Basic Pharmacology for Nurses 16th Ed by Clayton - Willihnganz

Chapter 3: Drug Action Across the Life Span Test Bank MULTIPLE CHOICE 1. What time will the trough blood level need to be drawn if the nurse administers the intravenous medication dose at 9:00 AM? a. 6:30 AM b. 8:30 AM c. 9:30 AM d. 11:30 AM ANS: B Trough blood levels measure the lowest blood level of medicine and are obtained just before the dose is administered. In this case, 6:30 AM is too early to obtain the blood level. The other two times occur after the medication is administered. DIF: Cognitive Level: Application REF: p. 26 OBJ: 3 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 2. What will the nurse expect the health care provider’s order to be when starting an older adult patient on thyroid hormone replacement therapy? a. Administering a loading dose of the drug b. Directions on how to taper the drug c. A dosage that is one third to one half of the regular dosage d. A dosage that is double the regular dosage ANS: C To prevent toxicity, dosages for new medications in older adults should be one third to one half the amount of a standard adult dosage. Loading doses of drugs could cause severe toxicity. Tapering off is characteristic of discontinuation of medications and is not appropriate for this situation. Older adults generally need a lower medication dosage than younger patients. DIF: Cognitive Level: Application REF: p. 29 OBJ: 3 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 3. Which drugs cause birth defects? a. Teratogens b. Carcinogens c. Metabolites d. Placebos ANS: A Teratogens are drugs that cause birth defects. Carcinogens cause cancer. Metabolites are the end product of metabolism. Placebos are drugs that have no pharmacologic activity. DIF: Cognitive Level: Knowledge REF: p. 30 OBJ: 6 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 4. Which life threatening illness may occur as a result of aspirin (salicylate) administration during viral illness to patients younger than 20 years of age? a. Anaphylactic shock b. Reye’s syndrome c. Chickenpox d. Influenza A ANS: B Children are susceptible to Reye’s syndrome if they ingest aspirin at the time of or shortly after a viral infection of chickenpox or influenza. Anaphylactic shock is caused by a hypersensitivity reaction. Chickenpox is the result of being infected with a virus. Influenza A is caused by a pathogen. DIF: Cognitive Level: Knowledge REF: pp. 27-28 OBJ: 3 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 5. Which classification of medications commonly causes allergic reactions in children? a. Antacids b. Analgesics c. Antibiotics d. Anticonvulsants ANS: C Antibiotics, especially penicillins, commonly cause allergic reactions in children. Intravenous antibiotics can cause rapid reactions; therefore, the pediatric patient’s response to a medication should be assessed and monitored closely. Antacids rarely cause allergic reactions. Children are not particularly allergic to analgesics or anticonvulsants. DIF: Cognitive Level: Knowledge REF: p. 28 OBJ: 3 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 6. After giving instructions to an expectant mother about taking medications during pregnancy, which patient statement indicates the need for further teaching? a. “I will not take herbal medicines during pregnancy.” b. “For morning sickness, I will try crackers instead of taking a drug.” c. “If I get a cold, I will avoid taking nonprescription medications until I check with my physician.” d. “I will limit my alcohol intake to only one glass of wine weekly.” ANS: D Alcohol needs to be eliminated during pregnancy and for 2 to 3 months prior to conception. Limited studies are available regarding the use of herbal medications in general, and thus they should be avoided during pregnancy. Alternative nonpharmacologic treatments are appropriate to use during morning sickness. The pregnant woman should also avoid using nonprescription drugs because few data are available about safe use in pregnancy. Because few medicines can be considered completely safe for use in pregnancy, the physician needs to approve and recommend the use of nonprescription drugs. DIF: Cognitive Level: Application REF: p. 30 OBJ: 6 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 7. When is the ideal time for a nursing mother to take her own medications? a. Before the infant latches on to begin to breastfeed b. As soon as the mother wakes up in the morning c. Right before the mother goes to sleep at night d. As soon as the infant finishes breastfeeding ANS: D Taking medications after breastfeeding reduces the amount of the medication that will reach the baby. Medications taken directly before breastfeeding may have a high concentration in the milk and possibly pass on to the baby. The mother must take into consideration when her medications are ordered to be taken, and schedule them around breastfeeding. DIF: Cognitive Level: Comprehension REF: p. 31 OBJ: 6 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 8. Which age-related change would affect transdermal drug absorption in geriatric patients the most? a. Difficulty swallowing b. Diminished kidney function c. Changes in pigmentation d. Altered circulatory status ANS: D The decreased circulation that occurs with aging will affect transdermal drug absorption. Difficulty swallowing would not affect transdermal drugs being absorbed. Kidney function affects drug excretion. Changes in pigmentation would not affect transdermal drug absorption. DIF: Cognitive Level: Application REF: p. 22 OBJ: 3 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 9. Which intervention would be considered to reduce accumulation of a drug in a patient who has decreased liver function? a. Decreasing the time interval between dosages b. Reducing the dosage c. Administering the medication intravenously d. Changing the drug to one that has a longer half life ANS: B Dosages must be reduced to prevent accumulation. Decreasing the time interval between dosages would increase the accumulation of the drug. The intravenous route has the fastest absorption and with liver dysfunction would increase the accumulation of the drug. A similar drug with a longer half life would stay in the system longer; with impaired liver function, the result would be increased accumulation. DIF: Cognitive Level: Comprehension REF: p. 24 OBJ: 3 TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Physiological Integrity 10. The nurse is teaching an elderly patient with difficulty swallowing about his medications. Which explanation by the nurse is most helpful? a. “Enteric coated tablets can be crushed and taken with applesauce.” b. “Tablets that are scored can be broken in half.” c. “Medications labeled ‘SR’ can be crushed.” d. “Avoid taking medications in liquid form.” ANS: B It is acceptable to break scored tablets in half to facilitate swallowing of the medication. Enteric coated tables should never be crushed because of the effect on the absorption rate and potential for toxicity. Medications labeled “SR” indicate “sustained release” and should not be crushed because of the effect on the absorption rate. Medication in liquid form may be easier to swallow. DIF: Cognitive Level: Application REF: p. 29 OBJ: 3 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 11. The nurse is administering an antibiotic intravenously. Which blood level determines the lowest amount of medication present in the patient? a. Peak b. Serum c. Therapeutic d. Trough ANS: D The lowest amount of a medication in the blood is the trough. The peak is the highest amount of medication in the blood. Serum level identifies the amount of medication present. Therapeutic levels identify the range in which a medication is effective. DIF: Cognitive Level: Knowledge REF: p. 26 OBJ: none TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 12. Which patient would the nurse identify as having the lowest rate of absorption of enteral medications? a. A 5-year-old boy b. An 18-year-old woman c. A 55-year-old man d. An 85-year-old woman ANS: A Males’ stomachs empty more rapidly; children have increased motility, resulting in decreased absorption time. As one gets older, gastrointestinal (GI) motility is decreased, allowing for increased absorption time; women have slower gastric emptying, resulting in more time for absorption. Males’ stomachs empty more rapidly; however, as one gets older, GI motility is decreased, resulting in an increase in absorption time. As one gets older, GI motility is decreased, allowing for increased absorption time; women have slower gastric emptying, resulting in more time for absorption. DIF: Cognitive Level: Application REF: pp. 20-21 OBJ: 3 | 4 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 13. What is the definition of cumulative effect of a drug? a. Drug toxicity related to overmedication b. Drug buildup related to decreased metabolism c. The inability to control the ingestion of drugs d. The need for higher dosage to produce the same effect as previous lower dosages ANS: B Cumulative effects are related to diminished metabolism or excretion of a drug that causes it to accumulate. Cumulative effects can lead to drug toxicity. Toxicity occurs when adverse effects are severe. Inability to control the ingestion of drugs is drug dependence. The need for higher dosage to produce the same effect as previous lower dosages is the definition of tolerance. DIF: Cognitive Level: Knowledge REF: p. 22 OBJ: 2 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 14. Which patient, when compared with the general population, would require a larger dose or more frequent administration of a drug to attain a therapeutic response? a. A 29 year old who has been diagnosed with kidney failure b. A 35 year old obese male who is being evaluated for an exercise program c. A 52 year old diagnosed with hypothyroidism and decreased metabolic rate d. A 72 year old with decreased circulatory status ANS: B An obese individual would require a larger dose of a drug to attain a therapeutic response. An individual with kidney failure would require less medication because of decreased excretory ability. Individuals with decreased metabolic rate would metabolize drugs more slowly and require smaller doses or less frequent administration. Individuals with decreased circulation would require less medication. DIF: Cognitive Level: Application REF: p. 20 OBJ: 3 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 15. A resident in a long term care facility reports difficulty swallowing enteric coated aspirin and asks the nurse to crush it prior to administration. The most appropriate action for the nurse to take is to: a. crush the tablet and mix with applesauce. b. encourage the resident to swallow the tablet with a full glass of water. c. hold the medication and notify the physician. d. substitute a regular aspirin for the enteric coated tablet. ANS: C The medication should be held and the physician notified. The physician has the authority to determine how to proceed in this situation. Enteric coated tablets should not be crushed because this will increase the absorption rate and the potential for toxicity. Geriatric patients may have difficulty swallowing and are at risk for choking and aspiration. They should not be encouraged to swallow medications if they report difficulty swallowing. The physician must determine if a substitution can be ordered. Prescribing is not in the nurse’s scope of practice. DIF: Cognitive Level: Analysis REF: p. 22 OBJ: 3 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity MULTIPLE RESPONSE 16. One of the prescribed medications for a 36 week gestational age baby girl is a topical water soluble medication to be applied to the perineum daily to treat an inflammatory rash. What considerations is the nurse aware of before medication administration? (Select all that apply.) a. Age of the client b. Location of topical application c. Increased intestinal transit rate d. Condition of the skin e. Gastric pH of 8 ANS: A, B, D The premature infant’s outer layer of skin is not fully developed, although it is more hydrated, which will enhance the absorption of the topical water soluble medication. Neonates often wear diapers, which will act as an occlusive dressing, thereby increasing absorption. The client’s inflammatory condition will increase the absorption of medication. The intestinal transit rate increases as the newborn matures. This is irrelevant when a medication is applied topically. Gastric pH