TEST BANK Claytons Basic Pharmacology for Nurses 19th Edition PDF

Chapter 01: Drug Definitions, Standards, and Information Sources Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which name identifies a drug listed by the US Food and Drug Administration (FDA)? a. Brand b. Nonproprietary c. Official d. Trademark ANS: C The official name is the name under which a drug is listed by the FDA. The brand name, or trademark, is the name given to a drug by its manufacturer. The nonproprietary, or generic, name is provided by the United States Adopted Names Council. DIF: Cognitive Level: Knowledge REF: p. 9 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Patient Education 2. Which source contains information specific to nutritional supplements? a. USP Dictionary of USAN & International Drug Names b. Natural Medicines Comprehensive Database c. United States Pharmacopoeia/National Formulary (USP NF) d. Drug Interaction Facts ANS: C United States Pharmacopoeia/National Formulary contains information specific to nutritional supplements. USP Dictionary of USAN & International Drug Names is a compilation of drug names, pronunciation guide, and possible future FDA approved drugs; it does not include nutritional supplements. Natural Medicines Comprehensive Database contains evidence-based information on herbal medicines and herbal combination products; it does not include information specific to nutritional supplements. Drug Interaction Facts contains comprehensive information on drug interaction facts; it does not include nutritional supplements. DIF: Cognitive Level: Knowledge REF: p. 4 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Nutrition | Patient Education 3. Which drug reference contains drug monographs that describe all drugs in a therapeutic class? a. Drug Facts and Comparisons b. Drug Interaction Facts c. Handbook on Injectable Drugs d. Martindale—The Complete Drug Reference ANS: A Drug Facts and Comparisons contains drug monographs that describe all drugs in a therapeutic class. Monographs are formatted as tables to allow comparison of similar products, brand names, manufacturers, cost indices, and available dosage forms Online version is available. DIF: Cognitive Level: Knowledge REF: p. 4 Table 1.2 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Safety | Patient Education | Clinical Judgment 4. Which drug reference contains monographs about virtually every single-entity drug available in the United States and describes therapeutic uses of drugs, including approved and unapproved uses? a. Martindale: The Complete Drug Reference b. AHFS Drug Information c. Drug Reference d. Drug Facts and Comparisons ANS: B AHFS Drug Information contains monographs about virtually every single-entity drug available in the United States and describes therapeutic uses of drugs, including approved and unapproved uses. DIF: Cognitive Level: Knowledge REF: p. 4 Table 1.2 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Safety | Patient Education | Clinical Judgment 5. Which online drug reference makes available to healthcare providers and the public a standard, comprehensive, up-to-date look up and downloadable resource about medicines? a. American Drug Index b. American Hospital Formulary c. DailyMed d. Drug Reference ANS: C DailyMed makes available to healthcare providers and the public a standard, comprehensive, up-to-date look up and downloadable resource about medicines. The American Drug Index is not appropriate for patient use. The American Hospital Formulary is not appropriate for patient use. The drug reference is not appropriate for patient use. DIF: Cognitive Level: Knowledge REF: p. 3 | p. 4 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Safety | Patient Education | Clinical Judgment 6. Which legislation authorizes the FDA to determine the safety of a drug before its marketing? a. Federal Food, Drug, and Cosmetic Act (1938) b. Durham Humphrey Amendment (1952) c. Controlled Substances Act (1970) d. Kefauver Harris Drug Amendment (1962) ANS: A The Federal Food, Drug, and Cosmetic Act of 1938 authorized the FDA to determine the safety of all drugs before marketing. Later amendments and acts helped tighten FDA control and ensure drug safety. The Durham Humphrey Amendment defines the kinds of drugs that cannot be used safely without medical supervision and restricts their sale to prescription by a licensed practitioner. The Controlled Substances Act addresses only controlled substances and their categorization. The Kefauver Harris Drug Amendment ensures drug efficacy and greater drug safety. Drug manufacturers are required to prove to the FDA the effectiveness of their products before marketing them. DIF: Cognitive Level: Knowledge REF: p. 5 Table l.3 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Safety | Patient Education | Evidence | Health Care Law 7. Which classification does meperidine (Demerol) fall under? a. I b. II c. III d. IV ANS: B Meperidine (Demerol) is a Schedule II drug; it has a high potential for abuse and may lead to severe psychological and physical dependence. Schedule I drugs have high potential for abuse and no recognized medical use. Schedule III drugs have some potential for abuse. Use may lead to low to moderate physical dependence or high psychological dependence. Schedule IV drugs have low potential for abuse. Use may lead to limited physical or psychological dependence. DIF: Cognitive Level: Knowledge REF: p. 10 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Patient Education | Addiction | Pain 8. Which action would the FDA take to expedite drug development and approval for an outbreak of smallpox? a. List smallpox as a health orphan disease. b. Omit the preclinical research phase. c. Extend the clinical research phase. d. Fast track the investigational drug. ANS: D Once the Investigational New Drug Application has been approved, the drug can receive highest priority within the agency, which is called fast tracking. A smallpox outbreak would become a priority concern in the world. Orphan diseases are not researched in a priority manner. Preclinical research is not omitted. Extending any phase of the research would mean a longer time to develop a vaccine. The FDA must ensure that all phases of the preclinical and clinical research phase have been completed in a safe manner. DIF: Cognitive Level: Knowledge REF: p. 7 OBJ: 5 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Health Care Law | Health Care Policy | Infection | Care Coordination 9. Which statement is true about over-the-counter (OTC) drugs? a. They are not listed in the USP NF. b. A prescription from a healthcare provider is needed. c. They are sold without a prescription. d. They are known only by their brand names. ANS: C OTC medications do not require a prescription. A variety of names, both generic and trade, can be used for individual drugs sold OTC. OTC drugs are listed in the USP NF. Prescription drugs require an order by a health professional who is licensed to prescribe, such as a physician, nurse practitioner, physician assistant, or dentist. DIF: Cognitive Level: Comprehension REF: p. 2 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Patient Education 10. Which is the most authoritative reference for medications that are injected? a. Martindale: The Complete b. Handbook on Injectable Drugs c. DailyMed d. Handbook of Nonprescription Drugs ANS: B The Handbook on Injectable Drugs is the most comprehensive reference available on the topic of compatibility of injectable drugs. It is a collection of monographs for more than 300 injectable drugs that are listed alphabetically by generic name. DIF: Cognitive Level: Knowledge REF: p. 4 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 11. Which statement is true about Lomotil? a. Abuse potential for this drug is low. b. Psychological dependency is likely. c. There is a high potential for abuse. d. This drug is not a controlled substance. ANS: A Lomotil, a Schedule V drug, has an abuse potential of limited physical or psychological dependence liability compared with drugs in Schedule IV. Because abuse potential is low with a Schedule V drug, a prescription may not be required. Psychological dependency is not likely with a Schedule V drug. Schedule V drugs are classified as controlled substances. DIF: Cognitive Level: Knowledge REF: p. 5 Box 1.1 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education 12. Which medication ordered for a patient with a substance abuse history has the greatest risk for abuse? a. Lomotil b. Diazepam c. Phenobarbital d. Lortab ANS: D Lortab is a Schedule III drug with a high potential for abuse but less so than drugs in Schedules I and II. Lomotil is a Schedule V drug with a low potential for abuse compared with those in Schedule V. Diazepam is a Schedule IV drug with a low potential for abuse compared with those in schedule III. Phenobarbital is a Schedule IV drug with a low potential for abuse compared with those in Schedule III. DIF: Cognitive Level: Application REF: p. 5 Box 1.1 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Addiction | Patient Education | Safety 13. An older adult experiencing shortness of breath is brought to the hospital by her daughter. While obtaining the medication history from the patient and her daughter, the nurse discovers that neither has a list of the patient‘s current medications or prescriptions. The patient has is a weekly pill dispenser that contains four different pills. The prescriptions are filled through the local pharmacy. Which resource would be appropriate to use in determining the medication names and doses? a. Martindale—The Complete Drug Reference b. Drugs and Facts Comparisons c. Senior citizens‘ center d. Patient‘s home pharmacy ANS: D The patient‘s pharmacy would have an accurate account of all the medications the client is currently taking. Martindale—The Complete Drug Reference has written information on medications and would not be an appropriate resource. Drugs and Facts Comparisons contains drug monographs that describe all drugs in a therapeutic class but would not help identify medications by photograph. The senior citizens‘ center is not likely to have specific patient medication information. DIF: Cognitive Level: Application REF: p. 2 