Test Bank Lehne's Pharmacology for Nursing Care, 11th Test Bank Lehne's Pharmacology for Nursing Care, 11th
Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1- Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1-
112|Complete Guide A+ 112|Complete Guide A+
Chapter 1: Orientation to Pharmacology ANS: D
Test Bank
MULTIPLE CHOICE
1. The nurse is teaching a patient how a medication works to treat an illness. To do this, the
nurse will rely on knowledge of:
a. clinical pharmacology.
b. drug efficacy.
c. pharmacokinetics.
d. pharmacotherapeutics.
ANS: D
Pharmacotherapeutics is the study of the use of drugs to diagnose, treat, and prevent
conditions. Clinical pharmacology is concerned with all aspects of drug–human interactions.
Drug efficacy measures the extent to which a given drug causes an intended effect.
Pharmacokinetics is the study of the impact of the body on a drug.
DIF: Cognitive Level: Comprehension REF: Four Basic Terms
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. What does it mean when a drug is described as easy to administer?
a. It can be stored indefinitely without need for refrigeration.
b. It does not interact significantly with other medications.
c. It enhances patient adherence to the drug regimen.
d. It is usually relatively inexpensive to produce.
ANS: C
A major benefit of drugs that are easy to administer is that patients taking them are more
likely to comply with the drug regimen. Drugs that are easy to give may have the other
attributes listed, but those properties are independent of ease of administration.
DIF: Cognitive Level: Comprehension
REF: Additional Properties of an Ideal Drug: Ease of Administration
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
3. A patient tells the nurse that he was told by the prescriber that the analgesic he is taking is
very effective. Which statement by the patient demonstrates an understanding of the drug‘s
effectiveness?
a. ―I don‘t have to worry about toxicity, since it takes a large amount of this drug to
cause an overdose.‖
b. ―It has no side effects and doesn‘t interact with other drugs.‖
c. ―I only have to take it every 12 hours.‖
d. ―It might make me sleepy, and it lessens pain for several hours at a time.‖
, Test Bank Lehne's Pharmacology for Nursing Care, 11th Test Bank Lehne's Pharmacology for Nursing Care, 11th
Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1- Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1-
112|Complete Guide A+ 112|Complete Guide A+
A drug is effective if it produces the intended effects, even if it also produces side effects. Chapter 2: Application of Pharmacology in Nursing Practice
Because no drug is completely safe, the level of toxicity does not determine effectiveness. All Test Bank
drugs have side effects and many react with other substances; these do not affect the drug‘s
effectiveness. Ease of administration is independent of a drug‘s effectiveness.
MULTIPLE CHOICE
DIF: Cognitive Level: Comprehension REF: Properties of an Ideal Drug
TOP: Nursing Process: Evaluation 1. A patient is using a metered-dose inhaler containing albuterol for asthma. The medication
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies label instructs the patient to administer ―2 puffs every 4 hours as needed for coughing or
wheezing.‖ The patient reports feeling jittery sometimes when taking the medication, and she
MULTIPLE RESPONSE doesn‘t feel that the medication is always effective. Which is not an appropriate nursing
intervention for this patient?
1. What are the properties of an ideal drug? (Select all that apply.) a. Asking the patient to demonstrate use of the inhaler
a. Irreversible action b. Assessing the patient‘s exposure to tobacco smoke
b. Predictability c. Auscultating lung sounds and obtaining vital signs
c. Ease of administration d. Suggesting that the patient use one puff to reduce side effects
d. Chemical stability
ANS: D
e. A simple trade name
It is not within the nurse‘s scope of practice to change the dose of a medication without an
ANS: B, C, D order from a prescriber. Asking the patient to demonstrate inhaler use helps the nurse to
In addition to predictability, ease of administration, and chemical stability, other properties evaluate the patient‘s ability to administer the medication properly and is part of the nurse‘s
include a reversible action so that any harm the drug may cause can be undone and a simple evaluation. Assessing tobacco smoke exposure helps the nurse determine whether nondrug
generic name, because generic names are usually complex and difficult to remember and therapies, such a smoke avoidance, can be used as an adjunct to drug therapy. Performing a
pronounce. physical assessment helps the nurse evaluate the patient‘s response to the medication.
