery disease. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: VII.7 Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 35-4 Discuss the role of therapeutic lifestyle changes in the management of coronary artery disease.

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11) A client is diagnosed with coronary artery disease (CAD). What will the nurse teach the client in regards to weight and exercise? 1. Exercise, even when not strenuous, is beneficial. 2. Exercise and weight have no relation to CAD. 3. Exercise is not necessary. 4. Weight loss is more important than exercise. Answer: 1 Explanation: Both weight loss and exercise are beneficial. Studies have shown that exercise, even when not strenuous, is beneficial. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: VII.7 Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 35-4 Discuss the role of therapeutic lifestyle changes in the management of coronary artery disease. 12) The nurse is preparing to teach a client therapeutic lifestyle changes that can decrease the risk of coronary artery disease. Which topics will the nurse include in the teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Eliminating the consumption of alcohol 2. Eliminating foods high in cholesterol and saturated fats 3. Maintaining blood pressure within normal levels 4. Exercising and maintaining a healthy weight 5. Decreasing the number of cigarettes smoked Answer: 2, 3, 4 Explanation: It is recommended that clients eliminate foods high in cholesterol and saturated fats in order to decrease the risk of CAD. Keeping blood pressure within normal levels decreases the risk of CAD. Exercising and maintaining a healthy weight decrease the risk of CAD. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values | AACN Essential Competencies: VII.7 Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 35-4 Discuss the role of therapeutic lifestyle changes in the management of coronary artery disease. 644

13) The nurse educator is preparing an inservice for nurses who are new to the cardiac care unit. When discussing antianginal therapy, which basic strategies will the educator include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Decreasing the oxygen consumption of the brain 2. Increasing myocardial contractility 3. Increasing blood flow to the peripheral blood vessels 4. Increasing blood flow to the myocardium 5. Decreasing myocardial oxygen demand Answer: 4, 5 Explanation: Angina is a mismatch between myocardial oxygen supply and oxygen demand. A basic antianginal strategy is to increase oxygen supply by increasing blood flow to the coronary arteries. Angina is a mismatch between myocardial oxygen supply and oxygen demand. A basic antianginal strategy is to decrease myocardial oxygen demand. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 35-5 Describe the pharmacologic management of the different types of angina. 14) Nitroglycerin relieves angina in part by vasodilating veins. What is the ultimate effect for a client who is prescribed nitroglycerin? 1. Increased cardiac output 2. Increased coronary artery perfusion 3. Increased heart rate 4. Decreased contractility Answer: 4 Explanation: Dilation of veins reduces the amount of blood returning to the heart (preload). Decreased preload causes a decrease in myocardial contractility due to Starling's law of the heart, reducing myocardial oxygen demand. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 35-5 Describe the pharmacologic management of the different types of angina.

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15) The nurse is teaching a client about the pharmacologic management of angina. The nurse plans to include which points in the client teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The medications increase the heart rate. 2. The medications dilate the veins so that the heart receives less blood. 3. The medications cause the heart to contract with less force. 4. The medications increase blood pressure. 5. The medications increase the ability of the body to produce red blood cells. Answer: 2, 3 Explanation: Medications that dilate the veins so that the heart receives less blood treat angina by decreasing preload. Medications that cause the heart to contract with less force reduce contractility and are useful in treating angina. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 35-5 Describe the pharmacologic management of the different types of angina. 16) The nurse is caring for a client who is recovering from a myocardial infarction (MI). The nurse anticipates that the client will be prescribed which medications in order to reduce post-MI mortality? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Aspirin 2. Beta blockers 3. Narcotic analgesics 4. ACE inhibitors 5. Antidysrhythmics Answer: 1, 2, 4 Explanation: Aspirin is often prescribed to reduce the risk of post-MI mortality. Beta blockers are often prescribed to reduce the risk of post-MI mortality. ACE inhibitors are prescribed to reduce the risk of post-MI mortality. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 35-6 Describe the pharmacologic management of myocardial infarction. 646

17) The nurse is auditing the medical records of MI clients treated with thrombolytic therapy in the emergency department. The nurse knows that the ideal time for a client to be treated with thrombolytics is within minutes or less for the best outcomes. Record your answer rounding to the nearest whole number. Answer: 30 Explanation: Thrombolytics are most effective when administered from 20 minutes to 12 hours after the onset of MI symptoms. Ideally, the time from presentation in the emergency department to administration of the thrombolytic agent should be 30 minutes or less. Research has demonstrated little or no therapeutic benefit if the drugs are administered 24 hours or more after the MI onset. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 35-6 Describe the pharmacologic management of myocardial infarction. 18) The nurse is reviewing the health history for a client who may be a candidate for thrombolytic therapy for the treatment of an MI. The nurse knows that therapy is contraindicated in which circumstances? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Menses 2. A history of intracranial hemorrhage 3. Hemophilia 4. Liver disease 5. Peptic ulcer disease Answer: 2, 3, 4, 5 Explanation: A history of intracranial hemorrhage is a contraindication for thrombolytic therapy. Hemophilia, a clotting disorder, is a contraindication for thrombolytic therapy. Liver disease is a contraindication for thrombolytic therapy. Peptic ulcer disease is a contraindication for thrombolytic therapy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 35-6 Describe the pharmacologic management of myocardial infarction.

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19) The nurse is preparing to administer a beta-adrenergic blocker to a client experiencing angina. A student nurse asks the nurse why the medication is being used to treat angina. Which mechanism of action will the nurse include in the response to the student? 1. Positive chronotropic effect 2. Antidysrhythmic effect 3. Positive inotropic effect 4. Negative inotropic effect Answer: 4 Explanation: Beta blockers decrease the workload of the heart by slowing heart rate (negative chronotropic effect) and reducing contractility (negative inotropic effect). Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 35-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 20) The nurse is preparing to administer a calcium channel blocker to a client experiencing angina. Which mechanism of action makes this medication appropriate for this client? 1. It increases preload. 2. It has a positive inotropic effect. 3. It decreases afterload. 4. It has a positive chronotropic effect. Answer: 3 Explanation: Calcium channel blockers cause arteriolar smooth muscle relaxation, leading to lowered peripheral resistance and decreased blood pressure (decreased afterload). This decreases myocardial oxygen demand and reduces frequency of anginal pain. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 35-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 648

21) A client diagnosed with myocardial infarction is prescribed thrombolytic therapy. The nurse recognizes that which is the goal of this therapy? 1. Prevent clot formation. 2. Dissolve clots. 3. Provide immediate relief of chest pain. 4. Prevent platelet aggregation. Answer: 2 Explanation: Thrombolytic drugs are used to dissolve clots that are already formed in early stages of myocardial infarction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 35-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 22) The nurse preparing to discharge a client with a prescription of nitroglycerin for angina knows it is important to teach the client to contact emergency medical services if chest pain is not relieved within two to three doses of nitroglycerin or 10 to minutes. Record your answer rounding to the nearest whole number. Answer: 15 Explanation: When given sublingually, nitroglycerin reaches peak plasma levels within minutes, thus quickly terminating angina pain. Chest pain that does not respond within 10 to 15 minutes after two or three doses of sublingual nitroglycerin may indicate MI, and emergency medical services (EMS) should be contacted. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 35-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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23) Which assessment finding in the client receiving a thrombolytic drug indicates a serious problem that should be reported to the healthcare provider immediately? 1. Excessive bleeding 2. Hypertension 3. Bradycardia 4. Prolonged prothrombin time Answer: 1 Explanation: Thrombolytics have a narrow margin of safety between having therapeutic effects and causing severe adverse reactions. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 35-8 Apply the nursing process to care for patients receiving pharmacotherapy for angina and myocardial infarction. 24) The nurse cautions the client receiving isosorbide dinitrate for treatment of angina that long-term use can lead to the development of which manifestation? 1. Urinary retention 2. Tachycardia 3. Tolerance 4. Hypotension Answer: 3 Explanation: Tolerance is a common problem with the use of longer acting organic nitrates. Clients often are instructed to remove the transdermal patch for 6 to 12 hours each day to delay development of tolerance to the drug. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 35-8 Apply the nursing process to care for patients receiving pharmacotherapy for angina and myocardial infarction.

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25) A client prescribed 81 mg of aspirin (ASA) daily following a myocardial infarction (MI) asks the nurse why the baby dose of ASA is prescribed. Which response by the nurse is the most appropriate? 1. "This low dose is effective and causes less GI bleeding." 2. "This is all the ASA you need right now." 3. "The lower dose is much more economical, because you will need to take this throughout your life." 4. "High doses of ASA do not prevent recurrences of an MI." Answer: 1 Explanation: The low dose of ASA (75-150 mg) used for maintenance therapy reduces the common side effects of GI distress and bleeding. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 35-8 Apply the nursing process to care for patients receiving pharmacotherapy for angina and myocardial infarction. 26) The nurse is caring for a client who is being admitted to the emergency department with severe chest pain. The healthcare provider has ordered a nitroglycerin drip. The nurse knows it is essential to ask the client about the use of erectile dysfunction drugs within the last 24 to hours in order to decrease the risk of a hypotensive crisis. Record your answer rounding to the nearest whole number. Answer: 48 Explanation: Be aware that use of erectile dysfunction drugs (for example, sildenafil [Viagra], vardenafil [Levitra], or tadalafil [Cialis]) within the past 24 to 48 hours may cause profound and prolonged hypotension when nitrates are administered. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 35-8 Apply the nursing process to care for patients receiving pharmacotherapy for angina and myocardial infarction. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 36 Pharmacotherapy of Heart Failure 1) A client has hypertension and asks the nurse how this condition can lead to heart failure. Which 651

is the best response by the nurse? 1. "Hypertension limits the ability of your heart to stretch before emptying, or afterload; your heart works harder and weakens." 2. "Hypertension causes resistance in your aorta, or afterload; your heart works harder and weakens." 3. "Hypertension causes resistance in your blood vessels, or afterload; your heart works harder and weakens." 4. "Hypertension limits the amount of blood entering your left ventricle, or afterload; your heart works harder and weakens." Answer: 3 Explanation: The most common cause of increased afterload is an increase in peripheral resistance due to hypertension. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 36-1 Identify the major diseases associated with heart failure. 2) As the nurse completes a medical history on a client admitted with heart failure, which disease should the nurse associate with heart failure? 1. Chronic obstructive pulmonary disease (COPD) 2. Stroke 3. Epilepsy 4. Myocardial infarction Answer: 4 Explanation: The most common cause of heart failure in the United States is a progressive weakening of the heart muscle related to myocardial ischemia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 36-1 Identify the major diseases associated with heart failure.

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3) The nurse is assessing a client with heart failure. Which finding is of greatest concern? 1. Mitral murmur 2. Diffuse wheezes 3. Capillary refill of 2 seconds 4. Clubbed nails Answer: 1 Explanation: Mitral stenosis is a common cause of heart failure. A mitral murmur could be indicative of mitral stenosis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 36-1 Identify the major diseases associated with heart failure. 4) The nurse is caring for a client who is diagnosed with heart failure. The nurse knows that which conditions may have contributed to the development of heart failure in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Uncontrolled hypertension 2. Coronary artery disease 3. Diabetes mellitus 4. HIV 5. Mitral stenosis Answer: 1, 2, 3, 5 Explanation: Uncontrolled hypertension is associated with the development of heart failure. Coronary artery disease is associated with the development of heart failure. Diabetes is associated with the development of heart failure. Mitral stenosis is associated with the development of heart failure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 36-1 Identify the major diseases associated with heart failure.

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5) A client comes to the emergency department complaining of coughing and difficulty breathing. The diagnosis is heart failure. The client asks the nurse how difficulty breathing could be a heart problem. Which response by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The right side of your heart has enlarged, and cannot effectively pump blood." 2. "What you have is called heart failure." 3. "The left side of your heart is weak, and pumps blood too quickly." 4. "The right side of your heart has weakened and blood has entered your lungs." 5. "The left side of your heart has weakened and blood has entered your lungs." Answer: 2, 5 Explanation: Left-sided heart failure is sometimes called heart failure, because it causes pulmonary edema (congestion). When the left ventricle cannot compensate for increased preload, blood backs up into the lungs, resulting in cough and shortness of breath. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 36-2 Relate how the symptoms associated with heart failure may be caused by a weakened heart muscle and diminished cardiac output. 6) Which assessment finding would the nurse expect in a client with right-sided heart failure (HF) as opposed to left-sided failure? 1. Orthopnea 2. Pulmonary edema 3. Dyspnea 4. Peripheral edema Answer: 4 Explanation: In right-sided HF, the blood backs up to the large veins, resulting in peripheral edema and engorgement of organs such as the liver. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 36-2 Relate how the symptoms associated with heart failure may be caused by a weakened heart muscle and diminished cardiac output.

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7) Which physical assessment finding would the nurse expect in a client with left-sided heart failure? 1. Enlarged liver 2. Lung congestion 3. Jugular venous distention 4. Peripheral edema Answer: 2 Explanation: Left-sided heart failure results in blood backing up into the lungs, causing pulmonary edema. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 36-2 Relate how the symptoms associated with heart failure may be caused by a weakened heart muscle and diminished cardiac output. 8) The nurse is caring for a client with systolic left-sided heart failure. The nurse knows that 60% to % of left-sided heart failure is systolic in nature. Record your answer rounding to the nearest whole number. Answer: 80 Explanation: Left-sided HF is further subdivided into two types. Systolic HF occurs when cardiac output (CO) is diminished due to decreased contractility of the myocardium. Approximately 60% to 80% of left-sided HF is the systolic type. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 36-2 Relate how the symptoms associated with heart failure may be caused by a weakened heart muscle and diminished cardiac output.

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9) A client with heart failure asks how blood pressure and heart rate can be high if the heart is failing. Which response by the nurse is the most appropriate? 1. "The heart must be recovering." 2. "The blood pressure and heart rate are trying to compensate because the heart cannot pump enough blood." 3. "The blood pressure and heart rate are inaccurate readings." 4. "The client must be excited." Answer: 2 Explanation: In response to decreased cardiac output, the body releases epinephrine and activates the renin-angiotensin-aldosterone system, leading to increased heart rate and blood pressure. While this would compensate for lower cardiac output in a normal client, it has a deleterious effect in heart failure, making it worse. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 36-3 Identify compensatory mechanisms used by the body to maintain cardiac output in patients with heart failure. 10) The nurse is educating a client with heart failure on monitoring for signs and symptoms. Which statement by the client indicates appropriate understanding of the teaching session? 1. "I should weigh myself every day." 2. "As long as I'm not short of breath, I don't have heart failure." 3. "If I sleep on three pillows, I will be fine." 4. "My heart rate and blood pressure would be high." Answer: 1 Explanation: Increased daily weight is a sign that a client could be decompensating. Daily weights are an effective means of monitoring for heart failure symptoms. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 36-3 Identify compensatory mechanisms used by the body to maintain cardiac output in patients with heart failure.

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11) The nurse is educating a client diagnosed with heart failure (HF). Which statements made by the client indicate the teaching was effective regarding compensatory mechanisms? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "My heart enlarged in order to compensate for the effects of heart failure." 2. "My nervous system kicks in to compensate for the effects of heart failure." 3. "My body will decrease blood flow to other organs in order to compensate for heart failure." 4. "My body will increase urine output in order to compensate for the effects of heart failure." 5. "My body will produce anti-inflammatory agents to compensate for heart failure." Answer: 1, 2, 3 Explanation: Ventricular hypertrophy occurs as a compensatory mechanism to heart failure. One of the fastest homeostatic responses to diminished cardiac output is activation of the sympathetic nervous system (SNS). The increased heart rate resulting from sympathetic activation is a normal compensatory mechanism that serves to increase cardiac output. When cardiac output in a client with HF is diminished, blood flow to the kidneys is reduced. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 36-3 Identify compensatory mechanisms used by the body to maintain cardiac output in patients with heart failure. 12) A client diagnosed with heart failure reports shortness of breath only when climbing stairs or playing with grandchildren. According to the NYHA classification, the nurse documents which stage of heart failure for this client? 1. Stage B heart failure 2. Severe heart failure 3. Stage II heart failure 4. Mild heart failure Answer: 3 Explanation: Dyspnea with moderate-to-heavy exertion is classified as stage II heart failure. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 36-4 Describe how heart failure is classified.

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13) A client asks about the difference between the New York Heart Association (NYHA) and American College of Cardiology/ American Heart Association (ACC/AHA) heart failure classification models. Which response by the nurse is the most appropriate? 1. "The NYHA classifications omit asymptomatic clients." 2. "The ACC/AHA model includes extra classifications for the most severe cases.' 3. "There is no true difference between the classifications." 4. "The ACC/AHA classifications include clients who do not have, but are at risk for, heart failure." Answer: 4 Explanation: The ACC/AHA model includes an additional classification for clients who do not have heart failure but are susceptible. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 36-4 Describe how heart failure is classified. 14) The nurse is caring for a client with heart failure. Which assessment findings indicate the client is currently experiencing stage II heart failure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fatigue with physical activity 2. Palpitations with physical activity 3. No symptoms with physical activity 4. Dyspnea with physical activity 5. Angina at rest Answer: 1, 2, 4 Explanation: Clients experiencing stage II heart failure often experience fatigue. Clients experiencing stage II heart failure often experience palpitations. Clients experiencing stage II heart failure often experience dyspnea. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 36-4 Describe how heart failure is classified.

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15) The client is prescribed an IV infusion of milrinone (Primacor) for the treatment of acute heart failure. What is the priority plan of the nurse? 1. Monitor the ECG continuously. 2. Monitor for hypertension. 3. Take vital signs every 15 minutes. 4. Monitor for atrial fibrillation. Answer: 1 Explanation: The client's ECG is usually monitored continuously during an infusion of milrinone (Primacor). Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 36-5 Describe the nurse's role in the pharmacologic management of heart failure. 16) The nurse administers isosorbide dinitrate (Isordil). Which is the correct instruction to give the client? 1. "Do not walk around until the tablet has dissolved." 2. "Rinse your mouth thoroughly after the tablet has dissolved." 3. "Take it with a glass of water." 4. "Rinse your mouth and brush your teeth before taking this medication." Answer: 3 Explanation: Isosorbide dinitrate (Isordil) is given by mouth. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 36-5 Describe the nurse's role in the pharmacologic management of heart failure.

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17) The client has a history of cardiac disease and receives furosemide (Lasix) and digoxin (Lanoxin). The nurse determines that education about dietary needs with these medications has been effective when the client makes which selection for lunch? 1. Cottage-cheese-and-peach salad and blueberry pie 2. Baked fish, sweet potatoes, and banana pudding 3. Green bean soup, whole-wheat bread, and an apple 4. Hamburger, french fries, and chocolate chip cookies Answer: 2 Explanation: Fish, sweet potatoes, and bananas are high in potassium, which will help prevent digoxin toxicity. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 36-5 Describe the nurse's role in the pharmacologic management of heart failure.

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18) The nurse is caring for a client who is being treated pharmacologically for the symptoms of heart failure. Which interventions would be included in the nurse's role of pharmacologic management of this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Teaching the client how to space medications to decrease adverse effects 2. Teaching the client the long-term benefits of beta blockers 3. Continually monitoring the client during IV infusions 4. Decreasing medication dosages when the client complains of adverse effects 5. Changing a medication that is no longer working to decrease the client's symptoms Answer: 1, 2, 3 Explanation: One role of the nurse is client teaching. The nurse should teach the client how to space medications to decrease the hypotensive effects that can occur during treatment for heart failure. Beta blockers can have many adverse effects that can affect adherence. The nurse should teach the client the long-term benefits in order to increase medication adherence. Clients who are receiving medications used to treat heart failure by IV require continual monitoring by the nurse. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 36-5 Describe the nurse's role in the pharmacologic management of heart failure.

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19) The nurse is caring for a client who is prescribed digoxin (Lanoxin) for a cardiac dysrhythmia. The nurse teaches the client about digoxin (Lanoxin) toxicity and determines that learning has occurred when the client makes which statements? 1. "It is okay to keep taking my ginseng." 2. "I can drink orange juice every morning." 3. "If I have nausea I will notify my healthcare provider." 4. "I must check my pulse, and not take the medication if it is less than 60." 5. "I should limit my fluids while taking this medication." Answer: 1 Explanation: Ginseng can increase the risk of digoxin (Lanoxin) toxicity. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 36-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 20) A client who is diagnosed with heart failure is prescribed digoxin (Lanoxin). Prior to discharge, what will the best teaching plan for the nurse to include? 1. "If you miss a dose, take two doses." 2. "Report mental changes such as euphoria." 3. "Stop the medication if your pulse is 61." 4. "Report a weight gain of two or more pounds per day." Answer: 4 Explanation: Weight gain could indicate fluid retention and a worsening of heart failure. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 36-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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21) The nurse teaches a client about lisinopril (Prinivil), and evaluates that additional teaching is required when the client makes which statement? 1. "It takes a while for this medication to take effect." 2. "I don't need to worry about having blood tests done." 3. "I will avoid using salt substitutes for seasoning." 4. "I will monitor my blood pressure until my next appointment." Answer: 2 Explanation: The use of ACE inhibitors can lead to neutropenia, and the client should be monitored for this side effect by having the absolute neutrophil count (ANC) measured. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 36-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 22) The nurse is preparing to administer digoxin to a client with heart failure. The nurse assesses an apical pulse of less than beats/min and must hold the medication and notify the healthcare provider. Record your answer rounding to the nearest whole number. Answer: 60 Explanation: As a general rule, if the apical pulse falls below 60 beats/min, the medication is withheld and the healthcare provider notified. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 36-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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23) The nurse is reviewing the lab values of a client receiving digoxin for the treatment of heart failure. The nurse plans to hold the next dose of digoxin because the serum blood level is greater than ng/mL. Record your answer rounding to the nearest whole number. Answer: 2 Explanation: The healthcare provider should establish acceptable parameters for serum digoxin levels for each client, and the drug should be discontinued if the level rises above the maximum. Digoxin levels higher than 2.0 ng/mL are considered toxic. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 36-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 24) The client is prescribed digoxin (Lanoxin) for the treatment of heart failure. Which assessment findings would indicate adverse effects of this medication? 1. Anorexia and constipation 2. Tachycardia and hypotension 3. Anorexia and nausea 4. Blurred vision and tachycardia Answer: 3 Explanation: Anorexia and nausea are common adverse effects of digoxin (Lanoxin). Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 36-7 Apply the nursing process to care for patients receiving pharmacotherapy for heart failure.

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25) A client admitted with heart failure overhears the healthcare provider discussing plans to "digitalize" the client and asks the nurse what this means. Which response by the nurse is the most appropriate? 1. "The dose of digoxin gradually is increased until the heart tissue is saturated and symptoms of heart failure subside." 2. "You will be given a series of digoxin injections over the next few days." 3. "You will be given increasing doses of digoxin until you reach a toxic level, and then the drug will be stopped." 4. "You will be given twice the usual dose of digoxin every day until therapeutic results are seen." Answer: 1 Explanation: Digitalization is the process in which the dose of digoxin gradually is increased until the heart tissue is saturated and symptoms of heart failure subside. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 36-7 Apply the nursing process to care for patients receiving pharmacotherapy for heart failure. 26) The client is prescribed enalapril (Vasotec) as treatment for heart failure. Which is the priority nursing assessment following the initial administration of this drug? 1. Assess the client for an irregular pulse. 2. Assess the client's blood pressure. 3. Assess the client for ototoxicity. 4. Assess the client for a serious rash. Answer: 2 Explanation: Severe hypotension, known as first-dose phenomenon, can occur after the initial administration of enalapril (Vasotec). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 36-7 Apply the nursing process to care for patients receiving pharmacotherapy for heart failure.

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27) The nurse is caring for a client being treated pharmacologically for heart failure. Which laboratory values should the nurse carefully monitor during treatment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Potassium levels 2. BUN 3. Creatinine 4. Liver function tests 5. Serum drug levels Answer: 1, 2, 3, 5 Explanation: It is important to monitor electrolyte levels, especially potassium, when a client is being treated pharmacologically for heart failure. It is important to monitor renal function while a client is being treated pharmacologically for heart failure. It is important to monitor renal function while a client is being treated pharmacologically for heart failure. It is important to monitor serum drug levels while a client is being treated pharmacologically for heart failure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 36-7 Apply the nursing process to care for patients receiving pharmacotherapy for heart failure. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 37 Pharmacotherapy of Dysrhythmias 1) A client presents in the emergency department with complaints of lightheadedness, dizziness, and shortness of breath. The cardiac monitor shows the client to be in atrial fibrillation with a ventricular rate of 156 beats/min. Which finding from the client's history is least likely to have resulted in this rhythm disorder? 1. Hypertension 2. Type 2 diabetes 3. Heart failure 4. Benign prostatic hyperplasia Answer: 4 Explanation: Benign prostatic hyperplasia does not promote dysrhythmias. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between 666

knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 37-1 Identify disorders associated with an increased risk of dysrhythmias. 2) A client experienced a myocardial infarction (MI) 12 hours ago. It is most important for the nurse to monitor which aspect of this client's care? 1. Breath sounds 2. Cardiac rhythm 3. Cardiac enzymes 4. Serum glucose level Answer: 2 Explanation: The client is at severe risk of developing a dysrhythmia and must be closely monitored for changes in cardiac rhythm. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 37-1 Identify disorders associated with an increased risk of dysrhythmias.

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3) A client in the emergency department complains of chest pain, diaphoresis, shortness of breath, lightheadedness, and dizziness. The cardiac monitor displays ventricular tachycardia at 180 beats/min. What is the nurse's most immediate concern for this client? 1. The client may be experiencing a posterior myocardial infarction. 2. The client may suffer a stroke. 3. The client is at risk for development of a pulmonary embolism. 4. The client is at risk for cardiac death. Answer: 4 Explanation: The most vital concern is deterioration into cardiac arrest. If not treated quickly, the client will die due to lack of circulation of oxygen. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 37-2 Explain how rhythm abnormalities can affect cardiac function. 4) A client is prescribed dofetilide (Tikosyn) for conversion of atrial fibrillation. The nurse plans to monitor for which adverse effect? 1. Widening of the QT interval 2. Inverted T waves 3. Widening of the PR interval 4. Widening of the QRS complex Answer: 1 Explanation: Like other potassium channel blockers, dofetilide prolongs the refractory period and action potential duration, thus increasing the QT interval. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 37-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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5) A client diagnosed with atrial fibrillation is prescribed a calcium channel blocker to help control the ventricular rate. The nurse plans to monitor the client's cardiac rhythm strip for which change? 1. Widening of the QRS complex 2. Widening of the QT interval 3. Inverted T waves 4. Prolongation of the PR interval Answer: 4 Explanation: Prolonging the refractory period by calcium channel blockade causes prolongation of the PR interval. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 37-6 Identify the primary mechanisms of action of antidysrhythmic drugs. 6) A client is prescribed oral verapamil (Calan) for the treatment of atrial fibrillation. Which statement indicates that the client understands the medication teaching provided by the nurse? 1. "I should not take the medication with grapefruit." 2. "This medication will slow my heart rate so I will not get so fatigued." 3. "This medication will allow my heart to go back into normal, regular rhythm." 4. "Taking this medication might cause me to need a pacemaker." Answer: 2 Explanation: Calcium channel blockers like verapamil (Calan) prolong the PR interval, thereby controlling ventricular rate in cases of atrial fibrillation. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 37-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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7) The nurse admits a client to the emergency department with new-onset atrial fibrillation and a heart rate of 168 beats/min. The client is complaining of dizziness and shortness of breath. The nurse starts an intravenous line in anticipation of administering which drug? 1. Digoxin (Lanoxin) 2. Disopyramide (Norpace) 3. Ibutilide (Corvert) 4. Lidocaine (Xylocaine) Answer: 3 Explanation: Ibutilide (Corvert) is a preferred drug for rapidly converting atrial fibrillation to normal sinus rhythm. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 37-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 8) A client is admitted to the emergency department (ED) with new-onset atrial fibrillation. Which cardiac rhythm history would be a contraindication for the use of a sodium channel blocker antidysrhythmic medication? 1. Occasional premature ventricular contractions (PVCs) 2. Multiple premature atrial contractions (PACs) 3. Elevated blood sugar 4. Second-degree AV block Answer: 4 Explanation: Sodium channel blockers slow the action potential and delay conduction, therefore risking complete heart block and cardiac arrest if used on a client with a history of existing secondor third-degree block. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 37-6 Identify the primary mechanisms of action of antidysrhythmic drugs.

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9) A client is receiving an intravenous lidocaine infusion after being converted from ventricular tachycardia. The client begins to display signs of confusion, anxiety, agitation, and restlessness. What should the nurse do first? 1. Increase the rate of lidocaine infusion. 2. Turn off the lidocaine infusion. 3. Administer oxygen at 4 L per nasal cannula. 4. Notify the client's healthcare provider. Answer: 2 Explanation: The first signs of lidocaine toxicity usually involve the CNS and include confusion, anxiety, tremors, and other symptoms. The infusion should be discontinued immediately, and the healthcare provider notified. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 37-4 Design a table that indicates the classification of dysrhythmias and the types of drugs used to treat them. 10) A client with a history of heart failure (HF) is prescribed propranolol (Inderal) for control of ventricular tachycardia. Which instruction is most important for the nurse to provide to this client? 1. "Report nausea to your healthcare provider." 2. "Immediately report an increase of shortness of breath or weight gain of 2 pounds over 1 day." 3. "Weigh yourself each day at approximately the same time, with the same amount of clothing." 4. "Exercise at least 30 minutes daily." Answer: 2 Explanation: Propranolol (Inderal) reduces myocardial automaticity, thereby potentially reducing cardiac output and exasperating symptoms of HF. Symptoms of HF should be reported immediately when taking a beta blocker. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 37-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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11) A client is started on sotalol (Betapace) for conversion of atrial fibrillation. Which finding requires immediate nursing action? 1. A widening of the QRS complex 2. Complaints of a "flutter" feeling in the chest 3. Complaints of headache 4. Increased blood glucose level Answer: 1 Explanation: Sotalol delays repolarization and prolongs the refractory period, thus widening the QT interval. Widening of the QRS complex can be a precursor to ventricular tachycardia. The healthcare provider should be alerted immediately, and the medication held. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 37-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 12) A client prescribed a calcium channel blocker for control of hypertension is now prescribed a beta blocker to control a fast ventricular rate. What should the nurse include in instructions regarding the medications? 1. Eat a high-fiber, low-carbohydrate diet. 2. Do not take this medication with grapefruit juice. 3. Maintain a daily exercise regimen. 4. Report irregular heart rate or shortness of breath to the healthcare provider. Answer: 4 Explanation: Because concurrent use of a calcium channel blocker and a beta-adrenergic blocker can cause partial or complete heart block, palpitations or dyspnea should be reported immediately. The nurse should give instructions in terms the client can understand. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 37-6 Identify the primary mechanisms of action of antidysrhythmic drugs.

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13) The nurse is preparing to administer procainamide (Pronestyl) intravenously for conversion of atrial flutter. How should the nurse position the client? 1. In the Trendelenburg position 2. Prone 3. Supine 4. With the head of the bed elevated Answer: 3 Explanation: The supine position should be maintained with IV infusion of procainamide (Pronestyl) due to the increased risk of hypotension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 37-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 14) Discharge orders for a client who suffered a myocardial infarction 5 days ago state, "Continue home medications." The client's medications include flecainide (Tambocor). How should the nurse proceed? 1. Include instructions for the client to rise slowly to an upright position. 2. Instruct the client to limit alcohol intake to very moderate amounts. 3. Contact the healthcare provider to verify whether the client is to restart the flecainide. 4. Instruct the client to carry a medic alert card at all times with instructions for flecainide. Answer: 3 Explanation: Flecainide is contraindicated in clients who have experienced a recent MI. The nurse should verify the order. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 37-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 673

15) A client who underwent cardioversion for atrial fibrillation is prescribed amiodarone (Cordarone). Which testing should the nurse ensure has been completed before the client starts this medication? 1. A hearing test 2. A fasting blood sugar 3. A pulmonary lung function test 4. A 24-hour urine test for creatinine Answer: 3 Explanation: The most serious side effect of amiodarone can occur in the lungs. Because pulmonary toxicity can be fatal, baseline and periodic assessments of lung function are essential. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 37-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 16) Which statement would the nursing supervisor evaluate as indicating that a new cardiac nurse understands the fluxes associated with cardiac action potentials? 1. "Phase 4 is the time in which the cells rest." 2. "Depolarization occurs during phase 1." 3. "The inside of the plasma membrane becomes negative during phase 1." 4. "Repolarization occurs during phase 4." Answer: 1 Explanation: In phase 4, the action potential has not yet occurred and the cell is resting. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 37-3 Sketch a typical cardiac action potential and label the flow of potassium, sodium, and calcium ions during each phase.

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17) Which client in a cardiac step-down unit would the nurse monitor most closely for the development of stroke? 1. An 80-year-old client whose cardiac monitor reveals bradycardia with a rate of 58 2. A 56-year-old client with a PR interval of 0.22 seconds 3. A 37-year-old client with recent-onset atrial fibrillation 4. A 63-year-old client with occasional premature ventricular contractions (PVCs) Answer: 3 Explanation: Atrial fibrillation slows the movement of blood through the chambers of the heart and may result in clot formation. If a clot is ejected from the heart into the systemic circulation, a stroke may occur. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 37-2 Explain how rhythm abnormalities can affect cardiac function. 18) A client presents to the emergency department (ED) with dyspnea, diaphoresis, and lightheadedness. The cardiac monitor reveals paroxysmal supraventricular tachycardia (SVT). Which class of antiarrhythmic drug does the nurse anticipate will be administered? 1. A calcium channel blocker 2. A Class IC drug 3. A Class IB drug 4. A Class IA drug Answer: 1 Explanation: Calcium channel blockers are Class IV antiarrhythmic drugs and are administered to treat SVT. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 37-4 Design a table that indicates the classification of dysrhythmias and the types of drugs used to treat them.

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19) A client scheduled for a catheter ablation to treat atrial fibrillation says, "I am not sure about this procedure. Can they just treat me with medicine?" Which response by the nurse is the most appropriate? 1. "Many people do take drugs for atrial fibrillation. Your case must be different." 2. "Catheter ablation is more successful and has fewer long-term adverse effects than drug therapy." 3. "Most of the medications used for atrial fibrillation have been taken off the market." 4. "Atrial fibrillation is too dangerous to be treated with medications alone." Answer: 2 Explanation: Catheter ablation has been shown to be more successful in treating many dysrhythmias than is the prophylactic use of medications. The treatment is generally definitive and results in fewer adverse effects. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 37-5 Describe general principles guiding the management of dysrhythmias. 20) The nurse in a heart failure clinic explains the effect of cardiac dysrhythmia on the body to a group of clients. What is the most important information to include in this teaching? 1. "Cardiac rhythm disturbances cause the amount of blood pumped out of your heart to decrease." 2. "Most cardiac rhythm disturbances do not affect the body at all." 3. "The biggest problem with most cardiac rhythm disturbances is that they cause nervousness and irritability." 4. "Cardiac rhythm disturbances often cause gastrointestinal upset." Answer: 1 Explanation: One of the biggest results of cardiac rhythm disturbance is decreased cardiac output. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 37-2 Explain how rhythm abnormalities can affect cardiac function.

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21) A client is admitted with the medical diagnosis of sick sinus syndrome. The nurse expects that this client's apical pulse will be less than beats/min. Record your answer rounding to the nearest whole number. Answer: 40 Explanation: In sick sinus syndrome, the SA node fails to generate or transmit sufficient electrical impulses. A client with this diagnosis experiences severe bradycardia with a rate lower than 40 beats/min. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 37-2 Explain how rhythm abnormalities can affect cardiac function. 22) The nurse is administering an intravenous antiarrhythmic drug known to have the adverse effect of prolonging the QRS interval. As the medication is administered, the nurse watches for a QRS interval that exceeds second. Record your answer rounding to the nearest hundredths place. Answer: 0.11 Explanation: The normal QRS interval is up to 0.11 second. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 37-5 Describe general principles guiding the management of dysrhythmias.

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23) The nurse and a home health client have established this expected outcome: "The client will be free from adverse effects of administration of diltiazem (Cardizem)." Which finding indicates this outcome has not been met? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client complains of headache at each visit by the nurse. 2. The client has 3+ edema in the ankles and feet. 3. The client says, "Everything I eat tastes like metal." 4. The client says, "I got so dizzy yesterday that I had to lie down for a while." 5. The client's face is flushed. Answer: 1, 2, 4 Explanation: Headache is a potential adverse effect of diltiazem. Edema of the ankles and feet is a potential adverse effect of diltiazem. Dizziness is an expected adverse effect of diltiazem. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 37-8 Apply the nursing process to care for patients receiving pharmacotherapy for dysrhythmias.

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24) A client is prescribed an additional once-daily antidysrhythmic drug to control persistent atrial fibrillation. Which instructions should the nurse provide for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Take your first dose of this new medication before you go to bed tonight." 2. "Do not eat or drink anything for 2 hours after taking the new medication." 3. "Before you get out of bed in the morning, sit up on the side of the bed for a few minutes." 4. "Plan to return to the clinic to have your electrolytes checked in 2 weeks." 5. "Contact the clinic if you notice any loss of hair from your head." Answer: 1, 3, 4 Explanation: The addition of a second medication makes the client prone to hypotension. Taking the drug right before bedtime is a safety precaution. Orthostatic hypotension can be an adverse effect of antidysrhythmic medications, particularly when multiple drugs are taken. Sitting on the side of the bed before arising is a safety precaution. Electrolyte imbalance can occur secondary to drug therapy for dysrhythmia. Electrolyte levels should be monitored. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 37-8 Apply the nursing process to care for patients receiving pharmacotherapy for dysrhythmias.

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25) A client is prescribed potassium channel blocker for 4 weeks. Which statements would indicate the client understands the teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I got some sunglasses like you said. Do you like them?" 2. "I know that the rash is from the new medication." 3. "I am scheduled to see the eye doctor in another month." 4. "I wear sunscreen whenever I am outdoors." 5. "I think that medicine is making my hair gray." Answer: 1, 2, 3, 4 Explanation: Potassium channel blockers can cause photosensitivity, and wearing sunglasses protects the eyes. Potassium channel blockers can cause skin rashes. Potassium channel blockers may cause blurred vision. Potassium channel blockers cause increased risk of sunburn. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 37-8 Apply the nursing process to care for patients receiving pharmacotherapy for dysrhythmias.

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26) The nurse is providing information for a client who will self-administer a twice-daily antidysrhythmic medication at home. Which client statements evaluates understanding of the teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "If I get the flu, I should stop taking the medication until my fever goes down." 2. "I should take my doses as close to 12 hours apart as I can." 3. "If I forget a dose of medication I should take two pills for the next dose." 4. "If I can't take the medication for a couple of days because I am sick, I should call the clinic for advice." 5. "I should get my prescription refilled before I am completely out of medicine." Answer: 2, 4, 5 Explanation: Doses of antidysrhythmic medications should be evenly spaced. The healthcare provider should be consulted if the client is going to miss medication for more than 1 day. Abrupt discontinuation of antidysrhythmic medications can have serious side effects, so an adequate supply of the medication should be available. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 37-8 Apply the nursing process to care for patients receiving pharmacotherapy for dysrhythmias.

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27) A client who has been taking medication for a month for an atrial dysrhythmia returns to the clinic for a checkup. Which statements indicate the nurse should plan extra time with the client for additional teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Since I can't drink coffee anymore, I have started drinking diet cola in the mornings." 2. "I have found that a glass of wine after work and one with dinner helps me to relax from my stressful job." 3. "We have celebrated several birthdays since I saw you last. I love chocolate birthday cake." 4. "I have really worked at stopping my smoking since I was last here." 5. "My friends and I have found several restaurants in our area that offer good, low-fat meals." Answer: 1, 2, 3 Explanation: Unless the diet cola is decaffeinated, it should also be avoided. Alcohol should be limited when taking medications for atrial arrhythmias. Chocolate contains caffeine, which should be avoided when taking medications for atrial arrhythmias. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 37-8 Apply the nursing process to care for patients receiving pharmacotherapy for dysrhythmias.

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28) A client who is admitted to the hospital for treatment of premature ventricular contractions (PVCs) says, "I took a medicine called procainamide years ago when I had PVCs and it worked great. I quit taking it because I did not think I needed it anymore. Maybe the doctor can give me some of that." Which responses by the nurse are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You must be confused, because procainamide is not given orally." 2. "I will be certain to let the doctor know that. He might just restart your medication." 3. "Procainamide is given for arrhythmias that come from a different part of the heart than yours." 4. "Procainamide is no longer the preferred drug for your type of arrhythmia." 5. "Procainamide has some serious side effects and we have better drugs for your condition now." Answer: 4, 5 Explanation: Procainamide is now considered the drug of "last choice" for advanced cardiac life support due to its toxicity. Procainamide has a narrow therapeutic index, and dosage must be monitored carefully to avoid serious adverse effects. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 37-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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29) Which phase occurs with the influx of calcium into the cells and the efflux of potassium from the cells? 1. Phase 4 2. Phase 1 3. Phase 2 4. Phase 3 Answer: 3 Explanation: In phase 2, entry of calcium and the efflux of potassium from the cells occurs. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 37-3 Sketch a typical cardiac action potential and label the flow of potassium, sodium, and calcium ions during each phase. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 38 Pharmacotherapy of Coagulation Disorders 1) Assessment for deep vein thrombosis (DVT) is a priority for which client? 1. A client with a gastric ulcer 2. A client with hypertension 3. A client recovering from a knee replacement 4. A client with pneumonia Answer: 3 Explanation: Surgery of the lower extremities, especially knee and hip replacements, are common causes of DVT. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 38-1 Describe primary risk factors for thromboembolic disorders. 2) The nurse is addressing a group of clients who have experienced thromboembolic disorders. One of the clients states, "My dad had a problem with clotting too much and so does my brother." Before responding to this comment, the nurse considers which information? 1. A genetic deficiency of protein C can produce hypercoagulability. 2. Familial eating habits can result in deficiency of vitamin C that would increase clotting. 3. Genetic deficiency of C peptide is implicated in clotting disorders. 4. If there is a genetic tendency to decreased C reactive protein (CRP), the clotting cascade is enhanced. Answer: 1 Explanation: Protein C is a natural anticoagulant. Too little would cause increased clotting. 684

Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 38-1 Describe primary risk factors for thromboembolic disorders.

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3) The client states, "I've never had such trouble breathing. What is a pulmonary embolus anyway?" Which response by the nurse is the most appropriate? 1. "A pulmonary embolus is a stationary blood clot that formed in your lung." 2. "An embolus is a piece of the injured blood vessel that is moving in your lung." 3. "A pulmonary embolus is a portion of a blood clot that has moved from its original location to your lung." 4. "A pulmonary embolus is an area of tissue in your lung that has lost its blood supply and has become necrotic." Answer: 3 Explanation: A thrombus that detaches and moves is called an embolus. Because the thrombus has moved to the lung, it is called a pulmonary embolus. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-2 Explain the etiology and symptoms of coagulation disorders. 4) The nurse is planning a teaching session for a client newly diagnosed with hemophilia A. Which information should be included? 1. An extra protein is present that breaks down clots too quickly. 2. A substance that is part of the clotting process is missing. 3. The blood is missing a substance that inhibits clotting. 4. There are not enough platelets present. Answer: 2 Explanation: Hemophilia is characterized by a missing clotting factor. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 38-2 Explain the etiology and symptoms of coagulation disorders.

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5) Which class of drugs would the nurse expect to be prescribed to a client who is bleeding excessively at a surgical site? 1. Thrombolytics 2. Antifibrinolytics 3. Anticoagulants 4. Prothrombin activators Answer: 2 Explanation: Antifibrinolytic drugs inhibit normal removal of fibrin, resulting in a clot that remains intact longer. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-3 Identify the primary mechanisms by which coagulation-modifying drugs act. 6) A clinic nurse is developing a teaching handout for clients who are prescribed warfarin (Coumadin) therapy. Which statements should be included in this information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Tell your dentist you are taking warfarin prior to any procedures." 2. "Report to the lab for testing of activated partial thromboplastin time (APTT)." 3. "Avoid strenuous activities." 4. "Place ice at the injection site if stinging or burning occurs." 5. "Take nonsteroidal anti-inflammatories (NSAIDs) for minor pain relief." Answer: 1, 3 Explanation: Warfarin increases the risk of bleeding from dental procedures. Strenuous or risky activities place the client at risk for injury and bleeding. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-7 Apply the nursing process to care for patients receiving pharmacotherapy for coagulation disorders.

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7) A client is prescribed intermittent intravenous heparin therapy to treat deep vein thrombosis (DVT). Which laboratory value should the nurse review prior to administering this medication? 1. Prothrombin time (PT) 2. Fibrinogen level 3. Activated partial thromboplastin time (APTT) 4. Factor VIII level Answer: 3 Explanation: APTT measures the effectiveness of heparin therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IV.6 Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 38-4 Explain how laboratory testing of coagulation parameters is used to monitor anticoagulant pharmacotherapy. 8) The baseline international normalized ratio (INR) of a client started on warfarin (Coumadin) for atrial fibrillation was 1.2. The nurse notes that the INR value is 2.5 prior to administration of the next dose of medication. Which action by the nurse is the most appropriate? 1. Administer the antidote and observe for bleeding. 2. Notify the healthcare provider so that the dose can be increased. 3. Administer the medication as ordered. 4. Hold medication and contact the healthcare provider. Answer: 3 Explanation: INR values averaging 2.5 are considered therapeutic for most indications. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality | AACN Essential Competencies: IV.6 Evaluate data from all relevant sources, including technology, to inform the delivery of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-4 Explain how laboratory testing of coagulation parameters is used to monitor anticoagulant pharmacotherapy.

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9) A nurse assessing a client on a heparin drip notes bloody drainage in the nasogastric tube and indwelling urinary catheter. A stat partial thromboplastin time (PTT) is drawn according to heparin protocol. The result is 224 seconds. Which action by the nurse is the most appropriate? 1. Notify the healthcare provider and prepare to administer protamine sulfate. 2. Stop the infusion, increase the IV rate, and prepare to administer aminocaproic acid (Amicar). 3. Notify the supervisor and obtain a unit of clotting factors. 4. Call the healthcare provider and prepare to administer vitamin K. Answer: 1 Explanation: Bleeding accompanied by a PTT of 224 seconds indicates dangerously high overheparinization. Notification of the healthcare provider is essential. Protamine sulfate is administered to neutralize the anticoagulant activity of heparin. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-5 Describe the nurse's role in the pharmacologic management of patients with coagulation disorders. 10) The client prescribed heparin therapy asks how the "blood thinner" works. Which response by the nurse is the most appropriate? 1. "Heparin dissolves the clot." 2. "Heparin makes the blood less viscous." 3. "Heparin decreases the number of platelets so that blood clots more slowly." 4. "Heparin prevents clots from forming." Answer: 4 Explanation: Heparin inhibits the clotting cascade, preventing clots from forming. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-5 Describe the nurse's role in the pharmacologic management of patients with coagulation disorders.

689

11) A hospitalized client is prescribed warfarin (Coumadin). The nurse teaches the client to avoid which food on the lunch selection menu? 1. Whole-wheat bread with margarine 2. Roast beef 3. Salt substitute 4. Broccoli salad Answer: 4 Explanation: Broccoli is high in vitamin K, and must be avoided when a client receives warfarin (Coumadin). Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 12) A client with a newly placed prosthetic heart valve will be maintained on long-term anticoagulant therapy. Which medication does the nurse anticipate being used for this purpose? 1. Enoxaparin (Lovenox) 2. Dalteparin (Fragmin) 3. Heparin 4. Warfarin (Coumadin) Answer: 4 Explanation: Warfarin (Coumadin) is the preferred drug for long-term anticoagulation in a client with a prosthetic heart valve. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 38-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

690

13) How would a nurse explain the action of pentoxifylline (Trental) to a client? 1. Pentoxifylline is given to dissolve clots. 2. Pentoxifylline acts by increasing platelet production. 3. Pentoxifylline increases fibrin production. 4. Pentoxifylline reduces the viscosity of red blood cells. Answer: 4 Explanation: Pentoxifylline acts on red blood cells to decrease their viscosity, increasing their flexibility and allowing them to enter vessels that are partially occluded and prevent thrombi formation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

691

14) An adult client is brought to the emergency department (ED) and diagnosed with a thrombotic stroke. The team plans to administer alteplase (Activase). The client makes the following comments to a nurse. Which information is critical for the nurse to relay to the healthcare provider? 1. "I can't believe this is happening. My baby is only a year old." 2. "I thought this was just my asthma acting up." 3. "I wonder if this was happening when I fell and hit my head last week." 4. "I had a blood clot in my leg last year after my baby was born." Answer: 3 Explanation: The use of alteplase (Activase) increases the risk of severe bleeding. Clients with head injury can experience intracranial bleeding, which can cause brain damage and is potentially fatal. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

692

15) The nurse is planning care for a client prescribed enoxaparin (Lovenox). Which interventions should be included? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Teach the client or family to give subcutaneous injections at home. 2. Monitor for development of deep vein thrombosis. 3. Monitor multiple lab tests. 4. Teach the client signs of excessive bleeding. 5. Schedule administration times right before breakfast and the evening meal. Answer: 1, 2, 4 Explanation: Family and clients can be taught to give subcutaneous injections at home. Enoxaparin (Lovenox) is used to prevent DVTs. The nurse should observe for the development of DVTs. Although enoxaparin (Lovenox) is more predictable than are other anticoagulants and has fewer adverse effects, bleeding is still a possibility. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-7 Apply the nursing process to care for patients receiving pharmacotherapy for coagulation disorders.

693

16) As the nurse is completing the physical assessment of a client receiving heparin therapy for deep vein thrombosis (DVT), the client complains of severe lumbar pain. Which is the nurse's priority action? 1. Evaluate further because this could indicate a complication of drug therapy. 2. Reposition the client to promote comfort. 3. Administer pain medication. 4. Document the finding and report it to the next shift. Answer: 1 Explanation: A major side effect of heparin is bleeding. Lumbar pain and unilateral abdominal wall bulges or swelling could indicate retroperitoneal hemorrhage. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-7 Apply the nursing process to care for patients receiving pharmacotherapy for coagulation disorders. 17) Alteplase (Activase) is prescribed for a client with an acute myocardial infarction. Which is the priority nursing intervention for this client? 1. Monitor APTT. 2. Monitor PT/INR. 3. Monitor injection sites. 4. Monitor level of consciousness (LOC). Answer: 4 Explanation: Thrombolytics dissolve any clots they encounter. Cerebral hemorrhage is a major concern, so the nurse must assess the level of consciousness and neurologic status. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 38-7 Apply the nursing process to care for patients receiving pharmacotherapy for coagulation disorders.

694

18) A client has lost 50 lb by following a diet that allows 1,200 calories each day. Today's laboratory results reveal a significant decrease in platelets. Which foods should the nurse recommend the client add to the daily diet? 1. Moderate-carbohydrate foods 2. Foods high in vitamin C 3. Fiber-rich foods 4. Foods rich in folic acid Answer: 4 Explanation: A common cause of decreased platelet production is folic acid deficiency. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-2 Explain the etiology and symptoms of coagulation disorders. 19) The nurse is providing discharge instructions to a client who is going home after a knee replacement. Which information regarding symptoms of deep vein thrombosis (DVT) should the nurse include? 1. "If you develop a DVT, you will know it." 2. "Watch for paleness or coolness in your toes." 3. "Report any swelling in your knee." 4. "Look for increased tenderness in your lower legs." Answer: 4 Explanation: Tenderness, warmth, or swelling in the lower legs may indicate DVT. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-1 Describe primary risk factors for thromboembolic disorders.

695

20) A client's intravenous heparin drip rate will be increased at 1400. The nurse plans to draw an activated partial thromboplastin time (aPTT) at which time? 1. Immediately after increasing the rate 2. At 2000 3. At 1530 4. At 0800 the next morning Answer: 2 Explanation: The most accurate representation of aPTT from the new rate will occur at least 6 hours after a rate increase. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 38-1 Describe primary risk factors for thromboembolic disorders. 21) A client is maintained on warfarin (Coumadin) therapy secondary to refractory atrial fibrillation. Which statement by the client would alert the nurse to a possible problem with this therapy? 1. "I have started taking a vitamin C supplement to prevent colds this winter." 2. "I am learning to use olive oil in my cooking." 3. "I've stopped drinking coffee and now drink decaffeinated green tea." 4. "I have a big glass of grapefruit juice with my breakfast every day." Answer: 3 Explanation: Drinking green tea while taking warfarin may increase the risk of bleeding. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 38-5 Describe the nurse's role in the pharmacologic management of patients with coagulation disorders.

696

22) The nurse is monitoring for the development of thrombocytopenia in a client receiving heparin therapy. The nurse determines that thrombocytopenia has occurred when the platelet count drops below mm3. Record your answer rounding to the nearest whole number. Answer: 150,000 Explanation: Thrombocytopenia occurs when the platelet count falls below 150,000 mm3. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 38-2 Explain the etiology and symptoms of coagulation disorders. 23) A client is being treated for a thromboembolic disorder. If the goal is to prevent clot formation, the nurse anticipates the client will be treated with which classifications of drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Hemostatics 2. Thrombolytics 3. Anticoagulants 4. Antiplatelet agents 5. Clotting factor concentrates Answer: 3, 4 Explanation: Anticoagulants inhibit specific clotting factors, thereby preventing clot formation. Antiplatelet agents inhibit the action of platelets, thereby preventing clot formation. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 38-3 Identify the primary mechanisms by which coagulation-modifying drugs act.

697

24) The nurse is providing care for a client who developed heparin-induced thrombocytopenia (HIT) during heparin therapy. The nurse is aware that lepirudin (Refludan) is often given to clients with this condition. Which assessment findings should the nurse report to the medical team? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The most recent aPTT is 2.8. 2. The client's last stool tested positive for blood. 3. The client is allergic to eggs. 4. The client's spleen was removed after a motor vehicle crash 3 years ago. 5. The client drinks 5 to 6 cups of coffee daily. Answer: 1, 2 Explanation: Lepirudin is contraindicated if the aPTT is above 2.5. Lepirudin is contraindicated in clients who are actively bleeding. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-5 Describe the nurse's role in the pharmacologic management of patients with coagulation disorders.

698

25) The nurse is providing discharge teaching regarding anticoagulant therapy. Which statements by the client would the nurse evaluate as indicating the need for further instruction? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I'll ask for an electric razor for my birthday next week." 2. "I guess my trip to the amusement park is off for now." 3. "I won't be able to cook anymore." 4. "I'll get one of those new electric toothbrushes with the firm bristles." 5. "I should make an appointment for a B12 injection monthly." Answer: 3, 4, 5 Explanation: The client should be cautious when cutting food for preparation, but cooking is not prohibited. The client should use a soft-bristle toothbrush. IM injections should be avoided. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 38-7 Apply the nursing process to care for patients receiving pharmacotherapy for coagulation disorders.

699

26) A client is prescribed ticagrelor (Brilinta) after a myocardial infarction and stent placement. How should the nurse explain the action of this medication to the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "It will dissolve any clots that might form in your stent." 2. "It will make the platelets in your blood less sticky." 3. "It will change the way your platelets work their entire lives." 4. "It decreases your blood's ability to clot." 5. "It works just like the heparin you have been on in the hospital." Answer: 2, 3, 4 Explanation: Ticagrelor is an adenosine diphosphate (ADP) receptor blocker that acts to make platelets unable to aggregate, thus rendering them less "sticky." Ticagrelor causes irreversible changes in platelet plasma membranes. Ticagrelor does decrease the blood's ability to clot. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-3 Identify the primary mechanisms by which coagulation-modifying drugs act. 27) A nurse manager is making nurse assignments for care of clients who have just received thrombolytic therapy. The nurse specifically tells a new nurse, "Be certain to hold pressure on any puncture sites for at least minutes." Record your answer rounding to the nearest whole number. Answer: 30 Explanation: Thrombolytic therapy increases the risk of bleeding from any invasive procedure. Pressure should be held on any puncture site for a minimum of 30 minutes. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-7 Apply the nursing process to care for patients receiving pharmacotherapy for coagulation disorders.

700

28) A client who has hemophilia A is scheduled for a minor surgical procedure. The client states, "I'm worried about this surgery. My doctor told me I had to come to the hospital for some kind of treatment a week before it. What is that all about?" Which responses by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You must have misunderstood the directions. Let me check with the healthcare provider." 2. "Blood will be taken and banked in case you need to have it retransfused on the day of surgery." 3. "You will be given a test dose of a medication used to increase your clotting factors." 4. "This visit is related to your hemophilia and keeping you safe during the surgery." 5. "Don't be worried about the testing. Nothing will hurt." Answer: 3, 4 Explanation: Desmopressin therapy can cause an increase in Factor VIII levels. A test dose is given 1 week prior to minor surgery to determine if the client is responsive to the drug. Simple answers that assure the client that his or her safety is being protected are useful when working with clients whose anxiety is elevated. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 38-7 Apply the nursing process to care for patients receiving pharmacotherapy for coagulation disorders.

701

29) During the health history assessment, an adult client says, "I've been told I have some sort of bleeding disorder, but I'm not certain." Which responses by the nurse are the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Did the healthcare provider mention von Willebrand disease?" 2. "None of the inherited bleeding disorders affect women." 3. "Is there a history of bleeding disorders in your family?" 4. "Have you ever experienced excessive bleeding or easy bruising?" 5. "If you had a true bleeding disorder you would have had symptoms earlier in your life." Answer: 1, 3, 4 Explanation: Von Willebrand disease is the most common inherited coagulation disorder. Many bleeding disorders are inherited. Excessive bleeding and easy bruising are signs of bleeding disorders. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 38-7 Apply the nursing process to care for patients receiving pharmacotherapy for coagulation disorders.

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30) A client has been taking oral anticoagulant therapy for a number of years secondary to atrial fibrillation. Which client statement alerts the nurse to assess more closely for the development of drug-induced hepatitis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I seem to be making more urine that normal." 2. "My stools are a funny light yellow color." 3. "I need an ointment to keep my skin from itching so much." 4. "My legs hurt when I walk very far." 5. "I seem to be very thirsty most of the time." Answer: 2, 3 Explanation: Clay-colored stools are indicative of liver changes. Itchy skin can be associated with hepatitis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 38-7 Apply the nursing process to care for patients receiving pharmacotherapy for coagulation disorders. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 39 Pharmacotherapy of Hematopoietic Disorders 1) A client who recently started on chemotherapy states, "The doctor told me my stem cells were down. A stem cell sounds like something on a flower! What did the doctor mean?" Which response by the nurse provides the best explanation? 1. "Stem cells are found in your bone marrow. They can turn into red blood cells, white blood cells, or platelets, depending on what your body needs at the time. Right now, your body is producing fewer than it should." 2. "Did the oncology nurse give you a copy of the pamphlet that discusses the unwanted effects of chemotherapy?" 3. "Bone marrow depression is a common side effect of chemotherapy, but it can be treated." 4. "The complete blood count you had yesterday showed a decrease in the number of stem cells. Your doctor is keeping you informed." Answer: 1 Explanation: Stem cells are located in the bone marrow. They can differentiate into several cell lines, depending on the body's requirements. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing 703

Process: Implementation Learning Outcome: 39-1 Describe the physiology of hematopoiesis. 2) One of the adverse effects of a chemotherapy drug being administered to a client is depression of pluripotent stem cells. Which change in this client's lab values would the nurse expect after treatment is initiated? 1. Decrease in red blood cells only 2. Abrupt decrease in hemoglobin and serum ferritin levels 3. Abrupt decrease in red blood cells, white blood cells, and platelets 4. Gradual decrease in red blood cells with a gradual increase in white blood cells Answer: 3 Explanation: Depression of pluripotent stem cells decreases the blood level of RBCs, WBCs, and platelets. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 39-1 Describe the physiology of hematopoiesis.

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3) After major surgery, a client's hemoglobin is 9.6 g/dL. The nurse expects that the client's erythropoietin output would go up, but recognizes that increased production is largely dependent on which factor? 1. Resumption of regular and balanced dietary intake 2. Normal kidney function 3. Normal bone marrow function 4. Normal serum ferritin levels Answer: 2 Explanation: The bone marrow is stimulated by erythropoietin from the kidney. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 39-1 Describe the physiology of hematopoiesis. 4) The nurse is caring for a client with a very low platelet count. The nurse recognizes that a resurgence in the platelet count is most likely to occur in response to a higher circulating level of which substance? 1. Thrombopoietin 2. Colony-stimulating factors 3. An interferon 4. Erythropoietin Answer: 1 Explanation: Platelets are derived from megakaryocytes. Their production is driven by thrombopoietin. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 39-1 Describe the physiology of hematopoiesis.

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5) A client is hospitalized for pharmacologic management of a hematopoietic disorder secondary to chemotherapy treatment. The client states, "This sounds really bad. How will I be treated for this problem?" Which responses by the nurse are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You will probably need multiple blood transfusions." 2. "In many cases we can give you medications that are very similar to substances already produced in your body." 3. "We will give you medications to reverse your chemotherapy." 4. "Since you are low on some blood cells, we will give you medications to increase your body's production of those cells." 5. "You will need several radiation treatments to slow down production of your blood cells." Answer: 1, 4 Explanation: Since the client has been hospitalized for pharmacologic treatment, the need for multiple blood transfusions is unlikely. A simple statement of the action of the medications that will be administered, along with the reason they are being given, is a good response to this client's concerns. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-1 Describe the physiology of hematopoiesis. 6) A nurse administers an exogenous erythropoietin in the form of epoetin alfa (Epogen) to a client on dialysis. Which statement best describes the action of this drug to the client? 1. "Epogen will change the shape of your red blood cells to increase their flexibility." 2. "Epogen changes the molecular structure of your hemoglobin, making it carry more oxygen." 3. "Epogen helps to increase the concentration of the oxygen carrier in your blood." 4. "Epogen makes your red blood cells bigger around." Answer: 3 Explanation: Epogen helps to increase hemoglobin concentration as well as the number of red blood cells. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-2 Describe how aspects of hematopoiesis can be modified by the administration of pharmacologic agents.

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7) A nurse who works in an outpatient chemotherapy unit has received an order to administer filgrastim (Neupogen) to a client who received chemotherapy this morning. The client's white blood cell count is dropping rapidly. The nurse asks the client to return to the unit tomorrow for the filgrastim. What is the rationale for the nurse's request? 1. If given today, the increase in the white blood cell count will occur too rapidly. 2. The actions of the filgrastim and chemotherapy drugs will oppose each other. 3. If the filgrastim is given today, the risk of liver damage will increase. 4. There is an increased risk of adverse reaction to both drugs. Answer: 2 Explanation: Because antineoplastic drugs and CSFs produce opposite effects, filgrastim is not administered until at least 24 hours after a chemotherapy session. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 39-2 Describe how aspects of hematopoiesis can be modified by the administration of pharmacologic agents. 8) A client is receiving epoetin alfa (Epogen) therapy. The nurse would evaluate the therapy as successful if the client averages a % increase in hematocrit weekly. Record your answer rounding to the nearest whole number. Answer: 2 Explanation: Epoetin alfa therapy results in a slow rise in hematocrit at a rate of about 2% per week. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 39-2 Describe how aspects of hematopoiesis can be modified by the administration of pharmacologic agents.

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9) The healthcare provider has ordered epoetin alfa 50 units/kg subcutaneously three times weekly. Today the client weighs 143 lb. The nurse should administer units of epoetin. Record your answer rounding to the nearest whole number. Answer: 3,250 Explanation: The nurse divides the client's weight in pounds (143) by 2.2 (2.2 lb/kg) to determine that the client weighs 65 kg. That figure is multiplied by 50 units to achieve a dose of 3,250 units. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-2 Describe how aspects of hematopoiesis can be modified by the administration of pharmacologic agents. 10) A client with chronic obstructive pulmonary disease (COPD) demonstrates a consistently low pulse oximetry value. The nurse notes a ruddy facial color with purple undertones and recognizes the effects of which elevated blood levels? 1. Colony-stimulating factors and white blood cells 2. Erythropoietin and red blood cells (RBCs) 3. Interleukin-11 and macrophage activity 4. Colony-stimulating factors and serum ferritin Answer: 2 Explanation: Erythropoietin is high due to chronically low levels of oxygen passing through the kidneys. The resultant increase in RBCs gives the COPD client the classic ruddy complexion. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 39-3 Explain the functions of erythropoietin.

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11) A client who has just returned from an extended mountain-climbing trip in the Andes is seen in a clinic for an elective procedure. Preprocedure blood work reveals a very high hemoglobin level and red blood cell count. Which action should the nurse take? 1. Ask if the client ate a lot of iron-rich raisins in trail mix on the journey. 2. Place the lab results in the chart for the healthcare provider to review prior to the procedure. 3. Ask if the client used supplemental oxygen during high-altitude climbing. 4. Call the lab and have the test repeated. Answer: 2 Explanation: Chronic hypoxia at high altitudes increases the red blood cell count and the hemoglobin level. These levels are compensatory changes that allow the blood to carry more oxygen to the cells. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-3 Explain the functions of erythropoietin. 12) A client whose hemoglobin level was 6 g/dL 2 days ago has received parenteral epoetin alfa. A hemoglobin level has just been drawn to evaluate therapy. The nurse would consider which hemoglobin lab result as most problematic? 1. 13-14 g/dL 2. 7-8 g/dL 3. 11-12 g/dL 4. 9-10 g/dL Answer: 1 Explanation: If the level exceeds 12 g/dL, the risk of blood clots increases, which puts the client at risk for stroke and heart attack. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 39-3 Explain the functions of erythropoietin.

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13) Lab work reveals that a client has an extremely low neutrophil count. The nurse recognizes that colony-stimulating factors (CSFs) can increase the white blood cell count, provided that the client has normal function of which organ? 1. Liver 2. Bone marrow 3. Kidney 4. Gastrointestinal tract Answer: 2 Explanation: The bone marrow must be functional for CSFs to achieve their desired effect. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 39-4 Explain the functions of colony-stimulating factors. 14) A client has a surgical wound infection. The nurse recognizes that a healthy body will respond by rapidly increasing colony-stimulating factors (CSFs) in the blood. How does this increase help in fighting the infection? 1. Slowed migration of leukocytes 2. Elevated level of serum antibodies 3. Increased phagocytosis 4. Decreased antibody toxicity Answer: 3 Explanation: White blood cell phagocytosis is increased by CSFs and is necessary because of a heavy load of bacteria in the wound. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 39-4 Explain the functions of colony-stimulating factors.

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15) An oncology nurse is administering colony-stimulating factors (CSFs) to a client who has been receiving chemotherapy. How should the nurse explain the expected effect of this medication? 1. "This medication will help overcome your fatigue and improve your overall energy level." 2. "This medication will help reduce the possibility of bleeding in the brain." 3. "This medication will help to counteract the tendency of chemotherapeutic agents to cause peripheral edema." 4. "This medication will help protect you from developing severe infections." Answer: 4 Explanation: The goal of CSF supplementation is to reduce the risk of infection, which is a major source of morbidity and mortality. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-4 Explain the functions of colony-stimulating factors. 16) The nurse is assessing a client who is pale and complains of dizziness and chronic fatigue. The client's heart rate increases with exertion. The medical diagnoses include possible anemia. Based on this assessment, which conclusion can the nurse draw? 1. The client's signs and symptoms are typical of anemia. 2. Pallor indicates the client has iron deficiency anemia. 3. Blood work will indicate the client has pernicious anemia. 4. Constant exhaustion indicates the client is probably losing blood. Answer: 1 Explanation: Pallor, fatigue, exercise intolerance, and compensation from the cardiovascular system are typical of all forms of anemia. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 39-5 Classify types of anemia based on their causes.

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17) The nurse is caring for a client diagnosed with aplastic anemia. The nurse recognizes that the medical management of this type of anemia is based on the fact that it is triggered by which event? 1. Acute destruction of red blood cells within the body 2. A hereditary problem with the formation of red blood cells 3. An episode of acute bleeding 4. Lack of intrinsic factor in the gastrointestinal tract Answer: 1 Explanation: Aplastic anemia is caused by an abnormal process within the body that destroys large numbers of red blood cells. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 39-5 Classify types of anemia based on their causes. 18) A pregnant client is receiving counseling related to proper nutrition for fetal development. When told that an iron supplement is advised, the woman says, "Why should I take iron? I was never told I was anemic." Which is the nurse's best response? 1. "Your body needs more iron than usual for the baby, and you will temporarily have a greater blood volume." 2. "Your body does not absorb iron from food as readily because you are pregnant. A supplement will prevent anemia." 3. "More iron is eliminated from your body because of the increased urine output you experience during pregnancy. The supplement will prevent anemia." 4. "Nausea will probably keep you from eating enough meat to keep your iron up, so the supplement will prevent anemia." Answer: 1 Explanation: More iron is needed during pregnancy because of increased demand from the woman's body and the fetus. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-6 Illustrate the metabolism, storage, and transfer of iron in the body.

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19) A client who is a vegetarian is having difficulty maintaining a hemoglobin level over 12 g/dL. The nurse understands that this problem is primarily related to the client's choice to avoid animal products. Which food choices contain sufficient iron to meet this client's needs? 1. Red and orange vegetables such as tomatoes, sweet potatoes, and carrots 2. Cruciferous vegetables such as broccoli and cauliflower 3. Root vegetables such as potatoes, onions, and yams 4. Whole-grain bread and pastas, and fortified cereal Answer: 4 Explanation: Whole-grain breads and pasta and fortified cereal are the best nonanimal sources of iron. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-5 Classify types of anemia based on their causes. 20) The nurse is reviewing laboratory results for a client with a low level of intrinsic factor. Which blood smear report would help confirm the medical diagnosis of pernicious anemia? 1. Macrocytic and hypochromic red blood cells 2. Macrocytic and normochromic red blood cells 3. Microcytic and hypochromic red blood cells 4. Normocytic and normochromic red blood cells Answer: 2 Explanation: In pernicious anemia, the red blood cells are too few in number, too large (macrocytic), and abnormally shaped, but they have a normal color because they contain a normal amount of hemoglobin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 39-5 Classify types of anemia based on their causes.

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21) Morphology reports on a blood smear from a client who has documented anemia show normocytic-normochromic red blood cells. Which assessment questions should the nurse ask to further identify the etiology of this anemia? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Do you eat enough foods that contain iron?" 2. "Have you experienced any episodes of bleeding?" 3. "Do you follow a strict vegetarian diet?" 4. "Do you get enough folate in your diet?" 5. "Do you work around any strong chemicals?" Answer: 2, 5 Explanation: Hemorrhagic anemia results in normocytic-normochromic red blood cells. Exposure to some chemicals can result in hemolytic anemia. Hemolytic anemia results in normocytic-normochromic red blood cells. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 39-5 Classify types of anemia based on their causes. 22) The nurse is reviewing the blood work of a client newly diagnosed with iron deficiency anemia. Because of the way iron is stored in the body, the nurse pays closest attention to which lab value? 1. Serum ferritin 10 mg/mL 2. Red blood cell count of 5,000,000 3. Hb 10.1 g/dL 4. Platelet count of 75,000 Answer: 1 Explanation: A serum ferritin value of less than 12 mg/mL indicates iron deficiency anemia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 39-6 Illustrate the metabolism, storage, and transfer of iron in the body.

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23) A client is admitted with pernicious anemia. The nurse understands that therapy will include medication to address the client's lack of intrinsic factor. Which drug would the nurse anticipate administering? 1. Intravenous iron 2. An oral iron salt 3. Epoetin alfa subcutaneously 4. Cyanocobalamin subcutaneously Answer: 4 Explanation: Cyanocobalamin will supply the intrinsic factor necessary to treat pernicious anemia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 39-7 Identify the role of intrinsic factor in the absorption of vitamin B12. 24) Which client is most likely to require a folic acid supplement to treat anemia? 1. A client who has a forearm arterial-venous shunt and is scheduled for dialysis three times weekly 2. A client who has a history of chronic heart failure with multiple exacerbations 3. A client who has a history of chronic heavy alcohol intake 4. A client who has a history of type 2 diabetes mellitus Answer: 3 Explanation: Folic acid–related anemia is usually associated with poor nutrition. Ethanol interferes with folate metabolism in the liver, and the diet of an individual who abuses alcohol is often low in the nutrient. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 39-8 Compare and contrast anemias caused by vitamin B12 and folate deficiency.

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25) A client who had gastric bypass surgery 6 months ago is profoundly anemic. The client has memory loss and periodic hallucinations. A diagnosis of folate deficiency has been proposed. Why would the nurse question this provisional diagnosis? 1. Iron deficiency anemia is the anemia that occurs among gastric resection clients. 2. Folic acid absorption is usually enhanced during a rapid weight loss. 3. Folate deficiency anemia does not produce neurologic symptoms. 4. Folic acid deficiency has only a minimal impact on red blood cell counts. Answer: 3 Explanation: Neurologic symptoms accompany pernicious anemia, but not folate deficiency anemia. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 39-8 Compare and contrast anemias caused by vitamin B12 and folate deficiency. 26) A client with severe pernicious anemia tells the nurse, "I do not understand why everyone is so excited about a little anemia. Lots of people are anemic." The nurse responds that long-term pernicious anemia can cause severe damage to the tissues of which system? 1. Nervous system 2. Renal system 3. Cardiovascular system 4. Gastrointestinal system Answer: 1 Explanation: Profound neurologic damage differentiates pernicious anemia from other anemias. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-8 Compare and contrast anemias caused by vitamin B12 and folate deficiency.

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27) Mild folate deficiency can be managed with dietary interventions. Which foods would the nurse recommend? 1. Lean meat, cheese, and milk 2. Bread and pastas, dried beans, and fresh greens 3. Strawberries, melon, and blueberries 4. Fresh citrus fruits Answer: 2 Explanation: Whole grains, dried beans, and fresh green vegetables are good sources of folic acid. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-8 Compare and contrast anemias caused by vitamin B12 and folate deficiency. 28) A client says to the nurse, "My sister's doctor told her to start taking ferrous sulfate tablets. Do you think that would help me feel better?" Which client history would be of concern to the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. An episode of shingles last winter 2. Ulcerative colitis controlled by diet 3. Peptic ulcer disease 4. Frequent falls 5. Daily use of a proton pump inhibitor Answer: 2, 3, 5 Explanation: Ferrous sulfate may cause diarrhea if administered to clients with ulcerative colitis. Ferrous sulfate may irritate the stomach mucosa and increase bleeding in clients with peptic ulcer disease. Proton pump inhibitors reduce absorption of oral iron salts. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 39-8 Compare and contrast anemias caused by vitamin B12 and folate deficiency.

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29) The nurse is developing teaching materials on managing the side effects of oral iron salts for distribution in a free clinic. Which information should be included? 1. Take oral iron products with the largest meal of the day. 2. Take oral iron products just before bedtime. 3. Take oral iron products with plenty of fluid, such as milk, tea, or coffee. 4. Take oral iron products on an empty stomach unless nausea results. Answer: 4 Explanation: Iron is best absorbed on an empty stomach. If the client cannot tolerate it, or if nausea develops, iron may be taken with a small meal. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-9 Describe the nurse's role in the pharmacologic management of hematopoietic disorders. 30) A client received a first dose of cyanocobalamin (Nascobal) 2 days ago. The nurse is monitoring the client's electrolytes because of the possibility of which clinical manifestation? 1. A marked decrease in serum osmolality and the risk of cerebral edema 2. A marked decrease in calcium and the risk of tetany 3. A marked decrease in potassium and the potential for dangerous dysrhythmias 4. A decrease in sodium and the potential for renal failure Answer: 3 Explanation: Cyanocobalamin can cause potassium levels to drop, which can lead to marked hypokalemia with the risk of lethal dysrhythmia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 39-9 Describe the nurse's role in the pharmacologic management of hematopoietic disorders.

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31) The nurse is delivering care to a client on dialysis who received epoetin alfa during the previous visit. Which nursing intervention is most important during this treatment? 1. Ensuring that the client understands the indications and expected outcomes of epoetin alfa therapy 2. Ensuring that sufficient water is removed during dialysis, based on body weight 3. Ensuring that the shunt is appropriately cleaned and dressed after the treatment 4. Ensuring that the client receives sufficient heparin after the day's dialysis is complete Answer: 4 Explanation: The client is at great risk for clotting of the shunt because of increased RBC values. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 32) A client with preexisting bipolar disorder is receiving filgrastim (Neupogen) for the management of neutropenia following chemotherapy treatments for lymphocytic leukemia. The oncology nurse recognizes that which preparation for bipolar disorder could complicate the management of the client's leukemia? 1. Clonazepam (Klonopin) 2. Valproic acid (Depakene) 3. Carbamazepine (Tegretol) 4. Lithium carbonate Answer: 4 Explanation: Lithium has a synergistic effect when administered concomitantly with filgrastim. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 39-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 33) The nurse is preparing a dose of parenteral iron (iron dextran) for a client with severe resistant 719

anemia. The nurse is aware of the major adverse reaction that can accompany intravenous ferric gluconate. Which assessment parameters will the nurse attend to most closely? 1. Respiratory status and blood pressure 2. Balance and mobility 3. Level of consciousness and spontaneous movement 4. Temperature and muscle tone Answer: 1 Explanation: Anaphylaxis is a possibility after the administration of intravenous iron dextran. Blood pressure, pulse, and respirations should be tracked. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 34) The nurse completes an assessment of a client who is prescribed filgrastim after a bone marrow transplant. The nurse would attend most closely to which parameters on the complete blood count? 1. Platelet count and reticulocyte count 2. Band count and reticulocyte count 3. Hemoglobin and hematocrit 4. Total white blood cell (WBC) count and neutrophil count Answer: 4 Explanation: Filgrastim mimics endogenous CSF and promotes an increase in the total WBC count and in the percentage of neutrophils. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 39-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 35) The nurse is reviewing lab work prior to administering a client's regularly scheduled subcutaneous injection of epoetin alfa. The nurse notes that the client's hematocrit has dropped 720

from the last time the lab was drawn. Which action by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Discuss this finding with the client's healthcare provider immediately. 2. Schedule another hematocrit test tomorrow. 3. Give the epoetin alfa and hold pressure on the injection site for 5 minutes. 4. Ask the client, "How have you been feeling?" 5. Ask the lab to verify the lab results. Answer: 1, 4, 5 Explanation: Some clients with chronic kidney failure develop neutralizing antibodies to subcutaneous epoetin alfa, which can lead to a rapidly developing severe anemia known as pure red cell aplasia. Asking how the client has been feeling is the first step in assessing whether anemia is developing. A decrease in hematocrit is not the expected effect of administering epoetin alfa and may signal a severe adverse effect. The lab result should be verified. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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36) The healthcare provider has ordered darbepoetin alfa (Aranesp) for a client who has anemia secondary to chemotherapy. What teaching should the nurse provide to the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "This medication will help to increase your red blood cell count." 2. "You can take this medication by mouth." 3. "You will need to come in once a week for this medication." 4. "This drug has fewer side effects than the epoetin alfa we used to give." 5. "You should see maximum results from this medication in 2 to 4 weeks." Answer: 1, 3, 5 Explanation: Increasing red blood cell count is the desired effect of darbepoetin alfa. The benefit of darbepoetin alfa over epoetin alfa is that it has a longer duration of action and can be given once a week. Maximum response occurs in 2 to 4 weeks. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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37) The nurse is evaluating the laboratory results of a client who is receiving filgrastim (Neupogen). The nurse would be concerned if this client's leukocyte count exceeds cells/mm3. Record your answer rounding to the nearest whole number. Answer: 100,000 Explanation: If the leukocyte count exceeds 100,000 cells/mm3, the risk of serious adverse effects such as respiratory failure, intracranial hemorrhage or infarction, retinal hemorrhage, and myocardial infarction increases. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 39-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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38) A client is receiving the first dose of sargramostim (Leukine). Which assessment findings should the nurse evaluate as indicating a possible serious adverse effect of this drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increased blood pressure 2. Tachycardia 3. Difficulty breathing 4. Yellowing of the mucous membranes 5. Rash on the palms Answer: 2, 3 Explanation: Trapping of granulocytes in the pulmonary circulation may occur, which would result in tachycardia. Trapping of granulocytes in the pulmonary circulation may occur, which would result in difficulty breathing. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 39-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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39) A client who is a strict vegetarian is prescribed cyanocobalamin (Nascobal) for vitamin B12 deficiency. Which information should the nurse provide for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Your medication is in the form of a nasal spray." 2. "Nutrient-fortified breakfast cereals will help support your vitamin B12 levels." 3. "Your healthcare provider may want to do an intradermal test dose of the medication before you start taking it." 4. "Adverse effects of this drug are rare." 5. "Constipation is a concern with this drug." Answer: 1, 2, 3, 4 Explanation: Nascobal is a nasal spray preparation. Because strict vegetarians do not eat meat or meat products, other sources of vitamin B12 must be eaten. One source is nutrient-fortified breakfast cereal. Intradermal test doses of the medication are indicated for those who are suspected of sensitivity to any of its components. Adverse effects of cyanocobalamin are rare. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-7 Identify the role of intrinsic factor in the absorption of vitamin B12.

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40) The nurse has instructed a client on the self-administration of oral iron tablets. Which client statement indicates the need for further clarification? 1. "I should take this medication with meals, along with a big glass of milk." 2. "If I get constipated while I am taking this drug, I will stop taking the drug." 3. "I will have blood drawn after 3 or 4 weeks to see if this drug is improving my red blood cell count." 4. "The medicine will help my body build red blood cells." Answer: 1 Explanation: The client should take the drug on an empty stomach. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 39-11 Apply the nursing process to care for patients receiving pharmacotherapy for hematopoietic disorders. 41) The nurse is caring for an ambulatory client who requires treatment for pernicious anemia on a medical unit. The client is weak and short of breath, and recently has become confused. Vital signs at rest are temperature 98.0°F, pulse 98 beats/min, respirations 22 breaths/min, blood pressure 96/60 mmHg, and pulse oximetry 95%. Which nursing diagnosis has the highest priority? 1. Confusion, Acute related to aging, and abnormal vital signs 2. Falls, Risk for related to confusion, weakness, and unfamiliar environment 3. Knowledge, Deficient (anemia treatment) related to a new medical diagnosis and its treatment 4. Walking, Impaired related to weakness, low blood pressure, and fast heart rate Answer: 2 Explanation: High risk for falls is the priority because the client is accustomed to being ambulatory but can move around less safely now due to weakness and confusion. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 39-11 Apply the nursing process to care for patients receiving pharmacotherapy for hematopoietic disorders.

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42) The nurse is planning care for a client who will be administering injections of cyanocobalamin once a month. Which goal is most appropriate? 1. The client will safely self-administer cyanocobalamin as ordered every 4 weeks. 2. The client will be taught about the possible side effects of cyanocobalamin by the home health nurse. 3. The client will understand the purpose of cyanocobalamin before the first dose. 4. The client will be given cyanocobalamin monthly until the blood count improves. Answer: 1 Explanation: A client goal should be specific, measurable, attainable, realistic, and timed. The client will be self-administering the drug, and the time frame might gradually change to less frequent administration as the blood count improves. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 39-11 Apply the nursing process to care for patients receiving pharmacotherapy for hematopoietic disorders.

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43) The client and nurse have set a goal that the client will demonstrate proper technique for self-administration of epoetin alfa (Epogen) before the client is discharged from the hospital. Which client actions would the nurse evaluate as indicating this goal is met? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client shakes the vial prior to drawing up the medication. 2. The client warms the vial by holding it for a few minutes before drawing up the medication. 3. The client draws the appropriate amount of medication into the syringe. 4. The client saves the remaining medication in the vial for the next dose. 5. The client verbalizes a plan to keep the medication vials in a cabinet out of the reach of children. Answer: 2, 3 Explanation: The medication should be warmed. A good method for warming medication is to hold the vial in the hand for a few minutes. The client must be accurate in drawing up the medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 39-11 Apply the nursing process to care for patients receiving pharmacotherapy for hematopoietic disorders.

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44) A client and nurse have set this goal: "The client will verbalize precautions required while taking medications to reverse neutropenia by date of discharge." Which client statements would the nurse evaluate as indicating this goal is met? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I should eat plenty of fresh fruits and vegetables while on this drug." 2. "I should not worry if my stools are light in color." 3. "I will avoid going to the shopping mall until my therapy is complete." 4. "I will call my healthcare provider's office if my temperature goes over 100.5°F." 5. "If I develop a cough, I will call my healthcare provider's office." Answer: 3, 4, 5 Explanation: Crowded indoor areas should be avoided. Temperature elevation should be reported. Cough should be reported. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 39-11 Apply the nursing process to care for patients receiving pharmacotherapy for hematopoietic disorders.

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45) A client will be on long-term oral iron therapy. When discussing this therapy, the nurse mentions that a slow-release, enterically coated preparation may be advisable for the client. Which rationales would the nurse have for this suggestion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client has children at home. 2. This form is less expensive. 3. The enteric coating may reduce gastrointestinal (GI) upset. 4. This form reduces problems with constipation. 5. This preparation can be taken with coffee or milk. Answer: 1, 3 Explanation: Slow-release preparations are less dangerous if a child should take the medications and overdose. The enteric coating may help with GI upset. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 39-11 Apply the nursing process to care for patients receiving pharmacotherapy for hematopoietic disorders. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 40 Review of Body Defenses and the Immune System 1) A client has been diagnosed with cancer. The nurse plans an assessment based on the awareness that cancer can spread through which component of the lymphatic system? 1. Lymph vessels 2. Tonsils 3. Thymus gland 4. Spleen Answer: 1 Explanation: Lymph vessels drain interstitial fluid, and cancer cells can travel from one area to another via this fluid. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-1 Identify the major components of the lymphatic system. 2) Which cells of the nonspecific body defense are phagocytic? 730

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Mast cells 2. Macrophages 3. Dendritic cells 4. Neutrophils 5. Eosinophils Answer: 2, 3, 4, 5 Explanation: Macrophages are phagocytic. Dendritic cells are phagocytic. Neutrophils are phagocytic cells. Eosinophils are phagocytic cells. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 40-2 Describe the components of the nonspecific body defense system and their functions.

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3) A key aspect of the specific immune system is: 1. recognition of common bacterial receptors. 2. complement. 3. memory. 4. phagocytes. Answer: 3 Explanation: The specific immune system forms memory cells after the resolution of infection. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 40-3 Compare and contrast specific and nonspecific body defenses. 4) Which option reflects a key aspect of the nonspecific body defense? 1. Recognition of antigens 2. Inflammation 3. Systemic response 4. Antibodies Answer: 2 Explanation: Inflammation is a key part of the nonspecific body defense. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 40-3 Compare and contrast specific and nonspecific body defenses.

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5) A client asks, "Why does my leg swell when I have an infection?" How should the nurse respond? 1. "The fever from your infection causes you to drink more, and you become fluid overloaded." 2. "The infection causes the little vessels in your leg to become leaky, and fluid seeps out of your blood." 3. "The infection causes your lymphatic system to get blocked up so it doesn't drain." 4. "When you have an infection, more blood goes to your leg, causing it to swell." Answer: 2 Explanation: Increased capillary permeability allows plasma proteins such as antibodies and complement to exit the blood and enter the inflamed tissue. Water follows the proteins. The explanation to the client should be simple and use easily understandable terminology. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-4 Identify the signs and symptoms of inflammation. 6) A client asks, "Why does the infection in my finger make it so red?" What is the nurse's best response? 1. "When you have an infection, your body sends more blood to the area." 2. "Your blood vessels in that area are leaky." 3. "You don't get rid of fluid as quickly when you are sick, so you develop a fluid overload." 4. "Your fingers are small and a long way from your heart, so the lymph drainage is not as good." Answer: 1 Explanation: Erythema is caused by increased blood flow to the area. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-4 Identify the signs and symptoms of inflammation.

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7) During assessment of a client's infection site, the nurse determines that the site is warm to the touch. How should the nurse explain this warmth to the client? 1. "Infection causes fluid overload in your body, so the infected site gets warm and red." 2. "Your lymphatic system has shut down to keep the infection from spreading, so the site gets warm and red." 3. "The little vessels around your infection are leaking, so the area gets warm and red." 4. "Your body is sending extra blood and white cells to the site to fight the infection." Answer: 4 Explanation: Increased blood flow causes warmth and redness. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-4 Identify the signs and symptoms of inflammation. 8) A client is prescribed an antihistamine for an allergic reaction. The client asks, "Why am I getting this? What is a histamine anyway?" How can the nurse most accurately describe the action of histamine in the body? 1. "Histamine causes your blood vessels to dilate and leak. That is why you are swollen and itchy." 2. "Histamine stimulates production of the clotting parts of your blood. That is why you are blotchy." 3. "Histamine stimulates production of white blood cells to fight off infection. That is why you feel flushed." 4. "Histamine stimulates production of the red cells of your blood. That is why you are red." Answer: 1 Explanation: Histamine is responsible for vasodilation and increased vascular permeability. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-5 Outline the basic steps in the acute inflammatory response.

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9) A client is prescribed ibuprofen for pain. The nurse is aware that this drug is designed to target which inflammatory mediator to reduce pain? 1. Histamine 2. Leukotrienes 3. Complement 4. Prostaglandins Answer: 4 Explanation: Ibuprofen inhibits the production of prostaglandins. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-6 Explain the role of histamine and other chemical mediators in the inflammatory response. 10) A client has been stung by a bee. The site is warm, red, and swollen. Which agent does the nurse suspect to be the cause? 1. Histamine 2. Leukotrienes 3. Complement 4. Prostaglandins Answer: 1 Explanation: Histamine causes vasodilation, resulting in redness and warmth. Histamine also increases the permeability of capillary membranes, causing edema. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-6 Explain the role of histamine and other chemical mediators in the inflammatory response.

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11) Which properties are common to both the cell-mediated and humoral immune systems? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Recognition of common pathogenic features in bacterial cell walls 2. Both depend on the response of helper T cells. 3. Memory: the ability to mount a more rapid attack on a foreign antigen because of previous exposure 4. Specificity: the ability to react with molecules bearing a specific marker 5. Both react in the same way regardless of the nature of the offending agent. Answer: 3, 4 Explanation: Both the humoral and cell-mediated immune systems form memory cells so that they can respond more quickly to subsequent infections. Both systems are specific; they attack specific antigens. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 40-7 Compare and contrast the humoral and cell-mediated immune response. 12) Activation of the humoral immune system by an antigen results in the production of which substance? 1. Immunoglobulins (antibodies) specific for the antigen 2. Macrophages specific for the immunogen 3. Sensitized T lymphocytes 4. Sensitized natural killer (NK) cells Answer: 1 Explanation: Activation of the humoral immune system results in antibodies. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 40-7 Compare and contrast the humoral and cell-mediated immune response.

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13) A client with a disorder of the plasma cells has a deficiency in which part of the immune system? 1. Antigens that produce a diffuse immune response 2. Monocytes that are found in an exudate 3. Activated B lymphocytes that produce immunoglobulins specific to an antigen 4. Macrophages that devour bacteria Answer: 3 Explanation: Plasma cells are mature B cells that produce antibodies. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 40-7 Compare and contrast the humoral and cell-mediated immune response. 14) A client says, "The doctor says I have a problem with the fluid in my lymph system backing up. Where does lymph fluid come from?" How should the nurse respond? 1. "Lymph is a by-product of the production of urine." 2. "Lymph fluid is made in your stomach from the fluid you drink." 3. "Lymph fluid comes from the liquid part of your blood." 4. "Lymph is created in your lungs from the water you breathe in with air." Answer: 3 Explanation: Lymph fluid is created when fluid leaves the circulating blood system at the capillary level and enters lymphatic vessels. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-1 Identify the major components of the lymphatic system.

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15) A postmastectomy client tells the nurse, "The doctor says my arm is so swollen because of lymph fluid. How much lymph fluid do we have?" How should the nurse respond? 1. "Not very much. Most of your swelling is due to your cancer." 2. "The normal amount of lymph fluid in the body is about 3 liters." 3. "The lymph fluid is part of your blood, so it is hard to determine how much you have." 4. "Everyone is different. Some people have lots of lymph fluid and some have very little." Answer: 2 Explanation: As much as 3 liters of fluid per day travel through the lymphatic vessels. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-1 Identify the major components of the lymphatic system. 16) A client says, "I overheard my doctor tell the medical students that I don't have effective immune surveillance. What does that mean?" How should the nurse respond? 1. "I'll get the doctor to come talk to you about what you heard." 2. "I'm certain that the doctor was not talking about you." 3. "Your immune system is not identifying and removing pathogens from your system." 4. "Your body is working against itself." Answer: 3 Explanation: The various components of the immune system work together as a single unit to accomplish effective immune surveillance. A malfunction in any portion of the system may affect the effectiveness of the entire lymphatic system. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-1 Identify the major components of the lymphatic system.

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17) What is the purpose of the normal flora of the skin? 1. They control pathogens by competing with them for nutrients and space. 2. They phagocytize pathogens. 3. They secrete substances that kill pathogens. 4. They make the skin more acidic during times of stress, which discourages pathogen growth. Answer: 1 Explanation: Normal bacteria and fungi on the skin compete with pathogens for space and nutrients. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-2 Describe the components of the nonspecific body defense system and their functions. 18) The nurse has explained the process of phagocytosis to a client with an infected wound. The client is fascinated by the nurse's description of cells that eat other cells and asks, "Why don't they eat good cells, too?" How should the nurse respond? 1. "They do, but there are not enough phagocytic cells to kill enough good cells to make a person sick." 2. "The cells migrate to the infection before they start killing other cells." 3. "They don't eat good cells because of a process called chemotaxis." 4. "These cells can tell the difference between cells from the person's body and foreign cells." Answer: 4 Explanation: Phagocytic cells have proteins on their surface that allow them to recognize cells and cellular components that are "non-self." Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-2 Describe the components of the nonspecific body defense system and their functions.

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19) The infection control (IC) nurse has completed teaching newly hired nurses about the innate body defenses. Which statements by one of the participants would indicate the need for further instruction? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Fever is one of the process barriers we can expect our clients to demonstrate." 2. "Complement is a component of the adaptive immune response." 3. "I should try to keep my client's skin and mucous membranes intact." 4. "Dendritic cells are part of the nervous system involved in keeping the immune system strong." 5. "Phagocytes are cells that kill invading bacteria." Answer: 2, 4 Explanation: Complement is one of the process barriers of the innate body defenses. Dendritic cells are one of the cellular barriers. Dendrites are part of the nervous system, but are not specifically charged with keeping the immune system strong. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 40-1 Identify the major components of the lymphatic system.

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20) The school nurse is speaking to a group of children in middle school about preventing infection. How can the nurse best explain why it is so important for the children to keep from injuring their skin? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Your skin cells are packed together tightly to keep germs out. If you disrupt that barrier, germs can get into your body." 2. "The sweat on your skin discourages germ growth. You don't want to damage the cells that produce sweat." 3. "You shed skin cells all the time, along with the germs on the skin." 4. "If you damage the skin's outer layer, it will never grow back." 5. "The deep layers of your skin have special cells that eat germs." Answer: 1, 2, 3, 5 Explanation: Using simple, familiar terms helps clients understand the process. The skin cells are packed tightly together. Sweat does discourage pathogen growth. Shedding of skin cells helps to rid the skin of pathogens but leaves the surface of the skin intact. Dendritic cells are in the deeper layers of the epidermis and are phagocytic. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-2 Describe the components of the nonspecific body defense system and their functions.

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21) A client scheduled to undergo a lymph node biopsy asks, "If lymph nodes are so prone to cancer, why don't they just take them all out?" How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Lymph nodes filter out all kinds of debris and are essential to our good health." 2. "The surgeon will probably take out a majority of the nodes in the region where the biopsy will be done." 3. "The cells that are in the lymph nodes actually help protect us from cancer." 4. "The lymph nodes make up one of our best defenses against infection." 5. "They usually do take out all the lymph nodes if the client has lymphoma." Answer: 1, 3, 4 Explanation: An efficient lymph system, including lymph nodes, is essential to good health. The macrophages and lymphocytes in the lymph nodes kill, neutralize, or remove pathogens and cancer cells. The lymph system is a major contributor to defense against infection. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-1 Identify the major components of the lymphatic system.

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22) The newly licensed nurse tells the supervisor, "I thought that interferons were medications, but I heard the doctor tell my client that his interferons were suppressed." How should the supervisor respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Interferons are proteins produced in the body." 2. "Interferons can be produced to use as medications to fight cancer." 3. "The doctor probably said your client's immune system was depressed." 4. "Interferons help to stimulate other cells of the immune system." 5. "Interferons made by the body are the same as natural killer cells." Answer: 1, 2, 4 Explanation: Interferons are proteins produced in the body. Interferons have been isolated and are now available as medications for the treatment of immune disorders, viral infections, and cancer. Interferons stimulate the activity of phagocytes and NK cells. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-2 Describe the components of the nonspecific body defense system and their functions. 23) A client is being given cytokines to stimulate the immune system. What response should the nurse expect from this drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Some cytokines will kill foreign organisms in the body. 2. The client's inflammatory response will be stimulated. 3. The client's immune system will be taken over by the cytokines. 4. The client's lymphatic system will shut down. 5. There will be fewer white blood cells in the client's blood. Answer: 1, 2 Explanation: Some cytokines kill pathogens directly. Some cytokines act to stimulate the inflammatory response. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 40-7 Compare and contrast the humoral and cell-mediated immune response. 24) The healthcare providers and nurses caring for a group of clients with cancer have instituted a 743

strict nutritional program with the goal of stimulating the clients' natural killer cells. How do these cells work? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. They phagocytize cancer cells. 2. The cells secrete chemical toxins that kill cancer cells. 3. They help to enhance inflammation. 4. They protect noncancerous cells from attack by viruses that cause cancer. 5. They modulate the adaptive immune response. Answer: 2, 3, 5 Explanation: Natural killer cells do secrete toxins that kill cancer cells. Natural killer cells secrete chemicals that enhance inflammation. Natural killer cells modulate the adaptive immune response. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-3 Compare and contrast specific and nonspecific body defenses. 25) A client who is not immunized against influenza has been exposed to the antigen that causes it. The nurse is aware that peak production of antibodies against this antigen will take about days. Record your answer rounding to the nearest whole number. Answer: 10 Explanation: In a client who is not immunized and has not been exposed to the antigen before, peak production of antibodies takes about 10 days. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 40-7 Compare and contrast the humoral and cell-mediated immune response.

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26) A high school football player is unable to play due to an inflamed hamstring muscle. The nurse teaches this client that up to days are usually required for symptoms to resolve and for healing to begin. Record your answer rounding to the nearest whole number. Answer: 10 Explanation: The acute inflammatory process caused by minor physical injury requires 8 to 10 days for symptoms to resolve and for repair to begin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 40-5 Outline the basic steps in the acute inflammatory response. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 41 Pharmacotherapy of Inflammation and Fever 1) Once the inflammation process is initiated, which process causes edema of the surrounding tissues? 1. Typically, swelling and edema do not occur during the inflammatory process. 2. Increased permeability of the blood vessels causes edema. 3. Nearby blood vessels become permeable, allowing T-suppressor cells to reach and neutralize the antigen. 4. Tissue damage from the antibodies causes swelling of the surrounding tissues. Answer: 2 Explanation: Once the inflammatory process is initiated, the nearby blood vessels become permeable, allowing phagocytic cells to reach and neutralize the antigen. The increased permeability of the blood vessels causes edema of the surrounding tissues. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 41-1 Explain the pathophysiology of inflammation and fever. 2) Occasionally, acute inflammation is initiated by a rapid, massive release of inflammatory chemical mediators, which becomes a life-threatening allergic reaction that can cause cardiovascular shock and death. This condition is known as: 1. chemotaxis. 2. activation of Hageman factor. 3. phagocytosis. 4. anaphylaxis. Answer: 4 Explanation: Anaphylaxis, a life-threatening allergic response that can lead to cardiovascular 745

shock and death, is caused by the rapid, massive release of inflammatory chemical mediators throughout the entire body. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 41-1 Explain the pathophysiology of inflammation and fever.

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3) Which type of inflammation has a slow onset and lacks distinct stages? 1. Autoimmune 2. Chronic 3. Acute 4. Histocompatibility Answer: 2 Explanation: Chronic inflammation is insidious and has a slow onset of the inflammatory process that might not have the typical distinct stages of inflammation. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 41-1 Explain the pathophysiology of inflammation and fever. 4) A 3-year-old is admitted to the pediatric unit with a traumatic injury to the right forearm. The mother had been giving the child aspirin at home to control pain and fever. Approximately 3 weeks prior to admission, the child had an upper respiratory infection. The mother asks the nurse why the doctor changed the child's medication from aspirin to acetaminophen. What is the nurse's best response? 1. "Typically, aspirin is a safe salicylate for children of any age." 2. "Acetaminophen is given to children for inflammation and fever when there is a recent or current history of a viral infection, due to the risk of Reye's syndrome." 3. "I really do not know, but I am certain the healthcare provider has a good reason." 4. "It would be important for the doctor to allow you to continue to medicate your child, since there is a strong level of trust between mother and child." Answer: 2 Explanation: Aspirin should not be given to children who have or have had a viral infection, due to the risk of Reye's syndrome. If a child has a recent or current history of viral infection, the aspirin should be changed to acetaminophen. Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-5 Compare the actions and adverse effects of aspirin to ibuprofen and ibuprofen-like drugs.

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5) Which assessment findings would the nurse evaluate as possibly indicating an inflammatory response? 1. Pain, fever, and tremors 2. Fever, change in level of consciousness, and tremors 3. Pain, irritability, and change in level of consciousness 4. Fever, aches and pains, and lethargy Answer: 4 Explanation: Fever, aches and pains, and lethargy are common signs and symptoms of the inflammatory response. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 41-1 Explain the pathophysiology of inflammation and fever. 6) The nurse has administered an antipyretic agent to a client. What is the intended effect of this drug? 1. To stop inflammation 2. To reduce fever 3. To stop swelling 4. To block pain transmission Answer: 2 Explanation: Antipyretic agents reduce fever by acting directly on the hypothalamus heat-regulating center to produce peripheral vasodilation, sweating, and dissipation of heat. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-2 Identify drug classes used to treat inflammation and fever.

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7) Salicylates primarily inhibit the synthesis of which substance? 1. Pyrogens 2. Superoxide radicals 3. Histamines 4. Prostaglandins Answer: 4 Explanation: Aspirin blocks the synthesis of prostaglandins by inhibiting the enzyme cyclooxygenase (COX). Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 41-2 Identify drug classes used to treat inflammation and fever. 8) Aspirin has which adverse effect on the gastrointestinal mucosa? 1. Aspirin causes direct cellular injury as it is absorbed across the stomach mucosa. 2. Because all aspirin products have an enteric coating, there is no topical damage to the stomach. 3. After aspirin is systemically absorbed, it inhibits COX-2. 4. Aspirin enhances the effect of prostaglandins' protective function to the GI mucosa. Answer: 1 Explanation: Aspirin causes topical damage to the stomach as it crosses the mucosa. This direct cellular injury can result in GI bleeding. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 41-3 Explain how aspirin damages the gastrointestinal mucosa.

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9) A client has been advised to take a low-dose aspirin daily. Which significant adverse effect of aspirin should the nurse teach this client about? 1. Significant stomach irritation, heartburn, nausea/vomiting, diarrhea, and stomach pain 2. Significant tremors and change in level of consciousness 3. An increase in the amount of platelets in the body, causing blood clots to occur 4. Direct effect on the central nervous system, causing irritability and decreased level of consciousness Answer: 1 Explanation: A major adverse effect of aspirin is the risk of GI bleeding. It causes significant stomach irritation, heartburn, nausea/vomiting, diarrhea, and stomach pain. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-3 Explain how aspirin damages the gastrointestinal mucosa. 10) A client has been admitted for treatment of salicylism. The nurse would expect laboratory results to include a serum salicylate level: 1. below 100 mcg/mL. 2. above 200 mcg/mL. 3. above 400 mcg/mL. 4. of 100 mcg/mL. Answer: 2 Explanation: Salicylism is a serum salicylate level above 200 mcg/mL. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 41-4 Describe the symptoms and treatment of salicylism.

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11) A client has been admitted with possible aspirin overdose. Which finding should the nurse be alert for in this client? 1. Metabolic alkalosis 2. Respiratory acidosis 3. Hypoventilation 4. Tinnitus Answer: 4 Explanation: Symptoms of salicylism include tinnitus. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered car | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 41-4 Describe the symptoms and treatment of salicylism. 12) A client has just been admitted after taking an overdose of aspirin. The nurse prepares to assist with which initial treatment? 1. Gastric lavage 2. Administration of medication to acidify the urine 3. Retroperitoneal dialysis 4. Hemodialysis Answer: 1 Explanation: Gastric lavage is indicated to remove any aspirin remaining in the stomach and is generally the initial treatment. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 41-4 Describe the symptoms and treatment of salicylism.

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13) When instructing a group of senior citizens on the actions and adverse effects of aspirin compared to ibuprofen-like drugs, the nurse is asked why the doctor prescribed a low dose of daily aspirin rather than ibuprofen to prevent heart problems. What is the nurse's best response? 1. "Talk to your doctor, because both medications can cause heart disease." 2. "Ibuprofen and ibuprofen-like medications are not indicated to treat or prevent cardiovascular problems." 3. "Either medication is helpful for the prevention of heart attacks." 4. "Ibuprofen is better for you, even though you might be a candidate for heart attacks." Answer: 2 Explanation: Ibuprofen and ibuprofen-like medications are not indicated in the treatment or prevention of cardiovascular conditions. Ibuprofen inhibits platelet aggregation and prolongs the bleeding time without affecting the prothrombin or whole blood clotting times. Its effects on platelets are reversible within 24 hours after discontinuation of the drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-5 Compare the actions and adverse effects of aspirin to ibuprofen and ibuprofen-like drugs. 14) In the 1950s, researchers began searching for safer medications to treat rheumatoid arthritis (RA). Prior to this time, RA was treated with aspirin and corticosteroids. Which drug was identified by the researchers to be safer in the treatment of inflammation and pain for RA clients? 1. Gold compounds 2. Acetaminophen (Tylenol) 3. Celecoxib (Celebrex) 4. Ibuprofen (Motrin, Advil, others) Answer: 4 Explanation: Ibuprofen was introduced in the United States in 1974, and it became one of the first prescription-only drugs that were changed to OTC status in 1984. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-5 Compare the actions and adverse effects of aspirin to ibuprofen and ibuprofen-like drugs.

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15) Both aspirin and ibuprofen products inhibit which process in the body? 1. Histamine production 2. Platelet production 3. Cytokine IL-1 synthesis 4. Cyclooxygenase (COX) synthesis Answer: 4 Explanation: Aspirin blocks the synthesis of prostaglandins by inhibiting the enzyme cyclooxygenase (COX). Aspirin and the ibuprofen-like NSAIDs block both forms of the enzyme, cyclooxygenase 1 (COX-1) and cyclooxygenase 2 (COX-2), by changing their structures and preventing the formation of prostaglandins. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 41-5 Compare the actions and adverse effects of aspirin to ibuprofen and ibuprofen-like drugs. 16) A client has been started on a first-generation nonsteroidal anti-inflammatory medication for arthritis pain. The client says, "I remember something about one of these drugs causing heart attacks and strokes. Which drug was that?" The nurse responds that the drug was celecoxib (Celebrex) but that: 1. celecoxib (Celebrex) causes no problems at lower dosages. 2. the client has been prescribed a different medication. 3. the drug has been taken off the market. 4. newer research has proven that the concerns were unfounded. Answer: 2 Explanation: Celecoxib (Celebrex) is an effective second-generation NSAID but has limited use due to increased risk of myocardial infarction and stroke. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-6 Compare the actions and adverse effects of the cyclooxygenase-2 inhibitors to other nonsteroidal anti-inflammatory drugs.

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17) A client presents to the emergency department with influenza-like symptoms. The nurse assesses the client's medication history and finds that the client has been taking ibuprofen for arthritic pain. Warfarin (Coumadin) was recently prescribed due to a diagnosis of atrial fibrillation. What is the nurse's rationale for immediately discussing this finding with the healthcare provider? 1. If taken with NSAID medications, warfarin can cause a change in the client's oral mucosa and white patchy lesions. 2. Oral anticoagulants taken with ibuprofen can increase the risk of bleeding. 3. Taking ibuprofen and warfarin at the same time decreases the client's immune response. 4. Ibuprofen is contraindicated for patients who have influenza-like symptoms. Answer: 2 Explanation: Ibuprofen inhibits platelet aggregation and prolongs the bleeding time without affecting the prothrombin or whole blood–clotting times. Oral anticoagulants taken with ibuprofen can increase the risk of bleeding. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-6 Compare the actions and adverse effects of the cyclooxygenase-2 inhibitors to other nonsteroidal anti-inflammatory drugs. 18) The nurse supervisor has directed all nurses giving medications to be alert for the "aspirin triad." What will the nurses be alert for in their clients? 1. Chronic rhinitis, acute bronchospasm, and heart failure 2. Ibuprofen allergy, nasal congestion, and asthma 3. History of head trauma, heart failure, and asthma 4. Aspirin allergy, nasal polyps, and asthma Answer: 4 Explanation: Clients who have the "aspirin triad," which includes aspirin allergy, nasal polyps, and asthma, should not be administered aspirin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 41-6 Compare the actions and adverse effects of the cyclooxygenase-2 inhibitors to other nonsteroidal anti-inflammatory drugs.

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19) A client has been prescribed acetaminophen and has been instructed by the nurse not to take any over-the-counter (OTC) cough or cold medications without first checking with the healthcare provider or pharmacist. What is the rationale for this instruction? 1. There could be an increased risk for bleeding in the stomach and within other organs of the body. 2. Cough medications and other OTC drugs could contain acetaminophen, so inadvertent overdose could occur. 3. There is an increased risk for Reye's syndrome. 4. No one should be taking more than one medication for pain. Answer: 2 Explanation: Many over-the-counter medications contain acetaminophen that could cause the client to inadvertently overdose. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-7 Describe the nurse's role in the pharmacologic management of inflammation and fever. 20) A client has been admitted to the medical–surgical unit for pain evaluation. The client has arthritis and has been taking ibuprofen for many years to help alleviate the pain. What is the most important assessment for this client? 1. Respiratory auscultation to rule out congestion 2. Reviewing renal laboratory studies 3. A complete blood count (CBC) with differential to monitor for infection 4. An electrocardiogram for possible cardiomyopathy Answer: 2 Explanation: When used for a long duration, ibuprofen can cause renal insufficiency. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 41-7 Describe the nurse's role in the pharmacologic management of inflammation and fever.

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21) The nurse supervisor notices that the nurse administering medications in a long-term care facility routinely crushes enteric-coated medications so that they can be administered through feeding tubes. How should the nurse supervisor respond to this situation? 1. Tell the nurse that it is okay to crush these medications as long as they can be easily dissolved in water prior to administration. 2. Tell the nurse that enteric-coated or sustained release medications should never be crushed or altered in any manner. 3. Tell the nurse to continue crushing enteric-coated medications so they can be administered via feeding tube. 4. Tell the nurse that there is no real reason for the enteric coating to be on many medications. Answer: 2 Explanation: Enteric-coated and sustained release medications should never be crushed or altered in any way. The enteric coating helps provide relief from gastrointestinal discomfort. Altering the medication could cause a change in the chemical structure of the drug. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Teamwork: Effective strategies for communicating with different members of the health team, including nurses and other health professionals | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-7 Describe the nurse's role in the pharmacologic management of inflammation and fever. 22) The nurse is administering an analgesic medication to a client who has an infected surgical incision. Which response at the infection site would the nurse expect? 1. Reduction in swelling 2. Less surrounding redness 3. Reduction in skin temperature 4. Less pain Answer: 4 Explanation: Analgesics are medications that reduce pain. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 41-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 23) Salicylates are very popular anti-inflammatory drugs because they: 756

1. are given primarily by the IM or IV route. 2. have no adverse effect on blood clotting. 3. have minimal to no side effects. 4. reduce pain. Answer: 4 Explanation: Salicylates are given as anti-inflammatory agents to reduce pain and fever. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 24) A client has been advised to take a low-dose aspirin daily for prophylaxis of adverse cardiac events. The client states, "I can't take aspirin because it upsets my stomach. Can I take ibuprofen instead?" How should the nurse respond? 1. "Ibuprofen works differently than aspirin." 2. "Ibuprofen is not safe when used with your anticoagulant therapy." 3. "Ibuprofen has no effect on blood coagulation." 4. "Taking ibuprofen will significantly increase your risk of respiratory failure." Answer: 1 Explanation: Because ibuprofen has less effect on coagulation, it is not used for the prophylaxis of adverse cardiac events. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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25) The nurse suspects that a client has an infection. Which assessment findings support that suspicion? 1. Heart rate of 110 beats/min and rapid, shallow respirations 2. Temperature of 37°C and increased heart rate 3. Respirations of 12 breaths/min and increased heart rate 4. Respirations of 10 breaths/min and decreased heart rate Answer: 1 Explanation: Clients experiencing infection present with an increased heart rate and rapid, shallow respirations. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 41-9 Apply the nursing process to care for patients receiving pharmacotherapy for fever or inflammation. 26) The client has been treated with a corticosteroid for the last 3 weeks for a severe inflammatory response. The condition has improved but is not resolved. The nurse plans care for this client based on what prediction? 1. The dose of the corticosteroid will be increased. 2. The corticosteroid therapy will be discontinued and a nonsteroidal anti-inflammatory drug willbe started. 3. The client will be changed to a different corticosteroid. 4. Treatment for the inflammatory response will be discontinued. Answer: 2 Explanation: After 3 weeks of corticosteroid therapy, the medication is often changed to an NSAID. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 41-9 Apply the nursing process to care for patients receiving pharmacotherapy for fever or inflammation.

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27) A client is being assessed for the possible presence of inflammation and infection. The nurse would consider a white blood cell count greater than /mm3 as evidence that inflammation exists. Record your answer rounding to the nearest whole number. Answer: 12,000 Explanation: A white blood cell count of greater than 12,000/mm3 is associated with inflammation and infection. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 41-1 Explain the pathophysiology of inflammation and fever. 28) A client whose knee is inflamed after running a marathon is prescribed a regimen of rest, ice, and elevation. The client says, "I don't have time for all of that. Why doesn't the doctor just give me some medication?" How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I am not sure; you should ask when the doctor comes back in the room." 2. "You have overused your knee, so rest is a good treatment." 3. "Inflammation is a natural process. We would like to give your body a chance to heal itself first." 4. "The medications for this condition are very expensive and have major adverse effects." 5. "You need to slow down and take care of your body." Answer: 2, 3 Explanation: Inflammation is a symptom of an underlying disorder. The underlying cause of the problem should be identified and treated. Inflammation is a natural process for ridding the body of antigens and is usually self-limiting. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-1 Explain the pathophysiology of inflammation and fever.

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29) A person being seen at a health fair says, "I hurt my foot running last week and have been taking aspirin for the pain. Is that okay?" Which questions should the nurse ask before answering this question? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "How old are you?" 2. "Do you smoke?" 3. "Do you take vitamin C?" 4. "Have you ever been told you have a gastric ulcer?" 5. "Are you of Hispanic heritage?" Answer: 1, 2, 4 Explanation: The risk of gastrointestinal bleeding is greater in people over age 60. The risk of gastrointestinal bleeding is greater in people who smoke. Clients with gastric ulcer disease have a higher risk of gastrointestinal bleeding while taking aspirin. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 41-9 Apply the nursing process to care for patients receiving pharmacotherapy for fever or inflammation.

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30) A nurse's friend says, "I may have to have some dental work done and I am concerned because I take aspirin every day." How should the nurse respond to this information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "When you go to the dentist, be sure to report your aspirin use." 2. "Since you take such a small dose of aspirin, there is no problem." 3. "The usual recommendation is to stop taking aspirin a week before any dental or surgical procedure." 4. "Aspirin therapy is not associated with bleeding from dental procedures." 5. "Any bleeding from your procedure can be reversed by taking vitamin E." Answer: 1, 3 Explanation: The dentist should be made aware that the client takes aspirin daily. The usual recommendation is to discontinue use of aspirin a week prior to any dental or surgical procedure. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-9 Apply the nursing process to care for patients receiving pharmacotherapy for fever or inflammation.

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31) A woman in her third trimester of pregnancy has a history of back pain. The client says, "I do best on Doan's pills (magnesium salicylate), so I will just start taking them again." How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "If they helped you before, I would recommend you take them now." 2. "The magnesium salicylate in Doan's pills is not related to the salicylate in aspirin." 3. "I believe we should talk with the doctor to find a different medication for your discomfort." 4. "You should take aspirin instead." 5. "Have you tried any nonpharmaceutical pain relief measures?" Answer: 3, 5 Explanation: Magnesium salicylate should not be used. A different drug should be chosen. Nonpharmaceutical treatment measures should be used first, because drugs should be avoided during pregnancy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-9 Apply the nursing process to care for patients receiving pharmacotherapy for fever or inflammation. 32) A client who has been taking ibuprofen for several weeks to control pain and inflammation from a shoulder injury now needs surgery. The nurse tells the client to stop taking the ibuprofen at least hours before the surgery is scheduled. Record your answer rounding to the nearest whole number. Answer: 24 Explanation: Ibuprofen's effects on platelets are reversible within 24 hours after discontinuation of the drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-9 Apply the nursing process to care for patients receiving pharmacotherapy for fever or inflammation.

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33) A client reports taking four 325-mg acetaminophen capsules every 6 hours to control back pain. The nurse cautions the client against this practice as the maximum total daily dose of acetaminophen should not exceed grams per day. Record your answer rounding to the nearest whole number. Answer: 4 Explanation: The maximum total daily dose of acetaminophen should not exceed 4 g/day. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 34) Which instructions should be included as part of medication teaching for a client who has been started on a nonsteroidal anti-inflammatory drug (NSAID)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Take this medication at least 2 hours after eating." 2. "Be watchful for a yellow, grainy material if you vomit." 3. "If you start experiencing lightheadedness, call the office for instructions." 4. "You should avoid alcohol while taking this medication." 5. "You will know that you are taking enough of the drug when your stools take on a dark color." Answer: 3, 4 Explanation: Lightheadedness may indicate that the client is bleeding and not getting enough oxygen to the brain. Alcohol use should be avoided or eliminated when the client is taking an NSAID. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-9 Apply the nursing process to care for patients receiving pharmacotherapy for fever or inflammation.

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35) Last week, a client was advised to drink fluids, rest, and take aspirin to minimize symptoms of a head cold. Today the client calls the clinic and reports dizziness, nausea, and "a strange buzzing sound in my head." How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Are you having difficulty hearing?" 2. "You should increase your fluid intake." 3. "Come to the clinic today." 4. "Take an additional aspirin with each dose." 5. "Are you allergic to aspirin?" Answer: 1, 3 Explanation: Aspirin may be ototoxic and cause hearing loss. Buzzing or ringing in the ears, nausea, and dizziness are all associated with aspirin toxicity. This client should be evaluated in the clinic. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-9 Apply the nursing process to care for patients receiving pharmacotherapy for fever or inflammation.

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36) The nurse is instructing the parents of a young child on appropriate dosing of acetaminophen. Which instruction should the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Use the dosage cup that comes with the acetaminophen to measure the dosage." 2. "If you use an eyedropper to draw the dose out of the bottle, it is not so sticky and messy." 3. "If you already have acetaminophen pills at home, you can crush one up and put it in juice." 4. "If you lose this medication cup, use a cereal spoonful to measure the dose." 5. "Your pharmacist may be able to supply a calibrated dosing spoon you can use for this medication." Answer: 1, 5 Explanation: Acetaminophen should be dosed with the dosage cup included with the medication. Calibrated dosing spoons are an acceptable alternative to the medication cup included with the drug. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-9 Apply the nursing process to care for patients receiving pharmacotherapy for fever or inflammation.

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37) A client is brought to the emergency department (ED) after overdosing on acetaminophen last night. The client is conscious and tearful. The nurse prepares to administer the antidote to acetaminophen: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. in three stages by intravenous administration. 2. rectally by suppository. 3. orally. 4. intramuscularly. 5. subcutaneously. Answer: 1, 3 Explanation: Acetylcysteine is administered in the "three-bag" method. Acetylcysteine can be administered orally. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 41-9 Apply the nursing process to care for patients receiving pharmacotherapy for fever or inflammation. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 42 Immunostimulants and Immunosuppressants 1) The nurse demonstrates understanding of the appropriate use of immunostimulant therapy by anticipating its use in the client with which disorder? 1. Exophthalmus 2. Gout 3. Cancer 4. Rheumatoid arthritis Answer: 3 Explanation: Immunostimulants are used to treat clients with cancer. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 42-1 Compare and contrast the therapeutic applications of the immunostimulants and immunosuppressants. 2) The nurse demonstrates understanding of the appropriate use of immunosuppressant therapy by anticipating its use in the client with which disorder? 1. Gout 766

2. Exophthalmus 3. Rheumatoid arthritis 4. Cancer Answer: 3 Explanation: Immunosuppressants are used to diminish the immune response, as with clients with rheumatoid arthritis. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 42-1 Compare and contrast the therapeutic applications of the immunostimulants and immunosuppressants.

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3) The nurse is establishing outcomes for a client with rheumatoid arthritis. What would be an appropriate outcome following 3 days of immunosuppressant therapy? 1. Decreased serum calcium 2. Reduced joint inflammation 3. Increased erythrocyte sedimentation rate 4. Increased white blood cell count Answer: 2 Explanation: Immunosuppressants are used to reduce joint inflammation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 42-1 Compare and contrast the therapeutic applications of the immunostimulants and immunosuppressants. 4) The cells of the immune system secrete substances that mediate the immune response that are called: 1. antigens. 2. masts. 3. cytokines. 4. antibodies. Answer: 3 Explanation: The cells of the immune system secrete cytokines. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 42-2 Describe the roles of interferons, interleukins, and other cytokines in modulating the immune response.

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5) The nurse is teaching a course in pathophysiology. The students understood the material correctly if they identify which options as properties of interferons? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Antifungal 2. Antiviral 3. Anti-inflammatory 4. Antineoplastic 5. Antibiotic Answer: 2, 3, 4 Explanation: Interferons have antiviral properties and aid in the fight against disease. Interferons have anti-inflammatory properties and aid in the fight against inflammatory processes such as multiple sclerosis. Interferons have antineoplastic properties and aid in the fight against cancer. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 42-2 Describe the roles of interferons, interleukins, and other cytokines in modulating the immune response. 6) Which interferons have the greatest clinical utility? 1. Gamma interferons 2. Alpha interferons 3. Beta interferons 4. Mu interferons Answer: 2 Explanation: The alpha interferons have the greatest clinical utility. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 42-2 Describe the roles of interferons, interleukins, and other cytokines in modulating the immune response.

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7) Adding polyethylene glycol (PEG) to an interferon has which pharmacologic effect on the interferon? 1. Increased protein binding 2. Increased drug half-life 3. Decreased cellular permeability 4. Decreased first-pass effect Answer: 2 Explanation: The addition of PEG increases the interferon's half-life. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 42-3 Explain how pegylation of the interferon molecule allows for less frequent dosing. 8) The nurse preparing to administer the initial dose of an immunosuppressant agent for a client recovering from organ transplantation would make certain that screening has been performed to rule out: 1. electrolyte imbalance. 2. cardiomegaly. 3. anemia. 4. infectious processes. Answer: 4 Explanation: The priority would be to rule out infectious processes because administration of an immunosuppressant could exacerbate an infection. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 42-8 Apply the nursing process to care for patients receiving pharmacotherapy with immunostimulants and immunosuppressants.

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9) The nurse is explaining to a nursing student that allograft transplant clients need some form of immunosuppressant therapy. Which statement describes the pathophysiologic reasoning behind this? 1. The treatment is indicated only if signs of transplant rejection are present. 2. The treatment is a precaution; rejection in allografts seldom occurs. 3. The treatment is designed to target chronic rejection, which does not occur for several weeks. 4. Despite accurate tissue matching, allografts contain antigens that trigger the client's immune response. Answer: 4 Explanation: Allografts always contain certain antigens that trigger the immune response and rejection, and immunosuppressants help prevent this response. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 42-4 Explain why therapy with immunosuppressant medications is necessary following organ transplants. 10) A nurse caring for a client who has been on cyclosporine for 6 months following a renal allograft reviews the laboratory data and notes that the blood urea nitrogen and serum creatinine have shown a consistent elevation in the past 2 weeks. The nurse would correctly identify these findings as indicating which problem? 1. Metabolic acidosis 2. Metastatic carcinoma 3. An anaphylactic reaction 4. Cyclosporine side effects Answer: 4 Explanation: Side effects of cyclosporine include nephrotoxicity. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 42-8 Apply the nursing process to care for patients receiving pharmacotherapy with immunostimulants and immunosuppressants.

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11) Cyclosporine (Sandimmune, Neoral) and tacrolimus (Prograf) represent which category of immunosuppressants? 1. Calcineurin inhibitors 2. Glucocorticoids 3. Antimetabolites 4. Antibodies Answer: 1 Explanation: Cyclosporine and tacrolimus are calcineurin inhibitors. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 42-5 Identify the classes of drugs used as immunosuppressants. 12) The nurse would recognize that additional teaching is necessary if the nurse finds the client taking cyclosporine while: 1. drinking milk. 2. eating fish. 3. drinking grapefruit juice. 4. eating leafy green vegetables. Answer: 3 Explanation: Drinking grapefruit juice concurrently can increase cyclosporine levels by 50% to 200%. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 42-8 Apply the nursing process to care for patients receiving pharmacotherapy with immunostimulants and immunosuppressants.

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13) What is the primary advantage of using monoclonal antibodies (MABs) rather than polyclonal antibodies? 1. Oral administration 2. Single dosing 3. Broad-spectrum use 4. Fewer side effects Answer: 4 Explanation: Fewer adverse effects are the primary advantage of MABs. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 42-6 Compare and contrast polyclonal and monoclonal antibodies. 14) An advantage of the use of monoclonal antibodies over polyclonal antibodies is that monoclonal antibodies: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. can be administered in the presence of fever. 2. have fewer side effects. 3. are administered by intramuscular administration. 4. are administered in a single dose. 5. can be administered in smaller doses. Answer: 2, 5 Explanation: Monoclonal antibodies target a single type of cell, reducing side effects. Because of their specificity, smaller doses of monoclonal antibodies can be given. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 42-6 Compare and contrast polyclonal and monoclonal antibodies.

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15) A single infusion of antithymocyte globulin can reduce the lymphocyte by: 1. 85% to 90%. 2. 60% to 70%. 3. 40% to 50%. 4. 50% to 60%. Answer: 1 Explanation: A single dose can decrease lymphocytes by 85% to 90%. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 42-6 Compare and contrast polyclonal and monoclonal antibodies. 16) The nursing student correctly identifies what advantage of cyclosporine for the prevention of allograft rejection? 1. Increases white blood cell count 2. Can be administered subcutaneously 3. Decreases the risk of infection 4. Is less harmful to bone marrow Answer: 4 Explanation: Cyclosporine is less harmful to bone marrow cells. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 42-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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17) What is the expected outcome for the client receiving filgrastim (Neupogen)? 1. Increased white blood cell count 2. Reduction in tumor size 3. Reduction in paresthesia 4. Increased platelet count Answer: 1 Explanation: Filgrastim increases white blood cell counts. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 42-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 18) Concurrent use of azathioprine and an ACE inhibitor could result in which adverse effect? 1. Flulike symptoms 2. Hypercholesteremia 3. Hematuria 4. Anemia and leukopenia Answer: 4 Explanation: Concurrent use of azathioprine and an ACE inhibitor could result in anemia and severe leukopenia. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 42-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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19) A client is beginning aldesleukin (Proleukin) therapy for advanced renal carcinoma. The nurse should monitor the client for: 1. capillary leak syndrome. 2. hypertension. 3. hyperglycemia. 4. hyperuricemia. Answer: 1 Explanation: Capillary leak syndrome is a significant side effect of aldesleukin and can be fatal. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 42-8 Apply the nursing process to care for patients receiving pharmacotherapy with immunostimulants and immunosuppressants. 20) Which nursing intervention would help minimize side effects in a client receiving antithymocyte (Atgam) therapy? 1. Administering acetaminophen 2. Providing cough syrup 3. Limiting visitors 4. Limiting fluid intake Answer: 1 Explanation: Acetaminophen will help prevent the flulike symptoms that accompany cytokine release syndrome. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 42-8 Apply the nursing process to care for patients receiving pharmacotherapy with immunostimulants and immunosuppressants.

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21) Methylprednisolone is added to a client's chemotherapeutic regimen. Which effects would the nurse expect if the drug is taken long term? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Hyperglycemia 2. Fluid retention 3. Hypotension 4. Osteoporosis 5. Mental status changes Answer: 1, 2, 4, 5 Explanation: Hyperglycemia could occur due to increased glucose metabolism. Fluid retention could occur due to sodium and water retention. Osteoporosis can occur due to bone resorption. Mental changes can occur due to fluid retention. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 42-5 Identify the classes of drugs used as immunosuppressants.

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22) A client will be taking interferon alfa-2b (Intron A) as treatment for hairy cell leukemia. The nurse advises this client about which common adverse effects? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Nausea 2. Fever 3. Dizziness 4. Headache 5. Rash Answer: 1, 2, 3, 4 Explanation: Nausea is a common adverse effect of interferon alfa-2b. Fever is a common adverse effect of interferon alfa-2b. Dizziness is a common adverse effect of interferon alfa-2b. Headache is a common adverse effect of interferon alfa-2b. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 42-2 Describe the roles of interferons, interleukins, and other cytokines in modulating the immune response. 23) A client's medical history reveals vaccination with bacillus Calmette-Guérin (BCG) vaccine. The nurse is aware that this client has possibly had which condition? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Exposure to tuberculosis 2. Cervical cancer 3. Bladder cancer 4. Active tuberculosis 5. Hashimoto's thyroiditis Answer: 1, 3 Explanation: BCG is used to stimulate immunity against Mycobacterium tuberculosis. A form of BCG is used to treat cancer of the bladder. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 42-2 Describe the roles of interferons, interleukins, and other cytokines in modulating the immune response.

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24) A client is scheduled for kidney transplantation using an allograft. Which instruction should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You will be monitored for acute rejection for the first 48 hours." 2. "If your system has not rejected the kidney within 2 weeks of surgery, you will be out of danger." 3. "You will take antirejection medication for at least several months after surgery." 4. "You are in danger of developing chronic rejection for years after your surgery." 5. "Rejection usually occurs immediately after surgery, generally before the client gets out of the recovery room." Answer: 1, 3, 4 Explanation: Acute rejection occurs in the first 48 hours after transplant. Antirejection medications are given for at least several months and are sometimes continued at a lower dose indefinitely. Chronic rejection of the transplant may occur months or even years after surgery. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 42-4 Explain why therapy with immunosuppressant medications is necessary following organ transplants.

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25) A client reports taking corticosteroid therapy for the last 6 months to treat reactive airway disease. The client says, "My doctor wouldn't refill my prescription so I went to a different doctor and just didn't say anything about taking corticosteroids." The nurse would pay particular attention to which assessment in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Blood pressure 2. Weight 3. Visual acuity 4. Heart rhythm 5. Pedal pulses Answer: 1, 2, 3 Explanation: Corticosteroid therapy can cause fluid retention, which would increase blood pressure. Obesity and fluid retention are adverse effects of long-term corticosteroid use. Long-term corticosteroid use may cause cataract formation. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 42-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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26) A young woman who has been taking immunosuppressant therapy says, "I'll be glad to be off these drugs. My husband and I would like to start a family." How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Be sure to wait until you are off the medication to stop using birth control." 2. "Don't plan on breastfeeding, because use of this drug makes your success unlikely." 3. "You should wait at least 4 months after taking this medication before you try to get pregnant." 4. "You may not be able to get pregnant after taking this medication." 5. "You may wish to consider adoption because taking this medication raises the risk of having a baby with congenital defects." Answer: 1, 3 Explanation: Immunosuppressive medications can cause birth defects. The client should not get pregnant for 4 months after taking these medications. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 42-8 Apply the nursing process to care for patients receiving pharmacotherapy with immunostimulants and immunosuppressants. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 43 Immunizing Agents 1) What is the term used to describe the placement of a foreign substance on or in an individual for the purpose of disease prevention? 1. Eradication 2. Incubation 3. Immunity 4. Vaccination Answer: 4 Explanation: Vaccination is the process of introducing something foreign into the body to trigger immune activation before the client is exposed to the real pathogen. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-3 Explain the immune response that leads to the development of active immunity. 2) What was the first major disease to be prevented by inoculation? 781

1. Polio 2. Anthrax 3. Smallpox 4. Measles Answer: 3 Explanation: The first major disease to be prevented by inoculation was smallpox. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-1 Explain why the development of vaccines was one of the most significant discoveries of modern medicine.

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3) Smallpox vaccine was discovered in which century? 1. 19th 2. 17th 3. 16th 4. 18th Answer: 4 Explanation: The smallpox vaccine was discovered in the 18th century. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-1 Explain why the development of vaccines was one of the most significant discoveries of modern medicine. 4) Which statement is true regarding active immunity? 1. Only active immunity processes respond to antigens. 2. Once acquired, active immunity lasts for the life of the host. 3. Active immunity occurs in response to a pathogen. 4. Most individuals are born with active immunity. Answer: 3 Explanation: Active immunity occurs in response to a pathogen. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-2 Compare and contrast active and passive immunity.

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5) From which sources can passive immunity be acquired? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Immunoglobulin 2. Maternal antibodies 3. Immunizations 4. Inoculation 5. Blood transfusions Answer: 1, 2 Explanation: Immunoglobulin provides passive immunity. Maternal antibodies can provide passive immunity. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-2 Compare and contrast active and passive immunity. 6) The nursing student questions the faculty member regarding the need to obtain a hepatitis B titer. The faculty member is correct in saying that the purpose of a titer is to measure which component of immunity? 1. The degree of risk for future infections 2. The amount of vaccine present in the bloodstream 3. The amount of antibodies in the bloodstream 4. The amount of antigen in the bloodstream Answer: 3 Explanation: Titers measure the amount of antibodies. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-3 Explain the immune response that leads to the development of active immunity.

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7) As a result of vaccination, what cells are formed? 1. Immunoglobulins 2. Alpha and beta 3. Antigens 4. B and T cells Answer: 4 Explanation: In response to vaccination, B and T cells are formed. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-3 Explain the immune response that leads to the development of active immunity. 8) Active immunity is a response to exposure to what substance? 1. Allergens 2. Immunoglobulins 3. A true pathogen 4. Antigens Answer: 3 Explanation: Active immunity is a response to a true pathogen. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-3 Explain the immune response that leads to the development of active immunity.

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9) What is the goal of active immunity? 1. Prevention of illness 2. Augmentation of the allergic response 3. Reduction of disease symptoms 4. Completion of the process of passive immunity Answer: 1 Explanation: The goal of active immunity is the prevention of illness. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-3 Explain the immune response that leads to the development of active immunity. 10) The nurse would correctly question an order to administer the measles, mumps, and rubella vaccine in which client? 1. One with a history of asthma 2. One with a history of heart disease 3. The child in reverse isolation receiving chemotherapy 4. The student entering nursing school Answer: 3 Explanation: Attenuated vaccines are not administered to the client who is immunosuppressed. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-4 Prepare a table listing the types of vaccines, their indications, and potential adverse effects.

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11) The nurse teaches parents that which age is the earliest a pertussis vaccine should be administered? 1. 2 months 2. 5 years 3. 2 years 4. 15 months Answer: 1 Explanation: Pertussis immunization is started at age 2 months. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-5 Explain why it is important to administer childhood vaccines at specific ages. 12) The nurse would correctly educate parents about what common adverse effect of vaccine administration? 1. Cough and runny nose 2. Pain, swelling, and redness at injection site 3. Fever of 101°F or greater 4. Development of a full-body rash Answer: 2 Explanation: Pain, swelling, and redness at the injection site are common side effects. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-4 Prepare a table listing the types of vaccines, their indications, and potential adverse effects.

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13) The mother asks the nurse why her child must have three doses of a certain vaccine over the next few months. Which response by the nurse is correct? 1. "Multiple doses are needed over time to allow the development of full immunity." 2. "The drug level must be high enough to prevent disease." 3. "It is prophylactic because not all parents get the immunizations at the correct time." 4. "Single doses have proven to be more effective." Answer: 1 Explanation: Multiple doses might be needed to establish immunity. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-5 Explain why it is important to administer childhood vaccines at specific ages. 14) The mother asks the nurse who establishes immunization schedules. The nurse would correctly educate the mother by making which statement? 1. The American Academy of Pediatrics 2. The Centers for Disease Control and Prevention 3. The American Medical Association 4. The Food and Drug Administration (FDA) Answer: 2 Explanation: The Centers for Disease Control and Prevention establishes the immunization schedule. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-5 Explain why it is important to administer childhood vaccines at specific ages.

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15) The mother asks the nurse why the human papillomavirus vaccine (Gardasil) is administered at age 11 or 12 rather than earlier, as with other vaccines. The nurse would correctly educate the mother by making which statement? 1. "The vaccine requires the onset of puberty to be effective." 2. "Other vaccines must be given first to establish immunity, upon which this immunization is based." 3. "The virus is spread by sexual contact, which mostly likely begins during the teen years." 4. "There are too many side effects if given too early." Answer: 3 Explanation: The teen years are the most likely for the beginning of sexual contact. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-5 Explain why it is important to administer childhood vaccines at specific ages. 16) In which client should the hepatitis B vaccine be withheld? 1. A client with anemia 2. A client with arthritis 3. A client with hypertension 4. A client with an active infection Answer: 4 Explanation: An active infection would be a contraindication to the administration of hepatitis B vaccine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-6 Identify contraindications for vaccine administration.

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17) In which client would the MMR vaccine be contraindicated? 1. A client with an allergy to neomycin 2. A client with an allergy to mold 3. A client with an allergy to yeast 4. A client with an allergy to milk Answer: 1 Explanation: Allergy to neomycin is a contraindication to the administration of the MMR vaccine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-6 Identify contraindications for vaccine administration. 18) In which pregnancy category are almost all vaccines? 1. C 2. X 3. D 4. B Answer: 1 Explanation: Most vaccines are pregnancy category C drugs. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 43-6 Identify contraindications for vaccine administration.

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19) The nurse correctly understands that the diphtheria toxoid is created by adding which substance to the diphtheria toxin? 1. Yeast 2. Mercury 3. Formalin 4. Mold Answer: 3 Explanation: Formalin is added to the diphtheria toxin to produce diphtheria toxoid. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-7 Describe the pathogenesis and immunization of bacterial infections, including diphtheria, pertussis, tetanus, pneumococcus, and meningococcus. 20) The nurse understands the primary diagnostic characteristic of pertussis as being which finding? 1. Raised red rash 2. A whoop sound on inspiration 3. Gagging and vomiting 4. Tightening of the jaw muscles Answer: 2 Explanation: This is correct; hence its name, "whooping cough." Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 43-7 Describe the pathogenesis and immunization of bacterial infections, including diphtheria, pertussis, tetanus, pneumococcus, and meningococcus.

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21) The nurse correctly identifies which symptoms as the neurologic findings associated with symptoms of meningococcus? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Seizures 2. Photophobia 3. Nuchal rigidity 4. Vomiting 5. Headache Answer: 1, 2, 3, 5 Explanation: Seizures are a symptom of meningococcus. Photophobia is a symptom of meningococcus. Nuchal rigidity is a symptom of meningococcus. Headache is a symptom of meningococcus. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 43-7 Describe the pathogenesis and immunization of bacterial infections, including diphtheria, pertussis, tetanus, pneumococcus, and meningococcus. 22) Which vaccines are of the whole-agent type? 1. Diphtheria and tetanus 2. Measles and mumps 3. HPV and pertussis 4. Influenza and hepatitis A Answer: 4 Explanation: Whole-agent vaccines include influenza and hepatitis A. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 43-4 Prepare a table listing the types of vaccines, their indications, and potential adverse effects.

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23) Why was a recombinant form of the hepatitis B vaccine developed? 1. Concerns about liver immaturity of newborns 2. High number of allergic responses to the original form 3. Problems with virus inactivation by antibodies 4. Risk of HIV transmission with the original form of the vaccine Answer: 4 Explanation: A recombinant form was developed due to fear of HIV transmission. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.1 Explain the interrelationships among theory, practice, and research | AACN Essential Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-8 Describe the pathogenesis and immunization of viral infections, including hepatitis A and B, influenza, rabies, measles, mumps, rubella, polio, varicella zoster, human papillomavirus, and rotavirus. 24) Where do infected animals harbor the rabies virus? 1. Red blood cells 2. Saliva 3. Feces 4. Immunoglobulins Answer: 2 Explanation: The rabies virus is carried in the saliva of infected animals. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.1 Explain the interrelationships among theory, practice, and research | AACN Essential Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-8 Describe the pathogenesis and immunization of viral infections, including hepatitis A and B, influenza, rabies, measles, mumps, rubella, polio, varicella zoster, human papillomavirus, and rotavirus.

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25) The nurse would expect antibodies for passive immunity to be administered in which situations? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client is at great risk for exposure. 2. The initial immunization failed. 3. The client has already been exposed to a virulent pathogen. 4. The client has undergone bone marrow transplant. 5. There is not sufficient time to develop active immunity. Answer: 1, 3, 5 Explanation: Antibodies are administered when the client is at great risk for exposure. Antibodies are administered when the client has been exposed to virulent pathogens. Antibodies are administered when there is insufficient time to develop active immunity. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | AACN Essential Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-9 Explain the rationale for administering antibodies to establish passive immunity. 26) The nurse would expect RhoGAM to be administered to which client? 1. A client at 28 weeks' gestation 2. A client undergoing kidney transplant 3. An client who is HIV positive 4. An immunosuppressed client Answer: 1 Explanation: RhoGAM is indicated for the pregnant client or one who is 72 hours postdelivery. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | AACN Essential Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-9 Explain the rationale for administering antibodies to establish passive immunity.

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27) The client who has received intravenous immune globulin must wait what length of time before receiving active immunization? 1. 2 months 2. 1 year 3. 4 months 4. 1 month Answer: 3 Explanation: The client must wait at least 3 to 5 months. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-9 Explain the rationale for administering antibodies to establish passive immunity. 28) The nurse correctly understands that the administration of the pneumococcal conjugate vaccine (PCV) should occur at which ages? 1. 5 and 10 months 2. 15 and 18 months 3. 1, 8, 13, and 18 to 20 months 4. 2, 4, 6, and 12 to 15 months Answer: 4 Explanation: The PCV vaccine should be administered at 2, 4, 6, and 12 to 15 months. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: V.1 Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as work-arounds and dangerous abbreviations) | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 43-10 For each of the major vaccines and patient age groups, identify the schedule for the recommended dosage sequence established by the Centers for Disease Control and Prevention.

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29) The nurse correctly understands that the administration of the meningococcal vaccine should occur at which ages? 1. 2, 4, and 6 months 2. 11 years 3. 15 and 18 months 4. Within 12 hours of birth Answer: 2 Explanation: The meningococcal vaccine should be administered at age 11. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: V.1 Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as work arounds and dangerous abbreviations) | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-10 For each of the major vaccines and patient age groups, identify the schedule for the recommended dosage sequence established by the Centers for Disease Control and Prevention. 30) The nurse teaches nursing students that to maintain immunity, the booster for tetanus prevention should be given to adults at what intervals? 1. 5 years 2. 8 years 3. 10 years 4. 15 years Answer: 3 Explanation: Tetanus boosters should be administered every 10 years. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: V.1 Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as work arounds and dangerous abbreviations) | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-10 For each of the major vaccines and patient age groups, identify the schedule for the recommended dosage sequence established by the Centers for Disease Control and Prevention.

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31) A nurse is caring for a client who was just administered hepatitis B immune globulin. The client asks, "How long will it take until I'm protected against hepatitis?" The nurse's response is based on which understanding? 1. It takes several months for the immune system to respond to the antibodies. 2. The client is protected immediately. 3. It is impossible to determine how long it will take, but blood tests will be performed. 4. Active immunity will occur in 10 days to 2 weeks. Answer: 2 Explanation: The client will be protected immediately. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-11 Apply the nursing process to care for patients receiving immunizing agents. 32) Which population should receive the shingles vaccine (Zostavax)? 1. Adults over age 60 2. Pregnant women 3. Children at 15 months 4. College students Answer: 1 Explanation: Adults over age 60 should receive the Zostavax vaccine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-4 Prepare a table listing the types of vaccines, their indications, and potential adverse effects.

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33) After administering vaccines to a 15-month-old child, the nurse should counsel the parent to control temperature elevation using which method? 1. Acetaminophen 2. Ibuprofen 3. Sponge baths 4. Aspirin Answer: 1 Explanation: Acetaminophen is the preferred treatment. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-11 Apply the nursing process to care for patients receiving immunizing agents. 34) A client has experienced an adverse reaction to an immunization. The nurse has reported the event to the Vaccine Adverse Event Reporting System (VAERS). What response should the nurse expect from this group? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. An officer from VAERS will contact the nurse by telephone for follow-up. 2. The VAERS office will contact the client for verification of the report. 3. The data will be added to other data about the vaccine. 4. Information from the report will be published in a central repository. 5. The nurse will be asked to report the event to the state board of nursing. Answer: 3, 4 Explanation: The data are collected and added to other adverse effect reports. VAERS data are published in a central repository that can be accessed by healthcare providers and the public. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-11 Apply the nursing process to care for patients receiving immunizing agents.

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35) A nurse has administered a DTaP immunization to a 7-month-old infant. The nurse educates the parent that this is the first of a series of immunizations against which diseases? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Diphtheria 2. Tetanus 3. Varicella 4. Pertussis 5. Hepatitis A Answer: 1, 2, 4 Explanation: The DTaP includes a vaccine against diphtheria. The DTaP includes a vaccine against tetanus. There is a vaccine for pertussis in the DTaP vaccine. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-4 Prepare a table listing the types of vaccines, their indications, and potential adverse effects. 36) Four cases of meningococcal meningitis have been reported in a local school district. The school nurse prepares to treat the remaining school population based on which knowledge? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Anyone who has been potentially exposed should be immunized. 2. Immunization will occur using one of the four types of vaccines available. 3. No treatment is necessary, since meningitis is rarely contracted by casual contact. 4. Many people will choose not to be immunized because meningitis is not a lethal disorder. 5. Treatment often includes use of prophylactic antibiotics. Answer: 1, 5 Explanation: Exposure to meningitis is an indication for the need for immunization. Antibiotic therapy is frequently offered to individuals who have had close contact with infected individuals. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: V.1 Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as work arounds and dangerous abbreviations) | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 43-10 For each of the major vaccines and patient age groups, identify the schedule for the recommended dosage sequence established by the Centers for Disease Control and Prevention. 799

37) A parent states, "The doctor said the hepatitis B vaccine is a live virus. I don't want to run the risk of giving my child hepatitis." How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The virus is alive but weakened, so it won't give your child the disease." 2. "Live viral vaccine does not mean that the virus is alive." 3. "The vaccine is noninfectious and can't cause hepatitis." 4. "We will give your child additional medications to prevent the virus from replicating." 5. "I'll tell the doctor that you have refused the immunization." Answer: 2, 3 Explanation: "Live" does not indicate that the virus is actually alive. The hepatitis B vaccine is noninfectious. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.1 Explain the interrelationships among theory, practice, and research | AACN Essential Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-8 Describe the pathogenesis and immunization of viral infections, including hepatitis A and B, influenza, rabies, measles, mumps, rubella, polio, varicella zoster, human papillomavirus, and rotavirus. 38) A client who is going to Africa requires vaccination against hepatitis A. How should the nurse schedule the three injections needed for this vaccination? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Give the first of the series today. 2. Give the second of the series tomorrow. 3. Give all three injections today. 4. Give the third injection of the series in 8 weeks. 5. Give the next two injections at least 8 weeks apart. Answer: 1, 4 Explanation: The first injection of the series could be given today. If an injection is given today, the second of the series could be given in 4 weeks, and the third of the series in 8 weeks. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 43-4 Prepare a table listing the types of vaccines, their indications, and potential adverse effects.

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39) A client with chronic obstructive pulmonary disease (COPD) says, "I'm not going to get a flu shot this year. If there is an outbreak, I'll get one then." How should the nurse respond to this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I rarely get a flu shot either." 2. "Once the outbreak is here, it is usually too late for immunizations." 3. "We can't always treat influenza very effectively in people with COPD." 4. "If you had an immunization last year, it is probably still effective." 5. "If you change your mind, you can get one at your next appointment in January." Answer: 2, 3 Explanation: Once an outbreak of influenza occurs, immunization is no longer effective. It is difficult to treat influenza in any population, and those with chronic lung diseases are particularly difficult to treat. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-5 Explain why it is important to administer childhood vaccines at specific ages.

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40) Which clients would the nurse identify as acceptable candidates for live, attenuated intranasal vaccine (LAIV) for influenza? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A 25-year-old woman who is in the third trimester of pregnancy 2. A 3-year-old going to daycare for the first time 3. A 65-year-old resident of an assisted living community 4. A 24-year-old male who works in an inner-city homeless shelter 5. A 17-year-old soccer player Answer: 2, 4, 5 Explanation: LAIV is recommended for healthy people ages 2 to 49. As long as this client is healthy, he falls within the 2- to 49-year age level. Healthy people ages 2 to 49 are eligible for this form of vaccine. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.1 Explain the interrelationships among theory, practice, and research | AACN Essential Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-8 Describe the pathogenesis and immunization of viral infections, including hepatitis A and B, influenza, rabies, measles, mumps, rubella, polio, varicella zoster, human papillomavirus, and rotavirus.

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41) A nurse is working with an outreach group to educate the public regarding influenza immunization. Which groups should this nurse target? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Residents of long-term care 2. Healthcare providers 3. Healthy young males 4. Women who will be pregnant during influenza season 5. Children with asthma Answer: 1, 2, 4, 5 Explanation: Residents of long-term care or nursing homes should receive an influenza immunization. Healthcare providers should be immunized both for their own protection and for the protection of those for whom they care. Women who will be pregnant during influenza season should be immunized. Children with chronic conditions such as asthma should be immunized. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-5 Explain why it is important to administer childhood vaccines at specific ages.

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42) A client has been bitten by a pet raccoon. What rabies prophylaxis is indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. None, since pets are unlikely to carry rabies 2. Observation of the animal for 60 days 3. One dose of rabies immune globulin 4. Five doses of rabies vaccine over a 28-day period 5. One dose of vaccine each week for 6 months Answer: 2, 3, 4 Explanation: The incubation period for rabies is 60 days, so the animal must be observed for that length of time. Rabies immune globulin will offer immediate protection. Five doses of rabies vaccine are given over a 28-day period. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-5 Explain why it is important to administer childhood vaccines at specific ages. 43) A healthcare worker has just finished the three-dose regimen for hepatitis B vaccination and says, "I'm glad that is over. I'll never have to take that again." The nurse formulates a response based on the knowledge that immunity should last 5 to years. Record your answer rounding to the nearest whole number. Answer: 7 Explanation: Immunity from the three-dose series lasts 5 to 7 years. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-11 Apply the nursing process to care for patients receiving immunizing agents.

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44) A client who was bitten by a stray dog refuses to take the rabies prophylaxis offered. The nurse responds to this refusal based on the knowledge that rabies is often fatal within days of the onset of symptoms. Record your answer rounding to the nearest whole number. Answer: 10 Explanation: Rabies is almost uniformly fatal, and death generally occurs within 10 days of the onset of symptoms. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-11 Apply the nursing process to care for patients receiving immunizing agents. 45) An elementary school teacher who is 16 weeks pregnant has been exposed to rubella. The nurse formulates advice to this client based on the knowledge that infection carries the greatest risk in the first weeks of pregnancy. Record your answer rounding to the nearest whole number. Answer: 12 Explanation: The greatest risk to the infant is within the first 12 weeks of pregnancy. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-11 Apply the nursing process to care for patients receiving immunizing agents.

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46) A child who is scheduled to compete in Olympic trials has been exposed to mumps. The child is not immunized, and the parents are concerned about when they will know if the child has mumps. The nurse gives information to these parents based on the knowledge that the incubation period for mumps is 16 to days. Record your answer rounding to the nearest whole number. Answer: 18 Explanation: Symptoms of mumps develop 16 to 18 days after exposure. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-11 Apply the nursing process to care for patients receiving immunizing agents. 47) Which clients would the nurse identify as unacceptable candidates for the measles, mumps, and rubella (MMR) vaccine? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A 35-year-old woman who is in the third trimester of pregnancy 2. A 3-year-old going to daycare for the first time 3. A 18-year-old attending college for the first time 4. A 24-year-old man with HIV who works with other men who are HIV positive 5. A 41-year-old man who works in a business setting Answer: 1, 4 Explanation: MMR is not recommended for pregnant women. MMR is not recommended for patients who are immunocompromised. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.1 Explain the interrelationships among theory, practice, and research | AACN Essential Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 43-8 Describe the pathogenesis and immunization of viral infections, including hepatitis A and B, influenza, rabies, measles, mumps, rubella, polio, varicella zoster, human papillomavirus, and rotavirus. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 44 Pharmacotherapy of Asthma and Other Pulmonary Disorders 1) A trauma client has experienced a ruptured diaphragm. The nurse would anticipate that this client will have difficulty: 1. with an elevated oxygen level. 806

2. primarily during exhalation. 3. maintaining a high enough respiratory rate. 4. carrying out the respiratory cycle. Answer: 4 Explanation: Contraction and relaxation of the diaphragm are essential to the ventilation segment of the respiratory cycle. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 44-1 Identify the anatomic structures associated with the lower respiratory tract and their functions. 2) An adult is admitted to the emergency department with a respiratory rate of 32 breaths/min and gasping. The nursing interview reveals the client witnessed violence with the use of guns. The nurse recognizes the client's rapid breathing is probably driven by: 1. brainstem activity. 2. increased perfusion in the cerebral cortex. 3. increased perfusion in the alveolar capillary bed. 4. a sudden increase in blood pressure. Answer: 1 Explanation: The brainstem is highly influenced by emotions, particularly fear and anxiety. This client experienced both, which led to a sudden rise in respiratory rate. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 44-1 Identify the anatomic structures associated with the lower respiratory tract and their functions.

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3) A nurse is caring for several clients receiving bronchodilator therapy for asthma. The nurse has noted that some clients develop hyperglycemia during therapy. Which bronchodilator would the nurse consider problematic? 1. Albuterol (Proventil) 2. Ipratropium (Atrovent) 3. Theophylline Answer: 1 Explanation: Beta agonists such as albuterol may cause hyperglycemia. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 44-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 4) The nurse is assisting a client to master the use of a steroid inhaler. The client says, "I don't think I should be using steroids. I see steroids labeled as bad in the news at least once a week." The nurse's response is based on which statement? 1. The steroid preparations used to treat airway problems are very different from the steroids abused by people reported in the news media. 2. Steroids can be very risky, but the risk is necessary in this client's case. 3. Inhaled steroids are very useful in managing reactive airways, with a fairly good safety profile. 4. Inhaled steroid use is usually short term, so any risk to the client is minimal. Answer: 3 Explanation: Inhaled steroids are very useful in the management of chronic diseases like asthma and bronchitis. Because they are inhaled, their desired effect is local. The safety profile is good because the adverse effects are local as well. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-3 Explain the role of inflammation and bronchospasm in the pathogenesis of asthma.

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5) A client with chronic obstructive pulmonary disease (COPD) is experiencing difficulty with copious amounts of tenacious sputum. A mucolytic drug is prescribed. The outcome the nurse would track is: 1. increase in clearance of sputum. 2. decrease in respiratory rate with increase in depth. 3. resolution of atrial tachycardia. 4. decrease in wheezing. Answer: 1 Explanation: The intent of mucolytic therapy is to loosen the mucus so that it can be more easily expectorated. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 44-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 6) The nurse is planning care for a client with chronic obstructive pulmonary disease (COPD). The client's symptoms are wheezing, tachycardia, increased respiratory rate, coughing up of yellow mucus, and a low oxygen level. The highest priority nursing diagnosis is: 1. Falls, Risk for 2. Knowledge, Deficient 3. Gas Exchange, Impaired 4. Anxiety. Answer: 3 Explanation: The client has low oxygen levels. Increasing the level of oxygen in the client's bloodstream is the highest priority. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 44-8 Describe the nurse's role in the pharmacologic management of lower respiratory tract disorders.

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7) The nurse is teaching a client with asthma about the use of a corticosteroid inhaler prior to discharge. The expected outcome of this therapy is: 1. less histamine formation, with less mucus in the upper airway. 2. less swelling and mucus formation, and decreased hyperresponsiveness to allergens. 3. resolution of all asthma symptoms. 4. decreased inflammation of the midsized bronchial tubes. Answer: 2 Explanation: Corticosteroids decrease inflammation, mucus production, and edema and reduce bronchial hyperresponsiveness to allergens. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 44-8 Describe the nurse's role in the pharmacologic management of lower respiratory tract disorders. 8) A nurse in an intensive care unit is planning care for a client with severe bronchospasms triggered by a known allergy to peanuts. The nurse recognizes that constriction is related to inflammatory mediators that trigger: 1. formation of sticky mucous plugs. 2. formation of thick membrane between the alveoli and the capillary bed. 3. constriction of the muscles in the walls of the large bronchiole tubes. 4. swelling of the juncture between the alveolus and the capillary bed. Answer: 3 Explanation: Allergic reactions can occur when a hypersensitive person is inadvertently exposed to an allergen, causing IgE antibodies to release histamine and other irritating substances. Bronchoconstriction quickly results. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 44-3 Explain the role of inflammation and bronchospasm in the pathogenesis of asthma.

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9) The nurse is collaboratively setting goals for the inpatient management of new-onset asthma in a child. The nurse prioritizes the client's nursing diagnoses and gives which goal the highest priority? 1. The client will report improved ease of breathing by discharge. 2. The client will sleep uninterrupted for 4 hours at a stretch every night during admission. 3. The client's parents will verbalize the importance of the medication regimen by discharge. 4. The client's mother will correctly demonstrate the use of an inhaler with a spacer by discharge. Answer: 1 Explanation: The goal with the highest priority is for the medication to be effective in a specific, measurable way. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 44-10 Apply the nursing process to care for patients receiving pharmacotherapy for lower respiratory tract disorders. 10) A client is learning metered-dose inhaler technique. The client says, "I don't understand why I have to use this thing. Can't I just take pills?" The nurse responds that the inhalation route: 1. is easier to master than is oral therapy. 2. is less expensive than is oral therapy. 3. is more likely to lead to termination of the disease process than are pills. 4. delivers the medication directly to the site, resulting in lower doses and fewer systemic side effects. Answer: 4 Explanation: The inhaled route delivers the drug directly to the lungs, so lower doses are possible and there are fewer systemic side effects than are typically associated with pills. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-4 Compare the advantages and disadvantages of using the inhalation route of drug administration for pulmonary drugs.

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11) A client with degenerative arthritis is provided with a spacer along with a corticosteroid metered-dose inhaler. The nurse recognizes that the spacer assists this client to: 1. compensate for decreased dexterity. 2. use a larger dose of the steroid. 3. progress with weaning from the steroid drug. 4. avoid thrush infections. Answer: 1 Explanation: Spacers allow the client with decreased mobility or poor coordination to use a metered-dose inhaler more effectively. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-5 Describe the types of devices used to deliver aerosol therapies via the inhalation route. 12) A client in acute respiratory distress on a medical unit is receiving a nebulizer albuterol treatment. The client is annoyed because he already has an albuterol metered-dose inhaler (MDI). The nurse's response to the client's concern is based on the knowledge that: 1. nebulized therapy is more cost effective in the inpatient setting. 2. suspension of the medication in liquid and delivery over a longer period increase the bronchodilator's effectiveness. 3. the nebulized form of the drug will have fewer negative effects on this distressed client. 4. the client who is agitated and dyspneic is unlikely to be able to use a metered-dose albuterol inhaler effectively. Answer: 2 Explanation: The client in acute distress benefits from the administration of a nebulizer treatment because the medication is delivered over a relatively longer period of time. Suspension in liquid particles with the use of a mouthpiece or mask and the assistance of a professional provider ensure that the medication will get to the lung's surfaces. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-5 Describe the types of devices used to deliver aerosol therapies via the inhalation route.

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13) A client with limited strength in the hands is being prepared for discharge with a dry powder inhaler (DPI). The discharge nurse teaches the client that an advantage of this inhaler is that: 1. the client can activate the inhaler with less pressure than is needed for a metered-dose inhaler. 2. this inhaler has no dose limits. 3. the client can increase the effectiveness of the powder by instilling it into a small nebulizer. 4. the client can activate the inhaler simply by inhaling. Answer: 4 Explanation: Dry powder inhalers are activated by inhaling, which is an advantage to the client with decreased upper-body strength. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-5 Describe the types of devices used to deliver aerosol therapies via the inhalation route. 14) Over the course of treatment for chronic asthma, a client develops an allergy to the propellants in rapid-acting metered-dose inhalers (MDIs). What option would the nurse expect to be used to address this problem after discharge? 1. Oral medication of the same class as the metered-dose inhaler 2. Nebulizer treatments 3. A concentrated-dose metered-dose inhaler 4. A dry powder inhaler (DPI) Answer: 4 Explanation: Dry powder inhalers contain no propellants. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 44-5 Describe the types of devices used to deliver aerosol therapies via the inhalation route.

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15) The nurse is admitting a client with a history of asthma attacks every other day and three episodes at night in the last month. The client reports activity is somewhat limited. The nurse anticipates that the healthcare provider will determine the client's level of asthma to be: 1. severe. 2. mild persistent. 3. intermittent. 4. moderate persistent. Answer: 2 Explanation: This client fits the profile for mild persistent asthma with attacks that occur between three and six times per week and more than twice a month at night. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 44-6 Explain the three basic principles of asthma management recommended by the National Asthma Education and Prevention Program. 16) The nurse is caring for an orthopedic surgical client with mild intermittent asthma. During the second postoperative day, the client has an asthma attack while eating lunch. The nurse expects the healthcare provider to give an order for: 1. subcutaneous epinephrine. 2. a short-acting selective beta-agonist inhaler. 3. an oral corticosteroid. 4. theophylline. Answer: 2 Explanation: Short-acting selective beta-agonist therapy via the inhaled route is the most appropriate therapy for mild intermittent asthma, used on an as-needed rescue basis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical experience, and patient/family values | AACN Essential Competencies: III.3 Advocate for the protection of human subjects in the conduct of research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 44-7 Compare and contrast the indications for pharmacotherapy with the short- versus long-acting beta-adrenergic agonists.

814

17) A mother is struggling to manage her child's moderate persistent asthma at home. The mother asks the nurse if there are any nonpharmacologic measures she can use. Which strategies are most likely to be effective? 1. Keeping the child's immunizations up-to-date and wearing a face mask in public 2. Limiting intake of protein and foods with red and yellow dyes 3. Avoiding stimuli such as secondhand smoke, pollutants, and cold air 4. Homeschooling the child and limiting his contact with other children who might have upper respiratory infections Answer: 3 Explanation: Environmental controls call for limiting a child's contact with potential allergens, particularly at night, when the airway is most reactive. Stimuli such as secondhand smoke, pollutants, and cold air can trigger hyperresponsiveness in clients with asthma. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-10 Apply the nursing process to care for patients receiving pharmacotherapy for lower respiratory tract disorders. 18) The nurse is admitting a client with an exacerbation of asthma. The medication list includes albuterol, salmeterol, budesonide, cromolyn, and zafirlukast. The client takes these medicines every day, except for the albuterol. When planning the client's care, the nurse recognizes that: 1. the client is taking too many medications, and several should be discontinued. 2. the therapy is adequate, except that the client should be using the albuterol daily. 3. the client needs several additional preparations if the asthma control standards of the Agency for Healthcare Research and Quality (AHRQ) are to be met. 4. the client's combination of medications is appropriate according to current practice guidelines. Answer: 4 Explanation: Current practice guidelines recommend a long-acting bronchodilator and a steroid for long-term management. Mast cell stabilizer and leukotriene modifiers are also appropriate. Albuterol is appropriate as an as-needed short-acting inhaler. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical experience, and patient/family values | AACN Essential Competencies: III.3 Advocate for the protection of human subjects in the conduct of research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 44-7 Compare and contrast the indications for pharmacotherapy with the short- versus long-acting beta-adrenergic agonists.

815

19) A client with moderate and persistent asthma has obtained control with an arformoterol inhaler QID for bronchospasm for several years. In the past couple of weeks, however, the client has been reporting more chest tightness and wheezing during the day. The nurse recognizes that the most likely problem is that the client: 1. is not taking the medication as directed. 2. needs to have the dose reduced and work back up to the full dose. 3. has developed a tolerance to the medication. 4. needs an inhaled steroid. Answer: 3 Explanation: Clients sometimes develop tolerance to the beta-adrenergic binding effects of inhaled bronchodilators. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 44-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 20) The nurse is teaching a client about the use of an albuterol rescue inhaler. Which nursing diagnosis is most appropriate to avoid the adverse effects of albuterol? 1. Knowledge, Deficient related to proper use of albuterol inhaler 2. Gas Exchange, Impaired related to inadequate response to albuterol 3. Airway Clearance, Ineffective related to excess mucus formation 4. Activity Intolerance related to ineffective drug therapy Answer: 1 Explanation: Correct inhaler use is essential to allow albuterol to penetrate deep enough into the airway to dilate the bronchioles. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 44-10 Apply the nursing process to care for patients receiving pharmacotherapy for lower respiratory tract disorders.

816

21) When planning care for a client newly diagnosed with asthma, the nurse is aware that heavy caffeine intake could make the client intolerant of certain respiratory medications, including: 1. cromolyn. 2. albuterol. 3. budesonide. 4. montelukast. Answer: 2 Explanation: Products containing caffeine such as coffee and tea may cause nervousness, tremor, or palpitations in clients taking albuterol. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 44-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 22) The nurse is caring for a client with chronic bronchitis and a history of glaucoma. The nurse recognizes that which drug would not be an appropriate choice for the control of the client's bronchospasm? 1. Cromolyn (Intal) 2. Dyphylline (Lufyllin) 3. Formoterol (Foradil) 4. Ipratropium (Atrovent) Answer: 4 Explanation: Ipratropium is an anticholinergic that can elevate intraocular pressure. It is not a good choice for the client with glaucoma. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 44-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 23) A client with asthma has been taking zafirlukast (Accolate ) for a number of years. Warfarin (Coumadin) is being added to the client's medications because of atrial fibrillation. What concern 817

does the nurse have related to this addition? 1. Warfarin may significantly decrease prothrombin time (PT). 2. The client might experience an increase in BUN and creatinine values. 3. Less warfarin (Coumadin) will be needed to achieve the desired prothrombin time (PT). 4. The client will be at greater risk for stroke because of drug interaction. Answer: 3 Explanation: Warfarin (Coumadin) may significantly elevate the PT so that less warfarin (Coumadin) is needed. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 44-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 24) A client admitted with persistent asthma has a history of hypertension. Which class of asthma drugs must be used cautiously with clients who have hypertension? 1. Inhaled corticosteroids 2. Oral short-acting beta-adrenergic agonists 3. Inhaled anticholinergic medications 4. Mast cell stabilizers Answer: 2 Explanation: Oral beta-adrenergic agonists activate the sympathetic nervous system and must be used cautiously in clients with hypertension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 44-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 25) A client with persistent asthma has a history of multiple allergies, including peanuts and soy. The nurse knows that, given this history, which prophylactic medication should be avoided? 1. Cromolyn (Intal) 2. Ipratropium (Atrovent) 818

3. Triamcinolone (Azmacort) 4. Zafirlukast (Accolate) Answer: 2 Explanation: Ipratropium contains a substance derived from soya lecithin, so it is contraindicated in the presence of soy allergies. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 44-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 26) The nurse helps a client establish goals to control asthma with medications. The nurse emphasizes that the preferred drugs for long-term control of asthma are: 1. inhaled corticosteroids. 2. inhaled beta2 agonists. 3. anticholinergics. 4. systemic corticosteroids. Answer: 1 Explanation: Inhaled corticosteroids decrease inflammation, resulting in fewer asthma attacks. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 44-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

819

27) The nurse is planning strategies for managing the symptoms of a new client with asthma. Which strategies will decrease the risk for bronchospasms? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Educating the client regarding the use of asthma medications 2. Educating the client regarding environmental control measures 3. Successfully managing comorbidities 4. Not making changes once asthma control has been achieved 5. Using the maximum amount of medication allowed to achieve asthma control Answer: 1, 2, 3 Explanation: The National Asthma Education and Prevention Program (NAEPP) recommends client education regarding the use of medication for symptoms. The National Asthma Education and Prevention Program (NAEPP) recommends education regarding environmental triggers. The National Asthma Education and Prevention Program (NAEPP) recommends managing comorbidities. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical experience, and patient/family values | AACN Essential Competencies: V.5 Describe state and national statues, rules and regulations that authorize and define professional nursing practice | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 44-6 Explain the three basic principles of asthma management recommended by the National Asthma Education and Prevention Program.

820

28) The admitting nurse suspects a client has moderate persistent asthma because: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. symptoms occur every day. 2. symptoms occur more than one night a week. 3. symptoms affect daily activity. 4. symptoms occasionally affect daily activity. 5. symptoms occur two times a month. Answer: 1, 2, 3 Explanation: When symptoms occur every day, the asthma is considered moderate persistent. When symptoms occur more than one night a week, the asthma is considered moderate persistent. When symptoms affect daily activity, the asthma is considered moderate persistent. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical experience, and patient/family values | AACN Essential Competencies: V.5 Describe state and national statues, rules and regulations that authorize and define professional nursing practice | NLN Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 44-6 Explain the three basic principles of asthma management recommended by the National Asthma Education and Prevention Program.

821

29) A client asks the nurse why the healthcare provider has ordered the asthma medication in inhalant rather than oral form. What is the nurse's best response? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Inhaling an asthma medication offers a rapid and efficient way to get the medication directly into your lungs." 2. "Inhaling an asthma medication results in an almost instantaneous onset of action, which will relieve your symptoms much more quickly." 3. "Inhaling an asthma medication will control your symptoms with smaller doses, reducing the risk of systemic effects." 4. "Inhaling an asthma medication is an effective way to get the medication right into your lungs and is also a lot less expensive than oral medications." 5. "Inhaling an asthma medication automatically decreases the onset of the medication, resulting in quicker relief of your symptoms." Answer: 1, 2, 3 Explanation: Inhalation offers a rapid and efficient mechanism for delivering drugs directly to the site of action—the lungs. Delivering the medication directly into the lungs results in an almost instantaneous onset of action. Delivering the drug directly to the site allows for smaller doses of the drug, which results in a lower risk of systemic effects. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-4 Compare the advantages and disadvantages of using the inhalation route of drug administration for pulmonary drugs.

822

30) A pediatric nurse is educating a 6-year-old and the mother on the use of a metered-dose inhaler (MDI) with a spacer. The mother asks what the spacer is for. The nurse responds: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Without the spacer, most of the medication does not get into the lungs because the heavier particles fall out into the throat." 2. "It can be difficult to properly coordinate pressing the canister and inhaling so the medication falls into the mouth instead of getting to the lungs." 3. "The spacer holds the medication during inhalation, so your child will not have to worry about coordination." 4. "The spacer is automatically activated when your child inhales, making it a lot easier to get the medication into the lungs." 5. "The spacer vaporizes the medication so your child can inhale it. More medication gets directly into the lungs." Answer: 1, 2, 3 Explanation: Even when MDIs are properly used, the majority of the aerosolized drug never reaches the lungs because the heavier particles fall out by gravity and are deposited in the throat. Because the spacer holds the medication, the client does not have to precisely coordinate inhalation with activation. The spacer holds drops that fall out of the aerosol so that less medication is deposited in the mouth and throat. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-5 Describe the types of devices used to deliver aerosol therapies via the inhalation route.

823

31) The nurse instructs a client with asthma that quick-relief medications that should be used for acute symptoms include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. albuterol (Proventil). 2. ipratropium (Atrovent). 3. beclomethasone (Beconase). 4. cromolyn (Intal). 5. montelukast (Singulair). Answer: 1, 2 Explanation: Albuterol is a short-acting beta-adrenergic agonist and is the preferred drug for relief of acute symptoms because it relaxes bronchial smooth muscle. Ipratropium is an anticholinergic, which can relax bronchial smooth muscle and is an alternate quick-relief drug for clients who cannot tolerate short-acting beta-adrenergic agonists. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical experience, and patient/family values | AACN Essential Competencies: III.3 Advocate for the protection of human subjects in the conduct of research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 44-7 Compare and contrast the indications for pharmacotherapy with the short- versus long-acting beta-adrenergic agonists.

824

32) The nurse has taught a group of clients with asthma the importance of knowing when to use quick-relief medications and when to use long-acting medications. The nurse knows the clients have understood the teaching when they identify which medications as long acting? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. budesonide (Pulmicort) 2. nedocromil (Tilade) 3. zafirlukast (Accolate) 4. albuterol (Ventolin) 5. ipratropium (Atrovent) Answer: 1, 2, 3 Explanation: Budesonide is an inhaled corticosteroid. It is an anti-inflammatory medication used to decrease inflammation of the airways, resulting in long-term control of asthma symptoms. Nedocromil is a mast cell stabilizer. It is an anti-inflammatory medication used to decrease inflammation of the airways, resulting in long-term control of asthma symptoms. Zafirlukast is a leukotriene modifier. It is an anti-inflammatory medication used to decrease inflammation of the airways, resulting in long-term control of asthma symptoms. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 44-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

825

33) The nurse is providing discharge instruction to a client newly diagnosed with asthma. The client has been prescribed albuterol (Proventil) for bronchospasm. Which side effects should the nurse explain to the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Restlessness 2. Tremor 3. Nervousness 4. Abnormal EKG 5. Hypertensive crisis Answer: 1, 2, 3 Explanation: Albuterol activates the sympathetic nervous system, which results in bronchodilation but can also cause restlessness. Albuterol activates the sympathetic nervous system, which results in bronchodilation but can also cause tremors. Albuterol activates the sympathetic nervous system, which results in bronchodilation but can also cause nervousness. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-10 Apply the nursing process to care for patients receiving pharmacotherapy for lower respiratory tract disorders.

826

34) The nurse explains to a client that inhaled corticosteroid medications are used in the long-term management of asthma to decrease: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. inflammation of the airways. 2. mucus production. 3. bronchial hyperresponsiveness to allergens. 4. bronchial constriction. 5. edema. Answer: 1, 2, 3, 5 Explanation: Corticosteroids decrease inflammation. Corticosteroids decrease inflammation, thereby reducing mucus production. Corticosteroids decrease bronchial hyperresponsiveness to allergens that can cause inflammation, edema, and bronchospasm. Corticosteroids decrease inflammation, thereby reducing edema. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-10 Apply the nursing process to care for patients receiving pharmacotherapy for lower respiratory tract disorders.

827

35) A client has been prescribed beclomethasone (Beconase) for long-term management of persistent asthma. Prior to discharge, the nurse teaches the client about possible side effects, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. hoarseness. 2. dry mouth. 3. changes in taste. 4. nervousness. 5. insomnia. Answer: 1, 2, 3 Explanation: Hoarseness can occur as a local reaction to beclomethasone. Dry mouth can occur as a local reaction to beclomethasone. Changes in taste can occur as a local reaction to beclomethasone. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

828

36) A client is prescribed zafirlukast (Accolate) for persistent, chronic asthma. Which nursing interventions take priority? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Instruct the client not to take aspirin while on a zafirlukast regimen. 2. Instruct the client to take zafirlukast on an empty stomach. 3. Discuss the possibility of headache. 4. Encourage the client to report any hair loss. 5. Instruct the client to prevent falls by avoiding sudden changes in position. Answer: 1, 2, 3 Explanation: Concurrent use with aspirin can significantly increase blood levels of zafirlukast, increasing the risk of adverse effects. Taking zafirlukast with food can reduce its bioavailability. Headache is the most common complaint from clients who take zafirlukast. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-10 Apply the nursing process to care for patients receiving pharmacotherapy for lower respiratory tract disorders.

829

37) The nurse is reviewing the admission history of a client taking zileuton (Zyflo CR) in the emergency department. Which patient reports would take highest priority during the physical assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Sinusitis 2. Nausea 3. Yellow skin 4. Abdominal pain 5. Throat pain Answer: 2, 3, 4 Explanation: Nausea can be a symptom of liver damage, which is a serious concern in clients taking zileuton. Yellow skin implies jaundice, which is a serious concern in clients taking zileuton. Abdominal pain can be a symptom of liver damage, which is a serious concern in clients taking zileuton. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 44-10 Apply the nursing process to care for patients receiving pharmacotherapy for lower respiratory tract disorders.

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38) The nurse in a pulmonary clinic knows that theophylline should not be prescribed for: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. a teenager taking erythromycin for acne. 2. a client taking lorazepam for anxiety. 3. a client taking ciprofloxacin for prostatitis. 4. a client with elevated liver enzymes. 5. a client taking St. John's wort for menopausal symptoms. Answer: 1, 2, 3 Explanation: Erythromycin is one of the common antibiotics that have a drug–drug interaction with theophylline. Lorazepam is one of the antianxiety medications that have a drug–drug interaction with theophylline. Ciprofloxacin is one of the antibiotics that have a drug–drug interaction with theophylline. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 44-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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39) The nurse in a pulmonary clinic is evaluating several clients' theophylline levels. Which levels would have the highest priority? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. 8 mcg/mL 2. 19 mcg/mL 3. 21 mcg/mL 4. 12 mcg/mL 5. 15 mcg/mL Answer: 1, 2, 3 Explanation: This theophylline level is below therapeutic range. This theophylline level is nearing toxic levels. This theophylline level is in the toxic range. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 44-10 Apply the nursing process to care for patients receiving pharmacotherapy for lower respiratory tract disorders.

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40) The priority assessment for a client receiving asthma medications to determine effectiveness of therapy should include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. increased ease of breathing. 2. improved signs of peripheral oxygenation. 3. absence of adventitious sounds. 4. normal hepatic function. 5. therapeutic levels of medications. Answer: 1, 2, 3 Explanation: Increased ease of breathing would indicate less bronchospasm. Improved peripheral oxygenation would indicate improved gas exchange. Absence of adventitious sounds would indicate less mucus production. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 44-10 Apply the nursing process to care for patients receiving pharmacotherapy for lower respiratory tract disorders.

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41) The nurse, discharging a client recently diagnosed with asthma, explains that symptoms that should be reported immediately to the healthcare provider include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. difficulty breathing. 2. feeling breathless when speaking. 3. increased anxiety. 4. increased activity level. 5. increased appetite. Answer: 1, 2, 3 Explanation: Difficulty breathing would indicate a deteriorating respiratory status and should be reported immediately. Feeling breathless when speaking would indicate a deteriorating respiratory status and should be reported immediately. Anxiety can indicate a deteriorating respiratory status and should be reported immediately. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-10 Apply the nursing process to care for patients receiving pharmacotherapy for lower respiratory tract disorders. 42) The nurse explains to a client that drugs that activate beta2-adrenergic receptors: 1. relax bronchiolar smooth muscle. 2. result in airway diameter narrowing. 3. increase labored breathing 4. decrease production of viscous secretions. Answer: 1 Explanation: Drugs that activate beta2-adrenergic receptors cause bronchiolar smooth muscle to relax. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-2 Explain how the autonomic nervous system regulates airway diameter.

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43) The nurse explains to a nursing student that drugs that activate the parasympathetic branch of the autonomic nervous system: 1. relax bronchiolar smooth muscle. 2. result in airway diameter narrowing. 3. decrease labored breathing 4. increase production of viscous secretions. Answer: 2 Explanation: Drugs that activate the parasympathetic branch of the autonomic nervous system cause bronchiolar smooth muscle to contract, the airway diameter to narrow, and bronchoconstriction to occur. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 44-2 Explain how the autonomic nervous system regulates airway diameter. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 45 Pharmacotherapy of Allergic Rhinitis and the Common Cold 1) The nurse is teaching a group of grade-school children about body functions. A student asks, "Why do I sneeze?" The nurse's best response is: 1. "A sneeze is caused by a contraction of your throat and lungs." 2. "The back part of your brain is in charge of sneezes and coughs." 3. "A sneeze is your body's way of getting rid of something irritating." 4. "You sneeze because your body needs to take a really deep breath." Answer: 3 Explanation: Sneezing is triggered by irritants in the nasal passages. The diaphragm and other muscles of respiration contract. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-1 Identify structures of the upper respiratory tract that serve as body defenses against foreign substances. 2) The nurse is planning care for a client with allergies who has an order for a sympathomimetic drug. The nurse is aware that the desired effect for this client is: 1. relief of nasal dryness. 2. relief of nasal stuffiness. 3. calming of a wet cough. 4. increased blood flow to the nose. Answer: 2 835

Explanation: Sympathomimetic drugs shrink the nasal mucous membranes and relieve stuffiness. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 45-5 Explain why intranasal corticosteroids are preferred drugs for the treatment of allergic rhinitis.

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3) Which assessment data would provide the nurse with the best evidence of allergic rhinitis? 1. Copious thick, green nasal drainage and postnasal drip 2. Productive cough, sneezing, and low-grade fever 3. Coughing, sneezing, and watery eyes 4. Severe frontal headache and pressure along both sides of the nose Answer: 3 Explanation: Coughing, sneezing, and watery eyes are classic signs of allergic rhinitis. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 45-2 Describe the common causes and symptoms of allergic rhinitis. 4) The nurse is administering an antihistamine to a client with nasal allergies. The nurse is aware that antihistamines have which distinct limitation? 1. They have potent cholinergic side effects. 2. They block both H1 and H2 receptors. 3. They are most effective when taken prophylactically. 4. They are useful only during acute attacks. Answer: 3 Explanation: Antihistamines are most effective when taken prophylactically for the symptoms of nasal allergies. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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5) The nurse is administering a drug that antagonizes H1 histamine receptors. Which is the most likely expected outcome of this therapy? 1. The client will report that headache is improved. 2. The client will cough less. 3. The client will report less sneezing and tearing. 4. The client will report less wheezing and more energy. Answer: 3 Explanation: Antihistamines are histamine blockers (H1 blockers). Histamines are responsible for sneezing, itching, and watery eyes. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 45-3 Differentiate between H1 and H2 histamine receptors. 6) The nurse is teaching a client about the use of antihistamines for allergic rhinitis. Which pointer is appropriate for increasing effectiveness? 1. "Take this drug at the same time every day." 2. "Take this drug with the largest meal of the day." 3. "Take this drug when your symptoms are the worst." 4. "Take this drug before you are exposed to your allergens." Answer: 4 Explanation: Antihistamines are most effective if taken prior to exposure to allergens. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-11 Apply the nursing process to care for patients receiving pharmacotherapy for allergic rhinitis and the common cold.

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7) The nurse is advising a client who been using over-the-counter (OTC) diphenhydramine (Benadryl) to induce sleep. The client complains about a dry mouth. The nurse explains that: 1. diphenhydramine causes less dryness if taken in the liquid form. 2. drying of the mouth membranes is common after taking diphenhydramine. 3. drowsiness caused by the diphenhydramine caused the client to reduce fluid intake. 4. diphenhydramine has a muscle relaxant effect, so the client is likely sleeping with the mouth open. Answer: 2 Explanation: Diphenhydramine is an antihistamine with a potent anticholinergic effect that promotes dry mouth. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 8) A student needs to take an antihistamine for chronic rhinitis. Which preparation is least likely to make the student sleepy in class? 1. Hydroxyzine (Atarax) 2. Cetirizine (Zyrtec) 3. Diphenhydramine (Benadryl) 4. Fexofenadine (Allegra) Answer: 4 Explanation: Fexofenadine (Allegra) is the least sedating of the second-generation antihistamines. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 45-4 Compare and contrast the first- and second-generation antihistamines.

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9) A client is being treated in the emergency department for an anaphylactic reaction to an antibiotic. The client will be receiving an antihistamine in addition to other preparations. Which drug would the nurse anticipate administering? 1. Fexofenadine (Allegra) 2. Azelastine (Astelin) 3. Loratadine (Claritin) 4. Diphenhydramine (Benadryl) Answer: 4 Explanation: Diphenhydramine (Benadryl) is the preparation most likely to be used, because it can be administered by intravenous route. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 45-4 Compare and contrast the first- and second-generation antihistamines. 10) The nurse is teaching a client about beclomethasone (Beconase) nasal spray prior to discharge. Which side effects will the nurse prepare the client to manage? 1. Salt sensitivity and elevation of blood pressure 2. Nasal irritation and nosebleed 3. Bone demineralization and increased risk of fracture 4. Dyspepsia and gastric irritation Answer: 2 Explanation: Nasal steroids cause local irritation and might trigger nosebleeds. Systemic symptoms are uncommon. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-5 Explain why intranasal corticosteroids are preferred drugs for the treatment of allergic rhinitis.

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11) The nurse is evaluating outcomes for a client who has been using a nasal steroid consistently for several months. Which is the desired outcome? 1. The client reports decreased nasal congestion. 2. The client's upper respiratory system is free of infection. 3. The client is free of wheezing. 4. The client's tonsils are pink and free of swelling and exudate. Answer: 1 Explanation: Nasal steroids are indicated for control of allergic rhinitis. Nasal congestion, drainage, sneezing, and watery eyes should diminish after a month's use. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 45-5 Explain why intranasal corticosteroids are preferred drugs for the treatment of allergic rhinitis. 12) Which point should the nurse include when instructing a client in the use of a budesonide (Rhinocort) nasal preparation? 1. "Use this preparation before your nasal decongestant." 2. "Avoid the use of ultrasonic humidifiers with this preparation." 3. "You should see improvement in your symptoms in about a week." 4. "You could experience nosebleeds." Answer: 4 Explanation: Intranasal corticosteroids can cause excessive drying of the nasal mucosa, resulting in nosebleeds. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-11 Apply the nursing process to care for patients receiving pharmacotherapy for allergic rhinitis and the common cold.

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13) A mother is asking the nurse about relief of cold symptoms in her 4-year-old. Which preparation should the nurse advise the mother to avoid? 1. Loratadine (Claritin) 2. Acetaminophen (Tylenol) 3. Ibuprofen (Advil) 4. Dextromethorphan (Robitussin) Answer: 4 Explanation: Dextromethorphan should not be used in children under 6 years of age. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-8 Describe the appropriate use of cough suppressants. 14) The nurse is instructing a client on the proper use of an intranasal decongestant. The nurse's caution about rebound effect will center primarily on: 1. concerns about chest pain with repeated use. 2. the need to minimize the drug's systemic effects. 3. the need to count the number of sprays of medication at each application. 4. the need to stop the medication after 3 to 5 days of use. Answer: 4 Explanation: The primary concern with rebound effect is associated with an increase in congestion if the drug is used continuously for more than 5 days. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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15) A middle-aged male is taking pseudoephedrine for nasal congestion. What adverse effect is most likely if he also has benign prostatic hypertrophy? 1. Elevated uric acid level 2. Urinary retention 3. Incontinence of urine 4. Elevated creatine level Answer: 2 Explanation: Decongestants bind to alpha1-adrenergic receptors. This can cause changes in the urethra with urinary retention in a male with preexisting narrowing from an enlarged prostate. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 45-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 16) A client is receiving a phenylephrine (Afrin) nasal spray for the symptoms of a cold. Which assessment parameter would the nurse expect to see improved? 1. A decrease in nasal stuffiness 2. Improved energy level 3. Less coughing 4. Fewer nasal secretions Answer: 1 Explanation: Phenylephrine is a decongestant topical preparation that decreases puffiness of the mucous membranes inside the nose. Subjectively, the client will experience less stuffiness. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 45-11 Apply the nursing process to care for patients receiving pharmacotherapy for allergic rhinitis and the common cold.

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17) The nurse is teaching a client about the actions of an intranasal inhaler containing ipratropium (Atrovent). Which statement by the nurse is most accurate? 1. "You will notice a decrease in nasal secretions." 2. "You will notice you are not sneezing as much." 3. "You will not have as much postnasal drip." 4. "Your throat won't feel so scratchy." Answer: 1 Explanation: Intranasal ipratropium (Atrovent) decreases nasal secretions. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 18) An older male client with several chronic conditions is using pseudoephedrine for cold symptoms. Which adverse effect does the nurse teach the client to report to the physician? 1. Increased coughing 2. Irritated, crusty nares 3. Thickening and color change of nasal drainage 4. Decreased urinary stream Answer: 4 Explanation: Pseudoephedrine can cause diminished urinary outflow in clients who have prostate enlargement. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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19) The nurse is teaching a group about the use of cough medications. Which preparation should be used for nonproductive coughs? 1. Guaifenesin (Robitussin GF) 2. Acetylcysteine (Mucomyst) 3. Dextromethorphan (Delsym) 4. Guaifenesin (Mucinex) Answer: 3 Explanation: Delsym contains dextromethorphan, which is appropriate for dry coughs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-8 Describe the appropriate use of cough suppressants. 20) The nurse recognizes that respiratory depression is a risk with some cough suppressants. Which preparation has the least risk of causing respiratory depression? 1. A codeine-based preparation 2. Codeine with bromodiphenhydramine (Ambenyl) 3. Hydrocodone with homatropine (Hycodan) 4. Dextromethorphan (Delsym) Answer: 4 Explanation: Dextromethorphan (Delsym) is a nonnarcotic preparation with the lowest potential for respiratory depression. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 45-8 Describe the appropriate use of cough suppressants.