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Care Coordination | Safety | Patient Education | Clinical Judgment MULTIPLE RESPONSE 1. Which statement(s) will be included when planning patient teaching regarding drug names? (Select all that apply.) a. Most drug companies place their products on the market under generic names. b. The official name is the name under which the drug is listed by the US Food and Drug Administration (FDA). c. Brand names are easier to pronounce, spell, and remember. d. The first letter of the generic name is not capitalized. e. The chemical name is most meaningful to the patient. ANS: B, C, D The official name is the name under which the drug is listed by the FDA. Brand names are easier to pronounce, spell, and remember. The first letter of the generic name is not capitalized. Most drug companies place their products on the market under brand names instead of generic names. The chemical name is most meaningful to the chemist. DIF: Cognitive Level: Comprehension REF: p. 2 | p. 9 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Patient Education | Clinical Judgment | Safety 2. Which drug(s) would be considered to be in the category Schedule II? (Select all that apply.) a. Marijuana b. Percodan c. Amphetamines d. Fiorinal e. Flurazepam ANS: B, C Schedule II drugs have a high potential for abuse, they are currently accepted in the United States, and use may lead to severe psychological or physical dependence. Percodan and amphetamines are considered Schedule II drugs. Marijuana is a Schedule I drug. Fiorinal is a Schedule III drug. Flurazepam is a Schedule IV drug. DIF: Cognitive Level: Comprehension REF: p. 5 Box 1.1 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Addiction | Clinical Judgment | Patient Education Chapter 02: Basic Principles of Drug Action and Drug Interactions Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. Which priority action should be implemented when hives are assessed on a patient started on a new medication? a. Notify physician of allergic reaction. b. Notify physician of idiosyncratic reaction. c. Notify physician of potential teratogenicity. d. Notify physician of potential tolerance. ANS: A An allergic reaction is indicative of hypersensitivity and manifests with hives and/or urticaria, which are easily identified. An idiosyncratic reaction occurs when something unusual or abnormal happens when a drug is first administered. A teratogenic reaction refers to the occurrence of birth defects related to administration of the drug. Tolerance refers to the body‘s requirement for increasing dosages to achieve the same effects that a lower dose once did. DIF: Cognitive Level: Application REF: p. 17 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 2. The nurse administers an initial dose of a steroid to a patient with asthma. Thirty minutes after administration, the nurse finds the patient agitated and stating that ―everyone is out to get me.‖ Which term is used for this unusual reaction? a. Desired action b. Adverse effect c. Idiosyncratic reaction d. Allergic reaction ANS: C Idiosyncratic reactions are unusual, abnormal reactions that occur when a drug is first administered. Patients typically exhibit an overresponsiveness to a medication related to diminished metabolism. These reactions are believed to be related to genetic enzyme deficiencies. Desired actions are expected responses to a medication. Adverse effects are reactions that occur in another system of the body; they are usually predictable. Allergic reactions appear after repeated medication dosages. DIF: Cognitive Level: Knowledge REF: p. 18 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Patient Education | Clinical Judgment | Caregiving | Safety | Sensory Perception 3. Which is the best description of when drug interactions occur? a. On administration of toxic dosages of a drug b. On an increase in the pharmacodynamics of bound drugs c. On the alteration of the effect of one drug by another drug d. On increase of drug excretion ANS: C Drug interactions may be characterized by an increase or decrease in the effectiveness of one or both of the drugs. Toxicity of one drug may or may not affect the metabolism of another one. Drug interactions may result from either increased or decreased pharmacodynamics. Drug interactions may result from either increased or decreased excretion. DIF: Cognitive Level: Comprehension REF: p. 18 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Safety | Patient Education | Clinical Judgment 4. Which term describes when two drugs compete for the same receptor site, resulting in increased activity of the first drug? a. Desired action b. Synergistic effect c. Carcinogenicity d. Displacement ANS: D The displacement of the first drug from receptor sites by a second drug increases the amount of the first drug because more unbound drug is available. An expected response of a drug is the desired action. A synergistic effect is the effect of two drugs being greater than the effect of each chemical individually or the sum of the individual effects. Carcinogenicity is the ability of a drug to cause cells to mutate and become cancerous. DIF: Cognitive Level: Knowledge REF: p. 19 OBJ: 6 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Safety | Patient Education 5. What do drug blood levels indicate? a. They confirm if the patient is taking a generic form of a drug. b. They determine if the patient has sufficient body fat to metabolize the drug. c. They verify if the patient is taking someone else‘s medications. d. They determine if the amount of drug in the body is in a therapeutic range. ANS: D The amount of drug present may vary over time and the blood level must remain in a therapeutic range in order to obtain the desired result. Generic drugs do not necessarily produce a different drug blood level than proprietary medications. Body fat is not measured by drug blood levels. Drug blood levels only measure the amount of drug in the body; they do not determine the source of the medication. DIF: Cognitive Level: Comprehension REF: p. 17 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety 6. What is the process by which a drug is transported by circulating body fluids to receptor sites? a. Osmosis b. Distribution c. Absorption d. Biotransformation ANS: B Distribution refers to the ways in which drugs are transported by the circulating body fluids to the sites of action (receptors), metabolism, and excretion. Osmosis is the process of moving solution across a semipermeable membrane to equalize the dilution on each side. Absorption is the process by which a drug is transferred from its site of entry into the body to the circulating fluids for distribution. Biotransformation, also called metabolism, is the process by which the body inactivates drugs. DIF: Cognitive Level: Knowledge REF: p. 15 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Patient Education | Clinical Judgment | Safety 7. Which blood level is assessed to determine the amount of circulating medication in a patient? a. Peak b. Trough c. Drug d. Therapeutic ANS: C When a drug is circulating in the blood, a blood sample may be drawn and assayed to determine the amount of drug present; this is known as the drug blood level. Peak levels are only those drug blood levels that are at their maximum before metabolism starts to decrease the amount of circulating drug. Trough levels are only those drug blood levels that are at their minimum when metabolism has decreased the amount of circulating drug and before an increase caused by a subsequent dose of the medication. Therapeutic levels are only those within a prescribed range of blood levels determined to bring about effective action of the medication. DIF: Cognitive Level: Knowledge REF: p. 17 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Patient Education | Clinical Judgment | Safety 8. The nurse administers 50 mg of a drug at 6:00 AM that has a half-life of 8 hours. What time will it be when 25 mg of the drug has been eliminated from the body? a. 8:00 AM b. 11:00 AM c. 2:00 PM d. 6:00 PM ANS: C Fifty percent of the medication, or 25 mg, will be eliminated in 8 hours, or at 2:00 PM. 8:00 AM is 2 hours after administration; the half-life is 8 hours. 11:00 AM is 4 hours after administration; the half-life is 8 hours. 6:00 PM is 12 hours after administration; the half-life is 8 hours. DIF: Cognitive Level: Analysis REF: p. 16 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety | Elimination | Health Promotion 9. What will the nurse need to determine first in order to mix two drugs in the same syringe? a. Absorption rate of the drugs b. Compatibility of the drugs c. Drug blood level of each drug d. Medication adverse effects ANS: B Knowledge of absorption is important but not in order to mix drugs. In order to mix two drugs, compatibility is determined so there is no deterioration when the drugs are mixed in the same syringe. Drug level does not indicate if it is acceptable to mix medications in the same syringe. Adverse effects are important for the nurse to know but not in order to mix drugs. DIF: Cognitive Level: Application REF: p. 19 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 10. A patient developed hives and itching after receiving a drug for the first time. Which instruction by the nurse is accurate? a. Stop the medication and encourage the patient to wear a medical alert bracelet that explains the allergy. b. Explain to the patient that these are signs and symptoms of an anaphylactic reaction. c. Emphasize to the patient the importance to inform medical personnel that in the future a lower dosage of this drug is necessary. d. Instruct the patient that it would be safe to take the drug again because this instance was a mild reaction. ANS: A This initial allergic reaction is mild, and the patient is more likely to have an anaphylactic reaction at the next exposure; a medical alert bracelet is necessary to explain the reaction. Signs and symptoms of an anaphylactic reaction are respiratory distress and cardiovascular collapse. A more severe reaction will occur at the next exposure, and the patient should not receive the drug again. DIF: Cognitive Level: Application REF: p. 18 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Patient Education | Clinical Judgment | Safety 11. Which assessment data would the nurse identify as having the most effect on drug metabolism? a. History of liver disease b. Intake of a vegetarian diet c. Sedentary lifestyle d. Teacher as an occupation ANS: A Liver enzyme systems are the primary site for metabolism of drugs. Intake of a vegetarian diet may affect absorption but not metabolism. Sedentary lifestyle and occupations could affect metabolism (exposure to environmental pollutants), but these do not have the most significant effect on metabolism. DIF: Cognitive Level: Comprehension REF: p. 15 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education | Clinical Judgment | Safety 12. A physician‘s order indicates to administer a medication to the patient via the percutaneous route. Which route will the nurse anticipate the patient will receive this medication? a. Intramuscularly b. Subcutaneously c. Topically d. Rectally ANS: C The percutaneous route refers to drugs that are absorbed through the skin and mucous membranes. Methods of the percutaneous route include inhalation, sublingual (under the tongue), or topical (on the skin) administration. The parenteral route bypasses the gastrointestinal (GI) tract by using subcutaneous (subcut), intramuscular (IM), or intravenous (IV) injection. The parenteral route bypasses the GI tract by using subcut, IM, or IV injection. In the enteral route, the drug is administered directly into the GI tract by the oral, rectal, or nasogastric route. DIF: Cognitive Level: Comprehension REF: p. 14 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Patient Education | Clinical Judgment | Safety 13. Which medication should not be administered with tetracycline? a. Ativan b. Tylenol c. Colace d. Mylanta ANS: D Administering tetracycline with Mylanta can provide an antagonistic effect that will result in decreased absorption of the tetracycline. Ativan, Tylenol, and Colace are not contraindicated to administer with tetracycline. DIF: Cognitive Level: Comprehension REF: p. 18 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Patient Education | Clinical Judgment | Safety MULTIPLE RESPONSE 1. Which statement(s) about liberation of drugs is/are true? (Select all that apply.) a. A drug must be dissolved in body fluids before it can be absorbed into body tissues. b. A solid drug taken orally must disintegrate and dissolve in GI fluids to allow for absorption into the bloodstream for transport to the site of action. c. The process of converting the drug into a soluble form can be controlled to a certain degree by the dosage form. d. Converting the drug to a soluble form can be influenced by administering the drug with or without food in the patient‘s stomach. e. Elixirs take longer to be liberated from the dosage form. ANS: A, B, C, D Regardless of the route of administration, a drug must be dissolved in body fluids before it can be absorbed into body tissues. Before a solid drug taken orally can be absorbed into the bloodstream for transport to the site of action, it must disintegrate and dissolve in the GI fluids and be transported across the stomach or intestinal lining into the blood. The process of converting a drug into a soluble form can be partially controlled by the pharmaceutical dosage form used (e.g., solution, suspension, capsules, and tablets with various coatings). The conversion process can also be influenced by administering the drug with or without food in the patient‘s stomach. Elixirs are already drugs dissolved in a liquid and do not need to be liberated from the dosage form. DIF: Cognitive Level: Comprehension REF: p. 14 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Patient Education | Clinical Judgment | Safety 2. Which are routes of drug excretion? (Select all that apply.) a. GI tract, feces b. Genitourinary (GU) tract, urine c. Lymphatic system d. Circulatory system, blood/plasma e. Respiratory system, exhalation ANS: A, B, E The GI system is a primary route for drug excretion. The GU and the respiratory systems do function in the excretion of drugs. The lymphatic and circulatory systems are involved with drug distribution, not drug excretion. DIF: Cognitive Level: Knowledge REF: p. 15 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education | Clinical Judgment | Safety | Elimination 3. Which route(s) enable(s) drug absorption more rapidly than the subcut route? (Select all that apply.) a. IV route b. IM route c. Inhalation/sublingual d. Intradermal route e. Enteral route ANS: A, B, C IV route of administration enables drug absorption more rapidly than the subcut route. IM route of administration enables drug absorption more rapidly because of greater blood flow per unit weight of muscle. Inhalation/sublingual route of administration enables drug absorption more rapidly than the subcut route. Intradermally administered drugs are absorbed more slowly because of the limited available blood supply in the dermis. Enterally administered drugs are absorbed more slowly because of the biotransformation process. DIF: Cognitive Level: Knowledge REF: p. 14 OBJ: 1 | 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Patient Education | Clinical Judgment | Safety 4. Which factor(s) contribute(s) to digoxin toxicity in a 92-year-old patient? (Select all that apply.) a. Taking the medication with meals b. Prolonged half-life of the drug digoxin c. Impaired renal function d. Diminished mental capacity ANS: B, C Impaired renal and hepatic function in older adults impairs metabolism and excretion of drugs, thus prolonging the half-life of a medication. Food would decrease the absorption of the drug. Diminished mental capacity does not contribute to drug toxicity unless it is due to administration errors. DIF: Cognitive Level: Comprehension REF: p. 15 OBJ: 2 | 3 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Patient Education | Clinical Judgment | Safety 5. Which statement(s) about variables that influence drug action is/are true? (Select all that apply.) a. An older adult will require increased dosage of a drug to achieve the same therapeutic effect as that seen in a younger person. b. Body weight can affect the therapeutic response of a medication. c. Chronic smokers may metabolize drugs more rapidly than nonsmokers. d. A patient‘s attitude and expectations affect the response to medication. e. Reduced circulation causes drugs to absorb more rapidly. ANS: B, C, D Body weight can affect response to medications; typically, obese patients require an increase in dosage and underweight patients a decrease in dosage. Chronic smoking enhances metabolism of drugs. Attitudes and expectations play a major role in an individual‘s response to drugs. Older adults require decreased dosages of drugs to achieve a therapeutic effect. Decreased circulation causes drugs to absorb more slowly. DIF: Cognitive Level: Comprehension REF: p. 17 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Patient Education | Clinical Judgment | Safety 6. Which factor(s) affect(s) drug actions? (Select all that apply.) a. Teratogenicity b. Age c. Body weight d. Metabolic rate e. Illness ANS: B, C, D, E Age, body weight, metabolic rate, and illness may contribute to a variable response to a medication. Teratogenicity does not contribute to a variable response to a medication. DIF: Cognitive Level: Knowledge REF: p. 17 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education | Clinical Judgment | Safety COMPLETION 1. A patient receives 200 mg of a medication that has a half-life of 12 hours. How many mg of the drug would remain in the patient‘s body after 24 hours? ANS: 50 The half-life is defined as the amount of time required for 50% of the drug to be eliminated from the body. If a patient is given 200 mg of a drug that has a half-life of 12 hours, then 50 mg of the drug would remain in the body after 24 hours. DIF: Cognitive Level: Analysis REF: p. 16 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety Chapter 03: Drug Action Across the Life Span Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. What time will the trough blood level need to be drawn if the nurse administers the intravenous medication dose at 9:00 AM? a. 6:30 AM b. 8:30 AM c. 9:30 AM d. 11:30 AM ANS: B Trough blood levels measure the lowest blood level of medicine and are obtained just before the dose is administered. In this case, 6:30 AM is too early to obtain the blood level. The other two times occur after the medication is administered. DIF: Cognitive Level: Application REF: p. 28 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety 2. What will the nurse expect the healthcare provider‘s order to be when starting an older adult patient on thyroid hormone replacement therapy? a. Administering a loading dose of the drug b. Directions on how to taper the drug c. A dosage that is one-third to one-half of the regular dosage d. A dosage that is double the regular dosage ANS: C To prevent toxicity, dosages for new medications in older adults should be one-third to one-half the amount of a standard adult dosage. Loading doses of drugs could cause severe toxicity. Tapering off is characteristic of discontinuation of medications and is not appropriate for this situation. Older adults generally need a lower medication dosage than younger patients. DIF: Cognitive Level: Comprehension REF: p. 31 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education | Development 3. Which drugs cause birth defects? a. Teratogens b. Carcinogens c. Metabolites d. Placebos ANS: A Teratogens are drugs that cause birth defects. Carcinogens cause cancer. Metabolites are the end product of metabolism. Placebos are drugs that have no pharmacologic activity. DIF: Cognitive Level: Knowledge REF: p. 31 OBJ: 5 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education | Development 4. Which life-threatening illness may occur as a result of aspirin (salicylate) administration during viral illness to patients younger than 20 years of age? a. Anaphylactic shock b. Reye‘s syndrome c. Chickenpox d. Influenza A ANS: B Children are susceptible to Reye‘s syndrome if they ingest aspirin at the time of or shortly after a viral infection of chickenpox or influenza. Anaphylactic shock is caused by a hypersensitivity reaction. Chickenpox is the result of being infected with a virus. Influenza A is caused by a pathogen. DIF: Cognitive Level: Knowledge REF: p. 30 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education | Development 5. Which classification of medications commonly causes allergic reactions in children? a. Antacids b. Analgesics c. Antibiotics d. Anticonvulsants ANS: C Antibiotics, especially penicillins, commonly cause allergic reactions in children. Intravenous antibiotics can cause rapid reactions; therefore, the pediatric patient‘s response to a medication should be assessed and monitored closely. Antacids rarely cause allergic reactions. Children are not particularly allergic to analgesics or anticonvulsants. DIF: Cognitive Level: Knowledge REF: p. 29 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education | Development 6. Which patient statement indicates the need for further teaching after giving instructions to an expectant mother about taking medications during pregnancy? a. ―I will not take herbal medicines during pregnancy.‖ b. ―For morning sickness, I will try crackers instead of taking a drug.‖ c. ―If I get a cold, I will avoid taking nonprescription medications until I check with my physician.‖ d. ―I will limit my alcohol intake to only one glass of wine weekly.‖ ANS: D Alcohol needs to be eliminated during pregnancy and for 2 to 3 months prior to conception. Limited studies are available regarding the use of herbal medications in general, and thus they should be avoided during pregnancy. Alternative nonpharmacologic treatments are appropriate to use during morning sickness. The pregnant woman should also avoid using nonprescription drugs because few data are available about safe use in pregnancy. Because few medicines can be considered completely safe for use in pregnancy, the physician needs to approve and recommend the use of nonprescription drugs. DIF: Cognitive Level: Application REF: p. 34 OBJ: 6 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education 7. When is the ideal time for a nursing mother to take her own medications? a. Before the infant latches on to begin to breastfeed. b. As soon as the mother wakes up in the morning. c. Right before the mother goes to sleep at night. d. As soon as the infant finishes breastfeeding. ANS: D Taking medications after breastfeeding reduces the amount of the medication that will reach the baby. Medications taken directly before breastfeeding may have a high concentration in the milk and possibly pass on to the baby. The mother must take into consideration when her medications are ordered to be taken and schedule them around breastfeeding. DIF: Cognitive Level: Comprehension REF: p. 34 OBJ: 6 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education 8. Which age-related change would affect transdermal drug absorption in geriatric patients the most? a. Difficulty swallowing b. Diminished kidney function c. Changes in pigmentation d. Altered circulatory status ANS: D The decreased circulation that occurs with aging will affect transdermal drug absorption. Difficulty swallowing would not affect transdermal drugs being absorbed. Kidney function affects drug excretion. Changes in pigmentation would not affect transdermal drug absorption. DIF: Cognitive Level: Comprehension REF: p. 25 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education | Development 9. Which intervention would be considered to reduce accumulation of a drug in a patient who has decreased liver function? a. Decreasing the time interval between dosages b. Reducing the dosage c. Administering the medication intravenously d. Changing the drug to one that has a longer half-life ANS: B Dosages must be reduced to prevent accumulation. Decreasing the time interval between dosages would increase the accumulation of the drug. The intravenous route has the fastest absorption and with liver dysfunction would increase the accumulation of the drug. A similar drug with a longer half-life would stay in the system longer; with impaired liver function, the result would be increased accumulation. DIF: Cognitive Level: Comprehension REF: p. 26 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Safety | Patient Education | Health Promotion 10. Which explanation by the nurse is most helpful when teaching an elderly patient with difficulty swallowing about medications? a. ―Enteric coated tablets can be crushed and taken with applesauce.‖ b. ―Tablets that are scored can be broken in half.‖ c. ―Medications labeled ‗SR‘ can be crushed.‖ d. ―Avoid taking medications in liquid form.‖ ANS: B It is acceptable to break scored tablets in half to facilitate swallowing of the medication. Enteric coated tables should never be crushed because of the effect on the absorption rate and potential for toxicity. Medications labeled ―SR‖ indicate ―sustained release‖ and should not be crushed because of the effect on the absorption rate. Medication in liquid form may be easier to swallow. DIF: Cognitive Level: Application REF: p. 31 OBJ: 4 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education 11. Which blood level determines the lowest amount of medication present in the patient? a. Peak b. Serum c. Therapeutic d. Trough ANS: D The lowest amount of a medication in the blood is the trough. The peak is the highest amount of medication in the blood. Serum level identifies the amount of medication present. Therapeutic levels identify the range in which a medication is effective. DIF: Cognitive Level: Knowledge REF: p. 28 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 12. Which patient would the nurse identify as having the lowest rate of absorption of enteral medications? a. A 5-year-old boy b. An 18-year-old woman c. A 55-year-old man d. An 85-year-old woman ANS: A Males‘ stomachs empty more rapidly; children have increased motility, resulting in decreased absorption time. As one gets older, gastrointestinal (GI) motility is decreased, allowing for increased absorption time; women have slower gastric emptying, resulting in more time for absorption. Males‘ stomachs empty more rapidly; however, as one gets older, GI motility is decreased, resulting in an increase in absorption time. As one gets older, GI motility is decreased, allowing for increased absorption time; women have slower gastric emptying, resulting in more time for absorption. DIF: Cognitive Level: Comprehension REF: p. 24 | p. 25 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Development 13. What is the definition of cumulative effect of a drug? a. Drug toxicity related to overmedication b. Drug buildup related to decreased metabolism c. The inability to control the ingestion of drugs d. The need for higher dosage to produce the same effect as previous lower dosages ANS: B Cumulative effects are related to diminished metabolism or excretion of a drug that causes it to accumulate. Cumulative effects can lead to drug toxicity. Toxicity occurs when adverse effects are severe. Inability to control the ingestion of drugs is drug dependence. The need for higher dosage to produce the same effect as previous lower dosages is the definition of tolerance. DIF: Cognitive Level: Knowledge REF: p. 24 | p. 25 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 14. Which patient, when compared with the general population, would require a larger dose or more frequent administration of a drug to attain a therapeutic response? a. A 29 year old who has been diagnosed with kidney failure b. A 35-year-old obese male who is being evaluated for an exercise program c. A 52 year old diagnosed with hypothyroidism and decreased metabolic rate d. A 72 year old with decreased circulatory status ANS: B An obese individual would require a larger dose of a drug to attain a therapeutic response. An individual with kidney failure would require less medication because of decreased excretory ability. Individuals with decreased metabolic rate would metabolize drugs more slowly and require smaller doses or less frequent administration. Individuals with decreased circulation would require less medication. DIF: Cognitive Level: Comprehension REF: p. 22 | p. 23 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Health Promotion 15. Which action should the nurse implement when a resident in a long-term care facility reports difficulty swallowing enteric coated aspirin and asks the nurse to crush it prior to administration? a. Crush the tablet and mix with applesauce. b. Encourage the resident to swallow the tablet with a full glass of water. c. Hold the medication and notify the physician. d. Substitute a regular aspirin for the enteric coated tablet. ANS: C The medication should be held and the physician notified. The physician has the authority to determine how to proceed in this situation. Enteric coated tablets should not be crushed because this will increase the absorption rate and the potential for toxicity. Geriatric patients may have difficulty swallowing and are at risk for choking and aspiration. They should not be encouraged to swallow medications if they report difficulty swallowing. The physician must determine if a substitution can be ordered. Prescribing is not in the nurse‘s scope of practice. DIF: Cognitive Level: Application REF: p. 25 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education MULTIPLE RESPONSE 1. One of the prescribed medications for a 36-week gestational age baby girl is a topical water-soluble medication to be applied to the perineum daily to treat an inflammatory rash. Which considerations is the nurse aware of before medication administration? (Select all that apply.) a. Age of the client b. Location of topical application c. Increased intestinal transit rate d. Condition of the skin e. Gastric pH of 8 ANS: A, B, D The premature infant‘s outer layer of skin is not fully developed, although it is more hydrated, which will enhance the absorption of the topical water-soluble medication. Neonates often wear diapers, which will act as an occlusive dressing, thereby increasing absorption. The client‘s inflammatory condition will increase the absorption of medication. The intestinal transit rate increases as the newborn matures. This is irrelevant when a medication is applied topically. Gastric pH would not factor into metabolism of a medication that is applied topically. DIF: Cognitive Level: Comprehension REF: p. 25 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Development 2. The nurse is caring for a 4-month-old child who is on a water-soluble medication for seizures. The child‘s mother voices concern that the dosage seems ―too much‖ for the child‘s age and would like the dosage verified. What actions will the nurse take? (Select all that apply.) a. Verify dosage requirements in the Physicians’ Desk Reference (PDR) in mg/kg. b. Compare the water composition requirements of adults and children. c. Evaluate lean body mass and total fat content in adults and infants. d. Chart ―refused per mother‖ on the MAR and do not administer. e. Compare transportation in the circulation of plasma bound proteins between adults and children. ANS: A, B The PDR lists the recommended dosages for all age-groups. Because dilution may vary among age-groups, the water concentration should be verified prior to administration. As we age, lean body mass and total body water decrease while total fat content increases; however, this drug is not fat soluble. The nurse is responsible for administering the medication as ordered after verifying that it is correct; the mother is asking for verification, not refusal of administration. Drugs that are relatively insoluble are transported in the circulation by being bound to plasma proteins; however, this drug is water soluble. DIF: Cognitive Level: Application REF: p. 29 | p. 30 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education | Development 3. Which reason(s) explains why elderly patients are at increased risk for drug interactions and toxicity? (Select all that apply.) a. Higher incidence of malnourishment b. Renal function is enhanced c. Increased use of multiple medications d. Hepatic function is reduced e. Issues with swallowing ANS: A, C, D Older adult patients have an increased incidence of malnourishment, are often on multiple medications, and have reduced hepatic function, all of which put them at increased risk for drug interactions and toxicity. Renal function diminishes in the elderly as a result of decreased renal blood flow, reduced cardiac output, loss of glomeruli, and diminished tubular function and concentrating ability. Older adults have swallowing difficulties, leading to compliance issues, but taking drugs less often would not result in toxicity. DIF: Cognitive Level: Comprehension REF: p. 30 | p. 31 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education | Development 4. Which patient(s) require(s) special considerations for medication administration? (Select all that apply.) a. A 29-year-old pregnant woman b. A 2-month-old baby c. An 18-year-old college student d. A 45-year-old farmer e. An 82-year-old retired nurse ANS: A, B, E Drug therapy during pregnancy should be avoided. Recommendations by the provider are necessary during any stage of pregnancy. Pediatric and elderly patients are affected by differences in muscle mass and blood flow to muscles, as well as other physiologic systems. Teenagers and adult patients do not typically require special considerations for medication administration. DIF: Cognitive Level: Comprehension REF: p. 22-24 OBJ: 3 | 6 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Safety | Development 5. Which factor(s) in a patient would influence GI absorption of medications? (Select all that apply.) a. Stomach pH b. Level of consciousness c. Fever d. Blood flow to gastric mucosa e. Weight f. Body surface area ANS: A, D Absorption by passive diffusion across the membranes depends on the pH of the environment. Increased blood flow to gastric mucosa increases absorption of medication and decreases time of absorption. Drug absorption does not depend on the mental status of the patient. Fever does not affect drug absorption. The patient‘s absolute weight and body surface area do not affect drug absorption, although problems associated with weight greater than or less than normal may be a factor in the process. DIF: Cognitive Level: Comprehension REF: p. 24 | p. 25 | p. 28 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety 6. When receiving a report on a new admission from the emergency room, the nurse learns that the patient is newly diagnosed with renal failure. Which medication(s) in the patient‘s medication history will require dosage adjustment by the physician? (Select all that apply.) a. Lithium b. Tobramycin c. Atenolol d. Quinidine e. Ampicillin ANS: A, B, C, D, E Lithium, tobramycin, atenolol, quinidine, and ampicillin are all select medications that require dosage adjustment in renal failure. DIF: Cognitive Level: Comprehension REF: p. 27 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Patient Education 7. Which information should be relayed when providing prenatal education at a maternal family child clinic? (Select all that apply.) a. Herbal medicines are considered safe. b. Limit tobacco consumption to less than two cigarettes per day. c. Encourage a folic acid supplement. d. One alcoholic beverage per day is acceptable in the last trimester. e. Encourage nonpharmacologic treatments for symptoms such as nausea. ANS: C, E Good nutrition with appropriate ingestion of vitamins (especially folic acid) is particularly important during pregnancy to prevent birth defects. Before using medicines, pregnant women should be encouraged to try nonpharmacologic treatments. Herbal medicines that have not been scientifically tested in women during pregnancy should be avoided. Advise against the use of tobacco. Mothers who smoke have a higher frequency of miscarriage, stillbirths, premature births, and low-birth-weight infants. Consumption of alcohol should be eliminated 2 to 3 months before planned conception, as well as during pregnancy. DIF: Cognitive Level: Application REF: p. 31 | p. 32 OBJ: 6 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education Chapter 04: The Nursing Process and Pharmacology Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. What is the primary purpose of the nursing assessment? a. Identifying underlying pathologic conditions b. Assisting the physician in identifying medical conditions c. Determining the patient‘s mental status d. Exploring patient responses to health problems ANS: D A nursing assessment is done to identify the patient‘s response to health problems. During the nursing assessment phase, a comprehensive information base is developed through a physical examination, nursing history, medication history, and professional observation. Identifying underlying pathologic conditions and assisting the physician in identifying medical conditions is not part of the nursing process. Determining the patient‘s mental status is one part of the nursing assessment, but it is not the primary purpose. DIF: Cognitive Level: Comprehension REF: p. 39 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Health Promotion | Care Coordination | Collaboration 2. What is the basis of the NANDA-I taxonomy? a. Functional health patterns b. Human response patterns c. Basic human needs d. Pathophysiologic needs ANS: B The NANDA-I taxonomy identifies human response patterns. Functional components of health patterns are limited to activity, fluid volume, nutrition, self-care, and sensory perception. Basic human needs comprise less than merely health patterns. Pathophysiologic needs are not part of the scope of NANDA-I. DIF: Cognitive Level: Knowledge REF: p. 40 | p. 41 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Diagnosis CON: Clinical Judgment | Health Promotion 3. Which task is included in the assessment step of the nursing process? a. Establishing patient goals/outcomes b. Implementing the nursing care plan (NCP) c. Measuring goal/outcome achievement d. Collecting and communicating data ANS: D Data are collected and communicated in the assessment phase of the nursing process. Establishing goals is the function of planning. Implementing the NCP is the function of implementation. Measuring outcome achievement is the function of evaluation. DIF: Cognitive Level: Comprehension REF: p. 39 OBJ: 2 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment 4. Which statement regarding nursing diagnoses is accurate? a. Nursing diagnoses remain the same for as long as the disease is present. b. Nursing diagnoses are written to identify disease states. c. Nursing diagnoses describe patient problems that nurses treat. d. Nursing diagnoses identify causes related to illness. ANS: C Diagnostic statements identify problems a nurse is independently able to treat within the scope of professional practice. Nursing diagnoses vary with the changing condition of the patient. The response patterns are unique to the patient and are not disease specific. Nursing diagnoses describe the patient‘s human response pattern. DIF: Cognitive Level: Comprehension REF: p. 41 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Diagnosis CON: Clinical Judgment 5. Which phase of the nursing process occurs when the nurse analyzes data and identifies certain major and minor defining characteristics then relate them to a particular patient problem? a. Assessment b. Diagnosis c. Planning d. Evaluation ANS: B The nurse analyzes the data collected during the assessment phase This analysis determines which data is important to act on and which data is to be monitored. The nurse may conclude that certain actual problems are present and identifies them with a nursing diagnosis. Planning occurs after the patient has been assessed and problems have been diagnosed concluding with plans being formed to meet patient needs. Evaluation involves the nurse determining whether the expected outcomes were met. DIF: Cognitive Level: Knowledge REF: p. 41 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Health Care Organizations 6. Which type of nursing diagnosis will be written when the patient exhibits factors that make him or her susceptible to the development of a problem? a. Actual diagnosis b. Risk diagnosis c. Possible diagnosis d. Wellness diagnosis ANS: B When patients have the potential or risk for a problem to develop, a risk diagnosis is written. These diagnoses are two-part statements such as risk for falls related to unsteady gait. An actual diagnosis consists of a NANDA diagnostic