would not factor into metabolism of a medication that is applied topically. DIF: Cognitive Level: Application REF: p. 20 | p. 22 OBJ: 3 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 17. The nurse is caring for a 4 month old child who is on a water soluble medication for seizures. The child’s mother voices concern that the dosage seems “too much” for the child’s age and would like the dosage verified. What actions will the nurse take? (Select all that apply.) a. Verify dosage requirements in the Physicians’ Desk Reference( PDR) in mg/kg. b. Compare the water composition requirements of adults and children. c. Evaluate lean body mass and total fat content in adults and infants. d. Chart “refused per mother” on the MAR and do not administer. e. Compare transportation in the circulation of plasma bound proteins between adults and children. ANS: A, B The PDR lists the recommended dosages for all age groups. Because dilution may vary among age groups, the water concentration should be verified prior to administration. As we age, lean body mass and total body water decrease while total fat content increases; however, this drug is not fat soluble. The nurse is responsible for administering the medication as ordered after verifying that it is correct; the mother is asking for verification, not refusal of administration. Drugs that are relatively insoluble are transported in the circulation by being bound to plasma proteins; however, this drug is water soluble. DIF: Cognitive Level: Application REF: p. 27 OBJ: 3 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 18. For which reason(s) is/are elderly patients at increased risk for drug interactions and toxicity? (Select all that apply.) a. They have a higher incidence of malnourishment. b. Their renal function is enhanced. c. They have increased use of multiple medications. d. Hepatic function is reduced. e. There are often issues with swallowing. ANS: A, C, D Older adult patients have an increased incidence of malnourishment, are often on multiple medications, and have reduced hepatic function, all of which puts them at increased risk for drug interactions and toxicity. Renal function diminishes in the elderly as a result of decreased renal blood flow, reduced cardiac output, loss of glomeruli, and diminished tubular function and concentrating ability. Older adults have swallowing difficulties, leading to compliance issues, but taking drugs less often would not result in toxicity. DIF: Cognitive Level: Comprehension REF: p. 28 OBJ: 3 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 19. Which patient(s) require(s) special considerations for medication administration? (Select all that apply.) a. A 29-year-old pregnant woman b. A 2-month-old baby c. An 18-year-old college student d. A 45-year-old farmer e. An 82-year-old retired nurse ANS: A, B, E Drug therapy during pregnancy should be avoided. Recommendations by the provider are necessary during any stage of pregnancy. Pediatric and elderly patients are affected by differences in muscle mass and blood flow to muscles, as well as other physiological systems. Teenagers and adult patients do not typically require special considerations for medication administration. DIF: Cognitive Level: Application REF: pp. 20-21 OBJ: 3 | 4 | 5 | 6 TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Physiological Integrity 20. Which factor(s) in a patient would influence GI absorption of medications? (Select all that apply.) a. Stomach pH b. Level of consciousness c. Fever d. Blood flow to gastric mucosa e. Weight f. Body surface area ANS: A, D Absorption by passive diffusion across the membranes depends on the pH of the environment. Increased blood flow to gastric mucosa increases absorption of medication and decreases time of absorption. Drug absorption does not depend on the mental status of the patient. Fever does not affect drug absorption. The patient’s absolute weight and body surface area do not affect drug absorption, although problems associated with weight greater than or less than normal may be a factor in the process. DIF: Cognitive Level: Application REF: p. 22 OBJ: 3 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 21. When receiving a report on a new admission from the emergency room, the nurse learns that the patient is newly diagnosed with renal failure. Which medication(s) in the patient’s medication history will require dosage adjustment by the physician? (Select all that apply.) a. Lithium b. Tobramycin c. Atenolol d. Quinidine e. Ampicillin ANS: A, B, C, D, E Lithium, tobramycin, atenolol, quinidine, and ampicillin are all select medications that require dosage adjustment in renal failure. DIF: Cognitive Level: Application REF: p. 26 OBJ: 3 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 22. Prenatal education is being provided by the nurse at a maternal family child clinic. What information should be relayed? (Select all that apply.) a. Herbal medicines are considered safe. b. Limit tobacco consumption to less than two cigarettes per day. c. Encourage a folic acid supplement. d. One alcoholic beverage per day is acceptable in the last trimester. e. Encourage nonpharmacologic treatments for symptoms such as nausea. ANS: C, E Good nutrition with appropriate ingestion of vitamins (especially folic acid) is particularly important during pregnancy to prevent birth defects. Before using medicines, pregnant women should be encouraged to try nonpharmacologic treatments. Herbal medicines that have not been scientifically tested in women during pregnancy should be avoided. Advise against the use of tobacco. Mothers who smoke have a higher frequency of miscarriage, stillbirths, premature births, and low birth weight infants. Consumption of alcohol should be eliminated 2 to 3 months before planned conception, as well as during pregnancy. DIF: Cognitive Level: Application REF: pp. 30-31 OBJ: 6 TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Health Promotion and Maintenance Chapter 7: Principles of Medication Administration and Medication Safety Test Bank MULTIPLE CHOICE 1. Where would the procedures and treatments directed by the health care provider be found? a. Summary sheet b. Physician’s order form c. Physician’s progress notes d. History and