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21) The nurse is caring for a client who is taking benzonatate (Tessalon) for a cough. The client accidentally bites into one of the gelcaps prior to swallowing it. What should the nurse do next? 1. Call the physician and complete a variance report. 2. Explain that the client might experience numbness of the tongue. 3. Assess blood pressure frequently for the next hour. 4. Explain that the client is likely to become very nauseated. Answer: 2 Explanation: Tessalon contains a local anesthetic, and numbness of the tongue will occur but will be temporary. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-11 Apply the nursing process to care for patients receiving pharmacotherapy for allergic rhinitis and the common cold. 22) A client has been receiving a cough medicine with guaifenesin for 48 hours. Which nursing diagnosis would this medication best address? 1. Airway Clearance, Ineffective related to large amount of tenacious mucus 2. Perfusion: Gastrointestinal, Risk for Ineffective related to abdominal distention from gas buildup in stomach 3. Gas Exchange, Impaired related to inability to discharge carbon dioxide 4. Pain, Acute related to swollen tonsils and discomfort rated at 7 on 0–10 VAS Answer: 1 Explanation: Guaifenesin is an expectorant. It helps move thick mucus by increasing its production. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 45-9 Describe the use of drugs prescribed to treat thick bronchial secretions.

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23) A client is being treated with dornase alfa (Pulmozyme). The nurse anticipates that the client is most likely to experience which cluster of adverse effects? 1. Headache, nasal stuffiness, and earaches 2. Nausea, vomiting, and diarrhea 3. Epigastric pain, belching, and flatulence 4. Sore throat, conjunctivitis, and hoarseness Answer: 4 Explanation: The most common adverse effects of dornase alfa (Pulmozyme) are chest pain, hoarseness, sore throat, and conjunctivitis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 45-9 Describe the use of drugs prescribed to treat thick bronchial secretions. 24) The nurse is assisting with the administration of an acetylcysteine (Mucomyst) nebulizer treatment by mask. What warning to the client is essential prior to the start of the treatment? 1. "Tell us right away if your fingers start to tingle." 2. "This treatment does not smell very good." 3. "This treatment may make you feel dizzy." 4. "Tell us right away if you develop chest pain." Answer: 2 Explanation: Acetylcysteine (Mucomyst) smells like rotten eggs. The odor bothers some more than others. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-9 Describe the use of drugs prescribed to treat thick bronchial secretions.

847

25) The nurse is assessing a client who regularly takes an oral first-generation antihistamine for nasal allergies. Which medication order would trigger concerns about drug interaction with the antihistamine? 1. Hydrochlorothiazide, a diuretic 2. Tylenol with codeine, an opiate analgesic 3. Enoxaparin (Lovenox), an anticoagulant 4. Atenolol, an antihypertensive Answer: 2 Explanation: First-generation antihistamines cross the blood–brain barrier and can cause drowsiness. Codeine is a narcotic that also causes drowsiness, so there will be an additive effect. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 45-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 26) The nurse is teaching a client about the side effects of intranasal beclomethasone (Beconase), including: 1. nuchal rigidity and headache. 2. burning and nosebleed. 3. muscle aches and conjunctivitis. 4. frequent sneezing and hiccups. Answer: 2 Explanation: Intranasal steroids typically are well tolerated. The client might experience burning at the time of application, as well as nosebleed and headache. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 27) Rebound congestion is occasionally a problem after use of some drugs for allergic rhinitis. 848

Which preparation is mostly likely to cause this concern? 1. Intranasal decongestants 2. Intranasal steroids 3. Oral decongestants 4. Oral antihistamines Answer: 1 Explanation: Intranasal decongestants that are used repeatedly may cause rebound congestion. They should not be used for more than 5 consecutive days. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 45-6 Compare and contrast the oral and intranasal decongestants. 28) Which assessment is most relevant to the care of a client with a new order for an inhaled nasal steroid? 1. History of chronic bronchitis 2. History of emphysema 3. History of allergic rhinitis 4. History of asthma Answer: 3 Explanation: Inhaled steroids are appropriate for the management of allergic rhinitis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 45-5 Explain why intranasal corticosteroids are preferred drugs for the treatment of allergic rhinitis.

849

29) A client with a severe cough has a new order for a hydrocodone-based antitussive. Which history assessment would result in changing the prescription? 1. The client has been unable to sleep for four nights due to coughing. 2. The client has a history of lung cancer. 3. Hydrocodone makes the client drowsy. 4. The client has a history of persistent intermittent asthma. Answer: 4 Explanation: A history of asthma is a concern, because hydrocodone can trigger bronchospasm. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 45-11 Apply the nursing process to care for patients receiving pharmacotherapy for allergic rhinitis and the common cold. 30) What is an expected outcome of antihistamine therapy for allergic rhinitis? 1. The nasal airway opens wider. 2. The sinuses drain more effectively. 3. Coughing becomes productive. 4. Sneezing and tearing decrease. Answer: 4 Explanation: Antihistamines decrease inflammation, so sneezing, tearing, and reddened eyes improve. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 45-11 Apply the nursing process to care for patients receiving pharmacotherapy for allergic rhinitis and the common cold.

850

31) The nurse is teaching a group of teens with asthma how the structures of the upper respiratory tract protect against infections. Which statement by a teen demonstrates that teaching has been successful? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The passages of the nose and throat filter, warm, and humidify air when I inhale." 2. "The structures of the upper respiratory tract trap particulate matter and pathogens, preventing them from going down into my lungs." 3. "The upper respiratory tract is lined with tiny hairs that move back and forth, pushing foreign matter away from the lungs." 4. "Mucous membranes inside the nose produce allergens that neutralize pathogens." 5. "The saliva in my mouth contains cells that can eat bacteria." Answer: 1, 2, 3 Explanation: The passages of the nose and throat filter, warm, and humidify inhaled air. The structures of the upper respiratory tract trap particulate matter and pathogens, preventing them from going down into the lungs. The upper respiratory tract structures are lined with tiny hairs called cilia that move back and forth, pushing foreign matter outward and away from the lungs. Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 45-1 Identify structures of the upper respiratory tract that serve as body defenses against foreign substances.

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32) A pediatric nurse is triaging a 6-year-old in an urgent care facility and suspects the child is experiencing complications from allergic rhinitis. Which symptoms did the nurse assess? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Loss of smell and taste 2. Hoarseness 3. Plugged ears 4. Red, swollen, itchy eyes 5. Scratchy throat Answer: 1, 2, 3 Explanation: Complications of allergic rhinitis can include loss of smell or taste. Complications of allergic rhinitis can include hoarseness. Complications of allergic rhinitis can include plugged ears. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 45-2 Describe the common causes and symptoms of allergic rhinitis. 33) It has been determined that a client's rhinitis is not the result of previous exposure to an allergen. The nurse explains that a nonallergic response can occur with: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. x-ray dye. 2. certain drugs. 3. plasma expanders. 4. pollens. 5. animal dander. Answer: 1, 2, 3 Explanation: A nonallergic release of histamine can occur with radiographic contrast dye, resulting in allergic symptoms. A nonallergic release of histamine can occur with certain drugs, resulting in allergic symptoms. A nonallergic release of histamine can occur with plasma expanders used to restore circulating blood volume in hypovolemia, resulting in allergic symptoms. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-2 Describe the common causes and symptoms of allergic rhinitis.

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34) The nurse keeps which therapeutic goals in mind when teaching a client with allergic rhinitis about prescribed medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Prevent its occurrence. 2. Relieve symptoms. 3. Decrease the risk of infection. 4. Treat evidence of infection. 5. Avoid the use of medications that cause drowsiness. Answer: 1, 2 Explanation: The therapeutic goals of treating allergic rhinitis include preventing its occurrence. The therapeutic goals of treating allergic rhinitis include relieving the symptoms. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 45-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

853

35) The nurse instructing a client with allergic rhinitis would recommend which actions to decrease exposure to allergens? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Remove pets from the home or limit exposure. 2. Routinely clean moldy surfaces. 3. Clean frequently to remove dust mites from bedding, carpets, and furniture. 4. Remove all carpeting and replace with wood floors. 5. Buy new mattresses every 2 years. Answer: 1, 2, 3 Explanation: Removing or limiting exposure to animal dander will decrease exposure and subsequent allergic symptoms. Frequently cleaning surfaces to eliminate and prevent mold will decrease exposure and subsequent allergic symptoms. Frequent cleaning is recommended to decrease exposure to dust mites and subsequent allergic symptoms. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-2 Describe the common causes and symptoms of allergic rhinitis. 36) The nurse would expect to see an order for a drug that blocks H2 receptors in a client with: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. excess gastric acid production. 2. peptic ulcer disease. 3. gastroesophageal reflux disease (GERD). 4. allergic rhinitis. 5. seasonal allergies. Answer: 1, 2, 3 Explanation: Excess gastric acid production can be reduced by blocking H2 receptors. Symptoms of peptic ulcer disease are decreased when H2 receptors are blocked. When H2 receptors are blocked, gastric acid secretion is reduced, decreasing the symptoms of GERD. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-3 Differentiate between H1 and H2 histamine receptors. 854

37) A 12-year-old with allergies has been prescribed desloratadine (Clarinex). The nurse instructs the client and the mother about possible adverse effects, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. insomnia. 2. nervousness. 3. dizziness. 4. confusion. 5. urinary hesitancy. Answer: 1 Explanation: Antihistamines can cause insomnia in children. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-4 Compare and contrast the first- and second-generation antihistamines.

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38) A client asks the nurse why the physician has ordered an antihistamine for insomnia that is the same one a neighbor takes for seasonal allergies. The nurse explains that antihistamines are effective in treating a number of problems, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Parkinson's disease. 2. motion sickness. 3. hives. 4. bronchoconstriction. 5. hypotension. Answer: 1, 2, 3 Explanation: Antihistamines exert an anticholinergic action and are used to treat early symptoms of Parkinson's disease. Antihistamines suppress the vomiting center in the brain, decreasing the nausea accompanying motion sickness. Hives are most often caused by the release of histamine; antihistamines block that release. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

856

39) A client asks the nurse why the physician prescribed an oral rather than an intranasal decongestant. The nurse responds: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Intranasal decongestants can worsen congestion once the effects of the drug wear off." 2. "You will need medication for the length of the allergy season, but intranasal decongestants shouldn't be taken for longer than 5 days." 3. "Oral decongestants take less time to alleviate symptoms." 4. "Oral decongestants are more effective at relieving severe congestion." 5. "Oral decongestants carry a lower risk of systemic adverse effects." Answer: 1, 2 Explanation: Prolonged use of intranasal decongestants causes hypersecretion of mucus and worsening nasal congestion once the drug effects wear off. Because of the possibility of rebound congestion, the client would not be able to use an intranasal decongestant longer than 5 days, which might not be long enough to control symptoms. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-6 Compare and contrast the oral and intranasal decongestants.

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40) The community nurse explains to a group of clients that taking combination drugs for a cold can be dangerous and cites several examples, such as: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. an older male taking a cold medication with chlorpheniramine and phenylephrine for congestion. 2. a client with liver disease taking a medication containing diphenhydramine and acetaminophen (Tylenol PM). 3. a young adult with sinusitis taking a medication containing chlorpheniramine and phenylephrine. 4. a middle-aged client with a cough taking a medication containing diphenhydramine and phenylephrine (Benadryl Allergy and Cold caplets). Answer: 1, 2 Explanation: Chlorpheniramine can cause urinary retention in older males with enlarged prostate. Pseudoephedrine can cause bronchospasm in a client with COPD. Acetaminophen should be used cautiously in clients with liver disease. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.2 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-7 Explain why it is usually better to take individual drugs for the common cold, rather than a multisymptom combination product.

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41) Which outcomes would be most appropriate for a client who is receiving pharmacotherapy for cough and cold relief? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client will experience decreased congestion and drainage. 2. The client will easily expectorate excess mucus. 3. The client will report dry mouth and drowsiness to the provider. 4. The client will reduce fluid intake to assist in liquefying mucus. 5. The client will contact the healthcare provider if the cough becomes productive. Answer: 1, 2 Explanation: This would be an expected goal of pharmacologic therapy for cough and cold. This would be an expected goal of pharmacologic therapy for cough and cold. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 45-11 Apply the nursing process to care for patients receiving pharmacotherapy for allergic rhinitis and the common cold. 42) The nurse teaches the client with seasonal allergies that the most effective way to prevent allergy symptoms is to: 1. take allergy medication before allergy season begins. 2. take allergy medication as soon as symptoms begin. 3. take as little allergy medication as possible so the body will not become sensitized to the medication. 4. take supplemental nonpharmacologic measures. Answer: 1 Explanation: Taking allergy medication before allergy season begins prevents antihistamines and histamines from competing for receptors. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-11 Apply the nursing process to care for patients receiving pharmacotherapy for allergic rhinitis and the common cold.

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43) Allergy testing is most likely to be useful in directing therapy for a client with which allergy profile? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Multiple indoor allergens 2. Single outdoor allergen 3. Possible allergy to animal dander 4. Possible allergy to mold 5. Possible allergy to a medication Answer: 1, 2, 3, 4 Explanation: Allergy testing can help pinpoint particular allergens responsible for symptoms and direct a treatment plan that includes avoiding those allergens. Allergy testing can help pinpoint a particular allergen responsible for symptoms and direct a treatment plan that includes avoiding that allergen. Allergy testing can help pinpoint particular allergens, such as animal dander, responsible for a client's symptoms and direct a treatment plan that includes avoiding those allergens. Allergy testing can help pinpoint particular allergens, such as mold, responsible for a client's symptoms and direct a treatment plan that includes avoiding those allergens. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 45-2 Describe the common causes and symptoms of allergic rhinitis. 44) A pediatric nurse, teaching new parents about the body's structural defenses against respiratory infections, explains that pathogens are "swept" away from the lungs by the: 1. cilia. 2. mucous membranes. 3. vestibule. 4. internal nares. Answer: 1 Explanation: The cilia project from the epithelium of the nasal passages and sweep pathogens and particulate matter upward toward the oropharynx, where it is swallowed. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 45-1 Identify structures of the upper respiratory tract that serve as body defenses against foreign substances. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 46 Basic Principles of Anti-Infective Pharmacotherapy 860

1) Hyaluronidase, an enzyme secreted by certain bacteria, allows the bacteria to: 1. protect themselves from phagocytes. 2. penetrate anatomic barriers more easily. 3. multiply more rapidly. 4. produce exotoxins in greater abundance. Answer: 2 Explanation: Certain bacteria secrete hyaluronidase, which digests the matrix between human cells and allows the bacteria to penetrate anatomic barriers more easily. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-1 Explain the mechanisms by which pathogens infect the body. 2) Invasiveness refers to a pathogen's ability to: 1. produce endotoxins in greater abundance. 2. multiply more rapidly. 3. increase its virulence. 4. penetrate anatomic barriers more easily. Answer: 2 Explanation: Invasiveness is the term for the ability of a pathogen to grow rapidly. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-1 Explain the mechanisms by which pathogens infect the body.

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3) Pathogenicity refers to an organism's ability to: 1. cause disease. 2. penetrate anatomic barriers more easily. 3. multiply more rapidly. 4. use oxygen. Answer: 1 Explanation: Some pathogens are extremely infectious, while others produce no symptoms at all. Pathogenicity refers to an organism's ability to cause disease. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-1 Explain the mechanisms by which pathogens infect the body. 4) Classification of bacteria by their response to Gram stain includes: 1. rods, spirals, and spheres. 2. aerobic and anaerobic. 3. fungi and viruses. 4. gram positive and gram negative. Answer: 4 Explanation: Bacteria are classified as gram positive or gram negative by their ability or inability to respond to a violet color after staining. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-2 Describe methods for classifying bacteria.

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5) The client's culture report indicates the presence of gram-negative cocci in the urine. This means that the bacteria are: 1. round with thin cell walls. 2. round with thick cell walls. 3. rod shaped with thin cell walls. 4. spiral shaped with thin cell walls. Answer: 1 Explanation: Gram-negative cocci are round with thin cell walls. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-2 Describe methods for classifying bacteria. 6) The nursing student asks the instructor how concepts from microbiology directly relate to client care. The instructor's best response is: 1. "It will assist you in understanding how healthcare providers choose anti-infective agents." 2. "Knowledge of bacteria and their classification assists in the management of anti-infective therapy." 3. "Studying microbiology will help you understand laboratory reports." 4. "Microbiology is one of the few science electives that do not really have any direct effects on client care." Answer: 2 Explanation: The knowledge of bacteria and their classification assists in the management of anti-infective therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-2 Describe methods for classifying bacteria.

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7) A new antibiotic is classified as a bacteriocidal agent. This means that the drug: 1. slows the growth of the infectious agent. 2. has a high potency. 3. is highly efficacious. 4. kills the infectious agent. Answer: 4 Explanation: Bacteriocidal drugs kill bacteria. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-3 Explain the mechanisms by which anti-infective drugs act to kill pathogens or restrict their growth. 8) The ability of an antibiotic to target pathogens without major effects on human cells is termed: 1. selective toxicity. 2. selective synthesis. 3. bacteriostatic action. 4. opportunistic action. Answer: 1 Explanation: Antibiotic selective toxicity allows pathogens to be killed or their growth severely hampered without major effects on human cells. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-3 Explain the mechanisms by which anti-infective drugs act to kill pathogens or restrict their growth.

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9) Anti-infectives are grouped into pharmacologic classes by their: 1. staining ability. 2. size or shape. 3. sensitivity. 4. mechanism of action. Answer: 4 Explanation: Antibiotics are grouped into classes by their mechanism of action, susceptible organisms, and chemical structure. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-2 Describe methods for classifying bacteria. 10) The client asks the nurse why the healthcare provider did not prescribe the same antibiotic that the client always receives for an infection. The best response by the nurse would be: 1. "It doesn't matter which antibiotic you take." 2. "You don't want to take the same antibiotic all the time." 3. "Try this medicine, and if you're not better in 10 days, return to the office." 4. "These bacteria have developed resistance and will respond better to this antibiotic." Answer: 4 Explanation: Continuous use of the same type of antibiotic could lead to bacterial mutations that are insensitive to the effects of the antibiotic. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-4 Describe the clinical significance of bacterial resistance.

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11) A leading factor in the development of bacterial resistance is the ability of bacteria to undergo: 1. replication. 2. conjugation. 3. mutation. 4. colonization. Answer: 3 Explanation: Due to their rapid growth, bacteria make errors in duplicating their genetic code, thus forming a mutation. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-4 Describe the clinical significance of bacterial resistance. 12) The nurse caring for a client with an infection knows a contributing factor to the development of drug resistance is the presence of bacterial genetic errors called: 1. plasmids. 2. mutations. 3. conjugates. 4. duplications. Answer: 2 Explanation: Genetic errors are mutations. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-4 Describe the clinical significance of bacterial resistance.

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13) The ability of an organism to become unresponsive over time to an anti-infective is termed: 1. superinfection. 2. sensitivity. 3. mutation. 4. acquired resistance. Answer: 4 Explanation: Acquired resistance is the ability of an organism to become insensitive to the effects of an anti-infective. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-4 Describe the clinical significance of bacterial resistance. 14) The primary factor in the development of drug-resistant bacteria is the: 1. unwarranted use of antibiotics. 2. selection of the incorrect antibiotic. 3. lack of new antibiotics. 4. lack of client adherence. Answer: 1 Explanation: The widespread and sometimes unwarranted use of antibiotics has promoted the development of drug-resistant bacterial strains. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-4 Describe the clinical significance of bacterial resistance.

867

15) Guidelines for preventing antimicrobial resistance include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. using proper infection control procedures. 2. shortening the duration of antibiotic administration. 3. using antimicrobials wisely. 4. preventing infections. 5. treating infections properly. Answer: 1, 3, 4, 5 Explanation: Proper hygiene and infection control measures help prevent the transmission of infectious disease and the development of resistance. Using antimicrobials only when there is a clear rationale for their use helps prevent the development of resistance. The CDC guidelines for preventing antimicrobial resistance include preventing infections when possible. Diagnosing and treating infections properly helps prevent the development of resistance. Cognitive Level: Understanding Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-5 Identify steps that the nurse can take to limit the development of resistance.

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16) The nurse sending a wound culture to the laboratory knows that the purpose of culture and sensitivity testing is to: 1. prevent an infection, a practice called chemoprophylaxis. 2. identify bacteria that have acquired resistance. 3. promote the development of drug-resistant bacterial strains by killing the bacteria sensitive to a drug. 4. determine which antibiotic is most effective against the infecting microorganism. Answer: 4 Explanation: Culture and sensitivity testing isolates the infectious organism and determines which antibiotic would be most effective against it. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-6 Describe the clinical rationale for selecting specific antibiotics. 17) The nurse is preparing to administer a broad-spectrum antibiotic medication to a client. An important nursing intervention prior to administration of the anti-infective is: 1. performing a culture within 24 hours after starting the medication. 2. obtaining the culture report, as when starting any medication. 3. performing a culture prior to administering the first dose of the anti-infective. 4. administering the medicine without performing cultures. Answer: 3 Explanation: The culture should be obtained prior to administering the first dose of the anti-infective. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-6 Describe the clinical rationale for selecting specific antibiotics.

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18) An advantage of using a broad-spectrum antibiotic is that: 1. it is effective against a large number of organisms. 2. it is effective against a small number of organisms. 3. it has a high potency. 4. it produces a large number of side effects. Answer: 1 Explanation: A broad-spectrum antibiotic is effective against a large number of organisms. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-6 Describe the clinical rationale for selecting specific antibiotics. 19) Which type of antibiotic carries the highest risk of an allergic response? 1. Tetracyclines 2. Aminoglycosides 3. Cephalosporins 4. Penicillins Answer: 4 Explanation: The penicillins are the group of antibiotics that have the highest incidence of allergic reactions. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 46-7 Identify the role of the nurse in preventing, identifying, and treating adverse effects due to antibiotic therapy.

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20) The nurse knows that which antibiotic, when taken by a pregnant woman, can adversely affect the newborn's hearing? 1. Mycins 2. Aminoglycosides 3. Sulfonamides 4. Tetracyclines Answer: 2 Explanation: Aminoglycosides can adversely affect the newborn's hearing. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-7 Identify the role of the nurse in preventing, identifying, and treating adverse effects due to antibiotic therapy. 21) A female client is prescribed tetracycline for acne. When providing information regarding this drug, the nurse explains that tetracycline: 1. is contraindicated in people over 20 years old. 2. is classified as a narrow-spectrum antibiotic. 3. has been identified to be unsafe during pregnancy. 4. is used to treat a wide variety of disease processes. Answer: 3 Explanation: The drug is not safe for pregnant women because it can cross the placental barrier and cause mottling of the infant's teeth. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-8 Explain how the patient's immune status, local tissue conditions, history of allergic reactions, age, pregnancy status, and genetics influence anti-infective pharmacotherapy.

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22) Which location is the most difficult to reach with antibiotic therapy? 1. Gastrointestinal system 2. Integumentary system 3. Central nervous system 4. Lungs Answer: 3 Explanation: The central nervous system is the most difficult location to reach with antibiotic therapy because many medications have difficulty crossing the blood–brain barrier. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-8 Explain how the patient's immune status, local tissue conditions, history of allergic reactions, age, pregnancy status, and genetics influence anti-infective pharmacotherapy. 23) Which client would require the administration of prophylactic antibiotics? 1. A client with inflammation at the infection site 2. A client with a viral infection 3. A client with a suppressed immune system 4. A client with pus at the infection site Answer: 3 Explanation: A client with a suppressed immune system would need prophylactic antibiotics. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-8 Explain how the patient's immune status, local tissue conditions, history of allergic reactions, age, pregnancy status, and genetics influence anti-infective pharmacotherapy.

872

24) A pregnant client is seen in the emergency department for an infection. The nurse anticipates that antibiotics prescribed for this client would not include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. ampicillin. 2. minocycline. 3. neomycin. 4. streptomycin. 5. doxycycline. Answer: 2, 3, 4, 5 Explanation: Minocycline is a pregnancy category D drug. Neomycin is a pregnancy category D drug. Streptomycin is a pregnancy category D drug. Doxycycline is a pregnancy category D drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-9 Explain the clinical importance of selecting the correct antibiotic for the individual patient. 25) The client on penicillin who is complaining of an abnormal vaginal discharge has a superinfection secondary to: 1. a nosocomial infection. 2. an overdose of penicillin. 3. the destruction by penicillin of normal flora in the vagina. 4. the development of an organism resistant to penicillin. Answer: 3 Explanation: Superinfections occur when organisms normally present in the body are destroyed by an antibiotic and pathogenic organisms can grow unchecked. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-10 Describe the development of superinfections.

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26) The nurse caring for a group of clients recognizes that which client has a superinfection? 1. A 47-year-old client with type 2 diabetes and pneumonia 2. A 50-year-old client with AIDS and candida 3. A 46-year-old client with vascular disease and cellulitis of the leg 4. A 52-year-old client with gastroesophageal reflux disease (GERD) and gastritis Answer: 2 Explanation: Those who are immunosuppressed and receiving antibiotic therapy are at greater risk of developing superinfections. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-10 Describe the development of superinfections. 27) A client has been on an antibiotic for 2 weeks for treatment of an ulcer caused by Helicobacter pylori. The client asks the nurse if the antibiotic could be causing diarrhea. What is the nurse's most accurate response? 1. "The infection has become severe." 2. "This might be a secondary infection due to the antibiotic therapy." 3. "The infection has a restricted group of microorganisms." 4. "The organisms that caused the infection have developed immunity to the drug." Answer: 2 Explanation: A superinfection is a side effect of antibiotic therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-10 Describe the development of superinfections.

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28) The nurse tells a client that the antibiotic the healthcare provider has prescribed is for Clostridium, the organism responsible for a number of conditions, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. food poisoning. 2. gas gangrene. 3. tetanus. 4. pneumonia. 5. venereal disease. Answer: 1, 2, 3 Explanation: Clostridium is an anaerobe responsible for some cases of food poisoning. Clostridium is an anaerobe responsible for gas gangrene. Clostridium is an anaerobe responsible for tetanus. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-4 Describe the clinical significance of bacterial resistance.

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29) The client asks the nurse why culture and sensitivity (C&S) testing has to be done prior to starting the antibiotic for a urinary tract infection (UTI). The nurse explains that several organisms can cause UTIs and a C&S is performed to identify the organism. Which organism could be isolated on this client's C&S? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Escherichia coli 2. Enterococci 3. Proteus mirabilis 4. Treponema 5. Borrelia burgdorferi Answer: 1, 2, 3 Explanation: Escherichia coli is the organism most commonly associated with UTIs. Enterococci can cause UTI. Proteus mirabilis can cause UTI. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-6 Describe the clinical rationale for selecting specific antibiotics.

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30) A client is admitted to the emergency department with an infection of the skin on the upper right thigh. The nurse knows this infection could be caused by which organism? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Streptococci 2. Proteus mirabilis 3. Pseudomonas aeruginosa 4. Salmonella enteritides 5. Bacillus anthracis Answer: 1, 2, 3 Explanation: Streptococci can cause skin infections. Proteus mirabilis is an organism that can cause skin infections. Pseudomonas aeruginosa is an organism that can cause skin infections. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-6 Describe the clinical rationale for selecting specific antibiotics.

877

31) A pediatric client is admitted to the emergency department with symptoms of meningitis. Reviewing the client's culture and sensitivity (C&S) report, the nurse would expect evidence of which organisms to confirm this diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Streptococci 2. Escherichia coli 3. Haemophilus influenzae 4. Rickettsia rickettsii 5. Shigella Answer: 1, 2, 3 Explanation: Streptococci can cause meningitis in children. Escherichia coli can cause meningitis in children. Haemophilus influenzae can cause meningitis in children. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-8 Explain how the patient's immune status, local tissue conditions, history of allergic reactions, age, pregnancy status, and genetics influence anti-infective pharmacotherapy.

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32) The nurse is discharging a client with a prescription for penicillin. The client asks the nurse how this antibiotic works. The nurse's response is based on the knowledge that the mechanism of action of this class of anti-infectives is: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. inhibiting cell wall synthesis. 2. causing disruption of the cell wall, resulting in the cell absorbing water and lysing. 3. binding to specific proteins, resulting in the cell's inability to build a wall. 4. interfering with the transfer of ribonucleic acid (RNA). 5. changing the permeability of the cell membrane. Answer: 1, 2, 3 Explanation: Penicillin inhibits bacterial cell wall synthesis. Penicillin inhibits cell wall synthesis, resulting in the cell absorbing water and lysing. Binding to specific proteins disrupts the cell's ability to build a wall. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-3 Explain the mechanisms by which anti-infective drugs act to kill pathogens or restrict their growth.

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33) The community outreach nurse is teaching a group of older clients how bacterial organisms become resistant to antibiotics. Which statements by the clients demonstrate understanding of the instruction? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I need to get the recommended immunizations so I don't get an infection and need an antibiotic." 2. "If possible, my doctor will need to culture any infections I have to make sure I am taking the correct antibiotics." 3. "I need to take antibiotics only when my healthcare provider thinks I have an infection." 4. "As soon as my infection is gone, I can stop the antibiotic. This way, I'll avoid becoming resistant to the antibiotic." 5. "I should never take an antibiotic for more than 10 days. This is what causes resistance." Answer: 1, 2, 3 Explanation: It is easier to prevent an infection than it is to treat one. The causative organism must be identified and the correct antibiotic prescribed. This will lower the risk of developing resistance. The unwarranted use of antibiotics has promoted the development of drug-resistant bacteria. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-5 Identify steps that the nurse can take to limit the development of resistance.

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34) The healthcare provider asks the nurse to tell a client that tests confirm the client has a healthcare-associated infection (HAI). The nurse explains to the client that common sources of HAIs include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. the respiratory tract. 2. the urinary tract. 3. intravascular (IV) lines. 4. visitors with infectious illness. 5. drug-resistant bacteria. Answer: 1, 2, 3 Explanation: Bacteria residing in the lungs are a source of HAIs. Bacteria residing in the genitourinary tract are a source of HAIs. Invasive devices such as IV lines are a source of HAIs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-8 Explain how the patient's immune status, local tissue conditions, history of allergic reactions, age, pregnancy status, and genetics influence anti-infective pharmacotherapy.

881

35) The nurse is preparing to admit a client with a serious methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse knows MRSA will not respond to treatment with: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. fluoroquinolones. 2. macrolides. 3. aminoglycosides. 4. tetracyclines. 5. linezolid. Answer: 1, 2, 3, 4 Explanation: MRSA is resistant to fluoroquinolones. MRSA is resistant to macrolides. MRSA is resistant to aminoglycosides. MRSA is resistant to tetracyclines. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-9 Explain the clinical importance of selecting the correct antibiotic for the individual patient.

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36) A client is unable to give a urine sample for a culture and sensitivity (C&S) and asks the nurse why the healthcare provider does not just prescribe a "really strong" antibiotic. The nurse responds that careful selection of the correct antibiotic is important because prescribing the wrong antibiotic: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. will delay effective treatment. 2. will give the bacteria more time to grow. 3. can contribute to the development of drug-resistant bacteria. 4. could result in a lawsuit. 5. could result in an allergic response. Answer: 1, 2, 3 Explanation: Prescribing the wrong antibiotic will delay effective treatment. Prescribing the wrong antibiotic will give the bacteria time to multiply. Prescribing the wrong antibiotic can contribute to the development of drug-resistant strains of bacteria. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-9 Explain the clinical importance of selecting the correct antibiotic for the individual patient.

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37) The emergency department nurse anticipates that prophylactic antibiotics will likely be used to treat: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. a client with a suppressed immune system. 2. a client who has been bitten by a dog. 3. a client whose spouse has been diagnosed with tuberculosis (TB). 4. a client who is being treated for a venereal disease. 5. a client who has just delivered a premature baby. Answer: 1, 2, 3 Explanation: A client with a suppressed immune system would be treated with prophylactic antibiotics. Deep wounds such as dog bites are treated with prophylactic antibiotics. Antitubercular drugs are prescribed prophylactically for any client in close contact with an individual diagnosed with TB. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 46-8 Explain how the patient's immune status, local tissue conditions, history of allergic reactions, age, pregnancy status, and genetics influence anti-infective pharmacotherapy.

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38) The clinic nurse is calling back clients with various symptoms. Which symptoms would suggest a superinfection? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Diarrhea 2. Painful urination 3. Abnormal vaginal discharge 4. Cough 5. Joint pain Answer: 1, 2, 3 Explanation: Antibiotics can kill normal flora in the intestinal tract, resulting in a superinfection and diarrhea. Antibiotics can kill normal flora in the genitourinary tract, resulting in a superinfection and painful urination. Antibiotics can kill normal flora in the vagina, resulting in a superinfection and abnormal vaginal discharge. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 46-10 Describe the development of superinfections.

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39) A pediatric nurse is caring for a child who has an infectious organism that produces beta lactamase. The nurse knows that which drugs should not be prescribed for this infection? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Penicillins 2. Cephalosporins 3. Macrolides 4. Fluoroquinolones 5. Sulfonamides Answer: 1, 2 Explanation: Organisms that produce beta lactamase are resistant to many of the penicillins. Organisms that produce beta lactamase are resistant to many of the cephalosporins. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-9 Explain the clinical importance of selecting the correct antibiotic for the individual patient.

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40) A client is admitted to the emergency department for an infection. The nurse recognizes that host factors that play a role in the selection of anti-infective therapy include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. status of immune system. 2. location of the infection. 3. history of allergic reactions. 4. previous infections. 5. results of culture and sensitivity (C&S). Answer: 1, 2, 3 Explanation: Clients with a weakened immune system may require more aggressive and prolonged anti-infective therapy. The location of the infection must be considered in order to choose the most effective anti-infective. A history of allergic reaction to an anti-infective prevents the use of that particular class. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 46-8 Explain how the patient's immune status, local tissue conditions, history of allergic reactions, age, pregnancy status, and genetics influence anti-infective pharmacotherapy. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 47 Antibiotics Affecting the Bacterial Cell Wall 1) Which statement best describes the bacterial cell wall? 1. It is a rigid structure. 2. It is semipermeable. 3. It is composed of lipids. 4. It is a single layer. Answer: 1 Explanation: The bacterial cell wall is rigid. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 47-1 Explain the structure of a bacterial cell wall and its importance topharmacotherapy. 887

2) Bacterial enzymes participate in the construction of the bacterial cell wall. Penicillin targets these enzymes and interferes with: 1. bacterial DNA. 2. the addition of cross-links to the cell wall. 3. protein synthesis. 4. the channels in the cell's internal structure. Answer: 2 Explanation: Most penicillins target the enzyme that adds cross-links to the peptidoglycan layers in the cell wall. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 47-3 Explain the mechanisms by which antibiotics affect the bacterial cell wall.

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3) Classes of antibiotics that exert their antibacterial effect by interfering with the synthesis of the bacterial cell wall include: 1. cephalosporins. 2. aminoglycosides. 3. sulfonamides. 4. erythromycins. Answer: 1 Explanation: Beta-lactam antibiotics, including the cephalosporins, contain a beta-lactam ring that interferes with the synthesis of the bacterial cell wall. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 47-2 Identify the classes of antibiotics that act by affecting the synthesis of the bacterial cell wall. 4) Penicillin's antibacterial activity is based on its: 1. beta-lactam ring, which terminates construction of the cell wall. 2. alteration of bacterial DNA in the cell wall. 3. interference with cellular cytoplasm. 4. interruption of bacterial protein synthesis. Answer: 1 Explanation: The beta-lactam ring in penicillin interferes with the synthesis of the bacterial cell wall. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 47-3 Explain the mechanisms by which antibiotics affect the bacterial cell wall.

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5) The nurse would explain that Augmentin is a combination drug containing the antibiotic amoxicillin and clavulanate, which is: 1. a secondary antibiotic. 2. a beta-lactamase inhibitor to prevent the excretion of penicillin. 3. an anti-inflammatory to prevent allergic response. 4. an antiviral to prevent superinfection. Answer: 2 Explanation: Clavulanate prevents the action of beta-lactamase, which would decrease the life of the penicillin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 47-4 Compare and contrast the four classes of penicillin. 6) The nurse anticipates use of an extended-spectrum penicillin such as piperacillin when the patient is infected with which microbe? 1. Streptococcus 2. Herpes simplex 3. Pseudomonas 4. Staphylococcus Answer: 3 Explanation: Extended-spectrum penicillins have as their advantage antimicrobial activity against Pseudomonas. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 47-4 Compare and contrast the four classes of penicillin.

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7) First-generation cephalosporins are the most effective of this class of antibiotics against: 1. Protozoans. 2. gram-negative bacteria. 3. Rickettsia. 4. gram-positive bacteria. Answer: 4 Explanation: First-generation cephalosporins are the most effective cephalosporins against gram-positive bacteria. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 47-5 Compare and contrast the five generations of cephalosporins. 8) Which generation of cephalosporin would be selected to treat complicated, drug-resistant meningitis? 1. Second 2. Third 3. Fourth 4. First Answer: 3 Explanation: The fourth-generation cephalosporins are capable of crossing the blood–brain barrier in sufficiently high concentrations to treat central nervous system infections such as meningitis. They also are more effective against organisms that have developed resistance to earlier cephalosporins. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 47-5 Compare and contrast the five generations of cephalosporins.

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9) The nurse caring for a client with an allergy to cephalosporins would be cautious in implementing an order for an anti-infective agent from which class? 1. Aminoglycosides 2. Fluoroquinolones 3. Sulfonamides 4. Penicillins Answer: 4 Explanation: Five to ten percent of clients who are allergic to penicillin also exhibit hypersensitivity to cephalosporins. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 47-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 10) Which client should be most closely monitored for adverse effects directly related to receiving penicillin G? 1. A client who has osteomyelitis and will need IV medication for several months 2. A client who had a myocardial infarction 2 days ago and now has a fever of 102°F 3. A client who is postop from corneal transplant 4. A client who has diabetes and is on dialysis Answer: 4 Explanation: Clients with significant renal impairment must be monitored closely while on penicillin. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 47-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

892

11) A client being discharged with a prescription for penicillin also takes probenecid. The nurse explains that probenecid: 1. prevents diarrhea often associated with penicillin. 2. prevents an allergic response. 3. is a secondary antibiotic. 4. allows the penicillin to stay in the body longer. Answer: 4 Explanation: Probenecid prevents the renal excretion of penicillin and allows it to remain in the system longer. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 47-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 12) Which instruction should take priority in client teaching for any antibiotic therapy? 1. Complete the full course of prescribed drug therapy. 2. Maintain adequate food intake. 3. Maintain an adequate fluid intake. 4. Report symptoms of secondary infection, such as vaginal yeast infections. Answer: 1 Explanation: The priority teaching point is that the client must complete the entire prescription to ensure treatment success and prevent the development of resistance. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 47-8 Apply the nursing process to care for patients receiving pharmacotherapy with bacterial cell wall inhibitors.

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13) The mother of a 4-year-old calls the nurse to report her child has been having diarrhea since he began taking an antibiotic 48 hours ago. The mother asks if she should give her child an over-the-counter medication for the diarrhea. What is the nurse's best response? 1. "Wait one more day and see if the diarrhea clears." 2. "Yes, give something over the counter, but only one dose." 3. "Yes, give something over the counter according to the dosage directions on the label." 4. "Do not treat the diarrhea, and bring the child to the office." Answer: 4 Explanation: Diarrhea due to antibiotic therapy should not be treated with over-the-counter products and should be evaluated as soon as possible. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 47-8 Apply the nursing process to care for patients receiving pharmacotherapy with bacterial cell wall inhibitors. 14) The nurse is administering the first dose of ampicillin intramuscularly to a client with a severe infection. In addition to the six rights of medication administration, an important priority nursing action is to: 1. monitor bowel sounds. 2. teach the client about the side effects of the drug. 3. encourage the client to increase fluid intake. 4. monitor the client closely for hypersensitivity with the first dose. Answer: 4 Explanation: The chance of hypersensitivity is greater with parenteral administration of ampicillin. The priority nursing action is to monitor the client for 30 minutes following administration. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 47-8 Apply the nursing process to care for patients receiving pharmacotherapy with bacterial cell wall inhibitors.

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15) The nurse has received an order to give imipenem-cilastatin (Primaxin) intravenously (IV) to a client. Which assessments should alert the nurse to contact the healthcare provider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client is allergic to penicillin. 2. The client's medication list includes antiseizure medications. 3. The client is an older adult with long-standing diabetes. 4. The urine culture and sensitivity reveals a urinary tract infection (UTI). 5. A wound culture is positive for methicillin-resistant Staphylococcus aureus (MRSA). Answer: 1, 2, 3 Explanation: Imipenem-cilastatin (Primaxin) is contraindicated in clients with a history of allergy to other carbapenems, cephalosporins, or penicillins. Imipenem-cilastatin (Primaxin) should be used cautiously in clients with a history of seizures due to an increased risk of seizure activity. Because the kidneys excrete imipenem-cilastatin (Primaxin), clients with renal impairment must be closely monitored and doses lowered. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 47-6 Identify similarities and differences among drugs in the carbapenem class.

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16) A client asks why the healthcare provider ordered penicillin for the client's infection. How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Your infection was caused by gram-positive bacteria." 2. "Penicillin is a narrow-spectrum antibiotic that can be used when the bacteria causing the infection is known." 3. "Penicillins are widely distributed to most body tissues." 4. "Penicillins are slowly excreted by the kidneys. This allows for less frequent dosing." 5. "If you're allergic to penicillin, we can give you a smaller dose to avoid a reaction." Answer: 1, 2, 3 Explanation: Most penicillins are effective against gram-positive bacteria. Most penicillins have a narrow spectrum of antimicrobial activity. Penicillins are widely distributed to most body tissues, but only small amounts reach the CSF. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 47-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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17) A client in the emergency department experienced a severe allergic response to penicillin. The client tells the nurse this is the first time she has ever taken this particular drug. Which questions can the nurse ask to determine the reason for the allergic response? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Have you ever been exposed to mold?" 2. "Do you eat animal products that have been exposed to antibiotics such as penicillin?" 3. "Have you ever had another allergic reaction to a group of antibiotics called cephalosporins?" 4. "Do you have any seasonal allergies?" 5. "Do you have any diseases or are you taking any medications that suppress the immune system?" Answer: 1, 2, 3 Explanation: Inadvertent exposure to mold could trigger an allergy to penicillin. Some farmers and ranchers use antibiotics such as penicillins to decrease the risk of infection in farm animals. There is a degree of cross-sensitivity between penicillin and cephalosporin drugs. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 47-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

897

18) Which clients taking penicillin G should the nurse plan to monitor closely? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A client with diabetes 2. A client with heart failure 3. A client taking spironolactone for hormonal acne 4. A client taking oral contraceptives 5. A client with pharyngitis Answer: 1, 2, 3, 4 Explanation: Renal impairment can affect the kidneys' ability to excrete penicillin G. Hyperkalemia can result in clients with heart failure who take penicillin G. Potassium-sparing diuretics may cause hyperkalemia when taken with penicillin G. Clients taking oral contraceptives and penicillin should be told the combination may decrease the effectiveness of the birth control and that using an extra form of birth control such as condoms should be considered. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 47-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

898

19) A female client has been prescribed ampicillin (Principen). What should the nurse emphasize when instructing the client about the medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Do not become pregnant while on ampicillin. 2. If taking oral contraceptives, use an alternative form of birth control. 3. Ampicillin should be taken on an empty stomach. 4. Contact the healthcare provider immediately if persistent diarrhea with fever occurs. 5. Stop taking ampicillin if nausea occurs and report to the healthcare provider immediately. Answer: 2, 3, 4 Explanation: Ampicillin can decrease the effectiveness of oral contraceptives. Food decreases the absorption of ampicillin. Persistent diarrhea with fever should be reported immediately to the healthcare provider. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 47-8 Apply the nursing process to care for patients receiving pharmacotherapy with bacterial cell wall inhibitors.

899

20) Which interventions would the nurse consider including in a plan of care for clients taking cephalosporins? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Monitor kidney function in older adults. 2. Monitor for persistent diarrhea in young children. 3. Discuss the concurrent use of alcohol. 4. Teach clients to report any fever that does not decrease within 12 hours of starting therapy. 5. Instruct clients to immediately go to the emergency department if any symptoms of red man syndrome occur during treatment. Answer: 1, 2, 3 Explanation: Physiologic changes in the older adult's kidney function may require changes in dosing of cephalosporins. Diarrhea resulting from the use of cephalosporins may cause dehydration in young children. Some cephalosporins can cause a disulfiram-like reaction when taken with alcohol. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 47-8 Apply the nursing process to care for patients receiving pharmacotherapy with bacterial cell wall inhibitors.

900

21) Prior to discharge of a client on cephalosporin therapy, the nurse discusses potentially significant adverse effects, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. nausea. 2. vomiting. 3. abdominal pain. 4. transient shortness of breath 5. vaginal yeast infection. Answer: 1, 2, 3, 5 Explanation: Nausea is a significant GI effect of many antibiotics. If not contraindicated, taking the antibiotic with food may decrease the incidence of nausea. Vomiting is a significant GI effect of many antibiotics. If not contraindicated, taking the antibiotic with food may decrease the incidence of vomiting. Abdominal pain is a significant GI effect of many antibiotics. If not contraindicated, taking the antibiotic with food may decrease the incidence of abdominal pain. Vaginal yeast infections are common with antibiotic therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 47-8 Apply the nursing process to care for patients receiving pharmacotherapy with bacterial cell wall inhibitors.

901

22) The nurse, administering an infusion of vancomycin, will observe the client for which symptoms of red man syndrome? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Reddening of the upper body 2. Hypotension 3. Reflex tachycardia 4. Headache 5. Seizure Answer: 1, 2, 3 Explanation: This is the classic symptom of red man syndrome. The release of histamine results in vasodilation, leading to hypotension. The release of histamine results in vasodilation, leading to reflex tachycardia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 47-8 Apply the nursing process to care for patients receiving pharmacotherapy with bacterial cell wall inhibitors.

902

23) The emergency department nurse anticipates that which clients may be treated with ertapenem (Invanz)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A college student diagnosed with community-acquired pneumonia 2. A client diagnosed with complicated urinary tract infection (UTI) 3. A client with diabetes and an infected toe 4. A young child diagnosed with H. influenzae otitis media 5. An older client diagnosed with community-acquired methicillin-resistant S. aureus (MRSA) Answer: 1, 2, 3 Explanation: Ertapenem (Invanz) is approved for the treatment of community-acquired pneumonia. Ertapenem (Invanz) is approved for the treatment of complicated UTI. Ertapenem (Invanz) is approved for the treatment of diabetic foot infection. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 47-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

903

24) The nurse preparing to infuse vancomycin will monitor the client for: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. loss of hearing and balance. 2. reddening upper body with dizziness. 3. confusion or hallucinations. 4. abnormal liver function. 5. fever and chills. Answer: 1, 2, 3, 5 Explanation: Vancomycin toxicity can result in loss of hearing and impaired balance. These symptoms may indicate a common adverse effect called red man syndrome. Confusion or hallucinations can be a serious adverse effect of vancomycin. Fever and chills are common adverse effects of vancomycin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 47-8 Apply the nursing process to care for patients receiving pharmacotherapy with bacterial cell wall inhibitors. 25) How many generations of cephalosporins exert their antibacterial effect by interfering with the synthesis of the bacterial cell wall? 1. 5 2. 4 3. 3 4. 2 Answer: 1 Explanation: There are five generations of cephalosporins that interfere with the synthesis of bacterial cell wall. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 47-2 Identify the classes of antibiotics that act by affecting the synthesis of the bacterial cell wall.

904

26) What primary material in the bacterial cell wall forms the peptidoglycan? 1. Carbohydrate and protein chains 2. Fat and glycogen layers 3. Single, layered lipids and ribosomes 4. Sodium and potassium cells Answer: 1 Explanation: The bacterial cell wall is composed of carbohydrates and protein. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 47-1 Explain the structure of a bacterial cell wall and its importance topharmacotherapy. 27) The nurse has received an order to give imipenem-cilastatin (Primaxin) to a client. Prior to the administration of this medication, the nurse should assess which of the following? 1. Patency of the IV line 2. Vital signs 3. The client's allergies 4. Laboratory values Answer: 1 Explanation: Imipenem-cilastatin (Primaxin) must be given parentally. The patency of the IV line must be ensured prior to administration. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 47-6 Identify similarities and differences among drugs in the carbapenem class. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 48 Antibiotics Affecting Bacterial Protein Synthesis 1) Bacterial protein synthesis is: 1. similar to human protein synthesis. 2. limited to cellular reproduction. 3. linked to the 80S ribosome. 4. controlled by metabolizing enzymes. 905

Answer: 1 Explanation: Human protein synthesis is similar to bacterial protein synthesis. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 48-1 Explain the steps in the synthesis of bacterial proteins. 2) The components required for bacterial protein synthesis are: 1. mRNA, tRNA, and 80S ribosomes. 2. mRNA, tRNA, and 70S ribosome. 3. DNA, mRNA, cell wall, and nucleoid. 4. mRNA, tRNA, plasma membrane, and pili. Answer: 2 Explanation: Three components are required for bacterial protein synthesis: messenger ribonucleic acid (mRNA), transfer ribonucleic acid (tRNA), and the 70S ribosome (subunits 30S and 50S). Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 48-1 Explain the steps in the synthesis of bacterial proteins.

906

3) Antibiotics classified as bacteriocidal protein synthesis inhibitors at normal doses include: 1. gentamicin. 2. tetracycline. 3. clindamycin. 4. erythromycin. Answer: 1 Explanation: Aminoglycosides such as gentamicin have a bacteriocidal effect; that is, they kill the bacteria. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 48-2 Identify the classes of antibiotics that act by inhibiting bacterial protein synthesis. 4) Antibacterial protein synthesis inhibitors act by: 1. disrupting the growth of the polypeptide chain. 2. inhibiting the synthesis of enzymes. 3. promoting lysis of the cell wall. 4. disrupting cell wall synthesis. Answer: 1 Explanation: Antibacterial protein synthesis inhibitors act by interrupting formation of the polypeptide chain. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 48-3 Explain mechanisms by which antibiotics inhibit bacterial protein synthesis.

907

5) Bacterial protein synthesis inhibitors have selective toxicity because: 1. susceptible strains of bacteria are affected. 2. biochemical processes are the same. 3. human ribosomes are larger and denser than bacterial ribosomes. 4. antibacterial activity is broad spectrum. Answer: 3 Explanation: Human ribosomes are larger and denser than bacterial ribosomes. As a result, human ribosomes are not targeted by the drug's antibacterial activity. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 48-4 Explain how protein synthesis inhibitors exert selective toxicity toward bacterial, rather than human, cells. 6) A client reports no improvement after 5 days of therapy with tetracycline. The nurse suspects drug resistance and knows that drug resistance can develop in which ways? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A drug is prevented from concentrating inside the bacterial cell. 2. A broad-spectrum antibacterial drug is used instead of a narrow-spectrum drug. 3. A bacteriostatic agent is paired with a bacteriocidal agent. 4. Bacteria acquire the ability to degrade the antibiotic. 5. The shape of the bacteria mutates and prevents an antibiotic from binding to it. Answer: 1, 2, 4, 5 Explanation: Resistance can develop when a drug is prevented from concentrating within the bacterial cell. Broad-spectrum antibacterial agents are associated with bacterial drug resistance. Narrow-spectrum drugs should be used whenever the bacterial organism is known. A shortened duration of therapy can lead to development of resistant strains of bacteria. Altering the shape of the bacterial ribosome can prevent an antibiotic from binding to the ribosome. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 48-5 Describe means by which bacteria become resistant to protein synthesis inhibitors.

908

7) Administering an aminoglycoside as monotherapy: 1. shortens the duration of therapy. 2. can lead to resistant bacterial strains. 3. reduces the incidence of adverse effects. 4. indicates that it is given intravenously. Answer: 2 Explanation: Monotherapy can lead to the development of resistant strains of bacteria. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 48-5 Describe means by which bacteria become resistant to protein synthesis inhibitors. 8) A client is prescribed gentamicin (Garamycin) concurrently with acyclovir (Zovirax). Which assessment would be the priority for the nurse? 1. Balance 2. Kidney function lab tests 3. Hearing 4. Visual acuity Answer: 2 Explanation: Concurrent use of gentamicin and acyclovir increases the risk of nephrotoxicity. A symptom of nephrotoxicity would be detected by monitoring kidney function tests. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 48-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

909

9) In which situation is it appropriate for the nurse to instruct the client to stop taking minocycline (Minocin) and promptly seek medical advice? 1. The client reports epigastric burning. 2. The client reports dizziness and vertigo. 3. The client reports vaginal discharge. 4. The client reports occasional nausea. Answer: 2 Explanation: Minocycline is the only tetracycline that can cause reversible vestibular toxicity. Symptoms include dizziness, vertigo, and weakness. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 48-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 10) The nurse is instructing a female client about therapy with tetracycline (Sumycin). Which statement should be included in the instruction? 1. "Absorption of this drug is not affected by food." 2. "GI upset is a rare side effect." 3. "If taking oral contraceptives, an additional form of birth control is recommended." 4. "Take this drug immediately before bedtime." Answer: 3 Explanation: Tetracyclines decrease the effectiveness of oral contraceptive therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 48-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

910

11) A client who has been receiving therapy with tetracycline reports itching and yellowish discoloration of the skin. The nurse knows these symptoms could be associated with which adverse effect of tetracycline? 1. Cholestatic hepatitis 2. Acute pancreatitis 3. Fatty degeneration of the liver 4. Exfoliative dermatitis Answer: 3 Explanation: Pruritus, or itching, and jaundice, a yellowish discoloration of the skin, are associated with fatty degeneration of the liver, a serious adverse effect of tetracycline. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 48-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 12) The nurse is managing care for a client prescribed tetracycline who is reporting frequent episodes of diarrhea. The nurse plans to monitor this client for: 1. pseudomembranous colitis. 2. paralytic ileus. 3. intestinal obstruction. 4. impaired biliary function. Answer: 1 Explanation: Diarrhea is a symptom of pseudomembranous colitis, a serious adverse effect associated with tetracycline therapy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 48-7 Apply the nursing process to care for patients receiving pharmacotherapy with bacterial protein synthesis inhibitors.

911

13) The nurse is obtaining a client's drug history prior to initiating therapy with gentamicin (Garamycin). The client takes furosemide (Lasix). Based on this information, the nurse identifies the client is at increased risk for: 1. nephrotoxicity. 2. ototoxicity. 3. pseudomembranous colitis. 4. photosensitivity. Answer: 2 Explanation: Concurrent use of more than one ototoxic drug increases the risk of hearing impairment. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 48-7 Apply the nursing process to care for patients receiving pharmacotherapy with bacterial protein synthesis inhibitors. 14) A clinic nurse is teaching a group of teens taking tetracycline for acne. Which teaching points should take priority? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Take tetracycline on an empty stomach to increase absorption. 2. Tetracycline may cause photosensitivity, making the skin susceptible to sunburn. 3. Tetracycline may cause vaginal yeast infection in women who are using oral contraceptives. 4. Tetracycline is one of the safest antibiotics to take during pregnancy. 5. Tetracycline commonly causes diarrhea. The client should start a clear liquid diet and slowly resume a normal diet. Answer: 1, 2, 3 Explanation: Food, especially milk or diary products, decreases the absorption of tetracycline. Tetracycline does cause photosensitivity that makes the skin more susceptible to sunburn. Women on oral contraceptives and tetracycline have a higher incidence of vaginal yeast infections. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 48-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 15) The nurse tells a client with pneumonia that the physician has prescribed a macrolide antibiotic 912

because: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. newer macrolides have a longer half-life, which makes less frequent dosing attractive to clients. 2. newer macrolides cause fewer gastrointestinal symptoms. 3. macrolide antibiotics are considered one of the safest classes of antibiotics. 4. food does not interfere with the absorption of macrolide antibiotics as it does with other classes of antibiotics. 5. there are no strains of bacteria resistant to macrolide antibiotics. Answer: 1, 2, 3 Explanation: Newer macrolides have a longer half-life, which means less frequent dosing and greater client adherence. Newer macrolides do cause fewer gastrointestinal symptoms. Macrolide antibiotics are well tolerated and considered one of the safest classes of antibiotics. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 48-2 Identify the classes of antibiotics that act by inhibiting bacterial protein synthesis.

913

16) Which clients on erythromycin will the nurse monitor closely for drug–drug interactions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A client wearing a fentanyl patch for chronic pain syndrome 2. A client taking theophylline for chronic obstructive pulmonary disease 3. A client recovering from heroin addiction who takes methadone daily 4. A client using topical neomycin for wound infection 5. A client who is 4 months pregnant and taking prenatal vitamins Answer: 1, 2, 3 Explanation: Concurrent use with erythromycin may increase the serum levels and toxicity of fentanyl. Concurrent use with erythromycin may increase the serum levels and toxicity of theophylline. Concurrent use with erythromycin may increase the serum levels and toxicity of methadone. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 48-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

914

17) A pregnant client has been prescribed azithromycin (Zithromax) for an upper respiratory infection. The client asks the nurse why this medication was prescribed instead of erythromycin. The nurse explains that azithromycin: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. causes less nausea. 2. may be taken with or without food. 3. is safe to take during pregnancy. 4. does not cause diarrhea or abdominal pain. 5. is not associated with hypersensitivity. Answer: 1, 2, 3 Explanation: Azithromycin causes less nausea. Azithromycin may be taken with or without food. Azithromycin is a category B drug and is safe for pregnant clients. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 48-4 Explain how protein synthesis inhibitors exert selective toxicity toward bacterial, rather than human, cells.

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18) An older adult has been prescribed an aminoglycoside antibiotic. The nurse would immediately contact the physician if the client exhibits which symptoms? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. High-pitched tinnitus 2. Vertigo 3. Nausea and vomiting 4. Diarrhea 5. Rash Answer: 1, 2, 3 Explanation: High-pitched tinnitus may be a symptom of ototoxicity and impending inner ear damage. Vertigo may be a symptom of ototoxicity and impending inner ear damage. Nausea and vomiting may be symptoms of ototoxicity and impending inner ear damage. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 48-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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19) To prevent the most serious adverse effects of aminoglycosides in a client with diabetes, the nurse will monitor which diagnostic lab reports? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Serum drug concentration of aminoglycoside 2. Serum creatinine 3. Blood urea nitrogen (BUN) 4. Complete blood count (CBC) 5. Blood glucose Answer: 1, 2, 3 Explanation: Serum drug concentration should be obtained regularly and doses adjusted to prevent nephrotoxicity. Serum creatinine will reveal information about kidney function and potential nephrotoxicity. BUN will reveal information about kidney function and potential nephrotoxicity. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 48-3 Explain mechanisms by which antibiotics inhibit bacterial protein synthesis. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 49 Fluoroquinolones and Miscellaneous Antibacterials 1) DNA replication is necessary for bacterial cell replication. One of the ways that antibacterials are effective is by inhibiting the DNA replication. Antibacterials often accomplish this by: 1. encouraging the replication of the original DNA to form a new DNA strands. 2. encouraging migration of the DNA strands to opposite sides of the cell. 3. affecting the enzymes needed for DNA replication. 4. assisting the supercoil to relax and unwind. Answer: 3 Explanation: A large number of enzymes are needed for DNA replication, and some of these enzymes are targets for antibiotics. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 49-1 Explain the steps in bacterial DNA replication. 2) A client has come to the healthcare provider's office with symptoms of a urinary tract infection (UTI). She states that she had no symptoms when she went to bed last night but woke this morning with severe burning with urination. A urine culture is completed and grows Escherichia coli. The client asks the nurse why these symptoms occurred so suddenly. The nurse's best response is: 917

1. "You probably had the symptoms for some time, but you didn't notice it until it became severe." 2. "The severity of your symptoms indicates a hygiene problem." 3. "Do you often have complaints of severe pain when you awaken?" 4. "The bacteria that caused your infection grow very rapidly, so it is possible you had no symptoms the night before." Answer: 4 Explanation: E. coli can replicate every 20 minutes, producing a billion cells in as little as 10 hours. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 49-1 Explain the steps in bacterial DNA replication.

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3) A nursing instructor asks a group of students to explain the four-step process necessary for bacterial DNA replication. The student with the correct answer is the one who states that the four-step process is: 1. relax, unwind, replicate, and migrate. 2. migrate, replicate, unwind, and relax. 3. unwind, relax, migrate, and replicate. 4. replicate, unwind, relax, and migrate. Answer: 1 Explanation: The correct order of the four-step process is relax, unwind, replicate, and migrate. Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 49-1 Explain the steps in bacterial DNA replication. 4) Many medications are developed in hopes of treating cancer. Many of these cancer drugs work by: 1. encouraging cell replication. 2. forming new DNA. 3. assisting in the repair of DNA damage. 4. substituting the drug into the DNA of the cancer cell. Answer: 4 Explanation: Cancer drugs can work by mimicking molecules that are mistakenly incorporated into newly formed DNA, preventing its replication. Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-2 Identify classes of drugs that act by affecting bacterial DNA replication.

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5) A nursing student asks a nurse how antibacterials work. The nurse outlines the process, explaining that many antibacterials work by blocking bacterial DNA replication. The nurse knows further teaching is needed when the student states: 1. "Drugs inhibit the availability of precursor bases or nucleotides." 2. "Drugs can interact or bind with DNA, preventing the uncoiling or relaxation process." 3. "Drugs can bind to enzymes of DNA replication, halting the formation of new DNA strands." 4. "Drugs repair bacterial DNA damage." Answer: 4 Explanation: Drugs that block bacterial DNA replication would block the repair of the DNA, not allow it. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-2 Identify classes of drugs that act by affecting bacterial DNA replication. 6) How do fluoroquinolones block bacterial DNA replication? 1. Fluoroquinolones inhibit the synthesis of precursor bases. 2. Fluoroquinolones bind to enzymes of bacterial DNA replication, blocking the relaxation and migration processes. 3. Fluoroquinolones inhibit topoisomerase I so that DNA cannot be repaired. 4. Fluoroquinolones bind with the enzyme DNA polymerase, blocking the replication of the DNA process. Answer: 2 Explanation: Fluoroquinolones bind to enzymes gyrase and topoisomerase, blocking the relaxation and migration processes of bacterial DNA replication. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-2 Identify classes of drugs that act by affecting bacterial DNA replication.

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7) The nurse caring for a client with cancer is teaching the client about chemotherapeutic medications that affect bacterial DNA replication. Which medications should the nurse include in the teaching plan for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Cytarabine (Cytosar-U) 2. Fluorouracil (5-FU) 3. Daunorubicin (Cerubidine) 4. Bleomycin (Blenoxane) 5. Acyclovir (Zovirax) Answer: 1, 2, 3, 4 Explanation: Cytarabine (Cytosar-U) is a chemotherapeutic agent that resembles nucleotides and is mistakenly incorporated into newly formed DNA strands, inhibiting replication. Fluorouracil (5-FU) is a chemotherapeutic agent that resembles nucleotides and is mistakenly incorporated into newly formed DNA strands, inhibiting replication. Daunorubicin (Cerubidine) is a highly toxic chemotherapeutic antibiotic that interacts with DNA to physically block replication. Bleomycin (Blenoxane) is a highly toxic chemotherapeutic antibiotic that interacts with DNA to physically block replication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 49-2 Identify classes of drugs that act by affecting bacterial DNA replication.

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8) A client has been diagnosed with a gram-negative bacterial infection and has been prescribed a fluoroquinolone for treatment of this infection. What step of the bacterial DNA replication process is most likely being affected by the use of this medication? 1. It inhibits the enzyme DNA polymerase necessary for DNA replication. 2. It binds to the enzyme topoisomerase IV, preventing the new DNA strands from migrating to opposite sides of the cell, thus preventing bacterial cell replication. 3. It inhibits the relaxation of the supercoil prior to the unwinding process, which terminates replication. 4. It inhibits the unwinding of the two strands of the supercoil, thus terminating replication. Answer: 3 Explanation: It is thought that fluoroquinolones fight gram-negative organisms by binding to DNA gyrase, thereby inhibiting the ability of the supercoil to relax, resulting in termination of bacterial cell replication. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 49-3 Explain mechanisms by which fluoroquinolones inhibit bacterial DNA replication.

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9) During pharmacology class, a nursing professor poses the following question: "We have learned that certain medications, such as fluoroquinolones, are effective because they inhibit bacterial DNA replication. Why don't these medications cause harm to the nonbacterial cells in the body?" Which student nurse answered the question correctly? 1. Student B: "Medications such as fluoroquinolones do not appear to affect human DNA because human DNA is very similar to bacterial cell DNA." 2. Student D: "Human DNA is inherently healthier than bacterial DNA, so medications such as fluoroquinolones do not affect their replication." 3. Student C: "Medications such as fluoroquinolones don't appear to affect human DNA replication because of the difference between the enzymes needed for bacterial and human DNA replication." 4. Student A: "These medications protect healthy human cells while they attempt to disrupt bacterial DNA replication." Answer: 3 Explanation: It is thought that medications such as fluoroquinolones are very safe to use because they do not affect human DNA replication. This is because the enzymes that the medications affect in bacterial DNA replication are very different from the enzymes present in human DNA cells. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 49-3 Explain mechanisms by which fluoroquinolones inhibit bacterial DNA replication.

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10) Fluoroquinolones are known to be effective against both gram-negative and gram-positive organisms. How is this possible? 1. Fluoroquinolones that are effective against gram-negative organisms block the enzyme topoisomerase IV, which stops the migration process of the two new strands to opposite sides of the cell. 2. Fluoroquinolones that are effective against gram-positive organisms block the enzyme DNA gyrase, which stops relaxation of the supercoil of the DNA. 3. Fluoroquinolones that are effective against gram-negative organisms block the enzyme DNA gyrase, and those effective against gram-positive organisms block topoisomerase IV. 4. All fluoroquinolones are effective against both gram-negative and gram-positive organisms. There is no difference in the way they block bacterial DNA replication. Answer: 3 Explanation: Fluoroquinolones attack gram-negative organisms by blocking DNA gyrase and attack gram-positive organisms by blocking topoisomerase IV. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 49-3 Explain mechanisms by which fluoroquinolones inhibit bacterial DNA replication. 11) The nurse is caring for a client who has been prescribed a fluoroquinolone for the treatment of a respiratory infection. The nurse is explaining to the client that this class of medications affects DNA replication by inhibiting the strands of DNA from migrating to the opposite sides of the cell, therefore inhibiting division. Record your answer rounding to the nearest whole number. Answer: 2 Explanation: The fluoroquinolone antibiotics act on two enzymes in the DNA replication process. First, they bind to DNA gyrase, inhibiting its ability to relax the supercoiling of the bacterial DNA. When the replication enzymes reach an area still in a supercoiled state, replication terminates. A second mechanism is binding to topoisomerase IV. When this occurs, the two daughter DNA strands cannot migrate to opposite sides of the cell, and division cannot be completed. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-3 Explain mechanisms by which fluoroquinolones inhibit bacterial DNA replication.

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12) A client's urine culture has come back showing that the infecting organism is resistant to ciprofloxacin (Cipro). The client is upset, saying that this medication has worked every other time. What explanation should the nurse give to the client concerning the development of resistance? 1. "There are a number of ways that an organism can become resistant to an antibacterial. Sometimes one of the enzymes involved in bacterial DNA replication mutates so that the medication is no longer effective." 2. "You must be infected with one of the new 'superbugs.' There aren't many antibacterials that will work against it." 3. "Don't worry; the doctor will give you levofloxacin (Levaquin) to take instead of ciprofloxacin (Cipro)." 4. "There are a number of ways that an organism can become resistant to an antibacterial. It probably happened because you didn't take your medication correctly the last time you took it." Answer: 1 Explanation: One of the ways that resistance occurs against fluoroquinolones is by a mutation to DNA gyrase, decreasing the effectiveness of the fluoroquinolone. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-4 Describe means by which bacteria become resistant to fluoroquinolones. 13) The nurse explains to a student nurse the mechanism by which resistance to fluoroquinolones occurs. The nurse knows the student requires further education when the student states: 1. "Bacterial cell walls become less permeable to the fluoroquinolones." 2. "Mutations to DNA helicase alter its ability to bind with fluoroquinolones." 3. "Mutations to DNA gyrase alter its ability to bind with fluoroquinolones." 4. "Certain bacteria have developed resistance pumps that remove fluoroquinolones from the cell." Answer: 2 Explanation: Fluoroquinolones do not bind with the enzyme DNA helicase. They bind with DNA gyrase, so resistance will occur from mutations to DNA gyrase. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 49-4 Describe means by which bacteria become resistant to fluoroquinolones.

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14) A client who has developed a resistance to levofloxacin (Levaquin) is concerned that getting rid of an infection will be impossible. What is the best response by the nurse to the client? 1. "The physician will admit you to the hospital and put you on an IV form of levofloxacin (Levaquin). You will not be resistant to that." 2. "The physician will take you off of the levofloxacin (Levaquin) for a few days and then have you start taking it again. Then it will be effective." 3. "The physician will switch you from levofloxacin (Levaquin) to ciprofloxacin (Cipro)." 4. "The physician will switch you to another type of antibacterial to which you haven't developed resistance." Answer: 4 Explanation: The physician will switch the client to another class of antibacterial to which the client has not developed resistance. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-4 Describe means by which bacteria become resistant to fluoroquinolones. 15) The nurse is caring for a client who has developed an infection that is resistant to fluoroquinolone therapy. The nurse knows that this resistance is due to which reasons? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A mutation to the DNA gyrase 2. The development of resistant pumps within the bacteria 3. The bacterial cell wall structure becoming impermeable 4. Mutations to DNA helicase that alter its ability to bind with fluoroquinolones 5. Improper medication administration Answer: 1, 2, 3 Explanation: Mutations to DNA gyrase can alter its ability to bind fluoroquinolones, thus rendering the drug less effective. Some bacteria have developed resistance pumps that remove fluoroquinolones from inside their cells, thus rending the drug less effective. Some bacteria have developed a cell wall structure that is less permeable to the drugs, thus rendering the drug less effective. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 49-4 Describe means by which bacteria become resistant to fluoroquinolones. 16) A client has been hospitalized for a severe urinary tract infection (UTI). Ciprofloxacin IV 926

(Cipro) is prescribed. Two days later, the symptoms have abated, and the client is discharged with a prescription for oral ciprofloxacin (Cipro). What characteristics of fluoroquinolones allow for this quick discharge from the hospital? 1. Fluoroquinolones given as an IV infusion are very expensive, and must be switched to oral administration as soon as possible to save the client money. 2. Fluoroquinolones have equal serum drug levels with either IV or oral administration, which allows for a smooth transition from IV to oral therapy. 3. Fluoroquinolones given as an IV infusion eradicate infection quickly so that the client can be discharged. 4. Fluoroquinolones are less toxic when given orally. Answer: 2 Explanation: The serum levels of fluoroquinolones after oral administration are nearly equivalent to the levels achieved during IV administration. This allows for a rapid, smooth transition from IV therapy to oral therapy, potentially decreasing the length of the hospital stay. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-5 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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17) Fluoroquinolones are very effective against both gram-negative and gram-positive organisms. Several of the drugs in this class have been discontinued from use. What adverse effects have caused the removal of these drugs from the market? 1. The development of dysrhythmias after administration of fluoroquinolones 2. The development of pathologic fractures after administration of fluoroquinolones 3. The development of insomnia after administration of fluoroquinolones 4. The development of severe phototoxicity after administration of fluoroquinolones Answer: 1 Explanation: Fluoroquinolones have been indicated as the cause of potentially fatal dysrhythmias after the administration of gatifloxacin and moxifloxacin. These two fluoroquinolones have been removed from the market. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-5 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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18) A 13-year-old client has been diagnosed with meningitis caused by Haemophilus influenzae type B. What drug is commonly prescribed to prevent this disease from occurring in individuals who had close contact with the client prior to the illness? 1. Metronidazole (Flagyl) 2. Daptomycin (Cubicin) 3. Rifampin (Rifadin) 4. Ciprofloxacin (Cipro) Answer: 3 Explanation: Rifampin is the preferred drug for prophylaxis of individuals who have come in contact with clients with Haemophilus influenzae type B. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-5 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 19) The nurse is caring for a female client with an uncomplicated UTI that is being treated with ciprofloxacin hydrochloride (Proquin XR). The client asks the nurse how long she will need to take this medication. The nurse tells the client she will have to take the medication for days. Record your answer rounding to the nearest whole number. Answer: 3 Explanation: Approved in 2005, ciprofloxacin hydrochloride (Proquin XR) contains only the hydrochloride salt and has been formulated to cause less nausea, vomiting, and diarrhea than other formulations. ciprofloxacin hydrochloride (Proquin XR) is administered for only 3 days and is only approved for uncomplicated UTI (acute cystitis). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-5 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 929

20) The nurse is administering ciprofloxacin to a client with acute cystitis. The nurse anticipates administering this drug to the client twice a day because the duration of action is _ hours. Record your answer rounding to the nearest whole number. Answer: 12 Explanation: The duration of action for ciprofloxacin is 12 hours; therefore, the nurse anticipates the need to administer the medication twice a day. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 49-5 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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21) The nurse is caring for a client who is taking ciprofloxacin for the treatment of acute cystitis. The nurse knows ciprofloxacin interacts with several other classes of medication and that it is important to assess the client's medication administration record for which classifications of medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Anticoagulants 2. Antacids 3. Xanthines 4. Antibiotics 5. Antivirals Answer: 1, 2, 3 Explanation: Concurrent administration of ciprofloxacin with the anticoagulant warfarin may increase anticoagulant effects and result in bleeding due to the decreased metabolism of warfarin. Antacids may decrease the absorption of ciprofloxacin, thus causing decreased effectiveness of the antibiotic. Ciprofloxacin slows the hepatic metabolism of xanthines, including caffeine, theophylline, and theobromine. Theophylline levels may increase 15% to 30%. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-5 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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22) The healthcare provider has prescribed ciprofloxacin (Cipro) for four clients. For which client should the nurse contact the healthcare provider for further clarification? 1. A 67-year-old male who has just completed taking another antibacterial for chronic sinusitis 2. A 21-year-old female who gave birth 8 weeks ago and is still breastfeeding 3. A 49-year-old female who is experiencing "hot flashes" related to the onset of menopause 4. A 19-year-old male who plays soccer for his college team Answer: 2 Explanation: Ciprofloxacin is contraindicated in clients who are pregnant or breastfeeding because the drug is secreted in breast milk and crosses the placenta. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-6 Explain the nurse's role in the safe administration of fluoroquinolones. 23) Which statement by a client who has received a prescription for ciprofloxacin (Cipro) indicates that further instruction by the nurse is needed? 1. "I will drink more coffee to make sure I get more fluids." 2. "I will make sure I wear sunscreen when I go outside to do my gardening." 3. "If my knees start hurting, I will call the doctor immediately." 4. "I won't take any antacids until I have finished this medication." Answer: 1 Explanation: Clients are advised to limit caffeine intake, not increase it, to decrease the chance of insomnia, nervousness, and anxiety. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 49-6 Explain the nurse's role in the safe administration of fluoroquinolones.

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24) The nurse is preparing to administer a fluoroquinolone medication to a client with a urinary tract infection. The nurse knows it is important to contact a healthcare provider immediately if which adverse effects occur? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Severe diarrhea containing mucous 2. Decreased urine output 3. Nausea 4. Abdominal cramping 5. Headache Answer: 1, 2 Explanation: Severe diarrhea, especially containing mucus, blood, or pus, should be reported immediately. Decreased urine output should be reported immediately. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-6 Explain the nurse's role in the safe administration of fluoroquinolones. 25) A client who has been taking ciprofloxacin (Cipro) calls the healthcare provider to report that he has begun having loose stools. What instructions would be most helpful to this client? 1. Take a dose of antidiarrheal medication after every loose stool. 2. Do nothing until you have 8 to 10 loose stools per day. 3. Eat live-culture yogurt once or twice daily. 4. Limit the amount of water you drink to three glasses a day. Answer: 3 Explanation: Clients are often advised to consume live-culture dairy products to help maintain and restore normal intestinal flora. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-7 Apply the nursing process to care for patients receiving pharmacotherapy with fluoroquinolones and miscellaneous antibacterials.

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26) A client has been diagnosed with a skin infection. The infective organism has been identified as MRSA, and daptomycin (Cubicin) IV has been prescribed. If this client complains of muscle pain, what will be the priority nursing intervention? 1. Place the affected extremity in a resting position. 2. Place a warm compress on the affected muscles. 3. Encourage the client to exercise and work out the soreness. 4. Obtain a blood specimen for a CPK. Answer: 4 Explanation: Because myopathy is a possibly adverse effect of daptomycin, the nurse should immediately obtain a CPK for evidence of muscle damage. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-7 Apply the nursing process to care for patients receiving pharmacotherapy with fluoroquinolones and miscellaneous antibacterials. 27) The nurse is preparing to discharge a client with a urinary tract infection (UTI) from the urgent care center. The nurse tells the client to call the healthcare provider is the current fever does not diminish below degrees Celsius within 3 days. Record your answer rounding to one decimal place. Answer: 37.8 Explanation: Teach the client to report a fever that does not diminish below 37.8°C (100°F) or per the parameters set by the healthcare provider within 3 days, increasing signs and symptoms of infection, or symptoms that remain after taking the entire course of the antibacterial drug. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 49-7 Apply the nursing process to care for patients receiving pharmacotherapy with fluoroquinolones and miscellaneous antibacterials. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 50 Sulfonamides and the Pharmacotherapy of Urinary Tract Infections 1) A 28-year-old female client presents to the emergency department with a temperature of 102.4°F. She states that she began experiencing frequency and burning upon urination yesterday and in the middle of the night woke up with the fever and chills. She also states that her back is hurting. These symptoms describe what type of infection? 1. Urethritis 934

2. Acute pyelonephritis 3. Acute renal failure 4. Cystitis Answer: 2 Explanation: Acute pyelonephritis is an inflammation of the kidney, pelvis, and other renal cells. The symptoms include irritative voiding symptoms, vomiting, fever, chills, and acute costovertebral angle and flank tenderness. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 50-1 Classify types of urinary tract infections based on their anatomic location. 2) A 45-year-old male client comes to the healthcare practitioner with symptoms of cystitis. The client also has a fever, and states that it is very hard for him to "pass much urine." The healthcare practitioner performs a rectal examination and finds tenderness. What is possibly causing this client's set of problems? 1. Bladder infection 2. Urethritis 3. Acute pyelonephritis 4. Cystitis with prostatitis Answer: 4 Explanation: This client demonstrates symptoms of cystitis with prostatitis. The prostate becomes inflamed and can cause fever and urinary obstruction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 50-1 Classify types of urinary tract infections based on their anatomic location.

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3) A 19-year-old male client complains of burning while voiding. The healthcare practitioner diagnoses urethritis and explains that it is caused by a pathogen that infects the urethra. The client tells the nurse that his girlfriend had the same problem last week. The nurse knows that the most likely cause of the urethritis in this client is: 1. unrelated to his girlfriend's condition. 2. a descending bladder infection. 3. related to poor hygiene. 4. a sexually transmitted infection. Answer: 4 Explanation: The fact that the client reports that his girlfriend had similar symptoms last week is indicative of the possibility of a sexually transmitted infection. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 50-1 Classify types of urinary tract infections based on their anatomic location. 4) A client is being seen in the emergency department with a suspected urinary tract infection. The nurse believes the client has pyelonephritis based on which assessment findings? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Vomiting 2. Fever 3. Flank tenderness 4. Photophobia 5. Painful urination Answer: 1, 2, 3, 5 Explanation: Vomiting is a symptom that often accompanies pyelonephritis. Fever is a symptom that often accompanies pyelonephritis. Flank tenderness is often a symptom of pyelonephritis. Painful urination is often a symptom of pyelonephritis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 50-1 Classify types of urinary tract infections based on their anatomic location.

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5) A client is admitted with a high fever accompanied by chills. The client complains of costovertebral pain but denies dysuria, urgency, or frequency. The diagnosis is pyelonephritis related to pathogens present in the blood. How would the nurse classify this urinary tract infection? 1. Ascending 2. Hematogenous 3. Retrograde 4. "Against the flow" Answer: 2 Explanation: A hematogenous infection is caused by pathogens traveling through the blood. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 50-2 Explain the epidemiology and pathogenesis of urinary tract infections. 6) A school nurse is conducting a health class for fifth-grade girls. The nurse instructs the girls that when toileting, they must remember to wipe from front to back. Which statement by a student indicates the need for further education? 1. "Girls need to wipe from front to back to avoid urinary tract infections." 2. "Girls must be careful about the way they wipe to prevent infection from bacteria present near the rectum." 3. "Girls must be careful how they wipe because the connection from the outside to the bladder is very short." 4. "Girls need to wipe front to back only after a bowel movement." Answer: 4 Explanation: This is an incorrect statement. Girls should wipe front to back at all times because bacteria are present in the rectal area at all times. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-2 Explain the epidemiology and pathogenesis of urinary tract infections.

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7) A nurse is conducting a class for preschool parents concerning ways to prevent illness in children. A parent asks why little girls are at greater risk for urinary tract infections than little boys. Which response by the nurse is most accurate? 1. "Little boys have short urethras, but they also have testicles that block bacteria from the rectum." 2. "Most little girls don't wipe themselves as well as little boys do after using the bathroom." 3. "Little girls have short urethras, which makes it easier for bacteria to move into the bladder." 4. "Testosterone in boys helps prevent urinary tract infections." Answer: 3 Explanation: Girls have more frequent UTIs because their urethras are shorter than boys', making it easier for bacteria to move into the bladder. Their rectums are also in closer proximity to the urethra than are boys'. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-2 Explain the epidemiology and pathogenesis of urinary tract infections. 8) The nurse in a urology clinic is asked by a parent why her son does not get urinary tract infections but her daughter does. How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Your son's urethra is longer than your daughter's, which makes it more difficult for bacteria to enter." 2. "Your son's scrotum is a physical barrier between the urethra and the anus, which provides added protection against UTIs." 3. "Your son's urethra is shorter than your daughter's, which protects him from UTIs." 4. "Your daughter may not be properly wiping after urination, which can increase the risk of developing a UTI." 5. "There are no anatomic differences between the male and female urinary tract. Some people are just more prone to UTIs than others." Answer: 1, 2, 4 Explanation: The male urethra is longer than the female urethra. The male scrotum is a physical barrier between the urethra and the anus and does allow for added protection against UTIs for males. Improper wiping after urination and defecation can increase the risk of developing a UTI. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-2 Explain the epidemiology and pathogenesis of urinary tract infections. 9) A female client has had repeated bouts of acute uncomplicated cystitis (AUC). The healthcare 938

practitioner has recommended that she change the form of birth control she is using and see if she has fewer infections. What change would be most beneficial for this client? 1. The client should stop using spermicidal foam and begin using birth control pills. 2. The client should stop using a cervical cap and begin using a diaphragm. 3. The client should stop using the "sponge" and begin using a diaphragm. 4. The client should stop using a female condom and begin using a cervical cap. Answer: 1 Explanation: Switching from spermicidal foam to oral contraceptives might lessen this client's chances of having more AUC infections. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-3 Compare and contrast the pharmacotherapy of complicated versus uncomplicated urinary tract infections. 10) A female client with acute uncomplicated cystitis (AUC) has been treated with antibacterials, and now reports that all symptoms have resolved. What further instructions should be given to this client at this time? 1. "Don't try to figure out for yourself if you have an infection; it might be dangerous." 2. "Come back to the clinic in 2 weeks for a urinalysis to check for signs of infection." 3. "Your healthcare practitioner would like to see you in 2 weeks to see how you are feeling." 4. "You don't need to come back to the clinic unless your symptoms return." Answer: 3 Explanation: Clients whose symptoms have resolved quickly will be seen for a routine office visit. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-3 Compare and contrast the pharmacotherapy of complicated versus uncomplicated urinary tract infections.

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11) A client has been diagnosed with a complicated urinary tract infection (C-UTI). The nurse knows that C-UTIs are often treated differently than acute uncomplicated cystitis (AUC). What is a significant difference in the treatment of these infections? 1. Clients with AUC are rarely treated with antibacterials while those with C-UTIs almost always receive this therapy. 2. Clients with AUC receive a shorter course of antibacterials than do clients with C-UTIs. 3. Clients with AUC receive a longer course of antibacterials than do clients with C-UTIs. 4. Clients with AUC receive more toxic antibacterials than do clients with C-UTIs. Answer: 2 Explanation: Most clients with AUC are treated with a short course of an antibacterial, while a client with a C-UTI is treated for at least 14 days. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 50-3 Compare and contrast the pharmacotherapy of complicated versus uncomplicated urinary tract infections. 12) A female client has been diagnosed with an uncomplicated urinary tract infection. The healthcare provider has prescribed trimethoprim-sulfamethoxazole (TMP-SMZ). The client asks the nurse how long she will be on the medication. The nurse answers that this medication is often taken for days. Record your answer rounding to the nearest whole number. Answer: 3 Explanation: The traditional choice for AUC is trimethoprim-sulfamethoxazole (TMP-SMZ), a fixed-dose combination drug. Given as a 3-day regimen, this agent is effective at eliminating most of the common species of uropathogens. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-3 Compare and contrast the pharmacotherapy of complicated versus uncomplicated urinary tract infections.

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13) The nurse is caring for a client diagnosed with a complicated urinary tract infection. The nurse anticipates that the client will require days of antibiotic therapy. Record your answer rounding to the nearest whole number. Answer: 14 Explanation: Therapy for complicated urinary tract infections is often continued for 14 days to be certain that all uropathogens have been eliminated. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 50-3 Compare and contrast the pharmacotherapy of complicated versus uncomplicated urinary tract infections. 14) A 22-year-old female client has acute uncomplicated cystitis. The nurse knows that which antibacterial would not be an appropriate choice to treat this infection? 1. Trimethoprim-sulfamethoxazole (TMP-SMZ) 2. Metronidazole (Flagyl) 3. Norfloxacin (Noroxin) 4. Fosfomycin (Monurol) Answer: 2 Explanation: Metronidazole is a miscellaneous antibacterial that is used to treat protozoal infections, and is often used in the treatment of pelvic infections. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-4 Identify the classes of antibiotics used to treat urinary tract infections.

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15) A client is diagnosed with a urinary tract infection (UTI). The healthcare practitioner elects to treat the client with ciprofloxacin (Cipro). The client asks the nurse why she isn't receiving trimethoprim-sulfamethoxazole (TMP-SMZ), the drug she was given 8 months ago for a UTI. What would be the most accurate response? 1. "Many clients have developed resistance to TMP-SMZ, so that drug isn't used as much." 2. "It is obvious that the TMP-SMZ didn't clear up your infection the first time, so you are being given another medication." 3. "I'm sure there is a good reason why you are being given this different medication." 4. "Cipro is less expensive than the drug you took the last time." Answer: 1 Explanation: Many strains are resistant to TMP-SMZ, so its use as a first-line agent has been limited. Cipro is equally effective and has not developed as much resistance. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-4 Identify the classes of antibiotics used to treat urinary tract infections. 16) A 19-year-old client with symptoms of recurrent urinary tract infection states that she generally does not finish the prescription given to her for the infection. What medication is the healthcare practitioner most likely to prescribe for this client? 1. Nitrofurantoin (Furadantin) 2. Trimethoprim-sulfamethoxazole (TMP-SMZ) 3. Fosfomycin (Monurol) 4. Ciprofloxacin (Cipro) Answer: 3 Explanation: Fosfomycin would be the preferred drug for this client because it is given as a single dose, so compliance is not an issue. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-4 Identify the classes of antibiotics used to treat urinary tract infections.

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17) The nurse is caring for a client who has been diagnosed with AUC. The client lives in a community where drug resistance is an issue. Which antibiotics may be prescribed for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Trimethoprim-sulfamethoxazole (TMP-SMZ) 2. Ciprofloxacin (Cipro) 3. Norfloxacin (Noroxin) 4. Nitrofurantoin (Furadantin) 5. Fosfomycin (Monurol) Answer: 3, 4 Explanation: Norfloxacin is often prescribed in communities with a large number of drug-resistant conditions. Nitrofurantoin is often prescribed in communities with a large number of drug-resistant conditions. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 50-4 Identify the classes of antibiotics used to treat urinary tract infections. 18) A 3-year-old female is being seen in the clinic with symptoms of a urinary tract infection. Which medication would be appropriate for a child this age? 1. Levofloxacin (Levaquin) 2. Trimethoprim-sulfamethoxazole (TMP-SMZ) 3. Fosfomycin (Monurol) 4. Ciprofloxacin (Cipro) Answer: 2 Explanation: TMP-SMZ is the only drug listed that can be administered safely to a child. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 50-5 Describe modifications in the pharmacotherapy of urinary tract infections for infants and children, pregnancy, older adults, and those with recurring infections.

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19) A client is in her 16th week of pregnancy. A routine urinalysis has revealed bacteriuria, and the midwife has given the client a prescription for an antibacterial. The client asks why she must take this medication when she has no symptoms of an infection. What is the nurse's best response? 1. "Even though you don't have any symptoms, the infection could keep your baby from gaining enough weight before birth." 2. "I know you don't want to take this medication, but it is safe and will not harm you or your baby." 3. "You are denying your symptoms because you don't want to take the medication." 4. "Taking this medication will prevent your baby from developing kidney damage in the future." Answer: 1 Explanation: Even though the client is asymptomatic, she is treated to prevent the baby from being born with a below-normal weight. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-5 Describe modifications in the pharmacotherapy of urinary tract infections for infants and children, pregnancy, older adults, and those with recurring infections. 20) A female client has been provided with a 3-day course of therapy as prophylaxis against another urinary tract infection. Which statement indicates that the client understands when to use this medication? 1. "I will take this medication on the first 3 days of the month." 2. "I will take this medication after my husband and I have sexual intercourse." 3. "When I first have symptoms, I will drink cranberry juice. If that is not effective, I will take the medication." 4. "If I develop symptoms of an infection, I will call the healthcare provider and make sure it is OK for me to go ahead and take the medication." Answer: 2 Explanation: Prophylactic therapy is intended to be used after each act of coitus, or when symptoms first develop. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-5 Describe modifications in the pharmacotherapy of urinary tract infections for infants and children, pregnancy, older adults, and those with recurring infections. 21) An infant has been diagnosed with a urinary tract infection. The nurse anticipates the healthcare provider may prescribe which medications as part of the treatment regimen? 944

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Trimethoprim-sulfamethoxazole (TMP-SMZ) 2. Nitrofurantoin (Furadantin) 3. Fosfomycin (Monurol) 4. Norfloxacin (Noroxin) 5. Levofloxacin (Levaquin) Answer: 1, 2 Explanation: Trimethoprim-sulfamethoxazole (TMP-SMZ) is a safe and effective treatment for infants with a urinary tract infection. Nitrofurantoin (Furadantin) is a safe and effective treatment for infants with a urinary tract infection. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 50-5 Describe modifications in the pharmacotherapy of urinary tract infections for infants and children, pregnancy, older adults, and those with recurring infections. 22) A pregnant client has been diagnosed with a urinary tract infection. The nurse anticipates that the client will require a follow-up culture within weeks after the conclusion of antibiotic therapy. Record your answer rounding to the nearest whole number. Answer: 2 Explanation: Urinary screening is routinely performed by the 16th week of pregnancy. Discovery of high levels of bacteria in the urine is an indication for antimicrobial therapy, even if the client is asymptomatic at the time of testing. A follow-up culture is performed 1 to 2 weeks after therapy is completed. Continued asymptomatic bacteriuria is predictive of symptomatic UTI later in pregnancy. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 50-5 Describe modifications in the pharmacotherapy of urinary tract infections for infants and children, pregnancy, older adults, and those with recurring infections.

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23) Which statement by a nursing student about the mechanism of action of sulfonamides indicates the need for further instruction? 1. "Sulfonamides resemble the precursor molecule, PABA, so the enzymes needed for the synthesis of folic acid bind with sulfonamide instead of with PABA, stopping bacterial growth." 2. "Sulfonamides slow the growth of bacteria because they only inhibit folic acid that is synthesized by bacteria." 3. "Sulfonamides are effective against uropathogens by inhibiting the synthesis of bacterial folic acid." 4. "Sulfonamides are most effective in clients who eat large amounts of foods rich in folic acid." Answer: 4 Explanation: This is an incorrect statement. Sulfonamides are ineffective against the "premade" folic acid needed by humans. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 50-6 Explain why folic acid inhibitors exert selective toxicity toward bacterial cells. 24) The healthcare practitioner is preparing to prescribe trimethoprim-sulfamethoxazole (Bactrim). For which client should the nurse question an order for this medication? 1. The client who has a Shigella infection of the bowel 2. The client with P. jiroveci pneumonia 3. The client with iron deficiency anemia 4. The client with pernicious anemia Answer: 4 Explanation: Trimethoprim-sulfamethoxazole is contraindicated for clients with a folic acid– deficiency anemia because this drug is a folic acid inhibitor and would worsen the condition. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.4 Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

946

25) Which statement indicates that a client understands the reason for the need to drink approximately 3 liters of fluid while taking trimethoprim-sulfamethoxazole (TMP-SMZ)? 1. "I need to drink a lot of fluids to keep my bladder full." 2. "I need to drink a lot of fluids to flush the bacteria out of my bladder." 3. "I need to drink a lot of fluids to prevent crystals from forming in my urine." 4. "I need to drink a lot of fluids to prevent an allergy from developing." Answer: 3 Explanation: Clients must drink extra fluids to prevent crystalluria that can potentially obstruct the kidneys or urethra. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.4 Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 50-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 26) For which client is the use of nitrofurantoin (Furadantin) contraindicated? 1. The client who needs a rescue inhaler for asthma three times a week 2. The client who has pernicious anemia 3. The client who developed nausea the last time she took the drug 4. The client who had hepatitis A 10 years ago Answer: 1 Explanation: Nitrofurantoins are contraindicated in clients with preexisting pulmonary disorders such as poorly controlled asthma. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.4 Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 50-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

947

27) Trimethoprim-sulfamethoxazole (Bactrim) has been prescribed for a client with a urinary tract infection. The nurse can administer this medication by which routes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. By mouth 2. By intravenous injection 3. By intramuscular injection 4. By subcutaneous injection 5. By the topical route Answer: 1, 2 Explanation: This medication can be administered by mouth in the treatment of a UTI. This medication can be administered by the intravenous route in the treatment of a UTI. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.4 Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 50-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

948

28) A client has been prescribed nitrofurantoin (Furadantin) for the treatment of a UTI. The nurse explains that this medication is effective against which causative organisms? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. E. coli 2. S. saprophyticus 3. Pseudomonas 4. Proteus 5. Serratia Answer: 1, 2 Explanation: Nitrofurantoin (Furadantin) is effective in the treatment of UTIs caused by E. coli. Nitrofurantoin (Furadantin) is effective in the treatment of UTIs caused by S. saprophyticus. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.4 Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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29) The healthcare provider has ordered trimethoprim-sulfamethoxazole (Septra) to be administered IV to several hospitalized clients who have developed urinary tract infections. For which client should the nurse question the order? 1. The client with glaucoma 2. The client who has an indwelling urinary catheter inserted 3. The client who has AIDS 4. The client who had surgery yesterday Answer: 3 Explanation: Caution must be used when treating clients with acquired immunodeficiency syndrome (AIDS) because they experience a higher incidence of serious adverse effects than others. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Teamwork: Function competently within one's own scope of practice as leader or member of the healthcare team | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-8 Apply the nursing process to care for patients receiving pharmacotherapy for urinary tract infections. 30) A client has received a prescription for a sulfonamide. Which statement by the client indicates a need for further instruction? 1. "If I develop a fever or severe diarrhea, I will call my healthcare provider." 2. "I will call the healthcare provider if my symptoms have not improved in the next few days. " 3. "I will limit my fluid intake to about three glasses per day." 4. "I will return for my scheduled appointment for lab work." Answer: 3 Explanation: The client should increase fluid intake to 2 to 3 liters per day rather than limit intake to approximately 24 ounces. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 50-8 Apply the nursing process to care for patients receiving pharmacotherapy for urinary tract infections.

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31) The nurse is discharging a client from the urgent care clinic who has been diagnosed with a urinary tract infection. The nurse knows the client has understood teaching when she states she will contact the healthcare provider if her fever persists for more than days. Record your answer rounding to the nearest whole number. Answer: 3 Explanation: The nurse should teach the client to report a fever that does not diminish below 37.8°C (100°F) or per the parameters set by the healthcare provider within 3 days. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 50-8 Apply the nursing process to care for patients receiving pharmacotherapy for urinary tract infections. 32) A client is being treated with IV antibiotics for a complicated urinary tract infection. The nurse monitors the client for renal toxicity by monitoring for a weight gain of more than kg in a 24-hour period. Record your answer rounding to the nearest whole number. Answer: 1 Explanation: The nurse monitors for renal toxicity: diminished urine output, edema, or weight gain greater than 1 kg (2.2 lb) in 24 hours. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 50-8 Apply the nursing process to care for patients receiving pharmacotherapy for urinary tract infections.

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33) Which statement best classifies sulfonamides? 1. "Sulfonamides are bactericidal." 2. "Sulfonamides are bacteriostatic." 3. "Sulfonamides work by aiding in the growth of bacterial folic acid." 4. "Sulfonamides are most effective in clients who eat large amounts of foods rich in fruits and vegetables." Answer: 2 Explanation: Sulfonamides are bacteriostatic, rather than bactericidal, because they slow bacterial growth. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 50-6 Explain why folic acid inhibitors exert selective toxicity toward bacterial cells. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 51 Pharmacotherapy of Mycobacterial Infections 1) The nurse is reading the client's medical history and learns that the client has a history of infections with Mycobacterium leprae. Based on this finding, the nurse would expect the client to have which infection? 1. Leprosy 2. AIDS 3. Tuberculosis 4. Hepatitis Answer: 1 Explanation: Leprosy is caused by Mycobacterium leprae. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-1 Compare and contrast the types of infections caused by mycobacteria. 2) The nurse is reading the client's medical history and learns that the client has a history of infections with Mycobacterium scrofulaceum. Based on this finding, the nurse would expect the client to be from which age group? 1. 60 to 75 years 2. 40 to 50 years 3. 12 to 18 years 4. 1 to 3 years Answer: 4 Explanation: Mycobacterium scrofulaceum usually affects children. Cognitive Level: Understanding 952

Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-1 Compare and contrast the types of infections caused by mycobacteria.

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3) The substance present in Mycobacterium that protects it from disinfectants, including chlorinated water, is: 1. polysaccharides. 2. mycolic acid. 3. yeast. 4. acetylation. Answer: 2 Explanation: This answer is correct; the substance that protects Mycobacterium is mycolic acid. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-1 Compare and contrast the types of infections caused by mycobacteria. 4) The nurse caring for several clients with mycobacterium infections on a medical unit monitors which clients for atypical mycobacterial infections (AMIs)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A client with tuberculosis 2. A client with HIV 3. A client with leprosy 4. A client who is post-transplant 5. A client with leukemia Answer: 2, 4, 5 Explanation: A client with HIV is considered to be at risk for an atypical mycobacterial infection. A client who is post-transplant is considered to have an atypical mycobacterial infection. A client with leukemia is considered to have an atypical mycobacterial infection. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-1 Compare and contrast the types of infections caused by mycobacteria.

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5) The nurse is anticipating the arrival of a pediatric client with Mycobacterium scrofulaceum. The nurse anticipates the child will be between the ages of 1 and years. Record your answer rounding to the nearest whole number. Answer: 3 Explanation: Mycobacterium scrofulaceum usually affects children 1 to 3 years of age. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 51-1 Compare and contrast the types of infections caused by mycobacteria. 6) The nurse is teaching a community course at a local senior citizen center regarding tuberculosis. The nurse would be correct in informing the class that clients acquire Mycobacterium tuberculosis by which route? 1. Sexual transmission 2. Fecal-oral 3. Respiratory droplets 4. Hand-to-hand contact Answer: 3 Explanation: Mycobacterium tuberculosis is spread by the respiratory route. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Implementation Learning Outcome: 51-2 Explain the pathogenesis of tuberculosis.

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7) In a postprimary or reactivation stage of infection with tuberculosis, the most common nonrespiratory infection sites are the: 1. lymph nodes and genitourinary system. 2. skin and muscles. 3. bowel and liver. 4. heart and blood vessels. Answer: 1 Explanation: These organs are the sites of infection in the postprimary stage. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-2 Explain the pathogenesis of tuberculosis. 8) The nurse is caring for a client who is suspected of having tuberculosis. Which symptoms would the client exhibit with a tuberculosis infection? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fatigue 2. Nonproductive cough 3. Night sweats 4. High fever 5. Weight loss Answer: 1, 3, 5 Explanation: Fatigue is a symptom of tuberculosis. Night sweats are a symptom of tuberculosis. Weight loss is a symptom of tuberculosis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-2 Explain the pathogenesis of tuberculosis.

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9) The nurse caring for a client with tuberculosis knows that the infection can be spread through which activities? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Sneezing 2. Shaking hands 3. Coughing 4. Talking 5. Hugging Answer: 1, 3, 4 Explanation: During its infectious stages, the organism may be transmitted to others via airborne droplets by sneezing. During its infectious stages, the organism may be transmitted to others via airborne droplets by coughing. During its infectious stages, the organism may be transmitted to others via airborne droplets by talking. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-2 Explain the pathogenesis of tuberculosis. 10) The nurse is caring for a client who is hospitalized for the reactivation of tuberculosis. The nurse knows that once tuberculosis is reactivated, it is spread throughout the body by the: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. respiratory tract. 2. blood. 3. lymphatic system. 4. liver. 5. kidneys. Answer: 2, 3 Explanation: M. tuberculosis can be disseminated throughout the body via the blood. M. tuberculosis can be disseminated throughout the body via the lymphatic system. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-2 Explain the pathogenesis of tuberculosis.

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11) The nurse is educating a client with tuberculosis. The client asks the nurse to estimate the duration of treatment. Which responses would be correct in identifying the expected duration for pharmacologic management of tuberculosis? 1. 1 month 2. 7 days 3. 14 days 4. 6 to 12 months Answer: 4 Explanation: The required length of therapy can be 6 to 12 months. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 51-3 Describe how the pharmacotherapy of tuberculosis differs from that of bacterial infections. 12) The client recently diagnosed with tuberculosis asks the nurse why so many different pills are required to treat the infection. The nurse bases the response on the knowledge that: 1. Treatment is a trial-and-error process, and it will take 14 days for the appropriate drug to be identified. 2. Mycobacteria grow slowly and often develop resistance during the course of treatment. 3. It is difficult for a single drug to break down the cysts that are formed by the tubercle. 4. The client might have a genetic difference that requires multiple dosing. Answer: 2 Explanation: Mycobacteria grow slowly and often develop resistance during the course of treatment. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 51-3 Describe how the pharmacotherapy of tuberculosis differs from that of bacterial infections.

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13) The client recently diagnosed with tuberculosis asks the nurse why family members also will be treated. On what facts does the nurse base the response? 1. The medication for the family is preventive. 2. Smaller doses now will prevent side effects should they need the medication in larger doses later. 3. The medication will increase the family members' immune response. 4. The family members will get the disease, and treatment must begin early. Answer: 1 Explanation: Prophylactic treatment of family members can prevent the development of the disease in family members. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 51-3 Describe how the pharmacotherapy of tuberculosis differs from that of bacterial infections. 14) The nurse caring for a client with tuberculosis knows that the primary reason for lack of success in the treatment of tuberculosis is: 1. the development of resistance. 2. underdosing by the provider. 3. client nonadherence. 4. medication errors by the nurse. Answer: 3 Explanation: Client nonadherence is the primary reason that treatment regimens fail. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 51-3 Describe how the pharmacotherapy of tuberculosis differs from that of bacterial infections.

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15) The nurse is caring for a client who has been diagnosed with tuberculosis. The nurse anticipates that the client will require pharmacotherapy for 6 to months. Record your answer rounding to the nearest whole number. Answer: 12 Explanation: The pharmacotherapy of TB differs from that of other bacterial infections because the thick mycolic acid layer surrounding the mycobacterium is resistant to penetration by anti-infectives. For the drugs to reach the mycobacteria isolated in tubercles and inside macrophages, therapy must continue for 6 to 12 months. Although the client is not infectious this entire time and, indeed, may have no symptoms, it is critical that therapy be continued for the entire period. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 51-3 Describe how the pharmacotherapy of tuberculosis differs from that of bacterial infections. 16) The nurse is caring for a male client who has been diagnosed with a resistant strain of tuberculosis. The client asks the nurse how long he will have to take medications. The nurse states that because of the strain of tuberculosis involved, he may have to be on medications for up to year(s). Record your answer rounding to the nearest whole number. Answer: 2 Explanation: Clients who develop multidrug-resistant infections may require therapy for as long as 2 years. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 51-3 Describe how the pharmacotherapy of tuberculosis differs from that of bacterial infections.

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17) The nurse caring for a client with tuberculosis anticipates that the first 2 months of drug therapy for this client should include which medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Isoniazid 2. Albuterol 3. Ethambutol (Myambutol) 4. Rifampin (Rifadin, Rimactane) 5. Pyrazinamide (PZA) Answer: 1, 3, 4, 5 Explanation: Isoniazid is included in the first 2 months of therapy. Ethambutol is included in the first 2 months of therapy. Rifampin is included in the first 2 months of therapy. Pyrazinamide is included in the first 2 months of therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 51-4 Identify the most common drug regimens for treating tuberculosis. 18) The nurse caring for a client being treated for tuberculosis anticipates that the client will also receive which medications to help prevent peripheral neuropathy? 1. Niacin 2. Pyridoxine (vitamin B6) 3. Cyanocobalamin (vitamin B12) 4. Neurontin Answer: 2 Explanation: Pyridoxine prevents peripheral neuropathy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 51-4 Identify the most common drug regimens for treating tuberculosis.

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19) The nurse knows that which medication is considered the mainstay of pharmacologic intervention in the client with tuberculosis? 1. Isoniazid 2. Pyrazinamide (PZA) 3. Rifampin (Rifadin, Rimactane) 4. Ethambutol (Myambutol) Answer: 1 Explanation: Isoniazid is considered the mainstay of treatment for tuberculosis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 51-4 Identify the most common drug regimens for treating tuberculosis. 20) The nurse knows that which regimens are included in the initial phase of treatment for clients with tuberculosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Isoniazid daily for 2 months 2. Ethambutol (Myambutol) two to three times a week for 9 months 3. Ethambutol (Myambutol) daily for 4 months 4. Rifampin (Rifadin) daily for 2 months 5. Pyrazinamide (PZA) two to three times a week for 4 months Answer: 1, 4 Explanation: The initial phase of therapy includes 2 months of daily therapy with isoniazid. The initial phase of therapy includes 2 months of daily therapy with rifampin. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 51-4 Identify the most common drug regimens for treating tuberculosis.

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21) The nurse is caring for a client who has been diagnosed with tuberculosis (TB) of the kidneys. The nurse knows that treatment for this form of TB may last for months. Record your answer rounding to the nearest whole number. Answer: 9 Explanation: Nine months of therapy is recommended for clients with evidence of nonrespiratory TB. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 51-4 Identify the most common drug regimens for treating tuberculosis. 22) The nurse is teaching a community course regarding leprosy at a local senior citizen center. The nurse would be correct in informing the class that clients acquire Mycobacterium leprae by which route? 1. Sexual transmission 2. Hand-to-hand contact 3. Fecal-oral 4. Respiratory droplets Answer: 4 Explanation: Mycobacterium leprae is spread by the respiratory route. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 51-5 Describe the pathogenesis and treatment of leprosy.

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23) The nurse is caring for a client hospitalized with lepromatous leprosy. The nurse anticipates the duration of pharmacologic management to be: 1. 1 month. 2. 14 days. 3. 2 to 5 years. 4. 6 to 12 months. Answer: 3 Explanation: Two to 5 years could be the required length of therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 51-5 Describe the pathogenesis and treatment of leprosy. 24) The nurse is preparing a plan of care for a client with leprosy. Which medication is considered the mainstay of pharmacologic intervention for clients with leprosy and is included in all regimens? 1. Pyrazinamide (PZA) 2. Ethambutol (Myambutol) 3. Trimethoprim 4. Dapsone Answer: 4 Explanation: Dapsone is included in all treatment regimens for leprosy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 51-5 Describe the pathogenesis and treatment of leprosy.

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25) The nurse is explaining the pharmacotherapy of lepromatous leprosy to a client who has just been diagnosed with the illness. The nurse explains to the client that the initial three-drug regimen will continue for 2 to years. Record your answer rounding to the nearest whole number. Answer: 5 Explanation: The initial two-drug regimen, which includes dapsone and rifampin (Rifadin), is given for 2 to 5 years. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 51-5 Describe the pathogenesis and treatment of leprosy. 26) The nurse is caring for a client who has been diagnosed with an infection caused by Mycobacterium avium complex (MAC). The nurse knows that this organism primarily attacks which body systems? 1. Lymph nodes and genitourinary system 2. Bowel and liver 3. Heart and blood vessels 4. Lungs Answer: 4 Explanation: The lungs are the primary site of MAC infection. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 51-6 Describe the pathogenesis and treatment of infections caused by Mycobacterium avium complex.

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27) The nurse caring for a client who has been diagnosed with a respiratory infection caused by Mycobacterium avium complex (MAC) anticipates that this infection will be treated by what class of antibiotics? 1. Fluoroquinolones 2. Macrolides 3. Cephalosporins 4. Penicillins Answer: 2 Explanation: The macrolides are included in the treatment regimen for MAC. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 51-6 Describe the pathogenesis and treatment of infections caused by Mycobacterium avium complex. 28) The nurse is reviewing the medical record of a newly admitted client and notes that the client has been diagnosed with a Mycobacterium avium complex (MAC) infection. The nurse knows that this type of infection is believed to be spread via what route? 1. Blood contact 2. Contaminated meat 3. Respiratory droplets 4. Contaminated soil Answer: 4 Explanation: Mycobacterium avium is thought to be spread through contaminated soil. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 51-6 Describe the pathogenesis and treatment of infections caused by Mycobacterium avium complex.

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29) The nurse caring for a client who has been diagnosed with Mycobacterium avium complex anticipates that the client could be treated with which medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Clarithromycin (Biaxin) 2. Azithromycin (Zithromax) 3. Ethambutol (Myambutol) 4. Isoniazid (INH) 5. Rifabutin (Mycobutin). Answer: 1, 2, 3, 5 Explanation: Clarithromycin is relatively safe and effective against MAC and is included in most regimens. High doses of clarithromycin (1,000 mg bid) are associated with increased mortality rates. Azithromycin is relatively safe and effective against MAC and is included in most regimens. Although ethambutol is usually used for TB, this drug may be combined with clarithromycin in the pharmacotherapy of MAC. If a third drug is needed in the treatment of Mycobacterium avium complex, rifabutin is often effective. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 51-6 Describe the pathogenesis and treatment of infections caused by Mycobacterium avium complex.

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30) The nurse is administering dapsone to a client hospitalized on a medical–surgical unit. The nurse knows that the most frequent adverse effects of dapsone are related to which system? 1. Hematologic 2. Urinary 3. Respiratory 4. Gastrointestinal Answer: 1 Explanation: The hematologic system is affected by dapsone. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 51-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 31) The nurse reviewing the medication history of the client taking dapsone would have concern if which drug were listed? 1. Potassium 2. Aspirin 3. Viagra 4. St. John's wort Answer: 4 Explanation: St. John's wort can decrease levels of dapsone. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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32) The nurse is preparing to administer dapsone to a client and knows it is important to monitor which body system for adverse effects when administering this medication? 1. Urinary 2. Hematologic 3. Gastrointestinal 4. Respiratory Answer: 2 Explanation: The hematologic system is affected by dapsone. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 51-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 33) The nurse is preparing to administer INH to a client with tuberculosis and knows that this medication can be administered through which routes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. By mouth 2. Intramuscular 3. Intravenous 4. Subcutaneous 5. Intradermal Answer: 1, 2 Explanation: INH is most often administered via the PO route. If INH cannot be given via the PO route, it may be administered by the IM route. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 51-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 34) The nurse is caring for a client who has been prescribed isoniazid prophylactically for 969

tuberculosis. When used for prophylaxis, isoniazid will be used for what time period? 1. 6 to 12 months 2. 2 to 5 years 3. 1 year 4. 1 month Answer: 3 Explanation: One year is the recommended time period. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 51-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 35) The nurse is caring for a pregnant client who is taking isoniazid for the treatment of tuberculosis. The nurse knows that pregnant clients taking isoniazid therapy should also receive: 1. ethambutol (Myambutol). 2. pyrazinamide (PZA). 3. pyridoxine. 4. rifampin (Rifadin, Rimactane). Answer: 3 Explanation: Pregnant clients should also receive pyridoxine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.19 Manage the interaction of multiple functional problems affecting patients across the lifespan, including common geriatric syndromes | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-7 Explain significant patient variables that must be considered for effective pharmacotherapy with antimycobacterial drugs.

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36) In addition to close family members of clients with tuberculosis, which other group should the nurse expect to receive prophylactic treatment with antimycobacterial agents? 1. Clients with burns 2. Clients who have experience trauma 3. Clients with HIV/AIDS 4. Pregnant clients Answer: 3 Explanation: Clients with HIV/AIDS are often prescribed prophylactic antimycobacterial agents. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.19 Manage the interaction of multiple functional problems affecting patients across the lifespan, including common geriatric syndromes | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 51-7 Explain significant patient variables that must be considered for effective pharmacotherapy with antimycobacterial drugs. 37) The nurse is caring for a client who has been diagnosed with a form of tuberculosis that is resistant to isoniazid therapy. What drug does the nurse anticipate the client will be prescribed for first-line therapy? 1. Ethambutol (Myambutol) 2. Pyrazinamide (PZA) 3. Rifampin (Rifadin, Rimactane) 4. Pyridoxine Answer: 1 Explanation: Ethambutol is the agent of choice. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.19 Manage the interaction of multiple functional problems affecting patients across the lifespan, including common geriatric syndromes | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-7 Explain significant patient variables that must be considered for effective pharmacotherapy with antimycobacterial drugs.

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38) The nurse is caring for a client with latent TB. Which circumstances would place this nurse in the high-risk category for the transmission of TB? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Caring for a client in a pediatric clinic 2. Caring for a client who is HIV positive 3. Caring for a client who is currently serving a prison sentence 4. Caring for a pregnant client 5. Caring for a client who is living with someone with active TB Answer: 2, 3, 5 Explanation: Caring for a client who is HIV positive would put the nurse in the high-risk category. Caring for a client who is in prison would put the nurse in the high-risk category. Caring for a client who is in close contact with someone with active TB would put the nurse in the high-risk category. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.19 Manage the interaction of multiple functional problems affecting patients across the lifespan, including common geriatric syndromes | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 51-7 Explain significant patient variables that must be considered for effective pharmacotherapy with antimycobacterial drugs. 39) The nurse is caring for a male client who has been diagnosed with tuberculosis. The client asks when he will be considered noninfectious. The nurse knows that a client will be considered noninfectious when the: 1. PPD is negative. 2. white blood cell count is normal. 3. sputum culture and smear are negative. 4. chest x-ray is clear. Answer: 3 Explanation: Negative sputum culture and smear are the best indictors of the noninfectious state. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 51-9 Apply the nursing process to care for patients receiving pharmacotherapy for mycobacterial infections. 40) A nurse in an outpatient clinic is teaching a client about the criteria for being considered 972

noninfectious. The nurse knows the client has understood the teaching when the client states: 1. "I am considered noninfectious when my white blood cell count is normal." 2. "I am considered noninfectious when my sputum culture and smear are negative." 3. "I am considered noninfectious when my PPD is negative." 4. "I am considered noninfectious when my chest x-ray is clear." Answer: 2 Explanation: Negative sputum culture and smear are the best indictors of a noninfectious state. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-9 Apply the nursing process to care for patients receiving pharmacotherapy for mycobacterial infections. 41) The nurse is caring for a client being treated with ethambutol in the treatment of tuberculosis. What assessment findings would indicate that the client is experiencing a side effect of this therapy? 1. Alteration in colored vision 2. White patches in the mucous membranes 3. Ringing in the ears 4. Alteration in smelling Answer: 1 Explanation: Ethambutol affects the ability to distinguish red from green. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-9 Apply the nursing process to care for patients receiving pharmacotherapy for mycobacterial infections.

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42) For the client receiving treatment for tuberculosis, the priority assessment at monthly exams should include the monitoring of: 1. proteinuria. 2. liver function. 3. white blood cell counts. 4. electrolytes. Answer: 2 Explanation: Assessment should include signs of hepatotoxicity, including measurement of liver function. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-9 Apply the nursing process to care for patients receiving pharmacotherapy for mycobacterial infections. 43) The nurse is implementing directly observed therapy (DOT) for a client being treated for tuberculosis in the community. The nursing student asks what this means. The nurse correctly responds by saying: 1. "The client must swear all medications have been taken." 2. "The nurse must physically observe the client taking the medication." 3. "A family member must swear that the client is taking the medication." 4. "The nurse must watch the client document that the medication has been taken." Answer: 2 Explanation: DOT requires that a healthcare provider directly observe the client swallowing the pills. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-9 Apply the nursing process to care for patients receiving pharmacotherapy for mycobacterial infections.

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44) The nurse is caring for a client who is being discharged on dapsone (DDS) for the treatment of leprosy. The nurse educates the client that it is essential to notify a healthcare provider when which adverse effects occur? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Nausea 2. Weight gain 3. Nosebleeds 4. Brittle fingernails 5. Yellowing of the skin Answer: 3, 5 Explanation: Any abnormal bleeding, including nosebleeds, must be reported to the healthcare provider. Yellowing of the skin or sclera should be reported to the healthcare provider. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 51-9 Apply the nursing process to care for patients receiving pharmacotherapy for mycobacterial infections. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 52 Pharmacotherapy of Fungal Infections 1) The nurse is comparing fungal infections with bacterial infections. Which statement by the nurse is true? 1. "Antifungals are only fungistatic." 2. "Antibiotics are effective against fungi." 3. "Fungi are more similar to human cells." 4. "Bacteria are more similar to human cells." Answer: 3 Explanation: Fungal cells are eukaryotic, as are human cells. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 52-1 Compare and contrast the pharmacotherapy of fungal and bacterial infections. 2) A client has been prescribed a new antifungal medication and asks the nurse why the medication must be taken for so many days. The nurse's response is based on the knowledge that fungal 975

infections: 1. require drug holidays to prevent side effects. 2. are often resistant to treatment, and can require months of therapy. 3. occur at locations that are difficult to reach with traditional routes of medication administration. 4. are capable of destroying certain medications, so new medications must be added. Answer: 2 Explanation: Treatment requires many months to fully eradicate the organism. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 52-1 Compare and contrast the pharmacotherapy of fungal and bacterial infections.

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3) The nurse is caring for a client with a fungal infection. Which statement by the client would indicate understanding of this type of infection? 1. "There are many drugs available to treat fungal infections." 2. "Fungal infections grow quickly once they enter the body system." 3. "Treating fungal infections can require several weeks." 4. "Fungal infections are common in healthy athletes." Answer: 3 Explanation: Fungal infections can require months of treatment. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 52-1 Compare and contrast the pharmacotherapy of fungal and bacterial infections.

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4) The nurse knows that in recent years there has been a rising need for effective treatments for fungal infections because of: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. the increased incidence of HIV/AIDS. 2. advances in chemotherapeutic drugs. 3. increased use of indwelling IV catheters. 4. the overuse of broad-spectrum antibiotics. 5. the overuse of antiviral medications. Answer: 1, 2, 3, 4 Explanation: The past few decades have seen a dramatic rise in the incidence of fungal infections due to AIDS. Fungi are much more complex than bacteria and require a different approach to pharmacotherapy. The past few decades have seen a dramatic rise in the incidence of fungal infections due to aggressive cancer chemotherapy. Fungi are much more complex than bacteria and require a different approach to pharmacotherapy. The past few decades have seen a dramatic rise in the incidence of fungal infections due to the widespread use of indwelling intravenous (IV) catheters. Fungi are much more complex than bacteria and require a different approach to pharmacotherapy. The past few decades have seen a dramatic rise in the incidence of fungal infections due to the overuse of broad-spectrum antibiotics. Fungi are much more complex than bacteria and require a different approach to pharmacotherapy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 52-1 Compare and contrast the pharmacotherapy of fungal and bacterial infections.

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5) The nurse would correctly identify a superficial mycosis as one affecting the: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. skin. 2. mucous membranes. 3. dermis. 4. nails. 5. scalp. Answer: 1, 2, 4, 5 Explanation: Infections in the skin would be considered superficial mycoses. Infections in the mucous membranes would be considered superficial mycoses. Infections in the nails would be considered superficial mycoses. Infections in the scalp would be considered superficial mycoses. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 52-2 Classify mycoses based on the location of the infection and the causative organism. 6) The nurse is reviewing a client's medical record and notes that recent culture results identify the organism aspergillosis. Based on this report, the nurse would recognize that the client has which type of infection? 1. Community acquired 2. Opportunistic 3. Transmitted by direct contact 4. Vector transmitted Answer: 2 Explanation: Opportunistic fungal infections are more likely to be candidiasis, aspergillosis, cryptococcosis, and mucormycosis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 52-2 Classify mycoses based on the location of the infection and the causative organism.

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7) The nurse is caring for a client with a tinea fungal infection. The nurse expects the client will have symptoms that primarily affect the: 1. bowel. 2. mucous membranes of the mouth. 3. urinary tract. 4. skin and hair. Answer: 4 Explanation: Fungal infections of the skin and hair are called dermatomycoses. These infections are named by their Latin terms, beginning with tinea. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 52-2 Classify mycoses based on the location of the infection and the causative organism. 8) The nurse caring for a hospitalized client monitors for which opportunistic fungal infections? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Candidiasis 2. Aspergillosis 3. Sporotrichosis 4. Cryptococcosis 5. Mucormycosis Answer: 1, 2, 4, 5 Explanation: An opportunistic fungal infection that is likely to be acquired in a hospital setting is candidiasis. An opportunistic fungal infection that is likely to be acquired in a hospital setting is aspergillosis. An opportunistic fungal infection that is likely to be acquired in a hospital setting is cryptococcosis. An opportunistic fungal infection that is likely to be acquired in a hospital setting is mucormycosis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 52-2 Classify mycoses based on the location of the infection and the causative organism.

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9) The nurse is providing instruction to a client with a fungal infection who will be discharged home soon. The nurse evaluates that learning has occurred when the client makes which statement(s)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Systemic infections require oral medications that have serious adverse effects." 2. "Superficial infections are considered more benign than are systemic infections." 3. "Newer medications can be used for superficial as well as systemic infections." 4. "Systemic infections are much more common than are superficial infections." 5. "Superficial infections are more difficult to treat than are systemic infections." Answer: 1, 2, 3 Explanation: Systemic fungal infections require many months of treatment with oral medications, many of which have serious side effects. Superficial fungal infections are considered more benign than are systemic infections. Newer medications can be used for both superficial and systemic infections. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 52-3 Compare and contrast the pharmacotherapy of systemic and superficial fungal infections. 10) A client with AIDS is suffering from a systemic fungal infection. The nurse anticipates that the preferred drug for this client will be: 1. fluconazole. 2. amphotericin B. 3. nystatin. 4. griseofulvin. Answer: 2 Explanation: The preferred drug for these disorders is amphotericin B. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 52-3 Compare and contrast the pharmacotherapy of systemic and superficial fungal infections.

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11) The nurse is caring for a client who has both a superficial and a systemic fungal infection. Which drugs can be used to treat both infections? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Ketoconazole (Nizoral) 2. Voriconazole (Vfend) 3. Itraconazole (Sporanox) 4. Fluconazole (Diflucan) 5. Nystatin (Mycostatin) Answer: 1, 2, 3, 4 Explanation: Ketoconazole (Nizoral) can be used to treat both types of infections. Voriconazole (Vfend) can be used to treat both types of infections. Itraconazole (Sporanox) can be used to treat both types of infections. Fluconazole (Diflucan) can be used to treat both types of infections. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 52-3 Compare and contrast the pharmacotherapy of systemic and superficial fungal infections. 12) A pediatric client presents with tinea capitis. The nurse anticipates that the infection will be treated with griseofulvin (Fulvicin) for 8 to 10 weeks at a dose of _ mg/kg/day. Record your answer rounding to the nearest whole number. Answer: 10 Explanation: The typical regimen for griseofulvin (Fulvicin) is 10 mg/kg/day for 8 to 10 weeks. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 52-3 Compare and contrast the pharmacotherapy of systemic and superficial fungal infections.

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13) A client has a serious systemic fungal infection. The nurse anticipates that the physician will prescribe which medications to treat this infection? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Amphotericin B (Fungizone) 2. Flucytosine (Ancobon) 3. Caspofungin (Cancidas) 4. Griseofulvin (Fulvicin) 5. Terbinafine (Lamisil) Answer: 1, 2, 3 Explanation: Pharmacologic options for serious systemic mycoses are limited. Amphotericin B (Fungizone) has been the traditional preferred drug since the 1960s. Pharmacologic options for serious systemic mycoses are limited. Although rarely used as monotherapy, flucytosine (Ancobon) is sometimes used in combination with amphotericin B in the pharmacotherapy of severe Candida infections. Pharmacologic options for serious systemic mycoses are limited. Caspofungin (Cancidas) is a newer drug that is becoming an important alternative to amphotericin B in the treatment of aspergillosis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 52-3 Compare and contrast the pharmacotherapy of systemic and superficial fungal infections.

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14) The nurse works in infection control at a large hospital. Which client does the nurse recognize as being at greatest risk of acquiring a fungal infection? 1. The client with severe burns over 20% of the body 2. The client with malignant melanoma who is receiving chemotherapy 3. The adolescent client with a fractured femur from an automobile crash 4. The client with anemia who is pregnant with triplets Answer: 2 Explanation: Chemotherapy will decrease the client's immune response, thereby increasing susceptibility to fungal infection. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community | AACN Essential Competencies: VII.1 Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities, and populations | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 52-4 Identify the types of patients at greatest risk of acquiring serious fungal infections. 15) The nurse correctly identifies that the client with which disorder is at greatest risk of acquiring a fungal infection of the nail? 1. The client with arthritis 2. The client with diabetes 3. The client with gallbladder disease 4. The client with gout Answer: 2 Explanation: The client with diabetes has a 1-in-4 chance of developing a fungal infection of the nail due to poor circulation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community | AACN Essential Competencies: VII.1 Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities, and populations | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 52-4 Identify the types of patients at greatest risk of acquiring serious fungal infections.

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16) The nurse is caring for several clients on a medical unit in the hospital. Which client does the nurse recognize as being at greatest risk of acquiring an oral Candida infection? 1. The client with braces 2. The client who uses smokeless tobacco 3. The client with sleep apnea 4. The client using a steroid inhaler for asthma Answer: 4 Explanation: Clients taking inhaled corticosteroids experience local immunosuppression in the oral cavity. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community | AACN Essential Competencies: VII.1 Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities, and populations | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 52-4 Identify the types of patients at greatest risk of acquiring serious fungal infections.

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17) The nurse recognizes that which clients in a medical–surgical unit are at increased risk for acquiring systemic fungal infections and may require prophylactic pharmacologic therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client with lupus being treated with steroids 2. The client who has AIDS 3. The client who is being treated with chemotherapy for breast cancer 4. The client who is status post a heart transplant 5. The client recovering from an appendectomy Answer: 1, 2, 3, 4 Explanation: Prophylactic antifungal therapy is sometimes indicated for high-risk clients, such as those receiving prolonged therapy with corticosteroids. Prophylactic antifungal therapy is sometimes indicated for high-risk clients, such as those with HIV or AIDS. Prophylactic antifungal therapy is sometimes indicated for high-risk clients, such as those being treated with antineoplastic medications. Prophylactic antifungal therapy is sometimes indicated for high-risk clients, such as those who have undergone an organ transplantation. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 52-3 Compare and contrast the pharmacotherapy of systemic and superficial fungal infections. 18) The nurse is providing education regarding ketoconazole (Nizoral). The nurse knows the client has understood the teaching when the client states: 1. "I could develop nausea, vomiting, and abdominal pain with this medication." 2. "I cannot take this medication longer than 10 days." 3. "I should take this medication on an empty stomach." 4. "I could develop resistance to this medication if I take it too often." Answer: 1 Explanation: The most common side effect of ketoconazole is nausea. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition of care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 52-5 Describe the nurse's role in the pharmacologic management of fungal infections. 986

19) The nurse is providing discharge education for the patient with tinea corporis who will be using nystatin cream. What instructions should the nurse include? 1. "Wash your hair at least three times a day for 2 weeks." 2. "Do not share any towels with family members." 3. "Comb the medication into your hair and cover with a towel." 4. "Avoid meat and high-protein foods while taking this medication." Answer: 2 Explanation: Not sharing towels helps prevent the spread of the disease. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition of care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 52-5 Describe the nurse's role in the pharmacologic management of fungal infections.

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20) A client is being treated with amphotericin B for a serious systemic fungal infection. The nurse instructs the client to immediately report which adverse effects associated with this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Loss of hearing 2. Visual disturbances 3. Dizziness 4. Ringing in the ears 5. Nausea and vomiting Answer: 1, 3, 4 Explanation: Amphotericin B can cause ototoxicity potentially affecting both branches, cochlear and vestibular, of cranial nerve VIII. A loss of hearing can be indicative of ototoxicity and should be reported. Amphotericin B can cause ototoxicity potentially affecting both branches, cochlear and vestibular, of cranial nerve VIII. Dizziness can be indicative of ototoxicity and should be reported. Amphotericin B can cause ototoxicity potentially affecting both branches, cochlear and vestibular, of cranial nerve VIII. A ringing in the ears can be indicative of ototoxicity and should be reported. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition of care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 52-5 Describe the nurse's role in the pharmacologic management of fungal infections.

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21) A female client has a fungal infection and will receive griseofulvin. What assessment data is critical for the nurse to collect prior to administering this medication? 1. The type of birth control the patient is using 2. The client's height and weight 3. The client's cholesterol level 4. The amount of cheese products the client eats Answer: 1 Explanation: The medication is a pregnancy category C drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 52-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 22) The nurse would recognize which symptom as a sign of a serious adverse effect in a client taking amphotericin B? 1. Hypokalemia 2. Leukopenia 3. Hematuria 4. Paresthesia Answer: 3 Explanation: Hematuria is a symptom of nephrotoxicity and possible renal failure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 52-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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23) The nurse would question the use of amphotericin B in the client concurrently receiving which medication? 1. Actos 2. Vancomycin 3. Captopril 4. Coumadin Answer: 2 Explanation: Drug interactions with amphotericin B focus on worsening two of its potentially serious adverse effects: nephrotoxicity and hypokalemia. For example, concurrent therapy with aminoglycosides, cyclosporine, vancomycin, carboplatin, and furosemide is not recommended. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 52-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 24) The nurse is administering amphotericin B to a client with a serious systemic fungal infection. The client is experiencing acute fever, chills, and vomiting, and complains of headache. The nurse knows that this reaction occurs in % of clients and anticipates that symptoms will subside as treatment continues. Record your answer rounding to the nearest whole number. Answer: 50 Explanation: Amphotericin B can produce frequent and sometimes serious adverse effects. At the onset of therapy, as many as 50% of patients experience acute, infusion-related fever and chills, vomiting, anorexia, and headache. These symptoms usually subside as treatment continues. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 52-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 25) A client is due to receive fluconazole (Diflucan) for a fungal infection. The nurse would 990

question an order specifying which route of administration? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. By mouth 2. By intramuscular injection 3. By intravenous injection 4. By subcutaneous injection 5. Topically Answer: 2, 4, 5 Explanation: The nurse should question an order for this medication to be administered by IM injection. The nurse should question an order for this medication to be administered by subcutaneous injection. The nurse should question an order for this medication to be administered topically. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 52-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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26) The client has a fungal infection of the toenails, and receives oral terbinafine (Lamisil). The client asks the nurse how a pill will heal a nail infection. The nurse explains that terbinafine: 1. accumulates in nail beds and remains for several months. 2. breaks the cytoplasm in the fungal cell wall. 3. works by destroying toxins excreted by the fungi in the nails. 4. destroys circulating fungi in the blood. Answer: 1 Explanation: Lamisil accumulates in the toenail. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 52-7 Apply the nursing process to care for patients receiving pharmacotherapy for fungal infections. 27) The nurse should teach the client taking itraconazole (Sporanox) capsules that: 1. the medication may take 2 or more weeks to reach therapeutic levels. 2. the medication should be taken on an empty stomach. 3. the skin could turn yellow. 4. gynecomastia could occur. Answer: 1 Explanation: It can take 2 weeks for this medication to reach therapeutic levels. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 52-7 Apply the nursing process to care for patients receiving pharmacotherapy for fungal infections.

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28) A male client has been diagnosed with a dermatomycosis. The nurse informs the client that he has been diagnosed with which infection affecting the feet? 1. Tinea cruris 2. Tinea pedis 3. Tinea corporis 4. Tinea capitis Answer: 2 Explanation: Tinea pedis affects the feet. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 52-7 Apply the nursing process to care for patients receiving pharmacotherapy for fungal infections. 29) The nurse is instructing a client who will be taking fluconazole (Diflucan) at home for the treatment of a fungal infection. The nurse tells the client to increase fluid intake to liters per day. Record your answer rounding to the nearest whole number. Answer: 2 Explanation: The client on an oral antifungal drug should increase fluid intake to 2 L/day. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 52-7 Apply the nursing process to care for patients receiving pharmacotherapy for fungal infections. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 53 Pharmacotherapy of Protozoan and Helminthic Infections 1) The nurse asked to identify the most likely infestation site of helminths would be correct in identifying the: 1. lungs. 2. intestine. 3. eyes. 4. feet. Answer: 2 993

Explanation: The most likely site of infection of helminths is the intestine. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 53-1 Identify features of protozoa and helminths that distinguish them from bacteria. 2) The nurse is teaching a pharmacology course when a student comments that bacteria and protozoans are alike. The nurse would be correct in noting that, in contrast to bacteria, protozoans: 1. are more easily treated. 2. do not have vectors. 3. go through maturation stages in the host. 4. are short lived. Answer: 3 Explanation: The protozoans go through maturation stages in the host. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-1 Identify features of protozoa and helminths that distinguish them from bacteria.

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3) The nurse is caring for a client with a protozoan infection. The nurse instructs the client that the growing stage of a protozoan is termed a: 1. worm. 2. trophozoite. 3. vector. 4. cyst. Answer: 2 Explanation: The growing stage of a protozoan is a trophozoite. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-1 Identify features of protozoa and helminths that distinguish them from bacteria. 4) The nurse is educating a client on how protozoan infections are spread. The client asks if the infection is similar to a bacterial infection. To help distinguish the infections, what information regarding vectors does the nurse plan to include in the education session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The human body is considered a vector. 2. Mites are considered vectors. 3. Insects are considered vectors. 4. Ticks are considered vectors. 5. Dogs are considered vectors. Answer: 2, 3, 4, 5 Explanation: Several of the major protozoan infections are spread by vectors, organisms that harbor the pathogen and carry it from one host to another. Mites are considered vectors. Several of the major protozoan infections are spread by vectors, organisms that harbor the pathogen and carry it from one host to another. Insects are considered vectors. Several of the major protozoan infections are spread by vectors, organisms that harbor the pathogen and carry it from one host to another. Ticks are considered vectors. Several of the major protozoan infections are spread by vectors, organisms that harbor the pathogen and carry it from one host to another. Dogs are considered vectors. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 53-1 Identify features of protozoa and helminths that distinguish them from bacteria. 5) The nurse caring for a client diagnosed with amebiasis understands that amebiasis is best treated 995

with: 1. nitazoxanide. 2. tinidazole. 3. metronidazole. 4. pentamidine. Answer: 3 Explanation: Metronidazole is the primary treatment choice for amebiasis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-2 Identify protozoan and helminthic infections that may benefit from pharmacotherapy. 6) The nurse would correctly understand that pharmacotherapy of cryptosporidiosis is targeted at treating: 1. cough. 2. vomiting. 3. bullous rash. 4. diarrhea. Answer: 4 Explanation: Treatment of cryptosporidiosis targets the diarrhea it causes. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-2 Identify protozoan and helminthic infections that may benefit from pharmacotherapy.

996

7) A client is diagnosed with enterobiasis. The nurse recognizes the primary symptom of enterobiasis as: 1. severe diarrhea with dehydration. 2. erythematous rash on the chest and body. 3. chronic cough with sweating at night. 4. perianal itching, especially at night. Answer: 4 Explanation: Pinworms are manifested by perianal itching, especially at night. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 53-2 Identify protozoan and helminthic infections that may benefit from pharmacotherapy. 8) The nurse treating a client with malaria knows that the goals of pharmacotherapy include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. chemoprophylaxis. 2. treatment of acute attacks. 3. prevention of relapses. 4. prevention of bacterial infections. 5. prevention of viral infections. Answer: 1, 2, 3 Explanation: One of the three main goals of malaria pharmacotherapy is chemoprophylaxis. One of the three main goals of malaria pharmacotherapy is the treatment of acute attacks. One of the three main goals of malaria pharmacotherapy is the prevention of relapses. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 53-2 Identify protozoan and helminthic infections that may benefit from pharmacotherapy.

997

9) What drug would the nurse expect to be the first-line drug ordered during the chemoprophylaxis stage in the treatment of malaria? 1. Doxycycline 2. Primaquine 3. Mefloquine 4. Chloroquine Answer: 4 Explanation: The first-line agent for prophylaxis for malaria is chloroquine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 53-3 Explain why an understanding of Plasmodium's lifecycle is important to the successful pharmacotherapy of malaria. 10) A client has been hospitalized with malaria. The nurse explains to a family member that the primary determining factor for drug selection with this disease process is: 1. age. 2. the genus of the infecting organism. 3. the stage of infection. 4. the geographical location. Answer: 3 Explanation: The client's infection stage determines drug selection. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-3 Explain why an understanding of Plasmodium's lifecycle is important to the successful pharmacotherapy of malaria.

998

11) The nurse is providing education to a client with malaria. When the client asks about the relationship between the lifecycle of the Plasmodium and treatment of malaria, the nurse bases the answer on which concept? 1. The cycle of the Plasmodium dictates drug choice. 2. There is no true relationship. 3. Identification of the Plasmodium differentiates the type of malaria. 4. The lifecycle of the Plasmodium is disrupted by the drug choice. Answer: 4 Explanation: Pharmacotherapy of malaria attempts to interrupt the complex lifecycle of Plasmodium. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-3 Explain why an understanding of Plasmodium's lifecycle is important to the successful pharmacotherapy of malaria. 12) The nurse is providing chemoprophylaxis drug therapy for a client who will be traveling to a country with a high incidence of malaria. Which drugs are appropriate for chemoprophylaxis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Chloroquine 2. Atovaquone-proguanil 3. Primaquine 4. Artemether-lumefantrine 5. Quinine sulfate Answer: 1, 2, 3 Explanation: Chloroquine is a medication that can be used for chemoprophylaxis of malaria. Atovaquone-proguanil is a medication that can be used for chemoprophylaxis of malaria. Primaquine is a medication that can be used for chemoprophylaxis of malaria. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 53-3 Explain why an understanding of Plasmodium's lifecycle is important to the successful pharmacotherapy of malaria.

999

13) The nurse caring for a client with amebiasis explains that although other forms of transmission are possible, amebiasis is primarily acquired through: 1. blood transfer. 2. ingestion. 3. respiratory droplets. 4. open sores. Answer: 2 Explanation: Amebiasis is acquired primarily through ingestion. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies: apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 53-4 Explain the etiology, pathogenesis, and pharmacotherapy of amebiasis, giardiasis, cryptosporidiosis, toxoplasmosis, trichomoniasis, trypanosomiasis, and leishmaniasis. 14) The nurse caring for a client with giardiasis expects the client to have symptoms that primarily affect the: 1. gastrointestinal system. 2. integumentary system. 3. renal system. 4. respiratory system. Answer: 1 Explanation: Giardiasis is a disorder affecting the GI system. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 53-4 Explain the etiology, pathogenesis, and pharmacotherapy of amebiasis, giardiasis, cryptosporidiosis, toxoplasmosis, trichomoniasis, trypanosomiasis, and leishmaniasis.

1000

15) A client has been diagnosed with trichomoniasis. The nurse expects the client to exhibit symptoms in the: 1. gastrointestinal system. 2. integumentary system. 3. reproductive system. 4. respiratory system. Answer: 3 Explanation: Trichomoniasis is a disorder affecting the reproductive system. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 53-4 Explain the etiology, pathogenesis, and pharmacotherapy of amebiasis, giardiasis, cryptosporidiosis, toxoplasmosis, trichomoniasis, trypanosomiasis, and leishmaniasis. 16) The nurse is caring for a client suspected of having a protozoan infection of the intestines. The nurse knows that which protozoan infections are spread by poor sanitation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Amebiasis 2. Giardiasis 3. Cryptosporidiosis 4. Toxoplasmosis 5. Trichomoniasis Answer: 1, 2, 3 Explanation: Amebiasis is a protozoan infection that is typically spread by poor sanitation. Giardiasis is a protozoan infection that is typically spread by poor sanitation. Cryptosporidiosis is a protozoan infection that is typically spread by poor sanitation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies: apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 53-4 Explain the etiology, pathogenesis, and pharmacotherapy of amebiasis, giardiasis, cryptosporidiosis, toxoplasmosis, trichomoniasis, trypanosomiasis, and leishmaniasis.

1001

17) The nurse instructing a client who was diagnosed with trichomoniasis explains that this sexually transmitted illness (STI) affects approximately % of women who visit STI clinics in the United States. Record your answer rounding to the nearest whole number. Answer: 15 Explanation: Trichomoniasis is a parasitic infection caused by the protozoan T. vaginalis. It is a common sexually transmitted infection (STI), affecting approximately 15% of women visiting STI clinics in the United States (2.5 to 3 million women). Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies: apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-4 Explain the etiology, pathogenesis, and pharmacotherapy of amebiasis, giardiasis, cryptosporidiosis, toxoplasmosis, trichomoniasis, trypanosomiasis, and leishmaniasis.

1002

18) The nurse is caring for a male client diagnosed with visceral leishmaniasis, which he suspects he acquired on a mission trip to Brazil approximately 6 months ago. The client asks how he could have been infected with this disease while in Brazil. The nurse bases her response on the knowledge that leishmaniasis is carried by: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. dogs. 2. foxes. 3. squirrels. 4. rats. 5. cats. Answer: 1, 2, 3, 4 Explanation: Carriers for Leishmania include dogs. The disease is transmitted to humans by the bite of the sand fly. Carriers for Leishmania include foxes. The disease is transmitted to humans by the bite of the sand fly. Carriers for Leishmania include squirrels. The disease is transmitted to humans by the bite of the sand fly. Carriers for Leishmania include rodents. The disease is transmitted to humans by the bite of the sand fly. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies: apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-4 Explain the etiology, pathogenesis, and pharmacotherapy of amebiasis, giardiasis, cryptosporidiosis, toxoplasmosis, trichomoniasis, trypanosomiasis, and leishmaniasis.

1003

19) When oral mebendazole (Vermox) is prescribed for the treatment of ascariasis, the nurse would expect the drug regimen to be administered: 1. for 1 month. 2. over 3 days. 3. for 7 days. 4. as a single dose. Answer: 2 Explanation: Dosage of oral mebendazole (Vermox) is 3 days. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 53-5 Explain the etiology, pathogenesis, and pharmacotherapy of ascariasis, enterobiasis, hookworm, and tapeworm infections. 20) Following treatment with praziquantel (Biltricide) for tapeworm infestation, the nurse would expect to administer: 1. yogurt. 2. a laxative. 3. an antacid. 4. a liquid diet. Answer: 2 Explanation: A laxative is administered after treatment for tapeworm infestation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-5 Explain the etiology, pathogenesis, and pharmacotherapy of ascariasis, enterobiasis, hookworm, and tapeworm infections.

1004

21) What information should the nurse provide to the parents of a child being treated for enterobiasis (pinworms)? 1. A stool specimen analysis will be needed to determine if the treatment was successful. 2. Everyone in the family should be treated. 3. Special precautions should be employed in disposing of bowel contents. 4. Mebendazole will be administered daily for 1 week. Answer: 2 Explanation: Everyone in the family should be treated. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies: apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-5 Explain the etiology, pathogenesis, and pharmacotherapy of ascariasis, enterobiasis, hookworm, and tapeworm infections. 22) The nurse is receiving a shift report for a client with ascariasis. The nurse knows that this disease often affects children between the ages of 3 and years and plans to include the importance of proper hand hygiene in discharge teaching. Record your answer rounding to the nearest whole number. Answer: 8 Explanation: This infection occurs most commonly in children between the ages of 3 and 8 years, because this group is most likely to be exposed to contaminated soil without proper hand hygiene. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 53-5 Explain the etiology, pathogenesis, and pharmacotherapy of ascariasis, enterobiasis, hookworm, and tapeworm infections.

1005

23) The nurse is caring for a client who has been diagnosed with pinworms. Although a single dose often eradicates the pinworm issue, the nurse should educate the client and family that they may be asked to return for additional treatment in weeks. Record your answer rounding to the nearest whole number. Answer: 2 Explanation: A single dose is usually sufficient to eradicate the pinworms, although the dose may be repeated in 2 weeks to maximize therapeutic success. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-5 Explain the etiology, pathogenesis, and pharmacotherapy of ascariasis, enterobiasis, hookworm, and tapeworm infections. 24) The nurse is reviewing the medical record of a client prescribed mebendazole for the treatment of pinworm. Which patient would the nurse plan to monitor most closely? 1. Age under 12 years 2. Age of 35 years with cirrhosis 3. Age of 42 with lupus 4. Age of 17 with a femoral fracture Answer: 2 Explanation: Because it is metabolized by the liver, patients with serious hepatic impairment should be monitored carefully. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition of care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 53-6 Describe the nurse's role in the pharmacologic management of protozoan and helminthic infections.

1006

25) A nurse teaches a health education class for grade school children in a rural community. Which information should the nurse include to reduce the incidence of helminthic infections? 1. "Do not share hair combs and brushes with your friends." 2. "Limit the amount of sandwiches that you eat." 3. "Wash your hands after going to the restroom and before eating." 4. "Do not drink from someone else's glass or cup." Answer: 3 Explanation: Hand hygiene is most important. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition of care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies: apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-6 Describe the nurse's role in the pharmacologic management of protozoan and helminthic infections. 26) What would the nurse assess in a client taking primaquine based on an understanding of the adverse effects? 1. The urine for evidence of hemoglobin 2. The eyes for evidence of icterus 3. The skin for photosensitivity 4. The stool for lack of bile Answer: 1 Explanation: Hemolytic anemia is the major adverse effect. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition of care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-6 Describe the nurse's role in the pharmacologic management of protozoan and helminthic infections.

1007

27) While providing teaching for a client with leishmaniasis, the nurse explains that the medication prescribed, sodium stibogluconate (Pentostam), must be administered by injection for 4 to weeks. Record your answer rounding to the nearest whole number. Answer: 6 Explanation: Sodium stibogluconate is the traditional preferred drug for leishmaniasis; however, decades of use have led to near-total resistance in certain strains of Leishmania. The drug must be given parenterally for 4 to 6 weeks. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition of care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-6 Describe the nurse's role in the pharmacologic management of protozoan and helminthic infections. 28) A client taking metronidazole telephones the nurse to report that he has a strange metallic taste in his mouth. The nurse correctly responds by saying: 1. "You may also experience changes in your sense of smell. Do not be alarmed." 2. "This is a common side effect and is produced by the medication." 3. "This indicates an allergic response to the drug; please come in immediately." 4. "This could be an indication of a problem with your kidneys. Increase your fluid intake to 2,000 mL per day." Answer: 2 Explanation: Some patients experience a metallic taste. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

1008

29) The nurse understands that a client with which condition might respond abnormally to primaquine therapy? 1. Diabetes insipidus 2. G6PD deficiency 3. Gout 4. Trisomy 13 Answer: 2 Explanation: Clients with G6PD deficiency are at greater risk for hemolytic anemia. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 53-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 30) Which adverse effects in the client taking chloroquine would require the nurse to notify the provider immediately? 1. Nausea 2. Tinnitus 3. Diarrhea 4. Blurred vision Answer: 4 Explanation: Blurred vision could indicate retinal toxicity and should be reported immediately. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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31) The nurse knows that treatment with pyrimethamine must be stopped if the client exhibits which reactions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Seizure 2. A drop in red blood cell counts 3. Nausea 4. Vomiting 5. Anorexia Answer: 1, 2 Explanation: Pyrimethamine can stimulate the CNS and cause seizures. Serious adverse effects such as folic acid deficiency, megaloblastic anemia, pancytopenia, thrombocytopenia, and leukopenia may occur. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 53-7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 32) A client is receiving mebendazole (Vermox) as treatment for hookworm. The nurse teaches that part of the effectiveness of the drug is due to excretion through the: 1. urine. 2. lungs. 3. bile. 4. feces. Answer: 4 Explanation: The drug is eliminated through the feces. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered car with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-8 Apply the nursing process to care for patients receiving pharmacotherapy for protozoan and helminthic infections. 1010

33) Which priority principles must the nurse understand to effectively administer pharmacotherapy for protozoan and helminth infections? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Client compliance dictates treatment outcomes. 2. Infestation is present before symptoms appear. 3. Agents to treat these disorders have significant adverse effects. 4. Most therapies require single-day dosing. 5. Used appropriately, therapies are highly successful. Answer: 1, 2, 5 Explanation: Client compliance does dictate treatment success. Infestations are present before symptoms appear. Today's therapies are very successful. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered car with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-8 Apply the nursing process to care for patients receiving pharmacotherapy for protozoan and helminthic infections.

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34) A client is receiving medication for a hookworm infection. In planning education for the client, the nurse knows it is essential to include which client-centered points? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Stop taking the medication when feeling better. 2. Do not share doses with other family members with similar symptoms. 3. Return to the healthcare provider if symptoms have not subsided after a full course of treatment. 4. Report any fever that does not subside in 3 days. 5. Report any increasing symptoms. Answer: 2, 3, 4, 5 Explanation: The client should be taught not to share doses of medication with other family members with similar symptoms. The client should be instructed to return of the healthcare provider if symptoms have not subsided after a full course of treatment. The client should be taught to report any fever that does not subside in 3 days of treatment. The client should be taught to report increasing symptoms to the healthcare provider. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered car with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 53-8 Apply the nursing process to care for patients receiving pharmacotherapy for protozoan and helminthic infections. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 54 Pharmacotherapy of Non-HIV Viral Infections 1) A client is being treated with antiviral pharmacotherapy. The nurse understands that treatment with antiviral drugs is extremely challenging because: 1. their broad spectrum causes severe adverse effects. 2. the drug scheduling makes compliance difficult. 3. the rapid mutation of viruses quickly makes drugs ineffective. 4. high doses of medication are required to achieve therapeutic effects. Answer: 3 Explanation: Antiviral pharmacotherapy is extremely challenging because the rapid mutation of viruses quickly makes drugs ineffective. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 54-1 Describe the major structural components of viruses. 1012

2) The nurse teaches a client with genital herpes that a virus is known as an intracellular parasite because: 1. it is surrounded by a protein coat called a capsid. 2. it affects only one species of living organism. 3. it contains DNA or RNA, but not necessarily both. 4. it is incapable of causing infection unless it has invaded a host cell. Answer: 4 Explanation: Viruses must be inside a host cell to cause infection. They do not have the cellular equipment necessary for self-survival. Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-1 Describe the major structural components of viruses.

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3) The role of the capsid in the viral structure includes: 1. facilitating viral replication involving RNA and DNA. 2. allowing for release of the viral infection from the host. 3. triggering body defenses to remove the invader. 4. helping the virus attach to the cell membrane of the host. Answer: 4 Explanation: The role of the capsid is to help the virus attach to the cell membrane of the host. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 54-1 Describe the major structural components of viruses. 4) During an in-service on viruses, the nurse describes the components of a viral envelope, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. phospholipids. 2. glycoprotein. 3. protein "spikes." 4. glucose. 5. carbohydrate. Answer: 1, 2, 3 Explanation: The viral envelope consists partly of phospholipids. The viral envelope consists partly of glycoprotein. The viral envelope consists partly of protein "spikes." Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-1 Describe the major structural components of viruses.

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5) A client wants to be vaccinated against viral hepatitis. The nurse would inform the client that a vaccine is available for: 1. hepatitis B only. 2. hepatitis A (HAV) and B (HAB). 3. hepatitis non-A non-B. 4. hepatitis B and C. Answer: 2 Explanation: The best treatment for viral hepatitis is prevention through immunization, which is available for HAV and HBV. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-2 Identify viral infections that benefit from pharmacotherapy. 6) A client has genital herpes simplex 2. The nurse teaches the client that: 1. spermicides can help prevent transmission. 2. antiviral medication can cure this disease. 3. This infection is for life, but recurrences usually have a shorter course and are less severe. 4. HSV can only be transmitted when there are visible lesions. Answer: 3 Explanation: Herpes simplex is not curable and is lifelong, but with treatment, the recurrent episodes usually have a shorter course and are less severe. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-2 Identify viral infections that benefit from pharmacotherapy.

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7) The nurse caring for which client would question an order for acyclovir (Zovirax)? 1. Client with hepatitis B 2. Client with varicella-zoster 3. Client with herpes simplex 2 encephalitis 4. Client with cytomegalovirus Answer: 1 Explanation: Acyclovir (Zovirax) is not used to treat hepatitis B. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-2 Identify viral infections that benefit from pharmacotherapy. 8) The nurse would anticipate administering antiviral medications to which clients in the emergency department? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A client with an initial outbreak of the herpes simplex virus 2. A client with ringworm 3. An infant with respiratory syncytial virus (RSV) 4. A client with hepatitis 5. A client with methicillin-resistant Staphylococcus aureus (MRSA) Answer: 1, 3, 4 Explanation: A client with herpes simplex virus would benefit from the administration of antiviral medications. An infant with RSV would benefit from the administration of antiviral medication. A client with hepatitis would benefit from the administration of antiviral medication. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-2 Identify viral infections that benefit from pharmacotherapy.

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9) Lamivudine targets which stage in the pathogenesis of a viral infection? 1. Lamivudine inhibits the release of the virus. 2. Lamivudine inhibits penetration of the viral material. 3. Lamivudine inhibits viral replication. 4. Lamivudine inhibits attachment at the receptor site. Answer: 3 Explanation: Lamivudine inhibits the viral replication stage in the pathogenesis of a viral infection. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 54-3 Explain the five principal stages in the pathogenesis of a viral infection. 10) The synthesis stage of viral replication for viruses includes: 1. the virus living dormant in the environment for months to years. 2. the cell bursting and releasing viral particles throughout the host. 3. the virus penetrating the host cell in order to "inject" its genetic material into the host. 4. the virus replicating by making viral capsid proteins and enzymes. Answer: 4 Explanation: This accurately describes the synthesis stage. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 54-3 Explain the five principal stages in the pathogenesis of a viral infection.

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11) Antiviral medications work by inhibiting or stopping a stage of viral replication. Which statements are descriptions of these stages? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Attachment of the virus to the host cell 2. Destruction of host cell DNA. 3. Synthesis of the viral nucleic acid and proteins by the host cell 4. Assembly of all viral components, structural proteins, enzymes, and nucleic acids 5. Release of virions from the host cell Answer: 1, 3, 4, 5 Explanation: The first stage of viral infection is the attachment of the virus to the host cell. The third stage of viral infection is synthesis of the viral nucleic acid and proteins by the host cell. The fourth stage of viral infection is assembly. All the viral components, structural proteins, enzymes, and nucleic acids are packaged and made ready to leave the cell. The fifth stage of viral infection is the release of the virions from the host cell. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 54-3 Explain the five principal stages in the pathogenesis of a viral infection. 12) Which statement is accurate regarding non-HIV antiviral drugs? 1. Antivirals decrease the effects of the host cell's biological processes. 2. Research on antivirals has yielded more useful results than has research on antibacterials. 3. Antivirals have fewer adverse effects than antibiotics. 4. Antivirals have a narrow spectrum of coverage. Answer: 4 Explanation: Non-HIV antiviral drugs have a very narrow spectrum of activity. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 54-4 Explain general principles related to the pharmacotherapy of viral infections.

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13) A client who has been hospitalized with a viral infection asks the nurse why the doctor did not prescribe a medication. The nurse explains that with some viruses, drug therapy is not warranted because: 1. some viruses are self-limiting, and adverse effects can occur. 2. the drugs are not strong enough for effective treatment. 3. most drugs work for only a short period. 4. some drugs work only on prevention, not treatment. Answer: 1 Explanation: Some viruses are self-limiting, and the adverse effects of drug therapy can be worse than the symptoms of the viral infection itself. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-4 Explain general principles related to the pharmacotherapy of viral infections. 14) A client has a cold and asks for an antibiotic to treat the symptoms. The nurse states that a prescription is not needed for a cold because symptoms will resolve on their own in 7 to days. Record your answer rounding to the nearest whole number. Answer: 10 Explanation: Some viral infections, such as the common cold, cause acute symptoms but are self-limiting. While symptoms may be annoying, they resolve in 7 to 10 days. Drug therapy is not warranted due to the expense and the possibility of producing adverse effects that may be worse than the symptoms of the infection itself. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-4 Explain general principles related to the pharmacotherapy of viral infections.

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15) It is crucial for the nurse to monitor which laboratory tests when a client is taking acyclovir (Zovirax)? 1. Fasting and postprandial blood glucose 2. White blood count (WBC) and aspartate aminotransferase (AST) 3. Blood urea nitrogen (BUN), creatinine, and complete blood count (CBC) 4. Viral culture and urinalysis Answer: 3 Explanation: Acyclovir causes nephrotoxicity, hemolytic uremic syndrome, and thrombocytopenia purpura. These complications can be identified promptly by monitoring BUN, creatinine, and CBC frequently. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-5 Describe the nurse's role in the pharmacologic management of patients receiving medications for herpes viruses, influenza viruses, and hepatitis viruses. 16) A client is concerned about contracting influenza and asks about vaccination. The best response by the nurse would be: 1. "Once you are vaccinated, protection with the vaccination begins after about 2 weeks." 2. "The infectious particles are not easily spread, and you can wait on vaccination until the flu becomes prevalent this season." 3. "You would only need to be vaccinated if you are older than 50." 4. "Once you are vaccinated, you will only need a booster every 2 years." Answer: 1 Explanation: Adequate immunity is achieved about 2 weeks after vaccination. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-5 Describe the nurse's role in the pharmacologic management of patients receiving medications for herpes viruses, influenza viruses, and hepatitis viruses.

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17) To minimize the potential for kidney damage associated with giving acyclovir intravenously, the nurse will: 1. decrease the client's protein intake 2 days before and 2 days after treatment. 2. hydrate the client intravenously during and for 2 hours after the infusion. 3. discontinue the infusion if there is any concern about a potential increase in levels of BUN. 4. limit oral fluids during infusion. Answer: 2 Explanation: When given IV, acyclovir is associated with nephrotoxicity, so ensuring that the infusion is administered slowly and that the client is properly hydrated can lessen the potential for IV toxicity. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-5 Describe the nurse's role in the pharmacologic management of patients receiving medications for herpes viruses, influenza viruses, and hepatitis viruses. 18) A client has been prescribed acyclovir for recurrent attacks of herpes simplex. The nurse tells the client to take the prescribed medication within hours after symptoms appear to decrease the length of future outbreaks. Record your answer rounding to the nearest whole number. Answer: 24 Explanation: Recurrent herpes lesions are usually mild and often require no drug treatment. If drug therapy is initiated within 24 hours after symptoms first appear, the length of the acute episode may be shortened or even prevented. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-5 Describe the nurse's role in the pharmacologic management of patients receiving medications for herpes viruses, influenza viruses, and hepatitis viruses.

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19) The nurse has just administered an influenza vaccine to a college student. The student asks how long it will take for the vaccine to become effective. The nurse responds that adequate immunity is achieved in weeks after the injection is administered. Record your answer rounding to the nearest whole number. Answer: 2 Explanation: Adequate immunity is achieved about 2 weeks after vaccination and lasts for several months up to a year. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-5 Describe the nurse's role in the pharmacologic management of patients receiving medications for herpes viruses, influenza viruses, and hepatitis viruses. 20) The nurse is aware that to achieve the most therapeutic effects, the best time to administer oseltamivir (Tamiflu) or zanamivir (Relenza) is: 1. as soon as the client has been exposed to someone with influenza. 2. any time during the course of the illness. 3. at the same time as the vaccine. 4. within 48 hours of the onset of symptoms. Answer: 4 Explanation: Oseltamivir (Tamiflu) and zanamivir (Relenza) are examples of a new classification of drugs called neuraminidase inhibitors that are used to treat active influenza infection. When given within 48 hours of the onset of symptoms, their use can shorten the normal 7-day course of influenza to 5 days. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 54-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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21) The healthcare provider orders amantadine (Symmetrel) for a client with influenza. Which part of the client's health history would the nurse report to the healthcare provider prior to administering amantadine (Symmetrel)? 1. Epilepsy 2. Chronic obstructive pulmonary disease (COPD) 3. Diabetes mellitus 4. Allergy to shellfish Answer: 1 Explanation: Amantadine (Symmetrel) is associated with seizures, and should not be administered to a client with epilepsy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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22) A client telephones the nurse to report fatigue since starting ribavirin therapy 4 months ago. The client has also developed shortness of breath during the past week, which has been worsening. What should the nurse tell the client? 1. "This is a normal adverse effect of this medication. Take it easy, and your symptoms will resolve." 2. "Stop taking the medication. Your healthcare provider will try another medication for hepatitis treatment." 3. "These symptoms could be signs of an allergy to the medication. Take an antihistamine and see if you notice improvement." 4. "You should come into the office to have some blood work done for possible hemolytic anemia." Answer: 4 Explanation: An adverse effect of ribavirin can be hemolytic anemia. The client should be evaluated immediately with a complete blood count. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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23) Several clients are receiving the antiviral medication acyclovir. Which orders from the healthcare provider would the nurse question? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Acyclovir IM 2. Acyclovir IV 3. Acyclovir cream 4. Acyclovir by mouth 5. Acyclovir subcutaneously Answer: 1, 5 Explanation: Acyclovir cannot be administered by intramuscular injection. The nurse would question this order. Acyclovir cannot be administered by subcutaneous injection. The nurse would question this order. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 54-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 24) The nurse is preparing to administer lamivudine to a client with HIV. The nurse knows that the appropriate dose for this client is mg/day. Record your answer rounding to the nearest whole number. Answer: 300 Explanation: The dose recommended for treating HIV (300 mg/day) is much greater than for HBV (100 mg/day). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 54-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 25) The client receives acyclovir (Zovirax) for treatment of genital herpes. What is a priority 1025

assessment by the nurse? 1. Increased serum creatinine 2. Thrombocytopenia 3. Respiratory distress 4. Auditory and visual hallucinations Answer: 1 Explanation: Acyclovir (Zovirax) is nephrotoxic, so serum creatinine should be monitored. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 54-7 Apply the nursing process to care for patients receiving pharmacotherapy for viral infections. 26) Considering potential harmful side effects, which system would the nurse address as a priority area of assessment when a client is given lamivudine (Epivir)? 1. Cardiac 2. Renal 3. Hepatic 4. Pulmonary Answer: 3 Explanation: Lamivudine can cause an unusual type of liver abnormality called lactic acidosis and hepatomegaly with steatosis. This can result in death. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 54-7 Apply the nursing process to care for patients receiving pharmacotherapy for viral infections.

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27) The nurse determines that instruction of a client taking ganciclovir (Cytovene) is effective when the client states: 1. "I can take this medication on an empty stomach." 2. "This medication is OK to take during pregnancy." 3. "I should avoid becoming pregnant while on this medication." 4. "I can stop taking the medication when my symptoms are gone." Answer: 3 Explanation: This response is correct. Ganciclovir is in pregnancy category C and should be avoided during pregnancy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 54-7 Apply the nursing process to care for patients receiving pharmacotherapy for viral infections. 28) For which groups of clients would the community nurse recommend vaccination for hepatitis B? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. All infants 2. Sexually active people in a monogamous relationship 3. IV drug abusers 4. Homosexual males 5. Individuals with end-stage renal disease Answer: 1, 3, 4, 5 Explanation: All infants, beginning at birth, should be vaccinated against hepatitis B. IV drug abusers should be vaccinated against hepatitis B. Males who engage in sexual relations with other males should be vaccinated against hepatitis B. Individuals on dialysis are at increased risk. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 54-7 Apply the nursing process to care for patients receiving pharmacotherapy for viral infections. Pharmacology: Connections to Nursing Practice, 5e (Adams) 1027

Chapter 55

Pharmacotherapy of HIV Infection and AIDS

1) The nurse teaches a client that the transmission of HIV infection occurs by: 1. exposure to respiratory secretions. 2. exposure to fecal material. 3. exposure to blood or semen. 4. exposure to contaminated food. Answer: 3 Explanation: Transmission of HIV infection occurs by exposure to contaminated body fluids, most commonly blood or semen. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55-1 Describe the primary steps in the pathogenesis of HIV infection. 2) During the second stage of pathogenesis of HIV, the virus converts its genetic material from: 1. RNA to DNA. 2. DNA to RNA. 3. DNA to CD4 receptors. 4. RNA to CD4 receptors. Answer: 1 Explanation: HIV is called a retrovirus, because it converts RNA to DNA in the second stage of pathogenesis, whereas most other living organisms convert DNA to RNA. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55-1 Describe the primary steps in the pathogenesis of HIV infection.

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3) When HIV progresses to AIDS, there is a gradual destruction of the immune system, measured by: 1. decline in CD4 receptors. 2. decline in CD4 lymphocytes. 3. decline in platelet count. 4. decline in red blood cells. Answer: 2 Explanation: The progression to AIDS is measured by a decline in CD4 lymphocytes. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55-1 Describe the primary steps in the pathogenesis of HIV infection. 4) The client asks the nurse how HIV is transmitted. The nurse explains that HIV is transmitted through: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. needlesticks. 2. sexual activity. 3. breastfeeding. 4. casual contact. 5. birth. Answer: 1, 2, 3, 5 Explanation: HIV may be transmitted through contact of infected fluids with needles. HIV may be transmitted through sexual activity. Newborns of a mother who is infected with HIV may acquire the virus through breast milk. Newborns of a mother who is infected with HIV may acquire the virus during birth. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-1 Describe the primary steps in the pathogenesis of HIV infection.

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5) The nurse teaches clients with acquired immune deficiency syndrome (AIDS) about the importance of taking their medications as prescribed. What does the nurse recognize as the primary factor for medication nonadherence in the AIDS population? 1. The difficulty with availability of medications to treat AIDS 2. A lack of understanding for the reason to take medications 3. The necessity of having to take multiple medications throughout the day 4. The unpleasant side effects associated with the medications Answer: 3 Explanation: Multiple medications are required throughout the day. The more medications taken daily, the higher the noncompliance rate. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Conduct a health history, including environmental exposure and a family history that recognizes genetic risk, to identify current and future health problems | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 55-3 Identify reasons for virologic failure during HIV pharmacotherapy. 6) The client asks the nurse why there aren't better drugs available to treat HIV infection when so much money is spent on research. What is the best response by the nurse? 1. "Developing new drugs is difficult because we still do not understand the virus." 2. "Developing new drugs is difficult because we still do not have enough money." 3. "Developing new drugs is difficult because the virus mutates so readily." 4. "Developing new drugs is difficult because people think AIDS is a 'gay' disease." Answer: 3 Explanation: Antiviral pharmacotherapy can be extremely challenging because of the rapid mutation rate of viruses, which can render drugs ineffective quickly. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Conduct a health history, including environmental exposure and a family history that recognizes genetic risk, to identify current and future health problems | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-3 Identify reasons for virologic failure during HIV pharmacotherapy.

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7) When discussing antiviral drug resistance with a client initiating pharmacotherapy, the nurse explains that most of the reasons for drug resistance in certain medicines are related to: 1. the viral load. 2. the lymphocyte count. 3. the suppressor T cells. 4. the mutations that can occur in the virus. Answer: 4 Explanation: Drug resistance is related to genetic mutations that can occur, producing resistant strains in HIV. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Conduct a health history, including environmental exposure and a family history that recognizes genetic risk, to identify current and future health problems | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-3 Identify reasons for virologic failure during HIV pharmacotherapy. 8) A client with HIV asks the nurse why medications used to treat the virus are not effective over long periods of time. The nurse states it is because an individual infected with HIV may produce as many as billion new virions every day. Record your answer rounding to the nearest whole number. Answer: 10 Explanation: A client infected with HIV may produce as many as 10 billion new virions every day, and the immune system becomes overwhelmed by the infection. Medications grow resistant due to the rapid replication rate of the virus. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Conduct a health history, including environmental exposure and a family history that recognizes genetic risk, to identify current and future health problems | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-3 Identify reasons for virologic failure during HIV pharmacotherapy.

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9) When the client is started on antiretroviral drugs for HIV, what important information should the nurse teach the client? 1. This drug is readily available all over the world for treatment. 2. This type of drug will be used prior to vaccines. 3. This drug will cure the disease over a period of time. 4. This drug will not cure the disease, but could extend life expectancy. Answer: 4 Explanation: Drug therapy has not produced a cure but has resulted in a number of therapeutic successes. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-8 Explain recent advances in the preexposure prophylaxis of HIV infection. 10) The nurse is teaching a client about the goals of drug therapy for HIV-AIDS. Which statement by the client indicates the need for further teaching? 1. "A goal of pharmacotherapy is an increased lifespan." 2. "A goal of pharmacotherapy is curing the disease." 3. "Increased quality of life is a goal of pharmacotherapy." 4. "Reduced HIV RNA in the blood is a goal of pharmacotherapy." Answer: 2 Explanation: There are no drugs available currently that will cure HIV-AIDS. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 55-2 Explain the therapeutic goals for HIV pharmacotherapy.

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11) Which teaching point by the nurse is correct in regards to antiviral therapy? 1. Antiviral drug therapy can be challenging because of how slowly viruses become resistant to the drugs. 2. Antiviral drugs have a broad spectrum of activity. 3. It is difficult to administer adequate doses of medication to kill the virus without injuring normal cells. 4. Antiviral drugs must be given one at a time because of the possibility of severe side effects. Answer: 3 Explanation: A challenge to antiviral therapy is that it is difficult to administer adequate doses of medication without injuring the normal cells. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-2 Explain the therapeutic goals for HIV pharmacotherapy. 12) The nurse is providing discharge teaching to a client who has recently been diagnosed with HIV. The nurse knows the client has understood the instructions when the client states that a goal of HIV pharmacotherapy is to: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. prevent HIV-related morbidity. 2. prolong survival. 3. restore and preserve immunologic function. 4. increase viral load. 5. eliminate the potential for transmission from mother to child in pregnant clients who have HIV infection. Answer: 2, 3 Explanation: A goal of HIV pharmacotherapy is to prolong survival with HIV. A goal of HIV pharmacotherapy is to restore and preserve immunologic function. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 55-2 Explain the therapeutic goals for HIV pharmacotherapy.

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13) While discussing the pharmacotherapy of HIV with a group of nursing students, the nurse states that the goal of antiretroviral therapy is to reduce plasma HIV RNA to less than copies/mL. Record your answer rounding to the nearest whole number. Answer: 48 Explanation: HIV RNA levels are determined every 3 to 6 months to monitor progression of the disease and to assess the degree of success of antiretroviral therapy. The goal of antiretroviral therapy is to reduce plasma HIV RNA to less than 48 copies/mL. For most patients, 12 to 24 weeks of HIV pharmacotherapy is required to achieve this level. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-2 Explain the therapeutic goals for HIV pharmacotherapy. 14) The nurse is teaching a client about the standard drug therapy for HIV-AIDS. Which antiviral medications does the nurse include in the teaching plan? 1. Zidovudine (Retrovir, AZT) 2. Interferon-alfa 3. Rimantadine (Flumadine) 4. Acyclovir (Zovirax) Answer: 1 Explanation: Zidovudine is indicated for therapy for HIV-AIDS. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-4 Describe the advantages of antiretroviral therapy in the pharmacotherapy of HIV infection.

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15) The nurse states that the goal of HAART is: 1. reduction of the plasma level of HIV to the lowest level possible. 2. elimination of the virus from the lymph system. 3. reduction of side effects seen with other HIV-AIDS drugs. 4. elimination of the virus from the bloodstream. Answer: 1 Explanation: The goal of HAART is to reduce the plasma level of HIV to the lowest possible level. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-4 Describe the advantages of antiretroviral therapy in the pharmacotherapy of HIV infection. 16) The client with AIDS asks the nurse why so many medications are prescribed. What is the best response by the nurse? 1. "To decrease the possibility of the virus developing resistance to the medications." 2. "Because the earlier we start multiple medications, the better for you." 3. "To provide you with the most effective treatment for your illness." 4. "Research has shown single medications to be ineffective." Answer: 1 Explanation: Decreasing the possibility of resistance is the key. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-4 Describe the advantages of antiretroviral therapy in the pharmacotherapy of HIV infection.

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17) The nurse caring for a client who has been prescribed the antiretroviral medication emtricitabine explains that the advantages of this medication include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. once-daily dosing. 2. once-weekly dosing. 3. fewer adverse effects. 4. can be taken with concurrent HBV infection. 5. safe for pregnant women with HIV. Answer: 1, 3, 5 Explanation: This medication should be taken once a day, which increases compliance. This medication is associated with fewer adverse effects than other antiretroviral medication. This medication is pregnancy category B and is safe to take during pregnancy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-4 Describe the advantages of antiretroviral therapy in the pharmacotherapy of HIV infection. 18) All six major classes of drugs used to manage HIV infection have the ability to: 1. prevent the virus from entering the host cell. 2. destroy the cell walls of the virus. 3. inhibit enzymes that are necessary for viral replication. 4. promote cell division only in uninfected cells. Answer: 3 Explanation: All six major classes of drugs used to manage HIV infection inhibit enzymes necessary for viral replication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55-5 Compare and contrast the classes of antiretroviral medications.

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19) A client is started on efavirenz, a NNRTI. Which medication should the nurse question before giving it with efavirenz? 1. Diazepam 2. Penicillin 3. Ibuprofen 4. Diphenhydramine Answer: 1 Explanation: The CNS adverse effects of efavirenz are worsened if the client takes psychotropic drugs, such as diazepam. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Quality and Safety: communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-5 Compare and contrast the classes of antiretroviral medications. 20) A client with HIV has been on an antiviral protease inhibitor for 2 months and recently complains of being hungry and thirsty and urinating more frequently. Knowing the adverse effects of protease inhibitors, the nurse should assess for: 1. pancreatitis. 2. kidney failure. 3. hepatomegaly. 4. hyperglycemia. Answer: 4 Explanation: Some of the protease inhibitors are associated with hyperglycemia, and can cause diabetes or worsen existing diabetes. Worsening diabetes can be indicated by increased hunger and thirst along with more frequent urination. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Quality and Safety: communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55-5 Compare and contrast the classes of antiretroviral medications.

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21) The nurse is asked by a client which drug regimens have been shown to be the most successful for the initial therapy of HIV infection. The nurse responds: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "An NNRTI-based regimen." 2. "PI-based regimens." 3. "An integrase inhibitor-based regimen." 4. "NRTIs/NtRTIs-based regimens." 5. "Entry inhibitor-based regimens." Answer: 1, 2, 3 Explanation: An NNRTI-based regimen of efavirenz + tenofovir + emtricitabine has been shown to be a successful choice for the initial therapy of HIV infection. A PI-based regimen of atazanavir (ritonavir-boosted) + tenofovir + emtricitabine or darunavir (ritonavir-boosted) + tenofovir + emtricitabine has been shown to be a successful choice for the initial therapy of HIV infection. An integrase inhibitor–based regimen of raltegravir + tenofovir + emtricitabine has been shown to be a successful choice for the initial therapy of HIV infection. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-5 Compare and contrast the classes of antiretroviral medications. 22) A client who is HIV positive questions the nurse about a vaccine for HIV. Which response by the nurse is most accurate? 1. "Scientists are far from developing a vaccine to prevent HIV." 2. "The HIV vaccines developed can prevent fatal consequences of the virus." 3. "Scientists currently have many HIV vaccines in clinical trials." 4. "Scientists are close to discovering a vaccine for HIV." Answer: 1 Explanation: Despite much research, scientists are far from developing a vaccine to prevent HIV. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-6 Describe the difficulties in developing a vaccine to prevent HIV infection.

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23) Which statement by the nurse is true in regard to the development of a vaccine to prevent HIV? 1. HIV has a low number of genetic variants. 2. HIV has such a slow replication rate. 3. HIV has an extremely rapid replication rate. 4. There is a low mutation rate. Answer: 3 Explanation: HIV has a rapid replication rate. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-6 Describe the difficulties in developing a vaccine to prevent HIV infection. 24) The nurse states that the development of an HIV vaccination has been unsuccessful due to the large size of the HIV genome, which has _ base pairs and leads to the high mutation rate of the virus. Record your answer rounding to the nearest whole number. Answer: 10,000 Explanation: It is estimated that, given the size of the HIV genome at 10,000 base pairs, every possible mutation probably occurs at every nucleotide daily in an untreated client. These errors create huge numbers of genetic variants, or mutant strains, with new and different characteristics from the original. It is not unusual to find dozens of genetic variants of HIV replicating within the same client. Thus, vaccine development, and indeed antiretroviral therapy, is trying to hit a "moving target" that is changing its genetic makeup literally every minute. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-6 Describe the difficulties in developing a vaccine to prevent HIV infection.

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25) Although research for a vaccine to prevent HIV infection has been unsuccessful, the nurse states that benefits of HIV vaccine research include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. the development of new drugs. 2. advances on how to treat and control the disease. 3. ways to prevent transmission. 4. ethical treatment regimens. 5. vaccine cocktails. Answer: 1, 2 Explanation: Many new medications have been discovered due to the research for an HIV vaccination. Research for a vaccination for HIV has led to advances in the treatment and control of HIV. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-6 Describe the difficulties in developing a vaccine to prevent HIV infection. 26) The nurse accidentally sticks herself with a needle after starting an intravenous line on a client with AIDS. The nurse tells the supervisor about the accident. What is the best initial response by the supervisor to decrease anxiety in the nurse? 1. "Workers' compensation will cover the cost of your illness and medications." 2. "Fortunately, the chances of you contracting human immunodeficiency virus after the stick are very small." 3. "If you are started on medications soon, it will decrease the severity of the disease." 4. "Did you use the hospital protocols for starting IV lines on a client with AIDS?" Answer: 2 Explanation: Risk of transmission does exist, but is very small. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.7 Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions | NLN Competencies: Quality and Safety: communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-7 Explain the protocol and rationale for postexposure prophylaxis following occupational exposure to HIV.

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27) Postexposure prophylaxis (PEP) for occupational HIV exposure should be started within what time period after exposure to be most successful? 1. 2 weeks 2. 24 to 36 hours 3. 36 to 48 hours 4. 1 week Answer: 2 Explanation: PEP should be started 24 to 36 hours after exposure to be most successful. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.7 Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-7 Explain the protocol and rationale for postexposure prophylaxis following occupational exposure to HIV. 28) Why is PEP initiated only if exposure was severe, and the source of fluid is known or strongly suspected to contain HIV? 1. The cost and anxiety associated with taking the drugs are high. 2. There is not enough research supporting this treatment. 3. The cost of the drugs is high, and there are many ethical issues surrounding their use. 4. The cost of the drugs is high, and there are many adverse effects. Answer: 4 Explanation: PEP is initiated only in severe cases, and when the source of fluid is known to be or strongly suspicious of HIV, due to the expense of the drugs and the dangerous side effects. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.7 Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-7 Explain the protocol and rationale for postexposure prophylaxis following occupational exposure to HIV.

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29) An occupational health nurse is evaluating the risk of a healthcare worker exposed to HIV by a needlestick. The nurse initiates basic PEP because the source individual's viral load is below HIV RNA copies/mL. Record your answer rounding to the nearest whole number. Answer: 1,500 Explanation: Basic PEP is initiated when the source individual is asymptomatic for HIV or is known to have a low viral load (below 1,500 HIV RNA copies/mL). Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.7 Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 55-7 Explain the protocol and rationale for postexposure prophylaxis following occupational exposure to HIV. 30) The nurse is caring for a client with AIDS who has just learned she is pregnant. She tearfully asks the nurse if her baby will die of AIDS. What is the best course of action for this client? 1. The client will take tipranavir (Aptivus) as prescribed. 2. The client will take raltegravir (Isentress) as prescribed. 3. The client will take zidovudine (Retrovir) as prescribed. Answer: 3 Explanation: Zidovudine (Retrovir) is part of the recommended regimen for pregnant women. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.7 Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 55-9 Describe the antiretroviral protocols used for reducing the risk of perinatal transmission and for treating pediatric patients with HIV infection.

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31) Which regimen is part of the protocol to reduce perinatal transmission of HIV? 1. Intravenous zidovudine administered to the mother during the postpartum period 2. Continuous infusion of zidovudine during labor. 3. Intravenous zidovudine administered to the newborn for the first 3 days of life 4. Oral zidovudine administered to the newborn for 12 weeks following delivery Answer: 2 Explanation: Continuous infusion of zidovudine during labor is part of the protocol. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.7 Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 55-9 Describe the antiretroviral protocols used for reducing the risk of perinatal transmission and for treating pediatric patients with HIV infection. 32) The preferred drug to be used in combination with zidovudine for perinatal transmission prevention is: 1. ritonavir. 2. lamivudine. 3. tenofovir. 4. didanosine. Answer: 2 Explanation: The preferred drug to be used in combination with zidovudine for perinatal transmission prevention is lamivudine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.7 Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 55-9 Describe the antiretroviral protocols used for reducing the risk of perinatal transmission and for treating pediatric patients with HIV infection.

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33) The nurse is discussing the risk of transmission of HIV to a pregnant woman who is concerned her baby will become infected. The nurse states that by following the prescribed treatment regimen transmission can be reduced by approximately %. Record your answer rounding to the nearest whole number. Answer: 70 Explanation: A reduction of approximately 70% in transmission from mother to infant was achieved in clinical trials in 1994 with a zidovudine regimen. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.7 Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-9 Describe the antiretroviral protocols used for reducing the risk of perinatal transmission and for treating pediatric patients with HIV infection. 34) Opportunistic infections have become less common, and mortality is diminished, because HAART: 1. decreases RNA replication. 2. increases the amount of red blood cells in the body. 3. increases the number of CD4 lymphocytes. 4. decreases the transmission of opportunistic infections from one individual to another. Answer: 3 Explanation: HAART increases the number of CD4 lymphocytes, allowing clients with HIV infection to maintain a higher level of immunologic response. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55-10 Identify opportunistic infections commonly acquired by patients with HIV infections and the drugs used to treat them.

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35) The nurse does health teaching with a client who has HIV who has been started on antiviral medications. The nurse recognizes teaching has been effective when the client makes which statement? 1. "I will need to be on a high-calorie diet to enhance the effect of the medication." 2. "I will still need to take precautions to avoid spreading the virus to others." 3. "I will not be able to continue working at my high-stress job anymore." 4. "I will need to limit my travel to avoid people with other infections." Answer: 2 Explanation: Precautions are still necessary to avoid spreading the virus to others. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 55-11 Describe the nurse's role in the pharmacologic management of patients receiving antiretroviral medications. 36) A client has been prescribed tenofovir. What information should the nurse include in the client's education? 1. Double the next dose if a dose is missed. 2. Take the medicine on an empty stomach. 3. The risk of transmitting the disease through blood contamination is decreased. 4. The drug increases bone mineral density. Answer: 2 Explanation: Taking this drug on an empty stomach helps increase absorption. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-11 Describe the nurse's role in the pharmacologic management of patients receiving antiretroviral medications.

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37) A client who is pregnant is taking ritonavir. When asking about the safety of this medication in pregnancy, the nurse informs the client that this drug is in pregnancy category: 1. X. 2. B. 3. C. 4. A. Answer: 2 Explanation: Ritonavir is in pregnancy category B, so it is safe to use during pregnancy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-11 Describe the nurse's role in the pharmacologic management of patients receiving antiretroviral medications. 38) A client with HIV has been started on zidovudine (AZT) as part of the pharmacotherapeutic regimen. What is appropriate for the nurse to teach the client who is on this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The appropriate use of condoms with sexual activity 2. The importance of taking St. John's wort in conjunction with AZT 3. The need to notify the healthcare provider if pregnancy occurs 4. That breastfeeding is safe when taking this medication 5. Not to discontinue the medication without notifying the healthcare provider Answer: 1, 3, 5 Explanation: The nurse should teach the client the importance of using condoms with sexual activity because this medication is not a cure for HIV infection and it does not prevent the spread of HIV to others through sexual contact. Immediately notify the healthcare provider of any known or suspected pregnancy. Do not discontinue taking this medication without approval of the healthcare provider. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-11 Describe the nurse's role in the pharmacologic management of patients receiving antiretroviral medications.

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39) Which assessment finding would concern the nurse if found in the client receiving darunavir (Prezista)? 1. Nausea and vomiting 2. Constipation 3. Abdominal pain, headache, and rash 4. Complete numbness and tingling around the mouth Answer: 3 Explanation: Darunavir is a protease inhibitor. The nurse would report signs of fever, abdominal pain, headache, and rash. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-12 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 40) Which drug used to treat HIV-AIDS is a nonnucleoside reverse transcriptase inhibitor (NNRTI)? 1. Lamivudine (Epivir, 3TC) 2. Zidovudine (Retrovir, AZT) 3. Efavirenz (Sustiva) Answer: 3 Explanation: Efavirenz is an NNRTI. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55-12 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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41) A client has been started on efavirenz (Sustiva) for the treatment of HIV. The client is reporting nightmares, dizziness, and a reduced ability to concentrate. The nurse tells the client that these CNS symptoms should diminish in 3 to weeks. Record your answer rounding to the nearest whole number. Answer: 4 Explanation: CNS adverse effects are observed in at least 50% of clients when first initiating efavirenz therapy, including sleep disorders, nightmares, dizziness, reduced ability to concentrate, and delusions. The CNS adverse effects usually diminish after 3 to 4 weeks of therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-12 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 42) When providing client and family education for the nucleoside reverse transcriptase inhibitor (NRTI) drugs for HIV-AIDS, the nurse would include instructions to: 1. take the medicine with apple juice to decrease the bad taste. 2. take the medicine with orange juice to increase absorption. 3. take the medicine on an empty stomach. 4. take the medicine on a full stomach. Answer: 3 Explanation: The medicine should be taken on an empty stomach for better absorption. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered car with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-13 Apply the nursing process to care for patients receiving pharmacotherapy for HIV infection and AIDS.

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43) A client was recently given a prescription for enfuvirtide (Fuzeon). What educational information should be in the teaching plan? 1. Inject the drug into the same abdominal site area daily. 2. Take this drug with vitamin D to help absorption. 3. Some serious drug interactions could occur. 4. Inject the drug subcutaneously twice daily. Answer: 4 Explanation: This drug is to be given as a subcutaneous injection twice daily. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered car with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-13 Apply the nursing process to care for patients receiving pharmacotherapy for HIV infection and AIDS. 44) A priority system of assessment in a client recently started on efavirenz (Sustiva) includes: 1. pulmonary. 2. CNS. 3. GI. 4. cardiac. Answer: 2 Explanation: CNS-adverse effects are observed in at least 50% of the clients when first starting therapy with efavirenz. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered car with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55-13 Apply the nursing process to care for patients receiving pharmacotherapy for HIV infection and AIDS.

