Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E Chapter 9

Question 1 Type: MCMA The nurse is doing a holistic assessment on a patient prior to the initiation of antihypertensive medication. What will the best assessment include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Blood pressure 2. The biologic cause of the hypertension 3. Mood 4. Level of education 5. Belief in a higher power Correct Answer: 1,3,4,5 Rationale 1: Holistic health care incorporates the whole patient to include the biological (blood pressure) dimension. Rationale 2: The biologic cause of the hypertension focuses on a specific disease, its cause, and treatment; this is a medical model, not a holistic model. Rationale 3: Holistic health care incorporates the whole patient to include the psychological (mood) dimension. Rationale 4: Holistic health care incorporates the whole patient to include the sociocultural (level of education) dimension. Rationale 5: Holistic health care incorporates the whole patient to include the spiritual (belief in a higher power) dimension. Global Rationale: Holistic health care incorporates the whole patient to include the biological (blood pressure), psychological (mood), sociocultural (level of education), and spiritual (belief in a higher power) dimensions. The biologic cause of the hypertension focuses on a specific disease, its cause, and treatment; this is a medical model, not a holistic model. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Relationship-Centered Care: Respect the patient’s dignity, uniqueness, integrity and selfdetermination, and his or her own power and self-healing process. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 9-1 Describe fundamental concepts underlying a holistic approach to patient care and their importance to pharmacotherapy. MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings. Page Number: 95 Question 2 Type: MCSA The adolescent Hispanic male has been diagnosed with attention-deficit hyperactivity disorder (ADHD), and is taking methylphenidate (Ritalin). Even though the drug helps with focus and grades, the adolescent will not go to the school office at noon for his medication. Which statement best describes the result of the nurse's evaluation? 1. The adolescent has developed alternative coping mechanisms to increase his focus during classes. 2. The adolescent is fearful that this drug may be a "gateway drug" and he will abuse other substances. 3. The adolescent really does not need an additional dose of methylphenidate (Ritalin) at school. 4. The adolescent is embarrassed about having to take medicine at school; it is a social stigma. Correct Answer: 4 Rationale 1: Attention-deficit hyperactivity disorder is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes. Rationale 2: Appropriate treatment of attention-deficit hyperactivity disorder will result in less addiction to mood-altering substances, not more addiction. Rationale 3: Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the patient must receive a dose during school hours. Rationale 4: Some patients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Patients can also perceive this as a social stigma. Global Rationale: Some patients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Patients can also perceive this as a social stigma. Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the patient must receive a dose during school hours. Attention-deficit hyperactivity disorder is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes. Appropriate treatment of attention-deficit hyperactivity disorder will result in less addiction to mood-altering substances, not more addiction. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care: patient/family/community preferences; values coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; transitions and continuity. AACN Essentials Competencies: IX.18 Develop an awareness of patients as well as healthcare professionals’ spiritual beliefs and values and how those beliefs and values impact health care. NLN Competencies: Relationship-Centered Care: Respect the patient’s dignity, uniqueness, integrity and selfdetermination, and his or her own power and self-healing process. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 9-2 Identify psychosocial factors that can affect pharmacotherapeutics. MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings. Page Number: 96 Question 3 Type: MCSA The patient is from an Arab culture and is in labor and delivery. Her husband insists he must stay with her and will not allow her to receive any analgesia during the experience. What is the best action by the nurse? 1. Inform the husband that it is his wife's choice whether or not to receive analgesia. 2. Inform the husband that he must sign a release of responsibility to avoid future litigation against the hospital. 3. Allow the request but inform the husband that the physician will make the final decision about analgesia. 4. Allow this request and be available in the event the request changes. Correct Answer: 4 Rationale 1: With some cultures, the husband makes the choices, not the wife. Rationale 2: When cultural differences are allowed and supported, patients are not as likely to become involved in litigation. Rationale 3: With some cultures, the husband makes the choices, not the physician. Rationale 4: Nurses must allow and support cultural differences. The husband's decisions must be respected as long as patient safety is not involved, and it is not involved in this situation. Global Rationale: Nurses must allow and support cultural differences. The husband's decisions must be respected as long as patient safety is not involved, and it is not involved in this situation. With some cultures, the husband makes the choices, not the wife or the physician. When cultural differences are allowed and supported, patients are not as likely to become involved in litigation. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values. AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations. NLN Competencies: Relationship-Centered Care: Respect the patient’s dignity, uniqueness, integrity and selfdetermination, and his or her own power and self-healing process. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic outcomes. MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings. Page Number: 97 Question 4 Type: MCSA A patient is diagnosed with cancer. The physician has recommended chemotherapy, which would likely save the patient's life. The patient tells the nurse, "This is punishment from God for sins I have committed; some women at my church say so." What will the best plan of the nurse include? 1. With the patient's permission, plan to involve a hospital minister to discuss the patient's perspective about cancer. 2. With the patient's permission, plan to bring the case before the hospital's board of ethics. 3. With the patient's permission, plan to contact the patient's minister to discuss the patient's perspective about cancer. 4. With the patient's permission, plan to meet with family members to discuss the patient's perspective about cancer. Correct Answer: 3 Rationale 1: Involving a hospital minister may be an option, but it is best to work through the patient's minister initially. Rationale 2: Bringing the case before the hospital's board of ethics is premature at this point. Rationale 3: When patients have strong religious beliefs, these can affect the outcome of the illness. The nurse should involve the patient's religious leader when possible. Rationale 4: Meeting with famil