Complete A+ TEST BANK for Lilley’s Pharmacology for Canadian Health Care Practice 4th Edition by Sealock & Seneviratne (2021)/ All Chapters1-58 /

Chapter 01: Nursing Practice in Canada and Drug Therapy Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which is a judgement about a particular patient’s potential need or problem? a. A goal b. An assessment c. Subjective data d. A nursing diagnosis ANS: D Nursing diagnosis is the phase of the nursing process during which a clinical judgement is made about how a patient responds to heath conditions and life processes or vulnerability for that response. DIF: Cognitive Level: Knowledge 2. The patient is to receive oral furosemide (Lasix) every day; however, because the patient is unable to swallow, he cannot take medication orally, as ordered. The nurse needs to contact the physician. What type of problem is this? a. A “right time” problem b. A “right dose” problem c. A “right route” problem d. A “right medication” problem ANS: C This is a “right route” problem: the nurse cannot assume the route and must clarify the route with the prescriber. This is not a “right time” problem because the ordered frequency has not changed. This is not a “right dose” problem because the dose is not related to an inability to swallow. This is not a “right medication” problem because the medication ordered will not change, just the route. DIF: Cognitive Level: Application 3. The nurse has been monitoring the patient’s progress on his new drug regimen since the first dose and has been documenting signs of possible adverse effects. What nursing process phase is the nurse practising? a. Planning b. Evaluation c. Implementation d. Nursing diagnosis ANS: B Monitoring the patient’s progress is part of the evaluation phase. Planning, implementation, and nursing diagnosis are not illustrated by this example. DIF: Cognitive Level: Application 4. The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes mellitus. Which statement best illustrates an outcome criterion for this patient? a. The patient will follow instructions. b. The patient will not experience complications. c. The patient adheres to the new insulin treatment regimen. d. The patient demonstrates safe insulin self-administration technique. ANS: D Having the patient demonstrate safe insulin self-administration technique is a specific and measurable outcome criterion. Following instructions and avoiding complications are not specific criteria. Adherence to the new insulin treatment regimen is not objective and would be difficult to measure. DIF: Cognitive Level: Application 5. Which activity best reflects the implementation phase of the nursing process for the patient who is newly diagnosed with type 1 diabetes mellitus? a. Providing education regarding self-injection technique b. Setting goals and outcome criteria with the patient’s input c. Recording a history of over-the-counter medications used at home d. Formulating nursing diagnoses regarding knowledge deficits related to the new treatment regimen ANS: A Education is an intervention that occurs during the implementation phase. Setting goals and outcome criteria reflects the planning phase. Recording a drug history reflects the assessment phase. Formulating nursing diagnoses regarding a knowledge deficit reflects analysis of data as part of the planning phase. DIF: Cognitive Level: Analysis TopRankProf©Files PLC 1 6. The nurse is working during a very busy night shift, and the health care provider has just given the nurse a medication order over the telephone, but the nurse does not recall the route. What is the best way for the nurse to avoid medication errors? a. Recopy the order neatly on the order sheet, with the most common route indicated b. Consult with the pharmacist for clarification about the most common route c. Call the health care provider to clarify the route of administration d. Withhold the drug until the health care provider visits the patient ANS: C If a medication order does not include the route, the nurse must ask the health care provider to clarify it. Never assume the route of administration.h DIF: Cognitive Level: Application | Cognitive Level: Analysis 7. Which constitutes the traditional Five Rights of medication administration? a. Right drug, right route, right dose, right time, and right patient b. Right drug, the right effect, the right route, the right time, and the right patient c. Right patient, right strength, right diagnosis, right drug, and right route d. Right patient, right diagnosis, right drug, right route, and right time ANS: A The traditional Five Rights of medication administration were considered to be Right drug, Right route, Right dose, Right time, and Right patient. Right effect, right strength, and right diagnosis are not part of the traditional Five Rights. DIF: Cognitive Level: Comprehension 8. What correctly describes the nursing process? a. Diagnosing, planning, assessing, implementing, and finally evaluating b. Assessing, then diagnosing, implementing, and ending with evaluating c. A linear direction that begins with assessing and continues through diagnosing, planning, and finally implementing d. An ongoing process that begins with assessing and continues with diagnosing, planning, implementing, and evaluating ANS: D The nursing process is an ongoing, flexible, adaptable, and adjustable five-step process that begins with assessing and continues through diagnosing, planning, implementing, and finally evaluating, which may then lead back to any of the other phases. DIF: Cognitive Level: Application 9. When the nurse is considering the timing of a drug dose, which is most important to assess? a. The patient’s identification b. The patient’s weight c. The patient’s last meal d. Any drug or food allergies ANS: C The pharmacokinetic and pharmacodynamic properties of the drug need to be assessed with regard to any drug–food interactions or compatibility issues. The patient’s identification, weight, and drug or food allergies are not affected by the drug’s timing. DIF: Cognitive Level: Application 10. The nurse is writing nursing diagnoses for a plan of care. Which reflects the correct format for her nursing diagnosis? a. Anxiety b. Anxiety related to new drug therapy c. Anxiety related to anxious feelings about drug therapy, as evidenced by statements such as “I’m upset about having to give myself shots” d. Anxiety related to new drug therapy, as evidenced by statements such as “I’m upset about having to give myself shots” ANS: D Formulation of nursing diagnoses is usually a three-step process. The only complete answer is “Anxiety related to new drug therapy, as evidenced by statements such as ‘I’m upset about having to give myself shots.’” The answer “Anxiety” is missing the “related to” and “as evidenced by” portions. The answer “Anxiety related to new drug therapy” is missing the “as evidenced by” portion of defining characteristics. The “related to” section in “Anxiety related to anxious feelings about drug therapy, as evidenced by statements such as ‘I’m upset about having to give myself shots’” is simply a restatement of the problem “anxiety,” not a separate factor related to the response. DIF: Cognitive Level: Analysis OTHER 1. Place the phases of the nursing process in the correct order, starting with the first phase. a. Planning b. Evaluation c. Assessment d. Implementation e. Diagnosing ANS: C, E, A, D, B DIF: Cognitive Level: Analysis TopRankProf©Files PLC 2 Chapter 02: Pharmacological Principles Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient is receiving two different drugs, which, at their current dose forms and dosages, are both absorbed into the circulation in identical amounts. Which term best denotes that the drugs have the same absorption rates? a. Equivalent b. Synergistic c. Compatible d. Bioequivalent ANS: D Two drugs absorbed into the circulation at the same amount (in specific dosage forms) have the same bioavailability; thus, they are bioequivalent. “Equivalent” is incorrect because the term “bioavailability” is used to express the extent of drug absorption. “Synergistic” is incorrect because this term refers to two drugs given together whose resulting effect is greater than the sum of the effects of each drug given alone. “Compatible” is incorrect because this term is a general term used to indicate that two substances do not have a chemical reaction when mixed (or given, in the case of drugs) together. DIF: Cognitive Level: Comprehension 2. A patient is receiving medication via intravenous injection. Which information should the nurse provide for patient education? a. The medication will cause fewer adverse effects when given intravenously. b. The medication will be absorbed slowly into the tissues over time. c. The medication’s action will begin faster when given intravenously. d. Most of the drug is inactivated by the liver before it reaches the target area. ANS: C Intravenous injections are the fastest route of absorption. The intravenous route does not affect the number of adverse effects, the intravenous route is not a slow route of absorption, and the intravenous route does not cause inactivation of the drug by the liver before it reaches the target area. DIF: Cognitive Level: Comprehension 3. Which is true regarding parenteral drugs? a. They bypass the first-pass effect. b. They decrease blood flow to the stomach. c. They are altered by the presence of food in the stomach. d. They exert their effects while circulating in the bloodstream. ANS: A Drugs given by the parenteral route bypass the first-pass effect, but they still must be absorbed into cells and tissues before they can exert their effects. Enteral drugs (drugs taken orally), not parenteral drugs, decrease blood flow to the stomach and are altered by the presence of food in the stomach. Parenteral drugs must be absorbed into cells and tissues from the circulation before they can exert their effects; they do not exert their effects while circulating in the bloodstream. DIF: Cognitive Level: Analysis 4. A drug’s half-life is best defined as a. The time it takes for the drug to elicit half its therapeutic response. b. The time it takes one-half of the original amount of a drug to reach the target cells. c. The time it takes one-half of the original amount of a drug to be removed from the body. d. The time it takes one-half of the original amount of a drug to be absorbed into the circulation. ANS: C A drug’s half-life is the time it takes for one-half of the original amount of a drug to be removed from the body. It is a measure of the rate at which drugs are removed from the body. Answers A, B, and D are not correct definitions of a drug’s half-life. DIF: Cognitive Level: Comprehension 5. The term “duration of action” is best defined as a. The time it takes for the drug to elicit a therapeutic response. b. The time it takes a drug to reach its maximum therapeutic response. c. The length of time it takes to remove a drug from circulation. d. The time during which drug concentration is sufficient to elicit a therapeutic response. ANS: D Duration of action is the time during which drug concentration is sufficient to elicit a therapeutic response. The time it takes for a drug to elicit a therapeutic response is the drug’s “onset of action.” The time it takes a drug to reach its maximum therapeutic response is a drug’s “peak effect.” “The length of time it takes to remove a drug from circulation” defines a drug’s elimination and does not correctly define a drug’s duration of action. DIF: Cognitive Level: Comprehension TopRankProf©Files PLC 1 6. A drug interacts with enzymes by a. altering cell membrane permeability. b. “fooling” a receptor on the cell wall. c. enhancing the drug’s effectiveness within the cells. d. “fooling” the enzyme into binding with it instead of its normal target cell. ANS: D When drugs interact with enzymes, they inhibit the action of a specific enzyme by “fooling” the enzyme into binding to it instead of to its normal target cell. Thus, the target cells are protected from the action of the enzymes to result in a drug effect. The alteration of cell membrane permeability, the “fooling” of a receptor on the cell wall, and the enhancement of the effectiveness of drugs within cells do not occur with selective enzyme interactions. DIF: Cognitive Level: Comprehension 7. When administering a new medication to a patient, the nurse reads that it is highly protein bound. Which consequence will result from this protein binding? a. Renal excretion will take longer. b. The drug will be metabolized quickly. c. The duration of action of the medication will be longer. d. The duration of action of the medication will be shorter. ANS: C Drugs that are bound to plasma proteins are characterized by a longer duration of action. Protein binding does not make renal excretion longer and does not increase metabolism of the drug. Protein binding of a drug means that the duration of action is longer, not shorter. DIF: Cognitive Level: Application 8. When monitoring a patient on an insulin drip to reduce blood glucose levels, the nurse notes that the patient’s glucose level is extremely low, and the patient is lethargic and difficult to awaken. Which adverse drug reaction is the nurse observing? a. An adverse effect b. An allergic reaction c. An idiosyncratic reaction d. A pharmacological reaction ANS: D A pharmacological reaction is an extension of the drug’s normal effects in the body. In this case, the insulin lowered the patient’s blood glucose levels too much. An adverse effect is a predictable, well-known adverse drug reaction that results in minor or no changes in patient management. An allergic reaction (also known as a hypersensitivity reaction) involves the patient’s immune system. An idiosyncratic reaction is unexpected and is defined as a genetically determined abnormal response to normal dosages of a drug. DIF: Cognitive Level: Comprehension 9. A patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where should the nurse tell the patient to place the tablet? a. Under the tongue b. In the space between the cheek and gum c. At the back of the throat, for easy swallowing d. On a non-hairy area on the chest ANS: A Drugs taken by the sublingual route are placed under the tongue. Placing the tablet in the space between the cheek and gum is done for the buccal route; placing the tablet at the back of the throat (for easy swallowing) is done in the oral route; and placing the tablet on a non-hairy area on the chest is done in the topical or transdermal route. DIF: Cognitive Level: Comprehension 10. The nurse is administering medications to a patient who is in liver failure due to end-stage cirrhosis. The nurse is aware that patients with liver failure are most likely to have problems with which pharmacokinetic phase? a. Absorption b. Distribution c. Metabolism d. Excretion ANS: C The liver is the organ that is most responsible for drug metabolism. Decreased liver function will most affect a drug’s metabolism. The absorption of a drug is not affected by liver function, and distribution is not affected by liver function. Excretion is affected only because decreased liver function may not transform drugs into water-soluble substances for elimination via the kidneys, but this is not the best answer to this question. DIF: Cognitive Level: Application