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45) The nurse is providing discharge education to a client who has been prescribed lopinavir with ritonavir (Kaletra) for the treatment of HIV. Which information should the nurse include in the teaching plan for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Take on an empty stomach. 2. Take the medication with herbal supplements to enhance absorption. 3. Discontinue your statin drug. 4. Practice safe sex while taking this drug. 5. Discontinue medication if bothersome side effects occur. Answer: 3, 4 Explanation: The client should be advised not take statin drugs while taking this medication. Understand that this medication is not a cure for HIV infection, and it does not prevent the spread of HIV to others through sexual contact. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered car with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 55-13 Apply the nursing process to care for patients receiving pharmacotherapy for HIV infection and AIDS. 46) Opportunistic infections, such as bacterial infections, associated with a client with HIV can be treated with which of the following? 1. Ciprofloxacin 2. Trimethoprim-sulfamethoxazole. 3. Fluconazole 4. Benzathine penicillin Answer: 1 Explanation: Ciprofloxacin is the preferred drug for a client with HIV and a bacterial infection. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55-10 Identify opportunistic infections commonly acquired by patients with HIV infections and the drugs used to treat them.

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47) A client with HIV asks if there is a vaccine to prevent transmission to the client's significant other. What is the nurse's best response? 1. "This virus has challenged scientists and they have created a pseudo vaccine." 2. "There is a vaccine that prevents the older adults from getting the HIV infection." 3. "A vaccine has been developed but it only assists young children." 4. "At present, there is no vaccine to prevent HIV transmission." Answer: 4 Explanation: After decades of research, the FDA has not approved a single effective vaccine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.7 Collaborate with other healthcare professionals and patients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 55-8 Explain recent advances in the preexposure prophylaxis of HIV infection. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 56 Basic Principles of Antineoplastic Therapy 1) The nurse is caring for a client with cancer. The family asks the nurse to explain the differences between benign and malignant tumors. Which statement best describes the difference between benign and malignant tumors? 1. "Benign tumors are fast growing, remain localized, and can kill the host." 2. "Malignant tumors are slow growing but invasive, and they can kill the host." 3. "Benign tumors are slow growing but invasive." 4. "Malignant tumors are rapidly growing and invasive, and they can kill the host." Answer: 4 Explanation: Malignant tumors grow rapidly, are invasive, and can kill the host. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 56-1 Compare and contrast the differences between normal cells and cancer cells. 2) Cancer is a disease characterized by: 1. normal, controlled cell division. 2. abnormal, uncontrolled cell division. 3. normal, uncontrolled cell division. 4. abnormal, controlled cell division. Answer: 2 Explanation: Cancer is characterized by abnormal, uncontrolled cell division. Cognitive Level: Remembering 1051

Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 56-1 Compare and contrast the differences between normal cells and cancer cells.

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3) Unlike most normal cells, cancerous cells are able to move to other places in the body, traveling to distant sites where they populate new tumors. This process is called: 1. grading. 2. carcinogenesis. 3. metastasis. 4. angiogenesis. Answer: 3 Explanation: Metastasis occurs when cancerous cells travel to distant sites and populate new tumors. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 56-1 Compare and contrast the differences between normal cells and cancer cells. 4) The nurse is providing teaching to a client who has just been diagnosed with breast cancer. How would the nurse describe a malignant tumor? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Slow growing 2. Invasive 3. Lethal if left untreated 4. May be classified as a carcinoma 5. May be classified as a sarcoma Answer: 2, 3, 4, 5 Explanation: Malignant tumors are invasive. Malignant tumors can be lethal if left untreated. Malignant tumors are often classified as carcinomas. Malignant tumors are often classified as sarcomas. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-1 Compare and contrast the differences between normal cells and cancer cells.

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5) A client with cancer asks the nurse where cancer comes from. What is the best explanation by the nurse? 1. "Cancer cells are body cells that have lost the ability to regulate growth." 2. "Cancer is caused primarily by viruses in the environment." 3. "Cancer is genetic; you inherited the predisposition for your cancer." 4. "Cigarette smoking and secondhand smoke are the primary causes of cancer." Answer: 1 Explanation: Cancer is thought to result from damage to the genes that control cell growth. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-2 Identify etiologic factors associated with an increased incidence of cancer. 6) The nurse assesses several clients for their potential risk for developing cancer. Which client does the nurse assess to be at greatest risk for developing cancer? 1. The client who is an alcoholic and eats a diet high in fatty foods 2. The client who frequently forgets breast self-exams but has routine mammograms 3. The client who is 10 pounds overweight but exercises regularly 4. The client who applies sunscreen when arriving at the beach Answer: 1 Explanation: Alcoholism and a high-fat diet are lifestyle factors that put this client at risk for developing cancer. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 56-2 Identify etiologic factors associated with an increased incidence of cancer.

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7) Which causes are not part of the etiology of cancer? 1. Biological causes 2. Chemical causes 3. Structural causes 4. Physical causes Answer: 3 Explanation: Structural causes are not included in the etiology of cancer. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 56-2 Identify etiologic factors associated with an increased incidence of cancer. 8) The community health nurse is addressing a neighborhood group concerned about high rates of cancer. The nurse describes chemical carcinogens that contribute to the incidence of cancer, such as: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. tobacco. 2. alcohol. 3. asbestos. 4. ultraviolet light. 5. human papillomavirus (HPV). Answer: 1, 2, 3 Explanation: Tobacco is considered a chemical carcinogen. Alcohol is considered a chemical carcinogen. Asbestos is considered a chemical carcinogen. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-2 Identify etiologic factors associated with an increased incidence of cancer.

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9) The nurse is teaching a client with human papillomavirus (HPV) about the correlation between certain viruses and cancer. The nurse explains that viruses account for no more than % of all cancers. Record your answer rounding to the nearest whole number. Answer: 20 Explanation: It is estimated that viruses are associated with about 15% to 20% of all human cancers. Examples include herpes simplex types 1 and 2, Epstein-Barr, human papillomavirus (HPV), cytomegalovirus, and human T-lymphotrophic viruses. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe nursing care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-2 Identify etiologic factors associated with an increased incidence of cancer. 10) Receiving the HPV vaccine to prevent cervical cancer is an example of what type of prevention? 1. Secondary 2. Tertiary 3. Palliation 4. Primary Answer: 4 Explanation: Receiving the HPV vaccine to prevent cervical cancer is an example of primary prevention. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-3 Construct a table categorizing the major primary and secondary means of cancer prevention.

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11) The nurse recognizes that teaching about secondary prevention has been effective when the client states: 1. "If I stop smoking, I can decrease my risk of lung cancer." 2. "I need to have a Pap smear annually to detect any signs of cervical cancer." 3. "If I get a cancerous lesion removed early, I can prevent more areas of skin cancer." 4. "If I wear sunscreen, I can prevent skin cancer." Answer: 2 Explanation: This is an example of secondary prevention. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 56-3 Construct a table categorizing the major primary and secondary means of cancer prevention. 12) The acronym that the American Cancer Society recommends to help people remember what to look for when assessing themselves for cancer is: 1. CAUTION. 2. CANCER. 3. CHANGES. 4. PREVENTION. Answer: 1 Explanation: This is the acronym the American Cancer Society recommends. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 56-3 Construct a table categorizing the major primary and secondary means of cancer prevention.

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13) The community health nurse is planning programs aimed at reducing the incidence of cancer. Which strategies would the nurse plan to implement as part of primary prevention? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Providing health counseling and education 2. Reducing tobacco use 3. Providing annual Papanicolaou (Pap) smears 4. Instructing women in breast self-examination 5. Helping clients maintain weight within recommended levels Answer: 1, 2, 5 Explanation: Health counseling and education are considered primary preventions against cancer. Reducing the use of tobacco is considered primary prevention against cancer. Maintaining a healthy weight is an example of primary prevention against cancer. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 56-3 Construct a table categorizing the major primary and secondary means of cancer prevention. 14) A client is receiving chemotherapy in the treatment of breast cancer. The nurse explains that although chemotherapy has several goals, it does not attempt to: 1. control the cancer. 2. provide palliation. 3. cure the cancer. 4. prevent transmission of the cancer. Answer: 4 Explanation: Transmission prevention is not a goal of chemotherapy. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-4 Compare and contrast the following goals of chemotherapy: cure, control, palliation, prophylaxis, adjuvant therapy, and neoadjuvant therapy.

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15) The nurse on an oncology unit recognizes that a patient with which type of advanced cancer would most likely require palliation therapy? 1. Bladder cancer 2. Liver cancer 3. Skin cancer 4. Pancreatic cancer Answer: 4 Explanation: Pancreatic cancer benefits from palliation therapy. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 56-4 Compare and contrast the following goals of chemotherapy: cure, control, palliation, prophylaxis, adjuvant therapy, and neoadjuvant therapy. 16) Which statement is not true of adjuvant chemotherapy? 1. Adjuvant therapy is the administration of antineoplastic drugs after surgery or radiation therapy. 2. Adjuvant therapy is the administration of antineoplastic drugs before surgery or radiation therapy. 3. A goal of adjuvant therapy is to treat any micrometastases that might be developing. 4. A goal of adjuvant therapy is to rid the body of any cancerous cells that were not removed during surgery. Answer: 2 Explanation: This describes neoadjuvant chemotherapy. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 56-4 Compare and contrast the following goals of chemotherapy: cure, control, palliation, prophylaxis, adjuvant therapy, and neoadjuvant therapy.

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17) The nurse on an oncology unit anticipates that which clients are most likely to receive palliative cancer treatment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A client with Hodgkin's lymphoma 2. A client with osteosarcoma 3. A client with choriocarcinoma 4. A client with advanced pancreatic cancer 5. A client with Kaposi's sarcoma Answer: 2, 4, 5 Explanation: A client with osteosarcoma will be treated with palliative chemotherapy. A client with advanced pancreatic cancer will be treated with palliative chemotherapy. A client with Kaposi's sarcoma will be treated with palliative chemotherapy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 56-4 Compare and contrast the following goals of chemotherapy: cure, control, palliation, prophylaxis, adjuvant therapy, and neoadjuvant therapy. 18) In preparing a client for radiation therapy, the nurse explains that % of clients undergo radiation as part of their cancer treatment. Record your answer rounding to the nearest whole number. Answer: 50 Explanation: Approximately 50% of clients with cancer receive radiation therapy as part of their treatment. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-4 Compare and contrast the following goals of chemotherapy: cure, control, palliation, prophylaxis, adjuvant therapy, and neoadjuvant therapy.

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19) An inaccurate statement about the process of staging cancer is that staging: 1. determines where the cancer is located. 2. determines the extent of the cancer invasion. 3. helps the healthcare provider determine the best course of treatment. 4. compares the appearance of cancer cells with that of normal cells. Answer: 4 Explanation: This describes grading. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 56-5 Explain the purposes of staging and grading cancers. 20) Which statement is true regarding grading of cancer cells? 1. Grading has very few limitations, because tumors contain cell types that are similar in appearance. 2. If the biopsy cells appear differentiated and similar to parent cells, the tumor receives a grade of 1. 3. Grading does not change much over time as the tumor evolves. 4. If the biopsy cells appear differentiated and similar to parent cells, the tumor receives a grade of 4. Answer: 2 Explanation: This is true regarding grading. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 56-5 Explain the purposes of staging and grading cancers.

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21) The staging and grading of cancer are performed: 1. after the last chemotherapy treatment is completed. 2. when the client's symptoms start to worsen. 3. after the first chemotherapy treatment is completed. 4. upon initial diagnosis of cancer. Answer: 4 Explanation: Staging and grading are performed upon initial diagnosis of cancer to determine the best course of therapy and to predict client outcomes. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 56-5 Explain the purposes of staging and grading cancers. 22) A client has been diagnosed with Stage IV pancreatic cancer. The family asks the nurse what staging is. The nurse explains that: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. staging determines the location of the cancer. 2. the involvement of lymph nodes is assessed during staging. 3. staging changes as the cancer progresses. 4. the lower the stage of cancer at diagnosis, the better the prognosis. 5. staging examines cancerous cells under a microscope and compares them to normal cells. Answer: 1, 2, 4 Explanation: Staging does determine the location of the cancer. When solid tumors are staged, diagnostic testing also determines the involvement of the lymph nodes. Clients with cancer at a lower stage have a better prognosis than those who are diagnosed at a higher stage. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-5 Explain the purposes of staging and grading cancers.

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23) A client receiving antineoplastic agents in the treatment of lung cancer has been told that treatment options are limited. The nurse explains that lung cancer has a decreased sensitivity to antineoplastic agents because lung cancer cells: 1. have a very erratic cell cycle, and there is little difference between the number of replicating and resting cells. 2. grow for a long time before detection and are therefore less sensitive to antineoplastic agents. 3. grow in a high-oxygen environment and are therefore not very sensitive to antineoplastic agents. 4. have a low growth fraction, so there is little difference between the number of replicating and resting cells. Answer: 4 Explanation: The growth fraction is the ratio of the number of replicating cells to the number of resting cells. Antineoplastic drugs are much more toxic to tissues and tumors with high growth fractions. Breast and lung cancers have a low growth fraction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-6 Explain the significance of growth fraction and the cell cycle to the success of chemotherapy. 24) A client is receiving a cell cycle specific medication for the treatment of leukemia. The nurse recognizes that in order for these drugs to kill the most cancer cells, they should be administered in: 1. divided, infrequent doses. 2. divided, frequent doses. 3. a single dose each day. 4. a large, one-time dose. Answer: 2 Explanation: Cell cycle specific drugs kill the most cancer cells when administered in divided, frequent doses. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-6 Explain the significance of growth fraction and the cell cycle to the success of chemotherapy.

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25) Which statement most accurately describes the action that occurs during stage S (synthesis) of the cell cycle? 1. The cell undergoes prophase, metaphase, anaphase, and telophase. 2. The cell makes additional proteins that are necessary for cell division. 3. The cell conducts metabolism, impulse conduction, contraction, or secretion. 4. The cell duplicates its DNA. Answer: 4 Explanation: This describes stage S (synthesis). Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 56-6 Explain the significance of growth fraction and the cell cycle to the success of chemotherapy. 26) The nurse on an oncology unit is planning care for clients with various types of cancer. The nurse recognizes that certain cancer cells have a low growth fraction and are less sensitive to chemotherapeutic agents, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. leukemia cells. 2. lymphoma cells. 3. breast cancer cells. 4. lung cancer cells. 5. bone marrow cells. Answer: 3, 4 Explanation: Breast cancer cells have a low growth fraction and are less sensitive to cell cycle specific chemotherapeutic agents. Lung cancer cells have a low growth fraction and are less sensitive to cell cycle specific chemotherapeutic agents. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 56-6 Explain the significance of growth fraction and the cell cycle to the success of chemotherapy.

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27) Which statement most accurately describes the cell kill hypothesis? 1. It is a model that predicts the amount of normal cells that will be affected by antineoplastic drugs. 2. It is a model that predicts the ability of antineoplastic drugs to eliminate cancer cells. 3. It is a model that predicts how invasive a cancer has become. 4. It is a model that compares the appearance of potential cancer cells with that of normal parent cells. Answer: 2 Explanation: This statement describes the cell kill hypothesis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 56-7 Assess the ability of antineoplastic drugs to achieve a total cancer cure based on the cell kill hypothesis. 28) When discussing the outcome of treatment with a client, the nurse states that theoretically the cancer has been "cured" when: 1. The client no longer experiences the physiologic effects of cancer. 2. Every single cancer cell in the tumor has been eliminated. 3. The tumor cannot be identified on a CT scan. 4. The client's absolute neutrophil rises back to a normal level. Answer: 2 Explanation: This defines when a client is "cured." Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-7 Assess the ability of antineoplastic drugs to achieve a total cancer cure based on the cell kill hypothesis.

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29) Which statement is not one of the reasons that clients undergoing chemotherapy usually receive several rounds of treatment spaced over time? 1. Side effects can occur, and the client needs time to recover. 2. The neutrophil count can decrease, so time between treatments is necessary for the body to make more neutrophils to boost the immune system. 3. The cost of treatments is very high. 4. Each round of chemotherapy kills only a set percentage of cancer cells. Answer: 3 Explanation: Although treatments are expensive, this is not the reason that treatments are spaced over time. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 56-7 Assess the ability of antineoplastic drugs to achieve a total cancer cure based on the cell kill hypothesis. 30) A client has a 2-cm breast tumor, which is estimated to contain 2 billion cancer cells. The client has completed chemotherapy, and the healthcare provider indicates that 99% of these cancer cells have been killed. The nurse calculates that cancer cells remain. Record your answer rounding to the nearest whole number. Answer: 2,000,000 Explanation: If the drug kills 99% of 2 billion cells, then 1%, or 2 million, remain. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 56-7 Assess the ability of antineoplastic drugs to achieve a total cancer cure based on the cell kill hypothesis.

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31) The client receives several chemotherapeutic agents as treatments for cancer. The client asks the nurse why so many drugs are needed. What is the best response by the nurse? 1. "Using multiple drugs means a shorter treatment time." 2. "Using multiple drugs will help kill more of the cancer." 3. "Using multiple drugs is more cost effective in treating cancer." 4. "Using multiple drugs decreases the incidence of side effects." Answer: 2 Explanation: By using multiple drugs in combination, more of the cancer cells are killed. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-8 Explain how special chemotherapy protocols increase the effectiveness of therapy. 32) Most chemotherapeutic medications are administered intermittently, using specific dosing schedules. A factor that does not affect the dosing schedule is: 1. the psychologic stage of the client. 2. the condition of the client. 3. the type of tumor. 4. the stage of the disease. Answer: 1 Explanation: This is not a factor in determining the dosing schedule. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-8 Explain how special chemotherapy protocols increase the effectiveness of therapy.

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33) A client is being prepared for the delivery of an intravenous chemotherapeutic agent. The client asks why the drug cannot be given by mouth. The nurse explains that an advantage to intravenous delivery is that: 1. it protects the client from environmental infections. 2. a consistent serum drug level can be obtained. 3. it is administered outside of the home. 4. it can protect the veins during administration. Answer: 2 Explanation: This is an advantage of intravenous delivery. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 56-8 Explain how special chemotherapy protocols increase the effectiveness of therapy. 34) The nurse is preparing to administer methotrexate by mouth to a client with cancer. For what reasons would the nurse use the PO route rather than the other routes of administration? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The PO route is more acceptable to the client. 2. The PO route decreases the risk for phlebitis. 3. The PO route decreases the risk for tissue necrosis. 4. The PO route decreases the risk for nausea. 5. The PO route decreases the risk for vomiting. Answer: 1, 2, 3 Explanation: The PO route is more acceptable to clients than the other routes of administration. Receiving chemotherapeutic agents by mouth rather than intravenously decreases the risk for phlebitis. Receiving chemotherapeutic agents by mouth rather than intravenously decreases the risk for tissue necrosis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-8 Explain how special chemotherapy protocols increase the effectiveness of therapy.

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35) A female client has experienced alopecia due to chemotherapy. She is distraught and feels that no one will want to look at her. How can the nurse best address the client's concerns? 1. Show the client photos of cancer survivors whose hair grew back more thickly. 2. Discuss the client's feelings about the effects of her hair loss. 3. Have a cancer survivor visit the client and discuss wearing a wig. 4. Tell the client that her hair will grow back in a few weeks. Answer: 2 Explanation: The client needs to discuss and explore the meaning of her hair loss to deal with her feelings. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Personal and Professional Development: Demonstrate caring and compassion | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-9 Discuss the types of toxicity and adverse effects of chemotherapeutic agents on the various organ systems. 36) A client who is receiving chemotherapy frequently complains of headache. The most effective nursing intervention would be to administer: 1. ibuprofen. 2. naproxen. 3. aspirin. 4. acetaminophen. Answer: 4 Explanation: Acetaminophen is the preferred drug for chemotherapy clients because it does not precipitate bleeding. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Teamwork: Function competently within one's own scope of practice as leader or member of the healthcare team | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-9 Discuss the types of toxicity and adverse effects of chemotherapeutic agents on the various organ systems.

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37) The client experiences nausea and vomiting soon after chemotherapy treatments. What is the best action by the nurse? 1. Administer an antiemetic 1 to 2 hours before chemotherapy. 2. Increase fluid intake to flush the kidneys prior to chemotherapy. 3. Restrict food on the day the client receives chemotherapy. 4. Administer a sleeping medication during chemotherapy. Answer: 1 Explanation: An antiemetic is usually necessary to control nausea and vomiting. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Teamwork: Function competently within one's own scope of practice as leader or member of the healthcare team | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-9 Discuss the types of toxicity and adverse effects of chemotherapeutic agents on the various organ systems. 38) What would be the best response by the nurse to a client who says that her friends might not accept her now that she has had a mastectomy? 1. "It is just a mastectomy; don't worry so much." 2. "You should get some new friends." 3. "I understand your concerns about your body changes. Let's talk about it." 4. "It is normal to be worried about what other people think. Your friends will get over it." Answer: 3 Explanation: This is the best therapeutic response. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Personal and Professional Development: Demonstrate caring and compassion | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 56-9 Discuss the types of toxicity and adverse effects of chemotherapeutic agents on the various organ systems.

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39) The nurse understands that clients placed in reverse isolation might exhibit signs of depression because: 1. they often have additional side effects to therapy. 2. they often have a more severe form of cancer. 3. they might believe they are in isolation and that family will not want to visit because of the need to prevent infections that could be life threatening. 4. they always become claustrophobic. Answer: 3 Explanation: This answer is true. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Teamwork: Function competently within one's own scope of practice as leader or member of the healthcare team | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 56-9 Discuss the types of toxicity and adverse effects of chemotherapeutic agents on the various organ systems. 40) The nurse is caring for a client for myelosuppression. Which lab values would the nurse monitor for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. RBC 2. WBC 3. Platelets 4. Potassium 5. Sodium Answer: 1, 2, 3 Explanation: The nurse would monitor the client's RBCs. The nurse would monitor the client's WBCs. The nurse would monitor the client's platelet count. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Teamwork: Function competently within one's own scope of practice as leader or member of the healthcare team | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 56-9 Discuss the types of toxicity and adverse effects of chemotherapeutic agents on the various organ systems. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 57 Pharmacotherapy of Neoplasia 1) A common theme among all the antineoplastic agents is: 1. their adverse effects. 2. their ability to kill cancer cells. 1071

3. their drug interactions. 4. their mechanism of action. Answer: 2 Explanation: A common theme of all antineoplastic agents is their toxicity—their ability to kill cancer cells. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-1 Explain why it is difficult to accurately classify antineoplastic drugs. 2) Classification of antineoplastics is difficult because: 1. the drugs kill cancer cells by different mechanisms and have characteristics from more than one class. 2. the drugs cannot always kill the cancer cells. 3. the drugs only have characteristics from one class, even though they kill by different mechanisms. 4. the drugs have various adverse effects. Answer: 1 Explanation: These are the reasons classification is so difficult. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-1 Explain why it is difficult to accurately classify antineoplastic drugs.

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3) Many antineoplastic agents have characteristics of more than one class. Paclitaxel (Taxol) can be classified as: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. a natural product. 2. a taxane. 3. a mitotic inhibitor. 4. a cell cycle inhibitor. 5. an alkylating agent. Answer: 1, 2, 3, 4 Explanation: Paclitaxel (Taxol) can be classified as a natural product (it was derived from a plant). Paclitaxel (Taxol) can be classified as a taxane (its chemical structure). Paclitaxel (Taxol) can be classified as a mitotic inhibitor (its mechanism of action). Paclitaxel (Taxol) can be classified as a cell cycle inhibitor. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-1 Explain why it is difficult to accurately classify antineoplastic drugs. 4) Which statement regarding the adverse effects of antineoplastic drugs is the most accurate? 1. They produce the most, but a small range of, adverse effects. 2. They produce the same amount of adverse effects as any other medication. 3. They commonly produce serious adverse effects. 4. They produce the least amount of serious adverse effects of any medication. Answer: 3 Explanation: Antineoplastic drugs commonly produce serious adverse effects that may affect the patient's ability or willingness to continue therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-12 Apply the nursing process to care for patients receiving cancer chemotherapy.

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5) The nurse states that bone marrow toxicity does not suppress which type of cells? 1. White blood cells 2. Platelets 3. T cells 4. Red blood cells Answer: 3 Explanation: Bone marrow toxicity does not specifically suppress T cells. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 57-2 Describe the common and dose-limiting toxicities of antineoplastics. 6) The nurse tells the client that alkylating agents kill cancer cells by: 1. containing substances from bacteria that can kill cancer cells. 2. disrupting critical cellular pathways of cancer cells. 3. changing the shape of the DNA double helix and preventing DNA from duplicating during cell division. 4. blocking substances necessary for continued growth of tumors. Answer: 3 Explanation: This is the action of alkylating agents. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 57-3 Describe how the process of alkylation kills rapidly growing cells.

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7) The client receives cyclophosphamide (Cytoxan) as treatment for cancer and experiences oral irritation as an adverse effect. What does the best plan of the nurse include to promote oral comfort? 1. Ice fluids before drinking. 2. Teach good oral hygiene, including rinsing the mouth with plain water after eating. 3. Teach the client to drink tea to keep tissues moist. 4. Teach the client to use a firm toothbrush for brushing teeth. Answer: 2 Explanation: Simple rinsing of the mouth with plain water may help relieve symptoms. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 57-3 Describe how the process of alkylation kills rapidly growing cells. 8) The client receives cisplatin (Platinol) as therapy for cancer. Which assessment finding would prompt the nurse to contact the client's healthcare provider immediately? 1. Nausea and projectile vomiting 2. A temperature greater than 101°F 3. An elevation in blood glucose 4. A complaint of painful leg cramps Answer: 2 Explanation: A temperature greater than 101°F can indicate an infection, which can be life threatening because low WBCs are an adverse effect of cisplatin (Platinol). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-3 Describe how the process of alkylation kills rapidly growing cells.

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9) The nurse is explaining the mechanisms of action for alkylating agents and states that alkylating agents kill cancer cells by: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. altering the shape of the DNA double helix. 2. preventing the DNA from duplicating during cell division. 3. becoming incorporated into the DNA of cancer cells. 4. interfering with DNA replication and function. 5. an unknown mechanism of action. Answer: 1, 2 Explanation: Alkylating agents alter the shape of the DNA double helix. Alkylating agents prevent the DNA from duplicating during cell division. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 57-3 Describe how the process of alkylation kills rapidly growing cells. 10) The nurse is describing the mechanism of action of antimetabolites to a client with cancer. Which statement best describes how the antimetabolites kill cancer cells? 1. "They use the body's immune system to kill tumor cells." 2. "They disrupt metabolic pathways, slowing growth of cancer cells." 3. "They contain bacterial substances that can kill cancer cells." 4. "They change the shape of the DNA and prevent division of cancer cells." Answer: 2 Explanation: This describes antimetabolites. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 57-4 Describe how antimetabolites kill cancer cells.

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11) Folic acid analogs can be toxic to normal cells as well as to cancer cells. Which drug will the nurse administer following the administration of methotrexate to "rescue" the normal cells, causing them to be able to continue replication and development? 1. Leucovorin 2. Iron therapy 3. Immunoglobulin 4. Vitamin B12 Answer: 1 Explanation: Leucovorin is given to rescue normal cells during methotrexate administration. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 57-4 Describe how antimetabolites kill cancer cells. 12) When a client taking methotrexate notifies the nurse of a sudden onset of a rash, the nurse is alerted to what life-threatening adverse effect associated with methotrexate? 1. Peptic ulcer 2. Stevens–Johnson syndrome 3. Pancreatitis 4. Myocardial infarction Answer: 2 Explanation: This is the correct answer. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 57-12 Apply the nursing process to care for patients receiving cancer chemotherapy.

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13) The nurse is reviewing medications that are similar to methotrexate. Which medications are closely related to methotrexate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Pemetrexed 2. Pralatrexate 3. Idarubicin 4. Plicamycin 5. Doxorubicin Answer: 1, 2 Explanation: Pemetrexed is a medication that is similar in action to methotrexate. Pralatrexate is a medication that is similar in action to methotrexate. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-4 Describe how antimetabolites kill cancer cells. 14) The nurse is describing the mechanism of action for antibiotic antineoplastics to a client who is being treated for cancer. Which description by the nurse is most appropriate? 1. "They contain substances from bacteria that have the ability to kill cancer cells." 2. "They contain substances from plants that have the ability to kill cancer cells." 3. "They contain substances from viruses that have the ability to kill cancer cells." 4. "They contain substances from hormones that have the ability to kill cancer cells." Answer: 1 Explanation: They do contain substances from bacteria that can kill cancer cells. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 57-5 Describe mechanisms by which antitumor antibiotics kill cancer cells.

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15) Unlike alkylating agents, antitumor antibiotics: 1. are not given orally. 2. have severe adverse effects. 3. have no dose-limiting toxicities. 4. are not mitotic inhibitors. Answer: 1 Explanation: They must be given intravenously, or through direct instillation via a catheter into a body cavity or organ. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-5 Describe mechanisms by which antitumor antibiotics kill cancer cells. 16) The nurse knows that client education on drug interactions with doxorubicin has been successful when the client states: 1. "I can take acetaminophen if I get a fever." 2. "I can take my Celebrex for my arthritis." 3. "I can take ibuprofen for my back pain." 4. "I can take an aspirin for a headache." Answer: 1 Explanation: Acetaminophen is appropriate to take, because it doesn't increase the risk of bleeding. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 57-5 Describe mechanisms by which antitumor antibiotics kill cancer cells.

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17) The nurse is teaching a client about anthracyclines. Which medications will the nurse include in the teaching session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Doxorubicin 2. Daunorubicin 3. Epirubicin 4. Bleomycin 5. Dactinomycin Answer: 1, 2, 3 Explanation: The anthracyclines include doxorubicin. The anthracyclines include daunorubicin. The anthracyclines include epirubicin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 57-5 Describe mechanisms by which antitumor antibiotics kill cancer cells. 18) Which statement is true regarding hormone antagonists? 1. They are cytotoxic. 2. They enhance substances essential for hormone growth. 3. They produce debilitating adverse effects similar to those produced by the other antineoplastics. 4. They can produce debilitating adverse effects at high doses for prolonged periods. Answer: 4 Explanation: This classification of medications can produce debilitating adverse effects when given at high doses for prolonged periods of time. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-6 Explain applications of hormones and hormone antagonists to cancer chemotherapy.

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19) The client receives tamoxifen for treatment of breast cancer. She asks the nurse why the medicine works. What is the best response by the nurse? 1. "Tamoxifen works by inhibiting the metabolism of breast cancer cells." 2. "Tamoxifen works by inhibiting the cellular mitosis of breast cancer." 3. "Tamoxifen works by blocking estrogen receptors on breast tissue." 4. "Tamoxifen works by binding to the DNA of breast cancer cells." Answer: 3 Explanation: Tamoxifen acts by blocking estrogen receptors. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 57-6 Explain applications of hormones and hormone antagonists to cancer chemotherapy. 20) The nurse is discussing the use of tamoxifen with a client who has a family history of breast cancer. The nurse states that a unique approved use for tamoxifen is: 1. treatment for advanced lung cancer. 2. for prophylaxis of breast cancer. 3. treatment for estrogen receptor–negative cancers. 4. for the cure of advanced breast cancer. Answer: 2 Explanation: It is approved for prophylaxis of breast cancer for high-risk clients who are at risk of developing the disease. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 57-6 Explain applications of hormones and hormone antagonists to cancer chemotherapy.

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21) The nurse is teaching a client about tamoxifen therapy in the treatment of breast cancer. The nurse tells the client that the total length of endocrine therapy is years. Record your answer rounding to the nearest whole number. Answer: 5 Explanation: The American Society of Clinical Oncology (ASCO) recommends aromatase inhibitor therapy with exemestane (Aromasin) as an option for all postmenopausal women with ER-positive breast cancer. Aromatase inhibitors can be started as primary therapy, or instituted after the completion of 2 to 3 years of tamoxifen therapy. For most patients, the total length of endocrine therapy (tamoxifen plus aromatase inhibitor) is 5 years. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 57-6 Explain applications of hormones and hormone antagonists to cancer chemotherapy. 22) Agents with antineoplastic activity that have been isolated from a number of plants work in what way? 1. They aid in attachment to the receptor sites on the cancer cell. 2. They arrest cell division, or mitosis. 3. They contain substances that have the ability to kill the cancer cells. 4. They prevent conversion from DNA to RNA. Answer: 2 Explanation: They stop cell division, or mitosis. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-8 Explain the use of biologic response modifiers and targeted therapies in cancer chemotherapy.

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23) When administering vincristine, the nurse knows that its dose-limiting toxicity primarily affects what system? 1. Renal 2. Pulmonary 3. Cardiac 4. Central nervous system Answer: 4 Explanation: The system primarily affected by the dose-limiting toxicity of vincristine is the central nervous system. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-7 Identify natural products that have the ability to kill tumor cells. 24) A client shows a proper understanding of the adverse effects of vincristine when he states: 1. "I need to let my doctor know immediately if I have any weakness in my hands or feet." 2. "If I have swelling in my legs, I should keep them elevated for a while." 3. "I can take ibuprofen if I have any pain." 4. "I need to let my doctor know immediately if I took two pills instead of one." Answer: 1 Explanation: This is the correct response. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 57-7 Identify natural products that have the ability to kill tumor cells.

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25) The nurse is teaching a client about the different plants that can be used in the treatment of cancer. Which plants does the nurse include in the teaching session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Roses 2. Common periwinkle 3. Pacific yew 4. Mandrake 5. Tulips Answer: 2, 3, 4 Explanation: Common periwinkle is a plant that can be used to treat cancer. Pacific yew is a plant that can be used to treat cancer. Mandrake is a plant that can be used to treat cancer. Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-7 Identify natural products that have the ability to kill tumor cells. 26) Which statement is true regarding biologic response modifiers? 1. They are used to treat transplant rejections. 2. Some are immunostimulants and, when given with other antineoplastic agents, help limit severe myelosuppression. 3. They alter the body's defense system to decrease the removal of foreign cancer cells. 4. They are less toxic than are most classes of antineoplastics. Answer: 2 Explanation: This is true regarding biologic response modifiers. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-8 Explain the use of biologic response modifiers and targeted therapies in cancer chemotherapy.

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27) Which statement best explains the mechanism of action of monoclonal antibodies? 1. They alter the DNA of the tumor cells. 2. They prevent replication of the tumor cells. 3. They stimulate immune cell function. 4. They attack antigens on the surface of specific tumor cells. Answer: 4 Explanation: This is the correct mechanism of action of monoclonal antibodies. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-8 Explain the use of biologic response modifiers and targeted therapies in cancer chemotherapy. 28) The nurse is teaching a client about the use of hematopoietic growth factors to promote the formation of specific blood cells. Which medications will the nurse include in the teaching session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Epoetin alfa 2. Filgrastim 3. Sargramostim 4. Aldesleukin 5. IFN alfa-2b Answer: 1, 2, 3 Explanation: Epoetin alfa is a medication that is used to promote the formation of specific blood cells. Filgrastim is a medication that is used to promote the formation of specific blood cells. Sargramostim is a medication that is used to promote the formation of specific blood cells. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 57-8 Explain the use of biologic response modifiers and targeted therapies in cancer chemotherapy.

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29) If the nurse is caring for a client taking epoetin alfa and notices blood lab tests have dropped below normal, the best initial action would be to: 1. tell the client to take her normal dose that day, but come in for some lab work. 2. notify the healthcare provider. 3. tell the client to stop the drug and notify her healthcare provider. 4. tell the client to stop the drug for 3 days to give the body some time for the levels to rise back to normal. Answer: 2 Explanation: The nurse would notify the healthcare provider because the dose of epoetin alfa should be increased so that the therapeutic effects can be achieved. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 57-11 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 30) When administering cyclophosphamide (Cytoxan), which has the potential adverse effect of cardiotoxicity, what is the best action by the nurse during treatment? 1. Obtain baseline and periodic ECGs. 2. Stop the drug if abnormal heart sounds are auscultated. 3. Obtain baseline and periodic echocardiograms. 4. Obtain baseline and periodic cardiac enzymes. Answer: 1 Explanation: This is the correct answer. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 57-11 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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31) The nurse is preparing to administer cyclophosphamide (Cytoxan), which can cause nausea and vomiting. The nurse can best manage this by: 1. giving the client bland foods during treatment. 2. administering antiemetic drugs as necessary. 3. withholding food during administration. 4. increasing fluids during administration. Answer: 2 Explanation: This is the best way to manage nausea and vomiting. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 57-11 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 32) The nurse is preparing to administer a dose of methotrexate to a client in the treatment of non-Hodgkin's lymphoma. The nurse expects the client to experience adverse effects from 1 to hours after the medication is administered by mouth. Record your answer rounding to the nearest whole number. Answer: 4 Explanation: The onset of action for this medication is 1 to 4 hours when it is administered by mouth. The nurse would expect the client to experience adverse effects when the medication begins to act on the body. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 57-11 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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33) The nurse is caring for a pediatric client taking doxorubicin for the treatment of Wilms' tumor. The nurse anticipates the neutropenia nadir will occur on day 7 of administration and recover by days. Record your answer rounding to the nearest whole number. Answer: 14 Explanation: Severe myelosuppression may occur, which is the major dose-limiting toxicity. It may manifest as thrombocytopenia, leukopenia (especially granulocytes), and anemia. The neutropenia nadir occurs at 7 days and recovers by 14 days. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 57-11 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 34) Many chemotherapy agents cause nausea and vomiting. The type and dose of antiemetic prescribed are based on: 1. the potential of specific antineoplastics to cause nausea and vomiting. 2. how many other medications the client is taking. 3. the severity of the client's symptoms. 4. the dose of the antineoplastics. Answer: 1 Explanation: This is the correct answer. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IV.7 Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 57-9 Describe the types of drugs prescribed to reduce or prevent the adverse effects of antineoplastic drugs.

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35) The nurse anticipates administering which drug to stimulate neutrophil production in clients with myelosuppression? 1. Epoetin 2. Interferon alfa 3. Filgrastim 4. Oprelvekin Answer: 3 Explanation: This is the correct answer. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IV.7 Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 57-9 Describe the types of drugs prescribed to reduce or prevent the adverse effects of antineoplastic drugs. 36) The nurse is teaching a client about medications that can be taken to treat the diarrhea that often accompanies chemotherapy. Which medications would be appropriate for the nurse to include in the teaching session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Polyethylene glycol 3350 (MiraLAX) 2. Psyllium (Metamucil) 3. Atropine (Lomotil) 4. Loperamide (Imodium) 5. Bismuth salts (Pepto Bismol) Answer: 3, 4, 5 Explanation: This medication can be used to stop or decrease diarrhea. This medication can be used to stop or decrease diarrhea. This medication can be used to stop or decrease diarrhea. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IV.7 Recognize the role of information technology in improving patient care outcomes and creating a safe care environment | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-9 Describe the types of drugs prescribed to reduce or prevent the adverse effects of antineoplastic drugs.

1089

37) The nurse who has received special training to administer chemotherapy is called: 1. an antineoplastic administrator. 2. a chemotherapy nurse. 3. an oncology nurse. 4. an IV therapy nurse. Answer: 3 Explanation: This type of nurse is called an oncology nurse. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.9 Apply quality improvement processes to effectively implement patient safety initiatives and monitor performance measures, including nurse-sensitive indicators in the microsystem of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 57-10 Discuss ways nurses can protect themselves from exposure to antineoplastics. 38) A large number of antineoplastic medications are absorbed through what route? 1. Fecal–oral 2. Skin and mucous membranes 3. Respiratory secretions 4. Hair follicles Answer: 2 Explanation: Antineoplastic medications are absorbed via skin and mucous membranes. Cognitive Level: Understanding Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.9 Apply quality improvement processes to effectively implement patient safety initiatives and monitor performance measures, including nurse-sensitive indicators in the microsystem of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 57-10 Discuss ways nurses can protect themselves from exposure to antineoplastics.

1090

39) OSHA has established guidelines for the safe handling of chemotherapeutic medications. The nurse correctly states that safe handling includes: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. safe medication storage. 2. safe medication disposal. 3. safe medication handling. 4. required days off. 5. appropriate charges for services. Answer: 1, 2, 3 Explanation: OSHA has instituted specific guidelines for safe medication storage for chemotherapeutic agents. OSHA has instituted specific guidelines for safe medication disposal for chemotherapeutic agents. OSHA has instituted specific guidelines for safe medication handling for chemotherapeutic agents. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.9 Apply quality improvement processes to effectively implement patient safety initiatives and monitor performance measures, including nurse-sensitive indicators in the microsystem of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 57-10 Discuss ways nurses can protect themselves from exposure to antineoplastics. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 58 Review of the Gastrointestinal System 1) The nurse is aware that the alimentary canal extends from the: 1. esophagus to the small intestine. 2. stomach to the large intestine. 3. mouth to the anus. 4. mouth to the liver. Answer: 3 Explanation: The GI tract is a long, continuous, hollow tube that extends from the mouth to the anus. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-1 Describe the major anatomic structures of the digestive system. 2) Which assessment finding would indicate to the nurse that a client's gastrointestinal tract is functioning adequately? 1. Peristaltic waves seen upon inspection of the abdomen 2. Lack of a bowel movement for several days 1091

3. Hypoactive bowel sounds in all four quadrants of the abdomen 4. Active bowel sounds in all four quadrants of the abdomen Answer: 4 Explanation: Active bowel sounds are an indication of peristaltic waves and adequate functioning of the GI tract. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-1 Describe the major anatomic structures of the digestive system.

1092

3) The nurse is performing a head-to-toe assessment of a client and would expect to palpate the liver in which quadrant? 1. Right lower quadrant 2. Left upper quadrant 3. Right upper quadrant 4. Left lower quadrant Answer: 3 Explanation: The liver is anatomically positioned in the right costal border. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-1 Describe the major anatomic structures of the digestive system. 4) A client is scheduled to undergo gastric bypass surgery. Which structures does the nurse include in a discussion about accessory organs of digestion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Salivary glands 2. Liver 3. Stomach 4. Gallbladder 5. Pancreas Answer: 1, 2, 4, 5 Explanation: The salivary glands are considered an accessory organ of digestion. The liver is an accessory organ of digestion. The gallbladder is an accessory organ of digestion. The pancreas is an accessory organ of digestion. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-1 Describe the major anatomic structures of the digestive system.

1093

5) In some clients, ingestion bypasses the mouth and delivers nutrients directly into the stomach or small intestine. An example of this would be the client with: 1. a Salem sump feeding tube. 2. total parenteral nutrition (TPN) via central venous catheter. 3. partial parenteral nutrition (PPN) via intravenous catheter. 4. an ileostomy. Answer: 1 Explanation: A Salem sump tube delivers food to the stomach, bypassing the mouth. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-2 Outline the steps in the process of digestion. 6) The nurse is aware that which structure does not secrete digestive enzymes? 1. Esophagus 2. Small intestine 3. Salivary glands 4. Stomach Answer: 1 Explanation: The esophagus does not secrete digestive enzymes. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-2 Outline the steps in the process of digestion.

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7) The nurse is caring for a client with liver damage. Which process by the liver might be impaired? 1. Production of bile 2. Storage of bile 3. Secretion of insulin 4. Secretion of somatostatin Answer: 1 Explanation: The liver makes bile. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-2 Outline the steps in the process of digestion. 8) The nurse is teaching a client about the importance of enzymes to digestion. The nurse explains that digestive enzymes are secreted by the: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. salivary glands. 2. stomach. 3. large intestine. 4. small intestine. 5. liver. Answer: 1, 2, 4 Explanation: Digestive enzymes are secreted by the salivary glands. Digestive enzymes are secreted by the stomach. Digestive enzymes are secreted by the small intestine. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-2 Outline the steps in the process of digestion.

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9) A client is complaining of esophageal reflux. In order for stomach contents to reflux backward, the nurse knows they must go through: 1. the pyloric sphincter. 2. the cardiac sphincter. 3. the urethral sphincter. 4. Oddi's sphincter. Answer: 2 Explanation: During esophageal reflux, the stomach contracts, overwhelming the lower esophageal sphincter (cardiac sphincter). Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-3 Describe the primary functions of the stomach. 10) What strong acid in the stomach helps to break down food, activates pepsinogen, and kills ingested microbes? 1. Lactic acid 2. Acetoacetic acid 3. Carbonic acid 4. Hydrochloric acid Answer: 4 Explanation: Hydrochloric acid is secreted by the parietal cells of the stomach. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-3 Describe the primary functions of the stomach.

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11) A client has a newly placed percutaneous endoscopic gastrostomy tube. When checking the gastric pH, the nurse expects to find a pH of: 1. 5.0 to 7.30. 2. 3.5 to 5.0. 3. 1.5 to 3.5. 4. 7.35 to 7.45. Answer: 3 Explanation: The gastric juice is the most acidic fluid in the body, with a pH of 1.5 to 3.5. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-3 Describe the primary functions of the stomach. 12) The nurse, instructing a client prior to gastric bypass surgery, explains that chyme cannot pass into the small intestine until it is mm in size. Record your answer rounding to the nearest whole number. Answer: 2 Explanation: The pyloric sphincter regulates the flow of substances leaving the stomach. Chyme moves in "spurts" through the sphincter into the small intestine. Large pieces of food are refluxed back into the body of the stomach, where they are reduced in size to about 2 mm so that they may pass through the sphincter. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-3 Describe the primary functions of the stomach.

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13) The nurse is preparing to administer a drug to a client. The nurse anticipates that the medication will be destroyed completely in the stomach because the pH of the stomach is 1 to . Record your answer rounding to the nearest whole number. Answer: 2 Explanation: The pharmacologic importance of the stomach lies in its capacity to absorb drugs. For most oral drugs, the stomach is not the primary site of absorption because the drug does not stay long in the organ. Stomach acidity (pH 1-2) can either assist in the absorption process or destroy the drug entirely. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-3 Describe the primary functions of the stomach. 14) The nurse is explaining the role of hydrochloric acid in the digestive process to the family member of a client who has just had gastric bypass surgery. The nurse explains that the parietal cells in the stomach secrete 1 to liters of hydrochloric acid each day. Record your answer rounding to the nearest whole number. Answer: 3 Explanation: Parietal cells secrete 1 to 3 liters of hydrochloric acid each day. This strong acid helps to break down food, activates pepsinogen, and kills microbes that may have been ingested. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-3 Describe the primary functions of the stomach.

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15) A client is scheduled to have a segment of the terminal ileum removed secondary to cancer. The nurse anticipates this client is at risk for: 1. atelectasis. 2. decubitus ulcers. 3. pernicious anemia. 4. sepsis. Answer: 3 Explanation: The terminal ileum is a primary site for the absorption of vitamin B12. The inability to absorb B12 will likely cause pernicious anemia. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 58-4 Analyze how the anatomic structures of the small intestine promote the absorption of nutrients and drugs. 16) The small intestine is alkaline in nature. Which organ is responsible for raising the pH of the small intestine? 1. Pancreas 2. Large intestine 3. Gallbladder 4. Liver Answer: 1 Explanation: The pancreas is an essential accessory digestive organ, secreting about a quart of pancreatic fluid into the duodenum each day. This fluid is alkaline (pH 7.5 to 8.8) and contains digestive enzymes to chemically break down carbohydrates, lipids, proteins, and nucleic acids. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-4 Analyze how the anatomic structures of the small intestine promote the absorption of nutrients and drugs.

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17) A client has irritable bowel syndrome (IBS). The nurse explains that the majority of nutrient and drug absorption takes place in the first 1 to meters of the jejunum. Record your answer rounding to the nearest whole number. Answer: 2 Explanation: The first 1 to 2 meters of the jejunum is the site of the majority of nutrient and drug absorption. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-4 Analyze how the anatomic structures of the small intestine promote the absorption of nutrients and drugs. 18) A nurse is planning to administer acetaminophen (Tylenol) per rectum to a client. The nurse expects: 1. the onset of action to be slower than that of the oral route. 2. the onset of action to be faster than that of the oral route. 3. the onset of action to be faster than that of the intravenous route. 4. the onset of constipation. Answer: 1 Explanation: The onset of action for drugs given per rectum is usually slower than that of the oral route. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-5 Describe the primary structures and functions of the large intestine.

1100

19) A client has been taking oral antibiotic therapy for 3 days when the client develops diarrhea. The most likely cause of the diarrhea is: 1. disruption of normal flora. 2. idiopathic causes. 3. hospital-acquired infection. 4. fluid volume excess. Answer: 1 Explanation: Disruption of normal flora by the antibiotics is the likely cause. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 58-5 Describe the primary structures and functions of the large intestine. 20) The nurse is caring for a newborn who has been NPO since birth. Due to the lack of normal flora in the GI tract, the nurse anticipates the infant will require supplementation with: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. vitamin A. 2. vitamin B-complex. 3. vitamin C. 4. vitamin K. 5. electrolytes. Answer: 2, 4 Explanation: Normal flora is required to synthesize vitamin B-complex. Normal flora is required to synthesize vitamin K. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-5 Describe the primary structures and functions of the large intestine.

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21) The nurse identifies that the most important accessory digestive organ is the: 1. gallbladder. 2. teeth. 3. liver. 4. duodenum. Answer: 3 Explanation: The overall function of the liver is to filter and process nutrients and drugs delivered to it. Substances can be stored, chemically altered, or removed from the blood before they reach the general circulation. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-6 Describe the functions of the liver and their relevance to drug therapy. 22) In administering medications, the nurse is aware that most drugs are excreted by the kidneys after being metabolized by the: 1. gallbladder. 2. liver. 3. small intestine. 4. pancreas. Answer: 2 Explanation: When most drugs reach the liver, they are metabolized to less toxic substances that are more easily excreted by the kidneys. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-6 Describe the functions of the liver and their relevance to drug therapy.

1102

23) The nurse is planning care for a client with hepatitis. The nurse anticipates that drug metabolism: 1. will not be affected. 2. will never occur. 3. might be delayed. 4. might be accelerated. Answer: 3 Explanation: The liver is the organ primarily responsible for the metabolism of drugs. In a client with an inflammatory disease of the liver, drug metabolism might be impaired. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 58-6 Describe the functions of the liver and their relevance to drug therapy. 24) A client with cirrhosis of the liver asks the nurse why the liver is so important to bodily function. How can the nurse respond most accurately? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The liver helps the body synthesize bile." 2. "The liver helps the body synthesize plasma proteins." 3. "The liver helps the body retain ammonia." 4. "The liver synthesizes glucose for use by the body." 5. "The liver synthesizes clotting factors." Answer: 1, 2, 5 Explanation: The liver synthesizes bile. The liver synthesizes plasma proteins. The liver synthesizes certain clotting factors. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-6 Describe the functions of the liver and their relevance to drug therapy.

1103

25) Because of the first-pass effect, clients may require: 1. a larger dose of oral medication than of intravenous medication. 2. a smaller dose of oral medication than of rectal medication. 3. a smaller dose of oral medication than of intravenous medication. 4. the same oral and intravenous dosage of a medication. Answer: 1 Explanation: In order for medication to be available, it must first pass through the liver, where it is broken down into active and inactive molecules. Medications given by the oral route are subject to this first-pass effect; thus, oral doses must be larger than parenteral doses of the same medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-7 Explain the hepatic portal system and its importance to drug therapy. 26) The school nurse explains during health class that blood travels from the intestine to the liver in which fashion? 1. Through an artery 2. Through a vein 3. Through osmosis 4. Through active transport Answer: 2 Explanation: The portal vein carries blood from the intestine to the liver. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-7 Explain the hepatic portal system and its importance to drug therapy.

1104

27) The nurse is preparing to administer a sublingual nitroglycerin tablet. With regard to the first-pass effect, the nurse understands that: 1. The first-pass effect will decrease the drug's effectiveness by one third. 2. Drugs given sublingually are subject to the first-pass effect. 3. The first-pass effect will neutralize this drug's effect. 4. Drugs given sublingually bypass the first-pass effect. Answer: 4 Explanation: Drugs given by the buccal, sublingual, or rectal routes bypass the first-pass effect of the liver because the venous supply of the head and lower rectum is not part of the hepatic portal system. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-7 Explain the hepatic portal system and its importance to drug therapy. 28) The nurse is preparing to administer 10 a.m. medications to a group of clients on a medical– surgical unit. Which medications will bypass the first-pass effect of the liver? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Topical nitroglycerin 2. Sublingual nitroglycerin 3. Rectal diazepam 4. Buccal nitroglycerin 5. IV diazepam Answer: 2, 3, 4 Explanation: Medications that are given sublingually bypass the first-pass effect on the liver. Medications that are given rectally bypass the first-pass effect of the liver. Medications that are given buccally bypass the first-pass effect on the liver. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-7 Explain the hepatic portal system and its importance to drug therapy.

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29) The nurse is reviewing medication orders for a client and anticipates that which medications may cause adverse effects due to their extended half-life caused by enterohepatic recirculation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Digoxin 2. Morphine 3. Demerol 4. Fentanyl 5. Estrogen Answer: 1, 2, 5 Explanation: Certain drugs, including digoxin, are eliminated in the bile and reabsorbed by enterohepatic recirculation, which recycles the drug multiple times and can significantly extend a drug's half-life and cause increased adverse effects. Certain drugs, including morphine, are eliminated in the bile and reabsorbed by enterohepatic recirculation, which recycles the drug multiple times and can significantly extend a drug's half-life and cause increased adverse effects. Certain drugs, including estrogen, are eliminated in the bile and reabsorbed by enterohepatic recirculation, which recycles the drug multiple times and can significantly extend a drug's half-life and cause increased adverse effects. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-7 Explain the hepatic portal system and its importance to drug therapy. 30) A client with severe anxiety asks the nurse if anxiety can affect the stomach and digestion. What is the nurse's most accurate response? 1. "Everyone with anxiety develops irritable bowel disease." 2. "Mental health conditions do not affect digestive processes." 3. "Mental health conditions can affect digestive processes." 4. "I will ask your doctor to speak with you about this." Answer: 3 Explanation: Mental health conditions such as depression, anxiety, excessive stress, or bipolar disorder can affect appetite and digestive processes. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-8 Explain the nervous control of digestion.

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31) The GI tract is regulated by local reflexes known as the: 1. parasympathetic nervous system. 2. sympathetic nervous system. 3. enteric nervous system. 4. central nervous system. Answer: 3 Explanation: The enteric nervous system consists of a vast network of neurons in the submucosa of the alimentary canal that has sensory and motor functions. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-8 Explain the nervous control of digestion. 32) The nurse caring for a group of clients on a psychiatric–mental health unit expects that symptoms affecting both appetite and digestive processes may be exhibited by: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. the client with depression. 2. the client with schizophrenia. 3. the client with bipolar disorder. 4. the client with generalized anxiety disorder. 5. the client experiencing post-traumatic stress disorder (PTSD). Answer: 1, 3, 4, 5 Explanation: Depression is a mental health disorder that can affect appetite and digestion. Bipolar disorder is a mental health disorder that can affect appetite and digestion. Anxiety is a mental health disorder that can affect appetite and digestion. Any stress disorder, including PTSD, can affect appetite and digestion. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-8 Explain the nervous control of digestion.

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33) The nurse is planning care for a group of clients and determines that the client most likely to experience malnutrition from a lack of digestive enzymes is the client with: 1. pancreatic disorder. 2. pernicious anemia. 3. the jaw wired closed. 4. a percutaneous endoscopic gastrostomy (PEG) tube. Answer: 1 Explanation: Many digestive enzymes are produced by the pancreas. A disorder of the pancreas may inhibit digestive enzymes and cause malnutrition. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 58-9 Explain the enzymatic breakdown of nutrients by the digestive system. 34) A client asks how the nutrients from food enter the blood. How can the nurse best explain this process? 1. "When food hits the stomach, hydrochloric acid liquefies it and transports it into your blood." 2. "Chemical digestion breaks down food molecules into simpler substances." 3. "Only nutrients from liquid sources make it into the blood. That is why it is important to drink fluids with meals." 4. "The teeth and saliva break food into their smallest portions and transport nutrients to the blood." Answer: 2 Explanation: Chemical digestion must break down complex food molecules into simpler substances so that they can be absorbed and used by the body for metabolic processes. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-9 Explain the enzymatic breakdown of nutrients by the digestive system.

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35) The nurse teaching a client with gastroesophageal reflux disorder (GERD) about digestion explains that the process is regulated by: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. hormones. 2. the sympathetic nervous system. 3. medications. 4. peristalsis. 5. the parasympathetic nervous system. Answer: 1, 2, 5 Explanation: The secretion of digestive enzymes is regulated by hormones. The secretion of digestive enzymes is regulated by the nervous system. The secretion of digestive enzymes is regulated by the nervous system. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 58-9 Explain the enzymatic breakdown of nutrients by the digestive system. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 59 Pharmacotherapy of Peptic Ulcer Disease 1) The nurse correctly states that which function is not characteristic of the parietal cells? 1. Secretion of intrinsic factor 2. Microbial control 3. Secretion of hydrochloric acid 4. Secretion of pepsinogen Answer: 4 Explanation: Chief cells, not parietal cells, secrete the enzyme pepsinogen. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 59-1 Explain the physiologic regulation of gastric acid secretion. 2) A client with a diagnosis of peptic ulcer disease is prescribed omeprazole (Prilosec) and asks the nurse where in the body this medication will work. The nurse correctly answers: 1. "On the gastric mucosa layer." 2. "On the mucosa of the trachea." 3. "On the surface of parietal cells." 4. "On the H2 receptors." Answer: 3 1109

Explanation: Omeprazole is a proton pump inhibitor and works on the proton pump, which is located on the surface of parietal cells. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-1 Explain the physiologic regulation of gastric acid secretion.

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3) A client who was taking large doses of ibuprofen (Motrin) for over a year developed a peptic ulcer. The client asks the nurse why this occurred. The nurse best answers the client by stating: 1. "Motrin works against your own body's ulcer defenses." 2. "It sounds like your stress might have caused your ulcer." 3. "Taking Motrin cannot cause a peptic ulcer." 4. "The natural defenses of your large intestine were overwhelmed." Answer: 1 Explanation: Ibuprofen is a prostaglandin antagonist. This will decrease the defenses of the gastric mucosa and could precipitate a peptic ulcer. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-1 Explain the physiologic regulation of gastric acid secretion. 4) What are the principal physiologic stimuli that regulate acid secretion from the proton pump? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Gastrin 2. Histamine (H2) 3. Acetylcholine 4. Intrinsic factor 5. Dopamine Answer: 1, 2, 3 Explanation: Parietal cells receive messages from several sources, which tell them to increase or decrease acid production. These cells contain receptors for the hormone gastrin, which is a principal physiologic stimulus that regulates acid secretion from the proton pump. Parietal cells receive messages from several sources, which tell them to increase or decrease acid production. These cells contain receptors for histamine (H2), which is a principal physiologic stimulus that regulates acid secretion from the proton pump. Parietal cells receive messages from several sources, which tell them to increase or decrease acid production. These cells contain receptors for the neurotransmitter acetylcholine, which is a principal physiologic stimulus that regulates acid secretion from the proton pump. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 59-1 Explain the physiologic regulation of gastric acid secretion.

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5) What client has the greatest risk of having a peptic ulcer? 1. A 24-year-old who complains of being stressed mentally 2. A 52-year-old who smokes 3. A 56-year-old who is taking prednisone and ibuprofen for chronic low-back pain 4. A 48-year-old who is taking acetaminophen and aspirin to reduce fever Answer: 3 Explanation: This client has two risk factors for developing a peptic ulcer, making this the best choice. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 59-2 Describe factors that suppress and those that promote the formation of peptic ulcers. 6) The nurse is caring for an adult man diagnosed with a peptic ulcer. The nurse states that the most likely causative agent is: 1. Cryptococcus. 2. Pneumocystis carinii. 3. Helicobacter pylori. 4. Mycobacterium avium. Answer: 3 Explanation: Helicobacter pylori is associated with 70% of peptic ulcers. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-2 Describe factors that suppress and those that promote the formation of peptic ulcers.

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7) The healthcare team is attempting to determine cause for a client's duodenal ulcer. Which factors are not associated with peptic ulcer disease (PUD)? 1. Smoking cigarettes 2. Having a parent diagnosed with a peptic ulcer 3. Excessive stress at home 4. Having type A blood Answer: 4 Explanation: Having type O blood, not type A, places one at risk for developing a peptic ulcer. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-2 Describe factors that suppress and those that promote the formation of peptic ulcers. 8) The nurse is teaching the family of a client recently diagnosed with PUD. The nurse knows the family members understand the teaching when they state that the risk factors for the development of PUD include: Note: Credit will be given only if all correct choices and no incorrect choices are selected Select all that apply. 1. infection with the bacterium Helicobacter pylori. 2. daily use of aspirin. 3. blood type AB. 4. consumption of caffeine-free soda. 5. smoking. Answer: 1, 2, 5 Explanation: Helicobacter pylori is a risk factor for the development of PUD. Daily use of aspirin is a risk factor for the development of PUD. The use of tobacco products is a risk factor for the development of PUD. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 59-2 Describe factors that suppress and those that promote the formation of peptic ulcers.

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9) The nurse is caring for a client taking naproxen sodium on a regular basis for the treatment of arthritis. The nurse educates the client that there is a % chance of developing PUD due to this medication regimen. Record your answer rounding to the nearest whole number. Answer: 20 Explanation: Gastric and duodenal ulcers occur in about 20% of clients using NSAIDs on a regular basis, with 4% experiencing serious bleeding. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-2 Describe factors that suppress and those that promote the formation of peptic ulcers. 10) During a pain assessment, a client reports stomach pain that feels like gnawing in the upper abdomen that occurs about 1-1/2 hours after eating meals. The nurse identifies these symptoms to be most consistent with: 1. a duodenal ulcer. 2. acute appendicitis. 3. an exacerbation of diverticulitis. 4. cholelithiasis. Answer: 1 Explanation: The characteristic symptom of a duodenal ulcer is a gnawing or burning, upper abdominal pain that occurs 1 to 3 hours after a meal. The pain is worse when the stomach is empty and often disappears with ingestion of food. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 59-3 Compare and contrast duodenal ulcers and gastric ulcers.

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11) A client new to the clinic reports having peptic ulcer disease and a weight loss of 14 pounds in 2 months. The symptom of weight loss would be most consistent with: 1. a duodenal ulcer. 2. a gastric ulcer. 3. frequent exercise. 4. anorexia nervosa. Answer: 2 Explanation: Anorexia, weight loss, and vomiting are more common with gastric ulcers. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 59-3 Compare and contrast duodenal ulcers and gastric ulcers. 12) A 48-year-old male is returned from an endoscopic procedure with a diagnosis of a duodenal ulcer. The nurse is aware that the most likely causative agent for this ulcer is: 1. H. pylori. 2. prolonged NSAID use. 3. intermittent use of glucocorticoids. 4. chronic stress. Answer: 1 Explanation: H. pylori–associated ulcers are most likely to be duodenal. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 59-3 Compare and contrast duodenal ulcers and gastric ulcers. 13) The nurse plans to include information regarding duodenal ulcers for a male client who falls in the high-risk age group, which is 30 to years of age. Record your answer rounding to the nearest whole number. Answer: 50 Explanation: Duodenal ulcers most frequently occur in males in the 30- to 50-year age group. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 59-3 Compare and contrast duodenal ulcers and gastric ulcers. 14) The nurse preparing a teaching session on gastric ulcers plans to include that women are at 1115

greatest risk for these ulcers after the age of years. Record your answer rounding to the nearest whole number. Answer: 60 Explanation: Gastric ulcers are more common in women over age 60. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 59-3 Compare and contrast duodenal ulcers and gastric ulcers. 15) A client with a chronic cough, wheezing, and a sore throat states these symptoms have been present for 3 months, and asthma is not the cause. What does the nurse suspect to be causing this client's respiratory issues and sore throat? 1. Zollinger-Ellison syndrome 2. Gastroesophageal reflex disease 3. Crohn's disease 4. A gastric ulcer Answer: 2 Explanation: There is growing evidence that clients with GERD also can present with symptoms such as chronic cough, wheezing, bronchitis, sore throat, or hoarseness. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 59-4 Identify the etiology, signs, and symptoms of peptic ulcer disease and gastroesophageal reflux disease.

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16) A nurse is performing discharge teaching for a client being discharged with a diagnosis of gastroesophageal reflux disease. The nurse should teach the client to eliminate what foods from the diet? 1. Mashed potatoes 2. Tomato sauce 3. Bananas 4. Toast Answer: 2 Explanation: Substances that worsen GERD symptoms include caffeine, alcohol, citrus fruits, tomato-based products, onions, carbonated beverages, spicy foods, chocolate, and smoking. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-4 Identify the etiology, signs, and symptoms of peptic ulcer disease and gastroesophageal reflux disease. 17) A client complains of gastroesophageal symptoms every evening. The nurse would include what in the teaching to decrease the client's symptoms? 1. Moderating alcohol use 2. Avoiding acidic foods 3. Sleeping with the legs elevated on pillows 4. Eating smaller meals at least 1 hour before sleep Answer: 2 Explanation: Acidic foods should be avoided in clients with GERD. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-4 Identify the etiology, signs, and symptoms of peptic ulcer disease and gastroesophageal reflux disease.

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18) The nurse is caring for a client being treated for a duodenal ulcer. The nurse anticipates the client will begin to experience symptoms of discomfort associated with this condition in to 3 hours after eating a meal. Record your answer rounding to the nearest whole number. Answer: 1 Explanation: The characteristic symptom of duodenal ulcer is a gnawing or burning, upper abdominal pain that occurs 1 to 3 hours after a meal. The pain is usually worse when the stomach is empty and often disappears with ingestion of food. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 59-4 Identify the etiology, signs, and symptoms of peptic ulcer disease and gastroesophageal reflux disease. 19) The nurse is caring for a client with PUD. What signs and symptoms does the nurse expect the client to exhibit? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Anorexia 2. Weight loss 3. Vomiting 4. Heartburn 5. Belching Answer: 1, 2, 3 Explanation: Anorexia is a symptom that is often associated with PUD. Weight loss is a symptom that is often associated with PUD. Vomiting is a symptom that is often associated with PUD and GERD. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 59-4 Identify the etiology, signs, and symptoms of peptic ulcer disease and gastroesophageal reflux disease.

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20) A client diagnosed with GERD asks the nurse what the treatment will be. The nurse correctly states: 1. "You likely will be instructed to change your lifestyle to see if that helps relieve your symptoms." 2. "We will start you on an over-the-counter agent because you have easy access to it and a small chance of overdosing on it." 3. "We need to attack this early, and will start with combination therapy." 4. "GERD will require a surgical treatment for symptom relief." Answer: 1 Explanation: Before initiating pharmacotherapy, clients are usually advised to change lifestyle factors that might be contributing to the severity of GERD. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-5 Outline the treatment goals for the pharmacotherapy of peptic ulcer disease and gastroesophageal reflux disease. 21) The nurse is planning care for a client with PUD. What treatment goal should be included in the plan of care for this client? 1. Prevent recurrence of the disease. 2. Patient reports tolerating symptoms. 3. Reduce the level of H. pylori by one third. 4. Promote stasis of the ulcer. Answer: 1 Explanation: Preventing the recurrence of the disease is a treatment goal. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 59-5 Outline the treatment goals for the pharmacotherapy of peptic ulcer disease and gastroesophageal reflux disease.

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22) The nurse caring for a client with PUD explains that the treatment goals include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. immediate relief from symptoms. 2. promoting healing of the ulcer. 3. preventing complications of the disease. 4. preventing future recurrence of the disease. 5. reduction of the level of H. pylori by one third. Answer: 1, 2, 3, 4 Explanation: The goals of PUD pharmacotherapy include providing immediate relief from symptoms. The goals of PUD pharmacotherapy include promoting healing of the ulcer. The goals of PUD pharmacotherapy include preventing complications of the disease. The goals of PUD pharmacotherapy include preventing future recurrence of the disease. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-5 Outline the treatment goals for the pharmacotherapy of peptic ulcer disease and gastroesophageal reflux disease. 23) A client with peptic ulcer disease is undergoing pharmacologic therapy. After reviewing the medication administration record, the nurse suggests changing a prn pain order of ibuprofen to: 1. acetaminophen. 2. aspirin. 3. ketorolac. 4. naproxen. Answer: 1 Explanation: Acetaminophen has analgesic and antipyretic qualities only. This drug should not worsen the progression of PUD. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 59-5 Outline the treatment goals for the pharmacotherapy of peptic ulcer disease and gastroesophageal reflux disease.

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24) A client diagnosed with Barrett's esophagus might require the most efficient pharmacologic therapy of GERD. This would include the use of which class of drug? 1. Proton pump inhibitor 2. Antacid 3. Magnesium citrate 4. H2-receptor antagonist Answer: 1 Explanation: The proton pump inhibitors reduce acid secretion to a greater extent than do the H2-receptor antagonists and have a longer duration of action. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-6 Identify the classification of drugs used to treat peptic ulcer disease and gastroesophageal reflux disease. 25) A client is prescribed an H2-receptor antagonist. The nurse teaches this client that the purpose of the drug is to: 1. reduce gastric acid secretion in the stomach. 2. prevent the vasodilating effects of histamine. 3. alleviate nasal allergy symptoms. 4. prevent the release of histamine from MAST cells. Answer: 1 Explanation: The H2 receptors, located on the parietal cells in the stomach, promote acid secretion when activated. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-6 Identify the classification of drugs used to treat peptic ulcer disease and gastroesophageal reflux disease.

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26) A client with GERD must be cautioned against the overuse of antacids to avoid which syndrome? 1. Metabolic alkalosis 2. Metabolic acidosis 3. Respiratory alkalosis 4. Respiratory acidosis Answer: 1 Explanation: Ingestion of large amounts of antacid can leave a client with a pH base excess. This contributes to metabolic alkalosis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-6 Identify the classification of drugs used to treat peptic ulcer disease and gastroesophageal reflux disease. 27) The nurse who is planning care for a client with GERD anticipates that the healthcare provider will order medications from which drug class? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Proton pump inhibitors 2. H2-receptor antagonists 3. Antacids 4. Diuretics 5. Antianginals Answer: 1, 2, 3 Explanation: Proton pump inhibitors are utilized in the treatment of GERD. H2-receptor antagonists are utilized in the treatment of GERD. Antacids are utilized in the treatment of GERD. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 59-6 Identify the classification of drugs used to treat peptic ulcer disease and gastroesophageal reflux disease.

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28) A client is diagnosed with a gastric ulcer secondary to NSAID overuse. The nurse would question which healthcare provider order? 1. Clarithromycin 2. Omeprazole 3. Famotidine Answer: 1 Explanation: A combination of antibiotics is concurrently used to eradicate H. pylori and help decrease antibiotic resistance. Those with peptic ulcers who are not infected with H. pylori have been shown to have a worse outcome when receiving H. pylori treatment. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-7 Explain the pharmacologic strategies for eradicating Helicobacter pylori. 29) Effective client teaching regarding the treatment of H. pylori has been done for a client when the client states: 1. "I will stop taking this medication when my symptoms subside." 2. "I will be sure to take all of the medication exactly as prescribed." 3. "I will stop taking this medication if I get an upset stomach." 4. "I will take this medication when I experience pain or heartburn." Answer: 2 Explanation: This statement indicates that effective client teaching has been performed. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-7 Explain the pharmacologic strategies for eradicating Helicobacter pylori.

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30) A client is prescribed omeprazole, bismuth subsalicylate, and metronidazole for the treatment of H. pylori. The nurse explains that combination therapy will accomplish which outcome? 1. Increase the number of ulcerations. 2. Eliminate the population of H. pylori. 3. Allow H. pylori to adhere to the gastric mucosa. 4. Immediately relieve symptoms of gastric ulceration. Answer: 2 Explanation: A goal of combination therapy is to eliminate the population of H. pylori. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-7 Explain the pharmacologic strategies for eradicating Helicobacter pylori. 31) The nurse is reviewing the medication administration record for a client who is receiving an initial regimen for the eradication of H. pylori. The nurse anticipates the inclusion of which medications for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Omeprazole 2. Metronidazole 3. Bismuth subsalicylate 4. Amoxicillin 5. Clarithromycin Answer: 1, 4, 5 Explanation: Omeprazole is included in the initial medication regimen in the eradication of H. pylori. Amoxicillin is included in the initial medication regimen in the eradication of H. pylori. Clarithromycin is included in the initial medication regimen in the eradication of H. pylori. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 59-7 Explain the pharmacologic strategies for eradicating Helicobacter pylori.

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32) The nurse is performing a head-to-toe assessment on a client taking aluminum hydroxide (AlternaGEL). Why must the nurse closely assess for bowel changes? 1. Hyperactive bowel sounds indicate imminent vomiting; suction should be made available. 2. Hypoactive bowel sounds indicate duodenal ulcerations. 3. Hematochezia is a sign that the medication is working. 4. A distended abdomen could indicate constipation, a side effect of this medication. Answer: 4 Explanation: During treatment with aluminum hydroxide, the nurse must assess for bowel changes. Magnesium-based products can cause diarrhea, and those with calcium and aluminum can cause constipation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-8 Describe the nurse's role in the pharmacologic management of patients with peptic ulcer disease and gastroesophageal reflux disease. 33) A nurse is ordered to administer lansoprazole to a client on a mechanical soft diet. How should the nurse administer this medication? 1. Sprinkle granules into applesauce, then administer. 2. Crush the tablet and stir it into pudding, then administer. 3. Ask the client to chew the medication. 4. First ask the client to drink an entire glass of water, then give the medication. Answer: 1 Explanation: Lansoprazole granules may be sprinkled from the capsule into soft foods such as applesauce. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-8 Describe the nurse's role in the pharmacologic management of patients with peptic ulcer disease and gastroesophageal reflux disease.

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34) The nurse is teaching a client about the administration of omeprazole (Prilosec) for PUD. The nurse teaches the client that the medication must be administered no fewer than minutes prior to a meal, preferably breakfast. Record your answer rounding to the nearest whole number. Answer: 20 Explanation: Clients prescribed PPIs should be taught to take the medication 20 to 30 minutes before meals, preferably before breakfast. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-8 Describe the nurse's role in the pharmacologic management of patients with peptic ulcer disease and gastroesophageal reflux disease. 35) A client is prescribed omeprazole (Prilosec). The nurse prepares to perform client teaching based on the knowledge that omeprazole is a: 1. nicotinic receptor blocker. 2. proton pump inhibitor. 3. muscarinic receptor blocker. 4. histamine-2 receptor agonist. Answer: 2 Explanation: Omeprazole is a proton pump inhibitor. Cognitive Level: Knowing Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 59-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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36) A client brings her mother to the office and states, "I'm worried about Mom; she takes aluminum hydroxide up to three times a day for this pain in her abdomen." Which statement about aluminum hydroxide is true? 1. Aluminum hydroxide can cause acute appendicitis and should be stopped immediately. 2. A transient abdominal discomfort occurs with the use of aluminum hydroxide and there is no need for concern. 3. It is safe to take aluminum hydroxide up to three times daily, due to its safety profile. 4. Antacids are for occasional use only; further investigation is warranted. Answer: 4 Explanation: OTC medications taken long term can mask symptoms of more serious diseases such as cancer or complicated ulcers. This client's discomfort should be further investigated. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 59-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 37) The nurse is preparing a plan of care for a client with GERD who has been prescribed nizatidine (Axid) as part of the pharmacotherapy for the disease. The nurse educates the client that the medication must be continued for week(s). Record your answer rounding to the nearest whole number. Answer: 12 Explanation: Nizatidine is indicated for up to 8 weeks of PUD therapy and 12 weeks for GERD. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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38) A client with known peptic ulcer disease is placed on a clear-liquid diet pending an endoscopy. What proton pump inhibitor can be given in a liquid form to this client? 1. Famotidine (Pepcid) 2. Lansoprazole (Prevacid) 3. Esomeprazole (Nexium) Answer: 2 Explanation: Lansoprazole is available in a liquid suspension. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-10 Apply the nursing process to care for patients receiving pharmacotherapy for peptic ulcer disease and gastroesophageal reflux disease. 39) The nurse is providing teaching to a client with GERD on OTC antacids. The nurse correctly states that the client can expect relief from these agents within 10 to minutes of administration. Record your answer rounding to the nearest whole number. Answer: 15 Explanation: Self-medication with antacids is safe when taken in doses as directed on the labels. Although antacids act within 10 to 15 minutes, their duration of action is only 2 hours; thus, they must be taken often during the day. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 59-10 Apply the nursing process to care for patients receiving pharmacotherapy for peptic ulcer disease and gastroesophageal reflux disease. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 60 Pharmacotherapy of Bowel Disorders and Other Gastrointestinal Conditions 1) The definition of chronic constipation commonly used by healthcare providers may include which symptom? 1. Fewer than one bowel movement every 3 days 2. Lumpy, hard stools at least 25% of the time 3. Decrease in the frequency of bowel movements 4. Two bowel movements or fewer per week 1128

Answer: 2 Explanation: A diagnosis of constipation includes lumpy or hard stools at least 25% of the time. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community | AACN Essential Competencies: I.3 Use skills of inquiry, analysis, and information literacy to address practice issues | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 60-1 Compare and contrast the definition of constipation used by patients to that used for diagnosis by healthcare providers. 2) A client is being seen in a GI clinic. Which statement by the client suggests a diagnosis of constipation? 1. "I have only had one bowel movement every other day for the past week." 2. "I have been having trouble with pain, bloating, and gas. My last bowel movement was 4 days ago." 3. "I haven't had a bowel movement today, but I had one yesterday." 4. "I feel like I am constipated. Please give me a laxative." Answer: 2 Explanation: The client is reporting symptoms of constipation (pain, bloating, and gas) and the last bowel movement of 4 days ago. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community | AACN Essential Competencies: I.3 Use skills of inquiry, analysis, and information literacy to address practice issues | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 60-1 Compare and contrast the definition of constipation used by patients to that used for diagnosis by healthcare providers.

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3) Several hospitalized clients have an order for a laxative as needed for constipation. To which client would the nurse expect to administer a laxative? 1. A client who had a bowel movement yesterday and one the day before but not yet today 2. A client who has not had a bowel movement in 4 days 3. A client who did not have a bowel movement today, but had one yesterday 4. A client who has daily bowel movements that are formed Answer: 2 Explanation: This client is likely constipated, because the definition of constipation is two or fewer bowel movements per week. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community | AACN Essential Competencies: I.3 Use skills of inquiry, analysis, and information literacy to address practice issues | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 60-1 Compare and contrast the definition of constipation used by patients to that used for diagnosis by healthcare providers. 4) The nurse is assessing an older client for constipation. The client says, "I have difficulty moving my bowels about half the time." The nurse recognizes that a symptom of constipation is straining to pass stools at least % of the time. Record your answer rounding to the nearest whole number. Answer: 25 Explanation: Straining to pass stools at least 25% of the time is a symptom of constipation. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community | AACN Essential Competencies: I.3 Use skills of inquiry, analysis, and information literacy to address practice issues | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 60-1 Compare and contrast the definition of constipation used by patients to that used for diagnosis by healthcare providers.

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5) The nurse demonstrates an understanding of the different mechanisms of action of laxatives by stating: 1. "Bulk-forming laxatives are also called osmotic laxatives." 2. "Surfactant laxatives cause water and fat to be absorbed into the stools." 3. "Mineral oil can interfere with the absorption of water-soluble vitamins." 4. "Stimulant laxatives must be taken with plenty of water." Answer: 2 Explanation: Surfactant laxatives do cause water and fat to be absorbed into the stools. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 60-2 Compare and contrast the different mechanisms of action of laxatives. 6) The nurse demonstrates knowledge of the different mechanisms of action of laxatives by stating: 1. "My client should be encouraged to use a stimulant laxative whenever he feels the need to have a bowel movement." 2. "My client should consume plenty of water, since he is taking a bulk-forming laxative." 3. "My client should not strain when having a bowel movement, so the healthcare provider likely will prescribe a bulk-forming laxative." 4. "My client should expect to have a delayed reaction to a saline cathartic." Answer: 2 Explanation: Because fiber absorbs water and expands to provide "bulk," bulk-forming laxatives must be taken with plenty of water. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 60-2 Compare and contrast the different mechanisms of action of laxatives.

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7) Which type of laxative, as its mechanism of action, pulls water into the fecal mass to create a more watery stool? 1. Bulk-forming laxatives 2. Saline cathartics 3. Surfactant laxatives 4. Stimulant laxatives Answer: 2 Explanation: Saline cathartics, also called osmotic laxatives, are poorly absorbed in the intestine. They pull water into the fecal mass to create a more watery stool. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 60-2 Compare and contrast the different mechanisms of action of laxatives. 8) The nurse, preparing a client for a colonoscopy, tells the client, "You will be given a stimulant laxative by mouth to promote peristalsis. You will begin to feel the effects in 6 to hours." Record your answer rounding to the nearest whole number. Answer: 12 Explanation: Stimulant laxatives promote peristalsis by irritating the bowel. Their onset of action is 6 to 12 hours (PO) or 1 to 6 hours (rectal). Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 60-2 Compare and contrast the different mechanisms of action of laxatives.

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9) Which statements about bulk-forming laxative drugs are accurate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. They work immediately after one dose. 2. They are contraindicated when the client has undiagnosed abdominal pain, suspected intestinal obstruction, or fecal impaction. 3. They must be taken with plenty of water, or they can cause an esophageal obstruction. 4. The prototype of bulk-forming laxatives is milk of magnesia. 5. Bulk-forming laxative powder should never be taken dry. Answer: 2, 3, 5 Explanation: Bulk-forming laxatives are contraindicated when the client has undiagnosed abdominal pain, suspected intestinal obstruction, or fecal impaction. Bulk-forming laxatives must be taken with plenty of water; otherwise, psyllium could swell in the esophagus and cause an obstruction. Powders should never be swallowed dry, or esophageal obstruction may result. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 60-2 Compare and contrast the different mechanisms of action of laxatives. 10) Which statement correctly explains to a client the origin of the client's constipation? 1. "If you would use the laxatives daily, you would not have a problem with constipation." 2. "If the waste material passes through the colon too quickly, excess fluids are not absorbed, and the result is a watery stool." 3. "Ordinarily, fluid is absorbed in your large intestine as waste travels through. If the stool stays in the large intestine too long, too much water is reabsorbed, causing the stool to be small, hard, and difficult to pass without straining." 4. "Constipation is usually caused by infection." Answer: 3 Explanation: Too much water being reabsorbed results in small, hard stools that are difficult to pass without straining. This is the origin of constipation. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 60-3 Explain the pathogenesis of constipation and diarrhea.

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11) A client who is experiencing explosive diarrhea asks the nurse what causes the condition. The nurse responds that diarrhea can be a defense mechanism that removes: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. toxins. 2. pathogens. 3. excess stool. 4. excess water. 5. excess nutrients. Answer: 1, 2 Explanation: In some cases, diarrhea is a type of body defense, rapidly and completely ridding the body of toxins. In some cases, diarrhea is a type of body defense, rapidly and completely ridding the body of pathogens. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 60-3 Explain the pathogenesis of constipation and diarrhea. 12) A client complains of passing hard, pellet-like stools for several weeks and asks the nurse what would cause the condition. The nurse explains that constipation has various possible causes, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. pathogens. 2. toxins. 3. decreased dietary fiber. 4. inadequate fluid intake. 5. sedentary lifestyle. Answer: 3, 4, 5 Explanation: Inadequate dietary fiber can often cause constipation. Inadequate fluid intake is often a cause of constipation. A sedentary lifestyle often leads to constipation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 60-3 Explain the pathogenesis of constipation and diarrhea.

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13) A client with severe diarrhea asks the nurse why so much water is being expelled with each bowel movement. The nurse explains that: 1. the intestines are not reabsorbing sufficient fluid. 2. the client needs to take a laxative at this time. 3. the intestines are reabsorbing too much fluid. 4. peristalsis is too slow. Answer: 1 Explanation: Diarrhea occurs when the small or large intestine fails to reabsorb sufficient fluid. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 60-3 Explain the pathogenesis of constipation and diarrhea. 14) The nurse is caring for a group of clients on a medical–surgical unit. Which clients would the nurse assess as predisposed to constipation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A client who is 85 years old 2. A client with a bacterial infection 3. A client with a history of malabsorption 4. A client with a sedentary lifestyle 5. A client with decreased food intake Answer: 1, 4, 5 Explanation: Aging slows fecal transit time, which may result in constipation. Physical activity aids with peristalsis. A sedentary lifestyle could contribute to constipation. Decreased food intake can decrease the bulk of stool and contribute to constipation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 60-3 Explain the pathogenesis of constipation and diarrhea.

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15) A client has been diagnosed with inflammatory bowel disease (IBD). The nurse anticipates that the healthcare provider may prescribe a drug in which category to treat this disorder? 1. Symptom-targeted therapy, antidepressants, and antianxiety drugs 2. 5-aminosalicylic acid (5-ASA) agents, immunosuppressive agents, and biologic therapies 3. Antispasmodics, serotonin agents, and biologic therapies 4. 5-aminosalicylic acid (5-ASA) agents, symptom-targeted therapy, and antianxiety agents Answer: 2 Explanation: The pharmacotherapy for inflammatory bowel disease (IBD) includes 5-aminosalicylic acid (5-ASA) agents, immunosuppressive agents, and biologic therapies. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 60-4 Compare and contrast the types of drugs used to treat inflammatory bowel disease and irritable bowel syndrome. 16) The nurse is caring for a client with irritable bowel syndrome (IBS). Which drugs would most likely be used to treat this disorder? 1. Antispasmodics 2. Saline cathartics 3. Sulfasalazine 4. Immunosuppressive agents Answer: 1 Explanation: Antispasmodics may be used to treat irritable bowel syndrome. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 60-4 Compare and contrast the types of drugs used to treat inflammatory bowel disease and irritable bowel syndrome.

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17) A client is being treated for inflammatory bowel disease (IBD). The nurse anticipates receiving orders for which medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Loperamide (Imodium) 2. Doxepin (Sinequan) 3. Sulfasalazine (Azulfidine) 4. Prednisone 5. Azathioprine (Imuran) Answer: 3, 4, 5 Explanation: The first step of IBD treatment is usually with a 5-aminosalicylic acid (5-ASA) agent, which can include sulfasalazine (Azulfidine). When IBD is especially severe or when clients have not responded well to the 5-ASA drugs, oral corticosteroids such as prednisone are used. Should therapy with corticosteroids fail, or if they are needed for prolonged periods, step 3 of IBD therapy includes immunosuppressive agents, such as azathioprine (Imuran). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 60-4 Compare and contrast the types of drugs used to treat inflammatory bowel disease and irritable bowel syndrome. 18) The client has been diagnosed as having hyperemesis gravidarum. When would the nurse expect the healthcare provider to prescribe antiemetics? 1. After the pregnancy is terminated 2. After determining that other antinausea methods have been ineffective 3. If the client is troubled by the symptoms 4. Upon diagnosis Answer: 2 Explanation: Pharmacotherapy with fluid and electrolyte solutions and antiemetics is initiated after other antinausea measures have proven ineffective. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 60-5 Explain conditions for which the pharmacotherapy of nausea and vomiting is indicated.

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19) The most common reason for prescribing antiemetic drugs is: 1. psychosis. 2. morning sickness. 3. therapy with antineoplastic drugs. 4. hyperemesis gravidarum. Answer: 3 Explanation: Therapy with antineoplastic drugs is one of the most common reasons for prescribing antiemetic drugs. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 60-5 Explain conditions for which the pharmacotherapy of nausea and vomiting is indicated. 20) Which statement is true regarding the prevention and treatment of nausea and vomiting? 1. An antiemetic drug is indicated if the client has ingested a poisonous substance or taken an overdose of an oral medication. 2. Antihistamines and anticholinergic drugs may be used to treat nausea and vomiting due to motion sickness. 3. Medications for nausea and vomiting are available only by prescription. 4. Antiemetic drugs can be used throughout pregnancy. Answer: 2 Explanation: Antihistamines and anticholinergic drugs may be used to treat nausea and vomiting due to motion sickness. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 60-5 Explain conditions for which the pharmacotherapy of nausea and vomiting is indicated.

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21) Several clients are being seen in the emergency department for nausea and vomiting. Which clients are at an increased risk for dehydration and would require pharmacotherapy to treat this condition? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A 1-week-old neonate 2. A 2-year-old toddler 3. A 36-year-old female 4. A 22-year-old male 5. An 80-year-old female Answer: 1, 2, 5 Explanation: Dehydration is especially dangerous for infants, and nausea and vomiting should be treated due to the client's age. Dehydration is especially dangerous for small children, and nausea and vomiting should be treated due to the client's age. Dehydration is especially dangerous for the older adult. Nausea and vomiting may require treatment with pharmacotherapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 60-5 Explain conditions for which the pharmacotherapy of nausea and vomiting is indicated. 22) A client is being treated with pancreatic enzyme replacement therapy. What would the nurse recognize as a contraindication to this therapy? 1. Allergy to pork 2. Cystic fibrosis 3. Steatorrhea (bulky, foul-smelling, fatty stools) 4. Chronic pancreatitis Answer: 1 Explanation: An allergy to pork is a contraindication for treatment with pancrelipase, because the origin of the enzyme is pork. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 60-6 Identify drugs that are used to treat acute and chronic pancreatitis.

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23) Which client would be treated with pancreatic enzyme replacement? 1. A pregnant client 2. A client with hyperuricemia 3. A client who is constipated 4. A client with chronic pancreatitis Answer: 4 Explanation: Pancreatic enzyme replacement is indicated for the treatment of chronic pancreatitis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 60-6 Identify drugs that are used to treat acute and chronic pancreatitis. 24) Which statement is true regarding the use of pancreatic enzyme replacement in the pharmacotherapy of pancreatitis? 1. Its use is contraindicated when the client has cystic fibrosis. 2. Its use is indicated when lack of pancreatic enzyme secretion causes malabsorption disorders. 3. Its use is contraindicated when the client has pain in the abdomen. 4. Its use is indicated when the client has acute pancreatitis. Answer: 2 Explanation: Its use is indicated when lack of pancreatic enzyme secretion causes malabsorption disorders, because it helps to digest fats and prevent steatorrhea. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 60-6 Identify drugs that are used to treat acute and chronic pancreatitis.

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25) The nurse anticipates that a client admitted with acute pancreatitis will be treated with which medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Hydromorphone (Dilaudid) 2. Cimetidine (Tagamet) 3. Acetazolamide (Diamox) 4. Dicyclomine (Bentyl) 5. Pancrelipase (Creon) Answer: 1, 2, 3, 4 Explanation: For clients with acute pain, an opioid such as hydromorphone (Dilaudid) brings effective relief. To reduce gastric and pancreatic juice secretions, H2-receptor blockers such as cimetidine (Tagamet) may be prescribed. To decrease the amount of pancreatic enzymes secreted, carbonic anhydrase inhibitors such as acetazolamide (Diamox) may be used. To decrease the amount of pancreatic enzymes secreted, antispasmodics such as dicyclomine (Bentyl) may be used. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 60-6 Identify drugs that are used to treat acute and chronic pancreatitis.

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26) A client is being treated with sulfasalazine (Azulfidine) for inflammatory bowel disease (IBD). Which information is important for the nurse to provide to the client and family? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. It is important to avoid prolonged sun exposure, because the skin might be sensitive. 2. The drug should not be taken for longer than 12 weeks unless recommended by the healthcare provider. 3. Fluid intake should be 2 to 3 liters per day to avoid crystal formation in the urine. 4. The medication can color urine and skin orange-yellow. 5. The medication can affect female fertility. Answer: 1, 3, 4 Explanation: Sulfasalazine can cause skin sensitivity to prolonged sun exposure. Fluid intake for a client taking sulfasalazine for IBD should be 2 to 3 liters per day to avoid crystal formation in the urine. Sulfasalazine can color urine and skin orange-yellow. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 60-7 Describe the nurse's role in the pharmacologic management of bowel disorders, nausea and vomiting, and other gastrointestinal conditions. 27) The nurse instructs a client that the adverse effects of sulfasalazine (Azulfidine) typically begin within the first weeks of treatment. Record your answer rounding to the nearest whole number. Answer: 12 Explanation: Adverse reactions generally occur within a few days to 12 weeks after the start of therapy. They are most likely to occur in clients who are receiving high doses of sulfasalazine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 60-7 Describe the nurse's role in the pharmacologic management of bowel disorders, nausea and vomiting, and other gastrointestinal conditions.

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28) A primary indication for the use of an antiemetic medication is: 1. morning sickness in pregnancy. 2. diarrhea accompanied by severe abdominal cramping. 3. constipation. 4. nausea and vomiting associated with chemotherapy. Answer: 4 Explanation: Antiemetic medications are indicated for nausea and vomiting associated with chemotherapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 60-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 29) The nurse is instructing a client who has been prescribed bulk-forming laxatives. Which statement by the client indicates understanding of the use of laxatives? 1. "They work to increase the frequency and quality of bowel movements." 2. "They are indicated for the relief of bowel obstruction." 3. "I should use them when I have diarrhea caused by an infection." 4. "I can use them liberally whenever I don't have regular bowel movements." Answer: 1 Explanation: Laxatives work to increase the frequency and quality of bowel movements. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 60-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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30) The nurse receives an order to administer prochlorperazine (Compazine) to a client with nausea. The nurse can administer the medication by which routes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. By mouth 2. Per rectum 3. Intramuscularly (IM) 4. Subcutaneously (SQ) 5. Intravenously Answer: 1, 2, 3, 5 Explanation: Prochlorperazine (Compazine) can be administered by mouth. Prochlorperazine (Compazine) can be administered per rectum. Prochlorperazine (Compazine) can be administered by IM injection. Prochlorperazine (Compazine) can be administered intravenously. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 60-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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31) When implementing nursing care, what should the nurse instruct the client and family about laxative use? 1. A side effect of stool softeners is abdominal cramping. 2. Dependence on laxatives can cause constipation. 3. Stool softeners are appropriately used to treat constipation. 4. Laxatives are never harmful because they are available over the counter and should be used anytime the client feels the need to have a bowel movement. Answer: 2 Explanation: Dependence on laxatives can cause constipation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 60-9 Apply the nursing process to care for patients who are receiving pharmacotherapy for bowel disorders, nausea and vomiting, and other gastrointestinal conditions. 32) Immediately after administering a bulk-forming laxative, the nurse should assess: 1. if the client is taking other medications. 2. if the client is allergic to any medications. 3. the time of the client's last bowel movement. 4. whether the client has retrosternal pain. Answer: 4 Explanation: If the client has retrosternal pain after taking the drug, it might have been caused by a gelatinous mass from poor mixing of the bulk-forming laxative with liquids before administration. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 60-9 Apply the nursing process to care for patients who are receiving pharmacotherapy for bowel disorders, nausea and vomiting, and other gastrointestinal conditions. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 61 Vitamins and Minerals 1) The client who is prescribed vitamin K (phytonadione) asks the nurse, "How does the body normally receive this vitamin?" The most appropriate response by the nurse is "Vitamin K is: 1. obtained only by dietary consumption of dark green, leafy vegetables." 1145

2. abundant in dairy products, such as such as milk, cheese, and yogurt." 3. synthesized during fetal development, and not a replaceable substance." 4. produced through bacterial action in the gastrointestinal tract." Answer: 4 Explanation: Approximately 80% of an individual's vitamin K is produced by E. coli in the GI system. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 61-1 Describe the role of vitamins in maintaining wellness. 2) What education should the nurse provide to the client who is prescribed riboflavin (vitamin B2)? 1. "Avoid driving or operating heavy machinery until the effects of the drug are known." 2. "Expect tingling in the extremities when first taking the drug, but this will decrease." 3. "Recognize that large doses of riboflavin can cause an intense yellow discoloration of urine, which is harmless." 4. "Take the vitamin supplement at the same time every day." Answer: 3 Explanation: One harmless side effect of large doses of riboflavin is yellow discoloration of the urine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 61-1 Describe the role of vitamins in maintaining wellness.