physical examination form ANS: B The physician’s order form contains all procedures and treatments ordered by the health care provider. A summary sheet provides a brief overview of the hospital course at discharge. Physician’s progress notes provide regular observations on the patient’s course of treatment and response. A history and physical examination form provides information about baseline information from the patient. DIF: Cognitive Level: Knowledge REF: p. 80 OBJ: 2 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Safe, Effective Care Environment 2. Which action will the nurse take when it is determined that the narcotic count is incorrect while obtaining a medication from the narcotic area? a. Determine the cause of the discrepancy at the end of the shift. b. Notify the health care provider stat. c. Call the nurse from the previous shift to determine if there was a discrepancy earlier. d. Report the discrepancy to the charge nurse immediately. ANS: D Reporting the discrepancy to the charge nurse immediately enables the supervisory staff to narrow the time frame during which a medication was taken and not documented. The discrepancy needs to be addressed immediately, and therefore determining the cause of the discrepancy at the end of the shift is not the most appropriate action for the nurse to take. It is not appropriate to contact the health care provider for an incorrect narcotic count. The count would have been verified at shift change; calling the nurse from the previous shift is not an appropriate action for the nurse to take. DIF: Cognitive Level: Analysis REF: p. 95 OBJ: 3 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Safe, Effective Care Environment 3. Which action will the nurse take if a dosage is unclear on a health care provider’s order? a. Ask the patient what dosage was given in the past. b. Ask another physician to determine the correct dosage. c. Tell the patient that the medication will not be given. d. Contact the health care provider to verify the correct dosage. ANS: D Any questionable orders should be verified by the health care provider who wrote the orders. The patient is not a reliable source of verification. The physician who wrote the order should verify it. It would be a medication error to withhold the dose instead of verifying it. DIF: Cognitive Level: Application REF: p. 99 OBJ: 5 TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Physiological Integrity 4. What is the most reliable method to calculate a pediatric patient’s medication dosage? a. Age b. Height c. Body surface area (BSA) d. Placement on a growth scale ANS: C The most reliable method is by proportional amount of BSA or body weight. Because of the differences in weight among children, age is not a reliable method. Because of the differences in height among children, this is not a reliable method. Placement on a growth scale identifies how the child corresponds to other children on a percentile. Although it is determined by a specific measurement, the percentile identified would not be a specific measurement; therefore, this is not a reliable method. DIF: Cognitive Level: Comprehension REF: p. 101 OBJ: 10 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 5. Which medication route provides the most rapid onset of a medication, but also poses the greatest risk of adverse effects? a. Intradermal b. Subcutaneous (subcut) c. Intramuscular (IM) d. Intravenous (IV) ANS: D IV medications are delivered directly into the bloodstream and avoid the “first pass” effect of the liver. Intradermal, subcut, and IM administration have a slower absorption rate. DIF: Cognitive Level: Knowledge REF: p. 102 OBJ: 10 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 6. Which is known as the “fifth vital sign”? a. Temperature b. Respirations c. Pain d. Pulse ANS: C Pain is known as the “fifth vital sign.” DIF: Cognitive Level: Knowledge REF: p. 86 OBJ: 2 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 7. Which is true regarding the unit dose drug distribution system? a. The inventory is delivered to each nursing unit on a regular and recurring basis. b. The system delivers one dose of each medication to be administered until the subsequent delivery of inventory. c. The use of single dose packages of drugs dispensed to fill each dose requirement as it is ordered. d. The amount of inventory needed to dose all patients on the unit for a 24 hour interval. ANS: C The unit dose drug distribution system uses single unit packages of drugs dispensed to fill each dose requirement as it is ordered. DIF: Cognitive Level: Comprehension REF: p. 93 OBJ: 7 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 8. The nursing assessment identifies that the client is nauseated and cannot take acetaminophen (Tylenol) orally. Which is true regarding the substitution of this medication to suppository form? a. It is standard practice when the patient is unable to take the ordered medication. b. It is acceptable if the patient agrees to the altered route form. c. It is preferable to having the patient miss a dose of the medication. d. It is contraindicated without an order from the health care provider. ANS: D One dosage form of medication should never be substituted for another unless the prescriber is consulted; there can be a great variation in the absorption rate of the medication through different routes of administration. The substitution of one form for another is not standard practice, and is not acceptable or preferable without the prescriber’s order. DIF: Cognitive Level: Application REF: p. 99 OBJ: N/A TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 9. Which medication order requires nursing judgment and means “administer if needed”? a. Morphine 4 mg IV stat b. Morphine 4 mg IV prior to procedure c. Morphine 4 mg IV four times a day d. Morphine 4 mg IV every 4 hours PRN ANS: D PRN indicates for the nurse to administer morphine every 4 hours if needed and requires nursing judgment. Stat means the dose of morphine would be given immediately, not as needed. The orders for the dose of morphine to be given prior to the patient’s scheduled procedure and four times a day, do not indicate to give the dose as needed. DIF: Cognitive Level: Comprehension REF: p. 89 | p. 97 