DIF: Cognitive Level: Comprehension DIF: Cognitive Level: Application
REF: Properties of an Ideal Drug | Additional Properties of an Ideal Drug REF: Applying the Nursing Process in Drug Therapy: Preadministration Assessment [and all
TOP: Nursing Process: Assessment subsections under this heading] TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. Before administering a medication, what does the nurse need to know to evaluate how 2. A postoperative patient is being discharged home with acetaminophen/hydrocodone (Lortab)
individual patient variability might affect the patient‘s response to the medication? (Select all for pain. The patient asks the nurse about using Tylenol for fever. Which statement by the
that apply.) nurse is correct?
a. Chemical stability of the medication a. ―It is not safe to take over-the-counter drugs with prescription medications.‖
b. Ease of administration b. ―Taking the two medications together poses a risk of drug toxicity.‖
c. Family medical history c. ―There are no known drug interactions, so this will be safe.‖
d. Patient‘s age d. ―Tylenol and Lortab are different drugs, so there is no risk of overdose.‖
e. Patient‘s diagnosis
ANS: B
ANS: C, D, E Tylenol is the trade name and acetaminophen is the generic name for the same medication. It
The family medical history can indicate genetic factors that may affect a patient‘s response to is important to teach patients to be aware of the different names for the same drug to minimize
a medication. Patients of different ages can respond differently to medications. The patient‘s the risk of overdose. Over-the-counter (OTC) medications and prescription medications may
illness can affect how drugs are metabolized. The chemical stability of the medication and the be taken together unless significant harmful drug interactions are possible. Even though no
ease of administration are properties of drugs. drug interactions are at play in this case, both drugs contain acetaminophen, which could lead
to toxicity.
DIF: Cognitive Level: Analysis REF: Sources of Individual Variation
TOP: Nursing Process: Implementation DIF: Cognitive Level: Application
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential REF: Application of Pharmacology in Patient Education: Dosage and Administration
, Test Bank Lehne's Pharmacology for Nursing Care, 11th Test Bank Lehne's Pharmacology for Nursing Care, 11th
Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1- Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1-
112|Complete Guide A+ 112|Complete Guide A+
TOP: Nursing Process: Implementation 3. The nurse is preparing to care for a patient who will be taking an antihypertensive medication.
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential Which action by the nurse is part of the assessment step of the nursing process?
a.Asking the prescriber for an order to monitor serum drug levels
b.Monitoring the patient for drug interactions after giving the medication
c.Questioning the patient about over-the-counter medications
d.Taking the patient‘s blood pressure throughout the course of treatment
ANS: C
The assessment part of the nursing process involves gathering information before beginning
treatment, and this includes asking about other medications the patient may be taking.
Monitoring serum drug levels, watching for drug interactions, and checking vital signs after
giving the medication are all part of the evaluation phase.
DIF: Cognitive Level: Application REF: Preadministration Assessment
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
4. A postoperative patient reports pain, which the patient rates as an 8 on a scale from 1 to 10
(10 being the most extreme pain). The prescriber has ordered acetaminophen (Tylenol) 650
mg PO every 6 hours PRN pain. What will the nurse do?
a. Ask the patient what medications have helped with pain in the past.
b. Contact the provider to request a different analgesic medication.
c. Give the pain medication and reposition the patient to promote comfort.
d. Request an order to administer the medication every 4 hours.
ANS: B
The nursing diagnosis for this patient is severe pain. Acetaminophen is given for mild to
moderate pain, so the nurse should ask the prescriber to order a stronger analgesic medication.
Asking the patient to tell the nurse what has helped in the past is a part of an initial assessment
and should be done preoperatively and not when the patient is having severe pain. Because the
patient is having severe pain, acetaminophen combined with nondrug therapies will not be
sufficient. Increasing the frequency of the dose of a medication for mild pain will not be
effective.
DIF: Cognitive Level: Analysis REF: Analysis and Nursing Diagnosis
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
5. A patient newly diagnosed with diabetes is to be discharged from the hospital. The nurse
teaching this patient about home management should begin by doing what?
a. Asking the patient to demonstrate how to measure and administer insulin
b. Discussing methods of storing insulin and discarding syringes
c. Giving information about how diet and exercise affect insulin requirements
d. Teaching the patient about the long-term consequences of poor diabetes control
ANS: A
, Test Bank Lehne's Pharmacology for Nursing Care, 11th Test Bank Lehne's Pharmacology for Nursing Care, 11th
Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1- Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1-
112|Complete Guide A+ 112|Complete Guide A+
Because insulin must be given correctly to control symptoms and because an overdose can be adjunct to treatment, but it should not be recommended without complete information about
fatal, it is most important for the patient to know how to administer it. Asking for a drug effectiveness.
demonstration of technique is the best way to determine whether the patient has understood
the teaching. When a patient is receiving a lot of new information, the information presented DIF: Cognitive Level: Application REF: Evaluation TOP: Nursing Process: Evaluation
first is the most likely to be remembered. The other teaching points are important as well, but
they are not as critical and can be taught later.