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3) The nurse is discussing vitamins with a group of pregnant women at a community center when one of the participants asks, "What vitamin deficiency during pregnancy is a frequent cause of spina bifida in newborn infants?" What would be the correct response? 1. Folic acid (vitamin B9) 2. Cyanocobalamin (vitamin B12) 3. Ascorbic acid (vitamin C) 4. Manganese Answer: 1 Explanation: Studies indicate that birth defects such as spina bifida can be prevented with folic acid supplementation during pregnancy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 61-1 Describe the role of vitamins in maintaining wellness. 4) The nurse caring for a client receiving cyanocobalamin (vitamin B12) for pernicious anemia would monitor which laboratory values during therapy? 1. Blood urea nitrogen, urine creatinine, and urinalysis 2. Reticulocyte count, erythrocyte, hemoglobin, and hematocrit 3. Liver function studies, including bilirubin, albumin, and alkaline phosphatase 4. Serum sodium, potassium, magnesium, and chloride levels Answer: 2 Explanation: Vitamin B12 is essential for maturation of blood cells, which can be assessed by monitoring the client's reticulocyte counts, erythrocyte, hemoglobin, and hematocrit. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.3 Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities and populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 61-2 Identify conditions for which vitamin and mineral therapy may be indicated.

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5) The nurse states that due to its abundance in food, thiamine deficiency in the United States is not common except in: 1. older adults with heart failure. 2. pregnant women and children. 3. African American women. 4. individuals with alcoholism and chronic liver disease. Answer: 4 Explanation: Individuals with alcoholism and chronic liver disease have the highest incident of thiamine deficiency in the United States. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.3 Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities and populations | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 61-2 Identify conditions for which vitamin and mineral therapy may be indicated. 6) The client with parkinsonism asks the nurse why vitamin B6 should be avoided. Which response would be most appropriate for the nurse? 1. "The vitamin is excreted in the feces and bile." 2. "The vitamin causes mental confusion and hallucinations in people with Parkinson's disease." 3. "The vitamin reverses or antagonizes the therapeutic effects of some antiparkinsonism drugs" 4. "The vitamin increases the amount of dopamine entering the brain and promotes levodopa production." Answer: 3 Explanation: Vitamin B6 reverses the therapeutic effects of the antiparkinsonism drug levodopa. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.3 Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities and populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 61-2 Identify conditions for which vitamin and mineral therapy may be indicated.

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7) The nurse plans to provide clients with education regarding vitamins because, according to a 2016 survey by the Council for Responsible Nutrition, % of adults in America take vitamin supplements. Record your answer rounding to the nearest whole number. Answer: 71 Explanation: A 2016 survey by the Council for Responsible Nutrition, a Washington-based trade association representing ingredient suppliers and manufacturers in the dietary supplement industry, reported that 71% of adults in America take vitamin supplements. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: V.1 Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 61-3 Explain the governmental regulation of vitamins and minerals. 8) The nurse is educating a group of consumers regarding the governmental regulations of vitamins. The nurse correctly states that which standards mandated manufacturers to evaluate supplements for purity, strength, and composition? 1. The Dietary Supplement Health and Education Act 2. Current Good Manufacturing Practice (cGMP) regulations 3. The FDA's Office of Dietary Supplement Programs 4. The Food and Nutrition Board of the National Academy of Sciences Answer: 2 Explanation: In 2007, the FDA passed the current Good Manufacturing Practice (cGMP) regulations, which mandated manufacturers to evaluate supplements for purity, strength, and composition. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: V.1 Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 61-3 Explain the governmental regulation of vitamins and minerals.

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9) The nurse is educating a client regarding the FDA regulations of dietary supplements. The nurse correctly states that which products are included in these regulations? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Vitamins 2. Minerals 3. Herbal products 4. Cough suppressants 5. Acetaminophen Answer: 1, 2, 3 Explanation: The FDA regulates vitamin products as dietary supplements. The FDA regulates mineral products as dietary supplements. The FDA regulates herbal products as dietary supplements. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: V.1 Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 61-3 Explain the governmental regulation of vitamins and minerals.

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10) The client is a fitness enthusiast who adheres to a regimen of high vitamin supplement intake. Which vitamins would the nurse assess for hypervitaminosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Vitamin A (Aquasol A) 2. Vitamin E (Aquasol E) 3. Vitamin D (Rocaltrol) 4. Vitamin C (ascorbic acid) 5. Vitamin B2 (riboflavin) Answer: 1, 2, 3, 4 Explanation: Vitamin A (Aquasol A) is a fat-soluble vitamin and can cause hypervitaminosis when taken in large doses. Large doses of fat-soluble vitamin E (Aquasol E) can cause hypervitaminosis. Hypervitaminosis can be caused by the fat-soluble vitamin D (Rocaltrol). Vitamin C (ascorbic acid) has been associated with hypervitaminosis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: V.1 Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 61-4 Discuss the role of the recommended dietary allowance in determining the standardized requirement of various vitamins and minerals.

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11) The nurse who is caring for a group of older residents in a long-term care facility understands that the aging process influences the recommended dietary allowance (RDA) needs in this population. What statement by the nurse is most accurate concerning older adults? 1. "Normal aging causes a decline in skin turgor, producing an increase in metabolism of vitamins." 2. "Normal aging causes an increase in renal excretion of fat-soluble vitamins in the urine." 3. "Normal aging causes a stagnation of liver enzymes that aid in the dissection of water-soluble vitamins." 4. "Normal aging causes a reduction of gastric absorption, producing vitamin deficiencies." Answer: 4 Explanation: As part of the normal aging process, gastric absorption is reduced, causing decreased absorption of vitamins. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: V.1 Demonstrate basic knowledge of healthcare policy, finance and regulatory environments; including local, state, national and global healthcare trends | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 61-4 Discuss the role of the recommended dietary allowance in determining the standardized requirement of various vitamins and minerals. 12) The school nurse has presented a learning activity for a high school health promotion course. Which student statement indicates an understanding of water-soluble vitamins? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Vitamins C and B complex are the primary water-soluble vitamins." 2. "Water-soluble vitamins have the higher potential for toxicity and overdosing." 3. "Water-soluble vitamins can accumulate in the body for weeks before excretion." 4. "All water-soluble vitamins are stored in the liver." 5. "Daily intake of water-soluble vitamins is necessary." Answer: 1, 5 Explanation: The primary water-soluble vitamins are vitamin C and B complex. A daily intake of water-soluble vitamins is necessary to replenish the amount excreted. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 61-5 Compare and contrast fat-soluble and water-soluble vitamins.

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13) To promote a well-balanced diet, what information should the nurse who is helping the client select foods from the hospital menu take into account? 1. Vitamin supplementation can substitute for good nutrition. 2. Clients who cannot consume fat-soluble vitamins daily should be given a supplement. 3. Daily intake of water-soluble vitamins is essential to maintain and improve health. 4. All vitamins must be taken into the body by eating enriched foods. Answer: 3 Explanation: Daily intake of water-soluble vitamins is essential to promote a well-balanced diet and maintain and improve health. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 61-5 Compare and contrast fat-soluble and water-soluble vitamins. 14) The nurse has just completed education to a client regarding the differences between fat- and water-soluble vitamins. The client shows understanding of the teaching by listing which vitamins as fat soluble? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Vitamin A 2. Vitamin D 3. Vitamin E 4. Vitamin K 5. Vitamin C Answer: 1, 2, 3, 4 Explanation: Vitamin A is a fat-soluble vitamin found in fatty foods and oils. Vitamin D is a fat-soluble vitamin found in fatty foods and oils. Vitamin E is a fat-soluble vitamin found in fatty foods and oils. Vitamin K is a fat-soluble vitamin found in fatty foods and oils. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 61-5 Compare and contrast fat-soluble and water-soluble vitamins.

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15) The school health nurse is discussing vitamin supplements with a group of parents at the monthly PTO meeting. What concept would the nurse include in the teaching about vitamin C? 1. Vitamin C increases the absorption of iron when the two are taken together. 2. Vitamin C will prevent the symptoms of the common cold. 3. Vitamin C is synthesized in all mammals and not required as a supplement. 4. Vitamin C should be taken in large doses to reach therapeutic level rapidly. Answer: 1 Explanation: Vitamin C increases the absorption of iron when the two are taken concurrently. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 61-6 For each of the major vitamins, identify the mechanism(s) of action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 16) Which client would the nurse encourage to increase intake of ascorbic acid (vitamin C)? 1. A client with insomnia due to work-related tension 2. A client with thinning hair and baldness 3. A postmenopausal older female client 4. A client with wounds from a motorcycle crash Answer: 4 Explanation: Vitamin C helps maintain the functions of the immune system for improved wound healing. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 61-6 For each of the major vitamins, identify the mechanism(s) of action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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17) The nurse is caring for a pregnant client who asks whether it is safe to continue vitamin A supplements during pregnancy. The nurse educates the client that safety during pregnancy has not been established for vitamin A in amounts exceeding international units. Record your answer rounding to the nearest whole number. Answer: 6,000 Explanation: The safe use of vitamin A in amounts exceeding 6,000 international units during pregnancy is not established. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 61-6 For each of the major vitamins, identify the mechanism(s) of action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 18) The nurse is administering vitamin K for a client who is hemorrhaging following a liver laceration. The nurse anticipates that the hemorrhage will be controlled in 3 to hours following administration. Record your answer rounding to the nearest whole number. Answer: 8 Explanation: Vitamin K is essential for the hepatic biosynthesis of blood clotting Factors II, VII, IX, and X. Hemorrhage is usually controlled within 3 to 8 hours, with normal PT obtained in 12 to 14 hours after vitamin K administration. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 61-6 For each of the major vitamins, identify the mechanism(s) of action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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19) The nurse is teaching a client about the importance of the macromineral calcium in the diet. Which responses by the client indicate understanding of the information presented by the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Calcium is important for bone construction." 2. "Calcium is important for muscle contractions." 3. "Calcium is important for nerve conduction." 4. "Calcium is important for fluid balance." 5. "Calcium is important for a healthy immune system." Answer: 1, 2, 3 Explanation: A consistent level of calcium is needed for vital body processes and functions, such as bone matrix construction. A consistent level of calcium is needed for vital body processes and functions, such as muscle contraction. A consistent level of calcium is needed for vital body processes and functions, such as nerve conduction. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 61-7 Identify the major functions of macrominerals and microminerals. 20) The nurse is preparing to administer Lugol's solution for the treatment of thyrotoxic crisis. The nurse explains to the client that this medication contains % potassium iodine, which will suppress the thyroid and relieve symptoms. Record your answer rounding to the nearest whole number. Answer: 10 Explanation: At high concentrations iodine suppresses thyroid function. Lugol's solution, a mixture containing 5% elemental iodine and 10% potassium iodide, is given to hyperthyroid clients prior to thyroidectomy or during a thyrotoxic crisis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 61-7 Identify the major functions of macrominerals and microminerals.

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21) The nurse would expect to administer injections of cyanocobalamin (vitamin B12) to a client with: 1. iron deficiency anemia. 2. pernicious anemia. 3. sickle cell disease. 4. aplastic anemia. Answer: 2 Explanation: Injections of cyanocobalamin (vitamin B12) are administered to clients with pernicious anemia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 61-8 Apply the nursing process to care for patients receiving vitamin and mineral supplementation therapy. 22) The nurse knows that the pharmacologic uses for magnesium include multiple pathologic conditions, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. diabetes. 2. rheumatoid arthritis. 3. bowel evacuation. 4. anticonvulsant. 5. psychosis. Answer: 1, 2, 3, 4 Explanation: Magnesium supplementation has been shown to improve insulin sensitivity. Some individuals with rheumatoid arthritis achieve pain relief with magnesium compounds. The pharmacologic uses for magnesium include bowel evacuation. One example is milk of magnesia, which is a common laxative. Magnesium sulfate is used to prevent or stop seizures (eclampsia) during pregnancy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 61-8 Apply the nursing process to care for patients receiving vitamin and mineral supplementation therapy. 1157

Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 62 Enteral and Parenteral Nutrition 1) The nurse on a medical–surgical unit anticipates that clients who would benefit from the administration of either parenteral or enteral nutrition include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. a client with HIV who is vomiting. 2. a client with IBS who is suffering from malnutrition. 3. a client with minor burns who is preparing for discharge. 4. a client who is status postappendectomy without complications. 5. a client with anorexia who is refusing to eat by mouth. Answer: 1, 2, 5 Explanation: A client with HIV who is vomiting would benefit from parenteral or enteral nutrition. A client with IBS who is suffering from malnutrition would benefit from parenteral or enteral nutrition. A client with anorexia who is refusing to eat by mouth would benefit from parenteral or enteral nutrition. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 62-1 Identify conditions that may benefit from parenteral or enteral nutrition.

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2) The nurse, providing information about nutritional support to a client, explains that to benefit from enteral nutrition: 1. it must be administered as a continuous infusion. 2. the gag and swallow reflexes must be intact. 3. the client must not need specialized nutrient formulas. 4. the GI tract must be functional. Answer: 4 Explanation: For the client to be able to receive enteral nutrition, the GI tract must be functional. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 62-2 Compare and contrast enteral and parenteral methods of nutrition. 3) The nurse anticipates that parenteral nutrition will be used to meet the nutritional needs of: 1. a client with a nonfunctioning GI tract. 2. a client in a comatose state. 3. a client receiving radiation therapy to the neck. 4. a client with HIV-AIDS. Answer: 1 Explanation: A client with a nonfunctioning GI tract is a candidate for parenteral, but not enteral, nutrition. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 62-1 Identify conditions that may benefit from parenteral or enteral nutrition.

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4) The nurse is preparing to administer an enteral feeding to a client on a medical–surgical unit. This feeding can be administered by: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. nasogastric tube. 2. mouth. 3. percutaneous endoscopic gastrostomy (PEG) tube. 4. peripheral intravenous catheter. 5. central venous catheter. Answer: 1, 2, 3 Explanation: Enteral feedings can be administered by nasogastric tube. Enteral feedings can be administered by mouth. Enteral feedings can be administered by percutaneous endoscopic gastrostomy (PEG) tube. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 62-2 Compare and contrast enteral and parenteral methods of nutrition. 5) The nurse is instructing a client recovering from a severe burn injury about the importance of enteral nutrition. Which statement by the nurse is most accurate regarding this client's need for nutritional support? 1. "This product will maintain adequate hydration." 2. "This product is less likely to cause diarrhea." 3. "This product is designed for dumping syndrome." 4. "This product contains protein to support cell growth and to maintain and repair body tissues." Answer: 4 Explanation: Clients recovering from burn injuries have increased protein needs associated with repair of body tissues. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 62-3 Distinguish among polymeric, elemental, semielemental, and modular formulas for enteral nutrition.

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6) The nurse recognizes the best enteral formula for clients with digestive disorders is the: 1. oligomeric formula. 2. modular formula. 3. specialized formula. 4. polymeric formula. Answer: 1 Explanation: Oligomeric formulas are easily absorbed into the body, requiring little digestion, and are most appropriate for clients with digestive disorders. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 62-3 Distinguish among polymeric, elemental, semielemental, and modular formulas for enteral nutrition. 7) The nurse is caring for a client with chronic pancreatitis. Which enteral formulas would be most appropriate for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Precision HN 2. Criticare HN 3. Vivonex T.E.N. 4. Peptamen 5. Vital HN Answer: 4, 5 Explanation: Peptamen is an oligomeric formula and would be appropriate for a client with chronic pancreatitis. Vital HN is an oligomeric formula and would be appropriate for a client with chronic pancreatitis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 62-3 Distinguish among polymeric, elemental, semielemental, and modular formulas for enteral nutrition.

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8) A client with a malabsorption disorder has been prescribed enteral feedings. The nurse explains that the carbohydrates in the formula constitute 30% to % of the calories. Record your answer rounding to the nearest whole number. Answer: 90 Explanation: The percentage of total calories derived from carbohydrates in enteral formulas ranges from 30% to 90%, depending on the particular preparation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 62-4 Identify the basic classes of nutrients contained in enteral formulas and their functions. 9) For a client receiving enteral nutrition, which intervention is the nurse most likely to implement to reduce the risk of aspiration? 1. Administering the formula at room temperature 2. Elevating the head of the bed to 30 degrees 3. Administering an antidiarrheal agent 4. Adding fiber to the formula Answer: 2 Explanation: The risk of aspiration is increased when a client is supine. Elevating the head of the bed to 30 degrees during continuous feeding, and 30 minutes after a feeding, will decrease the risk of aspiration. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 62-5 Identify the possible complications and adverse effects of enteral nutrition administration.

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10) Damage to the nasal mucosa during enteral feeding is associated with: 1. secure feeding tube placement. 2. use of large-bore feeding tubes. 3. flushing the feeding tube before and after medication administration. 4. alternating nares for feeding tube placement. Answer: 2 Explanation: Extended use of large-bore nasal feeding tubes is associated with damage to the nasal mucosa. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 62-5 Identify the possible complications and adverse effects of enteral nutrition administration. 11) The nurse monitors a client receiving enteral feedings for which complications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Aspiration 2. Infiltration 3. Diarrhea 4. Systemic infections 5. Electrolyte disturbances Answer: 1, 3, 5 Explanation: Aspiration is a complication associated with enteral feedings. Diarrhea is a complication associated with enteral feedings. Electrolyte imbalances are a complication associated with enteral feedings. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 62-5 Identify the possible complications and adverse effects of enteral nutrition administration.

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12) The nurse is administering an enteral feeding to a client in a comatose state. The nurse elevates the head of the bed to 30 degrees and leaves it elevated for minutes to decrease the risk of aspiration. Record your answer rounding to the nearest whole number. Answer: 30 Explanation: The head of the bed should be elevated at least 30 degrees during the administration of the feeding and should remain elevated for at least 30 minutes after the feeding to decrease the risk of aspiration. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 62-5 Identify the possible complications and adverse effects of enteral nutrition administration. 13) A nurse is preparing to administer medications to a client receiving enteral nutrition. Which medication should not be administered via a PEG tube? 1. An enteric-coated pill for oral administration 2. An elixir for oral administration 3. A suspension for oral administration 4. A reconstituted powder for oral administration Answer: 1 Explanation: An enteric-coated pill should not be crushed and administered via the PEG tube. A more appropriate drug or route should be determined. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | AACN Essential Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 62-6 Describe the types of drug interactions that can occur when enteral nutrition formulas are given.

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14) The nurse is caring for a client who is prescribed phenytoin (Dilantin). To most effectively administer this agent, the nurse will: 1. hold the enteral feeding 2 hours before and 2 hours after giving phenytoin (Dilantin). 2. check the client's phenytoin (Dilantin) level before administering the dose. 3. request an alternate form and route to administer the phenytoin (Dilantin). 4. dilute the liquid form of phenytoin (Dilantin) with 100 mL of water. Answer: 1 Explanation: When phenytoin is administered with an enteral feeding, it binds with proteins in the enteral formula, which can result in subtherapeutic levels of the drug. To avoid this, it is recommended that the feeding be held 2 hours before and 2 hours after administering the drug. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | AACN Essential Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 62-6 Describe the types of drug interactions that can occur when enteral nutrition formulas are given. 15) The nurse is preparing to administer amoxicillin via PEG tube to a client who is suffering from a UTI. To prevent a drug interaction, the nurse plans to hold the feeding for hour(s) before and after administering the medication. Record your answer rounding to the nearest whole number. Answer: 1 Explanation: Holding the enteral feeding for 1 hour before and after an antibiotic dose will help minimize the drug's interaction with the enteral feeding. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | AACN Essential Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 62-6 Describe the types of drug interactions that can occur when enteral nutrition formulas are given.

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16) Prior to administering a hypertonic total parenteral nutrition solution, the nurse verifies that the client has: 1. serum electrolyte imbalances. 2. an insulin coverage scale. 3. robust peripheral veins. 4. a central venous access device. Answer: 4 Explanation: A central venous access device, with confirmed placement, is required to infuse a hypertonic TPN solution. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 62-7 Explain the differences between delivering parenteral nutrition through a peripheral line versus a central line. 17) The nurse is teaching a client about the central venous catheter (CVC) that will be inserted to provide total parenteral nutrition (TPN). Which statements by the client indicate the need for further education? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The CVC will be located in the superior vena cava." 2. "The CVC will need to be rotated every few days to prevent infection." 3. "A CVC is being inserted because I need long-term TPN." 4. "You will deliver the TPN by gravity through the CVC." 5. "My subclavian vein will be used for the insertion of the CVC." Answer: 2, 4 Explanation: Peripheral venous catheters are rotated every few days to decrease the risk for infection. TPN is administered with an infusion pump, not by gravity. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 62-7 Explain the differences between delivering parenteral nutrition through a peripheral line versus a central line. 1166

18) Amino acids are added to a parenteral nutrition solution to promote the production of: 1. glucose. 2. albumin. 3. triglycerides. 4. proteins. Answer: 4 Explanation: Amino acids are added to parenteral nutrition solutions to promote the production of proteins. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 62-8 Describe the components of total parenteral nutrition solutions and the function of each element in attaining the body's daily requirements. 19) Amino acids, a component of total parenteral nutrition, are needed by the body to: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. conserve lean body mass. 2. serve as a primary source of calories. 3. act as metabolic cofactors for enzymes. 4. promote wound healing. 5. promote the production of proteins. Answer: 1, 4, 5 Explanation: Adequate levels of amino acids conserve lean body mass. Adequate levels of amino acids promote wound healing. Amino acids promote the production of proteins. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 62-8 Describe the components of total parenteral nutrition solutions and the function of each element in attaining the body's daily requirements.

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20) The nurse is assessing a client for complications associated with parenteral nutrition therapy. The nurse checks for crackles (rales) and weight gain to identify: 1. a fluid overload. 2. a pneumothorax. 3. an air embolism. 4. an infection. Answer: 1 Explanation: Fluid overload is associated with dyspnea, distended neck veins, crackles (rales), and weight gain. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 62-9 Describe the possible complications of parenteral nutrition therapy. 21) To decrease the risk of infection associated with the introduction of bacteria from the TPN solution, the nurse will: 1. change the dressing every 3 days. 2. inspect the IV insertion site for redness. 3. assess temperature daily. 4. use a 0.22-micron inline filter. Answer: 4 Explanation: A 0.22-micron inline filter is used to reduce introduction of bacteria from the TPN solution. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 62-9 Describe the possible complications of parenteral nutrition therapy.

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22) The nurse is caring for a client with a central venous catheter (CVC). To decrease the risk of infection, the nurse plans to change the dressing every to 72 hours. Record your answer rounding to the nearest whole number. Answer: 48 Explanation: The dressing should be changed routinely (every 48 to 72 hours, per institutional policy) or when it becomes soiled, wet, or loose. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 62-9 Describe the possible complications of parenteral nutrition therapy. 23) The nurse is preparing to administer total parenteral nutrition (TPN) with lipids to a client for the first time. The nurse reviews the client's medication orders and notes that which medications pose a risk for a drug interaction? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Insulin 2. Ranitidine 3. Ampicillin 4. Warfarin 5. Kanamycin Answer: 3, 4, 5 Explanation: Ampicillin is physically incompatible with TPN. TPN with lipids may decrease the therapeutic effect of warfarin. TPN with lipids may decrease the therapeutic effect of kanamycin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.1 Explain the interrelationships among theory, practice, and research | AACN Essential Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 62-10 Identify drugs that may be incompatible with parenteral nutrition solutions.

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24) A client receiving parenteral nutrition has an increased pulse and pale, cool, clammy skin. Which intervention will the nurse perform? 1. Check blood glucose levels. 2. Administer insulin coverage. 3. Increase the parenteral nutrition infusion rate. 4. Stop the parenteral nutrition infusion. Answer: 1 Explanation: Blood glucose levels should be checked because the signs exhibited by the client are associated with hypoglycemia or excess insulin. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 62-11 Apply the nursing process to care for patients receiving enteral or parenteral nutrition. 25) The nurse anticipates that the plan for a client with insufficient weight gain will include: 1. changing to a bolus feeding schedule. 2. decreasing the protein content of the formula. 3. providing free water to dilute a hypertonic formula. 4. increasing the delivery rate of the enteral formula. Answer: 4 Explanation: Increasing the delivery rate will provide additional calories. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 62-11 Apply the nursing process to care for patients receiving enteral or parenteral nutrition.

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26) To evaluate stabilization of the nutritional status in a client receiving enteral nutrition, the nurse will: 1. measure abdominal girth. 2. monitor vital signs. 3. monitor daily weights. 4. assess oral intake. Answer: 3 Explanation: Daily weights will indicate if the client is losing, maintaining, or increasing body weight. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 62-11 Apply the nursing process to care for patients receiving enteral or parenteral nutrition. 27) The nurse is preparing to administer total parenteral nutrition (TPN) with lipids to a client for the first time. The nurse reviews the client's medication orders and recalls that some medications are physiologically stable. Which medications listed are stable with TPN? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Insulin 2. Ranitidine 3. Ampicillin 4. Warfarin 5. Tetracycline Answer: 1, 2 Explanation: Insulin is routinely mixed with TPN and does not pose a risk of a drug interaction. Ranitidine is routinely mixed with TPN and does not pose a risk of a drug interaction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.1 Explain the interrelationships among theory, practice, and research | AACN Essential Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 62-10 Identify drugs that may be incompatible with parenteral nutrition solutions. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 63 Weight Reduction Strategies and the Pharmacotherapy of Obesity 1) The nurse determines that the client understands an important principle of weight reduction 1171

when the client makes which statement? 1. "Obesity is closely linked with health risks, such as diabetes and hypertension." 2. "The most common cause of obesity is genetically linked hyperthyroidism." 3. "Everyone in my family is overweight; there is nothing I can do about my obesity." 4. "Lifestyle changes are not effective in weight loss if an individual's history includes obesity." Answer: 1 Explanation: Studies consistently reveal a direct relationship between obesity and diabetes and hypertension. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and continuity | AACN Essential Competencies: VII.3 Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 63-1 Identify genetic and lifestyle factors that contribute to obesity. 2) The client who has self-initiated a low-carbohydrate diet asks the nurse, "Why do carbohydrates cause obesity?" Which statement by the nurse is most appropriate? 1. "Carbohydrates cause a release of insulin from the pancreas, which converts carbohydrates to fat." 2. "Carbohydrates reduce the number of fat cells in certain body areas, such as hips and abdomen." 3. "Carbohydrates trigger a release of fat and protein from the liver and cause weight gain." 4. "Carbohydrates alone do not cause obesity." Answer: 4 Explanation: Complex carbohydrates are necessary for energy production. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and continuity | AACN Essential Competencies: VII.3 Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 63-1 Identify genetic and lifestyle factors that contribute to obesity.

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3) The nurse is teaching at a health promotion fair held in one of the local community centers when one of the participants asks, "What are the most important factors leading to obesity?" Which statement is the nurse's best response? 1. "Type of food and beverages consumed." 2. "Chronic conditions such as diabetes." 3. "Physical activity and caloric intake." 4. "Water and fluid retention." Answer: 3 Explanation: The most important factors leading to obesity are a decrease in physical activity and an increase in caloric intake. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and continuity | AACN Essential Competencies: VII.3 Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 63-1 Identify genetic and lifestyle factors that contribute to obesity. 4) Which lifestyle strategy would the nurse teach the client to promote healthy weight reduction? 1. Avoid eating between meals by consuming only three meals per day. 2. Reduce the intake of calories and increase the amount of physical activity. 3. Consume fruits and vegetables daily and eliminate all intake of meat and fish. 4. Begin a program of weight lifting and high-impact aerobic exercise. Answer: 2 Explanation: Reducing the intake of calories and increasing the amount of physical activity is the strategy that produces the best weight reduction results. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and continuity | AACN Essential Competencies: VII.3 Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 63-1 Identify genetic and lifestyle factors that contribute to obesity.

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5) The nurse who is educating a client about weight gain correctly states that as little as 10 surplus calories each day can lead to a weight gain of pound(s) per year. Record your answer rounding to the nearest whole number. Answer: 1 Explanation: Changes in weight are due to an energy imbalance. For example, an imbalance of as little as 10 surplus calories per day can lead to a 1-lb weight gain each year. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 63-2 Explain how energy imbalances can cause weight gain or loss. 6) The nurse is educating a client about ways to lose weight successfully and safely. Which recommendations does the nurse include in the teaching session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increase the amount carbohydrates in the diet. 2. Reduce calories in the diet. 3. Increase physical activity. 4. Increase the amount of protein in the diet. 5. Increase the amount of fats in the diet. Answer: 2, 3 Explanation: The most successful diet plans always include a reduction in calories. The most successful diet plans always include increased physical activity. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal education into nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 63-2 Explain how energy imbalances can cause weight gain or loss.

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7) The school nurse has prepared a learning activity for a high school health promotion course. To assess the class understanding, the nurse instructs the students to select the correct statements that apply to the brain's role in regulating appetite. Which statements should the students choose as correct? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The degree of satiety is directly recognized by a region of the brainstem known as the satiety center. 2. Hunger occurs when the cerebellum recognizes the level of glucose or hormone in the blood. 3. Receptors for leptin are located in the thalamus. 4. Neuropeptide Y (NPY) in the hypothalamus is associated with an increase in appetite. 5. Leptin receptors of clients who are obese are thought to develop a resistance to the satiety effects. Answer: 4, 5 Explanation: Located in the hypothalamus, neuropeptide Y (NPY) is associated with an increase in appetite. Leptin receptors of clients who are obese are thought to develop a resistance to the satiety effects. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 63-3 Describe the role of the hypothalamus in regulating appetite. 8) Which hormone that increases appetite and food consumption is secreted by the hypothalamus? 1. Follicle-stimulating hormone (FSH) 2. Antidiuretic hormone (ADH) 3. Insulin-like growth factors (ILGFs) 4. Neuropeptide Y (NPY) Answer: 4 Explanation: NPY is a hormone secreted by the hypothalamus that increases appetite and food consumption. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 63-3 Describe the role of the hypothalamus in regulating appetite.

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9) The nurse tells a client that, due to leptin secretion by adipocytes, the hypothalamus has what effect on appetite? 1. Intensification of appetite 2. Maintenance of appetite 3. Decrease of appetite 4. Inappropriate appetite Answer: 3 Explanation: The binding of leptin signals the hypothalamus to decrease appetite. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 63-4 Explain how leptin and brain neurotransmitters regulate appetite. 10) The client with morbid obesity asks the nurse why leptin is not used for weight reduction. Which response would be most appropriate for the nurse? 1. "Oral leptin would cause an increase in body mass index." 2. "Individuals who are obese develop a resistance to the effects of leptin." 3. "Leptin supplement is only effective in individuals with normal body weight." 4. "The amount of leptin required would potentiate nephrotoxicity." Answer: 2 Explanation: Leptin is not used for weight loss, because individuals who are obese develop a resistance to the effects of this substance. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 63-4 Explain how leptin and brain neurotransmitters regulate appetite.

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11) The parent of an adolescent female tells the nurse, "I am concerned about my daughter's weight gain, but she doesn't look obese." Which response by the nurse is the most appropriate? 1. "If your daughter is 10% more than the ideal weight, she is morbidly obese." 2. "Teenage girls are often obese and should be monitored for excessive caloric intake." 3. "The ideal body weight fluctuates, depending on gender, height, and general build." 4. "Your daughter's body mass index (BMI) should be calculated each month to determine obesity." Answer: 3 Explanation: Gender, height, and general body build are factors involved in determining ideal body weight. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and continuity | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 63-5 Describe how obesity is measured. 12) The nurse is assessing the body mass index (BMI) of a 43-year-old sedentary man, using a BMI calculation graph. The client is 57 and weighs 204 pounds. The nurse determine that the client's BMI indicates: 1. healthy weight. 2. morbid obesity. 3. obesity. 4. overweight. Answer: 3 Explanation: The client's body weight is considered obese, as indicated on the BMI graphs. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and continuity | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 63-5 Describe how obesity is measured.

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13) The nurse is teaching a client about obesity. The nurse states that obesity is defined as being % above ideal body weight. Record your answer rounding to the nearest whole number. Answer: 20 Explanation: In simple terms, obesity is the state of being more than 20% above the "ideal" weight. Ideal weight fluctuates, depending on the person's gender, height, and general build. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and continuity | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 63-5 Describe how obesity is measured. 14) The nurse correctly states to a client that obesity is defined as a BMI of kg/m2 or greater. Record your answer rounding to the nearest whole number. Answer: 30 Explanation: Obesity is defined by a BMI of 30 kg/m2 or greater. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient-centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and continuity | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 63-5 Describe how obesity is measured.

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15) A client has been on a weight reduction program for 2 months. The nurse anticipates that the total weight loss for this time frame should be: 1. 60 pounds. 2. 16 pounds. 3. 6 pounds. 4. 30 pounds. Answer: 2 Explanation: A 16-pound loss in 8 weeks is acceptable. Weight loss of 1 to 2 pounds per week is usually a realistic goal and is physically safe. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: I.B.15 communicate care provided and needed at each transition in care | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 63-6 Outline the major components of a successful weight management program. 16) The home health nurse is discussing nutrition with a client who asks, "What do you think of the new grapefruit-only diets that have become popular?" Which response by the nurse is the most appropriate? 1. "Weight loss through intake of grapefruit is not possible." 2. "Grapefruit is one of the healthiest food sources available." 3. "Comply with this type of diet for 6 months to avoid citrus overdose." 4. "Most fad diets have no scientific basis." Answer: 4 Explanation: Most quick weight loss schemes and fad diets are popular but have no scientific backing. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 communicate care provided and needed at each transition in care | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 63-6 Outline the major components of a successful weight management program.

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17) The nurse is educating an overweight female client about successful weight management programs and tells the client to reduce food intake to 1,000 to calories per day to facilitate weight loss. Record your answer rounding to the nearest whole number. Answer: 1,200 Explanation: Examining the client's diet and reducing the normal intake to 1,000 to 1,200 calories/day for women and to 1,200 to 1,600 calories/day for men is usually sufficient. However, small, progressive steps will be needed to achieve these values in clients who are accustomed to consuming two to six times the recommended daily calorie values. Weight loss of 0.5 to 1 kg (1 to 2 lb) per week is usually a realistic goal and is physically safe. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 communicate care provided and needed at each transition in care | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 63-6 Outline the major components of a successful weight management program. 18) The nurse is providing preoperative education for a client who will undergo a surgical weight loss procedure. The nurse evaluates that the client has understood the teaching when the client states, "I should lose 40 to % of my excess weight within the first year." Record your answer rounding to the nearest whole number. Answer: 70 Explanation: Most clients having obesity surgery experience a significant weight loss of 40% to 70% of their excess weight within 1 year. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 communicate care provided and needed at each transition in care | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote health and manage illness | NLN Competencies: Context and Environment: Apply health promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 63-6 Outline the major components of a successful weight management program.

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19) The school health nurse is discussing weight loss agents with a group of college women at the health promotion session. Which concepts does the nurse include in the teaching plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Several effective weight loss pills are readily available through telemarketers. 2. Ephedra is a healthy method for weight reduction and does not require a prescription. 3. Fenfluramine, one part of the Fen-Phen combination, causes heart disease. 4. Leptin as a weight loss medication has not shown to be effective. 5. Stimulants such as Dexedrine are highly addictive and are no longer prescribed. Answer: 3, 4, 5 Explanation: The substance fenfluramine is suspected of causing heart valvular disease. Trials of leptin as a weight reduction strategy have not proven to be effective. Dexedrine, a highly addictive stimulant, is no longer prescribed for weight reduction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 63-7 Identify several weight loss agents that were removed from the market due to their adverse effects. 20) Which statement made by the client about taking phenylpropanolamine indicates that further teaching is necessary? 1. "This medication was removed from the market due to increased incidence of stroke." 2. "Phenylpropanolamine was sold over the counter until it was discontinued." 3. "It is acceptable to take these pills on occasion when I want to lose a few pounds." 4. "I should dispose of any of these pills I might still have." Answer: 3 Explanation: Phenylpropanolamine can cause hypertension and dysrhythmias. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 63-7 Identify several weight loss agents that were removed from the market due to their adverse effects.

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21) The nurse is providing education to a client who was taking sibutramine (Meridia) as a part of a weight loss program. The client asks the nurse why the medication was removed from the market. Which statement by the nurse is most appropriate? 1. "Sibutramine (Meridia) was removed from the market due to the adverse effects of postnasal drainage, pruritus, and drowsiness." 2. "Sibutramine (Meridia) was removed from the market due to the adverse effects of headache, constipation, and xerostomia." 3. "Sibutramine (Meridia) was removed from the market to the increased risk of heart attack and stroke." 4. "Sibutramine (Meridia) was removed from the market due to the increased risk for facial twitching, backache, and anxiety." Answer: 3 Explanation: Sibutramine (Meridia) was removed from the market in 2010 due to the increased risk of heart attack and stroke that were associated with the medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 63-7 Identify several weight loss agents that were removed from the market due to their adverse effects.

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22) The nurse is reviewing medications that have been proven effective for weight loss. Which medications does the nurse identify as being removed from the market due to safety concerns? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Amphetamine and dextroamphetamine (Dexedrine) 2. Orlistat (Alli) 3. Fenfluramine and phentermine (Fen-Phen) 4. Ephedra alkaloids 5. Sibutramine (Meridia) Answer: 3, 4, 5 Explanation: Fenfluramine was removed from the market for causing heart valve defects. Ephedra alkaloids have been removed from the market due to an increased incidence of adverse cardiovascular events. Sibutramine (Meridia) was voluntarily withdrawn from the U.S. market due to an increased risk of heart attacks and strokes. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 63-7 Identify several weight loss agents that were removed from the market due to their adverse effects. 23) The client has started to take orlistat (Alli) as a part of a weight loss management program. Which preexisting health condition(s), if present, would make this medication contraindicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Depression treated with monoamine oxidase inhibitors (MAOIs) 2. Cholestasis 3. BMI greater than 40 4. Heart disease and dysrhythmias 5. Bulimia and anorexia nervosa Answer: 2, 5 Explanation: Orlistat (Alli) is contraindicated in clients with cholestasis. Bulimia and anorexia nervosa are worsened by the administration of orlistat (Alli). Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 63-8 Describe the nurse's role in the pharmacologic management of obesity. 24) Which of these statements, if made by a client, would indicate that further instruction is needed about orlistat (Alli)? 1183

1. "I should take the drug once a day." 2. "I should report stomach discomfort or oily stools to the prescriber." 3. "I should check blood pressure and report any consistently high readings." 4. "I can eat as much as I want when taking this medication and still lose weight." Answer: 4 Explanation: No medication can overcome an excessive intake of calories. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 63-8 Describe the nurse's role in the pharmacologic management of obesity. 25) The nurse is providing medication teaching to a client taking orlistat (Alli). Because the medication interferes with the absorption of fat-soluble vitamins, the nurse tells the client to wait at least hours after taking the medication to take these vitamin supplements. Record your answer rounding to the nearest whole number. Answer: 2 Explanation: Because orlistat inhibits the absorption of the lipid-soluble vitamins A, D, and E, a supplement containing these vitamins should be taken at least 2 hours before or after a dose of orlistat. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 63-8 Describe the nurse's role in the pharmacologic management of obesity.

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26) The nurse is teaching a client who has been prescribed orlistat (Xenical) as a part of a weight loss program. The nurse tells the client to take the medication during or up to hour(s) after eating a meal that contains fat. Record your answer rounding to the nearest whole number. Answer: 1 Explanation: Administer the drug during or up to 1 hour after a meal containing fat. Omit the dose if eating a meal that does not contain fat or if a meal is skipped. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 63-8 Describe the nurse's role in the pharmacologic management of obesity. 27) The nurse questions the prescription of orlistat (Alli) for which client? 1. A 58-year-old woman with long-term asthma 2. A 48-year-old woman with hypothyroidism 3. A 22-year-old man with borderline type 2 diabetes 4. A 62-year-old man with presbyopia Answer: 2 Explanation: Hypothyroid-related weight gain should not be treated with orlistat. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 63-9 For each class shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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28) The nurse is discussing orlistat (Alli) with a group of women at a community center when one of the participants asks, "What side effects are associated with this drug?" The nurse responds by stating: 1. "Tinnitus and hearing loss are side effects associated with orlistat (Alli)." 2. "Headache and photophobia are side effects associated with orlistat (Alli)." 3. "Flatus with oily stool discharge is a side effect often associated with orlistat (Alli)." 4. "Urinary frequency with urgency is a side effect associated with orlistat (Alli)." Answer: 3 Explanation: Common side effects associated with orlistat (Alli) are increased flatus and seepage of oily stool. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 63-9 For each class shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 29) The nurse is developing a health teaching document for a client prescribed orlistat (Alli). Which concept does the nurse include? 1. Limit food and beverage intake to once daily, or less, if possible. 2. Increase high-fat meals to minimize GI adverse effects. 3. Decrease physical activity for the first 6 months on medication. 4. Take a daily multivitamin containing fat-soluble vitamins. Answer: 4 Explanation: Individuals taking orlistat should also take a supplement that provides the fat-soluble vitamins A, D, E, and K. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 63-9 For each class shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 1186

30) The nurse correctly states that orlistat (Alli) is effective in weight loss because the medication inhibits fat absorption by approximately _%. Record your answer rounding to the nearest whole number. Answer: 30 Explanation: Orlistat inhibits fat absorption by approximately 30%. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 63-9 For each class shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 31) Orlistat (Alli) is initiated for a client with obesity who is taking warfarin. What health teaching would be most appropriate for this drug? 1. If you overeat, you may take more medication to counteract your indulgence. 2. You may resume your normal dietary habits while taking this drug. 3. You will need to closely monitor prothrombin time (PT) and international normalized ratio (INR). 4. Take the medication each evening 2 hours before taking warfarin. Answer: 3 Explanation: Monitor prothrombin time (PT) and international normalized ratio (INR) if the client is taking warfarin and orlistat (Alli) because the two medications have been known to interact. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 63-10 Apply the nursing process to care for patients receiving antiobesity therapy.

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32) A client is receiving orlistat (Alli) to aid in weight reduction. The nurse reviews the other drugs being taken by the client. Which drug should not be taken concurrently with orlistat? 1. Furosemide (a diuretic) 2. Cyclosporine (an antibiotic) 3. Warfarin (an anticoagulant) 4. Ibuprofen (a nonsteroidal anti-inflammatory) Answer: 2 Explanation: Orlistat decreases the absorption of cyclosporine; the two drugs should not be used concurrently. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 63-10 Apply the nursing process to care for patients receiving antiobesity therapy. 33) The nurse who will be administering orlistat (Alli) to a client knows that prior to the initiation of this drug, it is important to assess which body system? 1. Integumentary system 2. Neurologic system 3. Biliary system 4. Sensory system Answer: 3 Explanation: Orlistat should be used with caution in clients with cholestasis because the drug inhibits gallbladder contraction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 63-10 Apply the nursing process to care for patients receiving antiobesity therapy.

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34) The nurse is providing instruction on the proper use of orlistat (Alli) to a client who has just begun a weight loss program. The nurse evaluates that the client has understood the instructions when the client states, "Any side effects involving my stomach and intestines usually subside within weeks of therapy." Record your answer rounding to the nearest whole number. Answer: 4 Explanation: Adverse GI effects are common but typically resolve after 4 weeks of therapy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 63-10 Apply the nursing process to care for patients receiving antiobesity therapy. 35) The nurse is assessing a client with a BMI of 28 who is interested in losing weight. Reviewing the client's chart, the nurse notes that the healthcare provider will consider prescribing an anorexiant because the client has what risk factors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Depression 2. Anxiety 3. Hypertension 4. Hyperlipidemia 5. Diabetes Answer: 3, 4, 5 Explanation: Hypertension is a risk factor that would indicate the use of an anorexiant for a BMI of greater than 27. Hyperlipidemia is a risk factor that would indicate the use of an anorexiant for a BMI of greater than 27. Diabetes is a risk factor that would indicate the use of an anorexiant for a BMI of greater than 27. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 63-10 Apply the nursing process to care for patients receiving antiobesity therapy. Pharmacology: Connections to Nursing Practice, 5e (Adams) 1189

Chapter 64

Review of the Endocrine System

1) While reviewing a medical record, the nurse notes that a client's ACTH levels are low. The nurse knows this deficit will primarily impact the client's level of: 1. thyroxine. 2. insulin. 3. corticosteroids. 4. epinephrine. Answer: 3 Explanation: ACTH stimulates the adrenal cortex to produce corticosteroids. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integrations of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 64-1 Describe the general structure and functions of the endocrine system. 2) The nurse is checking lab work on a client's record. The client's FSH and LH levels are low. The nurse suspects this client may have health problems related to: 1. growth and development. 2. nutrition and metabolism. 3. the reproductive system. 4. the renal system. Answer: 3 Explanation: Follicular-stimulating hormone and luteinizing hormone target the gonads, which are part of the reproductive system. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integrations of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 64-1 Describe the general structure and functions of the endocrine system.

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3) A small-for-age child is to receive supplemental injections of growth hormone. The mother of the client asks, "Why does my child have to take these shots? I read that hormones are dangerous." Which response by the nurse is most appropriate? 1. "There are some hormones that are dangerous, but the shot your child will receive is not one of them." 2. "Are you worried that your child will get hooked on drugs?" 3. "Your child's pituitary gland is not making enough growth hormone. This hormone makes bones and muscles grow to normal size. The shots are safe." 4. "Your child's parathyroid glands are not making enough of a hormone called GH. The injection is very safe." Answer: 1 Explanation: Supplemental growth hormone is administered to children who have low GH levels. There are real concerns with all hormone therapies, because the differences between too much, too little, and the right amount are very small. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 64-1 Describe the general structure and functions of the endocrine system. 4) A client who is acutely ill is having difficulty maintaining a steady blood pressure. The nurse recognizes that when the client's blood pressure drops, the hormonal mechanism that immediately takes action is: 1. aldosterone, released by the adrenal cortex to conserve water. 2. cortisol, released by the adrenal cortex to raise blood sugar. 3. insulin, released by the pancreas to increase energy production. 4. epinephrine, released by the adrenal medulla to trigger vasoconstriction. Answer: 4 Explanation: Epinephrine is the fastest acting endocrine hormone. It is released from the adrenal medulla. When blood pressure drops, it triggers a compensatory increase in heart rate, as well as vasoconstriction. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integrations of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 64-2 Compare and contrast the nervous and endocrine systems in the control of homeostasis.

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5) The nurse is assisting a postpartum client who is new to breastfeeding. The nurse knows the production of breast milk is dependent on which hormonal mechanism? 1. Follicular-stimulating hormone binding to cells in the ovaries 2. Epinephrine binding to alpha receptors in the blood vessels of the chest wall 3. Luteinizing hormone binding to cells in the ovaries 4. Prolactin binding to receptors in the breast secretory cells Answer: 4 Explanation: The production of breast milk is triggered by the release of prolactin by the pituitary gland. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integrations of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 64-2 Compare and contrast the nervous and endocrine systems in the control of homeostasis. 6) A client with hypothyroidism is told by the healthcare provider that the thyroid-stimulating hormone level is elevated. The client says to the nurse, "I don't understand why my TSH is high. I thought I had low thyroid levels." The most appropriate response by the nurse is: 1. "You probably misunderstood your healthcare provider." 2. "TSH is a hormone released by the pituitary that signals your thyroid to make hormones. When the thyroid can't respond, the pituitary keeps trying to send its signal, and the TSH keeps going up." 3. "TSH is not thyroid hormone. When thyroid values are low, other lab tests are performed to see how you tolerate the low levels." 4. "TSH is an incomplete thyroid hormone. Because it cannot bind to tissues, it builds up in the bloodstream." Answer: 2 Explanation: TSH values increase in most cases of hypothyroidism because the thyroid gland is nonresponsive, so the normal negative feedback to the hypothalamus does not occur. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 64-3 Explain circumstances in which hormone receptors may be up-regulated or down-regulated.

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7) The nurse is caring for a client who had been receiving supplemental cortisone. The client developed a bleeding ulcer, and the steroid was discontinued. The bleeding has stopped, but the blood pressure remains unstable. The nurse recognizes that the unstable blood pressure is related to: 1. down-regulation of corticosteroid receptors. 2. up-regulation of epinephrine. 3. up-regulation of corticosteroid receptors. 4. down-regulation of epinephrine. Answer: 1 Explanation: The client's corticosteroid receptors decreased in number while exogenous steroids were given. This process is known as down-regulation. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 64-3 Explain circumstances in which hormone receptors may be up-regulated or down-regulated. 8) A client with an exacerbation of COPD is receiving steroid therapy in tapering doses. The nurse recognizes that this approach is medically appropriate because it applies what principle of up-regulation? 1. Up-regulation decreases the sensitivity of the cell-wall hormone receptors. 2. Up-regulation decreases the number of receptors on the cell-wall surface. 3. Up-regulation requires time for regrowth of cell-wall hormone receptors. 4. Up-regulation changes the configuration of cell-wall hormone receptors to allow them to bind better. Answer: 3 Explanation: When a hormone that was administered in large doses is discontinued, it takes several days for cells to produce enough protein receptors to capture endogenous hormone. Tapering the dose allows time for the process to finish before the hormone is stopped. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integrations of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 64-3 Explain circumstances in which hormone receptors may be up-regulated or down-regulated.

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9) The nurse notes that several clients prescribed supplemental thyroid hormone are all receiving different doses of the same drug. The nurse recognizes that this variation is mostly driven by: 1. the client's age and ethnicity. 2. the client's psychologic status and acceptance of hormone therapy. 3. the number and sensitivity of the individual client's tissue receptors. 4. the client's height and weight. Answer: 3 Explanation: The primary reasons for dose variations are the differences in the number of receptors and in their sensitivity. Each client presents a unique therapeutic challenge. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integrations of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 64-3 Explain circumstances in which hormone receptors may be up-regulated or down-regulated. 10) The nurse is evaluating a client who is receiving a thyroid hormone supplement. The client's TSH level has gone down, and the T3 and T4 levels have increased. The nurse knows that: 1. The TSH, T3, and T4 all should have increased. 2. A decrease in the TSH is undesirable. 3. An increase in the T3 and T4 is undesirable. 4. A decrease in the TSH is desirable. Answer: 4 Explanation: The decrease in the TSH is desirable, and is the result of negative feedback to the hypothalamus from the thyroid gland. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integrations of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 64-4 Through the use of a specific example, explain the concept of negative feedback in the endocrine system.

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11) A client with a pituitary defect is being treated for Addison's disease with supplemental corticosteroids. The client develops signs and symptoms of Cushing's syndrome. The nurse recognizes that this reaction is a result of the failure of normal: 1. chemical messengers. 2. feedback mechanisms. 3. receptor sensitivity. 4. ACTH formation. Answer: 2 Explanation: When corticosteroid levels increase too much, the adrenal glands send a negative feedback message to the hypothalamus. The hypothalamus decreases its output of the hormone that tells the anterior pituitary to make less ACTH. In this case, the pituitary is defective and cannot act on the hypothalamic message. If the dose of corticosteroid is not decreased, the client will continue to develop Cushing's syndrome. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 64-4 Through the use of a specific example, explain the concept of negative feedback in the endocrine system. 12) When a client's blood sugar drops too low, the pancreas refrains from releasing insulin. The nurse caring for the client recognizes that the drop in insulin production is a result of: 1. positive feedback. 2. negative feedback. 3. up-regulation. 4. down-regulation. Answer: 2 Explanation: Insulin lowers circulating blood sugar by allowing glucose to enter cells. When the blood sugar is already too low, the pancreas notes the low level and refrains from releasing additional insulin into the bloodstream. This chain of events is known as negative feedback. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 64-4 Through the use of a specific example, explain the concept of negative feedback in the endocrine system.

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13) The nurse is caring for a client with hypocalcemia. In planning to meet the client's needs, the nurse would expect which alteration? 1. An increased level of parathyroid hormone 2. An increased level of serum calcium 3. A decreased level of parathyroid hormone 4. A decreased level of T3 and/or T4 Answer: 1 Explanation: Hypocalcemia is recognized by the parathyroid gland, which releases parathyroid hormone, which strives to increase the calcium level back to normal via increased absorption and decreased excretion. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 64-5 Explain the three primary types of stimuli that regulate hormone secretion. 14) The nurse is caring for a client with hyperglycemia. When choosing nursing interventions, the nurse is aware that a high serum blood sugar produces changes in the client's pancreas that are consistent with a(n): 1. hormonal stimulus. 2. humoral stimulus. 3. exocrine gland stimulus. 4. neuronal stimulus. Answer: 2 Explanation: Humoral stimuli are driven by sensors in the endocrine gland itself. In the case of insulin, sensors in the pancreas detect the high blood sugar and increase the output of insulin. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integrations of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 64-5 Explain the three primary types of stimuli that regulate hormone secretion.

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15) The nurse in an endocrinology practice is seeing a client with low growth hormone levels. The client's history reveals extensive pituitary damage secondary to a large adenoma. The nurse recognizes that the client's small stature results from: 1. negative feedback from GH receptors. 2. an inability to respond to GH. 3. lack of tissue receptors for GH. 4. high levels of ACTH. Answer: 2 Explanation: Small stature occurs when GH is unavailable to stimulate the growth of bones, muscles, and soft tissues. The hypothalamus stimulates the pituitary to produce GH. In this case, the hypothalamic hormone cannot stimulate the pituitary, because the normal pituitary tissue was destroyed or compressed by a tumor. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 64-5 Explain the three primary types of stimuli that regulate hormone secretion. 16) The nurse is administering hormones to several clients. The nurse recognizes that which medication order represents exaggerated response therapy? 1. Insulin to a client with diabetes mellitus 2. Vasopressin to a client with diabetes insipidus 3. Thyroid hormone to a client with a history of Graves disease 4. Corticosteroid to a client with lupus Answer: 4 Explanation: Exaggerated response therapy is the administration of hormones in large amounts to obtain some specific effects. Corticosteroids are given in large amounts to clients with lupus in order to decrease the inflammatory responses throughout the body. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 64-6 Identify indications for hormone pharmacotherapy.

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17) The nurse is administering testosterone to a client with breast cancer. The nurse recognizes that this therapy is part of the client's treatment plan because: 1. testosterone has a high affinity for rapidly dividing cancer cells. 2. testosterone decreases the inflammation associated with rapid tumor growth. 3. testosterone replicates the action of antineoplastic drugs without nausea. 4. testosterone blocks the growth of estrogen-sensitive cancers. Answer: 4 Explanation: Testosterone is helpful in the treatment of estrogen-sensitive breast cancer. It is generally given with other chemotherapy drugs. It works by blocking off estrogen receptors. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 64-6 Identify indications for hormone pharmacotherapy. 18) A client with hyperthyroidism has been reading about propylthiouracil (PTU) on the internet. The client asks the nurse, "How do antihormones work to help my condition?" Which is the nurse's best response? 1. "Your body has been affected by too much thyroid hormone. PTU is a drug that can block your body's response to thyroid hormone." 2. "Antihormones oppose the action of estrogen, which allows thyroid to regain its effectiveness." 3. "PTU regenerates your thyroid gland and causes normal tissue to regrow, so the effects of too much thyroid will disappear." 4. "PTU replaces your abnormal thyroid hormone with normal thyroid hormone." Answer: 1 Explanation: PTU is an antihormone. It blocks thyroid hormone from various receptors throughout the body. Without access to the usual receptors, the signs and symptoms of hyperthyroidism are reduced. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 64-6 Identify indications for hormone pharmacotherapy.

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19) When instructing an adolescent on the reproductive system, the nurse explains that which hormones interact to promote maturation of ovarian follicles and produce estrogen? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Follicle-stimulating hormone 2. Gonadotropin-releasing hormone 3. Adrenocorticotropic hormone 4. Antidiuretic hormone 5. Growth hormone Answer: 1, 2 Explanation: This hormone responds to gonadotropin-releasing hormone to promote maturation of ovarian follicles and estrogen production. This hormone stimulates follicle-stimulating hormone to promote maturation of ovarian follicles and estrogen production. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 64-1 Describe the general structure and functions of the endocrine system. 20) A client is diagnosed with a disorder of the pituitary gland. When reviewing this client's medical history, the nurse will identify which health problems as potential results of the pituitary disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Diabetes insipidus 2. Acromegaly 3. Breastfeeding abnormalities 4. Graves' disease 5. Addison's disease Answer: 1, 2, 3 Explanation: The pituitary gland controls antidiuretic hormone. Disorders of this hormone can cause diabetes insipidus. The pituitary gland controls growth hormone. Disorders of this hormone can cause acromegaly. The pituitary gland controls oxytocin. Disorders of this hormone can cause delayed delivery or lack of milk ejection. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 64-1 Describe the general structure and functions of the endocrine system. 1199

21) A client receiving hormone replacement therapy tells the nurse that the medication is "not working." How should the nurse respond to this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Hormones affect all body cells." 2. "It may take several days or longer to achieve optimum results." 3. "The medication should work immediately." 4. "The medication will be changed to one that works faster." 5. "The wrong hormone is being replaced." Answer: 1, 2 Explanation: A hormone from the endocrine system may affect all body cells. A hormone may take several days or longer to produce an optimum response. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 64-2 Compare and contrast the nervous and endocrine systems in the control of homeostasis. 22) A client tells the nurse that because a hormone replacement medication "was not working," the client started taking double the prescribed dose. How should the nurse respond to this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The healthcare provider will need to be notified, because hormonal balance falls within a narrow range." 2. "It may take several days or longer to produce the desired effect." 3. "That was not a very wise thing to do." 4. "The wrong hormone replacement was prescribed." 5. "The healthcare provider would have probably made the same decision." Answer: 1, 2 Explanation: Hormonal balance is kept within a narrow range. Too much of a hormone may cause profound physiologic changes. Hormones from the endocrine system can affect all body cells and take as long as several days to produce optimum responses. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 64-2 Compare and contrast the nervous and endocrine systems in the control of homeostasis. 1200

23) A client's hormone replacement therapy for a health problem has been discontinued. The nurse should instruct the client about which effects because the therapy has been stopped? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Body cells will need time to adjust to the new hormone level. 2. Target cells are desensitized and are less responsive to the effects of the hormone. 3. Body cells will create more receptors on the plasma membrane to capture hormone molecules. 4. Body cells will send signals that hormone action is needed. 5. Body cells will secrete more hormone. Answer: 1, 2 Explanation: When therapy is discontinued, the cells will need time to synthesize more protein receptors and adjust to the new hormone level. When a hormone is provided for long periods, the body recognizes an abundance of the hormone and cells will down-regulate the number of receptors for that hormone. This causes a desensitization of the target cells, and they are less responsive to the effects of the hormone. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 64-3 Explain circumstances in which hormone receptors may be up-regulated or down-regulated.

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24) The nurse is reviewing the process of ovulation with a young woman desiring to become pregnant. During this teaching, the nurse will explain: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. gonadotropin-releasing hormone stimulates the luteinizing hormone to stimulate ovulation. 2. gonadotropin-releasing hormone stimulates luteinizing hormone to produce estrogen. 3. the presence of estrogen stops gonadotropin-releasing hormone from secreting more hormone. 4. the presence of estrogen signals the ovaries to continue releasing gonadotropin-releasing hormone. 5. luteinizing hormone stimulates estrogen to release gonadotropin-releasing hormone for ovulation to occur. Answer: 1, 2, 3 Explanation: Gonadotropin-releasing hormone does stimulate luteinizing hormone to stimulate ovulation. Gonadotropin-releasing hormone does stimulate luteinizing hormone to produce estrogen. Estrogen provides negative feedback to gonadotropin-releasing hormone to stop secreting. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 64-4 Through the use of a specific example, explain the concept of negative feedback in the endocrine system.

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25) The nurse is reviewing the pathophysiology of type 1 diabetes mellitus with a client newly diagnosed with the disorder. How will the nurse explain the control of pancreatic hormones in this disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Cells in the pancreas sense the level of glucose in the blood. 2. Depending on the level of glucose in the blood, the pancreas will either secrete insulin or stop the secretion of insulin. 3. Nerve impulses to the pancreas stimulate the release of insulin. 4. The pancreas reacts to other hormone levels in the blood. 5. Insulin is secreted in response to hormone levels within other digestive system organs. Answer: 1, 2 Explanation: The pancreas functions through humoral stimuli and senses the level of glucose in the blood. Because the pancreas functions through humoral stimuli and senses the level of glucose in the blood, it either secretes insulin or stops the secretion of insulin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 64-5 Explain the three primary types of stimuli that regulate hormone secretion.

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26) A client being treated for breast cancer is prescribed tamoxifen. What should the nurse instruct the client about this medication's mechanism of action? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. This medication is an antihormone. 2. This medication blocks the action of estrogen. 3. This medication replaces a hormone in the body. 4. This medication will shrink the breast tumor. 5. This medication will cause the breast cancer to become more aggressive. Answer: 1, 2 Explanation: Tamoxifen is an antihormone because it blocks the action of estrogen in estrogen-receptor-dependent breast cancers. Tamoxifen is an antihormone because it blocks the action of estrogen in estrogen-receptor-dependent breast cancers. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.I Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspective and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 64-6 Identify indications for hormone pharmacotherapy. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 65 Hypothalamic and Pituitary Drugs 1) The nurse is caring for a client who had deep brain surgery that resulted in damage to the hypothalamus. The nurse recognizes that the client's deficit of all pituitary hormones is related to the location of the hypothalamus, which is found: 1. anterior to the occipital lobe of the brain. 2. in the diencephalon, just above the brainstem. 3. deep within the brainstem. 4. within the parietal lobe of the brain. Answer: 2 Explanation: The hypothalamus is located in the center of the diencephalon, just superior to the brainstem. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 65-1 Explain the principal actions of the hormones secreted by the hypothalamus and the pituitary gland. 2) The nurse is teaching a client about the need for supplemental thyroid hormone following a hypophysectomy because of an anterior pituitary adenoma. The client says, "I thought thyroid 1204

hormone came from a gland in my neck." Which follow-up statement by the nurse is most appropriate? 1. "Your thyroid gland no longer gets messages from the pituitary." 2. "You will only need to take thyroid hormone until healing occurs." 3. "You need this hormone because your TSH is too high since surgery." 4. "Your thyroid gland was damaged because of the long surgical procedure." Answer: 1 Explanation: A hypophysectomy removes the anterior pituitary. Hormones normally produced by this portion of the pituitary are lacking. TSH is absent, so the thyroid gland does not receive messages to make thyroid hormone, and a lifelong supplement is needed. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 65-1 Explain the principal actions of the hormones secreted by the hypothalamus and the pituitary gland.

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3) A nurse is administering desmopressin to a client recovering from a head injury that increased pressure on the posterior pituitary gland. The nurse recognizes that this form of artificial antidiuretic hormone (ADH) will have the most impact on which portion of the assessment? 1. Peripheral nervous system function, including reflexes 2. Cardiac function, including the conduction system 3. Urine output and blood pressure 4. The Glasgow coma scale Answer: 3 Explanation: ADH is essential to fluid balance. Lack of ADH causes a condition called diabetes insipidus. Untreated ADH results in death from shock. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 65-1 Explain the principal actions of the hormones secreted by the hypothalamus and the pituitary gland. 4) A nurse is assessing a client with the diagnosis of SIADH. The nurse would anticipate the client's physical findings to be consistent with: 1. severe overhydration. 2. acute renal failure. 3. severe dehydration. 4. a shock state. Answer: 1 Explanation: SIADH is characterized by water retention. The urine output is scant, and the serum is very dilute. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 65-2 Identify indications for hypothalamic hormone therapy.

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5) A nurse is administering furosemide (Lasix) to a client with SIADH. The desired outcome would be: 1. a decrease in serum potassium. 2. an increase in blood pressure. 3. a decrease in serum osmolality. 4. an increase in urine output. Answer: 4 Explanation: SIADH is accompanied by low urine output and low serum osmolality. The goal of diuretic therapy is to eliminate water from the body. Urine output will increase. Loss of fluid from the vascular tree will thicken the serum, so serum osmolality will increase. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 65-2 Identify indications for hypothalamic hormone therapy. 6) A client with SIADH is upset about being prescribed a fluid restriction. Which explanation by the nurse is most appropriate? 1. "Your IV fluids are providing you with the liquids you need. You should not be thirsty." 2. "Your body is retaining too much water. Decreasing your intake, along with the other medicine you are receiving, helps correct the problem." 3. "Rinse your mouth with salt water. It will help to decrease your thirst." 4. "Your kidney is not working as it should. Decreasing your fluid intake allows your kidney to rest." Answer: 2 Explanation: Clients with SIADH already have too much fluid in their intracellular and extracellular spaces. Sodium levels are low because of hemodilution. Restricting fluid helps prevent signs of dilutional hyponatremia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 65-2 Identify indications for hypothalamic hormone therapy.

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7) A nurse is explaining the need to track blood glucose levels to a client who will be receiving growth hormone injections. The explanation is based on the recognition that additional growth hormone will: 1. increase insulin resistance. 2. decrease blood glucose levels. 3. promote very rapid growth. 4. trigger type 1 diabetes mellitus. Answer: 1 Explanation: Higher levels of growth hormone tend to increase insulin resistance at the cellular level, which makes blood glucose increase. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 65-3 Explain the pharmacotherapy of growth hormone disorders in children and adults. 8) A preschool-age client is well nourished but is in the fourth percentile for height according to age. The nurse recognizes this client needs to be referred promptly because: 1. there is evidence the client has inadequate GH levels. 2. there is evidence the client has inadequate ACTH levels. 3. there is evidence the child has inadequate TSH levels. 4. there is evidence the child has inadequate FSH and LH levels. Answer: 1 Explanation: A client who is below the fifth percentile in height and who is not malnourished might lack sufficient growth hormone (GH). Referral is appropriate because supplementation might be necessary. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 65-3 Explain the pharmacotherapy of growth hormone disorders in children and adults.

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9) A nurse is giving a presentation on steroid abuse to a group of adolescents. One of the students comments that growth hormone is safe because it is a natural product. The nurse's response would be based on the knowledge that: 1. growth hormone is more likely to be a drug of abuse among older individuals, because adolescents have sufficient growth hormone already present. 2. adolescents rarely abuse growth hormone because it is not as readily available as anabolic steroids. 3. adolescents might abuse growth hormone to improve their athletic performance or to impress others with their enhanced appearance. 4. growth hormone is safe for adolescents to use but should not be used by anyone whose bone ends are fused. Answer: 3 Explanation: Adolescents might obtain and use GH in an attempt to perform better at sports or to define the appearance of their muscles. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 65-3 Explain the pharmacotherapy of growth hormone disorders in children and adults. 10) The nurse is planning the discharge of a client with a known long-term deficit of ADH. The nurse recognizes that the discharge orders for an ADH supplement will most likely require teaching about: 1. self-administration of an every-third-day intramuscular preparation. 2. self-administration of a weekly intravenous preparation. 3. self-administration of an oral or intranasal preparation. 4. self-administration of a daily subcutaneous preparation. Answer: 3 Explanation: Long-term supplementation of ADH is typically via the oral or intranasal route. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 65-4 Explain the pharmacotherapy of antidiuretic hormone disorders.

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11) A client with long-term nephrogenic diabetes insipidus (DI) is admitted to a medical unit. During the medication reconciliation process, the nurse realizes it is crucial that which medication be included in the client's regimen? 1. Chlorpropamide 2. Hydrochlorothiazide (HCTZ) 3. Intranasal or oral desmopressin 4. Conivaptan (Vaprisol) Answer: 2 Explanation: Nephrogenic DI is a condition in which the kidneys do not respond to ADH or conserve water properly. The conventional treatment is administration of the thiazide diuretic HCTZ. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 65-4 Explain the pharmacotherapy of antidiuretic hormone disorders. 12) Conivaptan (Vaprisol) is prescribed for a client with severe SIADH. The nurse preparing this medication recognizes that the desired outcome of this therapy is: 1. a decreased urine output. 2. an increased urine output. 3. an increased blood pressure. 4. an increased heart rate. Answer: 2 Explanation: Conivaptan blocks receptors in the kidneys that normally bind to ADH. With less ADH, there is less antidiuresis. Less antidiuresis means more urine is produced and eliminated. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 65-4 Explain the pharmacotherapy of antidiuretic hormone disorders.

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13) The nurse is preparing to administer somatropin (Humatrope). In the process of planning care, the nurse is aware that the client is likely to experience what minor adverse effects? 1. Headache and joint ache 2. Nausea and vomiting 3. Diarrhea and increased flatus 4. Nasal congestion and flushing Answer: 1 Explanation: Somatropin is a GH analog. Minor adverse effects associated with GH analogs include joint pain, headache, swelling of the hands and feet, increased blood pressure, and pain at the injection site. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 65-5 For each of the classes shown in the chapter outline, identify the prototypes and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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14) A client with metastatic abdominal cancer has become debilitated secondary to bowel-related signs and symptoms. The nurse is preparing to administer octreotide (Sandostatin). The nurse would anticipate: 1. a decrease in gastric reflux signs and symptoms. 2. a decrease in nausea and vomiting episodes. 3. severe constipation and possible ileus. 4. a decrease in the number of diarrheal stools. Answer: 4 Explanation: Sandostatin is indicated for the management of signs and symptoms associated with metastatic carcinoid cancers and vasoactive intestinal peptide tumors. Severe diarrhea can result with these tumors, and Sandostatin should decrease the number of stools and increase stool consistency. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 65-5 For each of the classes shown in the chapter outline, identify the prototypes and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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15) An adolescent client is prescribed nasal desmopressin for treatment of diabetes insipidus (DI). It is essential for the nurse to teach the client and family the signs and symptoms associated with: 1. acute renal failure. 2. hypoglycemic reaction. 3. liver failure. 4. water intoxication. Answer: 4 Explanation: Desmopressin is a synthetic form of ADH. It corrects the polydipsia and polyuria associated with DI. Water intoxication and severe hyponatremia are real concerns if the client does not decrease fluid intake as the drug takes effect. Coma and death can result if the amount of fluid in the bloodstream is not decreased. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 65-5 For each of the classes shown in the chapter outline, identify the prototypes and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 16) The nurse is assessing a client who is newly prescribed to receive supplemental growth hormone therapy. Which parameters should the nurse assess? 1. Bowel sounds, vitamin B12 level, and history of gallbladder disease 2. Height and weight, head circumference, and EKG 3. Blood sugar, blood pressure, height, and weight 4. Urine specific gravity, serum osmolality, and serum electrolytes Answer: 3 Explanation: When preparing to administer growth hormone, the nurse should assess growth to date, including height and weight. Blood sugar and blood pressure can increase as a result of therapy, so baseline values are needed. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 65-6 Apply the nursing process to care of patients receiving pharmacotherapy for disorders of the hypothalamus and pituitary gland. 17) The nurse is evaluating outcomes after administering desmopressin therapy. Which 1213

assessment finding is considered a desired outcome in an adult male client? 1. Urine output of 3,500 mL/day 2. Urine specific gravity of 1.015 3. Edema of lower extremities absent 4. Serum sodium 156 mEq/L Answer: 2 Explanation: Desmopressin is administered to treat diabetes insipidus (DI). The client with DI is typically dehydrated before treatment. A urine specific gravity of 1.015 is normal, which indicates that the treatment has stopped the diuresis associated with DI. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 65-6 Apply the nursing process to care of patients receiving pharmacotherapy for disorders of the hypothalamus and pituitary gland.

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18) An adult client diagnosed with a malfunctioning hypothalamus is experiencing hormone deficiencies. Which hormones will the nurse expect to be prescribed for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Thyroid hormone 2. Corticosteroids 3. Estrogen 4. Progesterone 5. Gonadotropin-releasing hormone Answer: 1, 2, 3, 4 Explanation: It is more effective and less expensive to administer pituitary hormones rather than hypothalamic hormones when the hypothalamus is malfunctioning. Thyroid hormone may be prescribed for this client. It is more effective and less expensive to administer pituitary hormones rather than hypothalamic hormones when the hypothalamus is malfunctioning. Corticosteroids may be prescribed for this client. It is more effective and less expensive to administer pituitary hormones rather than hypothalamic hormones when the hypothalamus is malfunctioning. Estrogen may be prescribed for this client. It is more effective and less expensive to administer pituitary hormones rather than hypothalamic hormones when the hypothalamus is malfunctioning. Progesterone may be prescribed for this client. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 65-1 Explain the principal actions of the hormones secreted by the hypothalamus and the pituitary gland.

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19) A client is prescribed octreotide (Sandostatin) but has no evidence of acromegaly. The nurse realizes that this medication is indicated for which other health problems? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Severe diarrhea 2. Portal hypertension 3. Bleeding esophageal varices 4. Pancreatic fistulas 5. Diabetes mellitus Answer: 1, 2, 3, 4 Explanation: Octreotide (Sandostatin) stimulates the absorption of fluid and electrolytes from the gastrointestinal tract and is approved to treat severe diarrhea. Octreotide (Sandostatin) decreases hepatic and gastrointestinal blood flow and reduces hepatic-portal venous pressure. This makes the medication useful to treat portal hypertension. Octreotide (Sandostatin) decreases hepatic and gastrointestinal blood flow and reduces hepatic-portal venous pressure. This makes the medication useful to treat bleeding esophageal varices. Octreotide (Sandostatin) is used off-label to reduce the output from pancreatic fistulas. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 65-2 Identify indications for hypothalamic hormone therapy.

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20) An adult client is receiving treatment for a growth hormone deficiency. What effects of treatment will the nurse expect to assess in the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increased lean body mass 2. Decreased fat mass 3. Increased bone mineral density 4. Decreased lipid levels 5. Decreased insulin resistance Answer: 1, 2, 3, 4 Explanation: Treatment can result in increased lean body mass. Treatment can result in decreased fat mass. Treatment can result in increased bone mineral density. Treatment can result in decreased lipid levels. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 65-3 Explain the pharmacotherapy of growth hormone disorders in children and adults. 21) A preschool-age client weighing 44 lb is prescribed to receive subcutaneous injections of somatropin (Genotropin) 0.21 mg/kg/week to be administered over 7 days. The client will receive milligrams in one injection. Record your answer rounding to one decimal place. Answer: 0.6 Explanation: The client weighs 44 lb. To determine kilograms, divide 44 lb by 2.2. The client weighs 20 kg. Multiply the weekly dose of 0.21 mg by 20. The client should receive 4.2 mg of the medication every week. To determine the daily dose, divide the weekly dose of 4.2 by 7, for 7 days, to calculate that the client is to receive 0.6 mg of the medication every day. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 65-3 Explain the pharmacotherapy of growth hormone disorders in children and adults.

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22) The nurse caring for a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) will prepare to administer which medications to this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Furosemide (Lasix) 2. Conivaptan (Viprostol) 3. Demeclocycline (Declomycin) 4. Tetracycline 5. Bleomycin Answer: 1, 2, 3 Explanation: This medication is used to remove excess fluid caused by the disorder. This medication promotes renal water excretion in clients with SIADH. This medication is used off-label to treat SIADH because it causes diuresis through inhibiting ADH-induced water reabsorption in the tubules and collecting ducts of the kidneys. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 65-4 Explain the pharmacotherapy of antidiuretic hormone disorders.

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23) The nurse realizes that a client with a growth hormone deficiency is not a candidate to receive somatropin (Humatrope) because of which health problems? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Sleep apnea 2. Morbid obesity 3. Chronic renal failure 4. Type 2 diabetes mellitus 5. Foot wound Answer: 1, 2, 3, 4 Explanation: This medication is contraindicated in clients with sleep apnea due to potentially fatal respiratory impairment. This medication is contraindicated in clients with severe obesity due to potentially fatal respiratory impairment. This medication should be used with caution in clients with severe renal disease due to reduced clearance. This medication should be used with caution in clients with diabetes mellitus due to hyperglycemia and insulin resistance. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 65-5 For each of the classes shown in the chapter outline, identify the prototypes and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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24) The nurse is concerned that a client prescribed octreotide (Sandostatin) is at risk for drug interactions because the client is currently prescribed which medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Antidiabetic agent 2. Beta blocker 3. Calcium channel blocker 4. Antidiarrheal 5. Antibiotics Answer: 1, 2, 3, 4 Explanation: Concurrent administration with antidiabetic agents or insulin can produce hypoglycemia. Concurrent administration with a beta blocker can cause additive bradycardia. Concurrent administration with a calcium channel blocker can cause additive bradycardia. Concurrent administration with an antidiarrheal can lead to severe constipation, intestinal obstruction, or paralytic ileus. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 65-5 For each of the classes shown in the chapter outline, identify the prototypes and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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25) A client will be self-administering desmopressin (DDAVP) intranasally at home after discharge. What should the nurse instruct the client regarding the administration of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Direct the nasal spray high into the nasal cavity. 2. Shake the medication before use. 3. Store the medication at room temperature. 4. Warm the solution in the microwave before use. 5. Discard the solution if any particles are present in the solution. Answer: 1, 3, 5 Explanation: The nurse should instruct the client to direct the nasal spray high into the nasal cavity. The nurse should instruct the client to store the medication at room temperature. The nurse should instruct the client to discard any solutions with particulate matter present. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 65-6 Apply the nursing process to care of patients receiving pharmacotherapy for disorders of the hypothalamus and pituitary gland. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 66 Pharmacotherapy of Diabetes Mellitus 1) Which body tissue or organ cannot synthesize glucose for its energy supply? 1. The kidneys 2. The lungs 3. The heart 4. The brain Answer: 4 Explanation: Most body tissues can use fatty acids and protein for energy, if necessary. The brain cannot because it is unable to synthesize glucose, and it exhausts its supply after just a few minutes of activity. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 66-1 Explain how blood glucose levels are maintained within narrow limits by insulin and glucagon. 1221

2) Even though the normal range for serum glucose is 60 to 100 mg/dL, the body usually tightly regulates this level to: 1. 90 to 100 mg/dL. 2. 80 to 90 mg/dL. 3. 60 to 70 mg/dL. 4. 70 to 80 mg/dL. Answer: 2 Explanation: The body attempts to maintain tight glucose control between 80 and 90 mg/dL to prevent complications associated with hypo- or hyperglycemic states. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 66-1 Explain how blood glucose levels are maintained within narrow limits by insulin and glucagon.

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3) When instructing a client with diabetes about glucose balance, the nurse explains that following a meal, glucose that is not needed for immediate energy needs is stored as: 1. muscle tissue. 2. glycogen. 3. fat. 4. glucagon. Answer: 2 Explanation: The storage form of glucose is called glycogen. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-1 Explain how blood glucose levels are maintained within narrow limits by insulin and glucagon. 4) When caring for a client with diabetes, the nurse knows that the client is experiencing a breakdown of fatty acids for fuel because of which serum laboratory finding? 1. Leukocytes 2. Protein 3. Glucose 4. Ketones Answer: 4 Explanation: When the body must metabolize fatty acids for fuel, ketones accumulate in the blood. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 66-2 Compare and contrast the etiology and pathogenesis of type 1, type 2, and gestational diabetes.

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5) When instructing a client, the nurse explains that the primary factor contributing to the development of type 2 diabetes is: 1. age. 2. ethnicity. 3. a sedentary lifestyle. 4. obesity. Answer: 4 Explanation: Eighty percent of individuals with type 2 diabetes are overweight. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 66-2 Compare and contrast the etiology and pathogenesis of type 1, type 2, and gestational diabetes. 6) What will the nurse describe to a client as risk factors for developing type 2 diabetes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Ethnicity 2. Age younger than 45 3. Obesity 4. Race 5. Family history Answer: 1, 3, 4, 5 Explanation: Ethnicity is a risk factor for the development of type 2 diabetes. Obesity is a risk factor for the development of type 2 diabetes. Race is a risk factor for the development of type 2 diabetes. Family history is a risk factor for the development of type 2 diabetes. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health-promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-2 Compare and contrast the etiology and pathogenesis of type 1, type 2, and gestational diabetes.

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7) A client with diabetes is experiencing polyuria. The nurse explains that polyuria is caused by: 1. inflammation of the glomerulus. 2. excessive fluid intake. 3. lack of albumin. 4. osmotic diuresis. Answer: 4 Explanation: Osmotic diuresis leads to polyuria, which is the passage of large amounts of urine as a result of increased osmotic pressure that can result from hyperglycemia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-3 Describe the signs and diagnosis of diabetes. 8) A client is scheduled for a hemoglobin A1c laboratory test. The nurse explains to the client that this test monitors: 1. the percentage of glucagon in the blood. 2. the level of hemoglobin over time. 3. the percentage of glucose present in the blood. 4. the level of glucose over time. Answer: 4 Explanation: Hemoglobin A1c measures the level of blood glucose over time because glucose molecules attach to the hemoglobin molecule for the life of the RBC, which is 120 days. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 66-3 Describe the signs and diagnosis of diabetes.

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9) A client is acutely confused, sweating, and complaining of a headache. The nurse suspects hypoglycemia. The nurse's next action is to obtain: 1. a serum blood glucose. 2. a glucose tolerance test. 3. serum electrolytes. 4. a capillary blood glucose level. Answer: 4 Explanation: Obtaining a fingerstick blood sugar takes 15 seconds and provides an opportunity for rapid nursing intervention, if needed. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-4 Describe the acute complications of diabetes. 10) Which drug would alter a client's ability to recognize the symptoms of hypoglycemia? 1. beta blockers 2. antibiotics 3. diuretics 4. oral hypoglycemic agents Answer: 1 Explanation: Beta blockers interfere with the symptoms of hypoglycemia, making it more difficult for the client to recognize symptoms. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 66-4 Describe the acute complications of diabetes.

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11) The nurse explains that the difference between diabetic ketoacidosis (DKA) and a hyperosmolar hyperglycemic state (HHS) is that clients with HHS: 1. do not manifest ketoacidosis. 2. are dehydrated. 3. are confused. 4. have elevated glucose levels. Answer: 1 Explanation: Clients with HHS do not experience ketoacidosis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 66-4 Describe the acute complications of diabetes. 12) The nurse, instructing a group of community members on chronic health problems, explains that the leading cause of blindness in the United States is: 1. glaucoma. 2. cataracts. 3. hypertension. 4. diabetic retinopathy. Answer: 4 Explanation: The leading cause of blindness in the United States is retinopathy due to microvascular changes associated with the hyperglycemic states of diabetes. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Context and Environment: Apply health-promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-5 Identify the chronic complications of diabetes.

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13) What should the nurse instruct a client who is diagnosed with diabetes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Have eye examinations every 2 to 3 years. 2. Monitor blood pressure carefully. 3. Check feet daily for signs of irritation. 4. Maintain glucose control. 5. Quit smoking. Answer: 2, 3, 4, 5 Explanation: Monitoring blood pressure carefully is an important teaching point to aid recognition of hypertensive changes associated with diabetes. Checking the feet for signs of skin breakdown is an important teaching point because, due to peripheral neuropathy, the client might not sense small changes in skin integrity in the feet. Maintaining glucose control is an important teaching point because tight glucose control helps prevent the complications of diabetes. Quitting smoking in an important teaching point because nicotine is a vasoconstrictor, and clients with diabetes are at greater risk for microvascular changes. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-5 Identify the chronic complications of diabetes. 14) The nurse, preparing medications for a client with diabetes, recognizes that what percentage of adults with diabetes take oral agents only? 1. 60% to 70% 2. 30% to 40% 3. 50% to 60% 4. 40% to 50% Answer: 3 Explanation: 58% of adults with diabetes take oral agents only. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 66-6 Compare and contrast the pharmacotherapy of the different types of diabetes.

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15) A client is prescribed the insulin with the least rapid onset. Which insulin will the nurse administer to this client? 1. Glulisine 2. Regular 3. Aspart 4. Lispro Answer: 2 Explanation: The onset of regular insulin is 30 to 60 minutes. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-7 For each type of insulin, identify the onset of action, peak action and duration of action, administrations routes, when it is given related to meals, compatibility with other insulins, and adverse effects. 16) A client is prescribed insulin via the intravenous (IV) route. Which insulin will the nurse administer to this client? 1. Glulisine 2. Regular 3. Aspart 4. Lispro Answer: 2 Explanation: Only regular insulin can be administered through the intravenous route. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-7 For each type of insulin, identify the onset of action, peak action and duration of action, administrations routes, when it is given related to meals, compatibility with other insulins, and adverse effects.

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17) The nurse is instructing a client on the effects of insulin. What will the nurse include as the primary adverse effect? 1. Somogyi phenomenon 2. Swollen lymph glands 3. Hypoglycemia 4. Urticaria Answer: 3 Explanation: The primary adverse effect of insulin is hypoglycemia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-7 For each type of insulin, identify the onset of action, peak action and duration of action, administrations routes, when it is given related to meals, compatibility with other insulins, and adverse effects. 18) When teaching a client about a prescribed second-generation sulfonylurea for blood glucose control, the nurse explains that the advantage of this medication is that it: 1. exhibits fewer drug–drug interactions. 2. does not cause hypoglycemia. 3. can be administered in smaller doses. 4. causes fewer adverse effects. Answer: 1 Explanation: The advantage of second-generation sulfonylureas is that they exhibit fewer drug– drug interactions. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards of care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-8 For each of the classes shown in the chapter outline identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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19) The nurse should instruct a client to avoid which substance while taking a sulfonylurea medication? 1. Antacids 2. Calcium products 3. Alcohol 4. Antibiotics Answer: 3 Explanation: When administered with alcohol, sulfonylureas can cause a disulfiram-like reaction with flushing, palpations, and nausea. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards of care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-8 For each of the classes shown in the chapter outline identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 20) Prior to administering glyburide, the nurse will review a client's allergies because this medication is contraindicated in clients who are allergic to: 1. urea. 2. milk products. 3. eggs. 4. sulfa drugs. Answer: 4 Explanation: Glyburide is a sulfonylurea and is contraindicated in clients with a known sensitivity to sulfa drugs. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards of care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-8 For each of the classes shown in the chapter outline identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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21) The nurse knows that the prescribed dose of insulin should not be administered to a client whose blood glucose is: 1. lower than 70 mg/dL. 2. 80 mg/dL. 3. 90 mg/dL. 4. 100 mg/dL. Answer: 1 Explanation: The nurse should not administer insulin if blood glucose levels are lower than 70 mg/dL. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-9 Apply the nursing process to the care of patients receiving pharmacotherapy for diabetes. 22) When administering insulin to a client, the nurse will rotate injection sites primarily to prevent: 1. systemic absorption of insulin. 2. lipodystrophy. 3. abscess development. 4. ineffective dosing. Answer: 2 Explanation: Rotation of insulin sites helps to prevent lipodystrophy. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-9 Apply the nursing process to the care of patients receiving pharmacotherapy for diabetes.

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23) What should the nurse include when teaching a client about insulin? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Rotate injection sites. 2. Recognize the signs of hypoglycemia. 3. Store insulin in the freezer. 4. Carry a readily available supply of sugar. 5. Wear a medic-alert bracelet that explains the client has diabetes. Answer: 1, 2, 4, 5 Explanation: Injection sites should be rotated to prevent lipodystrophy. Clients should understand the symptoms of hypoglycemia. Diabetics should carry a readily available source of sugar. Clients should wear a medic-alert bracelet that identifies them as having diabetes. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-9 Apply the nursing process to the care of patients receiving pharmacotherapy for diabetes.

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24) The nurse is instructing a client on the role of the pancreas in controlling blood glucose levels. When does the pancreas excrete glucagon to maintain an adequate amount of glucose in the blood? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. During periods of fasting 2. During exercise 3. When drinking alcohol 4. After eating a large meal 5. When fighting an infection Answer: 1, 2, 3 Explanation: Glucagon is released from the pancreas during periods of fasting. Glucagon is released from the pancreas during exercise. Glucagon is released from the pancreas when alcohol is consumed. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-1 Explain how blood glucose levels are maintained within narrow limits by insulin and glucagon. 25) Which client statements indicate to the nurse that instruction about type 2 diabetes mellitus and insulin resistance has been effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Exercise will improve insulin resistance." 2. "Eating a healthy diet will reverse insulin resistance." 3. "Exercise will cure type 2 diabetes mellitus." 4. "Eating a healthy diet will cure type 2 diabetes mellitus." 5. "I can eat anything I want as long as I exercise afterward." Answer: 1, 2 Explanation: The activity of insulin receptors can be increased by exercise. Adhering to a healthy diet has been shown to reverse insulin resistance. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health-promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 66-2 Compare and contrast the etiology and pathogenesis of type 1, type 2, and gestational diabetes.

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26) The nurse is concerned that a client is at risk for developing gestational diabetes after collecting which assessment data? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Family history 2. Obesity 3. Previous spontaneous abortion 4. Sedentary lifestyle 5. Diagnosis of hypertension Answer: 1, 2, 3 Explanation: A family history of diabetes increases the client's risk of developing gestational diabetes. Obesity increases the client's risk of developing gestational diabetes. A previous spontaneous abortion increases the client's risk of developing gestational diabetes. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health-promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 66-2 Compare and contrast the etiology and pathogenesis of type 1, type 2, and gestational diabetes. 27) After an assessment, the nurse suspects that a client is experiencing signs of type 2 diabetes mellitus. What did the nurse assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Excessive urination 2. Excessive thirst 3. Blurred vision 4. Tingling of the fingers and toes 5. Itchy skin rash Answer: 1, 2, 3, 4 Explanation: Excessive urination or polyuria is a symptom of type 2 diabetes. Excessive thirst or polydipsia is a symptom of type 2 diabetes. Blurred vision is a symptom of type 2 diabetes. Tingling or paresthesias is a symptom of type 2 diabetes. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 66-3 Describe the signs and diagnosis of diabetes. 1235

28) The nurse is planning care for a client with diabetic ketoacidosis. What interventions will the nurse most likely perform for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Administer intravenous fluids as prescribed 2. Administer a loading dose of intravenous insulin as prescribed 3. Administer electrolyte replacements as prescribed 4. Administer intravenous antibiotics as prescribed 5. Administer nebulized bronchodilators as prescribed Answer: 1, 2, 3 Explanation: Treatment of diabetic ketoacidosis includes fluid replacement therapy. Treatment of diabetic ketoacidosis includes a loading dose of intravenous insulin therapy. Treatment of diabetic ketoacidosis includes electrolyte replacements. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-4 Describe the acute complications of diabetes.

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29) What should the nurse teach a client with diabetes about how to reduce the risk of cardiovascular complications from the disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Stop smoking. 2. Follow a low-fat diet. 3. Take blood pressure medication as prescribed. 4. Keep blood glucose levels within normal limits. 5. Prevent constipation. Answer: 1, 2, 3, 4 Explanation: Smoking cessation is a preventive measure to reduce the cardiovascular risk factors associated with diabetes. Lowering lipid levels is a preventive measure to reduce the cardiovascular risk factors associated with diabetes. Controlling blood pressure is a preventive measure to reduce the cardiovascular risk factors associated with diabetes. Optimal glucose control is a preventive measure to reduce the cardiovascular risk factors associated with diabetes. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.2 Describe EBP to include the components of research evidence, clinical expertise and patient/family values | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Context and Environment: Apply health-promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-5 Identify the chronic complications of diabetes.

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30) When reviewing a client's current medications, the nurse is concerned that the insulin dose will need to be adjusted because the client is currently prescribed which medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Beta blocker 2. Monoamine oxidase inhibitor 3. Angiotensin-converting enzyme inhibitor 4. Cardiac glycoside 5. Nonsteroidal anti-inflammatory agents (NSAIDs) Answer: 1, 2, 3 Explanation: Insulin must be used cautiously in conjunction with medications that can produce hypoglycemia, including beta blockers. Insulin must be used cautiously in conjunction with medications that can produce hypoglycemia, including monoamine oxidase inhibitors. Angiotensin-converting enzyme inhibitors increase insulin sensitivity and may enhance the hypoglycemic effects of insulin. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and principles | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 66-7 For each type of insulin, identify the onset of action, peak action and duration of action, administrations routes, when it is given related to meals, compatibility with other insulins, and adverse effects.