OBJ: 2 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 10. What is medication reconciliation? a. Comparing the patient’s current medication orders to all of the medications actually being taken b. The administration of high alert medications that have been ordered on admission to an acute care facility c. The completion of an incident report following a variance that resulted in a serious complication d. A printout of computerized patient data that identifies the times that all of the ordered medications are to be administered ANS: A Medication reconciliation is the process of comparing a patient’s current medication orders to all of the medications that the patient is actually taking. Administering high alert medications and completing an incident report are not the same as medication reconciliation. A printout of computerized patient data that identifies the times that all of the ordered medications are to be administered is a description of the medication administration record (MAR), not a description of medication reconciliation. DIF: Cognitive Level: Knowledge REF: p. 98 OBJ: 4 | 9 | 10 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 11. Which example best demonstrates safe drug administration by the nurse? a. Administering an oral medication with the patient sitting upright b. Asking children to say their name before administering the medication c. Leaving the medications on the bedside stand after verifying patient identification d. Returning the unused portion of a medication to a stock supply bottle ANS: A Sitting the patient upright for oral medications is safe medication practice. Children should never be asked their names as a means of positive identification. Remaining with a patient until the drug is swallowed is safe practice. Returning an unused portion of medication to the stock supply bottle is not safe medication practice. DIF: Cognitive Level: Application REF: p. 103 OBJ: 10 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 12. The nurse determines that a prescribed medication has not been administered as ordered on the previous shift. What action will the nurse take? a. Administer the medication immediately. b. Complete an incident report. c. Notify the nurse responsible for the error. d. Record the occurrence in the nurse’s notes. ANS: B An incident report is completed when a medication error occurs. Depending on the medication and frequency of administration, the medication may not be given immediately. It is not the nurse’s responsibility to notify another nurse of the error. Medication errors are not recorded in the nurse’s notes. DIF: Cognitive Level: Application REF: p. 100 OBJ: 6 | 11 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 13. A patient’s liquid cough medicine has been discontinued with one half of the bottle remaining. The home health nurse is aware that according to the U.S. Food and Drug Administration (FDA) guidelines on prescription medication disposal, the next step should be to: a. save the remainder for another patient with the same prescription. b. flush the remainder down the toilet. c. read the drug label for specific disposal instructions. d. pour remaining medication into a hazardous waste container. ANS: C The nurse must follow specific disposal instructions on the drug label or in the patient information leaflet that accompanies the medication. Prescription medications should not be shared among patients. Prescription drugs should not be flushed down the toilet unless specifically instructed to do so by the manufacturer. The first action to be taken is to follow disposal instructions on the label. If the drug label indicates it should be emptied into a hazardous waste container, measures should be taken to prevent leaking and/or accidental ingestion. DIF: Cognitive Level: Analysis REF: p. 96 OBJ: 7 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity MULTIPLE RESPONSE 14. Who defines the standards of care for the practice of nursing? (Select all that apply.) a. State boards of nursing b. Hospital policy and procedures c. Federal laws regulating health care facilities d. The Joint Commission e. Professional nursing associations ANS: A, C, D, E Standards of care are defined by state boards of nursing, federal laws regulating health care facilities, The Joint Commission, and professional nursing associations such as the American Nurses Association. Individual hospital policies and procedures incorporate federal and state guidelines into their respective policies and procedures and are often more stringent than state and federal regulations. DIF: Cognitive Level: Knowledge REF: p. 79 | p. 91 | p. 92 OBJ: 1 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Safe, Effective Care Environment 15. What must the nurse have before administering any medication? (Select all that apply.) a. A current license to practice b. A medication order signed by a practitioner licensed with prescription privileges c. Knowledge of the medication d. Consultation with a pharmacist e. Knowledge of the client’s diagnosis ANS: A, B, C, E Physicians must be licensed to prescribe medications; nurses must be licensed to administer medications. Safe medication administration includes knowledge of the medication, pathophysiology of patient diagnoses, and pharmacodynamics of the ordered medication on the pathophysiology. It is not necessary for the nurse to consult with a pharmacist each time medication is to be administered to a patient. DIF: Cognitive Level: Comprehension REF: p. 80 OBJ: 1 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Safe, Effective Care Environment 16. Which advantage(s) does the unit dose drug distribution system include? (Select all that apply.) a. There is decreased participation by the pharmacy. b. The pharmacist is able to analyze prescribed medications for each client for drug interactions and contraindications. c. There is less waste of medications. d. The time spent by nursing personnel preparing these medications is increased. e. Credit is given to the patient for unused medications. ANS: B, C, E Because the pharmacist has a profile of all medications for each patient, he or she is able to analyze prescribed medications for each patient for drug interactions and contraindications. This