DIF: Cognitive Level: Application REF: Planning TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
6. The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action
is not part of the six rights of drug administration?
a. Assessing the patient‘s pain level 15 to 30 minutes after giving the medication
b. Checking the medication administration record to see when the last dose was
administered
c. Consulting a drug manual to determine whether the amount the prescriber ordered
is appropriate
d. Documenting the reason the medication was given in the patient‘s electronic
medical record
ANS: A
Assessing the patient‘s pain after administering the medication is an important part of the
nursing process when giving medications, but it is not part of the six rights of drug
administration. Checking to see when the last dose was given helps ensure that the medication
is given at the right time. Consulting a drug manual helps ensure that the medication is given
in the right dose. Documenting the reason for a pain medication is an important part of the
right documentation—the sixth right.
DIF: Cognitive Level: Application
REF: Evolution of Nursing Responsibilities Regarding Drugs | Implementation
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
7. A patient tells a nurse that a medication prescribed for recurrent migraine headaches is not
working. What will the nurse do?
a. Ask the patient about the number and frequency of tablets taken.
b. Assess the patient‘s headache pain on a scale from 1 to 10.
c. Report the patient‘s complaint to the prescriber.
d. Suggest biofeedback as an adjunct to drug therapy.
ANS: A
When evaluating the effectiveness of a drug, it is important to determine whether the patient is
using the drug as ordered. Asking the patient to tell the nurse how many tablets are taken and
how often helps the nurse determine compliance. Assessing current pain does not yield
information about how well the medication is working unless the patient is currently taking it.
The nurse should gather as much information about compliance, symptoms, and drug
effectiveness as possible before contacting the prescriber. Biofeedback may be an effective
Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1- Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1-
112|Complete Guide A+ 112|Complete Guide A+
Chapter 1: Orientation to Pharmacology ANS: D
Test Bank
MULTIPLE CHOICE
1. The nurse is teaching a patient how a medication works to treat an illness. To do this, the
nurse will rely on knowledge of:
a. clinical pharmacology.
b. drug efficacy.
c. pharmacokinetics.
d. pharmacotherapeutics.
ANS: D
Pharmacotherapeutics is the study of the use of drugs to diagnose, treat, and prevent
conditions. Clinical pharmacology is concerned with all aspects of drug–human interactions.
Drug efficacy measures the extent to which a given drug causes an intended effect.
Pharmacokinetics is the study of the impact of the body on a drug.
DIF: Cognitive Level: Comprehension REF: Four Basic Terms
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. What does it mean when a drug is described as easy to administer?
a. It can be stored indefinitely without need for refrigeration.
b. It does not interact significantly with other medications.
c. It enhances patient adherence to the drug regimen.
d. It is usually relatively inexpensive to produce.
ANS: C
A major benefit of drugs that are easy to administer is that patients taking them are more
likely to comply with the drug regimen. Drugs that are easy to give may have the other
attributes listed, but those properties are independent of ease of administration.
DIF: Cognitive Level: Comprehension
REF: Additional Properties of an Ideal Drug: Ease of Administration
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
3. A patient tells the nurse that he was told by the prescriber that the analgesic he is taking is
very effective. Which statement by the patient demonstrates an understanding of the drug‘s
effectiveness?
a. ―I don‘t have to worry about toxicity, since it takes a large amount of this drug to
cause an overdose.‖
b. ―It has no side effects and doesn‘t interact with other drugs.‖
c. ―I only have to take it every 12 hours.‖
d. ―It might make me sleepy, and it lessens pain for several hours at a time.‖
, Test Bank Lehne's Pharmacology for Nursing Care, 11th Test Bank Lehne's Pharmacology for Nursing Care, 11th
Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1- Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1-
112|Complete Guide A+ 112|Complete Guide A+
A drug is effective if it produces the intended effects, even if it also produces side effects. Chapter 2: Application of Pharmacology in Nursing Practice
Because no drug is completely safe, the level of toxicity does not determine effectiveness. All Test Bank
drugs have side effects and many react with other substances; these do not affect the drug‘s
effectiveness. Ease of administration is independent of a drug‘s effectiveness.