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31) The nurse decides to withhold a prescribed dose of metformin to a client after reviewing the medical record. For which conditions is this medication contraindicated or used with caution? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Impaired renal function 2. Heart failure 3. Hyperthyroidism 4. Septicemia 5. Sleep apnea Answer: 1, 2, 3, 4 Explanation: Metformin is contraindicated in clients with impaired renal function. Metformin is contraindicated in clients with heart failure. Metformin is used with caution in clients with hyperthyroidism. Metformin is contraindicated in clients with a concurrent serious infection. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards of care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 66-8 For each of the classes shown in the chapter outline identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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32) What dietary instructions should the nurse provide a client who is prescribed repaglinide (Prandin)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Do not take with grapefruit juice. 2. Avoid using garlic. 3. Drink decaffeinated beverages only. 4. Avoid green leafy vegetables. 5. Limit the intake of milk products. Answer: 1, 2 Explanation: The concurrent intake of grapefruit juice with repaglinide may result in increased drug levels and hypoglycemia. Garlic may increase the hypoglycemic effects of repaglinide. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards of care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 66-8 For each of the classes shown in the chapter outline identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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33) Which statements indicate that instruction provided to a client with type 1 diabetes mellitus regarding exercise has been effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I should start any new exercise regimen slowly." 2. "I should exercise an hour after a meal." 3. "I should have a snack of 10 to 15 grams of carbohydrate before exercising." 4. "I should take 10- to 15-gram carbohydrate snacks with me to the gym if I plan to exercise longer than 30 minutes." 5. "I should withhold my routine insulin dose if I plan to exercise that day." Answer: 1, 2, 3, 4 Explanation: The client should be instructed to begin any new exercise routine or increase in exercise gradually. The client should be instructed to exercise an hour after a meal. The client should be instructed to exercise after a 10- to 15-gram carbohydrate snack. The client should be instructed to have small frequent carbohydrate snacks every 30 minutes during exercise to maintain the blood sugar level. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 66-6 Compare and contrast the pharmacotherapy of the different types of diabetes. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 67 Pharmacotherapy of Thyroid Disorders 1) A client is diagnosed with a thyroid hormone imbalance. The nurse recognizes that the body tissues that do not depend on thyroid hormones to stimulate the metabolic rate include the: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. anterior pituitary. 2. lungs. 3. brain. 4. kidneys. 5. testes. Answer: 1, 2, 3, 5 Explanation: The anterior pituitary's metabolic rate is not stimulated by thyroid hormones. The lung's metabolic rate is not stimulated by thyroid hormones. The brain's metabolic rate is not stimulated by thyroid hormones. The testes' metabolic rate is not stimulated by thyroid hormones. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation 1241

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3) The nurse is reviewing the results of a client's laboratory studies to find the level of an important chemical that must be available to assist in the synthesis of thyroid hormones. What is that chemical? 1. Cortisol 2. Iodide 3. Calcitonin 4. Iodine Answer: 4 Explanation: Iodine is involved in the synthesis of thyroid hormones. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 67-1 Explain the functions of thyroid hormone. 4) A client has low levels of T3 and T4. The nurse realizes that in response to these levels, the anterior pituitary will secrete: 1. thyroid-stimulating hormone. 2. tri-iodothyronine. 3. thyrotropin-releasing hormone. 4. thyroxine. Answer: 1 Explanation: Thyroid-stimulating hormone is released by the anterior pituitary in response to decreased levels of T3 and T4. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 67-2 Explain the negative feedback control of thyroid function.

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5) The nurse, learning that a client's thyroid hormone is elevated, recognizes that one of the strongest stimuli for an increase in thyroid hormone production is: 1. hunger. 2. exposure to cold. 3. ongoing infection. 4. hypocalcemia. Answer: 2 Explanation: One of the strongest stimuli for increased thyroid hormone production is exposure to cold. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 67-2 Explain the negative feedback control of thyroid function. 6) Which laboratory value will the nurse monitor to determine the progression of thyroid disease in a client? 1. TSH 2. T3 3. Iodine 4. T4 Answer: 1 Explanation: TSH is the preferred laboratory value for monitoring the progression of thyroid disease. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 67-3 Explain how thyroid disorders are diagnosed.

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7) To detect malignancy of a thyroid nodule, the nurse would prepare the client for: 1. thyroid scanning. 2. ultrasound. 3. needle biopsy. 4. x-ray. Answer: 3 Explanation: Needle biopsy is the diagnostic tool of choice for detecting thyroid nodule malignancy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 67-3 Explain how thyroid disorders are diagnosed. 8) How would the nurse explain the pathophysiologic etiology of cretinism to a client's family? 1. Lack of iodine replacement 2. Hypercalcemia from thyroid hyperplasia 3. Congenital hypofunction of the thyroid gland 4. Hypersecretion of the thyroid in the first six months of life Answer: 3 Explanation: Cretinism is caused by hypofunction of the thyroid gland. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 67-4 Describe the pathophysiology of thyroid disorders.

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9) The nurse would anticipate the client with hypothyroidism to exhibit which symptom? 1. Constipation 2. Heat intolerance 3. Weight loss 4. Hypertension Answer: 1 Explanation: The client with hypothyroidism experiences a slowing in metabolic rate and constipation. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 67-4 Describe the pathophysiology of thyroid disorders. 10) The nurse is concerned that a client is developing myxedema coma after assessing which symptoms? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Puffy face and eyes 2. Tachycardia 3. Hypoglycemia 4. Hyperthermia 5. Hypoventilation Answer: 1, 3, 5 Explanation: The manifestations of myxedema coma include edema of the face and eyes. The manifestations of myxedema coma include hypoglycemia. The manifestations of myxedema coma include hypoventilation. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 67-4 Describe the pathophysiology of thyroid disorders.

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11) The nurse knows the most visible signs of Graves' disease are goiter and exophthalmos. Exophthalmos is: 1. excessive heat production. 2. skin thickening with plaques. 3. hypertrophy of the thyroid gland. 4. outward bulging of the eyes. Answer: 4 Explanation: Exophthalmos is the outward bulging of the eyes. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 67-4 Describe the pathophysiology of thyroid disorders. 12) The nurse would anticipate the client with hyperthyroidism to exhibit which symptom? 1. Hypothermia 2. Bradycardia 3. Weight gain 4. Hypertension Answer: 4 Explanation: The client with hyperthyroidism experiences an increase in metabolic rate and possibly hypertension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 67-4 Describe the pathophysiology of thyroid disorders.

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13) The nurse should instruct the parents of a client with cretinism that the duration of thyroid replacement is expected to be: 1. 3 years. 2. the first year of life. 3. started at puberty. 4. continued until symptoms disappear. Answer: 1 Explanation: Children with cretinism should be treated for 3 years and reevaluated. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 67-5 Describe the pharmacotherapy of thyroid disorders. 14) The nurse is instructing a client taking levothyroxine (Synthroid) that full therapeutic benefits will be seen: 1. immediately. 2. within 3 to 5 days. 3. in 1 to 3 weeks. 4. within 24 hours. Answer: 3 Explanation: One to 3 weeks might be required for full therapeutic benefits of levothyroxine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 67-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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15) The nurse instructs a client with hypothyroidism about medications that accelerate the metabolism of levothyroxine, including: 1. warfarin. 2. phenytoin. 3. digoxin. 4. calcium. Answer: 2 Explanation: Phenytoin accelerates the metabolism of levothyroxine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 67-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 16) In which instance would the nurse hold the dose of levothyroxine (Synthroid)? 1. The client complains of palpitations. 2. The client's blood pressure 118/78 mmHg. 3. The client's respiratory rate is 10 breaths/min. 4. The client is fatigued. Answer: 1 Explanation: An adverse effect of levothyroxine is palpitations, which should be reported before providing the scheduled dose. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 67-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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17) The nurse would monitor carefully the client concurrently taking levothyroxine (Synthroid) and: 1. aspirin. 2. vitamin B12 supplementation. 3. warfarin. 4. penicillin. Answer: 3 Explanation: A client taking warfarin and levothyroxine concurrently might need a decrease in the warfarin dosage to prevent bleeding. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 67-7 Apply the nursing process to the care of patients receiving pharmacotherapy for thyroid disorders. 18) For which client would the nurse question the use of levothyroxine (Synthroid)? 1. A child under age 2 2. A pregnant client 3. A client allergic to shellfish 4. A client allergic to aspirin Answer: 4 Explanation: Synthroid can cause allergic reaction in clients sensitive to aspirin. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 67-7 Apply the nursing process to the care of patients receiving pharmacotherapy for thyroid disorders.

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19) A client is receiving thyroid hormone replacement therapy, which increases the number of beta1- and beta2-adrenergic receptors. The nurse knows that this increase in receptors will make the receptors more responsive to which neurotransmitters? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Norepinephrine 2. Epinephrine 3. Dopamine 4. Serotonin 5. Melatonin Answer: 1, 2, 3 Explanation: Thyroid hormone increases the number of beta1- and beta2-adrenergic receptors and enhances their affinity to catecholamines such as norepinephrine. Thyroid hormone increases the number of beta1- and beta2-adrenergic receptors and enhances their affinity to catecholamines such as epinephrine. Thyroid hormone increases the number of beta1- and beta2-adrenergic receptors and enhances their affinity to catecholamines such as dopamine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 67-1 Explain the functions of thyroid hormone. 20) A client is diagnosed with primary hypothyroidism. Which laboratory tests were used to aid in this diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Serum T4 level 2. TSH level 3. Serum calcium 4. Serum potassium 5. Serum iodine level Answer: 1, 2 Explanation: The serum T4 level is used to determine primary hypothyroidism. The TSH level is used to determine primary hypothyroidism. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 67-3 Explain how thyroid disorders are diagnosed. 21) A client is diagnosed with hyperthyroidism. The nurse will prepare to administer which medications as routine treatment of this disorder? 1251

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Propylthiouracil (PTU) 2. Methimazole (Tapazole) 3. Propranolol (Inderal) 4. Esmolol (Brevibloc) 5. Metoprolol (Toprol) Answer: 1, 2 Explanation: Propylthiouracil (PTU) is used to treat hyperthyroidism. Methimazole (Tapazole) is used to treat hyperthyroidism. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 67-5 Describe the pharmacotherapy of thyroid disorders. 22) Why is a client prescribed intravenous hydrocortisone (Solu-Cortef) as part of the treatment for thyroid storm? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Steroids block the conversion of T4 to T3 in peripheral tissues. 2. IV corticosteroids serve as replacement for corticosteroids in the body. 3. Steroids reduce the TSH level. 4. Steroids help maintain the blood pressure. 5. Steroids are used to stabilize the heart rate. Answer: 1, 2 Explanation: Intravenous corticosteroids may be ordered to treat acute hyperthyroid states because they block the conversion of T4 to T3 in peripheral tissues. Severe hyperthyroid states create high levels of stress that deplete adrenal corticosteroids in the body, and the administration of replacement doses is necessary. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 67-5 Describe the pharmacotherapy of thyroid disorders.

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23) What should the nurse instruct a client who is prescribed propylthiouracil (PTU)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "A rash can occur when taking this medication." 2. "Contact your healthcare provider with any changes in urine output at home." 3. "You might experience a headache." 4. "You might experience vertigo when taking this medication." 5. "Nausea and vomiting are side effects of this medication." Answer: 1, 2, 3, 4 Explanation: Serious hypersensitivity reactions are rare but may be serious and include rash. Serious hypersensitivity reactions are rare but may be serious and include glomerulonephritis. The nurse should instruct the client to alert the healthcare provider with any changes in urine output. The client may have headaches when taking this medication. Vertigo is an adverse effect of this medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 67-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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24) What foods should the nurse instruct a client to avoid when taking thyroid replacement medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Soy sauce 2. Yogurt 3. Milk 4. Strawberries 5. Red meat Answer: 1, 2, 3, 4 Explanation: Foods that contain soy should be avoided. Yogurt contains iodine and should be avoided. Milk contains iodine and salt and should be avoided. Strawberries contain iodine and salt and should be avoided. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 67-7 Apply the nursing process to the care of patients receiving pharmacotherapy for thyroid disorders.

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25) A client is being treated with radioactive iodine. What should the nurse instruct the client about this treatment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Tell family to visit for only 1 hour per day per person. 2. Ask pregnant family members not to visit. 3. Increase fluid intake up to 2 liters per day. 4. Limit the intake of all protein products. 5. Keep a wastebasket at the bedside to dispose of used tissues. Answer: 1, 2, 3 Explanation: Contact with family should be limited to 1 hour per day per person until the treatment period is over. Pregnant women should avoid contact with the client. Increased fluids will increase urine output, which helps to avoid irradiation of the gonads from radioactivity in urine excretion. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 67-7 Apply the nursing process to the care of patients receiving pharmacotherapy for thyroid disorders. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 68 Corticosteroids and Drugs Affecting the Adrenal Cortex 1) A client with an adrenal tumor experiences frequent infections. The nurse understands that the frequent infections are secondary to: 1. decreased blood glucose. 2. lipolysis. 3. bone demineralization. 4. suppression of the immune response. Answer: 4 Explanation: A tumor of the adrenal gland can cause hypersecretion of glucocorticoids. This leads to suppression of the inflammatory and immune responses and contributes to frequent infections. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-1 Identify the functions of the three classes of hormones secreted by the adrenal gland. 1255

2) The nurse is reviewing with a client the steroid hormones that are released from the adrenal glands. Which hormone is not secreted from the adrenal gland? 1. Mineralocorticoids 2. Corticosteroids 3. Adrenocorticotropic hormone (ACTH) 4. Glucocorticoids Answer: 3 Explanation: ACTH is not secreted by the adrenal gland. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-1 Identify the functions of the three classes of hormones secreted by the adrenal gland.

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3) A client has had one adrenal gland removed. The nurse anticipates the need to administer medication to raise the blood pressure and closely mimic the effects of: 1. gonadocorticoids. 2. mineralocorticoids. 3. glucocorticoids. 4. cortisone. Answer: 2 Explanation: Aldosterone is the predominant mineralocorticoid. Its primary function is to conserve sodium and water, thereby maintaining blood pressure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-1 Identify the functions of the three classes of hormones secreted by the adrenal gland. 4) A client has sustained a traumatic head injury with trauma to the hypothalamus. The nurse recognizes that which endocrine regulatory factor will be most affected? 1. Colony-stimulating factor 2. Von Willebrand factor 3. Factor VIII 4. Corticotropin-releasing factor Answer: 4 Explanation: Corticotropin-releasing factor is secreted by the hypothalamus, and could be affected by trauma to the hypothalamus. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-1 Identify the functions of the three classes of hormones secreted by the adrenal gland.

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5) A client has an ACTH-secreting tumor. The nurse understands that which assessment findings would be consistent with this type of tumor? 1. Clubbing of the fingers and circumoral cyanosis 2. Extreme tachycardia and tremors 3. Weight gain and muscle atrophy 4. Exophthalmos and skin that is hot to the touch Answer: 3 Explanation: Weight gain and muscle wasting are clinical manifestations seen in clients with hypersecretion of corticosteroids. This is consistent with an ACTH-secreting hormone. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-1 Identify the functions of the three classes of hormones secreted by the adrenal gland. 6) The nurse is administering cortisol to a client. This intervention should result in: 1. increased secretion from the pituitary. 2. decreased level of consciousness (LOC). 3. increased secretion from the hypothalamus. 4. decreased secretion from the pituitary. Answer: 4 Explanation: When the serum level of cortisol rises, it provides negative feedback to the hypothalamus and pituitary to shut off further release of glucocorticoids. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 68-2 Diagram the negative feedback regulation of corticosteroid secretion.

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7) A pregnant client asks why a steroid medication cannot be used for an allergic skin disorder. The nurse's most accurate response is: 1. "Steroids have the potential to cross the placenta, and should be avoided during pregnancy." 2. "The cause of your skin disorder is directly linked to your pregnancy. After you deliver, your skin should get better." 3. "Steroids will likely cause you to have an abortion; you'll have to put up with your skin disorder until after delivery." 4. "Steroids can cause liver failure, and are not recommended at this time." Answer: 1 Explanation: Steroids have the potential to cross the placenta, and should be avoided in pregnancy and lactation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-3 Identify common properties of the corticosteroid medications. 8) A client with dementia and severe pruritus is receiving intravenous steroids and is constantly scratching the skin. What intervention is best for the client at this time? 1. Placing four side rails in the up position 2. Application of hand mitts 3. Application of four-point leather restraints 4. Application of a falls-risk bracelet Answer: 2 Explanation: Applying hand mitts will protect the skin from breakdown secondary to scratching of the skin. The client is at risk for infection from the steroid medication, so the nurse should make every attempt to keep the client's skin clean, dry, and intact. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-3 Identify common properties of the corticosteroid medications.

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9) A client with diabetes is prescribed prednisone for acute asthma exacerbation. The client asks if this medication will affect the blood sugar. The nurse's best response is: 1. "Your blood sugar might drop unexpectedly." 2. "Your blood sugar will be unaffected." 3. "Your blood sugar might be elevated." 4. "Would you like to speak to the healthcare provider about this?" Answer: 3 Explanation: Administration of corticosteroids, such as prednisone, is likely to cause an increase in blood glucose levels. The client should check blood glucose levels more frequently and report abnormal values to the healthcare provider. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-4 Describe the potential adverse effects of long-term corticosteroid therapy. 10) A client is taking long-term corticosteroid therapy for adrenal insufficiency. Which medication would be recommended for the relief of minor aches and pains? 1. Ibuprofen (Motrin) 2. Ketorolac (Toradol) 3. Acetaminophen (Tylenol) 4. Aspirin (Bayer) Answer: 3 Explanation: Acetaminophen is an analgesic that will not inhibit the production of protective prostaglandins. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-4 Describe the potential adverse effects of long-term corticosteroid therapy.

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11) A client taking long-term corticosteroid therapy should be instructed to contact the healthcare provider before: 1. providing a blood specimen. 2. taking an eye exam. 3. receiving live vaccines. 4. providing a urine specimen. Answer: 3 Explanation: A client on long-term corticosteroid therapy might be immunosuppressed and should speak to the healthcare provider prior to receiving a vaccination. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-4 Describe the potential adverse effects of long-term corticosteroid therapy. 12) A client with adrenocortical insufficiency has been taking corticosteroids for 9 months. What symptom should be reported to the healthcare provider immediately? 1. Frequent palpitations 2. Headache 3. Nasal congestion 4. Fatigue Answer: 1 Explanation: Electrolyte changes are associated with long-term corticosteroid therapy. Frequent palpitations warrant further investigation. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-4 Describe the potential adverse effects of long-term corticosteroid therapy.

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13) A client with a history of adrenocortical insufficiency is experiencing nausea, vomiting, hypotension, and seizures. The nurse suspects the client discontinued which medication? 1. Hydrocortisone 2. Fluticasone propionate (Flonase) 3. Cosyntropin (Cortrosyn) 4. Methadone Answer: 1 Explanation: If a client with a history of adrenocortical insufficiency stops taking prescribed medications, the atrophied adrenal glands will not be able to secrete sufficient corticosteroids, and symptoms of adrenal crisis will appear. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-5 Compare and contrast the pharmacotherapy of acute and chronic adrenocortical insufficiency. 14) A client is diagnosed with chronic adrenocortical insufficiency. What would be the best route for medication replacement therapy for this client? 1. Intravenous 2. Rectal 3. Oral 4. Intramuscular Answer: 3 Explanation: Clients with adrenocortical insufficiency require lifelong therapy for the condition. The safest and easiest route of medication administration for this client is oral administration. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-5 Compare and contrast the pharmacotherapy of acute and chronic adrenocortical insufficiency.

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15) A client has been taking corticosteroids. The nurse suspects that the client has a history of adrenocortical insufficiency when the use of which other medication is documented in the record? 1. Isosorbide 2. Ciprofloxacin 3. Fludrocortisone 4. Metformin Answer: 3 Explanation: Clients requiring replacement therapy usually take corticosteroids their entire lifetime, and concurrent therapy with a mineralocorticoid such as fludrocortisone is necessary. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-5 Compare and contrast the pharmacotherapy of acute and chronic adrenocortical insufficiency. 16) For which purpose is cosyntropin (Cortrosyn) used? 1. To treat secondary adrenocortical insufficiency 2. To assist in the diagnosis of adrenocortical insufficiency 3. To treat primary adrenocortical insufficiency 4. To alleviate dermatologic pruritus Answer: 2 Explanation: The primary use of cosyntropin is to diagnose adrenal disorders. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-5 Compare and contrast the pharmacotherapy of acute and chronic adrenocortical insufficiency.

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17) A client receives cosyntropin (Cortrosyn). The nurse knows that if plasma cortisol levels fail to rise after an injection of cosyntropin, the pathology is: 1. idiopathic in nature. 2. at the level of the adrenal gland (primary adrenocortical insufficiency). 3. at the level of the hypothalamus. 4. at the level of the pituitary (secondary adrenocortical insufficiency). Answer: 2 Explanation: If plasma cortisol levels fail to rise after an injection of cosyntropin, the pathology is at the level of the adrenal gland (primary). Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-5 Compare and contrast the pharmacotherapy of acute and chronic adrenocortical insufficiency. 18) Which diagnostic test is the most helpful in distinguishing primary from secondary adrenocortical insufficiency? 1. Magnetic resonance imaging (MRI) 2. A computed tomography (CT) scan 3. Cosyntropin (Cortrosyn) 4. Dexamethasone (Decadron) Answer: 3 Explanation: The primary use of cosyntropin (Cortrosyn) is to diagnose adrenal disorders. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-5 Compare and contrast the pharmacotherapy of acute and chronic adrenocortical insufficiency.

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19) The nurse is caring for a client taking corticosteroids for immune suppression. Which laboratory value indicates the medication treatment is successful? 1. Increased lymphocytes and decreased monocytes 2. Increased monocytes and decreased lymphocytes 3. Increased numbers of lymphocytes, eosinophils, and monocytes 4. Decreased numbers of lymphocytes, eosinophils, and monocytes Answer: 4 Explanation: Decreased numbers of circulating lymphocytes, eosinophils, and monocytes would indicate immune suppression. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-6 Explain how corticosteroids affect the inflammatory and immune responses. 20) A client in anaphylactic shock receives a dose of hydrocortisone (Solu-Cortef). The nurse recognizes that the desired action of this medication is to: 1. raise serum oncotic pressure. 2. inhibit the inflammatory process. 3. stimulate the sympathetic nervous system. 4. raise circulating glucose levels. Answer: 2 Explanation: Corticosteroids frequently are used to suppress the inflammatory and immune responses. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 68-6 Explain how corticosteroids affect the inflammatory and immune responses.

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21) The nurse posts a sign limiting visitors on the door of a hospitalized client receiving high-dose intravenous corticosteroids. When the family inquires why visitors are limited, the nurse's best response would be: 1. "Visitors are not required to wash their hands when they enter the room." 2. "The germs of the client put all visitors at risk for infection." 3. "The client is very sick, and needs rest." 4. "The germs of visitors put the client at risk for infection." Answer: 4 Explanation: Corticosteroids suppress the immune response. Visitors, in particular visitors who are ill, should be limited at this time. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-6 Explain how corticosteroids affect the inflammatory and immune responses. 22) The nurse would question an order for corticosteroids for a client diagnosed with which health problem? 1. Exposure to active tuberculosis 2. Long-term asthma 3. Inflammatory bowel disease (IBD) 4. Seasonal allergic rhinitis Answer: 1 Explanation: Active tuberculosis is a highly contagious disease. Corticosteroids can suppress the immune system and should not be administered to this client. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-7 Recognize nonendocrine disorders that respond to corticosteroid therapy.

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23) How would the nurse explain to a client the rationale for administering corticosteroids after an organ transplant? 1. Corticosteroids prevent the immune system from rejecting the implant. 2. Corticosteroids enhance perfusion through the transplanted organ. 3. Corticosteroids promote graft-versus-host disease. 4. Corticosteroids provide prophylaxis against opportunistic infection. Answer: 1 Explanation: Corticosteroids are part of most therapeutic regimens to prevent transplant rejections. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-7 Recognize nonendocrine disorders that respond to corticosteroid therapy. 24) A client with inflammatory bowel disease is prescribed budesonide (Entocort-EC) and asks why this drug is ordered. The nurse correctly explains: 1. "The pharmacist will be making rounds this shift, and will explain the rationale to you at that time." 2. "Your healthcare provider ordered this medication to treat the underlying disease pathology." 3. "This is a corticosteroid that is not absorbed and remains in the intestine to treat the inflammation locally, without causing significant systemic effects." 4. "This is a systemic corticosteroid that will decrease system-wide inflammation." Answer: 3 Explanation: Budesonide is a locally acting anti-inflammatory without significant systemic effects. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-7 Recognize nonendocrine disorders that respond to corticosteroid therapy.

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25) The nurse would question the administration of mineralocorticoid replacement therapy for which client? 1. A client with a defect in the stimulation of aldosterone secretion 2. A client with a defect in aldosterone sensitivity 3. A client with a defect in the secretion of aldosterone 4. A client with Conn's syndrome Answer: 4 Explanation: A client with Conn's syndrome already has oversecretion of aldosterone and does not require mineralocorticoid replacement therapy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Quality and Safety: Communicate potential risk factor and actual errors | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-8 Describe indications for pharmacotherapy with mineralocorticoids. 26) Which assessment finding would be associated with a client requiring mineralocorticoid replacement therapy? 1. Respiratory rate 13 breaths/min 2. Oral temperature 100.0°F 3. Pulse 48 beats/min 4. Blood pressure 78/58 mmHg Answer: 4 Explanation: Clients requiring mineralocorticoid therapy typically have a lack of aldosterone. Aldosterone is the primary hormone regulating sodium and potassium in the body. Losses of aldosterone generally result in a drop in blood pressure and a rise in pulse. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-8 Describe indications for pharmacotherapy with mineralocorticoids.

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27) What should the nurse explain to a client with Addison's disease as the reason for needing mineralocorticoid replacement therapy? 1. Mineralocorticoids will reduce excessive serum glucose levels. 2. Mineralocorticoids will mimic the action of cortisol. 3. Mineralocorticoids will mimic the action of aldosterone. 4. Mineralocorticoids will reduce harmful bronzing of the skin. Answer: 3 Explanation: Mineralocorticoids, in addition to glucocorticoids, are indicated for use in clients with adrenocortical insufficiency. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-8 Describe indications for pharmacotherapy with mineralocorticoids. 28) A client with Cushing's syndrome is prescribed ketoconazole (Nizoral). What should the nurse explain as the reason for this medication? 1. "This medication will prevent infections." 2. "Cushing's syndrome is caused by an infection of the adrenal glands, and the medication will reverse the disease process." 3. "This drug blocks the formation of glucocorticoids, lowering their level in your blood." 4. "This has been prescribed because you have a fungal infection." Answer: 3 Explanation: Ketoconazole rapidly blocks the synthesis of glucocorticoids, lowering serum levels. It is considered an antiadrenal agent and is the preferred drug for clients with Cushing's disease needing long-term therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-9 Explain the pharmacotherapy of Cushing's syndrome.

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29) A young adult client with Cushing's syndrome is prescribed ketoconazole (Nizoral). What question should the nurse ask before providing the client with this medication? 1. "What is your height and weight?" 2. "Are you allergic to shellfish?" 3. "Do you have a family history of cancer?" 4. "When was your last menstrual period?" Answer: 4 Explanation: Ketoconazole should not be used during pregnancy because it has been shown to be teratogenic and embryotoxic at high doses in animals. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-9 Explain the pharmacotherapy of Cushing's syndrome. 30) Which medication will the nurse administer to a client who is being tested for Cushing's syndrome? 1. Metyrapone (Metopirone) 2. Mitotane (Lysodren) 3. Acetylcysteine (Mucomyst) 4. Ketoconazole (Nizoral) Answer: 1 Explanation: Metyrapone is an antiadrenal drug used to diagnose Cushing's syndrome. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-9 Explain the pharmacotherapy of Cushing's syndrome.

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31) Which client statement indicates that teaching about hydrocortisone replacement therapy has been ineffective? 1. "I should take aspirin if I develop a fever." 2. "I should report any wounds that are slow to heal to the healthcare provider." 3. "I might gain a small amount of weight." 4. "I should avoid alcohol and caffeine." Answer: 1 Explanation: Aspirin can contribute to ulcer development during long-term hydrocortisone therapy and should be avoided. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 68-10 Describe the nurse's role in the pharmacologic management of adrenal disorders. 32) The nurse is caring for a client taking long-term hydrocortisone replacement therapy. Which assessment finding indicates a masked infection? 1. A complaint of hiccups 2. Deformity of the left upper extremity 3. Purulent drainage from a puncture wound 4. A low-grade oral temperature Answer: 4 Explanation: Corticosteroids suppress the immune response. A low-grade fever in a client taking hydrocortisone replacement therapy is evidence that an infection is being masked. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-10 Describe the nurse's role in the pharmacologic management of adrenal disorders.

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33) The nurse recognizes that mineralocorticoid replacement therapy should be used judiciously in clients with: 1. hypotension. 2. aldosterone insufficiency. 3. heart failure. 4. Addison's disease. Answer: 3 Explanation: Mineralocorticoid therapy should be used cautiously if a client has any disorders in which fluid accumulation could be hazardous. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-11 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 34) Which client statement indicates that instruction about fludrocortisone (Florinef) has been ineffective? 1. "If I develop muscle cramps, I will call the office right away." 2. "If I notice a lot of swelling in my legs, I'll call the office right away." 3. "This drug could lower my potassium level, so I'll eat foods rich in potassium." 4. "This drug will drop my blood pressure, so I'll go from sitting to standing slowly." Answer: 4 Explanation: This medication is likely to cause the client's blood pressure to rise, not drop. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 68-11 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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35) A client on lifelong replacement therapy with hydrocortisone is scheduled for surgery. The nurse anticipates that prior to surgery, the client's hydrocortisone dose will: 1. remain unchanged. 2. be increased. 3. be decreased. 4. be rapidly withdrawn. Answer: 2 Explanation: Maintenance dosages of corticosteroids for adrenal insufficiency need to be increased during times of infection, surgery, or injury to adapt to the increased stress. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 68-11 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 36) When caring for a client with Addison's disease, the nurse will prepare to administer which medication as the treatment of choice? 1. Ketoconazole (Nizoral) 2. Cosyntropin (Cortrosyn) 3. Hydrocortisone 4. Fludrocortisone (Florinef) Answer: 3 Explanation: Hydrocortisone is the treatment of choice for Addison's disease. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 68-11 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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37) What is an expected assessment finding in a client recently started on fludrocortisone (Florinef)? 1. +4 peripheral edema 2. Decrease in weight 3. Increase in blood pressure 4. Increase in height Answer: 3 Explanation: A mild-to-moderate increase in blood pressure would be expected. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-12 Apply the nursing process to the care of patients receiving pharmacotherapy with corticosteroids and mineralocorticoids. 38) The nurse is planning care for a client with diabetes who is prescribed lifelong therapy for adrenal insufficiency. Which advice should not be given to this client? 1. "Cut your toenails straight across." 2. "Avoid wearing socks with shoes." 3. "Keep a diary of your blood glucose measurements." 4. "Call your healthcare provider if you are injured or get sick." Answer: 2 Explanation: A client with diabetes might have peripheral neuropathy. The addition of corticosteroids can prolong wound healing if a wound develops from friction of the shoe against bare skin. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-12 Apply the nursing process to the care of patients receiving pharmacotherapy with corticosteroids and mineralocorticoids.

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39) What should a client receiving lifelong therapy with corticosteroids be instructed to report immediately to the healthcare provider? 1. A change in prescription bottles 2. A change in health insurance plans 3. Cravings for sweet or salty foods 4. Weight gain of over 2 pounds in one day Answer: 4 Explanation: Weight gain of over 2 pounds per day should be reported immediately to the healthcare provider because this finding likely reflects fluid retention. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-12 Apply the nursing process to the care of patients receiving pharmacotherapy with corticosteroids and mineralocorticoids. 40) A client on long-term corticosteroid therapy is demonstrating signs of acute adrenocortical insufficiency. The nurse knows that these symptoms are caused by: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. the shutting down of ACTH secretion. 2. the failure of the adrenal cortex to secrete corticosteroids. 3. rebound ACTH secretion. 4. excessive secretion of ACTH. 5. toxic levels of mineralocorticoids. Answer: 1, 2 Explanation: Consistent high amounts of corticosteroid medications provide continuous negative feedback to the hypothalamus and pituitary, shutting down the secretion of ACTH. Without stimulation by ACTH, the adrenal cortex shrinks and stops secreting endogenous corticosteroids. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-2 Diagram the negative feedback regulation of corticosteroid secretion.

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41) A client has been prescribed long-term corticosteroid therapy. What should the nurse instruct the client about the potential effects of this medication regimen? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Have the blood glucose level checked frequently. 2. Avoid crowds and being around others with respiratory infections. 3. Avoid falling or any other type of injury to the bones. 4. Increase the intake of green leafy vegetables. 5. Increase the daily intake of fiber. Answer: 1, 2, 3 Explanation: Corticosteroids increase the level of blood glucose, leading to hyperglycemia. Corticosteroids suppress the immune response. Corticosteroids increase the breakdown of bony matrix, resulting in bone demineralization. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-3 Identify common properties of the corticosteroid medications. 42) What would the nurse expect to assess in a client who has been taking long-term corticosteroid replacement therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fasting blood glucose level 150 mg/dL 2. Reduced muscle mass 3. Elevated blood lipid levels 4. History of pathologic fractures 5. Serum potassium level 5.0 mg/dL Answer: 1, 2, 3, 4 Explanation: Corticosteroids have a hyperglycemic effect and increase the blood glucose level. Corticosteroids increase the breakdown of proteins to amino acids. Amino acids are then converted to glucose and glycogen in the liver, resulting in protein depletion. Corticosteroids increase the breakdown of lipids. Corticosteroids increase the breakdown of bony matrix, resulting in bone demineralization, which can cause pathologic fractures. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-3 Identify common properties of the corticosteroid medications. 1276

43) The nurse instructs a client receiving long-term corticosteroid replacement therapy to have annual eye examinations because of the risk of developing: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. glaucoma. 2. cataracts. 3. detached retina. 4. retinopathy. 5. macular degeneration. Answer: 1, 2 Explanation: Open-angle glaucoma is a frequent adverse effect of long-term corticosteroid therapy. Cataracts are a frequent adverse effect of long-term corticosteroid therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-4 Describe the potential adverse effects of long-term corticosteroid therapy.

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44) A client with a foot wound is prescribed short-term, high-dose corticosteroid therapy. What will the nurse assess as indications that the medication is effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Reduction in swelling 2. Reduced purulent drainage 3. Increased bleeding 4. Increased warmth to the area 5. Buildup of necrotic tissue Answer: 1, 2 Explanation: Corticosteroids decrease the numbers of circulating lymphocytes, eosinophils, monocytes, and basophils. They inhibit the movement of macrophages and leukocytes to areas of inflammation. They also decrease the production of inflammatory cytokines, including histamine, bradykinin, interferons, interleukins, and granulocyte-macrophage colony stimulating factor, and decrease the formation of prostaglandins. Corticosteroids decrease the numbers of circulating lymphocytes, eosinophils, monocytes, and basophils. They inhibit the movement of macrophages and leukocytes to areas of inflammation. They also decrease the production of inflammatory cytokines, including histamine, bradykinin, interferons, interleukins, and granulocyte-macrophage colony stimulating factor, and decrease the formation of prostaglandins. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 68-6 Explain how corticosteroids affect the inflammatory and immune responses.

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45) A client is experiencing severe musculoskeletal pain. The nurse is aware that corticosteroid therapy would be indicated for which musculoskeletal disorders? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Rheumatoid arthritis 2. Osteoarthritis 3. Osteoporosis 4. Fibromyalgia 5. Myasthenia gravis Answer: 1, 2 Explanation: Corticosteroid therapy is used in the treatment of rheumatoid arthritis to reduce pain and inflammation. Corticosteroid therapy is used in the treatment of osteoarthritis to reduce pain and inflammation. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 68-7 Recognize nonendocrine disorders that respond to corticosteroid therapy. 46) A client is experiencing symptoms associated with severe psoriasis. The nurse will prepare to administer which medications for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Betamethasone 2. Hydrocortisone acetate 3. Fludrocortisone 4. Metyrapone 5. Mitotane Answer: 1, 2 Explanation: Betamethasone is a primary initial treatment for psoriasis. Hydrocortisone acetate is a primary initial treatment for psoriasis. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 68-7 Recognize nonendocrine disorders that respond to corticosteroid therapy. 1279

47) A client is diagnosed with medication-induced hypoaldosteronism. The nurse will assess the client's medication history for which drug use? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Beta blockers 2. NSAIDs 3. Calcium channel blockers 4. Angiotensin-converting enzyme inhibitors 5. Nitrites Answer: 1, 2, 3, 4 Explanation: Beta blockers may reduce renin serum levels and suppress the stimulation of aldosterone secretion. NSAIDs may reduce renin serum levels and suppress the stimulation of aldosterone secretion. Calcium channel blockers may reduce renin serum levels and suppress the stimulation of aldosterone secretion. Angiotensin-converting enzyme inhibitors block the formation of angiotensin II, which is the normal signal for aldosterone secretion. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-8 Describe indications for pharmacotherapy with mineralocorticoids.

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48) The nurse caring for a client with Cushing's syndrome will prepare to administer which medications to this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Tapering doses of prescribed corticosteroid 2. Ketoconazole (Nizoral) 3. Fludrocortisone 4. Spironolactone (Aldactone) 5. Budesonide (Entocort-EC) Answer: 1, 2 Explanation: If the cause of Cushing's syndrome is corticosteroid therapy, gradual discontinuation of this medication is a treatment option. Ketoconazole (Nizoral) has become a preferred drug for long-term therapy of Cushing's syndrome because this drug rapidly blocks the synthesis of glucocorticoids, lowering serum levels. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 68-9 Explain the pharmacotherapy of Cushing's syndrome.

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49) A client on long-term corticosteroid therapy tells the nurse that the plan is to stop taking the medication when the current prescription is completed. How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You could develop nausea, vomiting, and other problems if you stop this medication abruptly." 2. "Your body will not be able to produce the steroid that you need and you will become very ill." 3. "Why do you plan to stop taking the medication?" 4. "I'm sure you know what is best for your health." 5. "You will feel sick for a short while after stopping the medication, but it will go away." Answer: 1, 2, 3 Explanation: If the corticosteroid medication is abruptly withdrawn, symptoms of adrenal crisis will appear. If the corticosteroid medication is abruptly withdrawn, symptoms of adrenal crisis will appear. The nurse should determine the reasons for the patient's actions. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-10 Describe the nurse's role in the pharmacologic management of adrenal disorders.

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50) A client is being started on corticosteroid replacement therapy. What should the nurse teach the client about taking this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Go to your pharmacy to get annual influenza immunization and a varicella vaccine." 2. "Restrict your salt intake." 3. "Take vitamin D supplements as prescribed." 4. "Do not stop taking this medication." 5. "Stop taking this medication if you have headaches, confusion, or insomnia." Answer: 2, 3, 4 Explanation: There is a risk of fluid retention with this medication. By restricting sodium, the amount of fluid retained can be reduced. Because of the risk of osteoporosis, the client should be instructed to take vitamin D supplements as prescribed. The client should be instructed to not abruptly stop taking this medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-4 Describe the potential adverse effects of long-term corticosteroid therapy.

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51) A client is prescribed dexamethasone. The nurse knows that this medication is indicated for which health problems? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Cerebral edema 2. Acute adrenocortical insufficiency 3. Gastritis 4. Heart failure 5. Spinal stenosis Answer: 1, 2 Explanation: Dexamethasone is indicated in the treatment of cerebral edema. Dexamethasone is indicated in the treatment of acute adrenocortical insufficiency. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 68-11 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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52) Which client statements indicate that teaching about corticosteroid replacement therapy has been effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I should take this medication with food." 2. "I should avoid alcohol when taking this medication." 3. "I should keep appointments with my healthcare provider for follow-up blood work." 4. "I can stop taking this medication if I feel funny or sick." 5. "I will need to drink more water with this medication because it makes me lose water." Answer: 1, 2, 3 Explanation: Corticosteroid therapy can cause gastrointestinal irritation and should be taken with food. Alcohol can exacerbate the gastrointestinal irritation caused by this medication and should be avoided. This medication affects blood glucose, electrolytes, and white blood cell counts. The client will need to have periodic serum laboratory studies done. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 68-12 Apply the nursing process to the care of patients receiving pharmacotherapy with corticosteroids and mineralocorticoids. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 69 Estrogens, Progestins, and Drugs Modifying Uterine Function 1) A client had an anterior pituitary tumor removed a few years ago and is curious if this will affect her future ability to become pregnant. What is the best response by the nurse to this client? 1. "You shouldn't have any problems at all because you still have your ovaries and uterus." 2. "You might have trouble getting pregnant. The hormones necessary for stimulating the ovaries are contained in the anterior pituitary." 3. "You will have trouble getting pregnant because the anterior pituitary secretes gonadotropin-releasing hormone (GnHR), which is necessary for conception." 4. "You shouldn't have any problems at all. The important hormones for conception are contained in the posterior pituitary." Answer: 2 Explanation: The anterior pituitary contains FSH and LH, which promote the development of immature ovarian follicles. This maturation process is necessary for ovulation. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health 1285

promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 69-1 Describe the roles of the hypothalamus, pituitary, and ovaries in maintaining female reproductive function. 2) The school nurse is teaching a group of middle-school students about the female reproductive system. Which statement by a student most accurately describes the reason menstruation begins? 1. "Your uterus starts to contract, and this causes the lining to come out, which is your period." 2. "Your brain sends a signal that there is enough estrogen and progesterone. Then these hormone levels drop, and you get your period." 3. "You have to have your period every 28 days to be normal." 4. "You get your period when you ovulate." Answer: 2 Explanation: Menstruation begins when high progesterone and estrogen levels in the final third of the uterine cycle provide negative feedback to shut off GnHR, LH, and FSH. This causes estrogen and progesterone levels to drop sharply, which causes the endometrium to be shed. Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 69-1 Describe the roles of the hypothalamus, pituitary, and ovaries in maintaining female reproductive function.

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3) The nurse is reviewing the menstrual cycle with a client who is experiencing menstrual irregularities. The nurse teaches that during the menstrual cycle, the majority of progesterone is secreted by the: 1. hypothalamus. 2. corpus luteum. 3. ovarian follicle. 4. anterior pituitary gland. Answer: 2 Explanation: The corpus luteum is the remnant of the ovarian follicle, which remains in the ovary. It secretes steadily increasing amounts of progesterone for 12 days, unless the ovum is fertilized. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 69-1 Describe the roles of the hypothalamus, pituitary, and ovaries in maintaining female reproductive function. 4) A postmenopausal client asks why she has been scheduled for a bone density test even though she has no history of fractures. What is the nurse's best response? 1. "This is a very quick test, and it won't cause you any pain." 2. "It is important to find out if you are losing bone density because you do not produce as much estrogen as you did previously." 3. "Because you are not ovulating, your bones will start breaking." 4. "Everyone should have a bone density test." Answer: 2 Explanation: The nurse explains the connection between estrogen and bone density as well as the rationale for the test. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 69-2 Identify indications for estrogen pharmacotherapy.

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5) An older male client has been prescribed estrogen therapy for prostate cancer and is confused because "it is a medication for women." How can the nurse best explain this use of estrogen to the client? 1. "Estrogen blocks the hormones that allow the prostate cancer to grow." 2. "Estrogen helps to restore sexual drive in men with prostate cancer." 3. "Estrogen helps with the hot flashes that clients with prostate cancer usually have." 4. "Estrogen helps to lift the mood of clients who have cancer." Answer: 1 Explanation: Estrogen is given to clients with prostate cancer because it blocks or suppresses androgen secretion. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 69-2 Identify indications for estrogen pharmacotherapy. 6) A postmenopausal client learns that her level of "good" cholesterol is decreasing and the level of "bad" cholesterol is rising. How should the nurse explain this physiologic mechanism to the client? 1. "At menopause, your body quits producing progesterone, which keeps your cholesterol level low." 2. "Menopause weakens the blood vessels and allows the bad cholesterol to become more prominent." 3. "During menopause, the estrogen level decreases dramatically. Estrogen helps to keep the 'good' cholesterol high and the 'bad' cholesterol low, and also helps to protect the heart." 4. "Because cholesterol problems are all hereditary, your 'bad' cholesterol levels are probably rising in the same manner as your family members' did." Answer: 3 Explanation: Estrogen decreases the levels of low-density lipoprotein (LDL) and increases the amount of high-density lipoprotein. These effects are cardioprotective and decrease the risk of myocardial infarction. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 69-2 Identify indications for estrogen pharmacotherapy.

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7) An adolescent client is experiencing oligomenorrhea with infrequent periods during the past year. What is the most likely cause of this client's problem? 1. Anovulatory cycles 2. Abnormal uterine lining 3. Polycystic ovarian syndrome 4. Pregnancy Answer: 1 Explanation: Dysfunctional uterine bleeding is common in adolescents and menopausal women and is often associated with anovulatory cycles. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-3 Identify indications for progestin pharmacotherapy. 8) Which client should not receive progestin therapy for the treatment of dysfunctional uterine bleeding? 1. The client with a history of asthma 2. The client with a history of a blood clot 3. The client with a history of glaucoma 4. The client with a history of hepatitis Answer: 2 Explanation: Progestins are contraindicated in clients who have had thromboembolic disease. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-3 Identify indications for progestin pharmacotherapy.

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9) Which statement by a client experiencing menopause reflects an advantage of using estrogen/progesterone combination hormone replacement therapy (HRT)? 1. "I have a lower chance of developing breast cancer while I am taking this medication." 2. "This medication protects me from uterine cancer." 3. "I am protected from developing Alzheimer's disease because I am taking this medication." 4. "I have a lower chance of having a heart attack until I turn 60." Answer: 4 Explanation: Clients between the ages of 50 and 59 who use combination HRT actually experience a slight decrease in adverse cardiovascular events. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 69-4 Compare and contrast the advantages and disadvantages of hormone replacement therapy during menopause. 10) Which client would benefit most from using hormone replacement therapy (HRT)? 1. The client who is unable to sleep because of continual hot flashes and night sweats 2. The client who finds sexual intercourse painful 3. The client who wants to prevent osteoporosis 4. The client who has a family history of colorectal cancer Answer: 1 Explanation: HRT is best used for short-term relief of moderate-to-severe menopausal symptoms. This client is unable to sleep; therefore, medication to control her symptoms would be helpful. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-4 Compare and contrast the advantages and disadvantages of hormone replacement therapy during menopause.

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11) Which statement by a client taking estrogen/progesterone combination hormone replacement therapy (HRT) requires immediate intervention by the nurse? 1. "I have gained 6 pounds since I began taking this medication 3 months ago." 2. "Sexual intercourse is still slightly uncomfortable, even though I have been on the medication for 2 months." 3. "I got nauseated and had right shoulder pain after I ate fried fish last night." 4. "My ankles are swollen when I go to bed at night." Answer: 3 Explanation: This client is demonstrating signs of gallbladder disease and needs immediate assessment. HRT can aggravate gallbladder disease. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-4 Compare and contrast the advantages and disadvantages of hormone replacement therapy during menopause. 12) A client at 35 weeks' gestation is having contractions caused by preterm labor. Which statement by the nurse best describes the rationale for giving this client magnesium sulfate? 1. "Magnesium sulfate will cause your baby to gain weight quickly so he will be more developed when he is born." 2. "Magnesium sulfate is used to decrease your stress level. This will cause your contractions to stop." 3. "Magnesium sulfate relaxes the uterus and slows contractions. This gives the baby's lungs a few more days to develop." 4. "Magnesium sulfate will allow you to be monitored from home." Answer: 3 Explanation: Magnesium sulfate is used to decrease uterine contractions and give the fetus a few days for increased lung development. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 69-6 Discuss the use of uterine relaxants in suppressing preterm labor.

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13) Which client would not be a good candidate for induction of labor using parenteral oxytocin (Pitocin)? 1. The client who is at 38 weeks' gestation and has gestational diabetes 2. The client at 37 weeks' gestation whose fetus has developed an abnormal heart rate 3. The client who is at 38 weeks' gestation and has developed signs of preeclampsia 4. The client at 39 weeks' gestation who wants the baby to have the same birthday as another family member Answer: 4 Explanation: Parenteral oxytocin should not be used for elective induction of labor. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-5 Explain the use of uterine stimulants to promote labor and delivery. 14) A client at 25 weeks' gestation has experienced a fetal demise. What medication is most likely to be used first to induce labor in this client? 1. Dinoprostone (Cervidil) 2. Methylergonovine (Ergotrate) 3. Parenteral oxytocin (Pitocin) 4. Carboprost (Hemabate) Answer: 1 Explanation: Dinoprostone is approved to prepare the cervix for labor or to abort a fetus that has died. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 69-5 Explain the use of uterine stimulants to promote labor and delivery.

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15) A client is being treated pharmacologically for endometriosis. Which statement by the client indicates a need for further instruction? 1. "I will be able to get pregnant as soon as I finish taking this medication." 2. "I will probably have to take this medication for 3 to 6 months." 3. "This medication could cause my voice to get deeper." 4. "I should dress in layers, because I might get hot flashes while I take this medication." Answer: 1 Explanation: There is no guarantee that relief of endometriosis will translate into the ability to conceive. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 69-7 Explain how drug therapy may be used to treat female infertility. 16) A client with infertility who was treated with clomiphene (Clomid) for 6 months without success will now be treated with a follitropin. Which statement by this client would require immediate intervention by the healthcare provider? 1. "I have had three diarrhea stools each day since I started these medications." 2. "I have had a headache since I began using these medications." 3. "I began wheezing last night." 4. "My husband is going to give me these injections." Answer: 3 Explanation: The client might be developing an acute exacerbation of asthma. This adverse effect must be addressed immediately. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-7 Explain how drug therapy may be used to treat female infertility.

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17) The nurse is taking a medication history from a client who is seeking information about infertility treatments. Which drug taken by this client could potentially contraindicate the use of clomiphene (Clomid)? 1. Cimetidine (Tagamet) 2. St. John's wort 3. Levothyroxine sodium (Synthroid) 4. Amoxicillin (Amoxil) Answer: 3 Explanation: Clomiphene should be avoided in clients with thyroid dysfunction. The client who reports taking levothyroxine sodium should be further evaluated for thyroid dysfunction. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-7 Explain how drug therapy may be used to treat female infertility. 18) Which outcome statement indicates that a client has effectively been treated with conjugated estrogen (Premarin) for severe and frequent hot flashes? 1. The client is able to sleep 4 to 5 hours every night. 2. The client reports one to two hot flashes per day. 3. The client reports experiencing headaches while taking this drug. 4. The client reports an improvement in mood. Answer: 2 Explanation: Having one to two hot flashes per day would be a good response to the medication. The client would not expect the hot flashes to completely disappear. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 69-8 Describe the nurse's role in the pharmacologic management of disorders and conditions of the female reproductive system.

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19) A client reports infertility in spite of trying to get pregnant for the past 18 months. A priority assessment in this client would be: 1. height and weight. 2. understanding of ovulation and timing of intercourse. 3. job status. 4. preferred position during sexual intercourse. Answer: 2 Explanation: The nurse must discover whether the client understands when conception is most likely to occur before proceeding with other assessments. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-8 Describe the nurse's role in the pharmacologic management of disorders and conditions of the female reproductive system. 20) The nurse is reviewing the labor and delivery plan for a pregnant client who is scheduled to receive oxytocin (Pitocin) for induction of labor contractions. Which client statement indicates the need for additional instruction from the nurse? 1. "I want to walk around as much as possible to help stimulate my labor." 2. "I will receive gradually increasing doses of the medication until I'm in active labor." 3. "I realize my blood pressure will need to be taken frequently as long as I am on this medication." 4. "I will tell you if I develop a headache." Answer: 1 Explanation: Clients receiving oxytocin require continuous fetal and maternal monitoring, so the client needs to realize that walking around will not be possible. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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21) The nurse is reviewing the indications for the use of clomiphene (Clomid) with couples seeking infertility treatment. Which statement concerning clomiphene (Clomid) does not accurately represent this medication? 1. Women who take clomiphene often experience a small weight gain. 2. Clomiphene may be given to males to increase the motility of the sperm. 3. A woman who takes clomiphene has a small chance (5% or less) of having a pregnancy with multiple gestations. 4. Clomiphene is used to induce ovulation in a woman who does not ovulate on a regular basis. Answer: 2 Explanation: Clomiphene may be given to males to treat low sperm count; it does not increase the motility of sperm. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 69-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 22) The nurse should question the use of medroxyprogesterone acetate (Provera) in a client who: 1. was hospitalized for depression 3 months ago. 2. has just been diagnosed with anemia. 3. was treated for acute bronchitis 2 weeks ago. 4. had a cyst removed from her kidney 6 months ago. Answer: 1 Explanation: Medroxyprogesterone should be used with caution in clients who have a history of depression; it should be discontinued at the first sign of depression. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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23) A client reports taking conjugated estrogen (Premarin) for many years. The nurse asks follow-up questions to determine the reasons the client is taking this medication, which may include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. contraception. 2. treatment of menopausal symptoms. 3. treatment of breast cancer. 4. treatment of vaginal bleeding. 5. treatment of cardiovascular disease. Answer: 2, 3 Explanation: Conjugated estrogen (Premarin) can be used to treat menopausal symptoms. Conjugated estrogen (Premarin) can be used to treat breast cancer. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-2 Identify indications for estrogen pharmacotherapy.

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24) The nurse is caring for a client who is taking medroxyprogesterone (Provera). For which health problems should the nurse contact the healthcare provider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Inability to conceive 2. Confusion 3. Lower extremity pain and swelling 4. Right-sided weakness 5. Changes in cardiac enzymes Answer: 2, 3, 4, 5 Explanation: Women over age 65 have increased risk of dementia when taking medroxyprogesterone (Provera). Lower extremity pain and swelling could indicate a deep vein thrombosis and should be reported to the healthcare provider. Right-sided weakness could be an indication of a stroke and should be reported to the healthcare provider. Changes in cardiac enzymes could indicate an acute myocardial infarction and should be reported to the healthcare provider. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 69-3 Identify indications for progestin pharmacotherapy.

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25) The nurse is monitoring a client who is receiving nifedipine (Adalat) for premature labor. For which side effects of this medication should the nurse contact the healthcare provider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Productive cough 2. Premature ventricular contractions on electrocardiogram rhythm 3. Blood pressure 70/48 mmHg 4. No uterine contractions for 20 minutes 5. Respiratory rate 18 breaths/min Answer: 1, 2, 3 Explanation: Productive cough could be an indication of pulmonary edema and should be reported to the healthcare provider. Dysrhythmias are an adverse effect of this medication and should be reported to the healthcare provider. Hypotension is an adverse effect of this medication and should be reported to the healthcare provider. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-6 Discuss the use of uterine relaxants in suppressing preterm labor. 26) The nurse should stop the infusion of terbutaline (Brethine) in a client being treated for premature uterine contractions based on which assessment findings? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Heart rate 110 beats/min 2. Premature ventricular contractions on electrocardiogram tracing 3. Serum potassium level 3.0 mg/dL 4. Cough and shortness of breath 5. Reduction in uterine contractions Answer: 1, 2, 3, 4 Explanation: A serious adverse reaction to this medication is increased heart rate. Dysrhythmias are a serious adverse reaction to this medication. Hypokalemia is a serious adverse reaction to this medication. Pulmonary edema is a serious adverse reaction to this medication. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-6 Discuss the use of uterine relaxants in suppressing preterm labor. 1299

27) The cervix of a laboring client is not adequately ripening to support the pending delivery of the fetus. Which medications should the nurse prepare to administer to this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Dinoprostone (Cervidil) 2. Misoprostol (Cytotec) 3. Methylergonovine (Methergine) 4. Oxytocin (Pitocin) 5. Medroxyprogesterone (Provera) Answer: 1, 2 Explanation: This medication is used to promote cervical ripening. This medication is used off-label to promote cervical ripening. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 69-5 Explain the use of uterine stimulants to promote labor and delivery.

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28) During a health history, a client who is taking conjugated estrogen (Premarin) tells the nurse about using a variety of herbal supplements. For which supplements should the nurse assess the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. St. John's wort 2. Red clover 3. Black cohosh 4. Ginseng 5. Garlic Answer: 1, 2, 3, 4 Explanation: St. John's wort may interfere with estrogen therapy. Red clover may interfere with estrogen therapy. Black cohosh may interfere with estrogen therapy. Ginseng may enhance the effects of estrogen. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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29) A client is receiving medroxyprogesterone (Provera) for secondary amenorrhea. Which medications would be contraindicated for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Barbiturates 2. Rifampin 3. Topiramate 4. Acetaminophen 5. Furosemide Answer: 1, 2, 3 Explanation: Serum levels of medroxyprogesterone are decreased by barbiturates. Serum levels of medroxyprogesterone are decreased by rifampin. Serum levels of medroxyprogesterone are decreased by topiramate. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-9 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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30) A client is being considered for progestin therapy. However, the nurse is concerned because of which risk factors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Current age 39 2. Being treated for atrial fibrillation 3. Smoking 4. Sedentary lifestyle 5. Vegetarian diet Answer: 1, 2, 3 Explanation: The risk for thromboembolic events with progestin increases over the age of 3. The risk for thromboembolic events with progestin increases in those with cardiovascular disease. The risk for thromboembolic events with progestin increases in those who smoke. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-10 Apply the nursing process to the care of patients receiving pharmacotherapy for disorders and conditions of the female reproductive system.

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31) A client who is prescribed progestin is experiencing hip joint pain. What does this new finding suggest to the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client could be experiencing bone demineralization. 2. The route of medication administration might need to be changed. 3. The dose needs to be increased. 4. The client needs to be prescribed penicillin. 5. The client needs an antidepressant medication. Answer: 1, 2 Explanation: Progestins are associated with an increased risk of loss of bone density. Bone density may need to be monitored. The occurrence of bone or musculoskeletal pain is higher in clients taking injectable progestins. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 69-10 Apply the nursing process to the care of patients receiving pharmacotherapy for disorders and conditions of the female reproductive system.

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32) A client receiving an infusion of oxytocin (Pitocin) begins to experience sustained uterine contractions. What should the nurse do to help this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Stop the infusion. 2. Provide intravenous fluids as prescribed. 3. Position the client on her side. 4. Provide oxygen. 5. Place the client in the lithotomy position. Answer: 1, 2, 3 Explanation: In the event of sustained uterine contractions, the infusion should be immediately stopped. In the event of sustained uterine contractions, the client should have an infusion of intravenous fluids as prescribed. In the event of sustained uterine contractions, the client should be placed on her side. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 69-10 Apply the nursing process to the care of patients receiving pharmacotherapy for disorders and conditions of the female reproductive system. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 70 Drugs for Modifying Conception 1) A client has decided to use the transdermal delivery method of contraception. What would contraindicate the use of this method? 1. The client has a history of blood clots. 2. The client exercises three times a week. 3. The client takes aspirin 81 mg every day. 4. The client has a history of scarlet fever. Answer: 1 Explanation: The transdermal delivery method uses estrogen and progestin for contraception. These drugs increase the chances of blood clots, so a person with a history of blood clots should not use this medication. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.5 Apply knowledge of social and cultural factors to the care of diverse populations | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 70-1 Identify the choices available for birth control. 1305

2) The nurse is discharging a client who gave birth to her first child 2 days ago. When discussing birth control, which question is the most important for the nurse to ask this client? 1. "Are you breastfeeding or bottle-feeding your baby?" 2. "What form of birth control does your husband want you to use?" 3. "How much weight did you gain during your pregnancy?" 4. "How soon do you plan to return to work?" Answer: 1 Explanation: Some types of hormonal birth control are contraindicated or should be delayed until breastfeeding is established. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.5 Apply knowledge of social and cultural factors to the care of diverse populations | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 70-1 Identify the choices available for birth control.

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3) If asked to recommend a delivery method of birth control, for which client would the nurse suggest the use of the depot injection method? 1. A 30-year-old with no children and a family history of breast cancer 2. A 37-year-old with three children and a history of irregular menstrual cycles 3. A 27-year-old with one child and no preexisting conditions 4. A 16-year-old with one child, age 6 months Answer: 4 Explanation: The depot injection is often recommended for clients who have trouble remembering to take the birth control pill. In this case, a teenager who already has a child would be the best choice. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.5 Apply knowledge of social and cultural factors to the care of diverse populations | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 70-1 Identify the choices available for birth control. 4) A young female client, deciding on which form of birth control to use, tells the nurse she does not want to have to touch "down there." Which form of birth control would be contraindicated for this client? 1. Oral contraceptives 2. Transdermal delivery method 3. Depot injection method 4. Intrauterine device Answer: 4 Explanation: The intrauterine device is inserted into the vagina by a healthcare provider, but the client must check its position on a regular basis. This is done by reaching into the vagina and checking to make sure that the string is still in the proper place. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 70-2 Delineate advantages and disadvantages of the different contraceptive options.

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5) Which statement by a client using the vaginal delivery method of contraception indicates a need for additional instruction? 1. "If the ring comes out, I will wash it off with water and reinsert it." 2. "I have a special waste container where I put the used rings." 3. "I will remove the ring while we have intercourse and then reinsert it." 4. "I will leave the ring in for 3 weeks and then remove it." Answer: 3 Explanation: The ring is not to be removed during intercourse. One of the reasons women discontinue use of the ring is because of the discomfort experienced during sexual intercourse. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 70-2 Delineate advantages and disadvantages of the different contraceptive options. 6) A client tells the nurse she wants to use birth control but does not want to have to wait for months before getting pregnant. Which form of birth control would allow a quick return to fertility after it is discontinued? 1. Depot injection method 2. Combination oral contraceptives 3. Transdermal delivery method 4. Mirena intrauterine device (IUD) Answer: 4 Explanation: The Mirena IUD may be removed at any time, and fertility returns quickly. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 70-2 Delineate advantages and disadvantages of the different contraceptive options.

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7) A client has decided to use the oral contraceptive norethindrone (Ortho Micronor). How can the nurse most accurately explain the way progestin-only contraceptives help to prevent pregnancy? 1. "Progestin-only pills thicken the cervical mucus and discourage the sperm from entering the uterus." 2. "The pill you have decided to take prevents the egg that is in the ovary from becoming mature." 3. "These pills prevent ovulation just like the combination pills do." 4. "Pills that contain progestin alone prevent pregnancy by preventing the release of follicle-stimulating hormones (FSH)." Answer: 1 Explanation: Progestin-only pills prevent pregnancy by thickening the cervical mucus, which discourages the penetration of the uterus by sperm. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 70-3 Explain the mechanisms by which estrogens and progestins prevent conception. 8) A contraceptive that does not contain estrogen has been recommended for a client with a history of deep vein thrombosis, but the client does not know why. Which statement by the nurse best explains the relationship of estrogen to thromboembolic events? 1. "Estrogen causes the bone marrow to form more red blood cells, which increases the chance of blood cells clumping together and forming a clot." 2. "Estrogen increases vascular vasoconstriction, which restricts blood flow and increases the opportunity for blood clots to form." 3. "Estrogen causes several clotting factors to increase in the blood, which increases the chances of a blood clot occurring." 4. "Estrogen decreases the force of blood flowing through the blood vessels, which increases the chances of blood clot formation." Answer: 3 Explanation: Estrogen increases the risk of thromboembolic events. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 70-3 Explain the mechanisms by which estrogens and progestins prevent conception.

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9) A school nurse is teaching a group of adolescents about oral contraceptives and how they work to prevent pregnancy. The nurse asks the students to name the part of the body that ultimately controls ovulation. Which student gives the nurse the correct answer? 1. The student who answers "The uterus" 2. The student who answers "The ovary" 3. The student who answers "The corpus luteum" 4. The student who answers "The pituitary gland" Answer: 4 Explanation: The medications in oral contraceptives prevent ovulation by providing negative feedback to the pituitary gland, which suppresses the secretion of LH and FSH. Without LH and FSH, the ovarian follicle cannot mature, and ovulation is prevented. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 70-3 Explain the mechanisms by which estrogens and progestins prevent conception. 10) After instruction from the nurse, which statement by the client indicates comprehension of the effectiveness of different birth control methods? 1. "Depot injections are about 95% effective if injections are given weekly." 2. "Combination oral contraceptives are about 100% effective if taken correctly." 3. "Progestin-only oral contraceptives are only about 80% effective in preventing pregnancy." 4. "The Mirena IUD is effective at preventing pregnancy for at least 10 years." Answer: 2 Explanation: Combination oral contraceptives provide close to 100% prevention of pregnancy when taken correctly. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 70-4 Compare the safety and effectiveness of different birth control methods.

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11) A client has decided to use a contraceptive sponge for pregnancy prevention. Which statement by the client indicates a need for further instruction? 1. "I can leave the sponge in place for up to 24 hours if I need to." 2. "I can insert the sponge at home before I go out for the evening." 3. "I will moisten the sponge with water before I insert it." 4. "I must remove the sponge as soon as possible after my partner and I have sexual intercourse." Answer: 4 Explanation: The sponge must be left in place for 6 hours after sexual intercourse. It should not be removed immediately. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 70-4 Compare the safety and effectiveness of different birth control methods. 12) A client tells the nurse that since using the vaginal ring for birth control, it always feels like there is something in her vagina. What information should the nurse give this client? 1. "Some women experience this feeling. If it continues, you might want to try another form of birth control." 2. "You must have inserted it incorrectly. I will go over the directions for using the ring again." 3. "You should remove the ring you are using and put a new ring in, and see if the feeling goes away." 4. "You must remove the ring immediately and be checked by the healthcare provider." Answer: 1 Explanation: This statement is correct. The feeling of a foreign body in the vagina is experienced by some women, and it might make it unpleasant for this client to use this form of birth control. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 70-4 Compare the safety and effectiveness of different birth control methods.

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13) A client tells the nurse she has had unprotected sexual intercourse and is worried about becoming pregnant. Which question by the nurse will elicit information most helpful to this client? 1. "When was your last period?" 2. "Have you ever used emergency contraception before?" 3. "How old are you?" 4. "Are you aware how dangerous it is to have unprotected sexual intercourse?" Answer: 1 Explanation: The nurse needs to know how close to possible ovulation this client might be; therefore, it is important to know when she had her last period. The nurse will give the client information about emergency contraception no matter when her last period was, but the nurse can give her better information about the probability of pregnancy with that knowledge. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 70-6 Explain the use of drugs for emergency contraception and for terminating pregnancy. 14) A client has decided to terminate a pregnancy using medication. Which medication would not be effective if used for this purpose? 1. Carboprost (Hemabate) 2. Mifepristone (RU-486) 3. Misoprostol (Cytotec) 4. Levonorgestrel (Plan B) Answer: 4 Explanation: Levonorgestrel (Plan B) is intended for emergency contraception, and will not cause termination of a pregnancy that is already in place. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 70-6 Explain the use of drugs for emergency contraception and for terminating pregnancy.

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15) A client will be having a second-trimester abortion using misoprostol (Cytotec) and methotrexate. Which statement by the client indicates an understanding of the side effects to be expected with these medications? 1. "I might experience chest pain with these medications." 2. "I know that these medications will most likely cause bleeding when I urinate." 3. "These medications will cause tingling and weakness in my legs." 4. "I will probably run a fever for a few hours after I take these medications." Answer: 4 Explanation: Drug-induced fever occurs in the majority of clients and can last up to 6 hours. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 70-6 Explain the use of drugs for emergency contraception and for terminating pregnancy. 16) A young female client is beginning to use oral contraceptives. What information should be shared with this client that relates to one of the possible adverse effects of these medications? 1. The client should be taught self-examination of the breasts. 2. The client needs to learn how to take her pulse. 3. The client should be instructed to drink 10 glasses of water daily. 4. The client needs to understand how to take the medication correctly. Answer: 1 Explanation: Estrogen can influence the development of breast tumors, and estrogen is one of the drugs most commonly used in oral contraceptives, so the client needs to know how to perform breast self-examination. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 70-7 Describe the nurse's role in the pharmacologic management of patients who are taking oral contraceptives.

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17) Which statement by a client taking oral contraceptives requires immediate intervention by the nurse? 1. "I have started attending a smoking-cessation program." 2. "I forgot to take my pill twice last month, and I haven't started my period yet." 3. "I am only drinking one cup of coffee a day since I started taking birth control pills." 4. "I don't take those last seven pills at the end of my pill pack." Answer: 2 Explanation: Missing the pill twice last month decreases the effectiveness of the contraceptive. The lack of a regular period could indicate pregnancy. The client needs a pregnancy test immediately, because oral contraceptives are pregnancy category X. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 70-7 Describe the nurse's role in the pharmacologic management of patients who are taking oral contraceptives. 18) The school nurse is discussing oral contraceptives with a group of adolescent females. Which factor associated with the use of these medications could prove to be the greatest deterrent to choosing this form of birth control? 1. Clients who use birth control pills need a yearly exam. 2. Clients who use birth control pills might develop high blood pressure. 3. Clients who use birth control pills might experience breast tenderness. 4. Clients who use birth control pills might experience weight gain. Answer: 4 Explanation: Most teenagers are very conscious of their body and the image they project; therefore, the possibility of gaining weight would deter them from using this medication. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 70-7 Describe the nurse's role in the pharmacologic management of patients who are taking oral contraceptives.

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19) A client with four children is asking about options for permanent birth control. Which option would provide the most reliable means of long-term pregnancy prevention for this client? 1. Transdermal delivery method 2. Mirena IUD 3. Sterilization 4. Vaginal delivery method (NuvaRing) Answer: 3 Explanation: When the desire to have children in the future no longer exists, sterilization of either the male or female is the most common and effective option for birth control. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 70-5 Compare and contrast the options available for long-term contraception. 20) A client has decided to use the depot injection delivery method of contraception. What information is most important for the nurse to share with this client to ensure consistent contraception? 1. "You must keep your 3-month appointment for your next injection." 2. "You will need to rest for 12 hours after receiving the injection." 3. "Do not rub the injection site immediately after you receive the injection." 4. "You must use sanitary pads instead of tampons when you have your period." Answer: 1 Explanation: The client must receive an injection every 3 months to maintain contraception. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 70-5 Compare and contrast the options available for long-term contraception.

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21) A client calls the clinic and reports that her contraceptive transdermal patch fell off while she was swimming in the ocean, and she is unable to find it. What advice should the nurse give to this client? 1. "Put a new patch on as soon as possible." 2. "You don't need to worry. The medication will remain in your system until it is time for you to put on a new patch." 3. "Use another form of birth control until it is time for you to put your next new patch on." 4. "Cut a new patch in half and put it on your shoulder." Answer: 3 Explanation: The client should use another form of birth control until it is time for a new patch. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 70-5 Compare and contrast the options available for long-term contraception. 22) A client has been taking estradiol and norethindrone (Ortho-Novum) for birth control for the past 3 years. Which condition might require the client to change to another form of birth control? 1. Complaints of fatigue 2. Gallbladder disease 3. Increased photosensitivity 4. Weight gain of 7 pounds Answer: 2 Explanation: Clients who develop gallbladder disease will need to change forms of birth control to avoid aggravating the condition. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 70-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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23) A client is surprised to learn she is pregnant in spite of using a contraceptive sponge for the past 5 years. Which condition might have altered the contraceptive ability of this form of birth control? 1. Migraine headaches 2. Vaginal yeast infection 3. Strep throat 4. Urinary tract infection Answer: 2 Explanation: The use of intravaginal azole antifungals can inactivate the spermicides used in the contraceptive sponge. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 70-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 24) A client has requested a pregnancy termination using mifepristone (RU-486) and misoprostol (Cytotec). Which statement by the client indicates the need for further instruction about these medications? 1. "I will avoid drinking grapefruit juice while I am taking this medication." 2. "I know that I will probably experience nausea with this medication." 3. "I'll take these medications with me while I am away on vacation." 4. "I will call the clinic if I have excessive bleeding." Answer: 3 Explanation: The client must receive further instruction that taking this medication requires three office visits; therefore, the client will not be able to go on vacation while taking the medications. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 70-6 Explain the use of drugs for emergency contraception and for terminating pregnancy.

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25) An adolescent client has been taking oral contraceptives for the past 6 months for treatment of an irregular menstrual cycle. Which statement indicates that the client has met the goals of treatment? 1. The client reports that a period occurs every 30 days. 2. The client reports a decrease in premenstrual symptoms. 3. The client reports that acne has improved. 4. The client reports that migraine headaches are better. Answer: 1 Explanation: The client is taking oral contraceptives for treatment of an irregular menstrual cycle; therefore, a regular menstrual cycle is the goal of the treatment. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 70-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 26) The nurse teaches a client about contraceptive choices. Which client statement about contraception requires clarification? 1. "If I use the Mirena IUD, I might be able to get pregnant soon after I have it removed." 2. "Birth control pills are very effective, but I must remember to take them every day." 3. "I don't want to use birth control pills because it increases my chances of getting cancer." 4. "If I use the contraceptive sponge, I can't take it out for at least 6 hours after I engage in sexual intercourse." Answer: 3 Explanation: Oral contraceptives containing estrogen can increase the risk for breast cancer, but long-term use has significantly reduced the incidence of endometrial and ovarian cancer. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 70-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 1318

27) The nurse is completing the health assessment of a client who is interested in taking oral contraceptives. Which set of data would indicate that the client should consider another form of birth control? 1. Height 5 feet, 7 inches; weight 156 pounds; P-87; R-18; B/P-128/78 2. Height 5 feet, 2 inches; weight 102 pounds; P-80; R-14; B/P-121/74 3. Height 5 feet, 6 inches; weight 140 pounds; P-86; R-16; B/P-112/79 4. Height 5 feet, 3 inches; weight 187 pounds; P-88; R-18; B/P-142/87 Answer: 4 Explanation: This client is overweight, and blood pressure is elevated. This client should consider using another form of birth control. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 70-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 28) A client tells the nurse that the ideal form of birth control is something she would not have to take every day and that cannot be seen by others. Which forms of birth control would be appropriate for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Progestin injections 2. Intrauterine device 3. Transdermal patch 4. Combination oral contraceptives 5. Progestin-only oral contraceptives Answer: 1, 2 Explanation: Progestin injections are administered every 3 months, eliminating the need to take medication every day. Intrauterine devices are not visible to others, and medication does not need to be taken every day. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: I.5 Apply knowledge of social and cultural factors to the care of diverse populations | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 70-1 Identify the choices available for birth control. 1319

29) After talking with the nurse, a client has decided not to proceed with the use of an intrauterine device as a contraceptive method because of the possible disadvantages, which include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. irregular bleeding. 2. pelvic pain. 3. allergic reaction. 4. vaginal dryness. 5. uterine perforation. Answer: 1, 2, 5 Explanation: Irregular bleeding is a disadvantage of the intrauterine device. Pelvic pain is a disadvantage of the intrauterine device. Uterine perforation is a disadvantage of the intrauterine device. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 70-2 Delineate advantages and disadvantages of the different contraceptive options.

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30) A client who has been prescribed an estrogen-progestin combination oral contraceptive asks the nurse how the medication works. How should the nurse respond to the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "It prevents ovulation by stopping the secretion of some hormones from the pituitary gland." 2. "It makes the uterine lining less favorable to an embryo." 3. "It makes the cervical mucus thicker to slow the sperm down." 4. "It kills the sperm." 5. "It stops menstruation." Answer: 1, 2, 3 Explanation: Estrogen-progestin combination oral contraceptives act by preventing ovulation. They accomplish this by providing negative feedback to the pituitary, which suppresses the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The estrogen-progestin agents make the uterine endometrium less favorable to receiving an embryo. Estrogen-progestin combinations promote the formation of thick cervical mucus that slows sperm transport. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 70-3 Explain the mechanisms by which estrogens and progestins prevent conception.

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31) A client is prescribed an oral contraceptive that has less progestin than her previous prescription. What assessment findings would support the use of a contraceptive with less progestin? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increased appetite 2. Weight gain 3. Fatigue 4. Hirsutism 5. Anorexia Answer: 1, 2, 3, 4 Explanation: Increased appetite is a common effect that is often caused by high amounts of progestin. Weight gain is a common effect that is often caused by high amounts of progestin. Fatigue is a common effect that is often caused by high amounts of progestin. Hirsutism is a common effect that is often caused by high amounts of progestin. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 70-4 Compare the safety and effectiveness of different birth control methods.

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32) A client being treated for rape asks why ulipristal (Ella) has been prescribed when the "morning after" pill can be obtained without a prescription. How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Only one dose of the medication needs to be taken." 2. "This medication prevents ovulation." 3. "It works for 5 days after having unprotected sex." 4. "It works better than other morning after pills." 5. "It will cause an abortion." Answer: 1, 2, 3 Explanation: Ulipristal (Ella) is a single-dose medication. Ulipristal (Ella) prevents ovulation. Ulipristal (Ella) retains its effectiveness for 5 days following unprotected sex. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 70-6 Explain the use of drugs for emergency contraception and for terminating pregnancy. 33) A client is taking oral contraceptives. The nurse instructs her to use another form of birth control when she takes which prescribed medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Ampicillin 2. Tetracycline 3. Warfarin 4. Insulin 5. Theophylline Answer: 1, 2 Explanation: Ampicillin can reduce the effectiveness of oral contraceptives and increase the risk of pregnancy. Tetracycline can reduce the effectiveness of oral contraceptives and increase the risk of pregnancy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 70-7 Describe the nurse's role in the pharmacologic management of patients who are taking oral contraceptives. 34) A client asks about the benefits of having a copper intrauterine device (IUD) inserted for birth 1323

control. What are the nurse's appropriate responses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The copper works like a spermicide to slow sperm motility." 2. "Even if an egg becomes fertilized, the device will not let it become implanted in the uterus." 3. "The device can be left in place for up to 10 years." 4. "It is a birth control option for someone who cannot take estrogen or progesterone." 5. "The device has no adverse effects." Answer: 1, 2, 3, 4 Explanation: The copper in the copper intrauterine device triggers a spermicidal-like reaction that slows sperm motility. If fertilization does occur with the copper intrauterine device, implantation is not likely to happen because the copper makes changes to the endometrial layer, making the lining less favorable for implantation. The copper intrauterine device can be left in place for up to 10 years. The copper intrauterine device is a good option for those who cannot take estrogen or progesterone. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 70-5 Compare and contrast the options available for long-term contraception.

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35) The nurse is preparing to instruct a nonpregnant client on the use of misoprostol (Cytotec) for a health problem. For which purposes other than medical abortion can this medication be used? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Prophylaxis for ulcers caused by NSAIDs 2. Kidney transplant rejection prophylaxis 3. Treatment of hemorrhagic cystitis 4. Treatment of hydatidiform mole 5. Treatment for menstrual irregularities Answer: 1, 2 Explanation: This medication is FDA approved for prophylaxis of ulcers caused by NSAIDs. This medication is used off-label for kidney transplant rejection prophylaxis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 70-6 Explain the use of drugs for emergency contraception and for terminating pregnancy. 36) A client is scheduled to receive mifepristone (Mifeprex) to end a pregnancy and asks the nurse how the medication works. What should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "It blocks progesterone, which is needed to maintain the pregnancy." 2. "It sensitizes the uterus to the effects of prostaglandins." 3. "It causes a large amount of prostaglandin to be released and start uterine contractions." 4. "It blocks ovulation from occurring." 5. "It increases the amount of estrogen in your body." Answer: 2, 3 Explanation: This medication increases the synthesis of prostaglandins and sensitizes the uterus to their effects. This medication promotes increased uterine contractions, which expel the embryo from the uterus. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 70-6 Explain the use of drugs for emergency contraception and for terminating pregnancy. 37) A client will be starting oral combination contraceptives. What should the nurse instruct the client to report to the healthcare provider as possible symptoms of a deep vein thrombosis? 1325

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Calf tenderness 2. Pain with walking 3. Dizziness 4. Numbness of an extremity 5. Blurred vision Answer: 1, 2 Explanation: Calf tenderness is a symptom of a thromboembolism. Pain with walking is a symptom of a thromboembolism. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 70-9 Apply the nursing process to the care of patients receiving pharmacotherapy for contraception.

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38) The nurse instructs a client taking oral combination contraceptives to have periodic serum liver function studies done and to report symptoms of liver dysfunction, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. abdominal pain. 2. yellowing of the skin. 3. clay-colored stools. 4. darkened urine. 5. constipation. Answer: 1, 2, 3, 4 Explanation: Abdominal pain could indicate gallbladder disease. Yellowing of the skin could indicate liver dysfunction. Clay-colored stools could indicate gallbladder disease. Darkened urine could indicate liver dysfunction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 70-9 Apply the nursing process to the care of patients receiving pharmacotherapy for contraception. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 71 Drugs for Disorders and Conditions of the Male Reproductive System 1) A client with a low sperm count asks the nurse to explain the disorder. The nurse responds that follicle-stimulating hormone (FSH) regulates: 1. sperm production. 2. male progesterone. 3. male estrogen. 4. corticosteroid production. Answer: 1 Explanation: Follicle-stimulating hormone (FSH) regulates sperm production in men. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-1 Explain the physiologic effects of androgens. 2) An adolescent client who has not yet begun to develop secondary sex characteristics has a testosterone level of 154 mg/dL. Based on this finding, the nurse will: 1327

1. anticipate that tests will be done to assess the client for an infection. 2. anticipate that tests will be done to assess the client for thyroid function. 3. identify the testosterone level as within normal limits. 4. identify the testosterone level as lower than normal. Answer: 4 Explanation: Normal plasma concentrations of testosterone are 250 to 1,000 mg/dL. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-1 Explain the physiologic effects of androgens.

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3) What will the nurse instruct a client regarding the actions of testosterone? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. It restricts bone growth. 2. It is responsible for the enlargement of the testes, scrotum, and penis. 3. It contributes to the development of muscle mass. 4. It promotes the synthesis of erythropoietin. 5. It is responsible for virilization. Answer: 2, 3, 4, 5 Explanation: Testosterone is responsible for supporting the growth of the testes and scrotum and the enlargement of the penis. Testosterone contributes to the development of skeletal muscle mass. Testosterone promotes the synthesis of erythropoietin, which results in higher hemoglobin and hematocrit levels in males than is found in females. Testosterone is responsible for the process of virilization, or the development of secondary sex characteristics in males. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-1 Explain the physiologic effects of androgens. 4) The nurse is reviewing the process of male maturation with a new mother who has given birth to a male child. The nurse explains that shortly after birth: 1. testosterone production is stimulated by the adrenal glands. 2. the pituitary gland secretes testosterone. 3. the Leydig cells are inactive until the onset of puberty. 4. luteinizing hormone is released. Answer: 3 Explanation: After birth, the Leydig cells are inactive until puberty, when they are activated by the gonadotropins, which are secreted by the pituitary gland. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-1 Explain the physiologic effects of androgens.

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5) The nurse counsels a male client regarding testosterone secretion based on knowledge that when testosterone levels rise above normal, the body responds by: 1. decreasing the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which results in a decrease in testosterone production. 2. increasing the secretion of estrogen to counteract the effects of the excess testosterone. 3. decreasing the release of testosterone directly from the testes. 4. increasing the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to decrease the testosterone secretion. Answer: 1 Explanation: When testosterone levels rise above normal, the body responds by decreasing the secretion of luteinizing hormone and follicle-stimulating hormone from the pituitary gland. This negative feedback response system triggers a reduction in testosterone secretion from the testes. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-2 Describe the roles of the hypothalamus, pituitary, and testes in regulating male reproductive function. 6) During a discussion on male fertility with a client, the nurse explains that the hormone that regulates testosterone production is: 1. progesterone. 2. thyrotoxin. 3. luteinizing hormone. 4. gonadotropin-releasing hormone. Answer: 3 Explanation: Luteinizing hormone regulates testosterone production. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-2 Describe the roles of the hypothalamus, pituitary, and testes in regulating male reproductive function.

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7) Which disorder is most likely to predispose a male client to develop hypogonadism? 1. Diabetes mellitus (DM) 2. Adrenal insufficiency 3. Mumps 4. Hydrocele Answer: 3 Explanation: Testicular failure is a complication of mumps and can lead to hypogonadism. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-2 Describe the roles of the hypothalamus, pituitary, and testes in regulating male reproductive function. 8) The nurse instructs a client that the androgens produced by the adrenal glands support: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. sebaceous gland stimulation. 2. cartilage growth of the larynx, producing a deeper toned voice. 3. pubic hair growth. 4. skeletal growth spurt. 5. sperm production. Answer: 3, 4 Explanation: Adrenal androgens have a role in the growth of pubic hair. Adrenal androgens are thought to influence the skeletal growth spurt in adolescents. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-2 Describe the roles of the hypothalamus, pituitary, and testes in regulating male reproductive function.

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9) Why would the nurse administer a high dose of androgen to a female client? 1. To improve athletic performance 2. To treat brain cancer 3. To treat breast cancer 4. As preparation for sexual reassignment surgery Answer: 3 Explanation: High doses of androgens are occasionally used as a palliative measure to treat certain types of breast cancer. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-3 Explain the role of androgens in the treatment of male hypogonadism, delayed puberty, and breast cancer. 10) A client is concerned about recent body changes resulting from androgen therapy and is not sure that the treatment is "worth it." What is the best therapeutic response by the nurse? 1. "You sound concerned. Make sure you share this concern with the doctor during your next appointment." 2. "You sound concerned. These changes in your body are only temporary." 3. "You sound concerned, but I don't see any real changes in your body." 4. "You sound concerned. Let's talk about the body changes you're experiencing." Answer: 4 Explanation: This is the most therapeutic response the nurse can offer. Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-3 Explain the role of androgens in the treatment of male hypogonadism, delayed puberty, and breast cancer.

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11) The nurse would consider testosterone therapy for the treatment of primary hypogonadism to be effective based on a change in which laboratory value? 1. Testosterone level 2. Luteinizing hormone (LH) 3. Sperm count 4. White blood cell (WBC) count Answer: 3 Explanation: Testosterone therapy causes an increase in the sperm count. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 71-3 Explain the role of androgens in the treatment of male hypogonadism, delayed puberty, and breast cancer. 12) The nurse suspects an adult client is experiencing hypogonadism after assessing: 1. underdeveloped testes. 2. lack of facial and pubic hair. 3. a swollen scrotal sac. 4. decreased subcutaneous fat. Answer: 2 Explanation: The adult man who presents with hypogonadism would likely have sparse body hair. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-3 Explain the role of androgens in the treatment of male hypogonadism, delayed puberty, and breast cancer.

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13) For what will the nurse assess an adolescent male client who is experiencing delayed puberty? 1. Addison's disease 2. Hypogonadism 3. Pheochromocytoma 4. Hypothyroidism Answer: 2 Explanation: Lack of sufficient testosterone secretion by the testes results in a condition called male hypogonadism. In young men, lack of sufficient testosterone secretion can lead to delayed onset of puberty. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-3 Explain the role of androgens in the treatment of male hypogonadism, delayed puberty, and breast cancer. 14) For which health problem would the administration of androgens be contraindicated in a male client? 1. Hypertension 2. Osteoarthritis 3. Peptic ulcer disease 4. Breast cancer Answer: 4 Explanation: Androgen therapy is contraindicated in males with breast cancer because it promotes the growth of the cancer. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-3 Explain the role of androgens in the treatment of male hypogonadism, delayed puberty, and breast cancer.

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15) The nurse plans to teach a group of high school athletes about anabolic steroids. What will the teaching plan include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The use of anabolic steroids is the most effective way to increase muscle mass. 2. The entire body, especially the liver, is affected by anabolic steroids. 3. The use of anabolic steroids can lead to aggressive behavior. 4. The use of anabolic steroids can lead to infertility. 5. The use of anabolic steroids should be monitored by a healthcare provider. Answer: 2, 3, 4 Explanation: Side effects of anabolic steroids include liver damage. Side effects of anabolic steroids include behavioral changes such as aggression. Side effects of anabolic steroids include infertility. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 71-4 Describe the potential consequences associated with the use of anabolic steroids to enhance athletic performance. 16) When teaching a class of young adult males about the dangers of steroid use, the nurse would stress which adverse effect that might discourage usage in this particular age group? 1. Hypercholesterolemia 2. Liver failure 3. Psychologic dependence 4. Impotence and testicular shrinkage Answer: 4 Explanation: The possibility of impotence and testicular shrinkage are the effects most likely to discourage men in this age group from using steroids. Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-4 Describe the potential consequences associated with the use of anabolic steroids to enhance athletic performance.

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17) While caring for a male client who has been using anabolic steroids, the nurse must monitor for which adverse effect? 1. Muscle weakness 2. Respiratory disease 3. Liver damage 4. Appearance of masculine characteristics Answer: 3 Explanation: The risk of hepatotoxicity and permanent liver damage are increased with anabolic steroid use. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-4 Describe the potential consequences associated with the use of anabolic steroids to enhance athletic performance. 18) A client admits using anabolic steroids to increase muscle mass. What is the nurse most likely to assess in this client? 1. Hypercholesterolemia 2. Increased sperm count 3. Male-pattern baldness 4. Mental depression Answer: 1 Explanation: Anabolic steroids raise cholesterol levels. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-4 Describe the potential consequences associated with the use of anabolic steroids to enhance athletic performance.

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19) What should the nurse instruct a client about male sexual dysfunction? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. It can be treated medically. 2. It can occur in those with anxiety or depression. 3. It can be improved to achieve successful conception or maintain a satisfactory sex life. 4. It is difficult to treat if the cause is psychologic. 5. It can be treated surgically. Answer: 1, 2, 3, 5 Explanation: Certain causes of male sexual dysfunction are medically treatable. Clients who present with psychologic conditions such as anxiety and depression have a high incidence of sexual dysfunction. Male sexual dysfunction can be improved to the degree that a couple can achieve successful conception or maintain a satisfactory sex life. Certain causes of male dysfunction are surgically treatable. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-5 Identify the types and causes of male sexual dysfunction disorders. 20) What should the nurse instruct a male client with sexual dysfunction? 1. Wear briefs rather than boxers for scrotal support. 2. Depression and anxiety make sexual dysfunction difficult to treat. 3. Decrease the use of over-the-counter medications, including nonsteroidal anti-inflammatory drugs (NSAIDs). 4. Stop smoking and limit alcohol use. Answer: 4 Explanation: Cigarette smoking and alcohol use are strongly associated with erectile dysfunction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-5 Identify the types and causes of male sexual dysfunction disorders.

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21) When completing the medication history of a male client with sexual dysfunction, the two drug classes that the nurse will assess as being most commonly associated with male sexual dysfunction are: 1. bronchodilators and antidepressants. 2. antihypertensives and penicillin-based antibiotics. 3. antidepressants and antihypertensives. 4. nonsteroidal anti-inflammatory drugs (NSAIDs) and antidepressants. Answer: 3 Explanation: Antidepressants and antihypertensives are the most common drug classes that cause sexual dysfunction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-5 Identify the types and causes of male sexual dysfunction disorders. 22) Which statement indicates that client teaching about male sexual dysfunction has been effective? 1. "I will start exercising this week by walking 15 to 30 minutes each day before I get ready for work." 2. "I will take an omega-3 fatty acid supplement three times a day with meals." 3. "I will drink one glass of wine daily to help me wind down and reduce my anxiety." 4. "I will stop taking acetaminophen (Tylenol) and ibuprofen (Motrin)." Answer: 1 Explanation: Obesity is strongly associated with male sexual dysfunction. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 71-5 Identify the types and causes of male sexual dysfunction disorders.

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23) The nurse has completed medication education for a client who is prescribed testosterone. The nurse evaluates that learning has been effective when the client makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I will weigh myself twice weekly and report any sudden weight gain." 2. "I need to have my serum cholesterol levels checked frequently." 3. "I need check my blood pressure weekly while on this medication." 4. "I don't need to use birth control while taking this medication." 5. "My blood glucose may go up while on this medication." Answer: 1, 2, 3, 5 Explanation: Testosterone can cause salt retention, leading to water retention, so weight should be checked twice weekly. Testosterone therapy can increase cholesterol levels and lead to cardiovascular disease, so serum cholesterol levels must be monitored during therapy. The patient should monitor blood pressure frequently. Testosterone therapy can increase blood glucose. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 71-6 Explain the role of drugs in the management of male infertility. 24) A client has been receiving androgen medication. What laboratory test should the nurse plan to assess? 1. Thyroid function 2. Blood glucose 3. Cardiac enzymes 4. Hemoglobin and hematocrit Answer: 4 Explanation: An adverse effect of androgens is increased red blood cell production. Hemoglobin and hematocrit should be monitored. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 71-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs, and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 25) Which assessment finding indicates a therapeutic effect of finasteride (Proscar) therapy in a 1339

client? 1. Less painful urination 2. Resolution of hematuria 3. Ability to initiate a steady urine stream 4. Decreased flow rate of urine Answer: 3 Explanation: Finasteride is indicated for the treatment of benign prostatic hypertrophy. Assessment findings that would indicate therapeutic effectiveness include the ability to initiate a stream of urine. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 71-8 Describe the pathogenesis and pharmacotherapy of benign prostatic hyperplasia. 26) Which laboratory value would concern the nurse who is caring for an adult client taking testosterone for an androgen deficiency? 1. Elevated sperm count 2. Increased serum calcium 3. Increased serum potassium 4. Elevated liver function tests Answer: 4 Explanation: Testosterone can cause severe hepatotoxicity and result in permanent liver damage if untreated. Elevated liver function tests should be reported to the healthcare provider immediately. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs, and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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27) Which assessment findings would be expected in a client who has had testosterone therapy? 1. Virilization 2. Precocious puberty 3. Electrolyte imbalances 4. Hepatomegaly Answer: 1 Explanation: Virilization is a desired effect of testosterone therapy. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs, and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 28) What would the nurse teach a client who is prescribed sildenafil (Viagra)? 1. Sildenafil (Viagra) works best when taken with high-fat meal. 2. Sildenafil (Viagra) can be taken up to 6 hours before sexual intercourse is planned. 3. Grapefruit juice will decrease the effectiveness of sildenafil (Viagra). 4. The maximum safe dosage is one pill per 24-hour period. Answer: 4 Explanation: Taking only one pill in a 24-hour period is recommended. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-7 Describe the etiology, pathogenesis, and pharmacotherapy of erectile dysfunction.

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29) When assessing a client with erectile dysfunction, on which body systems would the nurse focus? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Endocrine 2. Respiratory 3. Cardiovascular 4. Nervous 5. Renal Answer: 1, 3, 4 Explanation: The endocrine system could be involved in the client's erectile dysfunction. The cardiovascular system could be involved in the client's erectile dysfunction. The nervous system could be involved in the client's erectile dysfunction. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-7 Describe the etiology, pathogenesis, and pharmacotherapy of erectile dysfunction. 30) A client is requesting a prescription for tadalafil (Cialis). What priority assessment question should the nurse ask this client? 1. "Do you have any sexually transmitted infections?" 2. "Do you take nitroglycerin?" 3. "Have you received a diagnosis of diabetes?" 4. "Do you take medication for high blood pressure?" Answer: 2 Explanation: Combining tadalafil (Cialis) with nitroglycerin can lead to serious hypotension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-7 Describe the etiology, pathogenesis, and pharmacotherapy of erectile dysfunction.

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31) The use of which medication could predispose a client to erectile dysfunction? 1. Insulin 2. Oral hypoglycemic agents 3. Phenothiazines 4. Nonsteroidal anti-inflammatory drugs (NSAIDs) Answer: 3 Explanation: Erectile dysfunction is a potential adverse effect of phenothiazine use. Cognitive Level: Understanding Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-7 Describe the etiology, pathogenesis, and pharmacotherapy of erectile dysfunction. 32) When reviewing a male client's medication history, the nurse realizes that sildenafil (Viagra) would be contraindicated when taken with which medication? 1. Opioids 2. Isosorbide mononitrate 3. Insulin 4. Proton-pump inhibitor Answer: 2 Explanation: Isosorbide mononitrate is contraindicated for treatment with sildenafil (Viagra) due to the potential complication of life-threatening hypotension. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-7 Describe the etiology, pathogenesis, and pharmacotherapy of erectile dysfunction.