is an advantage of the unit dose drug distribution system. Less waste of medications is an advantage of the unit dose drug distribution system. Because each dose is individually packaged, credit can be given to the patient for unused medications. There is increased pharmacist involvement and better use of his or her extensive drug knowledge and nursing personnel time is decreased with this method. DIF: Cognitive Level: Knowledge REF: p. 93 OBJ: 7 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Safe, Effective Care Environment 17. Which statement(s) is/are true regarding the types of medication orders? (Select all that apply.) a. Stat orders are the same as single dose orders. b. Standing orders indicate the number of specified doses of a medication to be given. c. Renewal orders facilitate physician review before continuance of high risk medications. d. PRN medications will designate a mandatory number of times the medication is to be administered. e. Verbal orders should be used as much as possible. ANS: B, C Standing orders state the frequency of medication dosages to be administered or indicate the time frame of administration. Renewal orders require the physician to review medications that have “expired orders,” as determined by facility policy. Renewal policies facilitate physician verification of the necessity to continue a medication beyond a “usual” time frame and help ensure patient safety. Single dose and stat orders are not the same. PRN medications are not ordered a mandatory number of times, although a maximum number might be specified. Verbal orders should be avoided whenever possible. DIF: Cognitive Level: Comprehension REF: p. 97 OBJ: 8 TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Physiological Integrity 18. Which statement(s) is/are true regarding computerized prescriber order entry (CPOE)? (Select all that apply.) a. Integrates the ordering system with the pharmacy, laboratory, and nurses’ stations b. Provides instant access to online information to facilitate patient care needs c. Facilitates review of ordered medications for potential drug interactions d. Facilitates review of drugs for appropriateness of dosages e. Alleviates the need to perform mathematical computations ANS: A, B, C, D CPOE systems integrate patient information, provide instant access, facilitate review of ordered medications for potential drug interactions, and facilitate review of drugs for appropriateness of dosages. Alleviation of the need to perform mathematical computations is not a component of the CPOE system. DIF: Cognitive Level: Knowledge REF: p. 92 OBJ: 8 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity; Safe, Effective Care Environment 19. Which lab test(s) would be used to assess liver and/or renal function before administering medications? (Select all that apply.) a. CBC b. LDH c. ALT d. Crs e. BUN f. aPTT ANS: B, C, D, E Liver function tests include LDH (lactic dehydrogenase) and ALT (alanine aminotransferase). Renal function tests include Crs (serum creatinine) and BUN (blood urea nitrogen). Although a CBC (complete blood count) and an aPTT are useful in assessing the patient before administration of medication, they are not renal or hepatic function tests. DIF: Cognitive Level: Knowledge REF: p. 101 OBJ: N/A TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 20. The nurse is preparing to administer Lanoxin to a patient on the telemetry unit. In addition to understanding the patient’s diagnosis, the nurse must also know which characteristic(s) of the medication? (Select all that apply.) a. Chemical composition b. Adverse effects c. Expected actions d. Contraindications for use e. Usual dosing ANS: B, C, D, E The nurse must understand the individual patient’s diagnosis and symptoms that correlate with the rationale for drug use. The nurse should also know why a medication is ordered, expected actions, usual dosing, proper dilution, route and rate of administration, adverse effects, and contraindications for the use of a particular drug. It is not required that the nurse know the chemical composition of the medication prior to administration. DIF: Cognitive Level: Application REF: p. 80 OBJ: 5 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity 21. The nurse transcribes an order to administer Valium 10 mg IV stat. This order is correctly interpreted by the nurse to mean it should be provided how? (Select all that apply.) a. As needed b. Immediately c. One time only d. In divided doses e. Intravenously ANS: B, C, E The stat order is generally used on an emergency basis. It means that the drug is to be administered as soon as possible, but only once. IV indicates the route is intravenous. A PRN order means “administer if needed.” The order would specify “divided doses” and amount per dose if indicated. DIF: Cognitive Level: Analysis REF: p. 80 OBJ: 8 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity Chapter 14: Drugs Used for Sleep Test Bank MULTIPLE CHOICE 1. The nurse finds that a patient is extremely agitated, yells frequently, and is attempting to get out of bed without assistance. What is the nurse’s initial action? a. Administer zolpidem after taking the patient’s vital signs. b. Close the patient’s door for privacy after administering Tylenol. c. Administer benzodiazepine before calling the health care provider. d. Spend uninterrupted time listening to the patient. ANS: D Assessing the patient’s level of anxiety is important. The patient may only need someone to listen to what stressors he or she is facing. The nurse must assess the patient before medication can be administered. DIF: Cognitive Level: Analysis REF: p. 214 OBJ: 3 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 2. An older adult patient received a hypnotic agent at 9:00 PM. At 2:00 AM, the nurse discovers that the patient has removed her gown and is attempting to get out of bed without assistance. What type of medication effect is the patient exhibiting? a. Allergic b. Hypersensitivity c. Paradoxical d. Therapeutic ANS: C A paradoxical effect may occur in older adult patients. This includes periods of excitement, confusion, restlessness, and euphoria. Allergies to medications tend to manifest in skin or respiratory symptoms. A patient who is