TEST BANK FOR CLAYTON’S BASIC PHARMACOLOGY FOR NURSES 19TH EDITION BY MICHELLE J. WILLIHNGANZ, SAMUEL L. GUREVITZ,BRUCE CLAYTON CHAPTER 1-48.

4. A patient who is undergoing bone marrow transplantation has developed severe mucositis. Which treatment option(s) may promote comfort? (Select all that apply.) a. 2 % viscous lidocaine (Xylocaine) before meals b. Acetylcysteine (Mucomyst) therapy as needed c. Commercially prepared mouthwashes d. Docosanol (Abreva) therapy e. Milk of Magnesia mouth rinses ANS: A, E The pain with mucositis can be extremely severe. Viscous lidocaine 2% anesthetizes the entire mouth and throat. Used before meals, it facilitates patient eating. Care must be taken that the patient does not burn himself or herself because sensation is diminished. Milk of Magnesia can also be used as a mouth rinse to coat the mucous membranes. Acetylcysteine does not treat mucositis. Commercial mouthwashes contain alcohol, which is detrimental to the healing of mucositis. Docosanol is used to treat topical herpes infections, not mucositis. DIF: Cognitive Level: Application REF: Page 487 OBJ: 1 | 2 | 3 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity NOT: CONCEPT(S): Clinical Judgment; Inflammation; Pain; Patient Education 5. In addition to discomfort, which are adverse effects of xerostomia? (Select all that apply.) a. Reduced taste and appetite b. Excessive salivation c. Difficulty chewing and swallowing food d. Increase in dental caries e. Difficulty with speech f. Improved taste and enjoyment of food ANS: A, C, D, E Xerostomia increases tooth decay and causes loss of taste, difficulty in chewing and swallowing food, and difficulty talking. Xerostomia does not cause excessive salivation or food to taste better. DIF: Cognitive Level: Comprehension REF: Page 486 OBJ: 1 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity NOT: CONCEPT(S): Clinical Judgment; Nutrition; Safety; Communication MULTIPLE CHOICE 1. A patient who has just begun taking an angiotensin converting enzyme (ACE) inhibitor calls the nurse and reports feeling very dizzy when standing up, and asks if the medication should be discontinued. What is the nurse’s best response? a. “Stop taking the medication immediately.” b. “Rise to a sitting or standing position slowly; your symptoms will resolve.” c. “I will schedule you to visit the health care provider today.” d. “Cut the pill in half and take a reduced dosage.” ANS: B Dizziness is a common initial adverse effect of this medication, which is usually transient. The patient should be instructed to rise from a lying position slowly to avoid orthostatic hypotension and avoid falling. Medications should not be stopped immediately unless a serious adverse effect occurs. Because this is a common occurrence with ACE inhibitors, there is no need for a visit to the health care provider. A change in dosage will not alter the effect and should not be made without the advice of the primary care provider. DIF: Cognitive Level: Application REF: p. 366 | p. 370 OBJ: 6 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 2. Which nursing assessment confirms that the angiotensin II receptor blocker (ARB) that a patient is taking is effective? a. Weight loss of more than 2 pounds/week b. LDL cholesterol levels have decreased. c. Urinary output is increased. d. Blood pressure has decreased. ANS: D The primary therapeutic outcome expected from angiotensin II receptor antagonists is reduction of blood pressure to within a normal range. Angiotensin II receptor antagonists bind angiotensin II receptor sites in the vascular smooth muscle, brain, heart, kidneys, and adrenal gland. The blood pressure–elevating (vasoconstricting) and sodium retaining effects of angiotensin II are thus blocked. Weight loss, although advisable for treatment of hypertension, is not affected by ARBs. ARBs do not affect cholesterol levels. Urine output is not affected by ARBs. DIF: Cognitive Level: Application REF: p. 373 OBJ: 7 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity