Pharmacology And The Nursing Process 10th Edition Lilley Test Bank PDF

Chapter 01: The Nursing Process and Drug Therapy Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. The nurse is developing a human needs statement for a patient who has a new diagnosis of heart failure. Identification of human needs statements occur with which of these activities? a. Collection of patient data b. Administering interventions c. Deciding on patient outcomes d. Documenting the patient‘s behavior ANS: A Identification of human needs occurs with the collection of patient data. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Human Needs Statement MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. The patient is to receive oral guaifenesin twice a day. Today, the nurse was busy and gave the medication 2 hours after the scheduled dose was due. What type of problem does this represent? a. ―Right time‖ b. ―Right dose‖ c. ―Right route‖ d. ―Right medication‖ ANS: A ―Right time‖ is correct because the medication was given more than 30 minutes after the scheduled dose was due. ―Dose‖ is incorrect because the dose is not related to the time the medication administration is scheduled. ―Route‖ is incorrect because the route is not affected. ―Medication‖ is incorrect because the medication ordered will not change. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 3. The nurse has been monitoring the patient‘s progress on a new drug regimen since the first dose and documenting the patient‘s therapeutic response to the medication. Which phase of the nursing process do these actions illustrate? a. Human needs statement b. Planning c. Implementation d. Evaluation ANS: D Monitoring the patient‘s progress, including the patient‘s response to the medication, is part of the evaluation phase. Planning, implementation, and human needs statement are not illustrated by this example. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation If you need any other Test Banks or eTextbooks contact us: [email protected] MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. The nurse is assigned to a patient who is 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 will adhere to the new insulin treatment regimen. d. The patient will demonstrate correct blood glucose testing technique. ANS: D ―Demonstrating correct blood glucose testing technique‖ is a specific and measurable outcome criterion. ―Following instructions‖ and ―not experiencing complications‖ are not specific criteria. ―Adhering to new regimen‖ would be difficult to measure. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. Which activity best reflects the implementation phase of the nursing process for the patient who is newly diagnosed with hypertension? a. Providing education on keeping a journal of blood pressure readings b. Setting goals and outcome criteria with the patient‘s input c. Recording a drug history regarding over-the-counter medications used at home d. Formulating human needs statements regarding deficient knowledge related to the new treatment regimen ANS: A Education is an intervention that occurs during the implementation phase. Setting goals and outcomes reflects the planning phase. Recording a drug history reflects the assessment phase. Formulating human needs statements reflects analysis of data as part of planning. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. The medication order reads, ―Give ondansetron 4 mg, 30 minutes before beginning chemotherapy to prevent nausea.‖ The nurse notes that the route is missing from the order. What is the nurse‘s best action? a. Give the medication intravenously because the patient might vomit. b. Give the medication orally because the tablets are available in 4-mg doses. c. Contact the prescriber to clarify the route of the medication ordered. d. Hold the medication until the prescriber returns to make rounds. ANS: C A complete medication order includes the route of administration. If a medication order does not include the route, the nurse must ask the prescriber to clarify it. The intravenous and oral routes are not interchangeable. Holding the medication until the prescriber returns would mean that the patient would not receive a needed medication. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care If you need any other Test Banks or eTextbooks contact us: [email protected] 7. When the nurse considers the timing of a drug dose, which factor is appropriate to consider when deciding when to give a drug? a. The patient‘s ability to swallow b. The patient‘s height c. The patient‘s last meal d. The patient‘s allergies ANS: C The nurse must consider specific pharmacokinetic/pharmacodynamic drug properties that may be affected by the timing of the last meal. The patient‘s ability to swallow, height, and allergies are not factors to consider regarding the timing of the drug‘s administration. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. The nurse is performing an assessment of a newly admitted patient. Which is an example of subjective data? a. Weight 155 pounds b. Pulse 72 beats/minute c. The patient reports that he uses the herbal product ginkgo d. The patient‘s complete blood count results ANS: C Subjective data include information shared through the spoken word by any reliable source, such as the patient. Objective data may be defined as any information gathered through the senses or that which is seen, heard, felt, or smelled. A patient‘s pulse, weight, and laboratory tests are all examples of objective data. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. When giving medications, the nurse will follow the rights of medication administration. The rights include the right documentation, the right reason, the right response, and the patient‘s right to refuse. Which of these are additional rights? (Select all that apply.) a. Right drug b. Right route c. Right dose d. Right diagnosis e. Right time f. Right patient ANS: A, B, C, E, F Additional rights of medication administration must always include the right drug, right dose, right time, right route, and right patient. The right diagnosis is incorrect. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Implementation If you need any other Test Banks or eTextbooks contact us: [email protected] MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control OTHER 1. Place the phases of the nursing process in the correct order, with 1 as the first phase and 5 as the last phase. a. Planning b. Evaluation c. Assessment d. Implementation e. Human needs statement ANS: C, E, A, D, B The nursing process is an ongoing process that begins with assessing and continues with human needs statement, planning, implementing, and evaluating. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: General MSC: NCLEX: Safe and Effective Care Environment: Management of Care If you need any other Test Banks or eTextbooks contact us: [email protected] Chapter 02: Pharmacologic Principles Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. The patient is receiving two different drugs. At current dosages and dosage forms, both drugs have the same concentration of the active ingredient. Which term is used to identify this principle? a. Bioequivalent b. Synergistic c. Prodrugs d. Steady state ANS: A Two drugs absorbed into the circulation in the same amount (in specific dosage forms) have the same bioavailability; thus, they are bioequivalent. A drug‘s steady state is the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed from each dose. The term synergistic refers to two drugs, given together, with a resulting effect that is greater than the sum of the effects of each drug given alone. A prodrug is an inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. When given an intravenous medication, the patient says to the nurse, ―I usually take pills. Why does this medication have to be given in the arm?‖ What is the nurse‘s best answer? a. ―The medication will cause fewer adverse effects when given intravenously.‖ b. ―The intravenous medication will have delayed absorption into the body‘s tissues.‖ c. ―The action of the medication will begin sooner when given intravenously.‖ d. ―There is a lower chance of allergic reactions when drugs are given intravenously.‖ ANS: C An intravenous (IV) injection provides the fastest route of absorption. The IV route does not affect the number of adverse effects, nor does it cause delayed tissue absorption (it results in faster absorption). The IV route does not affect the number of allergic reactions. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs? a. Parenteral drugs bypass the first-pass effect. b. Absorption of parenteral drugs is affected by reduced blood flow to the stomach. c. Absorption of parenteral drugs is faster when the stomach is empty. d. Parenteral drugs exert their effects while circulating in the bloodstream. If you need any other Test Banks or eTextbooks contact us: [email protected] ANS: A Drugs given by the parenteral route bypass the first-pass effect. Reduced blood flow to the stomach and the presence of food in the stomach apply to enteral drugs (taken orally), not to parenteral drugs. 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: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. When monitoring the patient receiving an intravenous infusion to reduce blood pressure, the nurse notes that the patient‘s blood pressure is extremely low, and the patient is lethargic and difficult to awaken. This would be classified as which type of adverse drug reaction? a. Adverse effect b. Allergic reaction c. Idiosyncratic reaction d. Pharmacologic reaction ANS: D A pharmacologic reaction is an extension of a drug‘s normal effects in the body. In this case, the antihypertensive drug lowered the patient‘s blood pressure levels too much. The other options do not describe a pharmacologic reaction. 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: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug‘s half-life? a. The time it takes for the drug to cause half of its therapeutic response b. The time it takes for one half of the original amount of a drug to reach the target cells c. The time it takes for one half of the original amount of a drug to be removed from the body d. The time it takes for 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. The other options are incorrect definitions of half-life. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these? a. The time it takes for a drug to elicit a therapeutic response b. The amount of time needed to remove a drug from circulation If you need any other Test Banks or eTextbooks contact us: [email protected] c. The time it takes for a drug to achieve its maximum therapeutic response d. The time period at which a drug‘s concentration is sufficient to cause a therapeutic response ANS: D Duration of action is the time during which drug‘s concentration is sufficient to elicit a therapeutic response. The other options do not define duration of action. A drug‘s onset of action is the time it takes for the drug to elicit a therapeutic response. A drug‘s peak effect is the time it takes for the drug to reach its maximum therapeutic response. Elimination is the length of time it takes to remove a drug from circulation. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction. Which of these processes describes selective enzyme interaction? a. The drug alters cell membrane permeability. b. The drug‘s effectiveness within the cell walls of the target tissue is enhanced. c. The drug is attracted to a receptor on the cell wall, preventing an enzyme from binding to that receptor. d. The drug binds to an enzyme molecule and inhibits or enhances the enzyme‘s action with the normal target cell. ANS: D With selective enzyme interaction, the drug attracts the enzymes to bind with the drug instead of allowing the enzymes to bind with their normal target cells. As a result, the target cells are protected from the action of the enzymes. This results in a drug effect. The actions described in the other options do not occur with selective enzyme interactions. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient‘s albumin levels are normal, the nurse would expect which result, as compared to a medication, that is not highly protein bound? a. Renal excretion will be faster. b. The drug will be metabolized quickly. c. The duration of action of the medication will be shorter. d. The duration of action of the medication will be longer. ANS: D Drugs that are bound to plasma proteins are characterized by longer duration of action. Protein binding does not make renal excretion faster, does not speed up drug metabolism, and does not cause the duration of action to be shorter. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The patient is experiencing chest pain and needs to take a buccal form of nitroglycerin. Where does the nurse instruct the patient to place the tablet? a. Under the tongue If you need any other Test Banks or eTextbooks contact us: [email protected] b. On top of the tongue c. At the back of the throat d. In the space between the cheek and the gum ANS: D Drugs administered via the buccal route are placed in the space between the cheek and the gum. Drugs administered via the sublingual route are placed under the tongue. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase? a. Absorption b. Distribution c. Metabolism d. Excretion ANS: D The kidneys are the organs that are most responsible for drug excretion. Renal function does not affect the absorption and distribution of a drug. Renal function may affect metabolism of drugs to a small extent. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient who has advanced cancer is receiving opioid medications around the clock to keep him comfortable as he nears the end of his life. Which term best describes this type of therapy? a. Palliative therapy b. Maintenance therapy c. Empiric therapy d. Supplemental therapy ANS: A The goal of palliative therapy is to make the patient as comfortable as possible. It is typically used in the end stages of illnesses when all attempts at curative therapy have failed. Maintenance therapy is used for the treatment of chronic illnesses such as hypertension. Empiric therapy is based on clinical probabilities and involves drug administration when a certain pathologic condition has an uncertain but high likelihood of occurrence based on the patient‘s initial presenting symptoms. Supplemental therapy (or replacement therapy) supplies the body with a substance needed to maintain normal function. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The patient is stating that he has a headache and asks the nurse which over-the-counter medication form would work the fastest to help reduce the pain. Which medication form will If you need any other Test Banks or eTextbooks contact us: [email protected] the nurse suggest? a. A capsule b. A tablet c. A powder d. An enteric-coated tablet ANS: C Of the types of oral medications listed, the powder form would be absorbed the fastest, thus having a faster onset. The tablet, the capsule, and, finally, the enteric-coated tablet would be absorbed next, in that order. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse will be injecting a drug into the superficial skin layers immediately underneath the epidermal layer of skin. Which route does this describe? a. Intradermal b. Subcutaneous c. Intramuscular d. Transdermal ANS: A Injections under the more superficial skin layers immediately underneath the epidermal layer of skin and into the dermal layer are known as intradermal injections. Injections into the fatty subcutaneous tissue under the dermal layer of skin are referred to as subcutaneous injections. Injections into the muscle beneath the subcutaneous fatty tissue are referred to as intramuscular injections. Transdermal drugs are applied to the skin via an adhesive patch. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. Which drugs would be affected by the first-pass effect when administered? (Select all that apply.) a. Morphine given by IV push injection b. Sublingual nitroglycerin tablet c. Diphenhydramine elixir d. Levothyroxine (Synthroid) tablet e. Transdermal nicotine patches f. Esomeprazole capsule g. Penicillin given by IV piggyback infusion ANS: C, D, F Orally administered drugs (elixirs, tablets, and capsules) undergo the first-pass effect, because they are metabolized in the liver after being absorbed into the portal circulation from the small intestine. IV medications (IV push and IV piggyback) enter the bloodstream directly and do not go directly to the liver. Sublingual tablets and transdermal patches also enter the bloodstream without going directly to the liver, thus avoiding the first-pass effect. If you need any other Test Banks or eTextbooks contact us: [email protected] DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. A drug dose that delivers 10 mg has a half-life of 5 hours. Identify how much drug will remain in the body after one half-life. ANS: 5 mg A drug‘s half-life is the time required for one half of an administered dose of a drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced by 50%. Therefore, one half of 10 mg equals 5 mg. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies If you need any other Test Banks or eTextbooks contact us: [email protected] Chapter 03: Lifespan Considerations Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. Drug transfer to the fetus is more likely during the last trimester of pregnancy for which reason? a. Decreased fetal surface area b. Increased placental surface area c. Enhanced blood flow to the fetus d. Increased amount of protein-bound drug in maternal circulation ANS: C Drug transfer to the fetus is more likely during the last trimester of pregnancy as a result of enhanced blood flow to the fetus. The other options are incorrect. Increased fetal surface area, not decreased, is a factor that affects drug transfer to the fetus. The placenta‘s surface area does not increase during this time. Drug transfer is increased because of an increased amount of free drug, not protein-bound drug, in the mother‘s circulation. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Health Promotion and Maintenance 2. The nurse is monitoring a patient who is in the 26th week of pregnancy and has developed gestational diabetes and pneumonia. She is given medications that pose a possible fetal risk, but the potential benefits may warrant the use of the medications in her situation. The nurse recognizes that these medications are in which U.S. Food and Drug Administration pregnancy safety category? a. Category A b. Category B c. Category C d. Category D ANS: D Pregnancy category D fits the description given. Category A indicates no risk to the human fetus; Category B indicates no risk to animal fetus; information for humans is not available. Category C indicates adverse effects reported in animal fetus; information for humans is not available. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 3. When discussing dosage calculation for pediatric patients with a clinical pharmacist, the nurse notes that which type of dosage calculation is used most commonly in pediatric calculations? a. West nomogram b. Clark rule c. Height-to-weight ratio d. Milligram per kilogram of body weight formula ANS: D The milligram per kilogram formula, based on body weight, is the most common method of If you need any other Test Banks or eTextbooks contact us: [email protected] calculating doses for pediatric patients. Height-to-weight ratio is not used. The other options are available methods but are not the most commonly used. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 4. The nurse is assessing a newly admitted 83-year-old patient and determines that the patient is experiencing polypharmacy. Which statement most accurately illustrates polypharmacy? a. The patient is experiencing multiple illnesses. b. The patient uses one medication for an illness several times per day. c. The patient uses over-the-counter drugs for an illness. d. The patient uses multiple medications simultaneously. ANS: D Polypharmacy usually occurs when a patient has several illnesses and takes medications for each of them, possibly prescribed by different specialists who may be unaware of other treatments the patient is undergoing. The other options are incorrect. Polypharmacy addresses the medications taken, not just the illnesses. Polypharmacy means the patient is taking several different medications, not just one, and can include prescription drugs, over-the-counter medications, and herbal products. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses in an elderly patient who is taking which type of drug? a. Laxatives b. Anticoagulants c. Sedatives d. Antidepressants ANS: C Sedatives and hypnotics often cause confusion, daytime sedation, ataxia, lethargy, forgetfulness, and increased risk for falls in the elderly. Laxatives, anticoagulants, and antidepressants may cause adverse effects in the elderly, but not the ones specified in the question. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 6. For accurate medication administration to pediatric patients, the nurse must consider which of these factors? a. Organ maturity b. Renal output c. Body temperature d. Height ANS: A To administer medications to pediatric patients accurately, one must take into account organ maturity, body surface area, age, and weight. The other options are incorrect; renal output and body temperature are not considerations, and height alone is not sufficient. If you need any other Test Banks or eTextbooks contact us: [email protected] DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 7. The nurse recognizes that an elderly patient may experience a reduction in the stomach‘s ability to produce hydrochloric acid. This change may result in which effect? a. Delayed gastric emptying b. Increased gastric acidity c. Decreased gastrointestinal motility d. Altered absorption of some drugs ANS: D Reduction in the stomach‘s ability to produce hydrochloric acid is an aging-related change that results in a decrease in gastric acidity and may alter the absorption of some drugs. The other options are not results of reduced hydrochloric acid production. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 8. The nurse is administering drugs to neonates and will consider which factor may contribute the most to drug toxicity? a. The lungs are immature. b. The kidneys are small. c. The liver is not fully developed. d. Excretion of the drug occurs quickly. ANS: C A neonate‘s liver is not fully developed and cannot detoxify many drugs. The other options are incorrect. The lungs and kidneys do not play major roles in drug metabolism. Renal excretion is slow, not fast, because of organ immaturity, but this is not the factor that contributes the most to drug toxicity. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning dosage has been double-checked and updated MSC: NCLEX: Health Promotion and Maintenance 9. An 83-year-old woman has been given a thiazide diuretic to treat heart failure. She and her caregiver should be told to watch for which problems? a. Constipation and anorexia b. Fatigue, leg cramps, and dehydration c. Daytime sedation and lethargy d. Edema, nausea, and blurred vision ANS: B Electrolyte imbalance, leg cramps, fatigue, and dehydration are common complications when thiazide diuretics are given to elderly patients. The other options do not describe complications that occur when these drugs are given to the elderly. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies If you need any other Test Banks or eTextbooks contact us: [email protected] 10. An elderly patient with a new diagnosis of hypertension will be receiving a new prescription for an antihypertensive drug. The nurse expects which type of dosing to occur with this drug therapy? a. Drug therapy will be based on the patient‘s weight. b. Drug therapy will be based on the patient‘s age. c. The patient will receive the maximum dose that is expected to reduce the blood pressure. d. The patient will receive the lowest possible dose at first, and then the dose will be increased as needed. ANS: D As a general rule, dosing for elderly patients should follow the admonition, ―Start low, and go slow,‖ which means to start with the lowest possible dose (often less than an average adult dose) and increase the dose slowly, if needed, based on patient response. The other responses are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The nurse is trying to give a liquid medication to a 2 1/2-year-old child and notes that the medication has a strong taste. Which technique is the best way for the nurse to give the medication to this child? a. Give the medication with a spoonful of ice cream. b. Add the medication to the child‘s bottle. c. Tell the child you have candy for him. d. Add the medication to a cup of milk. ANS: A Ice cream or another nonessential food disguises the taste of the medication. The other options are incorrect. If the child does not drink the entire contents of the bottle, medication is wasted and the full dose is not administered. Using the word candy with drugs may lead to the child thinking that drugs are actually candy. If the medication is mixed with a cup of milk, the child may not drink the entire cup of milk, and the distasteful drug may cause the child to refuse milk in the future. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The nurse is preparing to give an injection to a 4-year-old child. Which intervention is age appropriate for this child? a. Give the injection without any advanced preparation. b. Give the injection, and then explain the reason for the procedure afterward. c. Offer a brief, concrete explanation of the procedure at the patient‘s level and with the parent or caregiver present. d. Prepare the child in advance with details about the procedure without the parent or caregiver present. ANS: C If you need any other Test Banks or eTextbooks contact us: [email protected] For a 4-year-old child, offering a brief, concrete explanation about a procedure just beforehand, with the parent or caregiver present, is appropriate. The other options are incorrect for any age group. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity MULTIPLE RESPONSE 1. Which statements are true regarding pediatric patients and pharmacokinetics? (Select all that apply.) a. The levels of microsomal enzymes are decreased. b. Perfusion to the kidneys may be decreased and may result in reduced renal function. c. First-pass elimination is increased because of higher portal circulation. d. First-pass elimination is reduced because of the immaturity of the liver. e. Total body water content is much less than in adults. f. Gastric emptying is slowed because of slow or irregular peristalsis. g. Gastric emptying is more rapid because of increased peristaltic activity. ANS: A, B, D, F In children, first-pass elimination by the liver is reduced because of the immaturity of the liver, and microsomal enzymes are decreased. In addition, gastric emptying is reduced because of slow or irregular peristalsis. Perfusion to the kidneys may be decreased, resulting in reduced renal function. The other options are incorrect. In addition, remember that total body water content is greater in children than in adults. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 2. Which statements are true regarding the elderly and pharmacokinetics? (Select all that apply.) a. The levels of microsomal enzymes are decreased. b. Fat content is increased because of decreased lean body mass. c. Fat content is decreased because of increased lean body mass. d. The number of intact nephrons is increased. e. The number of intact nephrons is decreased. f. Gastric pH is less acidic. g. Gastric pH is more acidic. ANS: A, B, E, F In the elderly, levels of microsomal enzymes are decreased because the aging liver is less able to produce them; fat content is increased because of decreased lean body mass; the number of intact nephrons is decreased as the result of aging; and gastric pH is less acidic because of a gradual reduction of the production of hydrochloric acid. The other options are incorrect statements. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance COMPLETION If you need any other Test Banks or eTextbooks contact us: [email protected] 1. A 7-year-old child will be receiving amoxicillin (Amoxil) 50 mg/kg/day in two divided doses. The child weighs 55 pounds. The medication, once reconstituted, is available as an oral suspension of 125 mg/5 mL. Identify how many milliliters will the child receive per dose. ANS: 25 mL per dose Convert pounds to kilograms: 55 pounds = 25 kg. 25 kg  50 mg/kg/day = 1250 mg/day. To get the amount per dose, divide 1250 by 2, which equals 625 mg/dose. To calculate the milliliters: 125 mg:5 mL:: 625 mg:x mL. (125  x) = (5  625); 125x = 3125; x = 25 mL/dose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies If you need any other Test Banks or eTextbooks contact us: [email protected] Chapter 04: Cultural, Legal, and Ethical Considerations Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. During the development of a new drug, which would be included in the study by the researcher to prevent any bias or unrealistic expectations of the new drug‘s usefulness? a. A placebo b. FDA approval c. Informed consent d. Safety information ANS: A To prevent bias that may occur as a result of unrealistic expectations of an investigational new drug, a placebo is incorporated into the study. The other options are incorrect. FDA approval, if given, does not occur until after phase III. Informed consent is required in all drug studies. Safety information is not determined until the study is under way. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 2. A member of an investigational drug study team is working with healthy volunteers whose participation will help to determine the optimal dosage range and pharmacokinetics of the drug. The team member is participating in what type of study? a. Phase I b. Phase II c. Phase III d. Phase IV ANS: A Phase I studies involve small numbers of healthy volunteers to determine optimal dosage range and the pharmacokinetics of the drug. The other phases progressively involve volunteers who have the disease or ailment that the drug is designed to diagnose or treat. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. During discharge patient teaching, the nurse reviews prescriptions with a patient. Which statement is correct about refills for an analgesic that is classified as Schedule C-III? a. No prescription refills are permitted. b. Refills are allowed only by written prescription. c. The patient may have no more than five refills in a 6-month period. d. Written prescriptions expire in 12 months. ANS: C Schedule C-III medications may be refilled no more than five times in a 6-month period. The patient should be informed of this regulation. No prescription refills are permitted for Schedule C-II drugs. Requiring refills by written prescription only applies to Schedule C-II drugs. Schedule C-III prescriptions (written or oral) expire in 6 months. DIF: Cognitive Level: Remembering (Knowledge) If you need any other Test Banks or eTextbooks contact us: [email protected] TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient has been selected as a potential recipient of an experimental drug for multiple sclerosis. The nurse knows that when informed consent has been obtained, it indicates which of these? a. The patient has been informed that he or she will need to stay in the study until it ends. b. The patient will be informed of the details of the study as the research continues. c. The patient will receive the actual drug during the experiment. d. The patient has had the study‘s purpose, procedures, and possible benefits as well as risks involved explained to him. ANS: D Informed consent involves the careful explanation of the purpose of the study, the procedures to be used, and the risks involved. The other options do not describe informed consent. Participation in studies is voluntary and patients have the right to end participation at any time. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. For which cultural group must the health care provider respect the value placed on preserving harmony with nature and the belief that disease is a result of ill spirits? a. Hispanics b. Asian Americans c. Native Americans d. African Americans ANS: C Some Native Americans believe in preserving harmony with nature and that disease is a result of ill spirits. The groups listed in the other options do not typically reflect these practices. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 6. The nurse is assessing an elderly Hispanic woman who is being treated for hypertension. During the assessment, what is important for the nurse to remember about cultural aspects? a. The patient should be discouraged from using folk remedies and rituals. b. The nurse will expect the patient to value protective bracelets and ―root doctors‖ as healers. c. The nurse will remember that the balance among body, mind, and environment is important for this patient‘s health beliefs. d. The nurse‘s assessment needs to include gathering information regarding religious practices and beliefs regarding medication, treatment, and healing. ANS: D All beliefs need to be considered clearly so as to prevent a conflict from arising between the goals of nursing and health care and the dictates of a patient‘s cultural background. Assessing religious practices and beliefs is part of a thorough cultural assessment. The other options are incorrect. The nurse should not ignore a patient‘s cultural practices. The concept of balance If you need any other Test Banks or eTextbooks contact us: [email protected] among body, mind, and environment and the valuing of protective bracelets and root doctors reflect beliefs or practices that usually do not apply to the Hispanic cultural group. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 7. When reviewing the various schedules of controlled drugs, the nurse knows that which description correctly describes Schedule II drugs? a. Drugs with high potential for abuse that have accepted medical use b. Drugs with high potential for abuse that do not have accepted medical use c. Medically accepted drugs that may cause moderate physical or psychologic dependence d. Medically accepted drugs with limited potential for causing physical or psychologic dependence ANS: A Schedule II drugs are those with high potential for abuse but that have accepted medical use. Drugs that have high potential for abuse but do not have accepted medical use are Schedule I drugs. Medically accepted drugs that have moderate physical or high psychologic dependence potential are Schedule III drugs. Medically accepted drugs with limited potential for causing physical or psychologic dependence are Schedule IV and V drugs. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is reviewing facts about pharmacology for a review course. The term legend drug refers to which item? a. Over-the-counter drugs b. Prescription drugs c. Orphan drugs d. Older drugs ANS: B The term legend drug refers to prescription drugs, which were differentiated from over-the-counter drugs by the 1951 Durham-Humphrey Amendment. Orphan drugs are drugs that are developed for rare diseases. The other options are not examples of legend drugs. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. Nurses have the ethical responsibility of doing or actively promoting good. What is this principle known as? a. Justice b. Veracity c. Beneficence d. Autonomy ANS: C Veracity is defined as the duty to tell the truth. Justice is the ethical principle of being fair or equal in one‘s actions. Beneficence is the ethical principle of doing or actively promoting good. Autonomy is self-determination, or the ability to make one‘s own decisions. If you need any other Test Banks or eTextbooks contact us: [email protected] DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 10. A patient is undergoing major surgery and asks the nurse about a living will. He states, ―I don‘t want anybody else making decisions for me. And I don‘t want to prolong my life.‖ The patient is demonstrating which ethical term? a. Autonomy b. Beneficence c. Justice d. Veracity ANS: A Autonomy includes self-determination, or the ability to act on one‘s own, including making one‘s own decisions about health care. Veracity is defined as the duty to tell the truth. Justice is the ethical principle of being fair or equal in one‘s actions. Beneficence is the ethical principle of doing or actively promoting good. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 11. The nurse is reviewing a list of scheduled drugs and notes that Schedule C-I drugs are not on the list. Which is a characteristic of Schedule C-I drugs? a. No refills are permitted. b. They may be obtained over-the-counter with a signature. c. They are available only by written prescription. d. They are used only with approved protocols. ANS: D Schedule C-I drugs are used only with approved protocols. Schedule C-II drugs are available only by written prescription, and refills are not permitted. Being available over-the-counter with a signature may be true of Schedule C-V drugs in certain states. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. During a busy night shift, a new nurse administered an unfamiliar medication without checking it in a drug handbook. Later that day, the patient had a severe reaction because he has renal problems, which was a contraindication to that drug. The nurse may be liable for which of these? a. Medical negligence b. Nursing negligence c. Nonmaleficence d. Autonomy ANS: B Negligence is the failure to act in a reasonable and prudent manner or failure of the nurse to give the care that a reasonably prudent (cautious) nurse would render or use under similar circumstances. Nurses are expected to assess patients thoroughly before medications are given, and to be familiar with medications they are administering (see Box 4-2). In this case, nursing negligence applies to nurses, not medical negligence. Nonmaleficence is defined as the duty to do no harm; autonomy is defined as the right to make one‘s own decisions, or self-determination. If you need any other Test Banks or eTextbooks contact us: [email protected] DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control MULTIPLE RESPONSE 1. The nurse is reviewing the concept of drug polymorphism. Which factors contribute to drug polymorphism? (Select all that apply.) a. The number of drugs ordered by the physician b. Inherited factors c. The patient‘s diet and nutritional status d. Different dosage forms of the same drug e. The patient‘s cultural practices f. The patient‘s drug history g. The various available forms of a drug ANS: B, C, E Inherited factors, diet and nutritional status, and cultural practices are some of the factors that contribute to drug polymorphism. The other options are not factors that contribute to drug polymorphism. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is performing an admission assessment. Which findings reflect components of a cultural assessment? (Select all that apply.) a. The patient uses aspirin as needed for pain. b. The patient has a history of hypertension. c. The patient uses herbal tea to relax in the evenings. d. The patient does not speak English. e. The patient is allergic to shellfish. f. The patient does not eat pork products because of religious beliefs. ANS: A, C, D, F The past use of medicines, use of herbal treatments, languages spoken, and religious practices and beliefs are components of a cultural assessment. The other options reflect components of a general medication assessment or health history. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity If you need any other Test Banks or eTextbooks contact us: [email protected] Chapter 05: Medication Errors: Preventing and Responding Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. The nurse is reviewing medication errors. Which situation is an example of a medication error? a. A patient refuses her morning medications. b. A patient receives a double dose of a medication because the nurse did not cut the pill in half. c. A patient develops hives after having started an IV antibiotic 24 hours earlier. d. A patient complains of severe pain still present 60 minutes after a pain medication was given. ANS: B A medication error is defined as a preventable adverse drug event that involves inappropriate medication use by a patient or health care provider. The other options are not preventable. The patient‘s refusing to take medications and complaining of pain after a medication is given are patient behaviors, and the development of hives is a possible allergic reaction. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. The nurse is reviewing a list of verbal medication orders. Which is the proper notation of the dose of the drug ordered? a. Levothyroxine.75 mg b. Levothyroxine.750 mg c. Levothyroxine 0.75 mg d. Levothyroxine 0.750 mg ANS: C Levothyroxine 0.75 mg illustrates the correct notation with a leading zero before the decimal point. Omitting the leading zero may cause the order to be misread, resulting in a large drug overdose. Levothyroxine.75 mg and Levothyroxine.750 mg do not have the leading zero before the decimal point. Levothyroxine 0.750 mg has trailing zero, which also is incorrect. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. When given a scheduled morning medication, the patient states, ―I haven‘t seen that pill before. Are you sure it‘s correct?‖ The nurse checks the medication administration record and verifies that it is listed. Which is the nurse‘s best response? a. ―It‘s listed here on the medication sheet, so you should take it.‖ b. ―Go ahead and take it, and then I‘ll check with your doctor about it.‖ c. ―It wouldn‘t be listed here if it were not ordered for you!‖ d. ―Let me check on the order first before you take it.‖ ANS: D When giving medications, the nurse should always listen to and honor any concerns or doubts If you need any other Test Banks or eTextbooks contact us: [email protected] expressed by the patient. If the patient doubts an order, the nurse should check the written order and/or check with the prescriber. The other options illustrate that the nurse is not listening to the patient‘s concerns. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. During a period of time when the computerized medication order system was down, the prescriber wrote admission orders, and the nurse is transcribing them. The nurse is having difficulty transcribing one order because of the prescriber‘s handwriting. Which is the best action for the nurse to take at this time? a. Ask a colleague what the order says. b. Contact the prescriber to clarify the order. c. Wait until the prescriber makes rounds again to clarify the order. d. Ask the patient what medications he takes at home. ANS: B If a prescriber writes an order that is illegible, the nurse should contact the prescriber for clarification. Asking a colleague is not useful because the colleague did not write the order. Waiting for the prescriber to return is incorrect because it would delay implementation of the order. Asking the patient about medications is incorrect because this question will not clarify the current order written by the prescriber. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. When taking a telephone order for a medication, which action by the nurse is most appropriate? a. Verify the order with the charge nurse. b. Call back the prescriber to review the order. c. Repeat the order to the prescriber before hanging up the telephone. d. Ask the pharmacist to double-check the order. ANS: C For telephone or verbal orders, repeat the order back to the prescriber before hanging up the telephone. The other options are incorrect. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. During morning medication administration, the nurse discovered an error on the electronic MAR before the medication was given. Which action by the nurse is appropriate for this ―near-miss‖? a. Correct the MAR error but say nothing because nothing happened. b. Notify the pharmacy about the error they almost caused. c. Report the near-miss using the facility‘s recommended protocol, and correct the error on the MAR. d. Report the near-miss to the next shift before the next dose is due. ANS: C If a ―near-miss‖ occurs, report using the health care facility‘s policies and procedures for If you need any other Test Banks or eTextbooks contact us: [email protected] reporting, regardless of whether an error occurred. The other responses are not appropriate actions. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. When reviewing pediatric medication administration, the nurse recognizes that which type of medication error is most common with children? a. Oral medication administration errors b. Wrong route errors c. Incorrect dosage form errors d. Dosing errors ANS: D The most common medication errors in pediatrics are dosing errors. The other responses are possible, but are not the most common medication errors in pediatrics. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control MULTIPLE RESPONSE 1. The nurse can prevent medication errors by following which principles? (Select all that apply.) a. Assess for allergies after giving medications. b. Use two patient identifiers before giving medications. c. Always following the rights of medication administration. d. Minimize the use of verbal and telephone orders. e. Use trade names instead of generic names to avoid confusion. ANS: B, C, D Measures that prevent medication errors include using two patient identifiers, minimizing the use of verbal and telephone orders, and always following the rights of medication administration. Assessment for allergies should be done before medications are given. Generic names should be used to avoid the many sound-alike trade names of medications. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential COMPLETION 1. Levothyroxine is available in 88-mcg tablet form. Convert this dose to milligram strength. (do not round) ANS: 0.088 mg One mg equals 1000 mcg. To convert 88 mcg to mg, divide 88 by 1000 to equal 0.088 mg, or If you need any other Test Banks or eTextbooks contact us: [email protected] move the decimal point to the left three spaces. Do not forget to include the leading zero in front of the decimal point. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. Digoxin is available in 0.25-mg tablet form. Convert this dose to microgram strength. (do not round) ANS: 250 mcg One mg equals 1000 mcg. To convert 0.25 mg to mcg, multiply by 1000 to equal 250 mcg, or move the decimal point to the right three spaces. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies If you need any other Test Banks or eTextbooks contact us: [email protected] Chapter 06: Patient Education and Drug Therapy Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. The nurse is reviewing the teaching plan for a clinic patient who was seen for a sinus infection. Which of these outcomes reflect the affective domain of learning? a. The patient will take the prescribed antibiotic for the full 14 days of the prescription. b. The patient will demonstrate correct nasal spray self-administration. c. The patient will list signs and symptoms that need to be reported immediately if they occur. d. The patient will list measures to take to reduce allergy triggers at home. ANS: A The affective domain is the most intangible component of the learning process. Affective behavior is conduct that expresses feelings, needs, beliefs, values, and opinions. Adhering to the prescribed medication regimen is an example of the affective domain. Demonstrating nasal spray self-administration reflects the psychomotor domain; listing signs and symptoms or measures to take both reflect the cognitive domain. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. The nurse is developing a care plan for a patient who will be self-administering a metered-dose inhaler. Which statement reflects a measurable outcome? a. The patient will know about self-administration of a metered-dose inhaler. b. The patient will understand the principles of self-administration of a metered-dose inhaler. c. The patient will demonstrate the proper technique of self-administering a metered-dose inhaler. d. The patient will comprehend the proper technique of self-administering a metered-dose inhaler. ANS: C The word demonstrate is a measurable verb, and measurable terms should be used when developing goals and outcome criteria statements. The other options are incorrect because the terms know, understand, and comprehend are not measurable terms. If you need any other Test Banks or eTextbooks contact us: [email protected] DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. During a nursing assessment, which question by the nurse allows for greater clarification and additional discussion with the patient? a. ―Are you allergic to iodine?‖ b. ―What type of reaction did you have to penicillin?‖ c. ―Have you had a reaction to this drug?‖ d. ―Are you taking this medication with meals?‖ ANS: B Asking ―What type of reaction did you have?‖ is an open-ended question that will encourage greater clarification and additional discussion with the patient. The other options are examples of closed-ended questions, which prompt only a ―yes‖ or ―no‖ answer and provide limited information. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. The nurse is setting up a teaching session with an 85-year-old patient who will be going home on anticoagulant therapy. Which educational strategy would reflect consideration of the age-related changes that may exist with this patient? a. Show a video about anticoagulation therapy. b. Present all the information in one session just before discharge. c. Give the patient pamphlets about the medications to read at home. d. Develop large-print handouts that reflect the verbal information presented. ANS: D Developing large-print handouts addresses altered perception in two ways. First, by using If you need any other Test Banks or eTextbooks contact us: [email protected] visual aids to reinforce verbal instructions, one addresses the possibility of decreased ability to hear high-frequency sounds. By developing the handouts in large print, one addresses the possibility of decreased visual acuity. Showing a video does not allow discussion of the information; furthermore, the text and print may be small and difficult to read and understand. Presenting all the information in one session before discharge also does not allow for discussion, and the patient may not be able to hear or see the information sufficiently. Because of the possibility of decreased short-term memory and slowed cognitive function, simply giving pamphlets to read without other teaching strategies may not be appropriate. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 5. When the nurse teaches a skill such as self-injection of insulin to the patient, what is the best way to set up the teaching/learning session? a. Provide written pamphlets for instruction. b. Show a video, and allow the patient to practice as needed on his own. c. Verbally explain the procedure, and provide written handouts for reinforcement. d. After demonstrating the procedure, allow the patient to do several return demonstrations. ANS: D Return demonstration allows the nurse to evaluate the patient‘s newly learned skills. The techniques in the other options are incorrect because those suggestions do not allow for evaluation of the patient‘s technique. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A patient with a new prescription for a diuretic has just reviewed with the nurse how to include more potassium in her diet. This reflects learning in which domain? a. Cognitive b. Affective If you need any other Test Banks or eTextbooks contact us: [email protected] c. Physical d. Psychomotor ANS: A The cognitive domain refers to problem-solving abilities and may involve recall and knowledge of facts. The affective domain refers to values and beliefs. The term physical does not refer to one of the learning domains. The psychomotor domain involves behaviors such as learning how to perform a procedure. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. During an admission assessment, the nurse discovers that the patient does not speak English. Which is considered the ideal resource for translation? a. A family member of the patient b. A close family friend of the patient c. A translator who does not know the patient d. Prewritten note cards with both English and the patient‘s language ANS: C The nurse should communicate with the patient in the patient‘s native language if at all possible. If the nurse is not able to speak the patient‘s native language, a translator should be made available so as to prevent communication problems, minimize errors, and help boost the patient‘s level of trust and understanding of the nurse. In practice, this translator may be another nurse or health care professional, a nonprofessional member of the health care team, or a layperson, family member, adult friend, or religious leader or associate. However, it is best to avoid family members as translators, if possible, because of issues with bias, misinterpretation, and potential confidentiality issues. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation If you need any other Test Banks or eTextbooks contact us: [email protected] MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. A 60-year-old patient is on several new medications and expresses worry that she will forget to take her pills. Which action by the nurse would be most helpful in this situation? a. Teaching effective coping strategies b. Asking the patient‘s prescriber to reduce the number of drugs prescribed c. Assuring the patient that she will not forget once she is accustomed to the routine d. Assisting the patient with obtaining and learning to use a calendar or pill container ANS: D Calendars, pill containers, or diaries may be helpful to patients who may forget to take prescribed drugs as scheduled. The nurse must ensure that the patient knows how to use these reminder tools. Teaching coping strategies is a helpful suggestion but will not help with remembering to take medications. Asking the prescriber to reduce the number of drugs that are prescribed is not an appropriate action by the nurse. Assuring the patient that she will not forget is false reassurance by the nurse and inappropriate when education is needed. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential MULTIPLE RESPONSE 1. Which are appropriate considerations when the nurse is assessing the learning needs of a patient? (Select all that apply.) a. Cultural background b. Family history c. Level of education d. Readiness to learn e. Health beliefs If you need any other Test Banks or eTextbooks contact us: [email protected] ANS: A, C, D, E Family history is not a part of what the nurse considers when assessing learning needs. The other options are appropriate to consider when the nurse is assessing learning needs. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. The nurse is teaching an older patient about the use of an incentive spirometer after surgery. Which of these age-related changes are appropriate for the nurse to consider when teaching older patients? (Select all that apply.) a. Decreased sense of touch b. Increased conduction of sound c. Decreased cognitive function d. Decreased short-term memory e. Increased ability to concentrate ANS: A, C, D Age-related changes in older adults that may affect learning include a decreased sense of touch, decreased cognitive function, and decreased short-term memory. Sound conduction and ability to concentrate are also decreased. Refer to Table 6-1. DIF: Cognitive Level: Analyzing (Analysis) TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity COMPLETION 1. A patient is to receive prednisone 7.5 mg PO daily. The tablets are available in a 2.5-mg strength. Identify how many tablets will the patient receive. ANS: 3 tablets If you need any other Test Banks or eTextbooks contact us: [email protected] 1 tablet:2.5 mg::x tablet:7.5 mg. (1 7.5) = (2.5 x); 7.5 = 2.5x; x = 3; therefore 7.5 mg = 3 tablets. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies If you need any other Test Banks or eTextbooks contact us: [email protected] Chapter 07: Over-the-Counter Drugs and Herbal and Dietary Supplements Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go ―natural‖ with her pregnancy. She shows the nurse a list of herbal remedies that she wants to buy so that she can ―avoid taking any drugs.‖ Which statement by the nurse is correct? a. ―Most herbal remedies are not harmful and are safe for use during pregnancy.‖ b. ―Please read each label carefully before use to check for cautionary warnings.‖ c. ―Keep in mind that products from different manufacturers are required to contain consistent amounts of the herbal products.‖ d. ―It‘s important to remember that herbal remedies do not have proven safety ratings for pregnant women.‖ ANS: D The fact that a drug is an herbal or a dietary supplement does not mean that it can be safely administered to children, infants, or pregnant or lactating women. Many herbal products have not been tested for safety during pregnancy. Simply reading the labels may not provide enough information for use during pregnancy. Last, manufacturers of herbal products are not required to guarantee the reliability of the contents. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 2. The nurse is giving a lecture about current U.S. laws and regulations of herbal products. According to the United States Dietary Supplement and Health Education Act of 1994, which statement is true? If you need any other Test Banks or eTextbooks contact us: [email protected] a. Medicinal herbs are viewed as dietary supplements. b. Herbal remedies are held to the same standards as drugs. c. Producers of herbal products must prove therapeutic efficacy. d. Herbal remedies are protected by patent laws. ANS: A Current U.S. laws view herbal products as dietary supplements and do not hold them to the same efficacy standards as drugs. The other options do not correctly reflect current U.S. laws regarding herbal supplements. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The patient wants to take the herbal product kava to help him rest at night. The nurse would be concerned about potential interactions if he is taking a medication from which class of drugs? a. Digitalis b. Anticoagulants c. Sedatives d. Immunosuppressants ANS: C Kava may cause increased central nervous system depression if used with sedatives. Digitalis, anticoagulants, and immunosuppressants do not have interactions with kava. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential If you need any other Test Banks or eTextbooks contact us: [email protected] 4. The patient has been taking an over-the-counter (OTC) acid-reducing drug because he has had ―stomach problems‖ for several months. He tells the nurse that the medicine helps as long as he takes it, but once he stops it, the symptoms return. Which statement by the nurse is the best advice for this patient? a. ―The over-the-counter drug has helped you, so you should continue to take it.‖ b. ―The over-the-counter dosage may not be strong enough. You should be taking prescription-strength for best effects.‖ c. ―For best results, you need to watch what you eat in addition to taking this drug.‖ d. ―Using this drug may relieve your symptoms, but it does not address the cause. Please make an appointment with your health care provider.‖ ANS: D The use of OTC drugs may postpone effective management of chronic disease states and may delay treatment of serious or life-threatening disorders because these drugs may relieve symptoms without necessarily addressing the cause of the disorder. The other options do not address the need to investigate the cause of the symptoms and are incorrect. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. During an assessment, the patient tells the nurse that he takes a garlic supplement for its cardiovascular benefits. Which drug or drug class, if taken, would have a potential interaction with the garlic? a. Acetaminophen (Tylenol) b. Insulin c. Antilipemic drugs d. Sedatives ANS: B If you need any other Test Banks or eTextbooks contact us: [email protected] The use of garlic may interfere with hypoglycemic drugs. The other options are incorrect because acetaminophen, antilipemic drugs, and sedatives do not have interactions with garlic. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 6. A patient calls the clinic to ask about taking cranberry dietary supplement capsules because a friend recommended them. The nurse will discuss which possible concern when a patient is taking cranberry supplements? a. It may increase the risk for bleeding if the patient is taking anticoagulants. b. It may increase the risk of toxicity of some psychotherapeutic drugs. c. It may reduce elimination of drugs that are excreted by the kidneys. d. Cranberry may increase the intensity and duration of effects of caffeine. ANS: C The use of cranberry decreases the elimination of many drugs that are renally excreted. The other concerns do not occur with cranberry supplements. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 7. A patient wants to take the herb gingko to help his memory. The nurse reviews his current medication list and would be concerned about potential interactions if he is taking a medication from which class of drugs? a. Digitalis b. Antiplatelet drugs c. Sedatives d. Immunosuppressants ANS: B If you need any other Test Banks or eTextbooks contact us: [email protected] The use of gingko increases the risk of bleeding with antiplatelet drugs (aspirin, clopidogrel) and anticoagulants (warfarin, heparin). The other concerns do not occur with gingko supplements. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential MULTIPLE RESPONSE 1. The nurse is conducting a class for senior citizens about the use of over-the-counter (OTC) drugs. Which statements are true regarding the use of OTC drugs? (Select all that apply.) a. Use of OTC drugs may delay treatment of serious ailments. b. Drug interactions with OTC medications are rare. c. OTC drugs may relieve symptoms without addressing the cause of the problem. d. OTC drugs are indicated for long-term treatment of conditions. e. Patients may misunderstand product labels and use the drugs improperly. ANS: A, C, E It is true that use of OTC drugs may delay treatment of serious ailments; OTC drugs may relieve symptoms without addressing the cause of the problem, and patients may misunderstand product labels and use the drugs improperly. These statements should be included when teaching patients about their use. In contrast, drug interactions with OTC medications are not rare and may indeed occur with prescription medications and other OTC drugs. Normally, OTC drugs are intended for short-term treatment of minor ailments. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is reviewing the criteria for over-the-counter drugs. Which criteria for over-the-counter status in the United States are accurate? (Select all that apply.) If you need any other Test Banks or eTextbooks contact us: [email protected] a. The drug must be easy to use. b. The drug must have a low therapeutic index. c. The consumer must be able to monitor the drug‘s effectiveness. d. The drug must have a low potential for abuse. e. The drug must not have any interactions with other drugs. ANS: A, C, D In the United States, criteria for over-the-counter status include the drug being easy to use, the drug having a low potential for abuse, and the consumer must be able to monitor the drug‘s effectiveness for the condition. The drug must have a high therapeutic index (not a low one), and the drug must have limited interactions with other drugs. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. A patient with a PEG tube is to receive ferrous sulfate, 75 mg per the tube, daily. The medication is available as an elixir, 220 mg/5 mL. How many milliliters will the patient receive per dose? Record your answer using one decimal place. ANS: 1.7 mL 220 mg:5 mL::75 mg:x mL (220 x) = (5 75); 220x = 375; x = 1.704 which rounds to 1.7 mL/dose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies If you need any other Test Banks or eTextbooks contact us: [email protected] Chapter 08: Gene Therapy and Pharmacogenomics Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. The nurse is reviewing the applications of gene therapy. Which drug is manufactured as a result of indirect gene therapy? a. Vitamin K b. Warfarin c. Human insulin d. Heparin ANS: C A recombinant form of human insulin is one of the most widespread uses of indirect gene therapy. Other examples include hormones, vaccines, antitoxins, and monoclonal antibodies. The other options listed are not examples of drugs manufactured by indirect gene therapy. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is discussing gene therapy in a continuing education class. Which is the best definition of eugenics? a. The use of gene therapy to prevent disease b. The development of new drugs based on gene therapy c. Intentional selection, before birth, of genotypes that are considered more desirable than others d. The determination of genetic factors that influence a person‘s response to medications ANS: C If you need any other Test Banks or eTextbooks contact us: [email protected] Eugenics is the intentional selection of genotypes, before birth, that are considered more desirable than others, and it is a major ethical issue concerning gene therapy. The other options do not describe eugenics. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 3. The nurse is explaining the Human Genome Project to colleagues. Which of these is the main purpose of the Human Genome Project? a. The study of genetic diseases b. The study of genetic traits in humans c. The discovery new genetic diseases d. To describe the entire genome of a human being ANS: D The Human Genome Project was undertaken to describe in detail the entire genome of a human being. The other options do not describe the Human Genome Project. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. A patient has just been told that she has the genetic markers for a severe type of breast cancer. After the patient meets with the physician, the patient‘s daughter asks the nurse, ―What did the doctor tell my mother? She seems upset.‖ What is the nurse‘s best response? a. ―I‘m sorry, but I‘m not allowed to discuss that.‖ b. ―The physician will discuss this with you.‖ c. ―It seems that your mother has the genetic markers for a type of breast cancer.‖ d. ―This is information that your mother will need to discuss with you.‖ ANS: D If you need any other Test Banks or eTextbooks contact us: [email protected] Maintaining privacy and confidentiality is of utmost importance during genetic testing and counseling. The patient (not the nurse or the physician) is the one who decides whether to include or exclude any family members from the discussion and from knowledge of the results of genetic testing. Telling the patient‘s daughter that you are ―not allowed‖ to discuss the matter would cause more anxiety. Telling the daughter about the genetic markers would be a violation of the patient‘s privacy. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The nurse is asking a patient about his family history as part of an assessment. Which component is included in an effective family history? a. Asking the patient about the current and past health status of the patient‘s children b. Covering at least three generations of family history c. Obtaining a family history of the patient‘s spouse d. Asking about the family history for the patient‘s siblings and parents only ANS: B The family history is most effective if it covers at least three generations and includes the current and past health status of each family member. The other options are incorrect. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 6. The nurse is reviewing principles of genetics. Which of these is a long strand of DNA that is contained within the nuclei of cells? a. Gene b. Allele c. Genome d. Chromosome If you need any other Test Banks or eTextbooks contact us: [email protected] ANS: D A chromosome is a long strand of DNA that is contained in the nuclei of cells. DNA molecules, in turn, act as the template for the formation of RNA molecules, from which proteins are made. The other answers are incorrect. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. The nurse is asking a patient about his drug history, and the patient states, ―Whenever I take any strong pain medications, I usually sleep for hours. I have no idea why that happens!‖ The nurse considers that which of these is true about this patient‘s statement? a. The patient is exaggerating about a normal side effect of pain medications. b. The patient‘s reaction to pain medications may point to a difference in his ability to metabolize certain drugs. c. The patient will need higher doses of medication for pain control. d. The patient should never receive strong pain medications. ANS: B It is important to inquire about any unusual reactions to a drug—on the part of the patient, family members, significant others, and/or caregivers. An unusual or other than expected reaction to a drug in family members may point to a difference in the patient‘s ability to metabolize certain drugs. Genetic factors may alter a patient‘s metabolism of a particular drug, resulting in either increased or decreased drug action. The other statements are not correct. DIF: Cognitive Level: Analyzing (Analysis) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control MULTIPLE RESPONSE If you need any other Test Banks or eTextbooks contact us: [email protected] 1. The nurse is performing an assessment of a patient. Which assessment findings may indicate a higher risk for genetic disorders? (Select all that apply.) a. The patient‘s father was diagnosed with heart disease at 60 years of age. b. The patient‘s mother was diagnosed with breast cancer at 33 years of age. c. The patient‘s grandfather died of a cerebral vascular accident at 78 years of age. d. The patient‘s sister has a history of both renal and lung cancer. e. The patient has two uncles and a grandparent who have been diagnosed with Alzheimer‘s disease. ANS: B, D, E The nurse should assess for factors that may indicate a risk for genetic disorders. A few examples of factors that may indicate a risk for genetic disorders are a higher incidence of a particular disease or disorder in the patient‘s family than in the general population; diagnosis of a disease in family members at an unusually young age; or diagnosis of a family member with an unusual form of cancer or with more than one type of cancer. The options regarding heart disease at 60 years of age and cerebral vascular accident at 78 years of age are not factors that indicate a higher risk for genetic disorders. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 2. The nurse is preparing a class on gene therapy for a group of students. Which statements about gene therapy are true? (Select all that apply.) a. The FDA must review and approve all human clinical genetic trials. b. Gene therapy may involve creating new genes within a human. c. Gene therapy may involve replacing a mutated gene with a healthy copy of the gene. d. Some trials involve introducing a new gene into the body to help fight disease. e. Gene therapy may include inactivating a mutated gene that is not functioning properly. If you need any other Test Banks or eTextbooks contact us: [email protected] ANS: A, C, D, E Gene therapy may include: Replacing a mutated gene with a healthy copy of the gene; introducing a new gene into the body to help fight a disease; inactivating a mutated gene that is functioning improperly. In addition, the FDA must review and approve all human clinical genetic trials. Gene therapy does not include creating new genes. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Physiological Adaptation COMPLETION 1. A patient will be receiving famotidine 20 mg at bedtime. A liquid form is ordered because the patient cannot swallow pills or capsules; the concentration of the liquid is 40 mg/5 mL. How many milliliters will the patient receive per dose? ANS: 2.5 mL per dose 40 mg:5 mL::20 mg:x mL (40 x) = (5 20); 40x = 100; x = 2.5 mL/dose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies If you need any other Test Banks or eTextbooks contact us: [email protected] Chapter 09: Photo Atlas of Drug Administration Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. Before administering any medication, what is the nurse‘s priority action regarding patient safety? a. Verifying orders with another nurse b. Documenting the medications given c. Counting medications in the medication cart drawers d. Checking the patient‘s identification using two identifiers ANS: D Verifying the patient‘s identity, using two identifiers, before administering any medication is essential for the patient‘s safety and reflects checking one of the ―Nine Rights‖ of medication administration. Documentation is done after the medications are given. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 2. The nurse is giving an intradermal (ID) injection and will choose which syringe for this injection? a. b. c. d. PRIMEXAM.COM If you need any other Test Banks or eTextbooks contact us: [email protected] ANS: B The proper size syringe for ID injection is a 1-mL tuberculin. The other syringes pictured are incorrect. Insulin syringes (marked in units) are not used for intradermal injections. DIF: Cognitive Level: Analyzing (Analysis) TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 3. A patient is to receive a penicillin intramuscular (IM) injection in the ventrogluteal site. The nurse will use which angle for the needle insertion? a. 15 degrees b. 45 degrees c. 60 degrees d. 90 degrees ANS: D The proper angle for IM injections is 90 degrees. The other angles are incorrect. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. When administering medication by IV bolus (push), the nurse will occlude the IV line by which method? a. Injecting the bolus without pinching the tubing b. Pinching the tubing just above the injection port c. Pinching the tubing just below the injection port d. Pinching the tubing just above the drip chamber of the infusion set If you need any other Test Banks or eTextbooks contact us: [email protected] ANS: B Before a medication is injected by IV push, the IV line is occluded by pinching the tubing just above the injection port. The other locations are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse has an order to administer an intramuscular (IM) immunization to a 2-month-old child. Which site is considered the best choice for this injection? a. Deltoid b. Dorsogluteal c. Ventrogluteal d. Vastus lateralis ANS: D The vastus lateralis is the preferred site of injection of drugs such as immunizations for infants. The other sites are not appropriate for infants. The ventrogluteal site is the preferred site for adults and children. The deltoid site is used only for the administration of immunizations to toddlers, older children, and adults (not infants) and only for small volumes of medication. The dorsogluteal site is no longer recommended because of the possibility of nerve injury. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse needs to administer insulin subcutaneously to an obese patient. Which is the proper technique for this injection? a. Using the Z-track method b. Inserting the needle at a 5- to 15-degree angle until resistance is felt c. Pinching the skin at the injection site, and then inserting the needle to below the tissue fold at a 90-degree angle d. Spreading the skin tightly over the injection site, inserting the needle, and then If you need any other Test Banks or eTextbooks contact us: [email protected] releasing the skin ANS: C The proper technique for a subcutaneous injection for an obese patient is to pinch the skin at the injection site and inject the needle to below the skin fold at a 90-degree angle. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse will plan to use the Z-track method of intramuscular (IM) injections for which situation? a. The medication is known to be irritating to tissues. b. The patient is emaciated and has very little muscle mass. c. The medication must be absorbed quickly into the tissues. d. The patient is obese and has a deep fat layer below the muscle mass. ANS: A The Z-track method is used for medications known to irritate tissues or for medications that are painful or cause stains to the tissues. It also prevents the deposit of medication into more sensitive subcutaneous tissues. The other options are not appropriate situations for the Z-track method. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 8. After administering an intradermal (ID) injection for a skin test, the nurse notices a small bleb at the injection site. Which of these is the best action for the nurse to take at this time? a. Apply heat. b. Massage the area. c. Do nothing. d. Report the bleb to the physician. If you need any other Test Banks or eTextbooks contact us: [email protected] ANS: C The formation of a small bleb is expected after an ID injection for skin testing. The other actions are not appropriate. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The nurse is administering an IV push medication through an IV lock. After injecting the medication, which action will be taken next? a. Flushing the lock b. Regulating the IV flow c. Clamping the tubing for 10 minutes d. Holding the patient‘s arm up to improve blood flow ANS: A IV locks are to be flushed before and after each use; either heparin or saline flush is used, depending on the individual facility‘s policy. The other actions are not appropriate. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. When adding medications to a bag of intravenous (IV) fluid, the nurse will use which method to mix the solution? a. Shaking the bag or bottle vigorously b. Turning the bag or bottle gently from side to side c. Inverting the bag or bottle one time after injecting the medication d. Allowing the IV solution to stand for 10 minutes to enhance even distribution of medication If you need any other Test Banks or eTextbooks contact us: [email protected] ANS: B When medications are added to IV fluid containers, the medication and the IV solution are mixed by holding the bag or bottle and turning it end-to-end, mixing it gently. Shaking vigorously is not appropriate; inverting the bag just once or simply allowing the bag to stand for 10 minutes may not be sufficient to mix the medication into the fluid. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The nurse is measuring 4 mL of a liquid cough elixir for a child. Which method is most appropriate? a. Using a teaspoon to measure and administer

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