Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1
Item Type: MCQ
Clinical Scenario: A 68-year-old patient with a history of chronic
kidney disease (CKD) stage 3 and osteoporosis is experiencing
frequent heartburn. The patient asks the nurse about over-the-
counter (OTC) options for relief.
Question Stem: The nurse should advise the patient that which
OTC product is safest for symptomatic relief, given their history?
Answer Options:
A. Aluminum hydroxide (Amphojel)
B. Calcium carbonate (Tums)
C. Magnesium hydroxide (Milk of Magnesia)
D. Sodium bicarbonate (Alka-Seltzer)
Correct Answer: B. Calcium carbonate (Tums)
Comprehensive Rationale: Calcium carbonate is an effective
OTC antacid that can be used for occasional heartburn. In this
patient, it is the safest option of those listed. While it contains
calcium, the risk of hypercalcemia is less of a concern than the
electrolyte imbalances and systemic effects of the other agents.
Magnesium hydroxide can accumulate to toxic levels in renal
impairment, causing hypermagnesemia (weakness, bradycardia,
respiratory depression). Aluminum hydroxide can accumulate,
leading to aluminum toxicity (osteomalacia, encephalopathy)
and can also cause constipation and hypophosphatemia.
,Sodium bicarbonate can cause metabolic alkalosis, fluid
overload (sodium load), and worsen hypokalemia.
Distractor Analysis:
• A. Aluminum hydroxide: Incorrect. Aluminum is renally
excreted and can accumulate, causing neurotoxicity and
renal osteodystrophy. It is a high-risk choice for a patient
with CKD.
• C. Magnesium hydroxide: Incorrect. Magnesium is also
renally excreted. In a patient with CKD, it poses a
significant risk for hypermagnesemia, a potentially life-
threatening condition.
• D. Sodium bicarbonate: Incorrect. The high sodium
content can lead to fluid retention and hypertension, and
its systemic absorption can cause metabolic alkalosis.
Nursing Process Integration:
• Primary Component: Implementation - This question
assesses the nurse's ability to implement safe
pharmacologic therapy by selecting an appropriate OTC
medication based on patient-specific factors.
• Assessment: The nurse must assess the patient's renal
function and medication history.
, • Evaluation: The nurse would evaluate the patient's
understanding and monitor for relief of heartburn and any
adverse effects.
Clinical Judgment Measurement Model (NCJMM):
• Generate Solutions: The nurse must select the safest and
most effective antacid option for the patient.
• Take Action: The nurse provides specific, safe medication
recommendations.
Difficulty Level: Moderate
Bloom's Cognitive Level: Apply
NCLEX Client Needs Category: Pharmacological and Parenteral
Therapies
Key Learning Objective: Apply knowledge of antacid
pharmacology and patient-specific contraindications (e.g., renal
impairment) to select the safest over-the-counter option.
Question 2
Item Type: MCQ
Clinical Scenario: A patient is prescribed omeprazole (Prilosec)
20 mg daily for gastroesophageal reflux disease (GERD). The
nurse is providing discharge teaching.
Question Stem: Which statement by the patient indicates a
correct understanding of the medication teaching?
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1
Item Type: MCQ
Clinical Scenario: A 68-year-old patient with a history of chronic
kidney disease (CKD) stage 3 and osteoporosis is experiencing
frequent heartburn. The patient asks the nurse about over-the-
counter (OTC) options for relief.
Question Stem: The nurse should advise the patient that which
OTC product is safest for symptomatic relief, given their history?
Answer Options:
A. Aluminum hydroxide (Amphojel)
B. Calcium carbonate (Tums)
C. Magnesium hydroxide (Milk of Magnesia)
D. Sodium bicarbonate (Alka-Seltzer)
Correct Answer: B. Calcium carbonate (Tums)
Comprehensive Rationale: Calcium carbonate is an effective
OTC antacid that can be used for occasional heartburn. In this
patient, it is the safest option of those listed. While it contains
calcium, the risk of hypercalcemia is less of a concern than the
electrolyte imbalances and systemic effects of the other agents.
Magnesium hydroxide can accumulate to toxic levels in renal
impairment, causing hypermagnesemia (weakness, bradycardia,
respiratory depression). Aluminum hydroxide can accumulate,
leading to aluminum toxicity (osteomalacia, encephalopathy)
and can also cause constipation and hypophosphatemia.
,Sodium bicarbonate can cause metabolic alkalosis, fluid
overload (sodium load), and worsen hypokalemia.
Distractor Analysis:
• A. Aluminum hydroxide: Incorrect. Aluminum is renally
excreted and can accumulate, causing neurotoxicity and
renal osteodystrophy. It is a high-risk choice for a patient
with CKD.
• C. Magnesium hydroxide: Incorrect. Magnesium is also
renally excreted. In a patient with CKD, it poses a
significant risk for hypermagnesemia, a potentially life-
threatening condition.
• D. Sodium bicarbonate: Incorrect. The high sodium
content can lead to fluid retention and hypertension, and
its systemic absorption can cause metabolic alkalosis.
Nursing Process Integration:
• Primary Component: Implementation - This question
assesses the nurse's ability to implement safe
pharmacologic therapy by selecting an appropriate OTC
medication based on patient-specific factors.
• Assessment: The nurse must assess the patient's renal
function and medication history.
, • Evaluation: The nurse would evaluate the patient's
understanding and monitor for relief of heartburn and any
adverse effects.
Clinical Judgment Measurement Model (NCJMM):
• Generate Solutions: The nurse must select the safest and
most effective antacid option for the patient.
• Take Action: The nurse provides specific, safe medication
recommendations.
Difficulty Level: Moderate
Bloom's Cognitive Level: Apply
NCLEX Client Needs Category: Pharmacological and Parenteral
Therapies
Key Learning Objective: Apply knowledge of antacid
pharmacology and patient-specific contraindications (e.g., renal
impairment) to select the safest over-the-counter option.
Question 2
Item Type: MCQ
Clinical Scenario: A patient is prescribed omeprazole (Prilosec)
20 mg daily for gastroesophageal reflux disease (GERD). The
nurse is providing discharge teaching.
Question Stem: Which statement by the patient indicates a
correct understanding of the medication teaching?