label, contributing factor (if known), and defining characteristics such as signs and symptoms. A possible nursing diagnosis identifies a problem that may occur, but the assembled data are insufficient to confirm it. A wellness diagnosis applies to individuals for whom an enhanced level of wellness is possible. DIF: Cognitive Level: Comprehension REF: p. 41 OBJ: 3 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Diagnosis CON: Health Promotion 7. Which outcome statement identified by the nurse is written correctly? a. After surgery, patient will express acceptance of loss of breast. b. Patient will die with dignity. c. At the end of the shift, the nurse will determine whether the patient is more comfortable. d. Within the next 8 hours, urine output will be greater than 30 mL/hr. ANS: D The statement, ―Within the next 8 hours, urine output will be greater than 30 mL/hr‖ is patient oriented, realistic, and measurable, and has an appropriate time frame. DIF: Cognitive Level: Application REF: p. 42 | p. 43 OBJ: 6 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 8. Which is an example of an interdependent nursing action? a. Assess lung sounds every 4 hours. b. Educate the patient about the prescribed medication. c. Administer Demerol 50 mg intramuscularly (IM) every 4 hours PRN. d. Encourage the patient to express feelings. ANS: C ―Administer Demerol 50 mg IM every 4 hours PRN‖ requires the nurse to follow the parameters of the order, yet use nursing judgment to determine how often the medication is to be administered; therefore, it is an interdependent nursing action. Assessing lung sounds, educating the patient about medication, and encouraging the patient to express feelings are independent nursing actions. DIF: Cognitive Level: Application REF: p. 44 OBJ: 8 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment 9. What is the nurse‘s primary source of information when obtaining a patient history? a. The physician b. The patient record c. The family d. The patient ANS: D The focus of the nursing process is the patient. Although family members contribute to the nursing history, this information is secondhand. It is important that the nurse continue to assess patient data for validation of this information. The physician is not to be relied on to provide information about a complete patient history. The patient record reflects only recorded past information and not current input that may be relevant. The family may provide information about a patient history if the patient is unable to provide it, but the information is subject to interpretation by someone other than the patient. DIF: Cognitive Level: Knowledge REF: p. 39 | p. 40 OBJ: 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Clinical Judgment 10. An obese patient did not meet the goal of ―by the end of the second week, is able to follow a 1500 calorie diet.‖ What will the nurse and the patient reassess? a. Patient‘s weight b. Patient‘s understanding of the 1500 calorie diet c. Nurse‘s feelings about obese patients d. Healthcare agency‘s ability to provide the prescribed diet ANS: B When goals are not met, the nurse must reassess the patient‘s understanding of the interventions and commitment to reaching the identified goal. All phases of the nursing process are ongoing as the nurse continues to evaluate, assess, and readjust interventions as indicated to facilitate patient achievement of outcomes. The patient may have followed the diet but not lost any weight. The nurse‘s feelings should not be a factor in the assessment. The agency‘s ability to provide the prescribed diet should have been determined before implementation of the plan. DIF: Cognitive Level: Analysis REF: p. 42 | p. 43 OBJ: 1 | 6 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education 11. What is a critical care pathway? a. Nursing care plan for a patient in a critical care unit b. Standardized care plan derived from best practice patterns c. Care plan that has been critiqued by a quality improvement officer d. Care plan based on measurable goals and outcomes ANS: B A critical care pathway is a standardized care plan derived from best practice patterns, enabling the nurse to develop a treatment plan that sequences detailed clinical interventions to be performed over a projected amount of time for a specific case type of disease process. A nursing care plan for a patient in a critical care unit is not a critical care pathway. A care plan that has been critiqued by a quality improvement officer is not a critical care pathway. All good care plans are based on measurable goals and outcomes. DIF: Cognitive Level: Knowledge REF: p. 45 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment 12. When a nursing diagnosis statement is written, who or what directs the nurse to identify appropriate nursing interventions? a. Other nurses on staff who have experience with the diagnoses b. The patient and family who have an interest in the outcome c. The etiologies of the problems identified in the nursing diagnoses d. The medical staff who have more expertise than the nurses ANS: C Nursing actions are suggested by the etiologies of the problems identified in the nursing diagnoses and are used to implement plans. Nursing actions are not suggested by other nurses, the patient and family, or by the medical staff. DIF: Cognitive Level: Comprehension REF: p. 42 OBJ: 6 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment 13. Which information obtained by the nurse is subjective when a patient experiences adverse effects of a medication? a. Cough b. Edema c. Nausea d. Tachycardia ANS: C Nausea is a symptom for which only the person experiencing it can provide the information. Cough is heard by the nurse. Edema is measured and seen by the nurse. Tachycardia is assessed by the nurse. DIF: Cognitive Level: Application REF: p. 40 | p. 41 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 14. Which step of the nursing process is being used when it has been determined that the pain medication given to patient an hour ago has been effective? a. Evaluation b. Intervention c. Nursing diagnosis d. Planning ANS: A The nurse has used evaluation to assess the response to the administered medication. Intervention is the administration of the medication or teaching about the medication in this situation. This situation is not an example of making a nursing diagnosis. Planning is developing goal statements and prioritizing patient problems. DIF: Cognitive Level: Application REF: p. 39 | p. 40 OBJ: 1 | 6 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment 15. Which step of the nursing process is being used when prior to the administration of a nephrotoxic drug, the nurse determines that the kidney lab data are within normal range? a. Assessment b. Nursing diagnosis c. Planning d. Evaluation ANS: A The nurse is collecting information about renal function through lab data; this is baseline assessment data. This action is not an example of the development of a nursing diagnosis. Planning is developing goal statements and prioritizing patient problems. Evaluation determines if goals have been met. DIF: Cognitive Level: Application REF: p. 44 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 16. Which statement best describes the planning phase of the nursing process? a. Administer insulin subcutaneously (subcut) in the abdominal area. b. Patient is at high risk for falls related to hypotension. c. The patient will state the expected adverse effects of medication by the end of the teaching session. d. Itching has resolved; medication given is effective. ANS: C ―The patient will state the expected adverse effects of medication by the end of the teaching session‖ is an example of a goal statement that is developed in the planning phase. Administration of insulin subcut is an example of the implementation phase. Noting a high risk for falls related to hypotension is an example of the second phase or nursing diagnosis. Stating that the medication given is effective is an example of the evaluation phase. DIF: Cognitive Level: Application REF: p. 39 OBJ: 1 | 6 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment 17. The nurse is prioritizing care of a pediatric patient diagnosed with cystic fibrosis. Which patient problem would the nurse consider the highest priority? a. Decreased appetite b. Thickened mucus secretions c. Lack of knowledge about the disease process d. Decreased mobility ANS: B Thickened mucus secretions lead to an altered breathing pattern therefore would be the highest priority because the physiologic need of oxygenation is required for total body function. Decreased appetite, lack of knowledge, and decreased mobility would not be of higher priority than oxygenation. DIF: Cognitive Level: Analysis REF: p. 41 | p. 42 OBJ: 7 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Diagnosis CON: Clinical Judgment | Safety | Health Promotion 18. Rank the patient needs according to Maslow‘s hierarchy, beginning with the lowest level need to the highest level need. a. A patient would like to write a book. b. A patient becomes frightened when no one answers the call light during the night. c. A pediatric patient is worrying that school friends will forget him. d. A patient needs to be repositioned in bed. e. A chronically ill patient states that he feels worthless because he is unable to support his family. a. e, b, a, c, d b. d, b, c, e, a c. d, e, b, a, c d. e, a, c, d, b ANS: B The needs should be addressed in the following order: the patient‘s need for repositioning represents a basic need for comfort; the patient‘s alarm when the call light is not answered represents fear for safety; the patient‘s worry about his school friends forgetting him represents a threat to sense of love and belonging; the patient‘s feeling of worthlessness represents threatened self-esteem; and the patient‘s desire to write a book is related to self-actualization. DIF: Cognitive Level: Analysis REF: p. 42 | p. 43 OBJ: 7 NAT: NCLEX Client Needs Category: Health Promotion and Maintenance TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety | Care Coordination | Health Promotion MULTIPLE RESPONSE 1. Which statement(s) regarding critical pathways is/are true? (Select all that apply.) a. Efficient for specific diseases or case types b. The same as medical plans c. Standardized and enhanced quality care d. Evaluated less frequently than care plans e. Enhanced communication for a variety of healthcare providers ANS: A, C, E Critical pathways are standardized care plans that detail clinical interventions to be performed over a projected time frame for a specific disease or case type. Physician interventions are included in the pathways. Critical pathways enhance the quality of care and require evaluation and modification on an ongoing basis. Critical pathways assist as a communication system for all healthcare providers. Medical plans are distinct to physicians. Critical pathways should be evaluated as needed to achieve desired outcomes. DIF: Cognitive Level: Comprehension REF: p. 42 OBJ: 1 | 5 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Planning CON: Clinical Judgment 2. Which explanation indicates the difference between a nursing diagnosis and a medical diagnosis? (Select all that apply.) a. Statement of the patient‘s alterations in structure and functions b. Description of the patient‘s ability to function in relation to impairment c. Tend to remain the same throughout the course of illness or recovery from injury d. Varies depending on patient‘s state of recovery e. Based on research done by nurses f. Conditions can be accurately identified by nursing assessment methods ANS: B, D, E, F Nursing diagnoses, as exemplified by the NANDA-I taxonomy, are statements about the patient‘s ability to function in relation to an illness or injury, vary with the patient‘s state of recovery, are based on research done by nurses, and can be determined based on nursing assessment methods. Nursing diagnoses do not include statements of the patient‘s alterations in structure and function and do not remain the same throughout the course of illness or recovery from injury. DIF: Cognitive Level: Comprehension REF: p. 41 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment 3. Which action will the nurse take when formulating a plan to meet the patient‘s needs in the planning phase of the nursing process for a new admission to a long-term care facility? (Select all that apply.) a. Formulate nursing interventions. b. Collect data. c. Make a clinical judgment about the patient. d. Set priorities. e. Develop measurable goals. ANS: A, D, E Planning is the third phase of the five-step nursing process. Once the patient has been assessed and problems have been diagnosed, plans should be formulated to meet the patient‘s needs. Planning usually encompasses four phases: (1) priority setting, (2) development of measurable goal and outcome statements, (3) formulation of nursing interventions, and (4) formulation of anticipated therapeutic outcomes that can be used to evaluate the patient‘s status. Collecting data is part of the assessment phase of the nursing process. Making a clinical judgment about the patient takes place during the diagnosis phase. DIF: Cognitive Level: Application REF: p. 41 | p. 42 OBJ: 1 | 6 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Care Coordination | Health Promotion 4. Which intervention(s) will the nurse perform to ensure safety when preparing a patient‘s prescribed medications? (Select all that apply.) a. Select the correct supplies. b. Administer the medication by the correct route. c. Use room number to identify correct patient. d. Educate patient regarding medications prescribed. e. Document in chart all aspects of medication administration. ANS: A, B, D, E The nurse prepares prescribed medications using procedures to ensure patient safety, including selecting correct supplies, administering medication by the correct route, educating patients regarding medications prescribed, and documenting in chart all aspects of medication administration. To improve the accuracy of patient identification, it is now recommended that two patient identifiers, neither of which is the room number, be used when administering medications. Best practice would be to look at the patient‘s name band for identity and to request that the patient state his or her name and birth date. DIF: Cognitive Level: Application REF: p. 47 OBJ: 6 | 9 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Care Coordination Chapter 05: Patient Education to Promote Health Willihnganz: Clayton’s Basic Pharmacology for Nurses, 19th Edition MULTIPLE CHOICE 1. The nurse is educating a 13-year-old boy newly diagnosed with diabetes and his parents about diet and glucose monitoring. Which domain of learning is represented when the patient expresses concern about feeling different from his peers? a. Cognitive b. Psychomotor c. Affective d. Learning style ANS: C The affective domain is characterized by conduct that expresses feelings, needs, beliefs, values, and opinions. The cognitive domain relates to basic factual knowledge. The psychomotor domain relates to kinesthetic knowledge, implemented in performance and skills requiring coordination. Learning style is not one of the three domains of learning. DIF: Cognitive Level: Comprehension REF: p. 50 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Patient Education | Health Promotion 2. The nurse has taught a patient‘s spouse to administer an injectable medication. After the spouse completed a return demonstration of the injection in the hospital, the nurse does not feel confident that this can be carried out independently at home and requests referral for a home health nurse. Which phase of the nursing process is being used? a. Assessment b. Implementation c. Planning d. Evaluation ANS: D The nurse has evaluated the injection technique of the patient‘s spouse and determines additional instruction is needed. The nurse is not assessing the situation because she is not at the beginning of the process. The nurse is past implementation in the timeline of the process. The nurse has already planned and implemented interventions. DIF: Cognitive Level: Application REF: p. 52 OBJ: 5 | 6 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety | Patient Education | Health Promotion | Care Coordination 3. Which action is most appropriate when preparing for health teaching with a patient who has an auditory learning style? a. Pamphlets from a pharmaceutical company b. Models of equipment used in a procedure c. Verbal description of the steps of a procedure d. A workbook with space to record actions and results ANS: C Hearing the nurse present the information optimizes the patient‘s perception of the data. Pamphlets from a pharmaceutical company or a workbook would be suitable for a patient who has a visual learning style. Models of equipment would be suitable for a patient with a psychomotor learning style. DIF: Cognitive Level: Application REF: p. 51 OBJ: 1 | 2 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Communication 4. Which is the most intangible portion of the learning process? a. Cognitive b. Affective c. Psychomotor d. Eminent ANS: B The affective domain concerns feelings, needs, beliefs, values, and opinions. The cognitive domain is the level at which basic knowledge is learned and stored; it is the thinking portion of the learning process. The psychomotor domain involves learning new procedures or skills; it is often referred to as the ―doing domain.‖ Eminent domain in common law legal systems is the lawful power of the state to expropriate private property without the owner‘s consent, either for its own use or on behalf of a third party. DIF: Cognitive Level: Knowledge REF: p. 50 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education 5. Which would positively affect readiness to learn? a. Fear and denial b. Willingness to attain an optimal level of health c. Poor cognitive and motor development d. Lack of trust and confidence in the staff ANS: B Readiness or the ability to engage in learning depends on motive, relevant preparatory learning, and physiologic maturation. In fear and denial, the patient is neither prepared nor willing to accept the limitations imposed by the disease process and learn to manage lifestyle changes. Poor cognitive and motor development handicap the patient‘s willingness and ability to learn. Trust is essential in the process of patient education. The patient must have confidence in the staff in order to be receptive to teaching efforts. DIF: Cognitive Level: Comprehension REF: p. 52 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education 6. Which represents the psychomotor domain of learning? a. The patient draws up insulin in a syringe. b. The patient expresses a belief about medication use. c. The patient is able to verbalize foods that should be avoided. d. The patient relates past experience with smoking cessation. ANS: A The psychomotor domain involves the learning of a new procedure and is usually done by demonstration of the task. The patient expressing beliefs is an example of the affective domain. The patient verbalizing foods to be avoided is an example of the cognitive domain. The patient relating past experiences is an example of the affective domain. DIF: Cognitive Level: Comprehension REF: p. 51 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education 7. Which is an example of ethnocentrism? a. A 5-year-old Native American child colors in a book about diabetes. b. A 14-year-old African American attends a support group to learn about disease management. c. A 36-year-old Asian prefers to take herbs instead of an oral medication. d. A 72-year-old Hispanic asks questions about potential adverse effects to a newly prescribed medication. ANS: C Ethnocentrism is the assumption that one‘s culture provides the right way, and taking herbs instead of the medication exemplifies this belief. A 5-year-old Native American child coloring in a book about diabetes is an example of an age-appropriate learning process. A 14-year-old African American attending a support group to learn about disease management is an example of developmental impact on learning. A 72-year-old Hispanic person asking questions about potential adverse effects to a newly prescribed medication is demonstrating learning readiness. DIF: Cognitive Level: Comprehension REF: p. 55 OBJ: 2 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education 8. Which nursing consideration is the most important when teaching an older adult patient about a newly prescribed medication? a. Provide detailed information. b. Lengthen the time of each teaching session. c. Present information slowly. d. Limit discussion on the necessity of learning the information. ANS: C When teaching older adults, it is important to slow the pace of the presentation. Older adults process information more slowly because of limited short-term memory. Detailed information may be too overwhelming. The length of sessions should be limited for the older adult patient. Adults need to understand why they must learn something before they undertake the effort to learn. DIF: Cognitive Level: Comprehension REF: p. 54 OBJ: 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Patient Education | Communication 9. The nurse caring for a Spanish-speaking patient uses the assistance of an interpreter to help with preoperative teaching. While implementing the education, the nurse should a. look directly at the patient. b. never use pantomime gestures. c. ask lengthy questions to provide clarity. d. ask a family member to assist with interpretation. ANS: A When using an interpreter, the nurse should look directly at the patient, not at the interpreter, while conversing. Sometimes supplementing questions with pictures and pantomime gestures may be helpful. The nurse should keep questions brief, asking them one at a time to give the interpreter an opportunity to rephrase the question and obtain a response. Whenever a third person enters into the communication cycle, lack of clarity and misinterpretation can occur. DIF: Cognitive Level: Application REF: p. 55 OBJ: 2 | 4 NAT: NCLEX Client Needs Category: Psychological Integrity TOP: Nursing Process Step: Implementation CON: Health Promotion | Patient Education | Communication 10. Which action should be taken before initiating a teaching plan for the mother of a preterm infant on prescribed medications? a. Recognize the individual‘s health beliefs. b. Provide a formal learning setting. c. Ensure that information is generalized. d. Be sure that all care to the patient has been delivered. ANS: A Before initiating a teaching plan, the nurse must recognize the individual‘s health beliefs. Teaching does not require a formal setting. Because health teaching requires the integration of the patient‘s beliefs, attitudes, values, opinions, and needs, an individualized teaching plan must be developed or a standardized teaching plan must be adapted to the individual‘s beliefs and needs. Some of the most effective teaching can be done while care is being delivered. DIF: Cognitive Level: Application REF: p. 52 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Psychosocial Integrity TOP: Nursing Process Step: Implementation CON: Clinical Judgment | Safety | Patient Education | Communication | Health Promotion MULTIPLE RESPONSE 1. Which item(s) would be considered characteristic of the cognitive domain level of learning? (Select all that apply.) a. A patient‘s opinion regarding wellness b. Basic mathematical formulas learned in grade school c. Incorporation of a person‘s previous experiences and perceptions d. Skill demonstration using a step-by-step approach e. Relationship between prior experiences and new concepts ANS: B, C, E Basic mathematical formulas learned previously, incorporating a person‘s previous experiences and perceptions, and a relationship between prior experiences and new concepts characterize the cognitive domain level of learning. A patient‘s opinion regarding wellness is an example of the affective domain. Skill demonstration using a step-by-step approach is an example of the psychomotor domain. DIF: Cognitive Level: Comprehension REF: p. 50 OBJ: 1 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Patient Education | Communication 2. Which principle(s) of learning would be appropriate when preparing to instruct a patient and his wife on technique and importance of assessing pulse prior to taking heart medication? (Select all that apply.) a. The learning environment b. The patient‘s and wife‘s learning styles c. The objectives/goal statements listed on the patient‘s care plan d. The patient‘s financial ability to purchase the medication e. The patient‘s understanding of the seriousness of his illness ANS: A, B, C, E Learning environment, learning style, listing clear objectives and goal statements, and understanding the seriousness of the situation are all principles of learning. Financial ability is not a principle of learning, but should be an important consideration and assessment when preparing for discharge of the patient and future compliance of the treatment regimen. DIF: Cognitive Level: Application REF: p. 51 | p. 52 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education | Communication | Health Promotion 3. Which objective(s) is/are written in the correct format when writing a teaching plan for a 30-year-old patient who has AIDS? (Select all that apply.) a. The patient will state adverse effects of the daily medications before discharge. b. The patient will correctly fill the daily medication pillbox with the correct medications in the appropriate time slots prior to discharge. c. The patient will adjust the medications accordingly. d. The patient will schedule an appointment with the infectious disease physician before discharge. e. The patient will have lab tests performed regularly. ANS: A, B, D Each of correct objectives noted are measurable and specific. DIF: Cognitive Level: Analysis REF: p. 51 | p. 52 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education 4. Which action(s) by the nurse can foster patient responsibility for adhering to the therapeutic regimen? (Select all that apply.) a. Assessing the patient‘s readiness to learn b. Determining the patient‘s level of understanding of content c. Determining the patient‘s education level and learning style d. Maintaining an aloof attitude toward presented content e. Documenting expected outcomes independently ANS: A, B, C The nurse should assess the patient‘s readiness to learn when teaching the patient. The nurse should determine the patient‘s level of understanding of the content and the patient‘s education level and learning style when teaching the patient. The nurse should portray a positive attitude when teaching the patient. Goals should be mutually written with the patient. DIF: Cognitive Level: Comprehension REF: p. 57 OBJ: 4 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Patient Education | Care Coordination | Communication | Health Promotion 5. What should the nurse include during discharge in addition to verbal instructions? (Select all that apply.) a. Written instructions for the patient‘s reference b. A phone number of the provider or hospital unit for follow-up questions c. Written instructions for monitoring of parameters used to evaluate therapy d. Documentation in the nurse‘s discharge notes of the nursing and collaborative problems that require continued monitoring and intervention e. Identification of the patient‘s unreasonable expectations of therapy ANS: A, B, C, D Learning is an ongoing process. Verbal instructions should be followed up with instructions in writing. Patients should be given a contact number for future reference. Written instructions for monitoring of parameters used to evaluate therapy should be given to the patient. Documentation is an essential part of validating the patient‘s understanding of the instructions provided. Although identifying the patient‘s expectations will affect the outcome, they are not part of the discharge planning documentation. DIF: Cognitive Level: Application REF: p. 51 | p. 52 OBJ: 5 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Care Coordination | Communication | Health Promotion 6. Which action(s) would let the nurse know that the patient has mastered a psychomotor skill? (Select all that apply.) a. Describe the process verbally. b. Write a description of the process. c. Give a reciprocal demonstration of the process. d. Ask questions about the process. e. Demonstrate the process to another person while the nurse supervises. f. State whether the patient feels the process has been mastered. ANS: C, D Having the patient demonstrate the process to the nurse or to another person is the best way to ensure that he can perform the skill correctly. Having the patient describe the process or write a description of the process is not sufficient. Asking questions may reinforce learning but may also mask some deficiencies. Asking the patient whether he feels he has mastered the process is not sufficient. DIF: Cognitive Level: Comprehension REF: p. 52 OBJ: 1 NAT: NCLEX Client Needs Category: Physiological Integrity TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Patient Education | Care Coordination | Communication | Health Promotion 7. The nurse and patient are participating in cooperative goal setting regarding drug therapy. Which task(s) is imperative to encourage the patient to perform? (Select all that apply.) a. Contact the hospital for advice regarding discontinuation of medication. b. Keep records of essential data needed to evaluate prescribed therapy. c. See the healthcare provider regularly. d. Avoid community-based agencies for assistance. e. Monitor parameters used to evaluate therapy. ANS: B, C, E An attitude of shared input into the goals and outcomes can encourage the patient into a therapeutic alliance. Therefore, the patient should be taught to help monitor the parameters used to evaluate therapy, keep records of essential data, and contact the healthcare provider for advice rather than alter or discontinue the medication entirely. The healthcare provider, not the hospital, should be contacted. In the event that the patient, family, or significant others do not understand all aspects of the continuing therapy prescribed, they may be referred to a community-based agency for help in achieving long-term healthcare requirements. DIF: Cognitive Level: Application REF: p. 58 OBJ: 3 | 4 NAT: NCLEX Client Needs Category: Safe, Effective Care Environment TOP: Nursing Process Step: Planning CON: Clinical Judgment | Patient Education | Care Coordination | Communication | Health Promotion

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