MULTIPLE CHOICE
DIF: Cognitive Level: Comprehension REF: Properties of an Ideal Drug
TOP: Nursing Process: Evaluation 1. A patient is using a metered-dose inhaler containing albuterol for asthma. The medication
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies label instructs the patient to administer ―2 puffs every 4 hours as needed for coughing or
wheezing.‖ The patient reports feeling jittery sometimes when taking the medication, and she
MULTIPLE RESPONSE doesn‘t feel that the medication is always effective. Which is not an appropriate nursing
intervention for this patient?
1. What are the properties of an ideal drug? (Select all that apply.) a. Asking the patient to demonstrate use of the inhaler
a. Irreversible action b. Assessing the patient‘s exposure to tobacco smoke
b. Predictability c. Auscultating lung sounds and obtaining vital signs
c. Ease of administration d. Suggesting that the patient use one puff to reduce side effects
d. Chemical stability
ANS: D
e. A simple trade name
It is not within the nurse‘s scope of practice to change the dose of a medication without an
ANS: B, C, D order from a prescriber. Asking the patient to demonstrate inhaler use helps the nurse to
In addition to predictability, ease of administration, and chemical stability, other properties evaluate the patient‘s ability to administer the medication properly and is part of the nurse‘s
include a reversible action so that any harm the drug may cause can be undone and a simple evaluation. Assessing tobacco smoke exposure helps the nurse determine whether nondrug
generic name, because generic names are usually complex and difficult to remember and therapies, such a smoke avoidance, can be used as an adjunct to drug therapy. Performing a
pronounce. physical assessment helps the nurse evaluate the patient‘s response to the medication.
DIF: Cognitive Level: Comprehension DIF: Cognitive Level: Application
REF: Properties of an Ideal Drug | Additional Properties of an Ideal Drug REF: Applying the Nursing Process in Drug Therapy: Preadministration Assessment [and all
TOP: Nursing Process: Assessment subsections under this heading] TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. Before administering a medication, what does the nurse need to know to evaluate how 2. A postoperative patient is being discharged home with acetaminophen/hydrocodone (Lortab)
individual patient variability might affect the patient‘s response to the medication? (Select all for pain. The patient asks the nurse about using Tylenol for fever. Which statement by the
that apply.) nurse is correct?
a. Chemical stability of the medication a. ―It is not safe to take over-the-counter drugs with prescription medications.‖
b. Ease of administration b. ―Taking the two medications together poses a risk of drug toxicity.‖
c. Family medical history c. ―There are no known drug interactions, so this will be safe.‖
d. Patient‘s age d. ―Tylenol and Lortab are different drugs, so there is no risk of overdose.‖
e. Patient‘s diagnosis
ANS: B
ANS: C, D, E Tylenol is the trade name and acetaminophen is the generic name for the same medication. It
The family medical history can indicate genetic factors that may affect a patient‘s response to is important to teach patients to be aware of the different names for the same drug to minimize
a medication. Patients of different ages can respond differently to medications. The patient‘s the risk of overdose. Over-the-counter (OTC) medications and prescription medications may
illness can affect how drugs are metabolized. The chemical stability of the medication and the be taken together unless significant harmful drug interactions are possible. Even though no
ease of administration are properties of drugs. drug interactions are at play in this case, both drugs contain acetaminophen, which could lead
to toxicity.
DIF: Cognitive Level: Analysis REF: Sources of Individual Variation
TOP: Nursing Process: Implementation DIF: Cognitive Level: Application
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential REF: Application of Pharmacology in Patient Education: Dosage and Administration
, Test Bank Lehne's Pharmacology for Nursing Care, 11th Test Bank Lehne's Pharmacology for Nursing Care, 11th
Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1- Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1-
112|Complete Guide A+ 112|Complete Guide A+
TOP: Nursing Process: Implementation 3. The nurse is preparing to care for a patient who will be taking an antihypertensive medication.
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential Which action by the nurse is part of the assessment step of the nursing process?
a.Asking the prescriber for an order to monitor serum drug levels
b.Monitoring the patient for drug interactions after giving the medication
c.Questioning the patient about over-the-counter medications
d.Taking the patient‘s blood pressure throughout the course of treatment
ANS: C
The assessment part of the nursing process involves gathering information before beginning
treatment, and this includes asking about other medications the patient may be taking.
Monitoring serum drug levels, watching for drug interactions, and checking vital signs after
giving the medication are all part of the evaluation phase.
DIF: Cognitive Level: Application REF: Preadministration Assessment
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
4. A postoperative patient reports pain, which the patient rates as an 8 on a scale from 1 to 10
(10 being the most extreme pain). The prescriber has ordered acetaminophen (Tylenol) 650
mg PO every 6 hours PRN pain. What will the nurse do?
a. Ask the patient what medications have helped with pain in the past.
b. Contact the provider to request a different analgesic medication.
c. Give the pain medication and reposition the patient to promote comfort.
d. Request an order to administer the medication every 4 hours.
ANS: B
The nursing diagnosis for this patient is severe pain. Acetaminophen is given for mild to
moderate pain, so the nurse should ask the prescriber to order a stronger analgesic medication.
Asking the patient to tell the nurse what has helped in the past is a part of an initial assessment
and should be done preoperatively and not when the patient is having severe pain. Because the
patient is having severe pain, acetaminophen combined with nondrug therapies will not be
sufficient. Increasing the frequency of the dose of a medication for mild pain will not be
effective.
DIF: Cognitive Level: Analysis REF: Analysis and Nursing Diagnosis
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
5. A patient newly diagnosed with diabetes is to be discharged from the hospital. The nurse
teaching this patient about home management should begin by doing what?
a. Asking the patient to demonstrate how to measure and administer insulin
b. Discussing methods of storing insulin and discarding syringes
c. Giving information about how diet and exercise affect insulin requirements
d. Teaching the patient about the long-term consequences of poor diabetes control
ANS: A
, Test Bank Lehne's Pharmacology for Nursing Care, 11th Test Bank Lehne's Pharmacology for Nursing Care, 11th
Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1- Edition by Jacqueline Burchum, Laura Rosenthal Chapter 1-
112|Complete Guide A+ 112|Complete Guide A+
Because insulin must be given correctly to control symptoms and because an overdose can be adjunct to treatment, but it should not be recommended without complete information about
fatal, it is most important for the patient to know how to administer it. Asking for a drug effectiveness.
demonstration of technique is the best way to determine whether the patient has understood
the teaching. When a patient is receiving a lot of new information, the information presented DIF: Cognitive Level: Application REF: Evaluation TOP: Nursing Process: Evaluation
first is the most likely to be remembered. The other teaching points are important as well, but
they are not as critical and can be taught later.
DIF: Cognitive Level: Application REF: Planning TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
6. The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action
is not part of the six rights of drug administration?
a. Assessing the patient‘s pain level 15 to 30 minutes after giving the medication
b. Checking the medication administration record to see when the last dose was
administered
c. Consulting a drug manual to determine whether the amount the prescriber ordered
is appropriate
d. Documenting the reason the medication was given in the patient‘s electronic
medical record
ANS: A
Assessing the patient‘s pain after administering the medication is an important part of the
nursing process when giving medications, but it is not part of the six rights of drug
administration. Checking to see when the last dose was given helps ensure that the medication
is given at the right time. Consulting a drug manual helps ensure that the medication is given
in the right dose. Documenting the reason for a pain medication is an important part of the
right documentation—the sixth right.
DIF: Cognitive Level: Application
REF: Evolution of Nursing Responsibilities Regarding Drugs | Implementation
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
7. A patient tells a nurse that a medication prescribed for recurrent migraine headaches is not
working. What will the nurse do?
a. Ask the patient about the number and frequency of tablets taken.
b. Assess the patient‘s headache pain on a scale from 1 to 10.
c. Report the patient‘s complaint to the prescriber.
d. Suggest biofeedback as an adjunct to drug therapy.
ANS: A
When evaluating the effectiveness of a drug, it is important to determine whether the patient is
using the drug as ordered. Asking the patient to tell the nurse how many tablets are taken and
how often helps the nurse determine compliance. Assessing current pain does not yield
information about how well the medication is working unless the patient is currently taking it.
The nurse should gather as much information about compliance, symptoms, and drug
effectiveness as possible before contacting the prescriber. Biofeedback may be an effective