hypersensitive to a hypnotic would be difficult to rouse. A therapeutic effect for a hypnotic would be sedation. DIF: Cognitive Level: Application REF: p. 217 OBJ: 1 TOP: Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Physiological Integrity 3. For what conditions are benzodiazepines prescribed? a. Chronic amnesia b. Chronic insomnia c. Preoperative sedation d. Psychotic episodes ANS: C The sedative hypnotic effect of benzodiazepines facilitates surgical sedation. Short acting benzodiazepines are administered intramuscularly for preoperative sedation. They are also given intravenously for conscious sedation before short diagnostic procedures or for the induction of general anesthesia. Benzodiazepines are not recommended for long term use and do not affect amnesia. Benzodiazepines are a poor choice for the treatment of chronic insomnia because of their risk for habituation. Benzodiazepines do not have an antipsychotic effect. DIF: Cognitive Level: Knowledge REF: pp. 217-218 OBJ: 4 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 4. A patient receiving diazepam (Valium) is complaining of nausea and vomiting and is becoming jaundiced. Which type of blood work will be performed? a. Renal function tests b. Liver function tests c. Clotting times d. Electrolyte panels ANS: B Liver function tests will be performed because nausea, vomiting, and jaundice can be indicative of hepatotoxicity. Abnormal liver function test results (i.e., elevated bilirubin, aspartate transaminase [AST], alanine transaminase [ALT], gamma glutamyl transferase [GGT], and alkaline phosphatase levels, as well as prothrombin time) are indicative of hepatotoxicity. Benzodiazepines do not affect the kidneys, clotting times, and electrolytes. DIF: Cognitive Level: Application REF: p. 220 OBJ: 6 TOP: Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Physiological Integrity 5. In addition to facilitating sleep, what is another benefit of sedatives? a. Increased pain control postoperatively b. Reduced bronchial secretions c. Decreased patient anxiety d. Increased patient alertness ANS: C Preoperatively, sedatives will help decrease patient anxiety and facilitate sleep. Sedatives are not long acting enough to affect postoperative pain control. Sedatives do not affect bronchial secretions. Sedatives diminish patient alertness. DIF: Cognitive Level: Knowledge REF: pp. 213-214 OBJ: 1 TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Physiological Integrity 6. Which two phases make up normal sleep? a. Hypnagogic and hypnopompic b. Rapid eye movement (REM) and non REM c. Alpha and beta d. Delta and theta ANS: B Normal sleep can be divided into two phases, REM and non REM. Hypnagogic is the state between waking and sleeping; hypnopompic is the transition between sleeping and waking states. Beta waves are those associated with day to day wakefulness. During periods of relaxation while still awake, our brain waves become slower, increase in amplitude, and become more synchronous. These types of waves are called alpha waves. The first stage of sleep is characterized by theta waves. During a normal night’s sleep, a sleeper passes from the theta waves of stages 1 and 2 to the delta waves of stages 3 and 4. Delta waves are the slowest and highest amplitude brain waves. DIF: Cognitive Level: Knowledge REF: p. 212 OBJ: 1 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 7. Which sleep pattern stage diminishes as an effect of aging? a. Stage I b. Stage II c. Stage III d. Stage IV ANS: D As we age, stage IV sleep diminishes. Many people older than 75 years do not demonstrate any stage IV sleep patterns. Between 2% and 5% of sleep is stage I. Stage II comprises about 50% of normal sleep time. Stage III is a transition between lighter sleep and deeper sleep. DIF: Cognitive Level: Knowledge REF: p. 212 OBJ: 1 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 8. A patient has been prescribed lorazepam (Ativan), a benzodiazepine used to treat insomnia. Which action will the nurse take? a. Advise the patient to take the medication with food. b. Assess the patient’s blood pressure in sitting and lying positions. c. Inform the patient to discontinue the medication once sleep improves. d. Instruct the patient to lie down before taking the medication. ANS: B Measuring blood pressure in sitting and lying positions is important to assess for transient hypotension. Ativan does not have to be taken with food. Rapid discontinuance of the medication after long term use may result in symptoms similar to those of alcohol withdrawal. Gradual withdrawal of benzodiazepines is over 2 to 4 weeks. Medications should be taken sitting up. DIF: Cognitive Level: Application REF: p. 218 OBJ: 1 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 9. Which disease is associated with insufficient sleep? a. Cancer b. Glaucoma c. Myocardial infarction d. Renal failure ANS: C Individuals who sleep less than 5 hours a night have a threefold increased risk of heart attacks. Cancer, glaucoma, and renal failure are not associated with lack of sleep. DIF: Cognitive Level: Knowledge REF: p. 212 OBJ: 1 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 10. The nurse is caring for an older patient recently admitted to an assisted living center who is experiencing insomnia associated with the recent relocation. At bedtime, which nursing action will assist the patient to sleep? a. Offering the patient hot tea b. Encouraging the patient to ambulate in the hallway c. Performing back massage d. Administering an analgesic ANS: C Providing a back rub will promote relaxation and reduce anxiety associated with a new environment. This would also provide an opportunity for the nurse to encourage the patient to express feelings. The patient should avoid products containing caffeine, such as coffee, tea, soft drinks, and chocolate. A quiet unwinding activity before bedtime is helpful for sleep promotion. Administering an analgesic is not an appropriate action. DIF: Cognitive Level: Application REF: p. 214 OBJ: 3 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 11. The nurse is explaining the use of medications to a patient with insomnia. Which statement about sedatives is true? a. A sedative will produce sleep. b. Sedatives increase the total time