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33) A male client who is prescribed Sildenafil (Viagra) asks the nurse how the medication works. What is the nurse's best response? 1. "It causes an erection to occur." 2. "It restricts blood flow to the penis." 3. "It stimulates the release of phosphodiesterase-5, an enzyme that causes an erection." 4. "It inhibits the release of an enzyme that relaxes smooth muscle in the penis to allow blood flow leading to an erection." Answer: 4 Explanation: Sildenafil (Viagra) inhibits the release of phosphodiesterase-5, which relaxes smooth muscle in the corpus cavernosa and allows an increase of blood flow to the penis, causing an erection. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-7 Describe the etiology, pathogenesis, and pharmacotherapy of erectile dysfunction. 34) A male client complains of nocturia and a "feeling of fullness" in the lower pelvic region. What assessment question would the nurse ask? 1. "What is your age?" 2. "Are you sexually active?" 3. "Do you take a daily shower or a tub bath?" 4. "Are you constipated?" Answer: 1 Explanation: The age of a client is important in determining the etiology of the symptoms. For a male who is over the age of 60, these symptoms could indicate benign prostatic hyperplasia. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-8 Describe the pathogenesis and pharmacotherapy of benign prostatic hyperplasia.

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35) A client has benign prostatic hyperplasia and hypertension. Which medication could the client safely receive that might treat both conditions? 1. Finasteride (Proscar) 2. Doxazosin (Cardura) 3. Sildenafil (Viagra) 4. Tamsulosin (Flomax) Answer: 2 Explanation: Doxazosin (Cardura) is an alpha1-adrenergic blocker that relaxes smooth muscle in the prostate and can also reduce blood pressure. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 71-8 Describe the pathogenesis and pharmacotherapy of benign prostatic hyperplasia. 36) What should the nurse instruct a client about the function of the prostate gland? 1. It secretes fluids for the ejaculate. 2. It produces sperm. 3. It stimulates the release of testosterone. 4. It produces testosterone. Answer: 1 Explanation: The prostate gland secretes fluids for the ejaculate. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-8 Describe the pathogenesis and pharmacotherapy of benign prostatic hyperplasia.

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37) After administering the first dose of doxazosin (Cardura) to a client, the nurse should: 1. ask the client to sit down for a few minutes. 2. call the client's previously arranged ride to take him home, because he cannot drive until it is determined how he responds to the medication. 3. encourage increased oral hydration following administration. 4. monitor the client for diaphoresis and onset of headache. Answer: 1 Explanation: Doxazosin (Cardura) can cause hypotension with the first dose. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-8 Describe the pathogenesis and pharmacotherapy of benign prostatic hyperplasia. 38) When conducting medication teaching with a client, how can the nurse best describe the action of doxazosin (Cardura)? 1. It increases renal secretion of sodium. 2. It shrinks the size of the prostate. 3. It relaxes smooth muscle in the prostate. 4. It mobilizes excess fluid from the tissues. Answer: 3 Explanation: Doxazosin (Cardura) relaxes smooth muscle in the prostate to ease urinary obstruction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-8 Describe the pathogenesis and pharmacotherapy of benign prostatic hyperplasia.

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39) A client is prescribed finasteride but does not have a history of prostate disorder. What is the best assessment question for the nurse to ask at this time? 1. "Do you have erectile dysfunction?" 2. "Do you have male-pattern baldness?" 3. "Do you have a stomach ulcer?" 4. "Do you have high blood pressure?" Answer: 2 Explanation: Finasteride (Proscar) is also sold as Propecia, which is used to promote hair growth. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-9 Compare and contrast the nonpharmacologic and pharmacologic management of disorders and conditions of the male reproductive system. 40) Which medication would the nurse prepare to administer as primary treatment of oligospermia? 1. Clomiphene (Clomid) 2. Human chorionic gonadotropin (HCG) 3. Antiestrogens 4. Menotropin (Menopur) Answer: 2 Explanation: Human chorionic gonadotropin is administered intramuscularly three times per week over a 1-year period. Sperm counts are assessed periodically to assess therapeutic progress. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-9 Compare and contrast the nonpharmacologic and pharmacologic management of disorders and conditions of the male reproductive system.

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41) Which medications may be used to treat male infertility? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Saw palmetto 2. Antiestrogens 3. Human chorionic gonadotropin (HCG) 4. Menotropins 5. Omega-3 fatty acids Answer: 2, 3, 4 Explanation: Male infertility may be treated with antiestrogen medications. Male infertility is treated with human chorionic gonadotropin. Male infertility may be treated with menotropins. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 71-9 Compare and contrast the nonpharmacologic and pharmacologic management of disorders and conditions of the male reproductive system. 42) The major reason pharmacotherapy for male infertility is less successful than pharmacotherapy for female infertility is that: 1. males are typically less compliant in adhering to a medication regimen than are females. 2. endocrine problems affect only about 5% of males. 3. it takes more time to treat male infertility than female infertility. 4. it is more costly to treat male infertility than female infertility. Answer: 2 Explanation: Pharmacotherapy for male infertility affects only 5% of males and has limited research and pharmacology success. Cognitive Level: Remembering Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-9 Compare and contrast the nonpharmacologic and pharmacologic management of disorders and conditions of the male reproductive system.

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43) A female client is receiving testosterone in conjunction with antineoplastics for breast cancer. Which side effects would the nurse monitor for in this client? 1. Facial hair growth 2. Hypotension 3. Muscle tremors 4. Hyperglycemia Answer: 1 Explanation: Female clients receiving testosterone therapy need to be taught about the possible development of male sex characteristics, such as excessive facial hair. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs, and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 44) A client with prostate cancer is being treated with leuprolide (Lupron). The nurse would counsel the client regarding which side effect? 1. Increased risk of infection 2. Decreased libido and hair loss 3. Nausea with possible vomiting 4. Increased risk of bleeding Answer: 2 Explanation: Leuprolide (Lupron) is a gonadotropin-releasing hormone agonist that reduces the levels of circulating testosterone. Therefore, it is useful to treat prostatic tumors that respond to testosterone stimulation. The main side effect of leuprolide (Lupron) therapy is drug-induced hypogonadism, resulting in decreased libido and hair loss. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs, and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 1349

45) When counseling a male client about the goal of therapy with sildenafil (Viagra), the nurse emphasizes that sildenafil: 1. might be beneficial for his female sexual partner as well. 2. results in less satisfying intercourse than might have been enjoyed previously. 3. is not effective if the cause of erectile dysfunction is psychologic. 4. elicits an erection in an impotent male. Answer: 3 Explanation: For sildenafil to be effective, the erectile dysfunction must be physiologic in nature. It is not effective if the dysfunction is psychologic. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs, and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 46) The nurse should instruct a pregnant client to avoid skin contact with: 1. sildenafil (Viagra). 2. avanafil (Stendra). 3. tadalafil (Cialis). 4. finasteride (Proscar). Answer: 4 Explanation: Pregnant women who come in contact with finasteride might absorb the medication through their skin, which can cause severe harm to male fetuses. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs, and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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47) When teaching a client about an alpha1-adrenergic blocker to treat prostatic hyperplasia, the nurse will explain that this medication will begin to work within: 1. 1 to 2 months. 2. 5 to 7 days. 3. 1 to 2 weeks. 4. 1 or 2 days. Answer: 3 Explanation: The alpha1-adrenergic blockers improve urine flow and reduce symptoms of benign prostatic hyperplasia within 1 to 2 weeks after the initiation of medication therapy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs, and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 48) Which nursing intervention would be appropriate for the male client receiving testosterone therapy? 1. Assess for muscle wasting. 2. Assess for signs of fluid retention. 3. Assess for development of blood dyscrasias. 4. Monitor for a decrease in hematocrit. Answer: 2 Explanation: Adverse effects of testosterone therapy include salt and water retention, which can lead to edema. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 71-11 Apply the nursing process to the care of patients receiving pharmacotherapy for disorders and conditions of the male reproductive system.

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49) Which client statement indicates that teaching about finasteride (Proscar) has been effective? 1. "It reduces the inflammation and swelling associated with my prostatitis." 2. "It interferes with my circulating testosterone and causes my prostate to shrink so I can urinate again." 3. "It relaxes the smooth muscle in my urethra to facilitate the outflow of urine." 4. "It kills prostate cells that could lead to cancer." Answer: 2 Explanation: Finasteride (Proscar) works by inhibiting the enzyme responsible for converting testosterone to one of its metabolites, 5-alpha dihydrotestosterone, which causes proliferation of prostate cells and promotes enlargement of the gland. Finasteride promotes regression of prostate epithelial tissue and decreases mechanical obstruction of the urethra. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 71-11 Apply the nursing process to the care of patients receiving pharmacotherapy for disorders and conditions of the male reproductive system. 50) A testosterone (Testoderm) patch has been prescribed for a client. Where will the nurse instruct the client to place the patch on the skin? 1. On the scrotum 2. On the lower leg 3. On the head 4. On the thigh Answer: 4 Explanation: Testosterone (Testoderm) patches can be applied to the thigh, upper arm, back, or abdomen. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-11 Apply the nursing process to the care of patients receiving pharmacotherapy for disorders and conditions of the male reproductive system.

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51) An adolescent male client is recovering from surgery to remove the adrenal glands. The nurse understands that this surgery will have which effect on the client's growth and development? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Reduced amount of pubic hair 2. Negative effect on the growth spurt 3. No effect 4. Increased facial and pubic hair 5. Excessive deepening of the voice Answer: 1, 2 Explanation: Adrenal androgens have a role in the growth of pubic hair in adolescents. Adrenal androgens are thought to influence the skeletal growth spurt in adolescents. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-1 Explain the physiologic effects of androgens. 52) The nurse is instructing a group of preadolescent males on the influence of testosterone on normal growth and development. What will the nurse include in this teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Testosterone causes the testes, scrotum, and penis to enlarge. 2. Testosterone causes pubic and axillary hair to grow. 3. Testosterone causes the cartilage of the larynx to grow. 4. Testosterone causes an increase in acne. 5. Testosterone levels fluctuate every 28 days. Answer: 1, 2, 3, 4 Explanation: Testosterone causes the testes, scrotum, and penis to enlarge until they reach adult proportions. Testosterone causes pubic and axillary hair to grow. Testosterone causes the cartilage of the larynx to grow, resulting in a deeper male voice. Testosterone stimulates sebaceous gland activity, resulting in an increase in the level of acne. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-2 Describe the roles of the hypothalamus, pituitary, and testes in regulating male reproductive function. 53) What would the nurse include when explaining the process of testosterone production to a 1353

mother who has given birth to a male infant? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The same hormones from the pituitary gland control reproductive function in both males and females. 2. Luteinizing hormone regulates the production of testosterone by specialized cells in the testes. 3. Testosterone secretion begins at school age. 4. Testosterone production declines rapidly after middle age. 5. Testosterone production increases rapidly during puberty. Answer: 1, 2, 5 Explanation: The same hormones from the pituitary gland control reproductive function in both males and females. Luteinizing hormone in the male reproductive system regulates the production of testosterone by the Leydig cells of the testes. Testosterone production increases rapidly during puberty and maintains a high level of production. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-2 Describe the roles of the hypothalamus, pituitary, and testes in regulating male reproductive function.

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54) A client is prescribed leuprolide (Lupron) for the treatment of prostate cancer. The nurse describes possible side effects of this medication, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. erectile dysfunction. 2. low sperm count. 3. decreased libido. 4. loss of motivation. 5. euphoria. Answer: 1, 2, 3, 4 Explanation: Therapy with gonadotropin-releasing hormone (GnRH) agonists such as leuprolide (Lupron) can lead to secondary hypogonadism and erectile dysfunction. Therapy with gonadotropin-releasing hormone (GnRH) agonists such as leuprolide (Lupron) can lead to secondary hypogonadism and low sperm count. Therapy with gonadotropin-releasing hormone (GnRH) agonists such as leuprolide (Lupron) can lead to secondary hypogonadism and decreased libido. Therapy with gonadotropin-releasing hormone (GnRH) agonists such as leuprolide (Lupron) can lead to secondary hypogonadism and nonspecific complaints such as loss of motivation. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-3 Explain the role of androgens in the treatment of male hypogonadism, delayed puberty, and breast cancer.

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55) For which nonreproductive health problems would the nurse expect to provide androgen therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Aplastic anemia 2. Anemia associated with chronic kidney disease 3. Muscle wasting associated with acquired immunodeficiency syndrome (AIDS) 4. Male breast cancer 5. Prostate cancer Answer: 1, 2, 3 Explanation: Androgens have been used to treat aplastic anemia. Androgens have been used to treat anemias associated with chronic kidney disease. Androgens have been used to treat muscle-wasting diseases such as that seen in clients with AIDS. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 71-3 Explain the role of androgens in the treatment of male hypogonadism, delayed puberty, and breast cancer.

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56) During a physical examination, the nurse suspects an adolescent client may be using anabolic steroids after assessing: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. below-normal height for age. 2. elevated blood pressure. 3. increased acne. 4. argumentative behavior. 5. hunger and increased thirst. Answer: 1, 2, 3, 4 Explanation: Anabolic steroids can promote premature epiphyseal plate closure, thereby reducing adult height. Anabolic steroids cause salt and water retention, leading to hypertension. Anabolic steroids can cause acne. Behavioral changes caused by anabolic steroids include an increase in aggressive behavior. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-4 Describe the potential consequences associated with the use of anabolic steroids to enhance athletic performance.

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57) A college freshman wants to use anabolic steroids to ensure a place on the soccer team. How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Steroids can cause a low sperm count." 2. "Steroids can cause testicular atrophy." 3. "Steroids can cause impotence." 4. "Steroids cause more facial hair to grow." 5. "Steroids can cause high blood pressure." Answer: 1, 2, 3, 5 Explanation: The use of anabolic steroids can cause oligospermia or low sperm count. The use of anabolic steroids can lead to testicular atrophy. The use of anabolic steroids can cause impotence. The use of anabolic steroids causes sodium and water retention, which can lead to hypertension. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-4 Describe the potential consequences associated with the use of anabolic steroids to enhance athletic performance. 58) During a genitourinary health history, a male client says, "I think I have a sexual dysfunction." For which conditions will the nurse assess this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Lack of interest in sexual activity 2. Inability to obtain or sustain an erection 3. Disorder with ejaculation 4. Inability to conceive a child 5. Burning with urination Answer: 1, 2, 3, 4 Explanation: Diminished libido is a type of male sexual dysfunction. Erectile dysfunction is a type of male sexual dysfunction. Ejaculation disorders are a type of male sexual dysfunction. Infertility is a type of male sexual dysfunction. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-5 Identify the types and causes of male sexual dysfunction disorders. 1358

59) During a physical assessment, the nurse suspects a client is at risk for developing male sexual dysfunction. What did the nurse assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Blood pressure 170/92 mmHg 2. Fasting capillary blood glucose level 220 mg/dL 3. Body mass index 30 4. Smokes two packs of cigarettes per day 5. Age 45 Answer: 1, 2, 3, 4 Explanation: Hypertension is one medical condition that is associated with male sexual dysfunction. Diabetes mellitus is one medical condition that is associated with male sexual dysfunction. Obesity is associated with male sexual dysfunction. Smoking is associated with male sexual dysfunction. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-5 Identify the types and causes of male sexual dysfunction disorders. 60) The nurse is reviewing the current medications of a client with oligospermia. Which client medications would have a negative effect on sperm production? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Colchicine 2. Spironolactone 3. Cimetidine 4. Acetaminophen 5. Metoprolol Answer: 1, 2, 3 Explanation: Colchicine can lower sperm production. Spironolactone can lower sperm production. Cimetidine can lower sperm production. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-6 Explain the role of drugs in the management of male infertility.

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61) A client has completed treatment with intramuscular injections of human chorionic gonadotropin (HCG) for oligospermia. Which medications might be prescribed to ensure testosterone levels remain elevated in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Tamoxifen (Nolvadex) 2. Clomiphene (Clomid) 3. Sildenafil (Viagra) 4. Tadalafil (Cialis) 5. Vardenafil (Levitra) Answer: 1, 2 Explanation: Tamoxifen (Nolvadex) blocks the negative feedback of adrenal estrogen to the pituitary and hypothalamus, increasing the levels of FSH and LH to maintain the testosterone level. Clomiphene (Clomid) blocks the negative feedback of adrenal estrogen to the pituitary and hypothalamus, increasing the levels of FSH and LH to maintain the testosterone level. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 71-6 Explain the role of drugs in the management of male infertility.

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62) A client is being evaluated for erectile dysfunction (ED). The nurse anticipates that which diagnostic tests would be prescribed to determine the cause of the disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Serum testosterone level test 2. Prostate-specific antigen (PSA) test 3. Prolactin level test 4. Thyroxin level test 5. Serum sodium level test Answer: 1, 2, 3, 4 Explanation: A serum testosterone level test will be done to check for a hormonal cause of erectile dysfunction. A prostate-specific antigen test will be done to help determine the cause of erectile dysfunction. A prolactin level test will be done to help determine the cause of erectile dysfunction. A thyroxin level test will be done to help determine the cause of erectile dysfunction. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-7 Describe the etiology, pathogenesis, and pharmacotherapy of erectile dysfunction.

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63) Which client statement indicates that medication teaching about vardenafil (Levitra) has been effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "This medication acts within 30 to 60 minutes after I take it." 2. "The effects of this medication can last for 4 to 5 hours." 3. "I may have a headache or runny nose from taking this medication." 4. "I cannot use this medication if I start taking a medication with nitrates." 5. "This medication takes 4 hours to take effect." Answer: 1, 2, 3, 4 Explanation: This medication acts within 30 to 60 minutes. The effects of this medication can continue for 4 to 5 hours. Headache and rhinitis are common adverse effects of this medication. This medication may prolong the QT interval and should be used with caution in clients who are taking nitrates. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 71-7 Describe the etiology, pathogenesis, and pharmacotherapy of erectile dysfunction.

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64) A client who has been diagnosed with benign prostatic hyperplasia (BPH) does not want to take medication to treat the disorder. The nurse instructs the client that if this disorder is left untreated, possible complications include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. urinary tract infections. 2. incontinence of urine. 3. blood in the urine. 4. impaired kidney function. 5. prostate cancer. Answer: 1, 2, 3, 4 Explanation: Recurrent urinary tract infections are one serious complication of untreated BPH. Serious complications of untreated BPH include incontinence of urine. Serious complications of untreated BPH include gross hematuria. Chronic kidney failure is a serious complication of untreated BPH. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-8 Describe the pathogenesis and pharmacotherapy of benign prostatic hyperplasia.

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65) A client experiencing moderate symptoms of benign prostatic hyperplasia (BPH) is prescribed tamsulosin (Flomax). What will the nurse instruct the client about this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "This medication will not affect your blood pressure." 2. "This medication improves urine flow." 3. "You will see an improvement in symptoms in 1 to 2 weeks." 4. "You may experience a headache or dizziness with this medication." 5. "Notify your healthcare provider if you experience fatigue when taking this medication." Answer: 1, 2, 3, 4 Explanation: Tamsulosin (Flomax) at normal doses has no effect on blood pressure. Tamsulosin (Flomax) improves urine flow. Tamsulosin (Flomax) improves symptoms in 1 to 2 weeks. Common adverse effects of tamsulosin (Flomax) include headache and dizziness. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-8 Describe the pathogenesis and pharmacotherapy of benign prostatic hyperplasia. 66) A client with hypertension and diabetes mellitus asks the nurse what can be done to prevent the onset of erectile dysfunction (ED). What measures can the nurse suggest? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Maintaining optimal body weight 2. Stopping smoking 3. Limiting alcohol intake 4. Exercising more 5. Following a low-sodium, low-fat diet Answer: 1, 2, 3 Explanation: All clients at risk for erectile dysfunction should be encouraged to maintain an optimal body weight. All men at risk for erectile dysfunction should be encouraged to stop smoking. All men at risk for erectile dysfunction should be encouraged to limit alcohol intake. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-9 Compare and contrast the nonpharmacologic and pharmacologic management of disorders and conditions of the male reproductive system. 1364

67) The nurse reviews a client's current medications and realizes that which medications would be contraindicated in testosterone replacement therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Oral anticoagulants 2. Corticosteroids 3. Finasteride 4. Antibiotics 5. Antihypertensives Answer: 1, 2, 3 Explanation: Testosterone may potentiate the effects of oral anticoagulants and increase the risk of severe bleeding. Use of testosterone with corticosteroids may cause additional edema. Finasteride is an antiandrogenic medication; if used with testosterone, it inhibits the effects of both medications. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs, and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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68) During an assessment, the nurse realizes a client is experiencing adverse effects of finasteride (Proscar). What did the nurse assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Gynecomastia 2. Body rash 3. Transient dizziness 4. Blue-tinged vision 5. Weight loss Answer: 1, 2, 3 Explanation: Finasteride (Proscar) can cause gynecomastia. Finasteride (Proscar) can cause a rash. Finasteride (Proscar) can cause dizziness. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs, and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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69) A client is prescribed transdermal testosterone gel for replacement therapy. What should the nurse instruct the client about this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Apply the gel once per day in the morning to clean, dry skin. 2. Apply the gel to the upper arms, shoulders, or abdomen. 3. Avoid showering or swimming for several hours after applying the gel. 4. Avoid skin-to-skin contact with anyone who might be pregnant. 5. Keep all daily scheduled appointments to have testosterone levels assessed. Answer: 1, 2, 3, 4 Explanation: The gel should be applied once daily in the morning to clean, dry skin. The gel is applied to the skin of the upper arms, shoulders, or abdomen. Showering or swimming should be avoided for several hours after application to avoid washing off the drug. The gel can be transferred to another person by skin-to-skin contact and cause potential fetal harm. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-11 Apply the nursing process to the care of patients receiving pharmacotherapy for disorders and conditions of the male reproductive system.

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70) A client is prescribed sildenafil (Viagra) for erectile dysfunction. What teaching will the nurse provide to the client about this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Take this medication 30 minutes to 1 hour before sexual activity. 2. Take no more than one dose of the medication within a 24-hour period. 3. Seek attention from a healthcare provider if an erection lasts longer than 4 hours. 4. Avoid eating a high-fat meal before taking this medication. 5. Chest pain and blue-tinged vision are expected side effects. Answer: 1, 2, 3, 4 Explanation: This drug can be taken 30 minutes to 1 hour before sexual activity. Only one dose of the medication can be taken within a 24-hour period. The client should report and seek medical attention for an erection that lasts longer than 4 hours. A high-fat meal may cause a delay in the action of the medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 71-11 Apply the nursing process to the care of patients receiving pharmacotherapy for disorders and conditions of the male reproductive system. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 72 Pharmacotherapy of Bone and Joint Disorders 1) The nurse, instructing a client on the prevention of osteoporosis, includes the importance of maintaining a normal serum calcium level because: 1. calcium influences the contraction of skeletal muscle. 2. calcium ions assist in blood clotting. 3. appropriate nerve conduction depends on an adequate calcium level. 4. the support provided by bones is important for the structural integrity of the body. Answer: 4 Explanation: Calcium is bound as a hard matrix known as hydroxyapatite crystals that provides support to the skeleton. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 72-1 Describe the role of calcium in maintaining homeostasis in the nervous, muscular, skeletal, and cardiovascular systems. 1368

2) The nurse is planning an educational program for a group of senior citizens on the importance of calcium intake. The nurse will explain that approximately 50% of the calcium in the body participates in intracellular functions and is: 1. nonionized. 2. bound to albumin. 3. complexed. 4. ionized. Answer: 4 Explanation: Ionized calcium is the only physiologically and clinically significant form of calcium. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 72-1 Describe the role of calcium in maintaining homeostasis in the nervous, muscular, skeletal, and cardiovascular systems.

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3) The recommended dietary allowance for calcium in the normal healthy adult is: 1. 1,600 to 2,000 mg/day. 2. 1,000 to 1,200 mg/day. 3. 200 to 600 mg/day. 4. 2,400 to 2,800 mg/day. Answer: 2 Explanation: The normal healthy adult should consume 1,000 to 1,200 mg of calcium per day. Cognitive Level: Remembering Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 71-2 Describe the roles of the hypothalamus, pituitary, and testes in regulating male reproductive function. 4) A client has a serum calcium level of 12.0 mg/dL. The nurse suspects that the client is experiencing a pathophysiologic process such as: 1. osteomalacia. 2. metastatic bone tumor. 3. hypoparathyroidism. 4. chronic kidney disease. Answer: 2 Explanation: The bone destruction that occurs with metastatic bone tumors releases calcium into the bloodstream and elevates the serum calcium level. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 72-2 Identify the recommended dietary allowance and the normal serum levels of calcium.

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5) Which question is most important for the nurse to ask the client who has been diagnosed with osteoporosis? 1. "How much weight have you gained in the last year?" 2. "How many dairy products do you consume per day?" 3. "Does someone in your household smoke?" 4. "What would you estimate your cholesterol intake to be?" Answer: 2 Explanation: Osteoporosis is associated with a deficiency of calcium. Milk provides the most readily available form of calcium. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 72-4 Explain the etiology, pathogenesis, and pharmacotherapy for hypocalcemia, hypercalcemia, osteomalacia, osteoporosis, rickets, osteoarthritis, rheumatoid arthritis, and gout. 6) A client with a calcium imbalance has an elevated calcitonin level. The nurse recognizes that the secretion of calcitonin is increased when the client experiences: 1. hypocalcemia. 2. hypothyroidism. 3. hyperthyroidism. 4. hypercalcemia. Answer: 4 Explanation: Calcitonin is the hormone that opposes parathyroid hormone and is released when the serum calcium level is increased. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 72-3 Explain the roles of parathyroid hormone, calcitonin, and vitamin D in maintaining calcium balance.

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7) Normally, serum calcium level is maintained by: 1. folic acid and thyroxine. 2. vitamin C and prolactin. 3. vitamin B12 and aldosterone. 4. vitamin D and parathyroid hormone. Answer: 4 Explanation: Vitamin D and parathyroid hormone increase gastrointestinal absorption of calcium and decrease calcium excretion through the kidneys. These agents also increase bone resorption, which also increases calcium levels. Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 72-3 Explain the roles of parathyroid hormone, calcitonin, and vitamin D in maintaining calcium balance. 8) The nurse is instructing a mother to encourage her school-age children to play out of doors because it will help reduce the risk of osteomalacia by: 1. increasing renal perfusion, which helps to activate vitamin D. 2. increasing the level of an inactive form of vitamin D in the blood. 3. increasing osteoblastic activity to maintain calcium in the bone. 4. enhancing activation of the parathyroid hormone. Answer: 2 Explanation: Ultraviolet light increases the blood level of cholecalciferol synthesized from cholesterol in the skin. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 72-3 Explain the roles of parathyroid hormone, calcitonin, and vitamin D in maintaining calcium balance.

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9) A client with rheumatoid arthritis is prescribed hydroxychloroquine (Plaquenil). To encourage compliance, the nurse should advise the client to expect the effects of this drug to begin within: 1. 3 to 6 days. 2. 6 to 9 months. 3. 7 days. 4. 4 to 6 weeks. Answer: 4 Explanation: Hydroxychloroquine (Plaquenil) requires 4 to 6 weeks to achieve a therapeutic response. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 72-4 Explain the etiology, pathogenesis, and pharmacotherapy for hypocalcemia, hypercalcemia, osteomalacia, osteoporosis, rickets, osteoarthritis, rheumatoid arthritis, and gout. 10) A client is prescribed a disease-modifying antirheumatic agent. What will the nurse explain as the mechanism of action for this medication? 1. Provides rapid relief of symptoms. 2. Prevents the need for orthopedic surgery. 3. Reduces damage and delays disease progression. 4. Allows the client to be more active. Answer: 3 Explanation: Disease-modifying antirheumatic drugs reduce joint damage and delay disease progression. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 72-4 Explain the etiology, pathogenesis, and pharmacotherapy for hypocalcemia, hypercalcemia, osteomalacia, osteoporosis, rickets, osteoarthritis, rheumatoid arthritis, and gout.

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11) The nurse should instruct a client with the initial stages of osteoarthritis to engage in low-impact exercise and take: 1. opioid analgesics. 2. glucosamine and chondroitin agents. 3. acetaminophen. 4. high anti-inflammatory doses of aspirin. Answer: 3 Explanation: Acetaminophen is the preferred drug for osteoarthritis. It is effective and inexpensive. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 72-4 Explain the etiology, pathogenesis, and pharmacotherapy for hypocalcemia, hypercalcemia, osteomalacia, osteoporosis, rickets, osteoarthritis, rheumatoid arthritis, and gout. 12) The nurse is teaching a client about taking risedronate (Actonel) for osteoporosis. Which statement by the client indicates a need for further teaching? 1. "I will wait at least 30 minutes before eating." 2. "I will take the medication first thing in the morning, with water." 3. "I can return to bed while I wait for the medication to work." 4. "I will report difficulties with heartburn." Answer: 3 Explanation: Bisphosphonates can irritate the esophagus, so clients should remain upright for at least 30 minutes after administration to reduce this risk. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 72-5 Describe the nurse's role in the pharmacologic management of bone and joint disorders.

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13) A client with rheumatoid arthritis is prescribed hydroxychloroquine (Plaquenil). The nurse should caution the client to: 1. report blurred vision or decreased reading ability immediately. 2. continue taking a glass of red wine before dinner to reduce cardiovascular risk. 3. take this drug with an antacid to decrease stomach distress. 4. expose skin to sunlight for at least 20 minutes every day to help with bone formation. Answer: 1 Explanation: Blindness can result from retinal damage and is the most serious adverse effect of this medication. Clients should report any indications of visual problems. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 72-5 Describe the nurse's role in the pharmacologic management of bone and joint disorders. 14) A calcium supplement has been added to a client's drug regimen. The nurse should advise the client to: 1. decrease intake of dairy products to prevent hypercalcemia. 2. increase consumption of fruits and vegetables high in vitamin C. 3. avoid taking calcium supplements with bran or whole-grain cereal. 4. increase consumption of lean meats for additional protein intake. Answer: 3 Explanation: Bran and whole-grain foods inhibit the absorption of calcium in the gastrointestinal tract. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 72-5 Describe the nurse's role in the pharmacologic management of bone and joint disorders.

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15) A client has been prescribed allopurinol (Zyloprim) for gout. The purpose of this medication is to: 1. relieve the inflammation caused by this disease process. 2. reduce the formation of uric acid. 3. help the body excrete excess uric acid. 4. prevent the joint damage associated with this disease. Answer: 2 Explanation: Gout is a disorder caused by the accumulation of uric acid in the body. Allopurinol (Zyloprim) inhibits xanthine oxidase, which is necessary for the formation of uric acid. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 72-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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16) A client is being treated for type 2 diabetes mellitus, tuberculosis, and rheumatoid arthritis. The nurse would be most concerned about this patient being treated with which medication? 1. Etanercept (Enbrel) 2. Hydroxychloroquine (Plaquenil) 3. Methotrexate (Rheumatrex) 4. Sulfasalazine (Azulfidine) Answer: 1 Explanation: Etanercept is a tumor necrosis factor blocker. Because tumor necrosis factor is a cytokine that is important in cellular immunity, drugs that interfere with this cytokine increase the risk of infections and are contraindicated when a client has tuberculosis or a history of tuberculosis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 72-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 17) A client with osteoporosis has been prescribed raloxifene (Evista). Which question should the nurse ask to determine the client's risks for complications with this drug? 1. "Have you ever had esophageal or ulcer disease?" 2. "Do you have a history of abnormal breast biopsies?" 3. "Have you ever had or been treated for blood clots?" 4. "Have you ever had any broken bones?" Answer: 3 Explanation: Raloxifene increases the risk of deep vein thrombosis and resulting pulmonary embolism. This history would contraindicate the use of raloxifene. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 72-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 1377

18) For which symptom is it critical for the nurse to monitor when caring for a client with hypoparathyroidism? 1. Decreased peristalsis 2. Tetany 3. Weakness 4. Vomiting Answer: 2 Explanation: Tetany and its associated laryngospasm are manifestations of the severe hypocalcemia that is associated with hypoparathyroidism. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 72-7 Apply the nursing process to the care of patients receiving pharmacotherapy for bone and joint disorders. 19) The nurse is concerned that a client is at risk for the development of hypocalcemia because of which health problem? 1. Renal disease 2. Osteoporosis 3. Osteoarthritis 4. Cardiac damage Answer: 1 Explanation: Renal damage can result in excessive loss of calcium in the urine. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 72-7 Apply the nursing process to the care of patients receiving pharmacotherapy for bone and joint disorders.

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20) A client who is experiencing no symptoms of a low calcium level asks why calcium is important. How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Calcium is needed to keep the nervous system working properly." 2. "Calcium is used by the body to make the muscles move." 3. "Calcium is used in the blood to help with clotting." 4. "Calcium maintains the normal respiratory rate." 5. "Calcium is needed to control blood glucose levels." Answer: 1, 2, 3 Explanation: In the nervous system, calcium ions influence the release of neurotransmitters and the excitability of all neurons. Contraction is dependent on calcium ion movement in skeletal, smooth, and cardiac muscle cells. Calcium is important for blood coagulation; it converts prothrombin into thrombin. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 72-1 Describe the role of calcium in maintaining homeostasis in the nervous, muscular, skeletal, and cardiovascular systems. 21) Which clients would the nurse identify as needing 1,300 mg of calcium per day? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Client age 15 2. Pregnant client age 17 3. Client age 30 4. Client age 53 5. Client age 83 Answer: 1, 2 Explanation: The normal recommended intake of calcium for a 15-year-old client is 1,300 mg/day. The normal recommended intake of calcium for a 17-year-old pregnant client is 1,300 mg/day. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 72-2 Identify the recommended dietary allowance and the normal serum levels of calcium.

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22) A client is diagnosed with a vitamin D deficiency. To aid in the correction of this deficiency, the nurse instructs the client to: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. spend 15 minutes a day in the sun without sunscreen. 2. increase the intake of milk. 3. increase intake of vitamin-enriched foods. 4. increase intake of red meat. 5. increase intake of leafy greens. Answer: 1, 2, 3 Explanation: In the skin, cholecalciferol, the inactive form of vitamin D, is synthesized from cholesterol. Exposing the skin to sunlight or ultraviolet light increases the level of cholecalciferol in the blood. Cholecalciferol, the inactive form of vitamin D, can be obtained from dairy products such as milk. Cholecalciferol, the inactive form of vitamin D, can be obtained from foods fortified with vitamin D. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 72-3 Explain the roles of parathyroid hormone, calcitonin, and vitamin D in maintaining calcium balance.

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23) When planning care for a client, the nurse will include interventions to address factors that predispose the client to developing gout, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. taking a prescribed thiazide diuretic. 2. taking aspirin every day. 3. drinking four beers every night. 4. receiving treatment for polycythemia. 5. being diagnosed with heart failure. Answer: 1, 2, 3, 4 Explanation: Gout can be caused by thiazide diuretics. Gout can be caused by chronic aspirin use. Gout can be caused by alcohol ingested on a chronic basis. Polycythemia can cause secondary gout. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 72-4 Explain the etiology, pathogenesis, and pharmacotherapy for hypocalcemia, hypercalcemia, osteomalacia, osteoporosis, rickets, osteoarthritis, rheumatoid arthritis, and gout.

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24) A client with osteoarthritis does not want to use medication for pain control. What can the nurse suggest to improve the symptoms of this disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Begin a walking program. 2. Perform exercises to strengthen the quadriceps muscle. 3. Discuss the use of a brace with the healthcare provider. 4. Consider losing weight. 5. Schedule joint replacement surgery as soon as possible. Answer: 1, 2, 3, 4 Explanation: Walking helps maintain joint flexibility in the client with osteoarthritis. Improving the strength of the quadriceps muscle will enhance the ability to perform activities of daily living. Bracing may help keep joints positioned correctly and relieve pain. Weight reduction helps if the weight-bearing joints such as the hip and knee are affected. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 72-4 Explain the etiology, pathogenesis, and pharmacotherapy for hypocalcemia, hypercalcemia, osteomalacia, osteoporosis, rickets, osteoarthritis, rheumatoid arthritis, and gout.

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25) While conducting a physical assessment, the nurse is concerned that the client, who is taking a bisphosphonate, is showing signs of osteonecrosis of the jaw. What did the nurse assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Jaw pain and swelling 2. Several loose teeth 3. Elevated blood pressure 4. Oral lesions 5. Difficulty swallowing Answer: 1, 2 Explanation: Symptoms of osteonecrosis of the jaw, which is a possible adverse effect of bisphosphonate therapy, include jaw pain and swelling. Symptoms of osteonecrosis of the jaw, which is a possible adverse effect of bisphosphonate therapy, include loose teeth. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 72-5 Describe the nurse's role in the pharmacologic management of bone and joint disorders.

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26) A client is prescribed colchicine (Colcrys) for gout. The nurse discusses possible adverse effects of this therapy, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. nausea and vomiting. 2. abdominal pain. 3. diarrhea. 4. constipation. 5. muscle pain. Answer: 1, 2, 3 Explanation: Adverse effects of colchicine (Colcrys) include nausea and vomiting. Adverse effects of colchicine (Colcrys) include abdominal pain. Adverse effects of colchicine (Colcrys) include diarrhea. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 72-6 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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27) The nurse determines that teaching about gout has been effective when the client makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I should increase my fluid intake to 2 to 4 liters every day." 2. "I should avoid eating salmon, sardines, organ meats, alcohol, mushrooms, legumes, and oatmeal." 3. "I should notify my healthcare provider if my pain gets worse." 4. "I should weigh myself every day and notify my healthcare provider if I gain over 2 pounds in a day." 5. "I will expect to experience flank pain when taking this medication." Answer: 1, 2, 3, 4 Explanation: The client should be instructed to increase fluid intake to 2 to 4 L/day. These are foods that contain purine and should be avoided in the client with gout. Worsening pain could be an indication that the medication dosage needs to be adjusted and should be reported to the healthcare provider. The client should conduct daily weights and notify the healthcare provider about any weight gain of 2.2 pounds or more in a day. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 72-7 Apply the nursing process to the care of patients receiving pharmacotherapy for bone and joint disorders. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 73 Pharmacotherapy of Dermatologic Disorders 1) What should the nurse include when teaching a group of adolescents about the structure and function of the skin? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The amount of subcutaneous tissue varies and is determined by nutritional status and heredity. 2. The epidermis provides a foundation for the accessory structures, such as hair and nails. 3. Keratin is found in areas subject to mechanical stress such as the palms of the hands. 4. Most receptor nerve endings, oil glands, sweat glands, and blood vessels are found within the subcutaneous fat. 5. The outermost layer of the epidermis serves as the major waterproof barrier to the environment. Answer: 1, 3, 5 Explanation: The amount of subcutaneous tissue varies and is determined by body area, gender, age, nutritional status, and heredity. Keratin is found in those areas subject to mechanical stress such as the palms of the hands and the soles of the feet. 1385

The outermost layer of the epidermis is made up of sheets of dead cells that serve as the major waterproof barrier to the environment. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health-promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-1 Identify the structure and functions of the skin and associated structures.

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2) The client asks the nurse how skin cells are replaced. The nurse explains that when older cells have been damaged or lost, new cells are supplied by the: 1. stratum basale. 2. stratum spinosum. 3. dermis. 4. stratum lucidum. Answer: 1 Explanation: The deepest epidermal sublayer, the stratum basale, supplies the epidermis with new cells after older superficial cells have been damaged or lost through normal wear. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health-promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-2 Explain the process by which superficial skin cells are replaced. 3) The nurse, teaching a client about safety when using topical scabicide medications, determines instruction has been effective when the client states: 1. "I need to sign a consent for this medication." 2. "I should cover the area with a clean cloth." 3. "I must avoid putting this lotion around my eyes." 4. "I will need help in showering to remove the lotion." Answer: 3 Explanation: These medications are irritating to sensitive skin and eyes, so these areas should be avoided. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 73-4 Describe the drug therapies for bacterial, fungal, viral, and parasitic infections of the skin.

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4) The client receives a topical medication for treatment of a skin disorder. The nurse completes medication education and evaluates that learning has occurred when the client makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "My medication only needs to be applied once a day." 2. "My daughter has a similar problem, so she can use this too." 3. "I do not need to shower prior to using this medication." 4. "I will call my doctor if I notice a change in my symptoms." 5. "I will apply the medication only to the affected area." Answer: 4, 5 Explanation: The client must notify the healthcare provider if symptoms change. Medications can be irritating, so they should be applied only to the affected area. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 73-9 Describe the nurse's role in the pharmacologic management of dermatologic disorders. 5) A client received a minor sunburn while on vacation. What is the nurse's best advice to this client? 1. "Call your healthcare provider for a prescription for pain medication." 2. "Apply a local anesthetic to the sunburned area." 3. "Apply emollients to keep the skin moist until it heals." 4. "Take acetaminophen (Tylenol) or ibuprofen (Advil) for pain." Answer: 2 Explanation: A local anesthetic will relieve the pain. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.6 Use information and communication technologies in preventive care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-7 Describe the prevention and management of minor burns.

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6) A client is frantic because her two children have been sent home from school with head lice. She has treated their scalps but does not know what else to do. What is the best teaching by the nurse? 1. "Isolate the children from other family members for 3 days." 2. "Just continue to apply the medication to their scalps as directed." 3. "Do not let your children return to the school until it is fumigated." 4. "Wash bed linens and clothing that have come into contact with the children." Answer: 4 Explanation: Lice are spread by direct contact and can live many days on inanimate objects. The children could be reinfected if household items are not treated. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-9 Describe the nurse's role in the pharmacologic management of dermatologic disorders. 7) The mother of a client with head lice has completed the applications of a pediculicide. What is the best instruction by the nurse at this time? 1. "Check the heads of your child's friends before allowing them to play together." 2. "Remove all nits from the hair shaft with a nit comb or a fine-tooth comb." 3. "You are fine now; just watch your child for a reinfection." 4. "Keep your child's hair short so it will be easier to treat next time." Answer: 2 Explanation: After the shampoo treatment, the mother should remove all nits from the hair shaft with a nit comb or a fine-tooth comb. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-9 Describe the nurse's role in the pharmacologic management of dermatologic disorders.

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8) The nurse is preparing to apply a topical cream to a client with psoriasis. What will the nurse do prior to applying this lotion? 1. Use a mask to avoid inhaling the fumes. 2. Obtain a tongue blade for the application. 3. Give the cream to the client to apply. 4. Put on gloves before the application. Answer: 4 Explanation: The best way to apply the cream is with the hand, so the nurse should use gloves to prevent absorbing the medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-5 Explain the etiology, pathogenesis, and pharmacotherapy for acne vulgaris, rosacea, dermatitis, and psoriasis. 9) Clients in a nursing home have been prescribed permethrin (Nix) for head lice. The nurse will question the order for the client who has: 1. seizures. 2. hypothyroidism. 3. diabetes mellitus. 4. an allergy to sulfites. Answer: 4 Explanation: This medication is contraindicated in those with an allergy to sulfites. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 73-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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10) An adolescent is taking isotretinoin (Accutane) for treatment of severe acne. The nurse has completed medication education with the mother and evaluates that additional learning is required when the mother states: 1. "I will pay particular attention to her mood now." 2. "I will be sure she has a monthly period." 3. "She might complain of aches and pain." 4. "We will need to check her cholesterol levels." Answer: 2 Explanation: Isotretinoin (Accutane) has a black box warning about the dangers to an unborn fetus. The client must submit to two pregnancy tests and sign a statement of understanding about the drug's adverse effects. Each subsequent month, the pharmacist must document receipt of a negative pregnancy test and verify that two forms of effective contraception are being utilized by the client. Documenting that a monthly menstrual cycle has occurred is not enough. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 73-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 11) A client receives topical glucocorticoids for the treatment of dermatitis. The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement? 1. "This lotion is a lot safer and more effective than a pill." 2. "Long-term use of this lotion can lead to dependence." 3. "If this medication doesn't help me, there is nothing left to try." 4. "A pill would be more effective than this messy lotion." Answer: 1 Explanation: Topical agents are less likely than oral medications to cause systemic effects, so they are safer and more effective. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 73-5 Explain the etiology, pathogenesis, and pharmacotherapy for acne vulgaris, rosacea, dermatitis, and psoriasis.

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12) A client has scabies and will be using permethrin 5% cream (Elimite). What is the best instruction by the nurse? 1. "Leave the medication on the body for 24 hours." 2. "Apply the medication twice, so it can be more effective." 3. "Apply the medication topically to the affected area." 4. "Leave the medication on the body for 8 to 14 hours." Answer: 4 Explanation: Leaving the medication on the body for 8 to 14 hours is necessary for the medication to be effective. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-9 Describe the nurse's role in the pharmacologic management of dermatologic disorders. 13) What will the nurse instruct a client who is recovering from a severe sunburn? 1. "Do not go out into the sun again; you are more susceptible to burn again." 2. "Apply a sunscreen with a high SPF (skin-protection factor) when in the sun." 3. "Use a water-soluble sunscreen the next time you go out into the sun." 4. "Apply lotion or oil to your skin the next time you go out into the sun." Answer: 2 Explanation: The SPF should be at least 15; higher is better. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.6 Use information and communication technologies in preventive care | NLN Competencies: Context and Environment: Apply health-promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 73-7 Describe the prevention and management of minor burns.

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14) A mother tells the nurse that head lice have been discovered in her child's hair. What is the best instruction by the nurse? 1. "Purchase a lotion and apply it to your child's scalp. Leave it on for 12 hours." 2. "Purchase a lotion and apply it to your child's head three times a day for 2 weeks." 3. "Purchase a lotion, apply it to your child's head and body, and leave it on for 24 hours." 4. "Purchase a lotion and apply it to your child's scalp for 10 minutes." Answer: 4 Explanation: The medication should be allowed to remain on the hair and scalp for 10 minutes before removal. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-11 Apply the nursing process to the care of patients receiving pharmacotherapy for dermatologic disorders. 15) Prior to teaching a client about the care of psoriasis, the nurse assesses the client's knowledge of the disorder. Which statement indicates that the client has a knowledge base about this illness? 1. "Treatment can help lessen the discomfort of my psoriasis." 2. "I wish there were some way other than lotions to treat my psoriasis." 3. "No medications are effective for treating my disorder." 4. "Oral medications are the only medications that are effective." Answer: 1 Explanation: At this time, treatment can help lessen the discomfort of psoriasis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 73-11 Apply the nursing process to the care of patients receiving pharmacotherapy for dermatologic disorders.

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16) A client is seeking treatment for an infectious skin disorder. The nurse recognizes that skin disorders categorized as infectious include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. boils. 2. cold sores. 3. warts. 4. ringworm. 5. psoriasis. Answer: 1, 2, 3, 4 Explanation: Boils are classified as an infectious skin disorder. Cold sores are classified as an infectious skin disorder. Warts are classified as an infectious skin disorder. Ringworm is classified as an infectious skin disorder. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 73-3 Explain how skin diseases are classified. 17) A client with psoriasis will be receiving infliximab (Remicade). What will the nurse instruct the client about this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. An increase in infections can occur with this medication. 2. Latent infections can be reactivated with this medication. 3. This medication can only be administered through the intravenous route. 4. This medication is very expensive. 5. Multiple oral doses will need to be taken every day for several months. Answer: 1, 2, 3, 4 Explanation: This medication induces general immunosuppression, and clients are at greater risk for infection. Because this medication causes immunosuppression, latent infections can become reactivated. A major disadvantage of this medication is that it is not available in oral formulations. The cost of therapy may exceed $10,000 per year. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-6 Outline the stepwise approach to treating psoriasis. 1394

18) A client weighing 176 lb is prescribed infliximab (Remicade) intravenously, 5 mg/kg now and again in 2 weeks and 6 weeks. The client will receive a total of mg for the three doses. Record your answer rounding to the nearest whole number. Answer: 1,200 Explanation: The client weighs 80 kg (176 lb divided by 2.2). Each dose is 5 mg × 80 kg = 400 mg. Three doses at 400 mg equal 1,200 mg. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-6 Outline the stepwise approach to treating psoriasis. 19) A client with female-pattern hair loss is prescribed topical minoxidil (Rogaine). What will the nurse instruct the client about this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Apply this medication to the hair two to three times a day for a year." 2. "If you stop using this medication, the hair growth will stop." 3. "Keep the solution out of the reach of children." 4. "Take this medication orally once per day." 5. "Have your blood pressure checked every month while using this medication." Answer: 1, 2, 3 Explanation: This medication must be applied to the hair two to three times a day for a year to see an improvement in hair growth. Hair regrowth stops when the medication is discontinued. This medication is a pregnancy category C drug and should be kept out of the reach of children. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-8 Explain the pharmacotherapy of alopecia.

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20) What will the nurse instruct a client who is prescribed azelaic acid (Azelex) for rosacea? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. It is made from wheat, rye, and barley. 2. Local burning can occur with this medication. 3. The skin may itch with this medication. 4. The skin may peel with this medication. 5. This medication is safe for everyone. Answer: 1, 2, 3, 4 Explanation: This medication is a natural product found in wheat, rye, and barley. Adverse effects of this medication include burning. Adverse effects of this medication include pruritus. Adverse effects of this medication include peeling. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-5 Explain the etiology, pathogenesis, and pharmacotherapy for acne vulgaris, rosacea, dermatitis, and psoriasis. 21) A client has a minor infection of the skin around the fingernails. What can the nurse suggest the client use for this infection? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Bacitracin ointment 2. Neomycin with polymyxin B (Neosporin) ointment 3. Undecylenic acid (Cruex) 4. Clotrimazole (Mycelex) 5. Acyclovir (Zovirax) Answer: 1, 2 Explanation: Bacitracin ointment is an over-the-counter medication for minor skin infections. Neomycin with polymyxin B (Neosporin) ointment is an over-the-counter medication for minor skin infections. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-4 Describe the drug therapies for bacterial, fungal, viral, and parasitic infections of the skin.

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22) What should the nurse instruct a client about acitretin (Soriatane) for psoriasis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You will need to be on this medication for 2 to 3 months." 2. "The psoriasis may return after discontinuing this medication." 3. "At least two negative pregnancy tests are needed before starting this medication." 4. "You will need to use birth control for 3 years after discontinuing this drug." 5. "Reduce alcohol intake while taking this medication." Answer: 2, 3, 4, 5 Explanation: The lesions return soon after therapy is discontinued. This medication is teratogenic, and at least two negative pregnancy tests should be obtained before beginning therapy. This medication is pregnancy category X, and the client must use birth control for 3 years after discontinuing therapy. This medication is highly toxic to the liver, and the client should refrain from drinking any alcohol when taking this medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-10 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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23) A client with psoriasis is prescribed topical corticosteroids. What will the nurse instruct the client on the use of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Apply a moist dressing over the medication on the skin." 2. "Wrap the medication and moist dressing with an occlusive covering." 3. "Remove occlusive coverings and wraps every 8 hours." 4. "Ongoing use of this medication will improve healing." 5. "If this medication does not work, you'll need to take oral medications." Answer: 1, 2, 3 Explanation: Applying a warm, moist dressing over the medication on the skin is one way to enhance drug penetration. Wrapping the site with the medication and moist dressing with an occlusive covering will enhance drug penetration. Wraps should not be left in place for longer than 8 hours. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-11 Apply the nursing process to the care of patients receiving pharmacotherapy for dermatologic disorders.

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24) A nurse is teaching about inflammatory disorders. Which characteristics are associated with inflammatory conditions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Acne 2. Burns 3. Basal cell carcinoma 4. Lice infestation 5. Psoriasis. Answer: 1, 2, 5 Explanation: Acne is classified as an inflammatory skin disorder. Burns are classified as an inflammatory skin disorder. Psoriasis is classified as an inflammatory skin disorder. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 73-3 Explain how skin diseases are classified. 25) What part of the skin is a layer of connective tissues that contains no cells? 1. Dermis 2. Subcutaneous tissue 3. Sebaceous glands 4. Epidermis Answer: 1 Explanation: The dermis is the second primary layer of skin and is a layer of connective tissue that contains no cells. Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health-promotion/disease preventions strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-1 Identify the structure and functions of the skin and associated structures.

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26) A client with male-pattern hair loss asked the nurse about medications to treat this condition. What medications are available for male-pattern hair loss? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. minoxidil 2. finasteride 3. metronidazole 4. topical corticosteroids 5. benzocaine Answer: 1, 2 Explanation: Minoxidil is used for male-pattern hair loss. Finasteride is used for male-pattern hair loss. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 73-8 Explain the pharmacotherapy of alopecia. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 74 Pharmacotherapy of Eye and Ear Disorders 1) The nurse is explaining the anatomy of the eye to an adolescent client who wants to start wearing contact lenses. What eye structure will the nurse identify as supplying nutrients to the eye and removing wastes? 1. Conjunctiva layer 2. Vitreous humor 3. Lacrimal apparatus 4. Aqueous humor Answer: 4 Explanation: Aqueous humor is the fluid contained in the anterior chamber that helps maintain the shape of the eye and circulates to supply nutrients and remove waste. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-1 Identify the major anatomic structures of the eye. 2) A client's canal of Schlemm in the right eye is believed to be blocked. The nurse recognizes that the canal of Schlemm is an important structure because it: 1. supports the retina in place. 2. assists the iris in controlling the size of the pupil. 3. produces tears that help lubricate the eye. 1400

4. provides a means for drainage of aqueous humor. Answer: 4 Explanation: The canal of Schlemm is an opening in the trabecular meshwork or spongy connective tissue that drains the aqueous humor from the anterior chamber into the venous system. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 74-1 Identify the major anatomic structures of the eye.

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3) A client is prescribed an optic eye medication that will mimic the action of the sympathetic nervous system. The nurse expects that this medication will: 1. prepare the eye for near vision. 2. increase the ability of the eye to tear. 3. constrict the pupil. 4. dilate the pupil. Answer: 4 Explanation: Muscles that dilate the pupil are under the control of the sympathetic nervous system. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 74-1 Identify the major anatomic structures of the eye. 4) Which client should the nurse advise to seek medical help because of an increased risk of developing glaucoma? 1. A client with cirrhosis experiencing ascites 2. A client who is recovering from a heart attack 3. An individual who sustained a severe eye injury during a fight at a bar 4. A woman in the third trimester of pregnancy Answer: 3 Explanation: Trauma to the eye is a cause of secondary glaucoma. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.3 Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-2 Identify the primary risk factors associated with glaucoma.

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5) The nurse should encourage a client being treated with corticosteroids for an autoimmune disease to have frequent examinations by an ophthalmologist because corticosteroids increase the risk of: 1. muscle weakness secondary to hypokalemia. 2. glaucoma. 3. sodium and water retention. 4. bone fractures. Answer: 2 Explanation: The client who takes corticosteroids, especially high doses long term, is at increased risk of developing cataracts and glaucoma and should be seen regularly by an ophthalmologist. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.3 Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-2 Identify the primary risk factors associated with glaucoma. 6) A client with diabetes asks the nurse why regular eye examinations for glaucoma are needed. What is the nurse's most accurate response? 1. "Individuals with diabetes have a greater chance of developing glaucoma, and it is important to find this out early so that treatment can begin." 2. "An adverse effect of insulin is vision loss, and frequent examinations will catch problems at an early stage." 3. "The stress that you are under with this disease can result in an increased production of aqueous humor." 4. "Your diabetes is under such good control that it is probably not necessary to have eye examinations so frequently." Answer: 1 Explanation: Diabetes is a risk factor for developing glaucoma. Early intervention reduces the risk of blindness due to glaucoma. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.3 Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-2 Identify the primary risk factors associated with glaucoma.

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7) A client experiencing sudden acute eye pain is diagnosed with glaucoma. The diagnosis is more likely to be which type of glaucoma? 1. Open angle 2. Dry type 3. Wet type 4. Closed angle Answer: 4 Explanation: Closed-angle glaucoma occurs when there is a sudden increase in intraocular pressure. The sudden obstruction of the flow of aqueous humor can result in dull-to-severe eye pain. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 74-3 Compare and contrast open-angle and closed-angle glaucoma. 8) When teaching a client about glaucoma, the nurse explains that both open-angle and closed-angle glaucoma can result in blindness because: 1. pressure is applied to the optic chiasm. 2. the retina hemorrhages. 3. the optic nerve is irreversibly damaged. 4. the retina detaches. Answer: 3 Explanation: The persistence of increased intraocular pressure damages the optic nerve. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-3 Compare and contrast open-angle and closed-angle glaucoma.

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9) A client, concerned about developing glaucoma because a parent has the disorder, asks the nurse about the different types. The nurse responds that both open-angle and closed-angle glaucoma result in: 1. acute eye pain. 2. floaters in the vitreous humor. 3. a bulging iris. 4. an increased volume of aqueous humor. Answer: 4 Explanation: Both open-angle and closed-angle glaucoma are the result of an accumulation of aqueous humor in the anterior cavity. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-3 Compare and contrast open-angle and closed-angle glaucoma. 10) A client with glaucoma is prescribed latanoprost (Xalatan). The nurse instructs the client that this medication, a prostaglandin analog, is used for glaucoma because it: 1. is thought to protect neurons from injury. 2. enhances the outflow of aqueous humor. 3. decreases the production of aqueous humor by the ciliary body. 4. has a relatively short duration of action, and adverse effects can be limited. Answer: 2 Explanation: Prostaglandin analogs are used to treat open-angle glaucoma because they assist the flow of aqueous humor. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-4 Explain the two major mechanisms by which drugs reduce intraocular pressure.

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11) The nurse explains to a client with open-angle glaucoma that the purpose of using betaxolol (Betoptic), a selective beta-adrenergic blocker, is to: 1. decrease the production of aqueous humor. 2. promote the flow of aqueous humor. 3. reduce the redness and irritation associated with glaucoma. 4. protect the optic nerve from the increased blood supply that could occur. Answer: 1 Explanation: Beta blockers decrease the production of aqueous humor. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-4 Explain the two major mechanisms by which drugs reduce intraocular pressure. 12) Prior to administering a beta blocker to a client with glaucoma, the nurse should assess for which coexisting health problem that would place the client at increased risk of adverse events? 1. Type 2 diabetes mellitus 2. Sleep apnea 3. Cardiovascular disorders 4. Rheumatoid arthritis Answer: 3 Explanation: Beta blockers used to treat glaucoma are minimally absorbed but could cause adverse cardiovascular events such as bradycardia or heart failure and asthma if the beta blocker is not cardioselective. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 74-7 Describe the nurse's role in the nonpharmacologic and pharmacologic management of eye and ear disorders.

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13) The nurse is obtaining a history from a client recently diagnosed with open-angle glaucoma. When the nurse asks about symptoms, the client is most likely to respond: 1. "I began to notice colored halos around lights." 2. "I noticed that my vision seemed wavy and blurred." 3. "I had severe eye and facial pain, and I became nauseated." 4. "I had no symptoms of pain or pressure in my eyes." Answer: 4 Explanation: There are usually no symptoms associated with open-angle glaucoma because it occurs gradually. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 74-7 Describe the nurse's role in the nonpharmacologic and pharmacologic management of eye and ear disorders. 14) A client with glaucoma is being treated with timolol (Timoptic) ophthalmic drops. The client complains of blurry vision and eye burning and does not want to continue to use the medication. How should the nurse respond? 1. "These are expected side effects for this type of medication and might lessen over time." 2. "If you place a finger over the inner part of your eyes, these problems should become less noticeable." 3. "To preserve your eyesight, it is important to keep using these drops. It is normal to experience temporary burning." 4. "These problems might indicate another eye problem. Be sure to tell your ophthalmologist about these concerns." Answer: 3 Explanation: This answer emphasizes the need to continue to use the eyedrops despite the burning that occurs temporarily. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

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15) A client newly diagnosed with open-angle glaucoma has been prescribed timolol (Timoptic). Prior to administering this medication, which condition in the client's history should the nurse immediately inform the prescriber about? 1. Primary hypertension 2. Deep vein thrombosis 3. Supraventricular tachycardia 4. Asthma Answer: 4 Explanation: Nonselective beta blockers can cause bronchospasm. Clients with asthma are at risk for this adverse effect. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 74-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 16) A client is receiving latanoprost (Xalatan) for open-angle glaucoma. Which medication information provided by the nurse is incorrect? 1. "The medication will increase the outflow of aqueous humor." 2. "Your eyelashes may grow longer and thicker and could become darker." 3. "Your gray eyes might become more pigmented and turn brown." 4. "You must monitor your blood pressure and pulse prior to administration of this drug." Answer: 4 Explanation: Prostaglandins have fewer adverse effects than do beta blockers and do not require monitoring of blood pressure or pulse. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 1408

17) A client has received pilocarpine (Isopto Carpine) drops in both eyes. When assessing this client, the nurse will anticipate which reaction? 1. Unequal pupil shape 2. Dilated pupils 3. Constricted pupils 4. Improved distance vision Answer: 3 Explanation: Pilocarpine is a cholinergic agonist and constricts the pupils. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 74-5 Identify examples of drugs that dilate or constrict pupils, relax ciliary muscles, constrict ocular blood vessels, or moisten eye membranes. 18) A client tells the nurse, "It feels like there's something in my eye." To assess the eye for corneal abrasions, the examiner will first instill: 1. fluorescein sodium (Fluorescite). 2. echothiophate iodide (Phospholine Iodide). 3. azelastine (Optivar). 4. naphazoline HCL (Allerest). Answer: 1 Explanation: Fluorescein sodium (Fluorescite) is a dye that stains scratches, areas of damage, and foreign objects and provides some anesthesia. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 74-5 Identify examples of drugs that dilate or constrict pupils, relax ciliary muscles, constrict ocular blood vessels, or moisten eye membranes.

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19) The nurse administers polyvinyl alcohol (Liquifilm) to a client to prevent: 1. inflammation. 2. redness. 3. infection. 4. dry eyes. Answer: 4 Explanation: Polyvinyl alcohol is used as a lubricant to treat dry eyes. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-5 Identify examples of drugs that dilate or constrict pupils, relax ciliary muscles, constrict ocular blood vessels, or moisten eye membranes. 20) A 5-month-old infant has been unusually irritable and has been pulling on the ears. The nurse expects that medications for this client will probably include infant acetaminophen and antibiotics for the treatment of: 1. otitis interna. 2. mastoiditis. 3. external otitis. 4. otitis media. Answer: 4 Explanation: Most children will have an episode of acute otitis media by age 3. It is most likely that this infant has an otitis media infection, and at this age will be given antibiotics and analgesics. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 74-6 Identify the types of ear conditions that could benefit from pharmacotherapy.

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21) The nurse is caring for an older client who has difficulty hearing because of suspected wax accumulation. What measures will the nurse take to help this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Instill a cerumenolytic as prescribed prior to the irrigation. 2. Warm the irrigating solution to normal body temperature. 3. After instilling the irrigating solution, use a cotton-tipped applicator to gently dry the ear canal. 4. Use a large-bore syringe to apply enough pressure to loosen the impacted cerumen. 5. Pull the pinna up and back prior to instilling any medications. Answer: 1, 2, 5 Explanation: Cerumenolytics used prior to irrigation can loosen and help remove impacted cerumen from the ear. Solutions placed in the ear should be warmed prior to instillation to prevent the client from experiencing dizziness. The pinna of adults should be gently pulled up and back prior to instilling ear medications. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-6 Identify the types of ear conditions that could benefit from pharmacotherapy. 22) A client reports symptoms of continuing ear pain, difficulty hearing, and tenderness following treatment for otitis media. The area behind the ear is red and swollen. What problem might be indicated by these symptoms? 1. Otitis externa 2. Labyrinthitis 3. Chronic otitis media 4. Mastoiditis Answer: 4 Explanation: The symptoms the client is reporting are indicative of mastoiditis. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 74-6 Identify the types of ear conditions that could benefit from pharmacotherapy.

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23) A client with glaucoma is being treated with a pilocarpine (Isopto Carpine). To help reduce the risk associated with this medicine, the nurse suggests: 1. ensuring that hallways are well lit at night. 2. using skin softeners to reduce the risk of dry skin. 3. wearing sunglasses when doing yard work. 4. using lubricant eyedrops to reduce its drying effects. Answer: 1 Explanation: Pilocarpine constricts the pupils and decreases vision in low light. To decrease the risk of falls, clients should increase lighting. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-9 Apply the nursing process to the care of patients receiving pharmacotherapy for eye and ear disorders. 24) A client is using an ophthalmic beta-blocking agent for the treatment of glaucoma. Orthostatic hypotension and bradycardia are possible side effects of this medication. What instruction should the nurse provide to reduce the risk of these problems? 1. Apply pressure with the finger over the inside corner of each eye for 1 minute. 2. Arise from sitting positions slowly. 3. Instill the eyedrops in a sitting position and remain sitting for at least 5 minutes. 4. Assess the blood pressure and pulse before and after each dose. Answer: 1 Explanation: Applying pressure will reduce the risk of the medication's moving through the nasolacrimal duct and being absorbed through the nasal mucous membranes. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-9 Apply the nursing process to the care of patients receiving pharmacotherapy for eye and ear disorders.

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25) The nurse instructs a client who has been prescribed cyclopentolate (Cyclogyl) about appropriate safety measures. Additional teaching is required if the client states: 1. "I might experience a dry mouth until the effects of the medication are gone." 2. "I will avoid driving or operating hazardous machinery until the effects of the medication are gone." 3. "I will wear dark glasses until the light sensitivity and blurred vision have resolved." 4. "I will use sunscreen or protective clothing when outdoors because of the risk of sunburn due to photosensitivity." Answer: 4 Explanation: Photosensitivity is an adverse effect of this medication, but it applies to the eyes being sensitive to light, not to the skin being susceptible to sunburn. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 74-9 Apply the nursing process to the care of patients receiving pharmacotherapy for eye and ear disorders. 26) A client is being treated for acute closed-angle glaucoma. Immediate treatment to reduce the client's intraocular pressure would include: 1. morphine sulfate to reduce blood pressure. 2. antihistamines for sedation. 3. mannitol administered intravenously. 4. tricyclic antidepressants to relieve anxiety. Answer: 3 Explanation: Mannitol is an osmotic diuretic that reduces intraocular pressure. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-9 Apply the nursing process to the care of patients receiving pharmacotherapy for eye and ear disorders.

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27) In preparation for eye surgery, the nurse is teaching a client about the anatomy of the eye and explains that the purpose of the posterior chamber of the eye is to: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. help the eyeball maintain shape. 2. keep the retina in place. 3. change the diameter of the pupil. 4. provide nutrients to the eye. 5. remove waste products from the eye. Answer: 1, 2 Explanation: The posterior cavity of the eye is filled with vitreous humor that helps the eyeball to maintain its shape. The posterior cavity of the eye is filled with vitreous humor that helps keep the retina in place. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-1 Identify the major anatomic structures of the eye. 28) After completing a physical assessment, the nurse is concerned that a client is at risk for developing glaucoma because of which findings? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. High blood pressure 2. Migraine headaches 3. Type 2 diabetes mellitus 4. Heart failure 5. Gastroesophageal reflux disease Answer: 1, 2, 3 Explanation: Hypertension is a risk factor for the development of glaucoma. A risk factor for the development of glaucoma is migraine headaches. Diabetes mellitus is a risk factor for the development of glaucoma. Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.3 Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 74-2 Identify the primary risk factors associated with glaucoma.

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29) The nurse is planning care for a client with closed-angle glaucoma. What will be included in this plan of care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Administer prescribed pain medication. 2. Administer antiemetics as prescribed. 3. Instruct the client to use a call light for assistance with ambulation. 4. Administer oral medication as prescribed. 5. Prepare for emergency ocular surgery. Answer: 1, 2, 3, 5 Explanation: The client with closed-angle glaucoma will have ocular and facial pain and will be prescribed medications for pain. The client with closed-angle glaucoma may experience nausea and vomiting. Antiemetics would be prescribed for this problem. The client with closed-angle glaucoma will have a change in vision, which could impact safety. Closed-angle glaucoma is a medical emergency requiring surgical intervention to save vision in the affected eye. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice and research | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 74-3 Compare and contrast open-angle and closed-angle glaucoma.

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30) A client with open-angle glaucoma is prescribed an alpha2-adrenergic agonist. What will the nurse instruct the client about this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You may feel like there is something in your eye when using this medication." 2. "You may have headaches and feel sleepy with this medication." 3. "You may have blurred vision when using this medication." 4. "You may feel nervous or anxious, but this is rare." 5. "Acute eye pain is expected when taking this medication." Answer: 1, 2, 3, 4 Explanation: The most significant adverse effect with an alpha2-adrenergic agonist is the sensation of a foreign body in the eye. Adverse effects of alpha2-adrenergic agonists include headache and drowsiness. Blurred vision is an adverse effect of alpha2-adrenergic agonists. Rare systemic effects of alpha2-adrenergic agonists include nervousness and anxiety. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-4 Explain the two major mechanisms by which drugs reduce intraocular pressure.

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31) During a medication history, a client reports taking acetazolamide (Diamox) for glaucoma. The nurse should assess this client for: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. changes in energy level. 2. nausea and vomiting. 3. known allergies to any medications. 4. recent blood work done for electrolytes. 5. eye burning or excessive tearing. Answer: 1, 2, 3, 4 Explanation: This medication can cause lethargy and drowsiness. This medication can cause nausea and vomiting. This medication contains sulfur and may cause an allergic reaction. This medication is a diuretic and can cause electrolyte imbalances. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 74-4 Explain the two major mechanisms by which drugs reduce intraocular pressure.

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32) A client is prescribed medication for otitis media. What should the nurse instruct the caregiver about the administration of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Warm the solution in the microwave before using. 2. The client should be lying down with the affected ear dominant. 3. Pull the ear pinna down and back before administering the medication. 4. Instill the prescribed number of drops so that they slide down the ear canal. 5. The client should not change position for 5 to 10 minutes after the medication is instilled. Answer: 2, 4, 5 Explanation: The nurse should instruct the client to lie supine during medication administration, with the ear to be treated uppermost. The solution should be instilled so that it slides down the side of the ear canal. The client should continue lying down for 5 to 10 minutes to ensure complete absorption of the eardrop. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care | AACN Essential Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in healthcare | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 74-7 Describe the nurse's role in the nonpharmacologic and pharmacologic management of eye and ear disorders.

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33) The nurse is concerned that a client taking bepotastine (Bepreve) for allergic conjunctivitis is experiencing adverse effects of the medication after assessing: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. fatigue and dizziness. 2. dry mouth and cough. 3. headache and a bitter taste in the mouth. 4. pharyngitis and rhinitis. 5. bronchospasm. Answer: 1, 2, 3, 4 Explanation: Fatigue and dizziness are adverse effects of this medication. Dry mouth and cough are adverse effects of this medication. Headache and a bitter taste in the mouth are adverse effects of this medication. Pharyngitis and rhinitis are adverse effects of this medication. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 74-8 For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. Pharmacology: Connections to Nursing Practice, 5e (Adams) Chapter 75 Emergency Preparedness: Bioterrorism and Management of Poisoning 1) The most essential competency for nurses in this age of bioterrorism is: 1. managing mass casualties. 2. knowing the offending agent. 3. emergency preparedness. 4. teaching awareness of bioterrorism. Answer: 3 Explanation: Emergency preparedness has become an essential competency for all healthcare professionals. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: VII.9 Use clinical judgment and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situations | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 75-1 Discuss the role of professional nursing in emergency preparedness and 1419

the management of poisoning. 2) The difference between the standard emergency triage practice and the current emergency triage of mass casualties is that: 1. current emergencies triage women and children first. 2. standard triage treats those with least serious injuries first. 3. previous emergencies never involved the triage of mass casualties or victims of infectious agents. 4. emergency triage focuses on the clients with the best chance to live. Answer: 4 Explanation: Emergency triage may be reversed, focusing on clients with the best chance to live. Cognitive Level: Understanding Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: VII.9 Use clinical judgment and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situations | NLN Competencies: Teamwork: Adapt communication to the team and situation to share information or solicit input | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 75-1 Discuss the role of professional nursing in emergency preparedness and the management of poisoning.

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3) The nurse is reviewing the components of the Strategic National Stockpile (SNS), which include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. intravenous administration equipment. 2. antibiotics. 3. life support medications. 4. chemical antidotes. 5. hospital beds. Answer: 1, 2, 3, 4 Explanation: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes intravenous (IV) administration equipment. The Strategic National Stockpile (SNS), a national repository of medical equipment, includes antibiotics. The Strategic National Stockpile (SNS), a national repository of medical equipment, includes life support medications. The Strategic National Stockpile (SNS), a national repository of medical equipment, includes chemical antidotes. Cognitive Level: Remembering Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.8 Assess the health, healthcare, ad emergency preparedness needs of a defined population | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 75-2 Discuss the purpose, function, and components of the Strategic National Stockpile. 4) The nurse needs to find out what antibiotics are being stored by the Strategic National Stockpile (SNS). What agency will the nurse contact for this information? 1. Centers for Disease Control and Prevention 2. Department of Defense 3. Department of Homeland Security 4. The Joint Commission Answer: 1 Explanation: The Centers for Disease Control and Prevention manages the Strategic National Stockpile to ensure immediate availability and deployment of essentials to any state. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.8 Assess the health, healthcare, ad emergency preparedness needs of a defined population | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-2 Discuss the purpose, function, and components of the Strategic National Stockpile. 1421

5) The nurse is helping stock Push Packages. The purpose of these packages is to: 1. transport appropriate personnel to disaster sites. 2. maintain supplies available for emergencies within 12 hours. 3. manage incoming equipment when a disaster occurs. 4. provide information booklets to communities experiencing a disaster. Answer: 2 Explanation: Push Packages include preassembled caches of drugs, antidotes, and medical supplies that broadly cover a nonspecific emergency for use in early hours. Stored strategically, deployment can be accomplished within 12 hours. Cognitive Level: Understanding Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.8 Assess the health, healthcare, ad emergency preparedness needs of a defined population | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 75-2 Discuss the purpose, function, and components of the Strategic National Stockpile. 6) The nurse is reviewing a list from the Centers for Disease Control and Prevention that identifies bioterrorism agents that can easily be spread by person-to-person contact. What agents would be on this list? 1. Plague 2. Botulism 3. Hemorrhagic fever 4. Anthrax Answer: 1 Explanation: Within 1 to 6 days after exposure, a person with pneumonic plague would be infectious to everyone who has come in contact with the person during that time. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: VII.10 Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 75-3 Identify the types of agents that might be used for a bioterrorist attack.

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7) Which medication will the nurse prepare to administer as the primary antibiotic of choice for the treatment of anthrax? 1. Erythromycin 2. Ciprofloxacin 3. Ampicillin 4. Vancomycin Answer: 2 Explanation: Ciprofloxacin (Cipro) is the primary antibiotic used to treat anthrax, with a prophylaxis oral dose of 500 mg every 12 hours for 60 days. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: VII.10 Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 75-3 Identify the types of agents that might be used for a bioterrorist attack. 8) The nurse contacts the pharmacy to have the antidote for nerve agent poisoning available when victims of a mass casualty event arrive in the emergency department. The agent that the nurse is requesting is: 1. methylprednisolone. 2. acetylcysteine. 3. protamine sulfate. 4. atropine sulfate. Answer: 4 Explanation: The antidote for nerve gas is the anticholinergic drug atropine sulfate. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 75-4 Compare and contrast the various chemical agents that can be used as poisons.

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9) A client was exposed to cyanogen chloride. What will the nurse do to help this client? 1. Remove contaminated clothing. 2. Apply sodium bicarbonate to skin lesions. 3. Administer antibiotics intravenously. 4. Initiate emetic measures. Answer: 1 Explanation: The nurse should remove all clothing contaminated with this chemical agent. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-4 Compare and contrast the various chemical agents that can be used as poisons. 10) Clients arrive in the emergency department complaining of difficulty breathing and eye tearing after a bomb explosion in a nearby store. The priority intervention of the healthcare team initially should be to: 1. notify local law enforcement. 2. flush the skin and eyes with water. 3. complete a history and physical. 4. identify the offending agent. Answer: 2 Explanation: The healthcare team should initially flush the skin and eyes with copious amounts of water to flush the offending agent. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-4 Compare and contrast the various chemical agents that can be used as poisons.

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11) A client who experienced whole-body radiation exposure 6 hours ago is brought to the emergency department with radiation sickness. On assessment, the nurse would expect the client to report: 1. bleeding from the gums and nose. 2. bruises on skin not covered by clothing. 3. nausea and vomiting. 4. hair loss. Answer: 3 Explanation: Radiation sickness occurs after exposure to ionizing radiation and can last from hours to days. The initial symptoms include nausea and vomiting. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 75-5 Explain the risks associated with ionizing radiation emitted from a nuclear terrorist attack. 12) The danger from radiation exposure arises primarily from: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. the amount of exposure. 2. the long-lasting effects. 3. the amount of cellular death. 4. the distance from the initial incident. 5. the amount of potassium iodine ingested after exposure. Answer: 1, 2, 3, 4 Explanation: Radiation exposure can cause mass casualty deaths at the point of impact and create residual ionizing radiation for miles around the site. Some radioisotopes emit radiation for decades and even centuries. When exposed to large amounts of radiation, or to small amounts over many decades, clients tend to develop certain malignancies (cellular death) such as leukemia or thyroid cancer. When exposed to large amounts of radiation, or to small amounts over many decades, clients tend to develop certain malignancies (cellular death) such as leukemia or thyroid cancer. Radiation exposure can cause mass casualty deaths at the point of impact and create residual ionizing radiation for miles around the site. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 75-5 Explain the risks associated with ionizing radiation emitted from a nuclear terrorist attack. 1425

13) Which health problem is a direct effect of exposure to ionizing radiation? 1. Type 2 diabetes 2. Leukemia 3. Hypertension 4. Gout Answer: 2 Explanation: When exposed to large amounts of radiation, or to small amounts over many decades, people tend to develop certain malignancies such as leukemia or thyroid cancer. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 75-5 Explain the risks associated with ionizing radiation emitted from a nuclear terrorist attack. 14) Which of the five general principles for treating acute poisoning would the nurse use to treat a client who was exposed to an external chemical agent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Topical decontamination 2. Increase in the rate of excretion 3. Prevention of absorption 4. Neutralization 5. Antidotes and symptomatic therapy Answer: 1, 4, 5 Explanation: Topical decontamination includes the removal of contaminated clothing and flushing of the skin or eyes. This would be appropriate for exposure to an external chemical agent. Application of an agent to neutralize the poison would be appropriate for an exposure to an external chemical agent. Antidotes and symptomatic therapy could be indicated for treating an external or internal chemical agent. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up through the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-6 Describe the five general principles of treating acute poisoning.

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15) At a local health fair, the community nurse is educating the public on poison control strategies. Which strategy should the nurse emphasize as the most important to follow? 1. Keeping the Poison Control Hotline number handy 2. Preventing potential household poisoning 3. Identifying household poisons 4. Maintaining a stockpile of selected antidotes Answer: 2 Explanation: Educating the community about accidental poisoning is an important part of community health nursing. Prevention is the first line of defense against accidental poisoning. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up through the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-6 Describe the five general principles of treating acute poisoning. 16) The nurse instructs a group of adults with young families that the five general principles for the treatment of acute poisoning are: 1. modification of lifestyle, health teaching, antidote therapy, symptomatic therapy, absorbent administration, and dialysis. 2. antidote therapy, decontamination, neutralization, prevention of absorption, and increase in the rate of excretion. 3. identification of poison, symptomatic therapy, neutralization, dialysis, and absorbent administration. 4. identification of poison, modification of lifestyle, health teaching, decontamination, and increase in the rate of excretion. Answer: 2 Explanation: The five general principles are topical decontamination, prevention of absorption, neutralization, increase in the rate of excretion, and antidotes and symptomatic therapy. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up through the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-6 Describe the five general principles of treating acute poisoning.

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17) A client is found at home unconscious with an empty bottle of diltiazem (Cardizem) near the couch. The emergency response team prepares to administer which antidote? 1. Naloxone 2. Pyridoxine 3. Calcium 4. Atropine Answer: 3 Explanation: IV calcium is the antidote for diltiazem (Cardizem), a calcium channel blocker. Cognitive Level: Applying Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-7 Identify the drugs important in emergency preparedness and management of poisoning. 18) Which agent would the nurse administer to prevent the absorption of a poison that the client ingested? 1. Syrup of ipecac 2. Sodium bicarbonate 3. Charcoal 4. Furosemide (Lasix) Answer: 3 Explanation: Charcoal is used to prevent absorption of the poison. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-7 Identify the drugs important in emergency preparedness and management of poisoning.

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19) A client was exposed to iodine-131. Which medication would the nurse administer to counteract the effects of this exposure? 1. Anti-iodine vaccine intramuscularly 2. Potassium iodide orally 3. Penicillin intravenously 4. Antiviral nasal spray Answer: 2 Explanation: The only recognized treatment available to counter the thyroid uptake of radiation is ingestion of potassium iodine (KI) before or immediately after exposure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-7 Identify the drugs important in emergency preparedness and management of poisoning. 20) A group of concerned people asks the community nurse speaking at a local town hall meeting if there is a vaccine for anthrax and, if so, should they get it. The nurse's best response would be: 1. "Yes, the vaccine is available, but it is limited to select groups, such as the military." 2. "No vaccine has been developed to prevent anthrax." 3. "Yes, the vaccine is available, and you should ask your primary healthcare provider for it." 4. "Yes, the vaccine is available, but it has not been approved by the Food and Drug Administration." Answer: 1 Explanation: The Centers for Disease Control and Prevention recommends vaccination only for select populations: laboratory personnel who work with anthrax, military personnel deployed to high-risk areas, and those who deal with animal products imported from areas with a high incidence of the disease. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: VII.10 Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-8 Compare the pharmacologic management of biologic, chemical, radiologic, nuclear, and explosive agents in emergency preparedness.

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21) A client is diagnosed with acute poisoning of acetylsalicylic acid (aspirin). The nurse knows that ion trapping will be the therapy of choice for this medication and prepares to: 1. insert a nasogastric tube for lavage. 2. provide supportive therapy. 3. hang a bag of 100 mL normal saline solution with 100 units regular insulin adjusted to the client's rising blood glucose levels. 4. administer sodium bicarbonate and furosemide (Lasix) intravenously. Answer: 4 Explanation: Forced alkaline diuresis may be used to increase the excretion of acidic drugs like salicylates. A diuretic such as furosemide along with IV sodium bicarbonate makes the urine more alkaline. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: VII.10 Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-9 Discuss the management of poisoning by the poison control center, including minimizing poison absorption and enhancing poison removal. 22) A 3-year-old child ingested approximately 20 tablets of iron that were prescribed to the child's mother. The medication that the nurse will prepare to reverse iron overdose is: 1. fomepizole (Antizol). 2. pyridoxine (vitamin B6). 3. deferoxamine (Desferal). 4. sodium bicarbonate. Answer: 3 Explanation: Deferoxamine (Desferal) is the antidote for iron overdose. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: VII.10 Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 75-8 Compare the pharmacologic management of biologic, chemical, radiologic, nuclear, and explosive agents in emergency preparedness.

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23) Which interventions might the nurse include when planning care to enhance the removal of poison from a client who has overdosed on drugs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Administering activated charcoal 2. Monitoring urine output 3. Preparing the client for dialysis 4. Inserting a nasogastric tube 5. Preparing corticosteroids for administration Answer: 1, 2, 3, 4 Explanation: Charcoal works by binding with the poison agent. The client's urine output should be monitored, noting the characteristics of urine for early identification of rhabdomyolysis. The client might need dialysis for rapid removal of lethal toxins. A nasogastric tube might be needed for lavage of stomach contents. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: V.5 Describe state and national statues, rules and regulations that authorize and define professional nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 75-9 Discuss the management of poisoning by the poison control center, including minimizing poison absorption and enhancing poison removal. 24) A client has taken 24 acetaminophen (Tylenol) tablets at once in a suicide attempt. Which medication would most likely be administered to reverse the effects of acetaminophen (Tylenol)? 1. Acetylcysteine (Mucomyst) 2. Flumazenil (Romazicon) 3. Atropine (Protopam) 4. Naloxone (Narcan) Answer: 1 Explanation: Acetylcysteine (Mucomyst) is the antidote for acetaminophen (Tylenol) overdose. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: V.5 Describe state and national statues, rules and regulations that authorize and define professional nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-9 Discuss the management of poisoning by the poison control center, including minimizing poison absorption and enhancing poison removal.

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25) The nurse is facilitating a program on poison control and tells the group that if a known poison has been ingested, the first measure that must be taken is: 1. contacting the American Association of Poison Control Centers for the proper immediate treatment. 2. having the person drink large amounts of water to flush the poison through the gastrointestinal system. 3. notifying the local health agency and the Centers for Disease Control and Prevention (CDC) after the person has stabilized. 4. administering syrup of ipecac within 30 minutes. Answer: 1 Explanation: Education about accidental poisoning is an important part of nursing. Clients should keep the number of the local poison center close to the phone or call 1-800-222-1222. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-10 Apply the nursing process to the care of patients receiving pharmacotherapy for poisoning or overdose. 26) The nurse is teaching a group of community members about common potentially toxic substances. Which vitamin or mineral supplement would be addressed in this instruction? 1. Iron 2. Vitamin C 3. Zinc 4. Salt Answer: 1 Explanation: The most common dangerous substances can poison, such as medicines and iron pills. Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-10 Apply the nursing process to the care of patients receiving pharmacotherapy for poisoning or overdose.

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27) The nurse is attending a course to prepare for mass casualty incidents (MCIs). What technical skills will the nurse have to demonstrate to be a member of the response team? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Safe administration of medications 2. Safe administration of immunizations 3. Knowledge of nursing interventions for adverse medication events 4. Ability to insert a nasogastric tube 5. Ability to insert an intravenous infusion catheter Answer: 1, 2, 3 Explanation: Core competencies identified under technical skills include demonstrating the safe administration of medications. Core competencies identified under technical skills include demonstrating the safe administration of immunizations. Core competencies identified under technical skills include having knowledge of nursing interventions for adverse medication events. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: VII.9 Use clinical judgment and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situations | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 75-1 Discuss the role of professional nursing in emergency preparedness and the management of poisoning.

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28) The nurse is contacting the Centers for Disease Control and Prevention for supplies to be sent from the Strategic National Stockpile (SNS) to the site of a massive train derailment and chemical spill. What will the SNS provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Push Packages 2. Vendor-managed inventory packages 3. Whole blood and blood components 4. Hospital beds and surgical tables 5. Computer equipment and prepackaged meals Answer: 1, 2 Explanation: Push Packages are preassembled caches of drugs, antidotes, and medical supplies that broadly cover a nonspecific emergency for use in early hours. Vendor-managed inventory (VMI) packages contain additional supplies that can be more event specific and ship within 24 to 36 hours. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Management of Care Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.8 Assess the health, healthcare, ad emergency preparedness needs of a defined population | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 75-2 Discuss the purpose, function, and components of the Strategic National Stockpile.

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29) A cruise ship off the coast of Maryland has capsized, and the nurse is triaging victims who were submerged in cold water. Which supplies from the Push Packages would be of most use when caring for these victims? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Antibiotics 2. Life support medications 3. Intravenous administration equipment 4. Airway maintenance supplies 5. Activated charcoal Answer: 1, 2, 3, 4 Explanation: Antibiotics would be used to help the victims of this emergency. Life support medications would be used to help the victims of this emergency. Intravenous administration equipment would be used to help the victims of this emergency. Airway maintenance supplies would be used to help the victims of this emergency. Cognitive Level: Analyzing Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes | AACN Essential Competencies: VII.8 Assess the health, healthcare, ad emergency preparedness needs of a defined population | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-2 Discuss the purpose, function, and components of the Strategic National Stockpile.

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30) A client is suspected of exposure to Clostridium botulinum because of respiratory distress experienced after eating food from a street vendor during a carnival. What care should the nurse provide for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Prepare for endotracheal intubation. 2. Administer the trivalent botulinum antitoxin. 3. Administer the pentavalent toxoid vaccine. 4. Administer penicillin. 5. Administer ciprofloxacin and doxycycline. Answer: 1, 2 Explanation: Clostridium botulinum paralyzes the muscles, and respiratory failure can occur. The nurse should prepare to assist with ventilatory support for this client. The antitoxin should be given as soon as possible and not delayed pending the microbiologic testing. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: VII.10 Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-3 Identify the types of agents that might be used for a bioterrorist attack.

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31) A client is believed to have been exposed to the variola virus while working in a laboratory. What should the nurse assess before administering the vaccination to this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. White blood cell count 2. HIV status 3. History of eczema 4. Allergy to antibiotics 5. Blood pressure and heart rate Answer: 1, 2, 3 Explanation: Smallpox vaccinations are contraindicated for individuals with an impaired immune system, which would be assessed by the client's current white blood cell count. Smallpox vaccinations are contraindicated for individuals with impaired immune systems, such as those who are HIV positive. Smallpox vaccinations are contraindicated for individuals with eczema. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: VII.10 Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 75-3 Identify the types of agents that might be used for a bioterrorist attack.

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32) A client is brought to the emergency department after being exposed to nitrogen mustard. Which symptom(s) is the nurse likely to assess? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Conjunctivitis 2. Skin blisters 3. Nasal irritation 4. Vomiting 5. Excessive salivation Answer: 1, 2, 3 Explanation: Conjunctivitis is a symptom of nitrogen mustard exposure. Skin blisters are seen with nitrogen mustard exposure. Nasal irritation is a symptom of nitrogen mustard exposure. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 75-4 Compare and contrast the various chemical agents that can be used as poisons. 33) A group of students arrive at the emergency department with complaints of burning eyes, coughing, and skin burning with blisters. The nurse reviews these symptoms and suspects the students could have been exposed to: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. a vesicant. 2. an acid. 3. tear gas. 4. nerve gas. 5. incapacitating agent. Answer: 1, 2, 3 Explanation: Vesicants blister the skin, respiratory tract, or eyes on contact. An acid burns the eyes, skin, and lining of the respiratory tract on contact. Tear gas irritates the eyes and respiratory tract. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring | NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 75-4 Compare and contrast the various chemical agents that can be used as poisons. 34) A client was exposed to radiation from a nuclear reactor explosion a month ago. What care will the nurse most likely provide to the client? 1438

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Appetite stimulant as prescribed 2. Uninterrupted rest periods 3. Infection control precautions 4. Antiemetic as prescribed 5. Antidiarrheal as prescribed Answer: 1, 2, 3 Explanation: Weight loss and anorexia are long-term effects of radiation sickness. Fatigue is a long-term effect of radiation sickness. Radiation sickness causes suppression of the bone marrow, which increases the client's risk of developing or contracting infections. Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity: Basic Care and Comfort Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal education to build an understanding of the human experience | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 75-5 Explain the risks associated with ionizing radiation emitted from a nuclear terrorist attack. 35) A client is brought to the emergency department with acute poisoning from an unknown powdered agent on the skin. Which of the general principles of treating poisonings does the nurse follow first? 1. Topical decontamination 2. Prevention of absorption 3. Neutralization 4. Increase in rate of excretion Answer: 1 Explanation: The client's clothes are removed and the skin and eyes flushed to remove the agent. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Reduction of Risk Potential Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up through the lifespan | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-6 Describe the five general principles of treating acute poisoning.

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36) A client recovering from plutonium poisoning from a nuclear reactor explosion is receiving edetate calcium disodium (Calcium EDTA). What will the nurse do to support this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Administer intravenous fluids as prescribed prior to medication administration. 2. Apply chest leads for continuous cardiac rhythm monitoring. 3. Assess blood pressure frequently. 4. Stop the infusion if the client becomes febrile. 5. Notify the healthcare provider if the client develops a headache or nasal congestion. Answer: 1, 2, 3 Explanation: Calcium EDTA may produce renal damage such as proteinuria and microscopic hematuria. Treatment-induced nephrotoxicity is dose dependent and may be reduced by ensuring adequate diuresis before therapy begins. Clients should be monitored for cardiac rhythm irregularities and other electrocardiogram changes during IV therapy. This medication can cause hypotension. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: III.6 Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-7 Identify the drugs important in emergency preparedness and management of poisoning.

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37) A client is prescribed dimercaprol as treatment for acute poisoning. The nurse understands that this medication is used as an antidote for which agents? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Arsenic 2. Gold 3. Mercury 4. Lead 5. Nickel Answer: 1, 2, 3, 4 Explanation: Dimercaprol is a chelating agent that neutralizes the effects of various heavy metals such as arsenic. Dimercaprol is a chelating agent that neutralizes the effects of various heavy metals such as gold. Dimercaprol is a chelating agent that neutralizes the effects of various heavy metals such as mercury. Dimercaprol is used as an adjunct to EDTA in the treatment of lead encephalopathy. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: VII.10 Collaborate with others to develop an intervention plan that takes into account determinants of health, available resources, and the range of activities that contribute to health and prevention of illness, injury, disability and premature death | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 75-8 Compare the pharmacologic management of biologic, chemical, radiologic, nuclear, and explosive agents in emergency preparedness.

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38) A client with spinal stenosis was found unconscious by family members. The client's opioid pain medication and tricyclic antidepressant medication containers were empty. What will the nurse prepare to administer to this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Naloxone (Narcan) 2. Sodium bicarbonate 3. Pyridoxine (vitamin B6) 4. Syrup of ipecac 5. Activated charcoal Answer: 1, 2 Explanation: Naloxone (Narcan) is the antidote for opioid medication overdose. Sodium bicarbonate is the antidote for tricyclic antidepressant medication overdose. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others | AACN Essential Competencies: V.5 Describe state and national statues, rules and regulations that authorize and define professional nursing practice | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-9 Discuss the management of poisoning by the poison control center, including minimizing poison absorption and enhancing poison removal.

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39) A client is being treated for acute ethanol overdose. What interventions will the nurse perform when caring for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Ensure placement of an intravenous access device. 2. Ensure that dextrose 5% and water is available for infusion. 3. Notify the healthcare provider with serum electrolyte levels. 4. Monitor urine output. 5. Administer chelating medication as prescribed. Answer: 1, 2, 3, 4 Explanation: The client will need intravenous fluids. Dextrose 5% and water may be prescribed to treat hypoglycemia, which can occur as an effect of ethanol overdose. Electrolyte imbalances can occur because of acute ethanol overdose and should be reported to the healthcare provider to ensure appropriate treatment. Urine output should be monitored for all clients being treated for overdose. Cognitive Level: Applying Client Need/Sub: Physiological Integrity: Physiological Adaptation Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 75-10 Apply the nursing process to the care of patients receiving pharmacotherapy for poisoning or overdose.

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