LEHNE’S PHARMACOTHERAPEUTICS FOR
ADVANCED PRACTICE NURSES AND
PHYSICIAN ASSISTANTS 2ND EDITION
ROSENTHAL TEST BANK | Correct
Marking Scheme
/. .A nurse provides teaching to a patient who has had a hysterectomy and is about to
begin
hormone therapy to manage menopausal symptoms. Which statement by the patient
indicates
understanding of the teaching?
a. "Because I am not at risk for uterine cancer, I can take hormones indefinitely."
b. "I can take estrogen to reduce my risk of cardiovascular disease."
c. "I should take the lowest effective dose for the shortest time needed."
d. "I will need a progestin/estrogen combination since I have had a hysterectomy." -
Answer-✅ANS: C
For patients who have undergone hysterectomy, progestin is unnecessary; estrogen-
only preparations still carry increased risk of breast cancer and should be taken in the
lowest effective dose for the shortest time possible. Even though uterine cancer is no
longer a possibility, breast cancer isstill a risk. Studies have shown no protection
against coronary heart disease but increased risk ofstroke and breast cancer with
estrogens.DIF: Cognitive Level: ApplicationREF: p. 527TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
/.A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to
severe
vasomotor symptoms and is discussing estrogen therapy (ET) with the nurse. The
patient is
concerned about adverse effects of ET. The nurse will tell her that:
a. an estrogen-progesterone product will reduce side effects.
b. an intravaginal preparation may be best for her.
c. side effects of ET are uncommon among women her age.
d. transdermal preparations have fewer side effects. - Answer-✅ANS: D
,Transdermal preparations of estrogen have fewer adverse effects, use lower doses of
estrogen, and have less fluctuation of estrogen levels than do oral preparations.
Progesterone is contraindicated in women who have undergone hysterectomy.
Intravaginal preparations are most useful for treating local estrogen deficiency such as
vaginal and vulvar atrophy. Side effects of ET are the same at
the patient's age as for other women using ET.DIF: Cognitive Level: ApplicationREF: p.
525TOP:
Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
/.A child will receive 750 mg of an antibiotic for 10 days. The child attends day care. The
drug may be dosed in several ways and is available in two concentrations. Which
dosing regimen will the nurse discuss with the child's provider?
a. 250 mg/5 mL to 375 mg PO twice daily
b. 250 mg/5 mL to 250 mg PO three times daily
c. 500 mg/5 mL to 250 mg PO three times daily
d. 500 mg/5 mL to 375 mg PO twice daily - Answer-✅ANS: D
To promote adherence to a drug regimen in children, it is important to consider the size
and timing of the dose. In this case the preparation containing 500 mg/5 mL means that
a smaller volume can be given, which is more palatable to a child. Twice daily dosing is
more convenient for parents, especially when a child is in day care or school; it also
helps prevent the problem of the medication being left either at home or at school.DIF:
Cognitive Level: ApplicationREF: p. 68TOP: Nursing Process: Implementation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
/.A family nurse practitioner practicing in Maine is hired at a practice across state lines
in Virginia. Which aspect of practice may change for the APRN?
A. The APRN will have less prescriptive authority in the new position.
B. The APRN will have more prescriptive authority in the new position.
C. The APRN will have equal prescriptive authority in the new position.
D. The APRN's authority will depend on federal regulations. - Answer-✅ANS: A
Virginia allows limited prescriptive authority, while Maine gives full authority to certified
nurse practitioners. The federal government does not regulate prescriptive authority.
DIF: Cognitive Level: ComprehensionREF: p. 3TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
/.A nurse administers the same medication in the same preparation in the same dose to
several patients and notes that some patients have a better response to the drug than
others. What is the most likely explanation for this phenomenon?
a. Altered bioavailability of the drug
b. Patient compliance with the therapeutic regimen
,c. Pharmacogenomic differences among individuals
d. Placebo effects enhancing expectations of drug efficacy - Answer-✅ANS: C
Each patient's genetic makeup can determine how that patient responds to drugs
quantitatively and qualitatively, and this is the most likely cause of individual variation
when the same drug is given at the same dose. The bioavailability of a drug is
determined by the drug's composition and varies across formulations of the drug. The
patients in this example were given the same drug. The nurse was administering the
medication to the patients, so compliance is not an issue. Nothing in this example
indicates that a placebo effect was in play.DIF: Cognitive Level: ComprehensionREF: p.
53TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
/.A nurse caring for a 5-year-old child notes that the child has discoloration of several
teeth. When taking a medication history, the nurse will ask about which group of
medications?
a. Glucocorticoids
b. Salicylates
c. Sulfonamides
d. Tetracyclines - Answer-✅ANS: D
Tetracyclines cause discoloration in developing teeth in children. Glucocorticoids are
associated with growth suppression. Salicylates are associated with Reye syndrome.
Sulfonamides are associated with kernicterus in newborns.DIF: Cognitive Level:
ApplicationREF: p. 67TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential
/.A nurse is administering digoxin to a patient. To administer medications so that the
drug is as effective as possible, the nurse needs to consider what?
A) Pharmacotherapeutics
B) Pharmacokinetics
C) Pharmacoeconomics
D) Pharmacogenomics - Answer-✅Ans: B
Feedback: When administering a drug, the nurse needs to consider the phases of
pharmacokinetics so that the drug regimen can be made as effective as possible.
Pharmacogenomics is the area of study that includes mapping of the human genome.
Pharmacotherapeutics is the branch of pharmacology that deals with the uses of drugs
to treat, prevent, and diagnose disease. Pharmacoeconomics includes all costs involved
in drug therapy.
/.A nurse is caring for a patient and her newborn immediately after delivery. The
patient's medication history includes prenatal vitamins throughout pregnancy, one or
two glasses of wine before knowing she was pregnant, occasional use of an albuterol
inhaler in her last trimester, and intravenous morphine during labor. What will the nurse
expect to do?
, a. Administer opioids to the infant to prevent withdrawal syndrome.
b. Monitor the infant's respirations and prepare to administer naloxone if needed.
c. Note a high-pitched cry and irritability in the infant and observe for seizures.
d. Prepare the patient for motor delays in the infant caused by the alcohol use. -
Answer-✅ANS: B
Narcotics given for pain during labor cross the placenta and can cause respiratory
depression in the infant. Nurses must be prepared to provide respiratory support and to
give naloxone to reverse the narcotic effects if necessary. Exposure to opioids during
labor is not sufficient to cause dependence, so withdrawal syndrome is not an issue.
Infants withdrawing from drugs have a high- pitched cry and are irritable, which is not
expected in this case. Any drug taken during the first weeks of pregnancy tends to have
an "all or none" effect, meaning that it either causes death of the conceptus or, if
sublethal, the conceptus recovers.DIF: Cognitive Level: ApplicationREF: p. 58TOP:
Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Physiologic Adaptation
/.A nurse is caring for a patient who has been receiving a drug by the intramuscular
route but will receive the drug orally after discharge. How does the nurse explain the
increased dosage prescribed for the oral dose?
A) Passive diffusion
B) Active transport
C) Glomerular filtration
D) First-pass effect - Answer-✅Ans: D
Feedback: The first-pass effect involves drugs that are absorbed from the small
intestine directly into the portal venous system, which delivers the drug molecules to the
liver. After reaching the liver, enzymes break the drug into metabolites, which may
become active or may be deactivated and readily excreted from the body. A large
percentage of the oral dose is usually destroyed and never reaches tissues. Oral
dosages account for the phenomenon to ensure an appropriate amount of the drug in
the body to produce a therapeutic action. Passive diffusion is the major process through
which drugs are absorbed into the body. Active transport is a process that uses energy
to actively move a molecule across a cell membrane and is often involved in drug
excretion in the kidney. Glomerular filtration is the passage of water and water-soluble
components from the plasma into the renal tubule.
/.A nurse is caring for a patient who is supposed to receive two drugs at the same time.
What is the nurses priority action?
A) Wash her hands before handling the medications. B) Consult a drug guide for
compatibility.
C) Question the patient concerning drug allergies.
D) Identify the patient by checking the armband and asking the patient to state his
name. - Answer-✅Ans: B
Feedback: A nurse should first consult a drug guide for compatibility when two or more
drugs are being given at the same time. After compatibility is determined the medication
ADVANCED PRACTICE NURSES AND
PHYSICIAN ASSISTANTS 2ND EDITION
ROSENTHAL TEST BANK | Correct
Marking Scheme
/. .A nurse provides teaching to a patient who has had a hysterectomy and is about to
begin
hormone therapy to manage menopausal symptoms. Which statement by the patient
indicates
understanding of the teaching?
a. "Because I am not at risk for uterine cancer, I can take hormones indefinitely."
b. "I can take estrogen to reduce my risk of cardiovascular disease."
c. "I should take the lowest effective dose for the shortest time needed."
d. "I will need a progestin/estrogen combination since I have had a hysterectomy." -
Answer-✅ANS: C
For patients who have undergone hysterectomy, progestin is unnecessary; estrogen-
only preparations still carry increased risk of breast cancer and should be taken in the
lowest effective dose for the shortest time possible. Even though uterine cancer is no
longer a possibility, breast cancer isstill a risk. Studies have shown no protection
against coronary heart disease but increased risk ofstroke and breast cancer with
estrogens.DIF: Cognitive Level: ApplicationREF: p. 527TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
/.A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to
severe
vasomotor symptoms and is discussing estrogen therapy (ET) with the nurse. The
patient is
concerned about adverse effects of ET. The nurse will tell her that:
a. an estrogen-progesterone product will reduce side effects.
b. an intravaginal preparation may be best for her.
c. side effects of ET are uncommon among women her age.
d. transdermal preparations have fewer side effects. - Answer-✅ANS: D
,Transdermal preparations of estrogen have fewer adverse effects, use lower doses of
estrogen, and have less fluctuation of estrogen levels than do oral preparations.
Progesterone is contraindicated in women who have undergone hysterectomy.
Intravaginal preparations are most useful for treating local estrogen deficiency such as
vaginal and vulvar atrophy. Side effects of ET are the same at
the patient's age as for other women using ET.DIF: Cognitive Level: ApplicationREF: p.
525TOP:
Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
/.A child will receive 750 mg of an antibiotic for 10 days. The child attends day care. The
drug may be dosed in several ways and is available in two concentrations. Which
dosing regimen will the nurse discuss with the child's provider?
a. 250 mg/5 mL to 375 mg PO twice daily
b. 250 mg/5 mL to 250 mg PO three times daily
c. 500 mg/5 mL to 250 mg PO three times daily
d. 500 mg/5 mL to 375 mg PO twice daily - Answer-✅ANS: D
To promote adherence to a drug regimen in children, it is important to consider the size
and timing of the dose. In this case the preparation containing 500 mg/5 mL means that
a smaller volume can be given, which is more palatable to a child. Twice daily dosing is
more convenient for parents, especially when a child is in day care or school; it also
helps prevent the problem of the medication being left either at home or at school.DIF:
Cognitive Level: ApplicationREF: p. 68TOP: Nursing Process: Implementation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
/.A family nurse practitioner practicing in Maine is hired at a practice across state lines
in Virginia. Which aspect of practice may change for the APRN?
A. The APRN will have less prescriptive authority in the new position.
B. The APRN will have more prescriptive authority in the new position.
C. The APRN will have equal prescriptive authority in the new position.
D. The APRN's authority will depend on federal regulations. - Answer-✅ANS: A
Virginia allows limited prescriptive authority, while Maine gives full authority to certified
nurse practitioners. The federal government does not regulate prescriptive authority.
DIF: Cognitive Level: ComprehensionREF: p. 3TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
/.A nurse administers the same medication in the same preparation in the same dose to
several patients and notes that some patients have a better response to the drug than
others. What is the most likely explanation for this phenomenon?
a. Altered bioavailability of the drug
b. Patient compliance with the therapeutic regimen
,c. Pharmacogenomic differences among individuals
d. Placebo effects enhancing expectations of drug efficacy - Answer-✅ANS: C
Each patient's genetic makeup can determine how that patient responds to drugs
quantitatively and qualitatively, and this is the most likely cause of individual variation
when the same drug is given at the same dose. The bioavailability of a drug is
determined by the drug's composition and varies across formulations of the drug. The
patients in this example were given the same drug. The nurse was administering the
medication to the patients, so compliance is not an issue. Nothing in this example
indicates that a placebo effect was in play.DIF: Cognitive Level: ComprehensionREF: p.
53TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
/.A nurse caring for a 5-year-old child notes that the child has discoloration of several
teeth. When taking a medication history, the nurse will ask about which group of
medications?
a. Glucocorticoids
b. Salicylates
c. Sulfonamides
d. Tetracyclines - Answer-✅ANS: D
Tetracyclines cause discoloration in developing teeth in children. Glucocorticoids are
associated with growth suppression. Salicylates are associated with Reye syndrome.
Sulfonamides are associated with kernicterus in newborns.DIF: Cognitive Level:
ApplicationREF: p. 67TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential
/.A nurse is administering digoxin to a patient. To administer medications so that the
drug is as effective as possible, the nurse needs to consider what?
A) Pharmacotherapeutics
B) Pharmacokinetics
C) Pharmacoeconomics
D) Pharmacogenomics - Answer-✅Ans: B
Feedback: When administering a drug, the nurse needs to consider the phases of
pharmacokinetics so that the drug regimen can be made as effective as possible.
Pharmacogenomics is the area of study that includes mapping of the human genome.
Pharmacotherapeutics is the branch of pharmacology that deals with the uses of drugs
to treat, prevent, and diagnose disease. Pharmacoeconomics includes all costs involved
in drug therapy.
/.A nurse is caring for a patient and her newborn immediately after delivery. The
patient's medication history includes prenatal vitamins throughout pregnancy, one or
two glasses of wine before knowing she was pregnant, occasional use of an albuterol
inhaler in her last trimester, and intravenous morphine during labor. What will the nurse
expect to do?
, a. Administer opioids to the infant to prevent withdrawal syndrome.
b. Monitor the infant's respirations and prepare to administer naloxone if needed.
c. Note a high-pitched cry and irritability in the infant and observe for seizures.
d. Prepare the patient for motor delays in the infant caused by the alcohol use. -
Answer-✅ANS: B
Narcotics given for pain during labor cross the placenta and can cause respiratory
depression in the infant. Nurses must be prepared to provide respiratory support and to
give naloxone to reverse the narcotic effects if necessary. Exposure to opioids during
labor is not sufficient to cause dependence, so withdrawal syndrome is not an issue.
Infants withdrawing from drugs have a high- pitched cry and are irritable, which is not
expected in this case. Any drug taken during the first weeks of pregnancy tends to have
an "all or none" effect, meaning that it either causes death of the conceptus or, if
sublethal, the conceptus recovers.DIF: Cognitive Level: ApplicationREF: p. 58TOP:
Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Physiologic Adaptation
/.A nurse is caring for a patient who has been receiving a drug by the intramuscular
route but will receive the drug orally after discharge. How does the nurse explain the
increased dosage prescribed for the oral dose?
A) Passive diffusion
B) Active transport
C) Glomerular filtration
D) First-pass effect - Answer-✅Ans: D
Feedback: The first-pass effect involves drugs that are absorbed from the small
intestine directly into the portal venous system, which delivers the drug molecules to the
liver. After reaching the liver, enzymes break the drug into metabolites, which may
become active or may be deactivated and readily excreted from the body. A large
percentage of the oral dose is usually destroyed and never reaches tissues. Oral
dosages account for the phenomenon to ensure an appropriate amount of the drug in
the body to produce a therapeutic action. Passive diffusion is the major process through
which drugs are absorbed into the body. Active transport is a process that uses energy
to actively move a molecule across a cell membrane and is often involved in drug
excretion in the kidney. Glomerular filtration is the passage of water and water-soluble
components from the plasma into the renal tubule.
/.A nurse is caring for a patient who is supposed to receive two drugs at the same time.
What is the nurses priority action?
A) Wash her hands before handling the medications. B) Consult a drug guide for
compatibility.
C) Question the patient concerning drug allergies.
D) Identify the patient by checking the armband and asking the patient to state his
name. - Answer-✅Ans: B
Feedback: A nurse should first consult a drug guide for compatibility when two or more
drugs are being given at the same time. After compatibility is determined the medication