in REM sleep. c. Increased relaxation occurs with sedatives. d. Sedatives are more potent than hypnotics. ANS: C A hypnotic is a drug that produces sleep; a sedative quiets the patient and gives a feeling of relaxation and rest, not necessarily accompanied by sleep. Sedatives do not increase the total time in REM sleep. A small dose of a drug may act as a sedative, whereas a larger dose of the same drug may act as a hypnotic and produce sleep. DIF: Cognitive Level: Comprehension REF: p. 214 OBJ: 1 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 12. The nurse is assessing a patient who is being evaluated in an outpatient clinic for complaints of back pain. The patient reports taking diphenhydramine for insomnia related to job stress. Which statement by the nurse is accurate regarding this medication? a. “This medication should only be taken for 1 week.” b. “This medication can cause nausea.” c. “The medication should not be taken after eating a high fat meal.” d. “This is an herbal medication that has been used for hundreds of years.” ANS: A Antihistamines (particularly diphenhydramine and doxylamine) have sedative properties that may be used for short term treatment of mild insomnia. They are common ingredients in over the counter (OTC) sleep aids. Tolerance develops after only a few nights of use; increasing the dose actually causes a more restless and irregular sleep pattern. Diphenhydramine does not cause nausea. There is no restriction on taking diphenhydramine after a high fat meal. Diphenhydramine is not an herbal medication. DIF: Cognitive Level: Application REF: p. 220 OBJ: 3 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 13. When reviewing a patient’s history and physical information, the nurse notes that the patient has physician’s orders for chloral hydrate and warfarin. During assessment of this patient, the nurse observes areas of petechiae and ecchymosis on the upper and lower extremities. The most appropriate lab work for the nurse to assess next is: a. liver function studies. b. C-reactive protein. c. sedimentation rate. d. prothrombin time. ANS: D Chloral hydrate may enhance the anticoagulant effects of warfarin. The patient should be observed for petechiae, ecchymoses, nosebleeds, bleeding gums, dark tarry stools, and bright red or coffee ground emesis. Prothrombin time should be monitored, and the physician should reduce the dosage of warfarin, if necessary. DIF: Cognitive Level: Application REF: p. 222 OBJ: 6 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 14. The nurse is administering Somnote to a patient. When providing medication education to the patient, the nurse will include that Somnote should be: a. thoroughly chewed. b. taken with a full glass of water. c. taken on an empty stomach. d. taken only before bedtime. ANS: B Somnote is available in capsule form and should not be chewed, should be taken with a full glass of water, should be taken after meals, and is usually ordered to be taken three times a day after meals. DIF: Cognitive Level: Application REF: p. 221 OBJ: 4 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity MULTIPLE RESPONSE 15. Why are benzodiazepines often preferred over barbiturates? (Select all that apply.) a. They have selective action at specific receptor sites. b. There is a wide range of safety between therapeutic and lethal levels. c. REM sleep is decreased to a lesser extent. d. Accidental overdoses are well tolerated. e. There are no hypotensive episodes when rising to a sitting position. ANS: A, B, C, D The selectivity of specific drugs at receptor sites accounts for the wide variety of uses. There is a wide safety margin between the therapeutic and lethal dosages for these drugs. Benzodiazepines decrease REM sleep to a lesser extent. Intentional and unintentional overdoses of benzodiazepines are often well tolerated and not fatal. There are transient hypotensive episodes with benzodiazepine therapy. DIF: Cognitive Level: Comprehension REF: p. 217 OBJ: 4 TOP: Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Physiological Integrity 16. Barbiturates have which common adverse effect(s)? (Select all that apply.) a. Residual daytime sedation b. Headache c. Hyperactivity d. Blurred vision e. Impaired coordination ANS: A, B, D, E The long half life of a barbiturate medication often causes residual daytime sedation. Headache is a general adverse effect of barbiturates. Blurred vision is an adverse effect associated with the hypnotic dosages of long acting barbiturates. Impaired coordination is an adverse effect of barbiturates. Hyperactivity is not generally an adverse effect of barbiturates unless the patient is experiencing a paradoxical response. DIF: Cognitive Level: Knowledge REF: pp. 215-217 OBJ: 4 TOP: Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Physiological Integrity 17. What can occur as a result of rapid withdrawal from long term use of barbiturate therapy? (Select all that apply.) a. Anxiety b. Delirium c. Weakness d. Grand mal seizures e. Severe pain ANS: A, B, C, D Anxiety, delirium, weakness, and grand mal seizures can be symptoms of rapid withdrawal from long term use of barbiturate therapy. Severe pain is not a symptom of rapid withdrawal from long term use of barbiturate therapy. DIF: Cognitive Level: Knowledge REF: p. 216 OBJ: 4 TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Physiological Integrity 18. The nurse is assessing a patient prior to discharge from same day surgery following an incisional breast biopsy. When assessing the patient’s central nervous system (CNS) function following sedative hypnotic therapy, what will the nurse include? (Select all that apply.) a. Level of alertness b. Orientation c. Ability to perform motor functions d. Blood pressure e. Usual pattern of sleep ANS: A, B, C Because sedative hypnotics depress overall CNS function, the nurse should identify the patient’s level of alertness and orientation and ability to perform motor functions. Blood pressure is a vital sign and falls under cardiovascular assessment. Usual sleep pattern should be obtained for information on sleep pattern disruption, but not for CNS function. DIF: Cognitive Level: Application REF: p. 214 OBJ: 4 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity