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Pharmacology for Nurses, 6e (Adams)
Chapter 1 Introduction to Pharmacology
1) A nurse is reviewing key events in the history of pharmacology with a student nurse. Which
student comment indicates an understanding?
1. "Early researchers used themselves as test subjects."
2. "A primary goal of pharmacology is to prevent disease."
3. "Penicillin is one of the initial drugs isolated from a natural source."
4. "Pharmacologists began synthesizing drugs in the laboratory in the nineteenth century."
Answer: 1
Explanation:
1. Some early researchers, like Friedrich Serturner, used themselves as test subjects.
2. An early goal of pharmacology was to relieve human suffering.
3. Initial drugs isolated from complex mixtures included morphine, colchicine, curare, and
cocaine, but not penicillin.
4. By the twentieth century, pharmacologists could synthesize drugs in the laboratory.
Page Ref: 3
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
GRADESMORE.COM
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to
inform decision making. | NLN Competencies: Knowledge and Science: Integration of
knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Evaluation
Learning Outcome: 1-1 Identify key events in the history of pharmacology.
MNL Learning Outcome: 1.1 Examine the relationship between medicine and pharmacology.
1
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2) A student nurse asks a nursing instructor why anatomy and physiology as well as
microbiology are required courses when the student only wants to learn about
pharmacology. What is the best response by the instructor?
1. "Because pharmacology is an outgrowth of those subjects."
2. "You must learn all, since all of those subjects are part of the curriculum."
3. "Knowledge of all those subjects will prepare you to administer medication."
4. "An understanding of those subjects is essential to understand pharmacology."
Answer: 4
Explanation:
1. Pharmacology is an outgrowth of anatomy, physiology, and microbiology, but this is not
the most essential reason for the nurse to learn them.
2. The nurse must learn anatomy, physiology, and microbiology to understand
pharmacology, not because they are part of the curriculum.
3. Knowledge of anatomy, physiology, and microbiology prepares the nurse to understand
pharmacology, not to provide care such as administration of medications.
4. It is essential for the nurse to have a broad knowledge base of many sciences in order to
learn pharmacology.
Page Ref: 3
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
GRADESMOand
RE.education;
COM
integration of care; information, communication,
physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to
inform decision making. | NLN Competencies: Knowledge and Science: Integration of
knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 1-2 Explain the interdisciplinary nature of pharmacology, giving an example
of how knowledge from different sciences impacts the nurse's role in drug administration.
MNL Learning Outcome: 1.1 Examine the relationship between medicine and pharmacology.
2
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3) A nurse is teaching a group of nurses about the differences between pharmacology and
therapeutics. The nurse determines that learning has occurred when which statements are
made?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Pharmacology is the development of medicines."
2. "Pharmacology is the study of medicines."
3. "Therapeutics relates to drug use to treat suffering."
4. "Therapeutics is the study of drug interactions."
5. "Pharmacology is the study of drugs to prevent disease."
Answer: 2, 3, 5
Explanation:
1. Pharmacology is not the development of medicines.
2. Pharmacology is the study of medicines.
3. Therapeutics is the use of drugs in the treatment of suffering.
4. Therapeutics is not related to study of drug interactions.
5. Pharmacotherapy is the application of drugs for the purpose of disease prevention.
Page Ref: 4
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
GRADESMOand
RE.education;
COM
integration of care; information, communication,
physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to
inform decision making. | NLN Competencies: Knowledge and Science: Integration of
knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Evaluation
Learning Outcome: 1-3 Compare and contrast therapeutics and pharmacology.
MNL Learning Outcome: 1.1 Examine the relationship between medicine and pharmacology.
3
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4) A nurse administers a vaccine to a client. What is the nurse's best understanding as it
relates to the manufacture of a vaccine?
1. The vaccine is produced by natural plant extracts in the laboratory.
2. The vaccine is naturally produced in animal cells or microorganisms.
3. The vaccine is produced by a combination of animal and plant products.
4. The vaccine is most commonly synthesized in a laboratory.
Answer: 2
Explanation:
1. Vaccines are not produced by natural plant extracts.
2. Vaccines are naturally produced in animal cells, microorganisms, or by the body itself.
3. Vaccines are not produced by a combination of animal and plant products.
4. Vaccines are not synthesized in a laboratory.
Page Ref: 4
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Evaluation
GRcontrast
ADESMtraditional
ORE.COdrugs,
M
Learning Outcome: 1-4 Compare and
biologics, and complementary
and alternative medicine therapies.
MNL Learning Outcome: 1.1 Examine the relationship between medicine and pharmacology.
4
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5) An older client is admitted with gastrointestinal bleeding. The client says to the nurse, "I
don't understand this. All I did was take ibuprofen (Advil) for my arthritis." What is the
nurse's best response?
1. Review nonpharmacologic methods to relieve joint pain.
2. Encourage the client to substitute safer drugs, such as acetaminophen (Tylenol).
3. Remind the client to contact their healthcare provider before taking any over-thecounter (OTC) medications.
4. Teach the client about the side effects of ibuprofen (Advil).
Answer: 4
Explanation:
1. Reviewing nonpharmacologic methods to relieve joint pain is appropriate for this client,
but it's not the highest priority. It doesn't address the client's current concern about
how ibuprofen may have increased the risk of having a GI bleed.
2. Substitution of other drugs may be beneficial, but this cannot be done in all situations.
In addition, it doesn't address the client's current concern about how ibuprofen may
have increased the risk of having a GI bleed.
3. It is not a realistic plan to expect clients to contact their physician prior to taking any
over-the-counter (OTC) medication. In addition, it doesn't address the client's current
concern about how ibuprofen may have increased the risk of having a GI bleed.
4. It is essential for the nurse to teach clients about the advantages, and the disadvantages
(including side effects), of all medications and supplements the client is taking.
Page Ref: 6
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Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: II.7 Promote factors that create a culture of safety
and caring. | NLN Competencies: Context and Environment: Health promotion/disease
prevention. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 1-9 Outline the major differences between prescription and over-thecounter drugs.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
5
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6) A nurse teaches a student nurse about the pharmacological classification of drugs. The
nurse evaluates that learning has occurred when the student makes which response?
1. "An anti-anginal treats angina."
2. "A calcium channel blocker blocks heart calcium channels."
3. "An antihypertensive lowers blood pressure."
4. "An anticoagulant influences blood clotting."
Answer: 2
Explanation:
1. To say that a drug treats angina addresses the therapeutic usefulness of the drug, not
the pharmacological classification.
2. The pharmacological classification addresses a drug's mechanism of action, or how a
drug produces its effect in the body.
3. To say that a drug lowers blood pressure addresses the therapeutic usefulness of the
drug, not the pharmacological classification.
4. To say that a drug influences blood clotting addresses the therapeutic usefulness of the
drug, not the pharmacological classification.
Page Ref: 5
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.7 Integrate the knowledge and methods of a
variety of disciplines to inform decision making. | NLN Competencies: Knowledge and Science:
GRand
ADEother
SMOdisciplines.
RE.COM | Nursing/Integrated Concepts:
Integration of knowledge from nursing
Nursing Process: Evaluation
Learning Outcome: 1-5 Explain the basis for placing drugs into therapeutic and pharmacologic
classes.
MNL Learning Outcome: 1.2 Identify how drugs are named and classified.
6
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7) A nurse is providing medication education to a client with hypertension. The nurse teaches
the client that the healthcare provider ordered a diuretic to decrease the amount of fluid in
the client's body. Which statement best describes the nurse's instruction?
1. The nurse provided appropriate medication education.
2. The nurse explained the drug's mechanism of action.
3. The nurse taught the client about a prototype drug.
4. The nurse explained the consequences of not using the drug.
Answer: 2
Explanation:
1. The education was most likely appropriate, but this response is too vague.
2. A drug's mechanism of action explains how a drug produces its effect in the body.
3. There is no drug name present, so it is not known whether this is a prototype drug.
4. The nurse did not explain the consequences of not using the drug.
Page Ref: 5
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.7 Integrate the knowledge and methods of a
variety of disciplines to inform decision making. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Evaluation
Learning Outcome: 1-7 Describe what is meant by a drug's mechanism of action.
RADdrugs
ESMOare
REnamed
.COMand classified.
MNL Learning Outcome: 1.2 IdentifyGhow
8) A student nurse asks a nursing instructor how to remember all of the antibiotic drugs since
there are so many. What is the best response by the nursing instructor?
1. "Mnemonics will help you tell the difference between drugs."
2. "A flow chart will help enhance your memory."
3. "Categorize the individual drugs by therapeutic effect."
4. "Focus on a representative drug from each class."
Answer: 4
Explanation:
1. Using mnemonics is not the best way to learn about drugs.
2. Flow charts are not the best way to learn about drugs.
3. Categorizing individual drugs is not the best way to learn about drugs.
4. A prototype, or representative, drug is the well-understood drug model from which
other drugs in a pharmacological class are compared.
Page Ref: 5
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.7 Integrate the knowledge and methods of a
variety of disciplines to inform decision making. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
7
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Nursing Process: Implementation
Learning Outcome: 1-6 Discuss the prototype approach to drug classification.
MNL Learning Outcome: 1.2 Identify how drugs are named and classified.
GRADESMORE.COM
8
Copyright © 2020 Pearson Education, Inc.
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9) A client has been taking paroxetine (Paxil) for a year and tells a nurse it is no longer working.
What is the best response by the nurse?
1. "This sounds like your medication needs changing."
2. "Let's look for interactions with other medications you are taking."
3. "Are you taking name brand Paxil or the generic version paroxetine?"
4. "It is time for us to do the Beck Depression assessment again."
Answer: 3
Explanation:
1. Considering a change in medication is appropriate, but another assessment takes
priority.
2. Assessing for interactions with other drugs is appropriate, but another assessment takes
priority.
3. The bioavailability of a generic drug may not be the same as the bioavailability of a
brand name drug.
4. Assessing for worsening of depression is appropriate, but another assessment takes
priority.
Page Ref: 7
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.7 Integrate the knowledge and methods of a
variety of disciplines to inform decision making. | NLN Competencies: Knowledge and Science:
GRand
ADEother
SMOdisciplines.
RE.COM | Nursing/Integrated Concepts:
Integration of knowledge from nursing
Nursing Process: Assessment
Learning Outcome: 1-10 Explain the differences between trade name drugs and their generic
equivalents.
MNL Learning Outcome: 1.3 Recognize features of generic and trade-name equivalent drugs,
and biosimilar drugs.
9
Copyright © 2020 Pearson Education, Inc.
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10) A student nurse has completed an initial pharmacology course and tells a nurse that it was
difficult. What is the best response by the nurse?
1. "It may be over, but now you must apply what you have learned to patient care."
2. "Learning is gradual and continuous; we never completely master all areas of
pharmacology."
3. "Learning is always painful, but we must continue anyway."
4. "It really isn't over; you should take a graduate course next."
Answer: 2
Explanation:
1. It is true that the student must apply what has been learned to patient care, but this
response implies that learning is over.
2. Learning pharmacology is a gradual, continuous process that does not end with
graduation.
3. Learning is not always painful.
4. There is no reason for the student nurse to take a graduate level pharmacology course
at this time.
Page Ref: 4
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
GRADand
ESM
ORE.and
COMtransition and continuity. | AACN
emotional support; involvement of family
friends;
Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to
inform decision making. | NLN Competencies: Knowledge and Science: Integration of
knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 1-7 Describe what is meant by a drug's mechanism of action.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
10
Copyright © 2020 Pearson Education, Inc.
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11) A client says to the nurse, "My wife and I take the same drug, but we have different side
effects. Are we doing something wrong?" What is the best response by the nurse?
1. "Differences such as your sex can result in different side effects."
2. "I'll have to check. What is the name of the drug you were using?"
3. "Possibly. This could happen if one uses generic or brand name drugs."
4. "I'm not sure. Maybe the drug is not the same; you should check it."
Answer: 1
Explanation:
1. Drugs may elicit different responses depending on individual client factors such as age,
sex, body mass, health status, and genetics.
2. The nurse should not have to check the drug; basic knowledge should include knowing
that the sex of clients can result in different side effects.
3. There are differences between some generic and brand name drugs, but this is not the
best answer.
4. Asking the client to check a medication is fine, but this does not answer the client's
question.
Page Ref: 7
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
GRADand
ESM
ORE.and
COMtransition and continuity. | AACN
emotional support; involvement of family
friends;
Essential Competencies: II.7 Promote factors that create a culture of safety and caring. | NLN
Competencies: Relationship-Centered Care, Knowledge, Effective Communication. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 1-10 Explain the differences between trade name drugs and their generic
equivalents.
MNL Learning Outcome: 1.3 Recognize features of generic and trade-name equivalent drugs,
and biosimilar drugs.
11
Copyright © 2020 Pearson Education, Inc.
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12) A client comes to the emergency department with a myocardial infarction. The client's
husband tells the nurse that his wife has been taking calcium carbonate (Tums) for years for
what she thought was indigestion. What is the best response by the nurse?
1. "Your wife should not have self-diagnosed herself. I hope she will be okay."
2. "Why did you let her do that? She should have seen a physician."
3. "Well, I am glad she is here, as it certainly wasn't indigestion."
4. "Your wife was self-diagnosing, which is generally not a good idea."
Answer: 4
Explanation:
1. Telling the husband "I hope she will be okay" is a very frightening response that implies
she might die, and this is nontherapeutic.
2. Asking the husband why he let his wife take Tums is nontherapeutic and too accusatory;
do not ask "why" questions.
3. Telling the husband that "it certainly wasn't indigestion" is judgmental and will alienate
the client and husband.
4. Clients take over-the-counter (OTC) drugs for many reasons. Self-treatment is
sometimes ineffective, and the potential for harm may increase if the disease is allowed
to progress.
Page Ref: 6
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.C.1 Value seeing healthcare situations "through patients'
GRA
DECommunicate
SMORE.COM
eyes." | AACN Essential Competencies:
IX.4
effectively with all members of the
healthcare team, including the patient and the patient's support network. | NLN Competencies:
Relationship-Centered Care, Knowledge, Effective Communication. | Nursing/Integrated
Concepts: Nursing Process: Caring
Learning Outcome: 1-9 Outline the major differences between prescription and over-thecounter drugs.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
12
Copyright © 2020 Pearson Education, Inc.
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13) A nurse is teaching a class for clients about over-the-counter (OTC) medications. The nurse
determines that education has been effective when the clients make which of the below
statements?
1. "I will check with my provider first before I take any over-the-counter (OTC) medicine."
2. "A pharmacist can tell me how to take the over-the-counter (OTC) medicine."
3. "After reading all the directions on the label, I will call the healthcare provider's office if
they are not clear."
4. "Medicines that are available over-the-counter (OTC) are really safe, or they would be
prescription medicines."
Answer: 3
Explanation:
1. It is not realistic to expect clients to call the doctor's office before taking any over-thecounter (OTC) medicine.
2. Asking the pharmacist is a good idea, but does not replace reading the label directions.
Also, the pharmacist might not always be in the store when the medicine is purchased.
3. In most cases, clients may treat themselves safely if they carefully follow instructions
included with the medication.
4. Most OTC medicines have a high margin of safety, but none is considered completely
safe.
Page Ref: 6
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRExamine
ADESMhow
OREthe
.Csafety,
OM quality, and cost effectiveness
Standards: QSEN Competencies: I.A.4
of healthcare can be improved through the active involvement of patients and families. | AACN
Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental
stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster
patient engagement in their care. | NLN Competencies: Quality and Safety: Commit to a
generative safety culture. | Nursing/Integrated Concepts: Nursing Process: Teaching/Learning
Learning Outcome: 1-9 Outline the major differences between prescription and over-thecounter drugs.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
13
Copyright © 2020 Pearson Education, Inc.
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14) A client asks a nurse why a prescribed medication is very expensive. What is the best
response by the nurse?
1. Help the client receive free medicine through a "patient assistance" program.
2. Ask the healthcare provider if a cheaper brand name drug may be substituted.
3. Contact the healthcare provider to ask if a generic drug may be substituted.
4. Maintain the client on samples of the brand name drug from the physician's office.
Answer: 3
Explanation:
1. A patient assistance program is a good idea, but since the client may not qualify for this,
it is not the best plan.
2. Another brand name drug may not be what the client needs for the illness.
3. Generic drugs are much less costly than brand name drugs.
4. Providing samples is an option, but the office may temporarily run out of samples and
the client will not receive the medication.
Page Ref: 6
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.7 Integrate the knowledge and methods of a
variety of disciplines to inform decision making. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Implementation
RADESMObetween
RE.COtrade
M name drugs and their generic
Learning Outcome: 1-10 Explain theGdifferences
equivalents.
MNL Learning Outcome: 1.3 Recognize features of generic and trade-name equivalent drugs,
and biosimilar drugs.
14
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
15) A client is receiving a very expensive medication. The client asks the nurse why the medicine
is so expensive. What is the best response by the nurse?
1. "It is expensive, but your insurance covers it and you have a low co-pay."
2. "Drug companies are allowed to advertise medications and this adds to the cost."
3. "Drug companies must recoup the cost of developing and producing the drug."
4. "I think the drug companies should be more accountable for lowering costs."
Answer: 3
Explanation:
1. Telling the client that insurance covers the drug doesn't answer the client's question.
2. Advertising costs are expensive, but this answer implies the drug company is raising
costs unnecessarily.
3. If the cost of developing a new drug is not recouped by the drug company, there is no
impetus for the company to continue drug development.
4. It is nontherapeutic for the nurse to introduce her own beliefs, such as accountability of
drug companies, into a conversation with the client.
Page Ref: 6
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
RADknowledge
ESMOREand
.COmethods
M
Essential Competencies: I.7 IntegrateGthe
of a variety of disciplines to
inform decision making. | NLN Competencies: Knowledge and Science: Integration of
knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 1-8 Distinguish among a drug's chemical name, generic name, and trade
name.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
15
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16) A nurse is reviewing key events in the history of pharmacology with a student nurse. Which
student comment from below indicates a need for further teaching?
1. "Modern pharmacology began in the early 1600s."
2. "Herbal medicine is one of the oldest forms of healthcare."
3. "John Jacob Abel is considered the father of American pharmacology."
4. "New drugs can be synthesized faster than isolating active agents from natural
resources."
Answer: 1
Explanation:
1. Modern pharmacology began in the 1800s, not the 1600s.
2. It is true that herbal medicine is one of the oldest forms of healthcare.
3. John Jacob Abel, who is considered the father of American pharmacology owing to his
many contributions to the field, founded the first pharmacology department in the
United States at the University of Michigan in 1890.
4. In the twentieth century, pharmacologists are able to synthesize new medications faster
than by isolating active agents from natural resources.
Page Ref: 3
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
GRADand
ESM
ORE.and
COMtransition and continuity. | AACN
emotional support; involvement of family
friends;
Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to
inform decision making. | NLN Competencies: Knowledge and Science: Integration of
knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Evaluation
Learning Outcome: 1-1 Identify key events in the history of pharmacology.
MNL Learning Outcome: 1.1 Examine the relationship between medicine and pharmacology.
16
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17) A nurse is preparing to teach pharmacology concepts to a group of students. The nurse
should include which of the following?
1. Biologics include natural plant extracts and dietary supplements.
2. Biosimilar drugs don't require the same clinical testing as the comparable biologic drug.
3. Alternative therapies are agents produced in animal cells or by microorganisms.
4. Therapeutics is using drugs for the purpose of treating diseases and treatment of
suffering.
Answer: 2
Explanation:
1. Biologics are agents naturally produced in animal cells, by microorganisms, or by the
body itself.
2. Biosimilar drugs are similar to current biologic agents. They do not require the same
level of testing as their comparable biologic agents.
3. Alternative therapies include natural plant extracts, herbs, vitamins, minerals, dietary
supplements, and additional techniques outside the realm of conventional therapeutics.
4. Therapeutics is concerned with the prevention of disease and treatment of sufferings.
Page Ref: 4
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
GRADand
ESM
ORE.and
COMtransition and continuity. | AACN
emotional support; involvement of family
friends;
Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to
inform decision making. | NLN Competencies: Knowledge and Science: Integration of
knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Assessment
Learning Outcome: 1-3 Compare and contrast therapeutics and pharmacology.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
17
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18) A client with chronic back pain informs the nurse he has been receiving therapeutic touch in
addition to his medications. What is the nurse's best classification of this client's treatment?
1. Pharmacotherapy
2. Drug-absence therapy
3. Complementary therapy
4. Biologic therapy
Answer: 3
Explanation:
1. Pharmacotherapy is the application of drugs for the purpose of treating diseases and
alleviating human suffering.
2. The client is using medications as well as an alternative therapy.
3. The client is using a nonconventional type of treatment (therapeutic touch) that is
classified as complementary to his conventional pharmacotherapy. Biologic therapy
involves the use of naturally produced substances by microorganisms or within the
body. The client is using medications as well as an alternative therapy, which is why
complementary therapy is the best choice.
4. Biologic therapy involves the use of naturally produced substances by microorganisms
or within the body.
Page Ref: 4
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
GRADESMORpreferences,
E.COM values; coordination and
patient-centered care: patient/family/community
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an
understanding of human growth and development, pathophysiology, pharmacology, medical
management, and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings. | NLN Competencies: Relationship-Centered Care: Respect the
patient's dignity, uniqueness, integrity, and self-determination, and his or her own power and
self-healing process. | Nursing/Integrated Concepts: Nursing Process: Analysis
Learning Outcome: 1-4 Compare and contrast traditional drugs, biologics, and complementary
and alternative medicine therapies.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
18
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19) A client is receiving a brand name drug and wants to change to the generic form because it
is less expensive. What is the best outcome for this client?
1. State two ways a brand name drug differs from a generic name drug.
2. Take the brand name drug after speaking with the physician.
3. Ask the nurse why brand name drugs are better than generic drugs.
4. List two ways to obtain the medication at a reduced cost.
Answer: 1
Explanation:
1. The dosage of drugs may be the same with a brand name and generic drug, but the
bioavailability may be affected by the inert ingredients and tablet compression.
2. Referring the client to the physician is inappropriate because the nurse can educate the
client about the difference between generic and brand name drugs.
3. The client asking the nurse a question is not an outcome.
4. Knowing ways to obtain medication at a reduced cost is an appropriate outcome, but
the client will not learn why a brand name drug may be preferable over a generic drug.
Page Ref: 6
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.7 Integrate the knowledge and methods of a
variety of disciplines to inform decision making. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
GRADESMORE.COM
Nursing Process: Planning
Learning Outcome: 1-9 Outline the major differences between prescription and over-thecounter drugs.
MNL Learning Outcome: 1.3 Recognize features of generic and trade-name equivalent drugs,
and biosimilar drugs.
19
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20) A healthcare provider orders Lasix (furosemide) for a client. The hospital formulary
substitutes the generic equivalent of the brand name drug, and the nurse administers the
generic drug. Which of the statements best represent the nurse's action?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The nurse should have contacted the physician prior to administering the drug.
2. The nurse should have called the pharmacist to see if the drugs were bioequivalent.
3. The nurse used good judgment in administering the drug.
4. The nurse was correct; hospital policies allow for this.
5. The nurse should ask the client which brand of drug is used at home.
Answer: 3, 4
Explanation:
1. It is not feasible for the nurse to contact the physician every time there is a generic
substitution.
2. The pharmacist should only fill the prescription with a bioequivalent drug from the
approved formulary.
3. The nurse used good judgment as hospital policies allow for generic substitution of
certain drugs.
4. Use of formularies and negative formularies support the hospital policies allowing
substitution.
5. In most cases, the client will not know which brand of medication is used at home. The
brand used at home would be relevant only in very few medications.
GRADESMORE.COM
Page Ref: 7
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.7 Integrate the knowledge and methods of a
variety of disciplines to inform decision making. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Evaluation
Learning Outcome: 1-10 Explain the differences between trade name drugs and their generic
equivalents.
MNL Learning Outcome: 1.3 Recognize features of generic and trade-name equivalent drugs,
and biosimilar drugs.
20
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21) A nurse is documenting a client's list of current medications. Which substances would be
categorized as complementary and alternative medicine?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Garlic
2. Vitamin C
3. Zinc
4. Aspirin
5. Benadryl
Answer: 1, 2, 3
Explanation:
1. Garlic is considered an herb, which is considered complementary and alternative
medicine therapy.
2. Vitamins are considered complementary and alternative medicine therapy.
3. Zinc is a mineral and is considered complementary and alternative medicine therapy.
4. Aspirin is an over-the-counter medication.
5. Benadryl is an over-the-counter medication.
Page Ref: 4
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
GRADESMOand
RE.education;
COM
integration of care; information, communication,
physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an
understanding of human growth and development, pathophysiology, pharmacology, medical
management, and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings. | NLN Competencies: Knowledge and Science: Integration of
knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Analysis
Learning Outcome: 1-4 Compare and contrast traditional drugs, biologics, and complementary
and alternative medicine therapies.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
21
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22) A student nurse asks a nursing instructor about which type of classification system is being
used when drugs are grouped together because they help treat a particular disease or
condition? What is the nursing instructor's best response?
1. Therapeutic
2. Mechanism of action
3. Chemical
4. Pharmacological
Answer: 1
Explanation:
1. Therapeutic classification is based on the drug's usefulness in treating a particular
disease.
2. Mechanism of action is how a drug produces its physiological effect in the body.
3. Chemical classification relates to a substance's physical and chemical properties.
4. Pharmacological classification addresses a drug's mechanism of action.
Page Ref: 5
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.7 Integrate the knowledge and methods of a
variety of disciplines to inform decision making. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Assessment
GRAD
ES
MOREdrugs
.COM
Learning Outcome: 1-5 Explain the basis
for
placing
into therapeutic and pharmacologic
classes.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
22
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23) A nursing student asks a nursing instructor whether there are any tips that will make
learning pharmacology easier. The instructor gives an example of the anticoagulant heparin.
The instructor indicates that knowing heparin and comparing other drugs to it will facilitate
learning the many anticoagulants. Which approach is the instructor using?
1. Mechanism of action approach
2. Generic name approach
3. Trade name approach
4. Prototype drug approach
Answer: 4
Explanation:
1. Mechanism of action is how the drug produces its physiological effect in the body. This
approach does not limit the number of drugs that must be learned.
2. Heparin is the generic name, but this does not help the student understand the drug.
3. Trade names are specific to only one drug, so learning by this approach does not limit
the number of drugs that must be examined.
4. In the prototype approach, the student learns about one well-understood drug from a
class of drugs. Learning about this drug helps the student understand the other drugs in
the class.
Page Ref: 5
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
GRADEI.7
SMIntegrate
ORE.CO
M knowledge and methods of a
processes. | AACN Essential Competencies:
the
variety of disciplines to inform decision making. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 1-6 Discuss the prototype approach to drug classification.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
23
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24) A nurse understands that a particular agent causes a reduction in blood pressure by
blocking receptor sites. The nurse recognizes that this is an example of which drug
information?
1. Drug-drug interaction
2. Adverse effects
3. Indication
4. Mechanism of action
Answer: 4
Explanation:
1. Drug-drug interactions refer to possible adverse reactions from using multiple drugs at
the same time.
2. Adverse effects are what can result from drug use, not a description of how the drug
works.
3. Indications are the reasons the drug is being used.
4. The instructor is describing how a drug produces an effect within the body, which is
known as the mechanism of action.
Page Ref: 5
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.7 Integrate the knowledge and methods of a
variety of disciplines to inform decision making. | NLN Competencies: Knowledge and Science:
GRand
ADEother
SMOdisciplines.
RE.COM | Nursing/Integrated Concepts:
Integration of knowledge from nursing
Nursing Process: Implementation
Learning Outcome: 1-7 Describe what is meant by a drug's mechanism of action.
MNL Learning Outcome: 1.1 Examine the relationship between medicine and pharmacology.
25) A student nurse asks a nurse what the generic name of a drug means. Which of the
following is true regarding the generic name of a drug?
1. It describes the chemical composition of the medication.
2. Drugs that contain more than one active ingredient are classified as generic drugs.
3. The name drug is assigned by the company marketing the drug.
4. There is only one name for each medication.
Answer: 4
Explanation:
1. This answer describes the chemical name of a medication.
2. A combination drug contains more than one active ingredient.
3. Trade names are assigned by the company marketing the drug.
4. Although drugs can have multiple trade names, each drug only has one generic name.
Page Ref: 5
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.7 Integrate the knowledge and methods of a
24
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
variety of disciplines to inform decision making. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Analysis
Learning Outcome: 1-8 Distinguish among a drug's chemical name, generic name, and trade
name.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
26) A client says to a nurse, "Why do you need to know the names of all the over-the-counter
supplements I take? They aren't drugs." Which of the nurse's responses are appropriate?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "The healthcare provider needs to know everything you are taking."
2. "You're right. I'm not sure why the admitting paperwork asks for this information.
Would you mind listing them anyway?"
3. "The law requires us to keep a list of over-the-counter drugs and supplements that you
are taking."
4. "It is true that supplements are not considered drugs; however, some of these products
can cause adverse effects with prescribed drugs."
5. "We need to know if you are having an allergic reaction to one of them."
Answer: 1, 4
Explanation:
GRADinEthis
SMOclient's
RE.Ccare
OM will need to know everything she
1. The healthcare providers involved
is taking—both prescription and over-the-counter (OTC).
2. While it is true that supplements are not considered drugs, there is a specific reason
why the healthcare team needs to know this information, which is the reason for the
requested list on the paperwork. The nurse's answer did not address the client's
question appropriately.
3. No law requires hospitals to keep records of OTC drugs and supplements that clients
take. This information is needed, however, for other reasons.
4. Supplements are not subject to the same regulatory process as drugs, and some of
these products can cause adverse effects and interact with medications.
5. It is possible that this client could be having an allergic reaction, but there is not enough
information to determine this, and this is not the main reason why the healthcare team
needs to know what OTC medications she is taking.
Page Ref: 6
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an
understanding of human growth and development, pathophysiology, pharmacology, medical
25
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
management, and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings. | NLN Competencies: Knowledge and Science: Integration of
knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 1-4 Compare and contrast traditional drugs, biologics, and complementary
and alternative medicine therapies.
MNL Learning Outcome: 1.3 Recognize features of generic and trade-name equivalent drugs,
and biosimilar drugs.
GRADESMORE.COM
26
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
27) A nurse is explaining the benefits of using a prototype approach to learn pharmacology to a
nursing student. The nurse understands that studying the prototype drug makes it possible
to predict certain characteristics of drugs in the same class. Which response by the nursing
student below indicates the need for further teaching?
1. Therapeutic indications
2. Mechanism of action
3. Adverse effects
4. Duration of action
Answer: 4
Explanation:
1. The prototype drug has the same therapeutic indications, or clinical use, of other drugs
in the same class.
2. Studying the therapeutic indications of a prototype drug may allow the nurse to predict
actions and adverse effects of other drugs in the same group.
3. Studying the prototype drug may allow the nurse to predict the adverse effects of
another drug in the same class.
4. Drugs in the same class may have different duration of action.
Page Ref: 5
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.7 Integrate the knowledge and methods of a
GRAmaking.
DESMO
E.Competencies:
COM
variety of disciplines to inform decision
|R
NLN
Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Analysis
Learning Outcome: 1-6 Discuss the prototype approach to drug classification.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
27
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GRADESMORE.COM
WWW.GRADESMORE.COM
28) A nurse understands that chemical names are assigned for each drug. What are the major
reasons that nursing usually does not use the chemical name of the drugs?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. They are usually not brief or easy to remember.
2. They are often difficult to pronounce.
3. There is no standard for assigning names.
4. They do not explain the nature of the drug.
5. There is only one chemical name for each drug.
Answer: 1, 2
Explanation:
1. Chemical names are usually not brief or easy to remember.
2. Chemical names are often difficult to pronounce.
3. Chemical names are assigned by a standard nomenclature.
4. Chemical names do explain the nature of the drug.
5. While it is true each drug has only one chemical name, this is not one of the reasons
nurses do not use the chemical name.
Page Ref: 5
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.7 Integrate the knowledge and methods of a
GRAmaking.
DESMO
E.Competencies:
COM
variety of disciplines to inform decision
|R
NLN
Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 1-8 Distinguish among a drug's chemical name, generic name, and trade
name.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
28
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WWW.GRADESMORE.COM
29) A client says, "I don't understand why so much money is spent on trying to find a cure for
cancer. I have epilepsy and wish more money went into epilepsy drugs." What should the
nurse consider prior to responding?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. More people are affected by cancer than by epilepsy.
2. Drugs that are effective in treating epilepsy exist.
3. The amounts of money spent on drug development are determined at the federal level.
4. It would be easier to achieve a cure for cancer than to achieve a cure for epilepsy.
5. The client should realize that personal family may develop cancer one day.
Answer: 1, 2
Explanation:
1. According to the tenets of pharmacoeconomics, more money should be spent on
development of drugs that will impact the most people.
2. There are more drugs to successfully treat epilepsy than to cure cancer.
3. Money spent on drug development is determined at several levels, including individual
corporations, universities, and governments.
4. There is no indication that curing cancer is easier than curing epilepsy.
5. The nurse should not judge this client's statement as good or bad, but should attempt to
explain the allocation of resources.
Page Ref: 8
Cognitive Level: Applying
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Planning
Learning Outcome: 1-11 Describe how decisions are made relative to drug therapy among
groups of patients.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
29
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WWW.GRADESMORE.COM
30) A client with advanced heart disease says, "I read about a new drug that was just released.
Do you think my doctor could get it for me?" What should the nurse include in discussion
with the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Since the drug is new it is dangerous to use."
2. "Decisions on using drugs are based on many different variables."
3. "We certainly can talk to your physician about the drug."
4. "When drugs are first developed, they are very expensive and their use is limited to
those who can afford to purchase them."
5. "People who are very sick often have unrealistic expectations of what drugs can do."
Answer: 2, 3
Explanation:
1. It is nontherapeutic to tell the client the drug is dangerous. At this point, the nurse has
no knowledge of which drug is being discussed.
2. Use of particular drugs is based on many different variables, including cost-benefit ratio.
3. The nurse should support the client's interest in this drug by advocating for a discussion
about its use.
4. The nurse should not assume the drug is expensive or that the client is unable to obtain
it.
5. It is nontherapeutic to tell the client that interest in this drug is unrealistic.
Page Ref: 8
GRADESMORE.COM
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 1-11 Describe how decisions are made relative to drug therapy among
groups of patients.
MNL Learning Outcome: 1.4 Examine the nurse's role and responsibilities in drug
administration.
30
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Pharmacology for Nurses, 6e (Adams)
Chapter 2 Drug Approval and Regulation
1) A pharmaceutical representative comes to the physician's office and says his company's
pharmaceutical laboratory is marketing a drug that does not need approval by the Food and
Drug Administration (FDA). What is the best response by the nurse?
1. "Any pharmaceutical laboratory in America must have approval from the Food and Drug
Administration (FDA) before marketing a drug."
2. "Is this an over-the-counter (OTC) drug? They do not need approval by the Food and
Drug Administration (FDA)."
3. "Is your pharmaceutical laboratory private? Only public pharmaceutical laboratories
need approval from the Food and Drug Administration (FDA)."
4. "Your pharmaceutical laboratory must be involved in academic research because they
are exempt from approval by the Food and Drug Administration (FDA)."
Answer: 1
Explanation:
1. Any pharmaceutical laboratory must obtain approval from the Food and Drug
Administration (FDA) before marketing a drug.
2. Pharmaceutical laboratories that manufacture over-the-counter (OTC) drugs must
obtain approval from the Food and Drug Administration (FDA) before marketing these
drugs.
3. Private pharmaceutical laboratories must obtain approval from the Food and Drug
GRADESMORE.COM
Administration (FDA) before marketing a drug.
4. Pharmaceutical laboratories involved in academic research must obtain approval from
the Food and Drug Administration (FDA) before marketing a drug.
Page Ref: 12-13
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.1
Demonstrate basic knowledge of healthcare policy, finance and regulatory environments;
including local, state, national, and global healthcare trends. | NLN Competencies: Quality and
Safety: Policies and procedures. | Nursing/Integrated Concepts: Nursing Process: Analysis
Learning Outcome: 2-2 Discuss the role of the U.S. Food and Drug Administration (FDA) in the
drug approval process.
MNL Learning Outcome: 2.2 Examine the role of the U.S. Food and Drug Administration in the
process of drug approval and drug safety.
1
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2) A nurse is employed by the Food and Drug Administration (FDA) and is involved in clinical
investigation. The nurse's primary role in this phase of the FDA review and approval is to
perform tests on which of the following?
1. The population-at-large
2. Various species of animals
3. Human cells cultured in the laboratory
4. Human clients
Answer: 4
Explanation:
1. Performing tests on the population-at-large is the stage of postmarketing surveillance.
2. Performing tests on various species of animals is the preclinical investigation stage.
3. Performing tests on human cells cultured in the laboratory is the preclinical
investigation stage.
4. Clinical investigation includes performing tests on healthy volunteers, and later, on
selected clients with a particular disease.
Page Ref: 13
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation GRADESMORE.COM
Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biological
drugs.
MNL Learning Outcome: 2.2 Examine the role of the U.S. Food and Drug Administration in the
process of drug approval and drug safety.
2
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3) A student nurse is taking a pharmacology course and studying about the Food and Drug
Administration (FDA). Which statement indicates the student understands how the FDA has
decreased the amount of time involved in bringing a new drug to the market?
1. "The Food and Drug Administration (FDA) is not as strict as it once was with regard to
drug approval."
2. "Since consumers have demanded more drugs, the Food and Drug Administration (FDA)
has streamlined the review/approval process."
3. "Drug manufacturers are required to pay yearly user fees, which allow the Food and
Drug Administration (FDA) to hire more employees to increase its efficiency."
4. "Drug manufacturers are required by the Food and Drug Administration (FDA) to test
more drugs on an annual basis."
Answer: 3
Explanation:
1. The Food and Drug Administration (FDA) is just as strict now as it always was with
regard to drug approval.
2. The Food and Drug Administration (FDA) has not streamlined the review/approval
process.
3. In 1992, the Prescription Drug User Fee Act was passed. This required drug
manufacturers to provide yearly product user fees so the Food and Drug Administration
(FDA) could restructure, hire more employees, and operate more efficiently.
4. The Food and Drug Administration (FDA) does not require drug manufacturers to test
more drugs on an annual basis.
GRADESMORE.COM
Page Ref: 15
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Evaluation
Learning Outcome: 2-4 Discuss how the FDA has increased the speed with which new drugs
reach consumers.
MNL Learning Outcome: 2.2 Examine the role of the U.S. Food and Drug Administration in the
process of drug approval and drug safety.
3
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GRADESMORE.COM
WWW.GRADESMORE.COM
4) A client has skin lesions that have not responded to prescription drugs. He tells the nurse he
has heard about some research going on with a new drug and asks why he can't take it.
What is the best response by the nurse?
1. "I know it is frustrating, but the Food and Drug Administration (FDA) approval process is
in place to ensure that drugs are safe."
2. "The Food and Drug Administration (FDA) has very strict rules about new drugs; it is
important to be patient regarding the review/approval process."
3. "Your skin lesions really aren't that bad, but maybe the new drug will be available soon."
4. "Maybe you could contact the drug company about becoming involved in a clinical trial."
Answer: 1
Explanation:
1. Although the public is anxious to receive new drugs, the fundamental priority of the
Food and Drug Administration (FDA) is to ensure that drugs are safe. Also, telling the
client that the nurse knows he is frustrated is therapeutic because it communicates that
the nurse recognizes what he is feeling.
2. Telling the client to be patient is a condescending response; the client wants relief from
the skin condition.
3. Telling the client his skin lesions"aren't that bad" is a nontherapeutic response; the
client's perception is his reality.
4. The client could contact the drug company, but this response fosters false hope as he
may not be a viable candidate for this drug.
Page Ref: 13
GRADESMORE.COM
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2-2 Discuss the role of the U.S. Food and Drug Administration (FDA) in the
drug approval process.
MNL Learning Outcome: 2.2 Examine the role of the U.S. Food and Drug Administration in the
process of drug approval and drug safety.
4
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WWW.GRADESMORE.COM
5) A client asks a nurse how many Americans take at least one prescription drug per year.
What is the nurse's best response?
1. 50%
2. 10%
3. 40%
4. 25%
Answer: 1
Explanation:
1. About half of Americans take prescription drugs while about 17% take at least three
prescription drugs.
2. The percentage of Americans taking at least one prescription drug is higher.
3. This is not the percentage of Americans taking at least one prescription drug.
4. This is not the percentage of Americans taking at least one prescription drug.
Page Ref: 11
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.B.4 Read original research and evidence reports related to
area of practice. | AACN Essential Competencies: III.1 Explain the interrelationships among
theory, practice, and research. | NLN Competencies: Knowledge and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts:
Nursing Process: Assessment
Learning Outcome: 2-1 Identify key U.S. drug regulations that have provided guidelines for the
GRAtherapy.
DESMORE.COM
safe and effective use of drugs and drug
MNL Learning Outcome: 2.2 Examine the role of the U.S. Food and Drug Administration in the
process of drug approval and drug safety.
5
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WWW.GRADESMORE.COM
6) A nurse is teaching a medication class for parents of children with attention-deficit
hyperactivity disorder (ADHD) who are receiving stimulant medications. The nurse has
reviewed reasons why the medications are restricted. The nurse determines that learning
has occurred when the parents make which responses?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "The use of these medications is restricted so that the pharmacies can track the rate of
drug abuse in our city."
2. "The use of these medications is restricted because the physician needs to evaluate our
child more often."
3. "The use of these medications is restricted because they have the potential for abuse."
4. "The use of these medications is restricted so that the drug companies can make a
bigger profit."
5. "The use of these medications is restricted because this is the current law."
Answer: 3, 5
Explanation:
1. Pharmacies do not track the rate of drug abuse in cities.
2. More frequent evaluations is a good plan, but this is not the reason for restricted use of
stimulant medications.
3. Medications with abuse potential are restricted.
4. Drug companies do not make a bigger profit when medications are listed as restricted.
5. The Controlled Substance Act is the law under which medications with abuse potential
GRADESare
MOconsidered
RE.COM controlled substances.
are restricted. Stimulant medications
Page Ref: 16
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Evaluation
Learning Outcome: 2-7 Discuss why drugs are sometimes placed on a restrictive list, and the
controversy surrounding this issue.
MNL Learning Outcome: 2.4 Recognize controlled substances and drug schedules.
6
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WWW.GRADESMORE.COM
7) A client says to a nurse, "My healthcare provider said my drug is a controlled substance; am
I considered an addict?" What is the best response by the nurse?
1. "Are you concerned about becoming an addict? We can discuss this in more detail if you
would like to."
2. "You are not an addict; the Drug Enforcement Administration (DEA) restricts the use of
drugs with a high potential for abuse."
3. "Why do you ask about becoming an addict? Not many of our clients have asked this
question."
4. "You are not an addict, but the Drug Enforcement Administration (DEA) will monitor you
for this."
Answer: 2
Explanation:
1. It is premature at this time to ask the client if he is concerned about addiction; there is
no information to support an addiction.
2. Drugs that have a high potential for addiction are considered controlled substances.
3. "Why" questions are considered nontherapeutic because they put the client on the
defensive mood.
4. The Drug Enforcement Administration (DEA) does not monitor clients for addiction
when they receive controlled substances.
Page Ref: 16
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRDemonstrate
ADESMOREeffective
.COM use of technology and
Standards: QSEN Competencies: V.B.1
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2-6 Explain the U.S. Controlled Substance Act of 1970 and the role of the
U.S. Drug Enforcement Administration in controlling drug abuse and misuse.
MNL Learning Outcome: 2.4 Recognize controlled substances and drug schedules.
7
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GRADESMORE.COM
WWW.GRADESMORE.COM
8) A client is receiving methadone (which is a Schedule II drug). The client says to the nurse,"A
pharmacist told me the pharmacy must register with the Drug Enforcement Administration
(DEA) to give me this drug; will DEA agents be snooping around my house?" What is the
best response by the nurse?
1. "It is probably unlikely that Drug Enforcement Administration (DEA) agents will be
bothering you."
2. "No, the Drug Enforcement Administration (DEA) restricts drugs that have a high
potential for abuse."
3. "No. I think our system should be more like Europe; they have fewer controlled drugs."
4. "That's an interesting question. Are you worried about the Drug Enforcement
Administration (DEA)?"
Answer: 2
Explanation:
1. Telling the client that Drug Enforcement Administration (DEA) agents will "probably" not
bother him can lead the client to think DEA agents might bother him.
2. The Controlled Substance Act of 1970 restricts the use of drugs that have a high
potential for abuse. Hospitals and pharmacies must register with the Drug Enforcement
Administration (DEA) to obtain a specific registration number that will enable them to
purchase controlled drugs.
3. By saying that our system should be more like Europe's, the nurse is introducing her
beliefs and this is nontherapeutic; the client may not agree.
4. Asking the client if he is worried about the Drug Enforcement Administration (DEA) puts
GRAisDnontherapeutic.
ESMORE.COM
him on the defensive mode and
Page Ref: 16
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2-6 Explain the U.S. Controlled Substance Act of 1970 and the role of the
U.S. Drug Enforcement Administration in controlling drug abuse and misuse.
MNL Learning Outcome: 2.4 Recognize controlled substances and drug schedules.
8
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
9) During the admission assessment, a client tells a nurse, "Sure I smoke a little weed
(marijuana) to manage my stress. Doesn't everyone?" What is the nurse's best response?
1. "What other ways do you think you might use to help you to manage your stress?"
2. "Aren't you afraid of going to jail for a long time if you get caught?"
3. "Do you really believe that everyone smokes marijuana to manage stress?"
4. "How often do you smoke marijuana, and how much each time?"
Answer: 4
Explanation:
1. Stress management is not the main concern during the admission assessment.
2. Asking the client if he is afraid of going to jail is not an assessment question and is not
the issue during the admission assessment.
3. Asking the client if he really believes something is not an assessment question and can
lead to an argument with the client.
4. The nurse must assess the amount and frequency of any drug the client uses, including
illegal drugs.
Page Ref: 16
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation GRADESMORE.COM
Learning Outcome: 2-9 Identify the five drug schedules and give examples of drugs at each
level.
MNL Learning Outcome: 2.4 Recognize controlled substances and drug schedules.
9
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WWW.GRADESMORE.COM
10) A parent of an adolescent receiving methylphenidate (Concerta) for ADHD asks why she
needs a new prescription each month. What is the best response by the nurse?
1. "Just drop by and I will get you a prescription."
2. "We can't do that; maybe you can find another doctor's office that will do it."
3. "The law does not allow us to give you refills on this medication."
4. "How do you feel about having to get a new prescription each month?"
Answer: 3
Explanation:
1. Although it's true that the parent will need to get a new written prescription each
month, this response doesn't really answer the parent's question, so it's not the best
answer.
2. Referring the parent to another office is nontherapeutic and implies that other medical
offices violate the law.
3. Telling the mother about the law is accurate and is the only response that answers the
parent's question.
4. Although this is a therapeutic response, it doesn't answer the parent's question
Page Ref: 16
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
GRADE
SMprocedures.
ORE.COM| Nursing/Integrated Concepts:
Competencies: Quality and Safety: Policies
and
Nursing Process: Implementation
Learning Outcome: 2-7 Discuss why drugs are sometimes placed on a restrictive list, and the
controversy surrounding this issue.
MNL Learning Outcome: 2.4 Recognize controlled substances and drug schedules.
10
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GRADESMORE.COM
WWW.GRADESMORE.COM
11) A client who is terminally ill reports hearing about a drug that is in preclinical investigation.
The client asks the nurse if the drug will be available to the public soon. What should the
nurse consider when formulating an answer to this question?
1. After preclinical investigation the drug has one more step before being released for
public use.
2. The average length of preclinical investigation is 18 months.
3. When the drug reaches the clinical investigation stage it is usually released within 2
years.
4. The drug will not be available until after the postmarketing studies are done.
Answer: 2
Explanation:
1. Preclinical investigation is the first of three stages the drug must go through before
being released for use.
2. Preclinical investigation may last 1-3 years with 18 months being the average.
3. Clinical investigation may last 2-10 years with 5 years being the average.
4. Postmarketing studies are started as soon as the NDA review is completed and may
continue for years after drug release.
Page Ref: 13
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
GRADESrelevant
MORE.toCO
M provision of healthcare. | NLN
Examine legislative and regulatory processes
the
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Planning
Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biological
drugs.
MNL Learning Outcome: 2.3 Identify the 4 stages of drug approval.
11
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
12) A nurse provides medication education to a client with terminal cancer. The physician has
ordered morphine, a Schedule II drug, for the client. The nurse determines that learning has
occurred when the client makes which statement?
1. "I need to call the office for a refill before my medication runs out."
2. "This drug is addictive so I should only take it when my pain becomes severe."
3. "Maybe my physician could change me to a Schedule IV drug."
4. "I need to see my doctor before my prescription runs out so I can get a refill."
Answer: 4
Explanation:
1. Schedule II drugs cannot be refilled by phone order.
2. Not taking pain medication until the pain becomes severe is an inappropriate use of
pain medication for a client with terminal cancer.
3. A Schedule IV drug may not effectively relieve the client's pain.
4. The client must see the physician for a refill.
Page Ref: 16
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Evaluation
RADare
ESMsometimes
ORE.COplaced
M
Learning Outcome: 2-7 Discuss whyGdrugs
on a restrictive list, and the
controversy surrounding this issue.
MNL Learning Outcome: 2.4 Recognize controlled substances and drug schedules.
13) A nurse is teaching a student nurse about the stages of drug approval. A drug manufacturer
that is studying the effects of a drug on laboratory animals would be in which phase of the
new drug development timeline?
1. Clinical Investigation
2. Preclinical Investigation
3. New Drug Application Review
4. Postmarketing Studies
Answer: 2
Explanation: 1. Clinical investigation involves testing the drug on human subjects.
2. Preclinical investigation involves laboratory research on nonhuman subjects.
3. New Drug Application review occurs during human clinical trials.
4. Postmarketing Studies occur after the drug is being used by the general population.
Page Ref: 13
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
12
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biological
drugs.
MNL Learning Outcome: 2.3 Identify the 4 stages of drug approval.
14) While reading a medication package insert, a nurse notes the information contained within
the "black box." What is the significance of this information to the nurse?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The drug can cause "special problems."
2. It identifies extreme adverse drug reactions.
3. It differentiates a prescribed medication from an over-the-counter medication.
4. It highlights the cost of the medication.
5. It signifies the medication is generic.
Answer: 1, 2
Explanation:
1. The FDA created boxed warnings in order to regulate drugs with "special problems."
2. The black box warning is a primary alert for identifying extreme adverse drug reactions.
3. Black box warnings are not a mechanism to differentiate a prescribed medication from
an over-the-counter medication.
4. It does not highlight the cost of the medication.
GRADasEbeing
SMORgeneric.
E.COM
5. It does not signify the medication
Page Ref: 13
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Analysis
Learning Outcome: 2-1 Identify key U.S. drug regulations that have provided guidelines for the
safe and effective use of drugs and drug therapy.
MNL Learning Outcome: 2.2 Examine the role of the U.S. Food and Drug Administration in the
process of drug approval and drug safety.
13
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
15) A nurse is participating in the New Drug Review step for a new therapeutic agent. Which
activities will the nurse most likely perform during this phase of the drug approval process?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Attend meetings to finalize the brand name for the drug.
2. Check on the results of animal testing.
3. Survey for harmful effects in a larger population.
4. Evaluate the results of the drug on cultured cells.
5. Provide the medication to large groups of people with a particular disease.
Answer: 1, 2
Explanation:
1. During the NDA or the third stage of the drug approval process, the drug's brand name
is finalized.
2. During the NDA stage of the drug approval process, animal testing may continue.
3. Surveying for harmful effects in a larger population occurs during the postmarketing
surveillance step of the drug approval process.
4. Evaluation of the results of the drug on cultured cells occurs during the preclinical
investigation step of the drug approval process.
5. Providing the medication to large groups of people with a particular disease occurs
during the clinical phase trials, which is in the second stage of the drug approval
process.
Page Ref: 14
GRADESMORE.COM
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biological
drugs.
MNL Learning Outcome: 2.3 Identify the 4 stages of drug approval.
14
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
16) A nurse is teaching a group of nursing students about the role of the U.S. Food and Drug
Administration (FDA). The nurse plans to include which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Responsible for improving the health of Americans.
2. Publishes a summary of the standards of drug purity and strength.
3. Ensures the availability of effective drugs.
4. Takes action against any supplement that is deemed to be unsafe.
5. Facilitates the availability of safe drugs.
Answer: 1, 3, 4, 5
Explanation:
1. The FDA mission is to protect public health by ensuring the safety, efficacy, and security
of human and veterinary drugs, biologic products, medical devices, the nation's food
supply, cosmetics, and products that emit radiation.
2. It is the role of the U.S. Pharmacopeia (USP) to publish a summary of drug standards
(purity and strength).
3. Ensuring the availability of effective drugs is one of the FDA's roles.
4. It is the FDA's role to take action against any supplement that is deemed to be unsafe.
5. It is the role of the FDA to facilitate the availability of safe drugs.
Page Ref: 12
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRDemonstrate
ADESMOREeffective
.COM use of technology and
Standards: QSEN Competencies: V.B.1
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Planning
Learning Outcome: 2-1 Identify key U.S. drug regulations that have provided guidelines for the
safe and effective use of drugs and drug therapy.
MNL Learning Outcome: 2.2 Examine the role of the U.S. Food and Drug Administration in the
process of drug approval and drug safety.
15
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
17) A nurse is teaching a group of nursing students about the preclinical research stage of drug
development. The nurse understands that the students understand the teaching by which
of the following student responses?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Most drugs do not proceed past the preclinical stage because they are found to be too
toxic or just ineffective.
2. At the end of the preclinical research stage, client variability is determined and potential
drug-to-drug interactions are examined.
3. The preclinical stage of research involves extensive testing on animals in the laboratory
to determine if the drug will cause harm to humans.
4. Preclinical research results are always inconclusive.
5. The Food and Drug Administration (FDA) is responsible for extensive testing for safety
before the pharmaceutical company can begin the preclinical research stage of
development.
Answer: 1, 3, 4
Explanation:
1. Most drugs do not proceed past the preclinical research stage of development because
they are found to be either too toxic or just ineffective.
2. Client variability and potential drug-to-drug interactions are examined in Phase 3 of the
clinical investigation process after Food and Drug Administration (FDA) approval.
3. The preclinical stage involves extensive testing on human, microbial cells, and animals to
RADESwhether
MORE.the
COdrug
M will cause harm to humans.
determine drug action and toGpredict
4. Because lab tests cannot accurately predict human response to a drug, these results are
always inconclusive.
5. This extensive testing is done by the pharmaceutical company in the preclinical research
stage of drug development, not the FDA.
Page Ref: 13
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Evaluation
Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biological
drugs.
MNL Learning Outcome: 2.2 Examine the role of the U.S. Food and Drug Administration in the
process of drug approval and drug safety.
16
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
18) A nurse is developing a time line of drug regulations and standards. The nurse should list
which of the following events as the first drug regulation and/or standard?
1. Passage of the Sherley Amendment
2. Passage of the Childhood Vaccine Act
3. Development of the U.S. Pharmacopoeia
4. Passage of the Biologics Control Act
Answer: 3
Explanation:
1. Passed in 1912, the Sherley Amendment made medicines safer by prohibiting the sale of
drugs labeled with false therapeutic claims.
2. The Childhood Vaccine Act was passed in 1986 and allowed the FDA to acquire
information about clients taking vaccines, to recall biologics, and to recommend civil
penalties if guidelines regarding biologic use were not followed
3. The U.S. Pharmacopoeia was established in 1820 and served as the first comprehensive
publication of drug standards.
4. The Biologics Control Act was passed in 1902 and controlled the quality of serums and
other blood-related products.
Page Ref: 11
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
GRADESrelevant
MORE.toCO
M provision of healthcare. | NLN
Examine legislative and regulatory processes
the
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Analysis
Learning Outcome: 2-1 Identify key U.S. drug regulations that have provided guidelines for the
safe and effective use of drugs and drug therapy.
MNL Learning Outcome: 2.1 Consider the history of drug legislation and its effect on drug
standards and safety.
17
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19) A nurse is teaching a client about their medications. The client is worried about "getting
addicted" to their medications. The nurse explains that which of the following drugs has the
highest risk for dependence?
1. Acetaminophen
2. Codeine
3. Heroin
4. Diazepam
Answer: 3
Explanation:
1. Acetaminophen does not have a high abuse potential.
2. Codeine is a Schedule III drug.
3. Heroin is a Schedule I drug and has the highest potential for abuse, physical
dependence, and psychological dependence of the drugs listed.
4. Diazepam is a Schedule IV drug.
Page Ref: 16
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation
RAdrug
DESschedules
MORE.Cand
OM give examples of drugs at each
Learning Outcome: 2-9 Identify the G
five
level.
MNL Learning Outcome: 2.4 Recognize controlled substances and drug schedules.
18
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20) A drug is withdrawn from a client who has been taking it routinely for many years. The
client has developed muscle tremors. How will the nurse document this event?
1. An adverse effect
2. Evidence that the client had psychological dependence on the drug
3. An expected therapeutic effect of no longer taking the drug
4. Assessment finding associated with physical dependence on a drug
Answer: 4
Explanation:
1. Adverse effects are seen while the drug is being taken, not after it is withdrawn.
2. With psychological dependence, few physical signs are seen.
3. Therapeutic effects are seen while drugs are being used, not after they have been
removed.
4. The presence of physical withdrawal symptoms (muscle tremors) is seen when a person
is physically dependent on a drug and the drug is removed.
Page Ref: 16
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.5 Assess levels of physical and emotional comfort. | AACN
Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects and
understanding of human growth and development, pathophysiology, pharmacology, medical
management, and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings | NLN Competencies: Knowledge and Science: Integration of
GRADESM|ONursing/Integrated
RE.COM
knowledge from nursing and other disciplines.
Concepts: Nursing Process:
Analysis
Learning Outcome: 2-8 Explain the meaning of a controlled substance and teratogenic risk in
pregnancy.
MNL Learning Outcome: 2.2 Examine the role of the U.S. Food and Drug Administration in the
process of drug approval and drug safety.
19
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21) The nurse is reviewing prescription refill request messages. The nurse understands that a
prescription for which of the following drugs can be sent to the pharmacy by telephone?
1. Morphine
2. Cannabis
3. Meperidine
4. An anabolic steroid
Answer: 4
Explanation:
1. Morphine is a Schedule II drug. Telephone prescription requests are not allowed. The
client must be examined by a physician prior to a new prescription being written.
2. Cannabis is a Schedule I drug. Telephone prescriptions requests are not allowed.
3. Meperidine is a Schedule II drug. Telephone prescription requests are not allowed.
4. Anabolic steroids are Schedule III drugs. Telephone prescription refills are allowed.
Page Ref: 15
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2-5 Identify the advanced practice registered nurse's role in prescribing
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drugs.
MNL Learning Outcome: 2.4 Recognize controlled substances and drug schedules.
22) A nurse is administering a medication to a group of volunteers and is assessing for the
development of adverse effects. The nurse is working in which phase of the development of
this drug?
1. Clinical Phase I Trials
2. Preclinical Investigation
3. Clinical Phase II trials
4. Clinical Phase III trials
Answer: 1
Explanation:
1. The Clinical Phase I Trial is when investigators first begin to administered the drug to
volunteers to determine proper dosage and to assess for adverse effects.
2. Preclinical investigation is done on human and microbial cells.
3. Lasts about two years and involves 100-300 volunteer patients with the disease.
4. Takes about three years and involves 1000-3000 patients in hospitals and clinic
agencies.
Page Ref: 13
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
20
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WWW.GRADESMORE.COM
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biological
drugs.
MNL Learning Outcome: 2.3 Identify the 4 stages of drug approval.
23) A client has been chosen to participate in the clinical trial of a medication to treat
chemotherapy-induced nausea. When the nurse takes the informed consent form to the
bedside, the client says, "I am glad there is finally a medication to cure my cancer." How
should the nurse respond?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Who told you the medication would cure your cancer?"
2. "What questions do you have about this medication?"
3. "Let me explain how this medication works."
4. "Has anyone explained the research trial to you?"
5. "So am I. This research has been intense."
Answer: 2, 4
Explanation:
1. It is not important to discover who specifically gave the client this information.
GRA
DEShas
MOno
REquestions
.COM prior to having the consent
2. The nurse should be certain the
client
signed.
3. It is not the nurse's responsibility to explain how the medication works. It is the
responsibility of the researcher or healthcare provider. The nurse should refer questions
to those individuals.
4. It is the nurse's responsibility to ensure that the client has been provided with facts
about the medication and the clinical trial prior to having the consent signed.
5. The nurse should identify that this client does not fully understand the purpose of this
medication and should collaborate with the researcher or healthcare provider regarding
this misunderstanding.
Page Ref: 15
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.12 Facilitate informed patient consent for care. | AACN
Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the
provision of healthcare. | NLN Competencies: Quality and Safety: Policies and procedures. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 2-5 Identify the nurse's role in the drug approval process and in maintaining
safety practices.
MNL Learning Outcome: 2.2 Examine the role of the U.S. Food and Drug Administration in the
process of drug approval and drug safety.
21
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24) A student nurse asks a nurse why some medications get approved by the Federal Drug
Administration (FDA) faster. What is the nurse's best response?
1. The FDA collects a user fee from pharmaceutical companies and uses it to hire more
employees to speed up the process.
2. Pharmaceutical companies are allowed to skip the Preclinical Investigation phase if they
are developing a chemotherapy drug.
3. The Accelerated Approval Program allows earlier approval of a medication if it is a
commonly used drug.
4. A smaller group of patients with a particular disease are selected for the clinical phase
trials.
Answer: 1
Explanation:
1. The Prescription Drug User Fee was enacted in 1992. Drug manufacturers are required
to pay a user fee annually. The FDA uses this money to hire more employees and speed
up the approval process.
2. Drug companies that manufacture medications for serious conditions, such as cancer,
still have to follow the entire FDA new drug application process.
3. The Accelerated Approval Program allows for earlier approval of a new drug that is used
to treat serious medical problems.
4. A large group of patients with that medical disease are selected for clinical trials.
Page Ref: 15
Cognitive Level: Applying
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2-5 Identify the nurse's role in the drug approval process and in maintaining
safety practices.
MNL Learning Outcome: 2.4 Recognize controlled substances and drug schedules.
22
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25) A student nurse asks an advanced practice nurse (APRN) about the role of APRNs in
prescribing medications. Which of the following is the best response by the nurse?
1. The ability to prescribe drugs is regulated by federal law.
2. All advanced practice nurses can prescribe medications.
3. Nurse practitioners are an example of an advanced practice nurse.
4. Advanced practice nurses may increase the cost of healthcare.
Answer: 3
Explanation:
1. The ability to prescribe medications is regulated by state laws, not federal law.
2. Some states have not authorized APRNs to prescribe medications.
3. Nurse practitioners are an example of an advanced practice nurse.
4. Advanced practice nurses can decrease the cost of healthcare.
Page Ref: 15
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Planning
Learning Outcome: 2-5 Identify the nurse's role in the drug approval process and in maintaining
safety practices.
GRthe
ADrole
ESMofOthe
REU.S.
.COFood
M and Drug Administration in the
MNL Learning Outcome: 2.2 Examine
process of drug approval and drug safety.
26) A client says, "This morning's nurse told me that my pain medication is a scheduled drug.
Aren't all drugs given on a schedule?" How should the nurse respond?
1. "What time would you like to schedule your pain medication?"
2. "Medications are usually scheduled every 4 hours."
3. "Scheduled medications have a significant potential for abuse."
4. "During preclinical investigation, scheduled medications are tested."
Answer: 3
Explanation:
1. "Pain medication is usually given PRN (when needed)."
2. "Some medications are ordered to be given every 4 hours."
3. "Drugs with a significant potential for abuse are classified into five schedules or
categories. These drugs are called 'scheduled drugs.'"
4. During the preclinical investigation phase of drug approval, medications are tested to
make sure they are safe.
Page Ref: 16
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
23
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WWW.GRADESMORE.COM
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2-9 Identify the five drug schedules and give examples of drugs at each level.
MNL Learning Outcome: 2.4 Recognize controlled substances and drug schedules.
27) A nurse teaches a client that the newly prescribed medication has a very high risk of causing
fetal abnormalities and that reliable measures to prevent pregnancy are essential while
taking the medication. The nurse has described a medication that falls into which category?
1. A
2. B
3. D
4. X
Answer: 4
Explanation:
1. Category A are the safest medications to give during pregnancy.
2. Category B medications have failed to demonstrate a risk to the fetus.
3. Category D medications have positive evidence of fetal risk, but benefits may outweigh
the risk.
4. Category X drugs have animal and human studies that show fetal abnormalities. The
drug is contraindicated in women who are or may become pregnant. Reliable pregnancy
prevention measures must be followed.
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Page Ref: 16
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2-10 Identify the five categories of teratogenic drug classification.
MNL Learning Outcome: 2.2 Examine the role of the U.S. Food and Drug Administration in the
process of drug approval and drug safety.
24
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28) A nurse is providing preconception teaching to a group of women who wish to become
pregnant. The nurse informs the group that which classifications of medications have shown
no confirmed risk for fetal abnormalities if taken while pregnant?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Category A
2. Category B
3. Category C
4. Category D
5. Category X
Answer: 1, 2
Explanation:
1. Category A drugs are those in which controlled studies have failed to show a risk to the
fetus and the possibility of fetal harm appears unlikely.
2. Category B drugs are those in which animal-reproduction studies have not shown a fetal
risk or adverse effect. Risks have not been confirmed in controlled studies in women.
3. Category C drugs are those in which either studies in animals have revealed adverse
effects on the fetus and there are no controlled studies in women or studies in women
and animals are not advisable.
4. Category D drugs are those in which there is confirmation of human fetal risk, but the
benefits from use in pregnant women may be acceptable despite the risk (e.g., if the
drug is needed in a life-threatening situation or for a serious disease for which safer
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drugs cannot be used).
5. Category X drugs are those in which animal and human studies have shown fetal
abnormalities. The drug is contraindicated in women who are or may become pregnant.
Page Ref: 16
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2-10 Identify the five categories of teratogenic drug classification.
MNL Learning Outcome: 2.2 Examine the role of the U.S. Food and Drug Administration in the
process of drug approval and drug safety.
25
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29) A client at 14-weeks gestation is seen in the clinic with a sprained ankle. The healthcare
provider prescribes a mild analgesic, rest, compression, and application of an ice bag. The
client is very concerned about taking the prescribed medication, telling the nurse, "I don't
want to hurt my baby." How should the nurse respond?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "The most dangerous time for birth defects is probably in the first semester and you are
past that now."
2. "You are wise to avoid all drugs. I would only use the rest, compression, and ice."
3. "Let me check with the physician to see if he remembered you are pregnant."
4. "This is a category A drug, so there is very little risk to your baby."
5. "Don't worry, it will all be okay. You need to take care of yourself first."
Answer: 1, 4
Explanation:
1. The time of highest risk of birth defects is probably in the first trimester, and this client
is past that time. It is not possible to predict that there is no risk from drug
consumption.
2. While drug avoidance is preferred, in some cases it is necessary. If the nurse has
concerns about the drug prescribed, collaboration with the prescriber is indicated.
3. Without further information about which drug was prescribed, it is nontherapeutic to
make the client doubt the prescriber's choice of therapy.
4. With category A drugs, the risk of fetal harm is unlikely.
GRAand
DESdismisses
MORE.Cthe
OMclient's concern.
5. This statement is nontherapeutic
Page Ref: 16
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2-8 Explain the meaning of a controlled substance and teratogenic risk in
pregnancy.
MNL Learning Outcome: 2.2 Examine the role of the U.S. Food and Drug Administration in the
process of drug approval and drug safety.
26
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30) A nurse suspects a client has had an allergic reaction to a recently prescribed antibiotic. The
nurse is responsible for providing emergency treatment and for reporting this suspected
reaction to which persons?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Federal Drug Administration (FDA)
2. Healthcare provider
3. Hospital pharmacist
4. Medicare
5. Hospital risk management
Answer: 2, 3, 5
Explanation:
1. While it may be necessary to report this reaction to the FDA, it is not the bedside nurse's
responsibility to do so.
2. The prescriber should be notified as this is an unexpected event. A change in therapy is
likely to be required.
3. The hospital pharmacist should be advised of this possible reaction.
4. There is no reason for the bedside nurse to notify Medicare.
5. Hospital risk management should be notified of this event. A variance report may be
required.
Page Ref: 14
Cognitive Level: Applying
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: V.4
Examine legislative and regulatory processes relevant to the provision of healthcare. | NLN
Competencies: Quality and Safety: Policies and procedures. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 2-5 Identify the nurse's role in the drug approval process and in maintaining
safety practices.
MNL Learning Outcome: 2.2 Examine the role of the U.S. Food and Drug Administration in the
process of drug approval and drug safety.
27
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Pharmacology for Nurses, 6e (Adams)
Chapter 3 Principles of Drug Administration
1) A nurse is preparing to administer several medications for a client. The nurse is responsible
for understanding which of the following regarding medication administration?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Cost of the medication
2. Reason the medication was prescribed
3. Route of administration
4. How the medication is supplied by the pharmacy
5. Name of the medication
Answer: 2, 3, 4, 5
Explanation:
1. Although the cost of a medication may lead to noncompliance at home, it is not a factor
when administering medications in a healthcare facility.
2. Knowing the reason the medication was prescribed for the patient is the responsibility
of the nurse regarding medication administration.
3. Knowing how the medication is to be administered is the responsibility of the nurse
regarding medication administration.
4. Knowing how the medication is supplied by the pharmacy is the responsibility of the
nurse regarding medication administration.
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5. Knowing the name of the medication is the responsibility of the nurse regarding
medication administration.
Page Ref: 20
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: IX.3
Implement holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Quality and Safety: Current best practices. | Nursing/Integrated Concepts:
Nursing Process: Planning
Learning Outcome: 3-2 Describe the roles and responsibilities of nurses regarding safe drug
administration.
MNL Learning Outcome: 3.1 Recognize the nurse's role, responsibilities, and safe practices
when providing care to patients receiving pharmacotherapy.
1
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2) A nurse is preparing medications prior to administration. To promote client safety, the
nurse uses the "rights" of drug administration. What do these "rights" include?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The right medication
2. The right time of delivery
3. The right dose
4. The right route of administration
5. The right nurse
Answer: 1, 2, 3, 4
Explanation:
1. The right medication is an essential consideration of medication administration and is
considered one of the five rights.
2. The right time of delivery is an essential consideration of medication administration and
is considered one of the five rights.
3. The right dose is an essential consideration of medication administration and is
considered one of the five rights.
4. The right route of delivery is an essential consideration of medication administration
and is considered one of the five rights.
5. The right nurse is not one of the listed rights of medication delivery.
Page Ref: 21
Cognitive Level: Applying
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: IX.12
Create a safe environment that results in high quality patient outcomes. | NLN Competencies:
Quality and Safety: Current best practices. | Nursing/Integrated Concepts: Nursing Process:
Planning
Learning Outcome: 3-3 Explain how the five rights of drug administration affect patient safety.
MNL Learning Outcome: 3.1 Recognize the nurse's role, responsibilities, and safe practices
when providing care to patients receiving pharmacotherapy.
2
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3) A nurse is concerned that a client has not been taking the prescribed antihypertensive
medication because the patient's blood pressure remains elevated. What is the best
therapeutic response by the nurse?
1. "Taking medication can be difficult for some people. What are some of your concerns
about the medication?"
2. "Your blood pressure is really high; do you realize the serious consequences of not
taking your medication?"
3. "I really doubt that you are taking your medication. What would you think about talking
to the physician?"
4. "You are one of my favorite patients and I want you to be safe. Are you really taking
your medication?"
Answer: 1
Explanation:
1. The most therapeutic question informs the patient that compliance is difficult for many
people, and does not directly challenge the patient about not taking the medication.
2. Telling the patient his blood pressure is high and there are serious consequences is using
the "scare tactic," and is nontherapeutic; the patient most likely is aware of the
consequences.
3. Telling the patient that the nurse doubts they are taking the medication is a direct
challenge, and recommending that the patient see the physician is threatening.
4. Telling the patient that he is a favorite is manipulating.
Page Ref: 21
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Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences, and expressed needs as
part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essential
Competencies: IX.5 Deliver compassionate, patient-centered, evidence-based care that respects
patient and family preferences. | NLN Competencies: Relationship-Centered Care: Respect the
patient's dignity, uniqueness, integrity, and self-determination, and his or her own power and
self-healing process. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3-4 Give specific examples of how nurses can increase patient adherence in
taking medications.
MNL Learning Outcome: 3.1 Recognize the nurse's role, responsibilities, and safe practices
when providing care to patients receiving pharmacotherapy.
3
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4) The patient is having chest pain. The physician orders sublingual nitroglycerine STAT. The
nurse obtains the medication from the pharmacy and administers it to the patient 30
minutes later. Which statement best describes the nurse's action?
1. The medication should have been administered immediately.
2. The physician should have specified the time frame for the medication.
3. The medication should have been administered within a 5-minute time frame.
4. The nursing action was correct because the medication was not on the unit.
Answer: 3
Explanation:
1. Although the drug does not need to be administered immediately, there is a time limit
in which it should be administered.
2. For a STAT order, the time frame between writing the order and administering the drug
should be 5 minutes or less. Not having a drug on the unit is not an excuse, as
commonly ordered STAT medications should be kept in stock. Although the drug does
not need to be administered immediately, it should be done within 5 minutes. By using
the abbreviation STAT, the physician has specified the time frame for the medication.
3. For a STAT order, the time frame between writing the order and administering the drug
should be 5 minutes or less.
4. Not having a drug on the unit is not an excuse, as commonly ordered STAT medications
should be kept in stock.
Page Ref: 22
Cognitive Level: Applying
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: IX.3
Implement holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Quality and Safety: Current best practices. | Nursing/Integrated Concepts:
Nursing Process: Evaluation
Learning Outcome: 3-5 Interpret drug orders that contain abbreviations.
MNL Learning Outcome: 3.2 Accurately interpret drug orders
4
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5) A nurse is preparing to administer a client's medications. Which of the following is most
important to assess first?
1. Assess the patient's developmental level.
2. Assess the patient's medical history.
3. Assess the patient's disease process.
4. Assess the patient's learning needs.
Answer: 2
Explanation:
1. Assessing the patient's developmental level is important for medication education, but
not for safely administering medications.
2. An assessment of the patient's medical history, which includes allergies, is the most
important assessment prior to administering medications.
3. Assessing the patient's disease process is important in evaluating the effects of the
medications, but not for safely administering medications.
4. Assessing the patient's learning needs is important for medication education, but not for
safely administering medications.
Page Ref: 20
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: IX.3
Implement holistic, patient-centered care that reflects an understanding of human growth and
GRADESMmedical
ORE.Cmanagement,
OM
development, pathophysiology, pharmacology,
and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Quality and Safety: Current best practices. | Nursing/Integrated Concepts:
Nursing Process: Assessment
Learning Outcome: 3-1 Discuss drug administration as a component of safe, effective nursing
care, using the nursing process.
MNL Learning Outcome: 3.1 Recognize the nurse's role, responsibilities, and safe practices
when providing care to patients receiving pharmacotherapy.
5
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6) A nurse is preparing to administer oral medication to a client. What is the primary nursing
assessment of the client prior to receiving this medication?
1. Understanding of the medication
2. Ability to swallow
3. Allergies
4. Eyesight
Answer: 2
Explanation:
1. The patient's understanding is important, but not a priority.
2. The ability of the patient to swallow is a safety issue to prevent aspiration of the
medication.
3. The patient's allergies are important, but if the patient cannot swallow the medication,
then the allergies are not significant.
4. The patient's eyesight is not significant.
Page Ref: 24
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Current best
GRADNursing
ESMORProcess:
E.COMAssessment
practices. | Nursing/Integrated Concepts:
Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and
parenteral drugs.
MNL Learning Outcome: 3.1 Recognize the nurse's role, responsibilities, and safe practices
when providing care to patients receiving pharmacotherapy.
6
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7) A nurse incorrectly administered an oral medication intravenously. What is the best analysis
of the nurse's action?
1. An antidote cannot be given.
2. The nurse will be terminated from her job.
3. The medication cannot be retrieved.
4. A lawsuit by the patient will be impending.
Answer: 3
Explanation:
1. Antidotes may be given, but this must be done very quickly.
2. The nurse may be terminated, but patient safety is the main concern.
3. When a medication is given intravenously, its effects cannot be reversed because it is
already in the bloodstream.
4. A lawsuit may occur, but this is not the primary concern; patient safety is the primary
concern.
Page Ref: 24-34
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: VIII.12 Act to prevent unsafe, illegal, or unethical care
practices. | NLN Competencies: Quality and Safety: Current best practices. | Nursing/Integrated
Concepts: Nursing Process: Evaluation
Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and
GRADESMORE.COM
parenteral drugs.
MNL Learning Outcome: 3.1 Recognize the nurse's role, responsibilities, and safe practices
when providing care to patients receiving pharmacotherapy.
7
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8) A nurse is preparing to administer a topical medication. What is the priority nursing
intervention?
1. Check the medication for interactions with other medications.
2. Take the patient's vital signs.
3. Educate the patient to not disturb the patch.
4. Assess the patient's skin where the medication will be applied.
Answer: 4
Explanation:
1. Checking for drug interactions is important, but it is not the priority.
2. Vital signs are not always indicated; it depends on the medication.
3. Patient education is important, but is not the priority.
4. Planning to assess the patient's skin is imperative; if it is cracked, dry, or irritated, the
medication may not be properly absorbed.
Page Ref: 28
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Current best
practices. | Nursing/Integrated Concepts: Nursing Process: Planning
GRADE
SMOREof.C
OM
Learning Outcome: 3-7 Explain the proper
methods
administering
enteral, topical, and
parenteral drugs.
MNL Learning Outcome: 3.3 Consider nursing implications when delivering enteral or topical
medications.
8
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9) A client has a prescription for an intravenous medication for nausea. The client asks the
nurse how it will help his nausea since it is given in his vein. What is the best therapeutic
response by the nurse?
1. "We have more intravenous drugs for nausea than we do oral drugs."
2. "If you take an oral medication, you will just vomit it up."
3. "This will work much faster for your nausea."
4. "You can't have anything by mouth, so you will receive the medication intravenously."
Answer: 3
Explanation:
1. Telling the patient that the nurse has more intravenous drugs than oral drugs does not
answer the patient's question.
2. Telling the patient that they will vomit the medication is nontherapeutic.
3. The intravenous route provides the quickest route of medication absorption.
4. There is no evidence that the patient cannot have anything by mouth.
Page Ref: 24-34
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
GRADEand
SMquality
ORE.and
COMsafe patient care. |
Relationships between knowledge/science
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3-8 Compare and contrast the advantages and disadvantages of each route
of drug administration.
MNL Learning Outcome: 3.4 Consider nursing implications when delivering parenteral
medications.
9
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10) The physician orders enteric-coated aspirin, 300 mg every day, for the patient with a
nasogastric tube. What is the priority action by the nurse?
1. Crush the tablet and administer through the tube.
2. Put the tablet in the tube and "milk" it down the tube.
3. Withhold the medication and contact the physician.
4. Substitute plain aspirin and administer through the tube.
Answer: 3
Explanation:
1. Crushing the tablet destroys the enteric coating.
2. Putting the tablet in the tube will result in clogging of the tube.
3. The only option is to withhold the medication and contact the physician.
4. The nurse cannot substitute plain aspirin; this requires a physician's order.
Page Ref: 24-34
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Current best
practices. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and
GRADESMORE.COM
parenteral drugs.
MNL Learning Outcome: 3.3 Consider nursing implications when delivering enteral or topical
medications.
10
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11) A patient is receiving a sustained-release capsule for his cardiac condition. The patient tells
the nurse there is no way he can swallow such a large pill. What is the best response by the
nurse?
1. "Let me contact your physician to see if a change can be made."
2. "Place the capsule on the back of your tongue, and drink a full glass of water."
3. "I will open the capsule and sprinkle the contents over some applesauce for you to eat."
4. "It may be difficult, but try to swallow the capsule as it is the best medicine for your
heart condition."
Answer: 1
Explanation:
1. The only option is to contact the physician.
2. Placing the capsule on the back of the patient's tongue and having him drink a full glass
of water may cause the patient to aspirate the capsule and/or the water.
3. Sustained-release medications cannot be opened and sprinkled on food.
4. Encouraging the patient to try to swallow the capsule is coercive and may result in the
patient choking on the medication.
Page Ref: 24-34
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
GRADESMOacross
RE.Cthe
OMhealth-illness continuum, across
medical management, and nursing management
lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Current best
practices. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and
parenteral drugs.
MNL Learning Outcome: 3.3 Consider nursing implications when delivering enteral or topical
medications.
11
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12) While in the hospital, a pediatric patient has been receiving amoxicillin 10 mL orally bid, pc.
The client will be going home on this medication. What should the nurse include when
teaching parents about this medication?
1. Give 2 teaspoons by mouth, 3 times a day, before meals.
2. Give 2 teaspoons by mouth, twice a day, after meals.
3. Give 2 teaspoons by mouth, 3 times a day, after meals.
4. Give 2 teaspoons by mouth, twice a day, with meals.
Answer: 2
Explanation:
1. Giving 2 teaspoons by mouth, 3 times a day, on an empty stomach is incorrect.
2. Giving 2 teaspoons by mouth, twice a day, after meals is correct.
3. Giving 2 teaspoons by mouth, 3 times a day, after meals is incorrect.
4. Giving 2 teaspoons by mouth, twice a day, with meals is incorrect.
Page Ref: 22
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: IX.3
Implement holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Quality and Safety: Current best practices. | Nursing/Integrated Concepts:
Nursing Process: Implementation GRADESMORE.COM
Learning Outcome: 3-5 Interpret drug orders that contain abbreviations.
MNL Learning Outcome: 3.2 Accurately interpret drug orders
12
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13) A client is 3 days postop, and the physician orders an oral pain medication. The client asks
the nurse if it wouldn't be better to get the medication in the intravenous (IV) line. What is
the best response by the nurse?
1. "You could not medicate yourself intravenously (IV) at home."
2. "Pills are more effective than intravenous (IV) medications."
3. Pills are safer than intravenous (IV) medications."
4. "We are going to take your intravenous (IV) line out."
Answer: 3
Explanation:
1. There is no evidence that the patient will be going home with an intravenous line, so
this answer is incorrect.
2. Oral medications are not more effective than IV medications.
3. Oral medications are safer than intravenous (IV) medications.
4. Telling the patient that she cannot have the medication intravenously because the
intravenous line is to be removed does not answer the patient's question.
Page Ref: 24-34
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
GR|ANLN
DESCompetencies:
MORE.COM Knowledge and Science:
lifespan, and in all healthcare settings.
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3-8 Compare and contrast the advantages and disadvantages of each route
of drug administration.
MNL Learning Outcome: 3.4 Consider nursing implications when delivering parenteral
medications.
13
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14) The nurse plans to administer heparin by drawing the heparin up in an appropriate syringe,
donning gloves, prepping the patient's abdominal area, inserting the needle, aspirating for
blood, and injecting the medication. Which statement best describes the nurse's plan? A
student nurse is administering heparin subcutaneously (SQ) to a client. The nurse should
intervene if the student nurse does which of the following?
1. Apply gloves
2. Aspirate for blood
3. Prep the skin with alcohol
4. Inject at a 45-degree angle
Answer: 2
Explanation:
1. Gloves must always be worn for invasive techniques.
2. When performing heparin injections, the nurse should not aspirate for blood as this may
cause bruising or bleeding.
3. The skin should be prepped with alcohol prior to administering an injection.
4. The nurse did not perform the correct technique.
Page Ref: 24-34
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
GRADESMOacross
RE.Cthe
OMhealth-illness continuum, across
medical management, and nursing management
lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Current best
practices. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and
parenteral drugs.
MNL Learning Outcome: 3.4 Consider nursing implications when delivering parenteral
medications.
14
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15) The order is for a pain medication to be given intravenous (IV) q 3-4 hours prn. Which
statement, by the nurse, correctly teaches the client about this medication order?
1. "Let me know when you are having pain."
2. "This medication will be given to you at a set time every day, probably just before your
bath."
3. "You will be given this medication at bedtime each night so that you can rest."
4. "Always take this medication with food or milk because it might upset your stomach."
Answer: 1
Explanation:
1. The abbreviation PRN is used to designate as needed.
2. PRN does not mean every day.
3. PRN does not mean at bedtime.
4. PRN does not mean with food.
Page Ref: 22
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: IX.3
Implement holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Quality and Safety: Current best practices. | Nursing/Integrated Concepts:
Nursing Process: Implementation GRADESMORE.COM
Learning Outcome: 3-5 Interpret drug orders that contain abbreviations.
MNL Learning Outcome: 3.4 Consider nursing implications when delivering parenteral
medications.
15
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16) A client has an adverse reaction to a drug following a change in dietary habits. The nurse
understands that which change would most likely be the cause?
1. Increased intake of grapefruit juice
2. Reduced intake of alcohol
3. Increased fiber intake
4. Reduced intake of citrus fruit
Answer: 1
Explanation:
1. Grapefruit juice lowers the activity of enzymes in the GI system that break down
medications. This in turn results in higher medication absorption into the bloodstream.
2. A reduced intake of alcohol would not likely produce an increased reaction to a drug.
3. A reduced intake of fiber would not likely produce an increased reaction to a drug.
4. A reduction in citrus fruit intake would likely cause a lowered drug reaction.
Page Ref: 22
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: IX.3
Implement holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Quality and Safety: Current best practices. | Nursing/Integrated Concepts:
GRADESMORE.COM
Nursing Process: Analysis
Learning Outcome: 3-1 Discuss drug administration as a component of safe, effective nursing
care, using the nursing process.
MNL Learning Outcome: 3.3 Consider nursing implications when delivering enteral or topical
medications.
16
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17) A nurse administers an oral preparation of liquid acetaminophen 650 mg as ordered.
Afterward, the client indicates they have been receiving acetaminophen 650 mg in pill form.
Which statement is accurate in regards to the five rights?
1. The nurse failed to deliver the correct dose.
2. The nurse failed to administer the right medication.
3. The nurse did not violate the five rights.
4. The nurse failed to give the medication via the correct route.
Answer: 3
Explanation:
1. The correct dose was administered.
2. The correct medication was administered.
3. Nothing in the question depicts a violation of the five rights. Both forms of the
medication are oral preparations.
4. The correct route was used.
Page Ref: 21
Cognitive Level: Analyzing
Client Need/Sub: Safe and Effective Care Environment: Pharmacologic and Parenteral
Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: IX.12
Create a safe environment that results in high quality patient outcomes. | NLN Competencies:
Quality and Safety: Current best practices. | Nursing/Integrated Concepts: Nursing Process:
GRADESMORE.COM
Evaluation
Learning Outcome: 3-3 Explain how the five rights of drug administration affect patient safety.
MNL Learning Outcome: 3.1 Recognize the nurse's role, responsibilities, and safe practices
when providing care to patients receiving pharmacotherapy.
17
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18) A pediatric client has been receiving 5 mL of liquid antibiotic three times each day. The
nurse providing discharge instructions would teach the parents to administer which amount
for each dose?
1. 2 tablespoons
2. 1 fluid ounce
3. 15 drops
4. 1 teaspoon
Answer: 4
Explanation:
1. Five milliliters is not equivalent to two tablespoons.
2. A fluid ounce is equal to 30-32 mL.
3. Five milliliters is equal to about 60 drops.
4. One standard teaspoon is equal to 4 or 5 mL, so this is the best answer.
Page Ref: 23
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Current best
practices. | Nursing/Integrated Concepts: Nursing Process: Implementation
GRcontrast
ADESMthe
ORthree
E.CO
M
Learning Outcome: 3-6 Compare and
systems
of measurement used in
pharmacology.
MNL Learning Outcome: 3.3 Consider nursing implications when delivering enteral or topical
medications.
18
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19) A nurse is preparing to administer a buccal medication. The nurse should do which of the
following?
1. Place the medication between the cheek and gum.
2. Instruct the client to swallow the medication.
3. Apply the medication to clean, dry skin.
4. Insert the medication under the tongue.
Answer: 1
Explanation:
1. Buccal is the term used to describe a medication placed between the cheek and gum.
2. An oral medication is swallowed.
3. A transdermal medication is applied to the skin.
4. A sublingual medication is placed under the tongue.
Page Ref: 24-34
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Current best
practices. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and
GRADESMORE.COM
parenteral drugs.
MNL Learning Outcome: 3.3 Consider nursing implications when delivering enteral or topical
medications.
19
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20) A client will receive a liter of fluid intravenously to treat dehydration. The client says, "I
don't understand the metric system, how much is that?" What is the best response by the
nurse?
1. 2 cups
2. 1 quart
3. 1/2 gallon
4. 1000 mL
Answer: 2
Explanation:
1. 2 cups is equivalent to one half of a quart. One quart is equivalent to 1000 mL.
2. The household measurement most nearly equivalent to 1 liter is 4 cups or 1 quart.
3. One half of a gallon is equivalent to two quarts or 2000 mL.
4. Although one liter is equivalent to 1000 mL, this response does not answer the client's
question.
Page Ref: 23
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Current best
GRADNursing
ESMORProcess:
E.COMImplementation
practices. | Nursing/Integrated Concepts:
Learning Outcome: 3-6 Compare and contrast the three systems of measurement used in
pharmacology.
MNL Learning Outcome: 3.4 Consider nursing implications when delivering parenteral
medications.
20
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21) A nurse is observing a student nurse prepare to administer an intradermal medication.
Which observation by the nurse indicates the student nurse understands the correct
procedure to administer intradermal medications.
1. Injections should be limited to 1-2 mL.
2. Avoid sites with excess body hair.
3. Sites for administration include the upper and lower abdomen.
4. Medications should be injected into the epidermal skin layer.
Answer: 2
Explanation:
1. Intradermal injection involves administering small amounts (0.1-0.2 mL) of medication.
2. Usual sites of intradermal administration include nonhairy surfaces.
3. Usual sites of intradermal administration include the forearm, upper chest, and
scapulae.
4. Intradermal injection involves administering small amounts of medication into the
dermis layer of skin.
Page Ref: 24-34
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
GR|ANLN
DESCompetencies:
MORE.COM Quality and Safety: Current best
lifespan, and in all healthcare settings.
practices. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and
parenteral drugs.
MNL Learning Outcome: 3.4 Consider nursing implications when delivering parenteral
medications.
21
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22) A nurse is caring for the following clients. The nurse should assess for nonadherence with
prescribed medications in which clients?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. A 70-year-old male patient with hypertension who has a prescription for a diuretic and
is complaining that his medication is keeping him up all night
2. A 30-year-old college student who has a prescription for birth control pills and tells the
nurse she has had breakthrough bleeding this past cycle
3. A 45-year-old patient with diabetes who has a prescription for insulin and whose blood
sugar is within the normal range
4. A 57-year-old day laborer who has a prescription for Lipitor for high cholesterol and a
prescription card for a free health clinic
5. An 18-year-old male with a prescription for an acne medication that must be taken 4
times a day
Answer: 1, 5
Explanation:
1. This patient has been taking his diuretic in the evening instead of in the morning and is
most likely experiencing increased urination at night that is disrupting his sleep. Adverse
side effects are common causes for nonadherence.
2. Birth control pills often cause midcycle bleeding. This does not raise any red flags for
nonadherence.
3. The fact that this patient's blood sugar is within the normal range may be evidence that
RADESMORE.COM
the patient is taking insulin asGdirected.
4. The means to pay for medication (free clinic prescription card) decreases the patient's
risk for nonadherence.
5. One of the most common reasons for nonadherence is forgetting a dose, particularly
with drugs that must be taken more than twice a day.
Page Ref: 22
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.1 Elicit patient values, preferences, and expressed needs as
part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essential
Competencies: IX.5 Deliver compassionate, patient-centered, evidence-based care that respects
patient and family preferences. | NLN Competencies: Relationship-Centered Care: Respect the
patient's dignity, uniqueness, integrity, and self-determination, and his or her own power and
self-healing process. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 3-4 Give specific examples of how nurses can increase patient adherence in
taking medications.
MNL Learning Outcome: 3.1 Recognize the nurse's role, responsibilities, and safe practices
when providing care to patients receiving pharmacotherapy.
22
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23) A client admitted to the hospital tells the nurse they are very nervous about getting all their
medications while they are in the hospital because their healthcare provider has them on a
very "strict" schedule. The nurse understands that which of the following describes the
principles about how medication dosing schedules are determined?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The physical and biological characteristics of a drug may determine dosing schedule.
2. Specific times may improve effectiveness and decrease risk of adverse effects.
3. Some drugs must be taken a certain time prior to an event or immediately after an
event.
4. Dosing may be set for the convenience of patient and nurse.
5. Hospitals have routine dosing intervals so that all patients receive medications at the
same time each day.
Answer: 1, 2, 3, 4
Explanation:
1. The properties of a medication will determine how often it must be given to keep the
drug at a therapeutic level in the body.
2. Some medications are administered at certain times of day to improve effectiveness or
decrease adverse effects.
3. Some medications are taken to prevent or to cause an effect. For example, insulin
should be given 30 minutes prior to eating to promote glucose usage.
4. If the drug does not have a characteristic that relies on a certain event to take place,
RAD
ESMORE.of
COpatient
M
then the drug can be given atGthe
convenience
and/or nurse.
5. While most hospitals do have specific times of day (agency protocol) when medications
are administered, this is not a principle that determines any specific dosing schedule.
Page Ref: 21
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: IX.12
Create a safe environment that results in high quality patient outcomes. | NLN Competencies:
Quality and Safety: Current best practices. | Nursing/Integrated Concepts: Nursing Process:
Analysis
Learning Outcome: 3-3 Explain how the five rights of drug administration affect patient safety.
MNL Learning Outcome: 3.1 Recognize the nurse's role, responsibilities, and safe practices
when providing care to patients receiving pharmacotherapy.
23
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24) A patient at a community health center has been prescribed oral medications and tells the
nurse that medications were administered intravenously when they were in the hospital.
The nurse discusses the advantages and disadvantages of oral medications, based on which
of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The oral route is considered the second safest route, after the intradermal route.
2. Tablets that are scored may be crushed for easier swallowing.
3. Enteric-coated drugs are designed to dissolve in the stomach, not the small intestine.
4. A major disadvantage of oral medications is that the patient must be conscious and able
to swallow.
5. Enteric-coated drugs should be crushed to help facilitate dissolving by the stomach acid.
Answer: 2, 4
Explanation:
1. The oral route is considered the safest because the skin barrier is not compromised; if
an overdose occurs, drugs remaining in the stomach can be evacuated with stomach
contents.
2. The purpose of scoring a tablet is the greater ease of cutting the tablet in half or
quarters. These same tablets may be crushed, if needed.
3. Some drugs irritate the stomach lining and are coated to prevent being dissolved in the
stomach. These drugs go on to the small intestine and are dissolved in the alkaline
environment.
GRbeAconscious
DESMORand
E.Cable
OM to swallow is a major disadvantage
4. The fact that the patient must
of oral medications.
5. Enteric-coated drugs are designed specifically to bypass the stomach's acidic
environment and continue to the alkaline environment of the small intestine.
Page Ref: 24-34
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Current best
practices. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3-8 Compare and contrast the advantages and disadvantages of each route
of drug administration.
MNL Learning Outcome: 3.1 Recognize the nurse's role, responsibilities, and safe practices
when providing care to patients receiving pharmacotherapy.
24
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25) A nurse has finished teaching a client's husband how to administer drugs and enteral
feeding through a gastrostomy tube. The nurse knows the husband understands the
teaching when he makes which statements?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "My wife has a gastrostomy tube instead of a nasogastric tube because she will have the
tube for a long time."
2. "I will need to use liquid medications. If any of the medications are in pill form, I will use
the pill crusher to crush them and mix them with water before putting them in the
tube."
3. "This medication says it is enteric coated. I'm not supposed to crush this kind of
medication. I will need to ask the physician to substitute another medication that is
liquid or can be crushed."
4. "There's a big difference in how the drugs work in the body when they're taken orally
and when they're administered through the tube. That's why my wife has to have this
tube."
5. "I have to be very careful to flush the tube after I put medication in it. If I don't, the tube
could get clogged."
Answer: 1, 2, 3, 5
Explanation:
1. Nasogastric tubes are used for short-term care while gastrostomy tubes are placed in
patients who will need long-term care.
GRAdrugs
DESMinOliquid
RE.C
OM for NG and G tube patients. If a
2. Most healthcare providers order
form
medication does not come in liquid form, the solid form will need to be crushed and
mixed with water prior to administration unless there is a contraindication for crushing
the medication.
3. Enteric-coated medications should not be crushed. To do so would expose the drug to
the acid in the stomach when it is intended to bypass the stomach acid and be dissolved
in the alkaline environment of the small intestine.
4. Drugs administered via gastrostomy tube are affected by the same physiological
processes as those given orally.
5. While solid drugs may be crushed and dissolved in water prior to being administered,
they tend to clog the tubes if the tubes are not routinely flushed.
Page Ref: 24-34
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Current best
practices. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and
parenteral drugs.
25
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MNL Learning Outcome: 3.3 Consider nursing implications when delivering enteral or topical
medications.
26) A nurse is caring for a client who has been involved in a motor vehicle accident. The
healthcare provider has written orders for a transdermal patch for pain. The nurse knows
which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The transdermal patch should not be applied to areas of abrasion.
2. Transdermal medications undergo the first-pass effect in the liver.
3. Transdermal medications completely bypass digestive enzymes.
4. The actual dose received by the patient from this pain patch may vary.
5. The rate of delivery and actual dose of medications given by the transdermal route can
vary.
Answer: 1, 3, 4
Explanation:
1. Applying transdermal patches to skin that has abrasions may unintentionally increase
the dose of the medication.
2. Transdermal medications avoid the first-pass effect.
3. Transdermal medications never come into contact with digestive enzymes but go
straight into the bloodstream.
4. While transdermal patches do contain a specific amount of medication, the rate of
GRADESMORE.COM
delivery may vary for each patient.
5. It is true that the rate of delivery and actual dose received can vary, but this route is an
effective means of delivering many medications such as birth control medications and
nitroglycerin for angina.
Page Ref: 24-28
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Current best
practices. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3-8 Compare and contrast the advantages and disadvantages of each route
of drug administration.
MNL Learning Outcome: 3.3 Consider nursing implications when delivering enteral or topical
medications.
26
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27) Twenty minutes after receiving a dose of antibiotic, the client develops a red, itchy rash.
What should the nurse do first?
1. Plan to watch for a rash after the next dose is administered.
2. Contact the prescriber and relay this assessment information.
3. Place an allergy bracelet on the patient.
4. Document the presence of the rash in the medical record.
Answer: 2
Explanation:
1. Giving another dose of the antibiotic is not indicated and could have a serious outcome.
2. The nurse should first discuss this finding with the prescriber as an allergy likely exists.
3. The nurse should place an allergy bracelet on the patient. If it is determined that the
rash is from some other etiology, the bracelet can be removed. However, this is not the
first response by the nurse.
4. The nurse should always document the presence of an unexpected finding. However,
this is not the first response by the nurse.
Page Ref: 20
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
GR|ANLN
DESCompetencies:
MORE.COM Quality and Safety: Current best
lifespan, and in all healthcare settings.
practices. | Nursing/Integrated Concepts: Nursing Process: Analysis
Learning Outcome: 3-2 Describe the roles and responsibilities of nurses regarding safe drug
administration.
MNL Learning Outcome: 3.1 Recognize the nurse's role, responsibilities, and safe practices
when providing care to patients receiving pharmacotherapy.
27
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28) A nurse is observing a student nurse administer an intramuscular injection in the deltoid
muscle. The nurse should intervene if the student nurse does which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Locates the site by putting the heal of the hand on the greater trochanter.
2. Selects a 1-inch 23-gauge needle and 3 mL syringe.
3. Plans to administer 2 mL in a single injection.
4. Wipes the injection site with an antiseptic wipe.
5. Inserts the needle at a 45-degree angle with the skin.
Answer: 1, 3, 5
Explanation:
1. This describes the technique to locate the ventrogluteal site. The deltoid site is
approximately-3 fingers below the acromion process and midline in the upper part of
the arm.
2. A 1-inch 23-gauge needle and a 3 mL syringe are appropriate choices for an IM injection
in the deltoid muscle.
3. IM injections into the deltoid muscle are limited in volume to 1 mL because of the small
size of this muscle.
4. The skin should always be cleaned prior to an injection with an alcohol wipe.
5. When administering an intramuscular injection, the needle should be inserted at a 90degree angle.
Page Ref: 31
GRADESMORE.COM
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Current best
practices. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and
parenteral drugs.
MNL Learning Outcome: 3.4 Consider nursing implications when delivering parenteral
medications.
28
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29) A charge nurse is observing a nurse administer an intradermal injection. Which of the
following demonstrates that the nurse is using the correct technique?
1. Selects a 1-inch 23-gauge needle with a 3 mL syringe
2. Inserts the needle with the bevel down at a 10- to 15-degree angle.
3. Slowly injects the medication to form a small wheal or bleb.
4. Withdraws the needle and gently massages the injection site.
Answer: 3
Explanation:
1. A tuberculin or 1 milliliter syringe with 26-27 gauge, 3/8-5/8 inch needle should be used
to administer an intradermal injection.
2. The needle should be inserted bevel up at a 10- to 15-degree angle when administering
an intradermal injection.
3. When administering an intradermal injection, the medication should be injected slowly
to form a small wheal or bleb.
4. The injection site should never be massaged after administering an intradermal
medication.
Page Ref: 24-34
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
GRADESMOacross
RE.Cthe
OMhealth-illness continuum, across
medical management, and nursing management
lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Current best
practices. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and
parenteral drugs.
MNL Learning Outcome: 3.4 Consider nursing implications when delivering parenteral
medications.
29
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30) At the end of the shift, a client reports drinking 4 cups of water during the day. The client
also has an IV running at 125 mL/hour for the 12 hours. How many mL's of total intake
should the nurse document?
1. 960 mL
2. 1500 mL
3. 2460 mL
4. 3960 mL
Answer: 3
Explanation:
1. Each cup the client drank should be counted as 240 mL, making 4 cups equivalent to 960
mL. The client also received 1500 mL of IV fluid which should be included in the total
documented in the client's chart.
2. 1500 mL is the amount of IV fluid the client received. However, the 960 mL of the
client's oral intake should also be included.
3. The client received 1500 mL of IV fluid in addition to the 960 mL of oral intake. The total
intake is 2460 mL.
4. This is the amount the client would have received if the entire 24 hours of IV intake was
included (3000 mL + 960 mL).
Page Ref: 23
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
GRADEIX.3
SMO
RE.COMholistic, patient-centered care that
processes. | AACN Essential Competencies:
Implement
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Current best
practices. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 3-6 Compare and contrast the three systems of measurement used in
pharmacology.
MNL Learning Outcome: 3.1 Recognize the nurse's role, responsibilities, and safe practices
when providing care to patients receiving pharmacotherapy.
30
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Pharmacology for Nurses, 6e (Adams)
Chapter 4 Pharmacokinetics
1) A nurse is conducting medication education for patients with hypertension. The focus of the
education is on enhancing the absorption of their medications. The nurse determines that
learning has occurred when the patients make which statement?
1. "We can safely take the drug for at least 6 months beyond the expiration date."
2. "We don't need to worry about storage of the drug, it won't lose potency."
3. "We should not take our medications with milk or dairy products."
4. "We need to be careful about taking the medication with certain foods."
Answer: 4
Explanation:
1. Patients should be taught to avoid taking medications beyond the expiration date.
2. Storage can affect the medication's strength and may affect how it responds in the
body.
3. There are many more foods that will alter the absorption of medications other than milk
and dairy products.
4. Food can alter the absorption of many medications.
Page Ref: 38
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
GRADESMORE.COM
processes. | AACN Essential Competencies: II.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 4-4 Discuss factors affecting drug absorption.
MNL Learning Outcome: 4.1 Recognize how drugs cross plasma membranes to reach their
target cells.
1
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2) A client prescribed a loading dose to be followed by a lower maintenance dose asks the
nurse why the maintenance dose is lower. Which response should the nurse provide the
client?
1. "The initial dose shortens the half-life, so the medication would work more quickly."
2. "We always give medications this way; the healthcare provider did not make a mistake."
3. "You had a larger dose initially so that the medication would work more quickly."
4. "Giving a larger dose initially will reduce the chance of side effects."
Answer: 3
Explanation:
1. Loading doses do not shorten the half-life of a drug.
2. Not all medications are initiated with a loading dose.
3. Loading doses of medications are used to quickly induce a therapeutic response.
4. Loading doses do not reduce the occurrence of side effects.
Page Ref: 45
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: II.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 4-12 Differentiate between loading and maintenance doses.
RAtime-response
DESMORE.Crelationships
OM
MNL Learning Outcome: 4.4 Relate G
how
affect a drug's therapeutic
response.
2
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3) A nurse is caring for a client with meningitis who is receiving a water-soluble drug. The
client asks the nurse why the healthcare provider changed the prescription to a lipid-soluble
drug. What is the best response by the nurse?
1. Lipid-soluble drugs are better because of protein binding.
2. Lipid-soluble drugs are more effective in treating the client's illness.
3. Lipid-soluble drugs are better because they have fewer side effects.
4. Lipid-soluble drugs are more effective because they are excreted at a slower rate.
Answer: 2
Explanation:
1. Not all lipid-soluble drugs are protein bound.
2. Drug molecules that are lipid soluble will usually pass through plasma membranes by
simple diffusion and more easily reach their target cells. The client has meningitis, so a
drug that can cross the blood brain barrier will be more effective.
3. Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs
are protein bound.
4. Lipid solubility does not affect drug excretion.
Page Ref: 38
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health
teaching, health counseling, screening, outreach, disease and outbreak investigation, referral
GRA
DESCompetencies:
MORE.COM Knowledge and Science:
and follow-up throughout the lifespan.
| NLN
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Planning
Learning Outcome: 4-4 Discuss factors affecting drug absorption.
MNL Learning Outcome: 4.2 Consider how absorption and distribution of drugs affect a drug's
therapeutic response.
3
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4) The patient is malnourished and has a low serum albumin. A nurse is caring for a client with
a low serum albumin level. The healthcare provider has ordered aspirin, which is a highly
protein-bound drug. Which evaluation by the nurse best describes the effect this will have
on the client?
1. The client will be at risk of experiencing a decreased effectiveness of the drug.
2. The client will be at risk of experiencing toxic effects of the drug.
3. The client's kidneys will excrete the drug at a faster rate.
4. The client's liver will metabolize the drug at a faster rate.
Answer: 2
Explanation:
1. Effects from the drug will not be decreased because there is less protein for aspirin to
bind with and more free drug available.
2. Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to
bind with, making more free drug available. There may be toxic effects from the drug
because there is less protein for aspirin to bind with and more free drug available.
3. The kidney will not be able to balance the amount of the drug and excrete it at a faster
rate.
4. The liver will not be able to metabolize the drug at a faster rate.
Page Ref: 41
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
GRADEIX.8
SMO
RE.COMevidence-based nursing
processes. | AACN Essential Competencies:
Implement
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 4-7 Describe how plasma proteins affect drug distribution.
MNL Learning Outcome: 4.2 Consider how absorption and distribution of drugs affect a drug's
therapeutic response.
4
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5) A client is admitted to the hospital in chronic renal failure and several drugs are prescribed.
What best describes the nurse's assessment of this client?
1. The client's liver may compensate for renal failure so the drugs may be effective.
2. The client may have drug toxicity from all the drugs.
3. The client may have drug toxicity only if the drugs are excreted by the kidneys.
4. The client may have decreased effectiveness of the drugs.
Answer: 2
Explanation:
1. The liver cannot compensate for renal failure; the patient is at risk for drug toxicity.
2. Since the kidneys are the primary route of excretion for many drugs, chronic renal
failure puts the patient at risk for drug toxicity.
3. The patient in chronic renal failure will more likely have drug toxicity than decreased
effectiveness of the drugs.
4. Since the majority of drugs are excreted by the kidneys, the patient will most likely have
drug toxicity.
Page Ref: 41
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science: Integration
GR
ADESMO|RNursing/Integrated
E.COM
of knowledge from nursing and other
disciplines.
Concepts: Nursing
Process: Assessment
Learning Outcome: 4-8 Identify major processes by which drugs are excreted.
MNL Learning Outcome: 4.3 Consider factors that affect metabolism and excretion of drugs
and how they affect a drug's therapeutic response.
5
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6) A client comes to the emergency department following an overdose of aspirin, which is an
acidic drug. The nurse should anticipate administering which of the following?
1. Intravenous fluids to flush the kidneys
2. Ammonium chloride to increase metabolism in the liver
3. Sodium bicarbonate to alter the client's serum pH
4. Intravenous proteins to bind the aspirin
Answer: 3
Explanation:
1. Administering intravenous (IV) fluids will not increase the excretion of aspirin from the
body.
2. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin. It does
not increase metabolism of the drug.
3. Sodium bicarbonate will alkalinize the urine and increase the excretion of aspirin from
the body.
4. Administering proteins will not help with the excretion of aspirin from the body.
Page Ref: 43
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science: Integration
GR
ADESMO|RNursing/Integrated
E.COM
of knowledge from nursing and other
disciplines.
Concepts: Nursing
Process: Planning
Learning Outcome: 4-7 Describe how plasma proteins affect drug distribution.
MNL Learning Outcome: 4.2 Consider how absorption and distribution of drugs affect a drug's
therapeutic response.
6
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7) A healthcare provider prescribes aspirin to a client complaining of a severe headache.
Which action by the nurse will result in the fastest relief of the client's headache?
1. Administer the aspirin with an alkaline food, like cottage cheese.
2. Administer the aspirin in an enteric-coated formulation.
3. Administer the aspirin with a high-fat food, like peanut butter.
4. Administer the aspirin on an empty stomach.
Answer: 4
Explanation:
1. Cottage cheese will slow absorption and increase the time for the drug's effect.
2. Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal
irritation, but will increase the time for the drug's effect.
3. Peanut butter will slow absorption and increase the time for the drug's effect.
4. Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the
aspirin should be administered on an empty stomach.
Page Ref: 38
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
GRADESMORE.COM
Process: Analysis
Learning Outcome: 4-4 Discuss factors affecting drug absorption.
MNL Learning Outcome: 4.3 Consider factors that affect metabolism and excretion of drugs
and how they affect a drug's therapeutic response.
7
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8) A client is receiving lithium (Eskalith) and asks the nurse why their blood has to be drawn so
often. What is the best response by the nurse?
1. "To detect side effects before they become a problem."
2. "To be sure the medication is working properly."
3. "To determine if your body is responding as it should."
4. "To be sure you have the correct amount of medication in your system."
Answer: 4
Explanation:
1. Side effects are best determined by patient assessment.
2. A lab test will not confirm that the medication is working properly; assessment of the
patient confirms this.
3. Body response to the medication is best determined by patient assessment.
4. Medications, such as lithium (Eskalith), with a narrow therapeutic range must be
monitored with lab tests; this is how the correct dosage is determined.
Page Ref: 45
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
GRADESMORE.COM
Process: Teaching/Learning
Learning Outcome: 4-11 Explain how a drug reaches and maintains its therapeutic range in the
plasma.
MNL Learning Outcome: 4.3 Consider factors that affect metabolism and excretion of drugs
and how they affect a drug's therapeutic response.
8
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GRADESMORE.COM
WWW.GRADESMORE.COM
9) A nursing mother asks a nurse if it is all right to take St. John's wort for mild depression.
What is the best response by the nurse?
1. "No, it will probably cause your baby to have more allergies."
2. "No, because it might decrease the amount of milk you produce."
3. "No, it could be excreted in your milk and affect the baby."
4. "No, it will affect the taste of your milk, and your baby might reject nursing."
Answer: 3
Explanation:
1. Taking St. John's wort is not likely to cause the baby to have more allergies.
2. Taking St. John's wort is not likely to decrease the amount of milk the mother produces.
3. Many drugs are excreted in breast milk and can affect the nursing infant.
4. Taking St. John's wort may affect the taste of the mother's milk, but this is not the most
important response.
Page Ref: 43
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
Process: Teaching/Learning
GRprocesses
ADESMOby
REwhich
.COM
Learning Outcome: 4-8 Identify major
drugs are excreted.
MNL Learning Outcome: 4.3 Consider factors that affect metabolism and excretion of drugs
and how they affect a drug's therapeutic response.
9
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
10) A nursing instructor is teaching pharmacology to student nurses. What will the nursing
instructor include as the four major components of pharmacokinetics?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. How drugs move from the site of administration to circulating fluids
2. How drugs are converted to a form that is easily removed from the body
3. How drugs change body illnesses and pathogens
4. How drugs are transported throughout the body
5. How drugs are removed from the body
Answer: 1, 2, 4, 5
Explanation:
1. Absorption describes how drugs move from the site of administration to circulating
fluids.
2. Metabolism describes how drugs are converted to a form that is easily removed from
the body.
3. Pharmacodynamics describes how drugs change body illnesses and pathogens.
4. Distribution describes how drugs are transported throughout the body.
5. Excretion describes how drugs are removed from the body.
Page Ref: 38
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
GRADEIX.8
SMO
RE.COMevidence-based nursing
processes. | AACN Essential Competencies:
Implement
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-2 Identify the four components of pharmacokinetics.
MNL Learning Outcome: 4.2 Consider how absorption and distribution of drugs affect a drug's
therapeutic response.
10
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11) The patient is scheduled to receive a medication that is an enzyme inducer of the P450
system. What best describes the effect of this medication on the patient?
1. In time, the patient will experience no effect from other medications.
2. In time, the patient will experience increased effects from other medications.
3. In time, the patient will experience a reduced effect from this medication.
4. In time, the patient will experience an increased effect from this medication.
Answer: 3
Explanation:
1. The patient will experience a reduced effect from other medications, not an absence of
effect.
2. An enzyme inhibitor will result in a decreased effect from other medications.
3. An enzyme inducer will increase the rate of its own metabolism, thereby reducing its
effectiveness.
4. An enzyme inhibitor will result in an increased effect of this medication.
Page Ref: 41
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
GRADESMORE.COM
Process: Implementation
Learning Outcome: 4-5 Explain the metabolism of drugs and its applications to
pharmacotherapy.
MNL Learning Outcome: 4.3 Consider factors that affect metabolism and excretion of drugs
and how they affect a drug's therapeutic response.
11
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12) A client tells a nurse that he is on many medications and asks how they all get to the right
places. What are the best responses by the nurse?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "It depends on how much protein you have in your body."
2. "It depends on the health of your kidneys."
3. "It depends on whether they are fat based or water based."
4. "It depends on the amount of blood flow to your body tissues."
5. "It depends on the health of your liver."
Answer: 1, 3, 4
Explanation:
1. Distribution of drugs depends on protein binding.
2. The health of the kidneys refers to excretion, not distribution.
3. Distribution of drugs depends on the lipid solubility of the drug.
4. Distribution of drugs depends on the amount of blood flow to body tissues.
5. The health of the liver refers to metabolism, not distribution.
Page Ref: 42
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
GR
DECompetencies:
SMORE.COMKnowledge and Science: Integration
promoting health across the lifespan.
|A
NLN
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-6 Discuss how drugs are distributed throughout the body.
MNL Learning Outcome: 4.2 Consider how absorption and distribution of drugs affect a drug's
therapeutic response.
12
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13) A client is receiving a drug that is excreted in the bile. What will the best nursing assessment
of the effect of this drug on the patient include?
1. The effect of the drug will be a prolonged action.
2. The effect of the drug will be increased side effects.
3. The effect of the drug will be decreased side effects.
4. The effect of the drug will be decreased.
Answer: 1
Explanation:
1. Most bile is circulated back to the liver so drugs secreted into the bile will be
recirculated numerous times with the bile, resulting in a prolonged action of the drug.
2. Side effects may or may not be increased; this is dose dependent.
3. Bile-excreted drugs do not have decreased side effects.
4. Bile-excreted drugs do not have a decreased effect.
Page Ref: 43
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
Process: Assessment
RADESMORrecirculation
E.COM
Learning Outcome: 4-9 Explain howGenterohepatic
might affect drug activity.
MNL Learning Outcome: 4.3 Consider factors that affect metabolism and excretion of drugs
and how they affect a drug's therapeutic response.
13
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14) A nurse administers medications by various routes of delivery. The nurse recognizes which
route of administration requires higher dosages of drugs to achieve a therapeutic effect?
1. Intravenous route
2. Oral route
3. Rectal route
4. Sublingual route
Answer: 2
Explanation:
1. Intravenously administered drugs are not affected by the "first-pass effect."
2. Oral medications pass into the hepatoportal circulation and may be completely
metabolized before reaching the general circulation. This so-called "first-pass effect"
may necessitate the use of higher dosages of oral medications to achieve a therapeutic
effect.
3. Rectally administered drugs are not affected by the "first-pass effect."
4. Sublingually administered drugs are not affected by the "first-pass effect."
Page Ref: 41
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science: Integration
GR
ADESMO|RNursing/Integrated
E.COM
of knowledge from nursing and other
disciplines.
Concepts: Nursing
Process: Planning
Learning Outcome: 4-5 Explain the metabolism of drugs and its applications to
pharmacotherapy.
MNL Learning Outcome: 4.2 Consider how absorption and distribution of drugs affect a drug's
therapeutic response.
14
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15) A nurse is reviewing enzymatic activity that changes a medication to a less active form with
a nursing student. The nurse knows the teaching is effective if the nursing student responds
that which of the following is an example of this concept?
1. Pharmacodynamics
2. Active transport
3. Pharmacokinetics
4. Diffusion
Answer: 3
Explanation:
1. Pharmacodynamics involves how drugs change the body.
2. Active transport is the movement of a chemical against concentration or gradient.
3. Pharmacokinetics describes how drugs are handled within the body.
4. Diffusion is the movement of a chemical from an area of higher concentration to an area
of lower concentration.
Page Ref: 38
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
GRADESMORE.COM
Process: Teaching/Learning
Learning Outcome: 4-1 Explain the applications of pharmacokinetics to clinical practice.
MNL Learning Outcome: 4.3 Consider factors that affect metabolism and excretion of drugs
and how they affect a drug's therapeutic response.
15
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WWW.GRADESMORE.COM
16) A nursing student asks a nurse what the categories of pharmacokinetics are. What is the
nurse's best response?
1. Diffusion
2. Ingestion
3. Absorption
4. Movement
Answer: 3
Explanation:
1. Diffusion is not one of the four categories of pharmacokinetics.
2. Ingestion is not one of the four categories of pharmacokinetics.
3. Absorption is one of the categories of pharmacokinetics. The other categories are
distribution, metabolism, and excretion.
4. Ingestion is not one the four categories of pharmacokinetics.
Page Ref: 38
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
Process: Implementation
RAcomponents
DESMORE.ofCpharmacokinetics.
OM
Learning Outcome: 4-2 Identify the G
four
MNL Learning Outcome: 4.2 Consider how absorption and distribution of drugs affect a drug's
therapeutic response.
16
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
17) A nurse administers a drug to a client. Following ingestion, the drug crosses a membrane
from an area of higher concentration to an area of lower concentration. The nurse
understands that this is an example of which of the following?
1. Active transport
2. Osmosis
3. Diffusion
4. Metabolism
Answer: 3
Explanation:
1. Active transport is the movement of a chemical against concentration or gradient.
2. Osmosis involves the movement of water.
3. Diffusion is the movement of a chemical from an area of higher concentration to an area
of lower concentration.
4. Metabolism involves chemical conversion.
Page Ref: 38
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
GRand
ADEother
SMOdisciplines.
RE.COM | Nursing/Integrated Concepts:
Integration of knowledge from nursing
Nursing Process: Analysis
Learning Outcome: 4-3 Explain how substances travel across plasma membranes.
MNL Learning Outcome: 4.1 Recognize how drugs cross plasma membranes to reach their
target cells.
17
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18) A nurse is administering aspirin to a client. Aspirin is ionized as it enters the small intestine.
The nurse understands which of the following is correct regarding absorption of aspirin in
the small intestine.
1. Absorption is decreased.
2. Absorption is increased.
3. Ionization has nothing to do with the absorption rate.
4. Aspirin must travel past the small intestine for absorption to occur.
Answer: 1
Explanation:
1. The small intestine is a more alkaline environment. Aspirin is an acidic drug that is
ionized in the small intestine and will have lower absorption rates.
2. Higher rates of absorption occur in the stomach (an acidic environment).
3. Ionization state affects absorption rate.
4. Absorption of aspirin occurs in the stomach.
Page Ref: 38
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
GRand
ADEother
SMOdisciplines.
RE.COM | Nursing/Integrated Concepts:
Integration of knowledge from nursing
Nursing Process: Analysis
Learning Outcome: 4-4 Discuss factors affecting drug absorption.
MNL Learning Outcome: 4.2 Consider how absorption and distribution of drugs affect a drug's
therapeutic response.
18
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19) A client asks a nurse how medications are distributed within the body. What among the
below would be the nurse's response?
1. "The blood-brain barrier inhibits rapid crossing of all medications."
2. "Body organs with high levels of blood flow are more difficult organs to which to deliver
drugs."
3. "Medications that are lipid-soluble are more completely distributed."
4. "Drug-protein complexes must form prior to crossing capillary membranes."
Answer: 3
Explanation:
1. Some medications (sedatives) are able to rapidly cross the blood-brain barrier.
2. Body organs with low levels of blood flow are more difficult organs to which to deliver
drugs.
3. Lipid-soluble medications are absorbed and distributed quicker and more quickly than
those that are not.
4. When medications bind to proteins, their size increases, preventing them from passing
through capillary membranes.
Page Ref: 40
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
GRADESMOacross
RE.Cthe
OMhealth-illness continuum, across
medical management, and nursing management
lifespan, and in all healthcare setting. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
Process: Teaching/Learning
Learning Outcome: 4-6 Discuss how drugs are distributed throughout the body.
MNL Learning Outcome: 4.2 Consider how absorption and distribution of drugs affect a drug's
therapeutic response.
19
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WWW.GRADESMORE.COM
20) A nursing student asks a nurse which organ is the most responsible for the first-pass effect.
What is the nurse's best response?
1. Bladder
2. Kidneys
3. Liver
4. Stomach
Answer: 3
Explanation:
1. The bladder is not the organ most responsible for the first-pass effect.
2. The kidneys are not the organs most responsible for the first-pass effect.
3. The first pass effect occurs in the liver.
4. The stomach is not the organ most responsible for the first-pass effect.
Page Ref: 42
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare setting. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
Process: Teaching/Learning
GRADESMO
E.CO
M its applications to
Learning Outcome: 4-5 Explain the metabolism
ofRdrugs
and
pharmacotherapy; 4.9 Explain how enterohepatic recirculation might affect drug activity.
MNL Learning Outcome: 4.2 Consider how absorption and distribution of drugs affect a drug's
therapeutic response.
20
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WWW.GRADESMORE.COM
21) A nurse is preparing to administer medications to a client. The nurse understands that
which substance has the lowest rate of crossing renal tubular membranes and would
therefore be excreted in the urine?
1. Lipid-soluble drugs
2. Volatile drugs
3. Ionized drugs
4. Non-ionized drugs
Answer: 3
Explanation:
1. Lipid-soluble drugs cross renal tubular membranes easily and return to the circulation.
2. Volatile drugs are eliminated through respiration.
3. Ionized and water-soluble drugs are less likely to cross renal tubular walls and will
therefore be excreted.
4. Non-ionized drugs cross the renal tubular membranes easily and return to circulation.
Page Ref: 38
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare setting. | NLN Competencies: Knowledge and Science: Integration
GR
ADESMO|RNursing/Integrated
E.COM
of knowledge from nursing and other
disciplines.
Concepts: Nursing
Process: Analysis
Learning Outcome: 4-8 Identify major processes by which drugs are excreted.
MNL Learning Outcome: 4.3 Consider factors that affect metabolism and excretion of drugs
and how they affect a drug's therapeutic response.
21
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22) A nursing instructor is reviewing how medications are secreted with a nursing student.
Which statement is accurate regarding medications that end up being secreted in bile?
1. All medications secreted in bile are excreted in the feces.
2. Some medications are excreted in the feces while others can be recirculated to the liver
many times.
3. Most medications secreted in bile are metabolized in the gallbladder.
4. Generally, medications are not secreted in the bile.
Answer: 2
Explanation:
1. Some bile (and medications within) is excreted in the feces.
2. Most bile is circulated back to the liver by enterohepatic circulation, where medications
are metabolized in the liver.
3. Medications are not metabolized in the gallbladder.
4. Some medications are secreted in bile.
Page Ref: 43
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare setting. | NLN Competencies: Knowledge and Science: Integration
GR
ADESMO|RNursing/Integrated
E.COM
of knowledge from nursing and other
disciplines.
Concepts: Nursing
Process: Teaching/Learning
Learning Outcome: 4-9 Explain how enterohepatic recirculation might affect drug activity.
MNL Learning Outcome: 4.3 Consider factors that affect metabolism and excretion of drugs
and how they affect a drug's therapeutic response.
22
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23) Which assessment finding reflects a therapeutic range for a medication?
1. No serious adverse effects are experienced following administration.
2. The indication for administration was achieved without serious side effects.
3. A pre-specified amount (in mL) was administered.
4. The medication was effective, but the patient experienced a lethal dysrhythmia.
Answer: 2
Explanation:
1. Lack of serious adverse effects does not indicate therapeutic range has been reached.
2. The therapeutic range of a drug is between the minimum effective concentration and
the toxic concentration.
3. Standard doses of medications are determined by expected therapeutic range, not vice
versa.
4. Effective medication is desired, but not at the expense of a lethal dysrhythmia.
Page Ref: 44
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
GRADESMORE.COM
Nursing Process: Assessment
Learning Outcome: 4-11 Explain how a drug reaches and maintains its therapeutic range in the
plasma.
MNL Learning Outcome: 4.2 Consider how absorption and distribution of drugs affect a drug's
therapeutic response.
23
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WWW.GRADESMORE.COM
24) A nurse is teaching a client the importance of taking the medication as prescribed. Client
teaching is guided by the nurse's knowledge of which principles of pharmacokinetics?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. A medication taken by injection must cross the membranes of the gastrointestinal tract
to get to the bloodstream before it can be distributed throughout the body.
2. A drug may be exposed to several physiological processes while en route to target cells.
3. Liver enzymes may chemically change the drug.
4. Excretion organs such as kidneys and intestines must be healthy enough to eliminate
the drug.
5. Many processes to which drugs are exposed are destructive, thereby helping facilitate
the drug's movement throughout the body.
Answer: 2, 3, 4, 5
Explanation:
1. Medications taken by mouth must cross the membranes of the GI tract to get to the
bloodstream in order to be distributed throughout the body. This is not the case for
medications administered by injection.
2. Drugs taken orally are often exposed to physiological processes such as stomach acid
and digestive enzymes.
3. Enzymes in the liver may chemically change some drugs.
4. Drugs will continue to act on the body until they are either metabolized to an inactive
form or are excreted. Pathologic states such as kidney disease can increase the drug's
GRADESMORE.COM
action on the body.
5. Many destructive processes, such as when stomach acid breaks down food, can break
down the drug molecule before it can reach the target cells. This will facilitate the drug's
movement throughout the body.
Page Ref: 38
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 4-1 Explain the applications of pharmacokinetics to clinical practice.
MNL Learning Outcome: 4.2 Consider how absorption and distribution of drugs affect a drug's
therapeutic response.
24
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WWW.GRADESMORE.COM
25) The nurse is reviewing the role of diffusion in the distribution of medications with a nursing
student. The nurse understands that drugs that can be distributed by simple diffusion
include those with which of the below characteristics?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Large molecules
2. Ionization
3. Water-soluble agents
4. Alcohol
5. Urea
Answer: 4, 5
Explanation:
1. Large molecules have difficulty crossing plasma membranes by simple diffusion.
2. Ionized drugs have difficulty crossing plasma membranes by simple diffusion. These
drugs may require carrier, or transport, proteins to cross membranes.
3. Water-soluble agents have difficulty crossing plasma membranes by simple diffusion.
4. Diffusion assumes that the chemical is able to freely cross the plasma membrane. Drugs
may also enter through open channels in the plasma membrane; however, the molecule
must be very small, such as alcohol.
5. Diffusion assumes that the chemical is able to freely cross the plasma membrane. Drugs
may also enter through open channels in the plasma membrane; however, the molecule
must be very small, such as urea.
GRADESMORE.COM
Page Ref: 38
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare setting. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
Process: Analysis
Learning Outcome: 4-3 Explain how substances travel across plasma membranes.
MNL Learning Outcome: 4.1 Recognize how drugs cross plasma membranes to reach their
target cells.
25
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WWW.GRADESMORE.COM
26) A client who has received an oral medication for treatment of hives asks the nurse, "How
long will it be before my skin clears and quits itching?" Which concepts should the nurse
consider when formulating a response?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The amount of time between administration and the drug taking effect is known as
onset of action.
2. Peak plasma levels rarely occur with oral medications.
3. Duration of action is the amount of time a drug is effective.
4. Peak plasma level is dependent on the drug's plasma half-life (t1/2).
5. Drugs with short half-lives are ineffective in treating systemic illnesses.
Answer: 1, 3
Explanation:
1. Onset of drug action represents the amount of time it takes to produce a therapeutic
effect after drug administration.
2. All medications have a peak plasma level.
3. Duration of drug action is the amount of time a drug maintains its therapeutic effect.
4. Peak plasma level and plasma half-life (t1/2) are related but not strictly dependent on
one another.
5. The effectiveness of a drug is not dependent on half-life as long as dosing frequency is
correct.
Page Ref: 45
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Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare setting. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
Process: Teaching/Learning
Learning Outcome: 4-10 Explain the applications of a drug's onset, peak, and plasma half-life
(t1/2) to duration of pharmacotherapy.
MNL Learning Outcome: 4.4 Relate how time-response relationships affect a drug's therapeutic
response.
26
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27) Prior to administering a newly prescribed antibiotic, a nurse asks a client if any other drugs
have been taken today. The patient responds, "Why do you need to know?" Which of the
below indicate nursing responses?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "I need to be certain you are not taking another antibiotic."
2. "Some drugs block the action of others."
3. "Some drugs increase the activity of other drugs."
4. "The antibiotic I am about to give you is a prodrug."
5. "We don't want to increase first-pass effect."
Answer: 2, 3
Explanation:
1. There are many instances when a patient is prescribed more than one antibiotic at a
time.
2. Some drug-drug interactions are antagonistic, blocking or opposing the effects of the
drugs taken.
3. Some drug-drug interactions are synergistic, resulting in a potentiated effect.
4. Prodrugs have no pharmacologic activity unless they are first metabolized to their active
form by the body. This is not dependent on whether or not other drugs are present in
the system.
5. This question has nothing to do with first-pass effect.
Page Ref: 43
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Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare setting. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
Process: Analysis
Learning Outcome: 4-6 Discuss how drugs are distributed throughout the body.
MNL Learning Outcome: 4.2 Consider how absorption and distribution of drugs affect a drug's
therapeutic response.
27
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28) A nurse is reviewing excretion of medications with a student nurse. The nurse understands
that the student nurse understands the teaching when the student nurse states that
medications can be excreted by which route(s)?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Fecal
2. Gastric
3. Glandular
4. Pulmonary
5. Renal
Answer: 1, 3, 4, 5
Explanation:
1. Drugs can be excreted via feces.
2. Drugs are not excreted through the gastric system.
3. Drugs can be secreted glandularly.
4. Drugs can be secreted via the lungs.
5. Drugs can be excreted by the renal route.
Page Ref: 42
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
RADEand
SMOdevelopment,
RE.COM pathophysiology, pharmacology,
reflects an understanding of human G
growth
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare setting. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 4-8 Identify major processes by which drugs are excreted.
MNL Learning Outcome: 4.3 Consider factors that affect metabolism and excretion of drugs
and how they affect a drug's therapeutic response.
28
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29) A client asks a nurse why he experiences a metallic taste after taking certain medications.
The nurse explains that some medications are secreted by glandular activity. The nurse
would identify which substances as examples of this excretion?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Saliva
2. Sweat
3. Breast milk
4. Urine
5. Feces
Answer: 1, 2, 3
Explanation:
1. Water-soluble drugs may be secreted into the saliva, which can cause a "funny taste"
after the administration of a medication.
2. Water-soluble drugs may be secreted into the sweat, which may cause an odor to be
emitted by the person who has taken a medication.
3. Water-soluble drugs may be secreted into the breast milk. Breastfeeding mothers must
use caution in regards to medications while lactating as the medications can be passed
to their infants via the breast milk.
4. Urine is excreted by the kidneys and does not play a role in glandular activity.
5. Feces are excreted by the gastrointestinal system and do not play a role in glandular
activity.
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Page Ref: 43
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare setting. | NLN Competencies: Knowledge and Science: Integration
of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing
Process: Analysis
Learning Outcome: 4-8 Identify major processes by which drugs are excreted.
MNL Learning Outcome: 4.3 Consider factors that affect metabolism and excretion of drugs
and how they affect a drug's therapeutic response.
29
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30) A client asks a nurse why a large dose of a drug was administered first followed by a lower
dose of the same drug later. What is the nurse's best response?
1. Prevent a toxic concentration of the drug
2. Achieve a therapeutic dose more quickly
3. Decrease the side effects of this drug
4. Increase the absorption rate of this drug
Answer: 2
Explanation:
1. Administering a loading dose will not prevent a toxic concentration of the drug.
2. Administering a loading dose of a drug helps to achieve a therapeutic response to a drug
more quickly.
3. Administering a loading dose will not decrease the side effects of the drug.
4. Administering a loading dose will increase the absorption rate of a drug.
Page Ref: 45
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Implementation GRADESMORE.COM
Learning Outcome: 4-12 Differentiate between loading and maintenance doses.
MNL Learning Outcome: 4.4 Relate how time-response relationships affect a drug's therapeutic
response.
30
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Pharmacology for Nurses, 6e (Adams)
Chapter 5 Pharmacodynamics
1) A client looks up the drug they are taking in a drug guide. The client asks a nurse why the
healthcare provider prescribed a medication that has a lethal dose measure. What is the
best response by the nurse?
1. "It just refers to what is done in research; it is not used by healthcare providers
prescribing drugs."
2. "It is a value determined during research, which helps to determine the safe dose to
give."
3. "All that means is that the drug could be lethal, but I will watch you for side effects."
4. "Don't worry about that, I'll have your healthcare provider explain it to you."
Answer: 2
Explanation:
1. The lethal dose measure is used by healthcare providers prescribing drugs.
2. The difference between a median effective dose and a median lethal dose is a measure
of a drug's safety margin, which helps determine the safest dose to give.
3. Telling a client that the drug could be lethal, but that they will be observed for side
effects, will frighten the client and most likely result in the refusal of the medication.
4. Telling a client not to worry is nontherapeutic; this is a condescending response.
Page Ref: 50
Cognitive Level: Applying
GRADESMORE.COM
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: II.7 Promote factors that create a culture of safety
and caring. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 5-4 Compare and contrast median lethal dose (LD50) and median toxicity
dose (TD50).
MNL Learning Outcome: 5.1 Relate the level of a drug's dosing to its safety.
1
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2) Prior to administering medications, the student nurse reviews the therapeutic index. Which
statement best describes the student's understanding of therapeutic index?
1. The student is able to determine if the physician prescribed the best drug for the
patient.
2. The student is able to determine if the patients are receiving safe doses of the
medications.
3. The student is able to identify interactions among the drugs each patient is receiving.
4. The student is able to identify the patients who will need to have serum blood levels
monitored.
Answer: 4
Explanation:
1. The therapeutic index will not help to determine if the physician prescribed the best
drug for the patient.
2. The therapeutic index will give some information about safe doses, but this is not the
most complete response.
3. The therapeutic index will not help to identify interactions among the drugs the patients
receive.
4. Drugs with a narrow therapeutic index have a low safety margin and the concentration
of the drug should be monitored by regular serum tests.
Page Ref: 49
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRDemonstrate
ADESMOREeffective
.COM use of technology and
Standards: QSEN Competencies: V.B.1
standardized practices that support safety and quality. | AACN Essential Competencies: II.7
Promote factors that create a culture of safety and caring. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5-5 Discuss how a drug's therapeutic index is related to its margin of safety.
MNL Learning Outcome: 5.1 Relate the level of a drug's dosing to its safety.
2
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3) The nursing instructor prepares to teach student nurses about how mean effective doses of
medications are related to clinical practice. As a result of the instruction, what is the best
understanding by the student nurses?
1. About 50% of patients will experience severe side effects from the drug.
2. Some patients will respond differently depending on their ethnic background.
3. About 50% of patients will not experience any effect from the drug.
4. Some patients will require more or less than the average dose of the drug.
Answer: 4
Explanation:
1. The mean effective dose does not predict how many patients will experience severe side
effects from the drug.
2. The mean effective dose is not related to ethnicity.
3. The mean effective dose does not predict that 50% of patients will not experience any
effect of the drug.
4. The mean effective dose predicts how 50% of the population will respond to the
average dose of the drug. Some patients will require more or less of the drug.
Page Ref: 50
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.12 Create a safe environment that results in high
quality patient outcomes | NLN Competencies: Knowledge and Science: Relationships between
GRApatient
DESMOcare.
RE.|CNursing/Integrated
OM
knowledge/science and quality and safe
Concepts: Nursing
Process: Planning
Learning Outcome: 5-3 Explain the importance of the median effective dose (ED50) to nursing
practice.
MNL Learning Outcome: 5.2 Consider the significance of the therapeutic index and doseresponse relationship to drug safety and clinical practice.
3
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4) The patient receives antibiotics for a serious infection. The patient asks the nurse, "Why
don't you just give me more of that drug to cure this infection faster?" What is the best
response by the nurse?
1. "I will check with the physician to see if it is time to increase the medication."
2. "You are at a maximum dose; taking more will cause interactions with other
medications."
3. "You must stay on this drug for 2 more weeks before it can be increased."
4. "You are at a maximum dose; taking more will not help."
Answer: 4
Explanation:
1. Telling the patient the nurse will check with the physician is inappropriate because the
plateau of the drug has been reached; the physician will not change the dosage.
2. An increase in dosage may cause interactions with other medications, but this is not the
best answer.
3. Once the plateau of a drug has been reached, there is no time frame for an increase in
dosage because an increase in dosage will not produce a greater effect.
4. When the plateau of a drug has been reached, administering more of the drug will not
produce additional benefit.
Page Ref: 50
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
GRADEIII.2
SMO
RE.COM an understanding of the basic
processes. | AACN Essential Competencies:
Demonstrate
elements of the research process and models for applying evidence to clinical practice. | NLN
Competencies: Knowledge and Science: Relationships between knowledge/science and quality
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5-6 Explain the significance of the graded dose-response relationship to
nursing practice.
MNL Learning Outcome: 5.2 Consider the significance of the therapeutic index and doseresponse relationship to drug safety and clinical practice.
4
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5) The nurse administers narcotics to a surgical patient. Which statement represents the
nurse's best understanding as it relates to the potency of different narcotics?
1. Codeine is less potent than morphine; it will not produce an allergic reaction.
2. Morphine is more potent than codeine; a lesser dose will be required.
3. Morphine is more potent than codeine; it will produce more adverse effects.
4. Codeine is less potent than morphine; it will not relieve pain as well.
Answer: 2
Explanation:
1. The potency of a drug is not related to its ability to cause an allergic reaction.
2. A drug that is more potent will produce a therapeutic effect at a lower dose.
3. Potency does not mean the drug will produce more adverse effects.
4. Less potent narcotics can be very effective with pain relief.
Page Ref: 51
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 5-7 Compare and contrast the terms potency and efficacy.
MNL Learning Outcome: 5.2 Consider the significance of the therapeutic index and doseRAclinical
DESMOpractice.
RE.COM
response relationship to drug safetyGand
6) The nurse is conducting medication education about the difference between potency and
efficacy to a group of patients. The nurse correctly determines that learning has occurred
when the patients make which response?
1. "The best drug for us is the one with the highest potency."
2. "The best drug for us is the one with the greatest efficacy."
3. "Drugs with the greatest efficacy will produce the least side effects."
4. "Low-potency drugs have efficacy and do not produce side effects."
Answer: 2
Explanation:
1. Potency refers to the dose of the drug; high-potency drugs do not necessarily provide
the best response in the patient.
2. Efficacy means the magnitude of maximal response that can be produced from a
particular drug.
3. Efficacious drugs do produce side effects.
4. Low-potency drugs do produce side effects.
Page Ref: 51
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
5
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practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 5-7 Compare and contrast the terms potency and efficacy.
MNL Learning Outcome: 5.3 Relate the concepts of potency and efficacy to drug activity.
7) A client has a long history of hypertension. The healthcare provider orders an
antihypertensive drug that has just come on the market. The nurse teaches the patient that
this drug works more effectively than his prior drug and has fewer side effects. The patient
asks how this can be. What is the best response by the nurse?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Newer drugs are altered to affect your cells' receptors in a different way."
2. "Receptors tend to 'burn-out,' so newer drugs are required."
3. "Research into receptors helps 'fine-tune' drugs to be more effective."
4. "Changing the response of the drug to protein receptor-complexes produces fewer side
effects."
5. "It is a process of trial and error with receptors until the new drug proves effective."
Answer: 1, 3
Explanation:
1. Receptor research results in the development of new medications that activate very
specific receptors to produce a greater therapeutic response as well as fewer side
GRADESMORE.COM
effects.
2. Receptors do not "burn-out."
3. Research into receptors has resulted in the "fine-tuning" of medications that are more
effective with fewer side effects.
4. There is no such thing as a protein receptor-complex.
5. Research is not a process of trial and error with receptors.
Page Ref: 51
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 5-9 Explain the relationship between receptors and drug action.
MNL Learning Outcome: 5.3 Relate the concepts of potency and efficacy to drug activity.
6
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8) Which factor is used to help predict the safety of the dose of drug for a client?
1. Potency
2. Efficacy
3. Graded dose response
4. Frequency distribution curve
Answer: 4
Explanation:
1. Potency is a means to compare medications within therapeutic and pharmacologic
classes.
2. The efficacy of a drug is the magnitude of maximal response that can be produced from
a particular drug.
3. The graded dose response is used to compare the client's response of different dosages
of the drug.
4. A frequency distribution curve, is a graphical representation of the number of patients
responding to a drug action at different doses and can be used to help predict the safety
of a dose of a drug.
Page Ref: 49
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic
elements of the research process and models for applying evidence to clinical practice. | NLN
GRARelationships
DESMORE.between
COM knowledge/science and quality
Competencies: Knowledge and Science:
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Analysis
Learning Outcome: 5-3 Explain the importance of the median effective dose (ED50) to nursing
practice.
MNL Learning Outcome: 5.1 Relate the level of a drug's dosing to its safety.
7
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9) The client and his wife receive the same medication for hypertension. The client's wife asks
the nurse why she is receiving a higher amount of the medication. What is the best
response by the nurse?
1. "Females have a higher metabolism, so you need more medication."
2. "Everyone is unique and responds differently to medications."
3. "Your hormones are different from your husband's, so you need more medication."
4. "You have a greater percentage of body fat, so more medication is needed."
Answer: 2
Explanation:
1. Females do not necessarily have higher metabolic rates than males.
2. Many variables will influence how patients will respond to medications; each patient
must be individually evaluated for response to medications.
3. Hormone status is only one of the variables involved in the patient's response to
medications and may not pertain to this drug.
4. The percentage of body fat is only one of the variables involved in the patient's
response to medications and may not pertain to this medication.
Page Ref: 50
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: II.5 Participate in the process of retrieval, appraisal,
and synthesis of evidence in collaboration with other members of the healthcare team to
GRADESMOKnowledge
RE.COM and Science: Relationships
improve patient outcomes. | NLN Competencies:
between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 5-2 Discuss how frequency distribution curves may be used to explain how
patients respond differently to medications.
MNL Learning Outcome: 5.4 Examine how drugs act at the cellular level.
8
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10) The student nurse has been reading about the Human Genome Project and asks the nursing
instructor how this will impact future pharmacological therapies. What is the best response
by the instructor?
1. "We will be able to alter genes so we will not need drugs."
2. "We will be able to standardize drug doses to make prescribing easier."
3. "It will help prevent disease through gene manipulation but will not impact drugs."
4. "It will help to individualize drug therapy for people in a more effective way."
Answer: 4
Explanation:
1. Altering genes to prevent illness is a possibility, but we will always need medications.
2. Individuals will still respond differently to medications; not all drugs will have
standardized doses.
3. Medications will be very much impacted by this research.
4. The goal of pharmacogenetics is to help individualize drug therapy for people in a more
effective way.
Page Ref: 54
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic
elements of the research process and models for applying evidence to clinical practice. | NLN
Competencies: Knowledge and Science: Relationships between knowledge/science and quality
GRADEConcepts:
SMORE.Nursing
COM Process: Implementation
and safe patient care. | Nursing/Integrated
Learning Outcome: 5-10 Explain possible future developments in the field of
pharmacogenetics.
MNL Learning Outcome: 5.1 Relate the level of a drug's dosing to its safety.
9
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11) The home health nurse notes that the elderly patient doubled up on his pain medication,
even though the prescribed dose was at a therapeutic level. The patient says, "If one pill is
good, two pills are better." Which statement best describes the result of the patient's
action?
1. The patient develops tolerance and does not experience any difference.
2. The patient experiences more pain relief from the additional dose.
3. The patient develops tolerance and will need increased doses of the drug.
4. The patient is more likely to exhibit side effects from the additional dose.
Answer: 4
Explanation:
1. Tolerance may occur but is not the primary issue here.
2. Once the plateau of a drug has been reached, increased doses will not provide added
therapeutic benefit, such as more pain relief.
3. Tolerance may occur but is not the primary issue here.
4. Once the plateau of a drug has been reached, increasing the dose may produce adverse
effects.
Page Ref: 49
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic
elements of the research process and models for applying evidence to clinical practice. | NLN
GRARelationships
DESMORE.between
COM knowledge/science and quality
Competencies: Knowledge and Science:
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Analysis
Learning Outcome: 5-6 Explain the significance of the graded dose-response relationship to
nursing practice.
MNL Learning Outcome: 5.2 Consider the significance of the therapeutic index and doseresponse relationship to drug safety and clinical practice.
10
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12) The patient was receiving haloperidol (Haldol), a dopamine antagonist. The psychiatrist
changed the order to aripiprazole (Abilify), a partial dopamine antagonist. Which statement
best describes the effect of the change of medication on the patient?
1. The patient is more compliant in taking his medication.
2. The patient experiences greater efficacy.
3. The patient experiences a greater reduction in symptoms.
4. The patient experiences fewer side effects.
Answer: 4
Explanation:
1. The patient will not necessarily be more compliant in taking the medicine.
2. The patient will not necessarily experience greater efficacy.
3. Experiencing a greater reduction in symptoms is the same as greater efficacy.
4. Partial blocking of dopamine results in fewer side effects than complete blocking of
dopamine.
Page Ref: 53
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Analysis
GRADE
MORE.aCpartial
OM agonist, and an antagonist.
Learning Outcome: 5-8 Distinguish among
anSagonist,
MNL Learning Outcome: 5.4 Examine how drugs act at the cellular level.
11
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13) The student nurse asks the nursing instructor why drug plateaus occur with medications.
What are the best responses by the nursing instructor?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "It could be that all of the receptors for the drug are occupied."
2. "It may mean that the drug has brought 100% relief to the patient."
3. "It means that the patient has developed resistance and needs another drug."
4. "It probably means that the drug is losing efficacy."
5. "It means that the patient needs a higher dose of the drug."
Answer: 1, 2
Explanation:
1. Drug plateaus occur with medications because all the receptors for the drug are
occupied.
2. Drug plateaus occur with medications when the drug has brought 100% relief to the
patient.
3. Drug plateaus are not associated with resistance.
4. A drug plateau is not related to efficacy of the drug.
5. When a drug has reached its plateau, giving additional amounts will not result in an
increased therapeutic effect.
Page Ref: 50
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRADemonstrate
DESMORE.
COM
Standards: QSEN Competencies: III.A.1
knowledge
of basic scientific methods and
processes. | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic
elements of the research process and models for applying evidence to clinical practice. | NLN
Competencies: Knowledge and Science: Relationships between knowledge/science and quality
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5-6 Explain the significance of the graded dose-response relationship to
nursing practice.
MNL Learning Outcome: 5.2 Consider the significance of the therapeutic index and doseresponse relationship to drug safety and clinical practice.
12
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14) When administering a standard or median effective dose to a client, the nurse explains that
this amount of drug will have which effect?
1. It will produce an effect without the presence of adverse effects.
2. It will be metabolized within 24 hours.
3. It will be effective in half of the population.
4. It will be effective in the majority of clients.
Answer: 3
Explanation:
1. The median effective dose may result in toxicity in some patients.
2. Rate of metabolism is not a specific factor in determining median effective dose.
3. The median effective dose is the amount of a drug that produces an effect in 50% of a
group of patients.
4. Median does not refer to a value in excess of 50%.
Page Ref: 50
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic
elements of the research process and models for applying evidence to clinical practice. | NLN
Competencies: Knowledge and Science: Relationships between knowledge/science and quality
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5-3 Explain the importance of the median effective dose (ED50) to nursing
GRADESMORE.COM
practice.
MNL Learning Outcome: 5.3 Relate the concepts of potency and efficacy to drug activity.
13
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15) Drug X has a median lethal dose of 30 mg and a median effective dose of 10. Drug Y has a
therapeutic index of 4, while drug Z has a therapeutic index of 3. Which statement is
accurate based on this information?
1. Drugs X and Y are safer than drug Z.
2. The therapeutic index of drug X is 20.
3. Drug Y is the safest of the three.
4. Drug Z is the safest of the three.
Answer: 3
Explanation:
1. Drugs X and Z have the same therapeutic index and are more dangerous than drug Y.
2. The therapeutic index of drug X is 30/10 or 3.
3. Since drug Y has the highest therapeutic index, it is the safest drug.
4. Drugs X and Z have the same therapeutic index and are more dangerous than drug Y.
Page Ref: 49
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: II.7
Promote factors that create a culture of safety and caring. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Analysis
Learning Outcome: 5-5 Discuss how a drug's therapeutic index is related to its margin of safety.
GRthe
ADsignificance
ESMORE.of
COthe
M therapeutic index and doseMNL Learning Outcome: 5.2 Consider
response relationship to drug safety and clinical practice.
14
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16) When reading about a drug, the nurse learns it has a median toxic dose of 50 mg. The client
has been receiving 60 mg of the drug. What analysis does the nurse make?
1. It is likely the drug will not produce the desired effect.
2. The efficacy and potency of this drug have not been well defined.
3. The client will be at greater risk of adverse effects.
4. This amount of drug would have been lethal to half the population.
Answer: 3
Explanation:
1. This information is insufficient to predict if the drug will produce the desired effect.
2. The median toxicity dose is not a measure of efficacy and potency.
3. Since the dose exceeds the median toxicity for this drug, the patient is at greater risk of
developing adverse effects.
4. Median toxicity dose has to do with development of toxicity, not lethality.
Page Ref: 50
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: II.7 Promote factors that create a culture of safety
and caring. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Analysis
Learning Outcome: 5-4 Compare and contrast median lethal dose (LD50) and median toxicity
GRADESMORE.COM
dose (TD50).
MNL Learning Outcome: 5.1 Relate the level of a drug's dosing to its safety.
15
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17) A nursing instructor plans to teach a group of nursing students about graded-dose response
curves. The instructor understands that they are most useful to determine what?
1. Response intensity within an individual
2. Response intensity within a large group of people with different characteristics
3. Response intensity within a large group of people with similar characteristics
4. Response intensity within a small group of people with similar characteristics
Answer: 1
Explanation:
1. Graded dose-response curves are used to determine response intensity within an
individual.
2. Frequency distribution curves are used to visualize client differences in response to
medication in a population.
3. Frequency distribution curves are used to visualize client differences in response to
medication in a population.
4. Frequency distribution curves are used to visualize client differences in response to
medication in a population.
Page Ref: 50
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic
elements of the research process and models for applying evidence to clinical practice. | NLN
GRARelationships
DESMORE.between
COM knowledge/science and quality
Competencies: Knowledge and Science:
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 5-6 Explain the significance of the graded dose-response relationship to
nursing practice.
MNL Learning Outcome: 5.2 Consider the significance of the therapeutic index and doseresponse relationship to drug safety and clinical practice.
16
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WWW.GRADESMORE.COM
18) At a dose of 10 mg, drug X lowers total cholesterol by 50 mg/dL, while a maximum drop in
cholesterol of 65 mg/dL is achieved at 40 mg. At a dose of 5 mg, drug Y lowers cholesterol
by 50 mg/dL, while a maximum drop in cholesterol of 55 mg/dL is achieved at 10 mg. What
can be concluded about the efficacy and potency of these two drugs?
1. Drug X is more potent, and drug Y has a higher efficacy.
2. Drug X is more potent and has higher efficacy.
3. Drug Y is more potent and has higher efficacy.
4. Drug Y is more potent, and drug X has a higher efficacy.
Answer: 4
Explanation:
1. Drug X is not more potent. Drug Y does not have higher efficacy.
2. Drug X is not more potent.
3. Drug Y does not have higher efficacy.
4. Drug Y causes a greater drop in cholesterol at lower doses (higher potency), whereas
drug X causes the highest drop in total cholesterol (efficacy).
Page Ref: 51
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
GRADESMORE.COM
Process: Evaluation
Learning Outcome: 5-7 Compare and contrast the terms potency and efficacy.
MNL Learning Outcome: 5.3 Relate the concepts of potency and efficacy to drug activity.
17
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19) A student nurse asks a nurse about a drug that has been prescribed to decrease the effects
of an endogenous chemical. The nurse understands this drug is placed in which category?
1. An agonist
2. A partial agonist
3. An antagonist
4. An agonist-antagonist
Answer: 3
Explanation:
1. An agonist drug produces the same type of response as the endogenous substance.
2. A partial agonist produces a weaker, or less efficacious, response than an agonist.
3. An antagonist occupies receptor sites, preventing them from being activated by the
medication. This prevents the endogenous chemical from acting.
4. An agonist-antagonist produces a weaker, or less efficacious, response than an agonist.
Page Ref: 53
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Analysis
Learning Outcome: 5-8 Distinguish among an agonist, a partial agonist, and an antagonist.
GRhow
ADEdrugs
SMOact
REat
.Cthe
OMcellular level.
MNL Learning Outcome: 5.4 Examine
20) A nurse explains to a student nurse that pharmacogenetics is a relatively new area within
pharmacology. Which statement best describes the potential of this new area?
1. To customize drugs and prevent idiosyncratic responses
2. To reduce the overall number of drugs and their associated adverse effects
3. To reduce medication errors and provide optimal drug choices
4. To provide cost-effective pharmacotherapy and higher drug efficacy
Answer: 1
Explanation:
1. Pharmacogenetics explores the role of heredity in drug response. It might be useful to
customize drugs based on genetic makeup and reduce idiosyncratic responses.
2. Reducing the number of drugs might occur but is not the best descriptive statement.
3. Pharmacogenetics will not reduce medication errors.
4. Currently, increased cost is a deterrent.
Page Ref: 54
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic
elements of the research process and models for applying evidence to clinical practice. | NLN
Competencies: Knowledge and Science: Relationships between knowledge/science and quality
18
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5-10 Explain possible future developments in the field of
pharmacogenetics.
MNL Learning Outcome: 5.2 Consider the significance of the therapeutic index and doseresponse relationship to drug safety and clinical practice.
21) From a transcription error, a client received an overdose of a prescribed medication. If the
therapeutic index of the medication is 10 and the median effective dose is 2, the nurse
would calculate as the median lethal dose for the medication as ________. Record your
answer rounding to the nearest whole number.
Answer: 20
Explanation: 10 = x/2; solving for x, the median lethal dose would be 20.
Page Ref: 50
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: II.7
Promote factors that create a culture of safety and caring. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Intervention
Learning Outcome: 5-5 Discuss how a drug's therapeutic index is related to its margin of safety.
MNL Learning Outcome: 5.2 Consider the significance of the therapeutic index and doseRAclinical
DESMOpractice.
RE.COM
response relationship to drug safetyGand
19
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22) The nurse is participating in the clinical trial of a new medication for the treatment of
hypertension. To assess the effectiveness of the medication, which assessments would the
nurse perform to help determine whether the average dose is effective for the patient?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Blood pressure
2. Heart rate
3. Laboratory values
4. Diet
5. Sleep habits
Answer: 1, 2, 3
Explanation:
1. By monitoring the patient's vital signs, the nurse helps to determine whether the
average dose is effective for the patient.
2. By monitoring the patient's vital signs, the nurse helps to determine whether the
average dose is effective for the patient.
3. By interpreting any associated laboratory data, the nurse helps to determine whether
the average dose is effective for the patient.
4. Monitoring the patient's diet will not help determine if the average dose of a medication
is effective for the patient.
5. Monitoring the patient's sleep habits will not help determine if the average dose of a
medication is effective for the patient.
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Page Ref: 49
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.B.1 Participate effectively in appropriate data collection and
other research activities. | AACN Essential Competencies: III.2 Demonstrate an understanding
of the basic elements of the research process and models for applying evidence to clinical
practice. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 5-1 Explain the applications of pharmacodynamics to nursing practice.
MNL Learning Outcome: 5.2 Consider the significance of the therapeutic index and doseresponse relationship to drug safety and clinical practice.
20
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23) A nurse is reviewing drug safety with a student nurse. The nurse explains that the median
lethal dose of drugs is often determined in laboratory preclinical trials because of which
factors?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. It would be unethical to determine these values in human subjects.
2. The safety of the medication must be determined prior to clinical trials.
3. It is difficult to obtain sufficient participants for clinical trials.
4. Clinical trials determine only the effective dose of a drug.
5. It is too costly to conduct the studies during clinical trials.
Answer: 1, 2
Explanation:
1. Laboratory animals are used in clinical trials to determine the LD 50, or the dose that kills
50% of the subjects. It would be unethical to kill human subjects.
2. Before a drug is released for trials in human subjects, its safety must be determined.
3. It can be challenging to obtain sufficient subjects at times, but this is not the reason for
doing lethal studies during preclinical trials.
4. Clinical trials determine not only the effectiveness of a drug, but also its adverse and
toxic effects.
5. The cost of the trials is the reason they are conducted with animal subjects.
Page Ref: 50
Cognitive Level: Applying
GRADESMORE.COM
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: II.7 Promote factors that create a culture of safety
and caring. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Intervention
Learning Outcome: 5-4 Compare and contrast median lethal dose (LD50) and median toxicity
dose (TD50).
MNL Learning Outcome: 5.2 Consider the significance of the therapeutic index and doseresponse relationship to drug safety and clinical practice.
21
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24) The nurse is preparing to administer a medication to a client on a medical-surgical unit. The
median lethal dose of the drug is 40 mg, and the median effective dose is 10 mg. The nurse
calculates the therapeutic index to be ________. Record your answer rounding to the
nearest whole number.
Answer: 4
Explanation: The therapeutic index is calculated by dividing the median lethal dose (LD 50) by
the median effective dose (ED50).
Page Ref: 50
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: II.7
Promote factors that create a culture of safety and caring. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 5-5 Discuss how a drug's therapeutic index is related to its margin of safety.
MNL Learning Outcome: 5.2 Consider the significance of the therapeutic index and doseresponse relationship to drug safety and clinical practice.
25) A client with hypertension is taking a potent antihypertensive without results. The client is
concerned when the healthcare provider orders a new drug. What is the nurse's response?
Note: Credit will be given only if all correct
choices are selected. Select
GRADchoices
ESMORand
E.no
COincorrect
M
all that apply.
1. "The drug you took is very potent, and a higher dose is needed."
2. "The new drug has greater efficacy, so it will help reduce your blood pressure."
3. "The prescriber must have made an error in the orders."
4. "Efficacy in treating your hypertension is more important than potency."
5. "You are correct. I think the prescriber meant to order both drugs."
Answer: 2, 4
Explanation:
1. A higher dose of a potent drug may cause more serious adverse effects without greater
efficacy.
2. Efficacy is more important than potency in providing blood pressure control.
3. This is not an appropriate response by the nurse.
4. Efficacy is more important than potency in pharmacologic treatment.
5. This is not an appropriate response, and the nurse cannot assume the order was
supposed to be for two drugs.
Page Ref: 51
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
22
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
Process: Intervention
Learning Outcome: 5-7 Compare and contrast the terms potency and efficacy.
MNL Learning Outcome: 5.3 Relate the concepts of potency and efficacy to drug activity.
26) The nurse is reviewing the medication administration record for a group of clients and
recognizes that which agents have nonspecific cellular responses?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Ethyl alcohol
2. General anesthetics
3. Osmotic diuretics
4. Calcium channel blockers
5. Alpha-adrenergic antihypertensives
Answer: 1, 2, 3
Explanation:
1. Ethyl alcohol is an example of an agent that acts by nonspecific mechanisms,
independently of cellular receptors.
2. General anesthetics are an example of agents that act by nonspecific mechanisms,
independently of cellular receptors.
3. Osmotic diuretics are an example of agents that act by nonspecific mechanisms,
independently of cellular receptors.
4. Calcium channel blockers have a specific mechanism of action.
GRADEhave
SMOaRspecific
E.COM
5. Alpha-adrenergic antihypertensives
mechanism of action.
Page Ref: 53
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Analysis
Learning Outcome: 5-8 Distinguish among an agonist, a partial agonist, and an antagonist.
MNL Learning Outcome: 5.4 Examine how drugs act at the cellular level.
23
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27) The educator has reviewed the phases of graded dose-response with the nursing staff.
Which statement made by a nurse indicates an understanding of phase 2 of the response?
1. "This is the measure of the safety margin of the drug."
2. "Very few target cells have been affected by the drug."
3. "The client's response is based on the amount of drug given."
4. "Increasing the drug dose will produce no additional therapeutic response."
Answer: 3
Explanation:
1. The therapeutic index is the margin for safety of a drug.
2. Phase 1 occurs at the lowest doses of the drug. During this phase very few target cells
have been affected by the drug.
3. Phase 2 demonstrates the amount of drug administered and the degree of response
obtained by the client.
4. Phase 3 is the plateau phase. The plateau phase occurs when increasing the drug dose
produces no additional therapeutic response.
Page Ref: 50
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic
elements of the research process and models for applying evidence to clinical practice. | NLN
Competencies: Knowledge and Science: Relationships between knowledge/science and quality
GRADEConcepts:
SMORE.Nursing
COM Process: Implementation
and safe patient care. | Nursing/Integrated
Learning Outcome: 5-2 Discuss how frequency distribution curves may be used to explain how
patients respond differently to medications.
MNL Learning Outcome: 5.2 Consider the significance of the therapeutic index and doseresponse relationship to drug safety and clinical practice.
24
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28) A literature review reveals that a new drug has a median lethal dose of 10 and a median
effective dose of 5. The nurse determines that an error in which ________ times the correct
dose is given could be lethal. Record your answer rounding to the nearest whole number.
Answer: 2
Explanation: x = 10/5; solving for x, the therapeutic index would be 2. This means it would only
take an error in magnitude of approximately 2 times the average dose to be lethal.
Page Ref: 50
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: II.7
Promote factors that create a culture of safety and caring. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Intervention
Learning Outcome: 5-5 Discuss how a drug's therapeutic index is related to its margin of safety.
MNL Learning Outcome: 5.2 Consider the significance of the therapeutic index and doseresponse relationship to drug safety and clinical practice.
GRADESMORE.COM
25
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29) During assessment, the patient mentions that he recently "sent off to a company for
pharmacogenomic testing." What nursing responses are indicated?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Have you changed your medications any?"
2. "Have you talked with your physician about the results?"
3. "Why did you do that?"
4. "Was that test expensive?"
5. "Who told you about the testing?"
Answer: 1, 2
Explanation:
1. The most important question is if the patient has changed therapy secondary to test
results.
2. It is important for the patient to discuss the results of the tests and any indicated
changes with the healthcare provider.
3. Asking a "why" question is confrontational and is likely to result in the patient not
sharing more information.
4. The nurse may be curious as to the expense of the test, but the cost is not pertinent to
this discussion.
5. Asking who suggested the test is confrontational and is likely to result in the patient not
sharing more information.
Page Ref: 53
GRADESMORE.COM
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic
elements of the research process and models for applying evidence to clinical practice. | NLN
Competencies: Knowledge and Science: Relationships between knowledge/science and quality
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 5-10 Explain possible future developments in the field of
pharmacogenetics.
MNL Learning Outcome: 5.4 Examine how drugs act at the cellular level.
26
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30) The nurse reads that a newly discovered drug is a functional antagonist for some commonly
administered medications. The nurse interprets this information as indicating the new drug
could have which actions?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Blocks alpha receptors
2. Enhances drug excretion
3. Blocks beta receptors
4. Speeds drug metabolism
5. Inhibits protein synthesis
Answer: 2, 4
Explanation:
1. Functional antagonists do not block alpha receptors.
2. Functional antagonists change pharmacokinetic factors such as excretion.
3. Functional antagonists do not block beta receptors.
4. Functional antagonists change pharmacokinetic factors such as metabolism.
5. Drugs that bind with DNA may inhibit protein synthesis.
Page Ref: 49
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
GRADESKnowledge
MORE.COand
M Science: Relationships between
practice, and research. | NLN Competencies:
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Analysis
Learning Outcome: 5-1 Explain the applications of pharmacodynamics to nursing practice.
MNL Learning Outcome: 5.4 Examine how drugs act at the cellular level.
27
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Pharmacology for Nurses, 6e (Adams)
Chapter 6 The Nursing Process in Pharmacology
1) The nurse follows the nursing process when conducting medication education about insulin.
What will the nurse ask the client to evaluate the client's knowledge of insulin?
1. "Is your abdomen the best place to inject insulin?"
2. "What questions do you have about insulin?"
3. "Can you recognize when you are experiencing hypoglycemia?"
4. "Can you tell me four points you remember about how to take your insulin?"
Answer: 4
Explanation:
1. Asking the client if their abdomen is the best place to inject insulin is an assessment
question.
2. Asking the client what questions he or she has about insulin is an assessment question.
3. Asking the client if he or she can recognize when he or she is experiencing hypoglycemia
is an assessment question.
4. The nurse is evaluating the effectiveness of medication education by asking the patient
for feedback from the education provided.
Page Ref: 59
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
GRADESMORE.COM
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.9 Monitor client outcomes to evaluate the effectiveness of
psychobiological interventions. | NLN Competencies: Knowledge and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts:
Nursing Process: Evaluation
Learning Outcome: 6-1 Compare and contrast the different steps of the nursing process.
MNL Learning Outcome: 6.4 Recognize how the evaluation phase of the nursing process is used
to measure outcomes and revise care.
1
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2) The nurse assesses the client with diabetes mellitus prior to administering medications.
Which questions are important to ask the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Are you allergic to any medications?"
2. "Are you taking any herbal or over-the-counter (OTC) medications?"
3. "How difficult is it for you to maintain your ideal body weight?"
4. "Will you please tell me about the kind of diet you follow?"
5. "What other medications are you currently taking?"
Answer: 1, 2, 4, 5
Explanation:
1. Questions about allergies are important during assessment.
2. Questions about herbal and OTC medications are an important part of assessment.
3. Ideal body is an important question, but does not refer specifically to medication
administration.
4. Questions about normal diet help to assess health management and are pertinent to
drug administration.
5. Questions about current medication are important during assessment.
Page Ref: 60
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
GRADESMORpreferences,
E.COM values; coordination and
patient-centered care: patient/family/community
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral,
psychological, spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate approaches. | NLN
Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase
that are pertinent to medication administration.
MNL Learning Outcome: 6.1 Determine assessment data that is relevant to the care of a
patient taking medications.
2
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3) The healthcare provider has prescribed a nitroglycerine (Nitrodur) patch for the client. The
nurse understands that which of the following is the best outcome for this client as it relates
to use of the medication?
1. Client will be able to identify the expiration date of the medication prior to discharge.
2. Client will verbalize three side effects of the medication prior to discharge.
3. Client will state the reason for receiving the medication prior to discharge.
4. Client will demonstrate correct application of the patch prior to discharge.
Answer: 4
Explanation:
1. The client does not need to identify the expiration date of the medication in order to
correctly apply the patch.
2. The client does not need to identify side effects of the medication in order to correctly
apply the patch. The client does not need to state the reason for the medication in order
to correctly apply the patch. The client does not need to identify the expiration date of
the medication in order to correctly apply the patch.
3. The client does not need to state the reason for the medication in order to correctly
apply the patch.
4. The overall goal of nursing care related to pharmacotherapy is the safe and effective
administration of medication. In this instance, the most important aspect of client
teaching is that the client be able to correctly apply the patch. If the patch is not
correctly applied, the other issues are irrelevant. The client does not need to identify
side effects of the medication in order to correctly apply the patch. The client does not
RAmedication
DESMORE
COM to correctly apply the patch. The
need to state the reason for G
the
in.order
client does not need to identify the expiration date of the medication in order to
correctly apply the patch.
Page Ref: 61
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Analysis
Learning Outcome: 6-3 Describe the areas of concern relating to pharmacotherapy that should
be addressed during the diagnosis phase of the nursing process.
MNL Learning Outcome: 6.2 Recognize pharmacotherapeutic factors that contribute to the
diagnosis and planning phase of the nursing process.
3
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4) The client is receiving albuterol (Proventil) for treatment of bronchospasm related to
asthma. What is the primary nursing intervention as it relates to this medication?
1. Monitor the client for relief of bronchospasms.
2. Monitor the client for nausea and headache.
3. Monitor the client's serum drug levels.
4. Provide the client with age-appropriate education about albuterol (Proventil).
Answer: 1
Explanation:
1. Monitoring drug effects, in this case the relief of bronchospasms, is a primary
intervention that nurses perform.
2. Nausea and headache are expected side effects, but monitoring for these side effects is
not part of the primary intervention.
3. Monitoring of serum drug levels for albuterol (Proventil) is not indicated.
4. Education about medication is important but is not part of the primary intervention.
Page Ref: 60
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
GRProcess:
ADESMAssessment
ORE.COM
Nursing/Integrated Concepts: Nursing
Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase
that are pertinent to medication administration.
MNL Learning Outcome: 6.1 Determine assessment data that is relevant to the care of a
patient taking medications.
4
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5) The client is receiving an oral antibiotic as treatment for cellulitis of the lower extremity.
The client's outcome is "Client will state a key point about antibiotic treatment for
cellulitis." Which statement would the nurse evaluate as best indicating this outcome has
been met?
1. "If the pain gets too bad, I can take my prescribed pain medication."
2. "If the swelling continues, I can apply an ice pack."
3. "I need to take all the pills even if my leg looks better."
4. "I must keep my leg elevated until the swelling goes down."
Answer: 3
Explanation:
1. Taking pain medication does not address the outcome for antibiotic treatment.
2. Applying an ice pack does not address the outcome for antibiotic treatment.
3. Taking all the medication even if the leg looks better is a key point about antibiotic
therapy and meets the client's outcome.
4. Keeping the leg elevated does not address the outcome for antibiotic treatment.
Page Ref: 64
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Quality and Safety:
GRachievement.
ADESMORE|.Nursing/Integrated
COM
Contribute to assessment of outcome
Concepts: Nursing
Process: Evaluation
Learning Outcome: 6-6 Explain the importance of the evaluation phase of the nursing process
as applied to pharmacotherapy.
MNL Learning Outcome: 6.4 Recognize how the evaluation phase of the nursing process is used
to measure outcomes and revise care.
5
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6) The healthcare provider has prescribed quetiapine (Seroquel) for the client with chronic
auditory hallucinations. The client has stopped taking the medication. The nurse incorrectly
uses the diagnosis of "noncompliance." In which situation would this diagnosis be
appropriate?
1. The client reported a physical change as the reason for stopping the medication.
2. The client made an informed decision not to take the medication.
3. The client was unsure about how to order a refill for the prescription.
4. The client did not understand why the medication was prescribed.
Answer: 2
Explanation:
1. If the client reports a physical change as the reason for stopping the medication, the
nursing diagnosis should be related to that change. For example, if the client reports
being fatigued, the nursing diagnosis would relate to that finding.
2. Noncompliance assumes that the client has been properly educated about the
medication and has made an informed decision not to take it.
3. Being unsure of the way to obtain a refill on the medication is related to a knowledge
deficit, not noncompliance.
4. Not knowing why the medication was prescribed is related to a knowledge deficit, not
noncompliance.
Page Ref: 61
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRProvide
ADESMpatient-centered
ORE.COM care with sensitivity and
Standards: QSEN Competencies: I.B.3
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Relationship-Centered
Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing
Process: Diagnosis
Learning Outcome: 6-3 Describe the areas of concern relating to pharmacotherapy that should
be addressed during the diagnosis phase of the nursing process.
MNL Learning Outcome: 6.2 Recognize pharmacotherapeutic factors that contribute to the
diagnosis and planning phase of the nursing process.
6
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7) The nurse is preparing for medication administration to a group of clients. What is the best
overall outcome for the clients?
1. Clients will take the medications after receiving medication instruction.
2. Clients will receive the best therapeutic outcome from the medications.
3. Clients will state the reason they are receiving the medications.
4. Clients will experience minimal side effects after taking the medications.
Answer: 2
Explanation:
1. The fact that the client takes the medication is not the best overall outcome for the
clients.
2. Outcomes should focus first on the therapeutic outcome of the medications.
3. Having the clients state the reason they are receiving the medications is not the best
overall outcome for the clients.
4. The treatment of side effects is not the best overall outcome for the clients.
Page Ref: 64
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
GRProcess:
ADESMEvaluation
ORE.COM
Nursing/Integrated Concepts: Nursing
Learning Outcome: 6-6 Explain the importance of the evaluation phase of the nursing process
as applied to pharmacotherapy.
MNL Learning Outcome: 6.4 Recognize how the evaluation phase of the nursing process is used
to measure outcomes and revise care.
7
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8) The nurse is managing care for several clients at a diabetic treatment center. The nurse
understands that which of the following is the priority nursing intervention?
1. To administer the correct medicine to the correct client at the correct dose and the
correct time via the correct route
2. To return the client to an optimum level of wellness while limiting adverse effects
related to the client's medical diagnosis
3. To include any cultural or ethnic preferences in the administration of the medication
4. To answer any questions the client may have about the medicine, or any possible side
effect of the medication
Answer: 2
Explanation:
1. The correct client, dose, and time refer to the five "rights" of medication administration
and, while important, is not the best, overall nursing intervention.
2. Interventions are aimed at returning the client to an optimum level of wellness and
limiting adverse effects related to the client's medical diagnosis or condition.
3. Answering questions the client may have is an appropriate intervention but is not the
best overall intervention. While important to include cultural and ethnic preferences,
this is not the best overall intervention.
4. Answering questions the client may have is an appropriate intervention but is not the
best overall intervention.
Page Ref: 63
Cognitive Level: Analyzing
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase
of the nursing process for patients receiving medications.
MNL Learning Outcome: 6.3 Recognize key nursing interventions required in the
implementation phase of the nursing process for patients receiving medications.
8
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9) What is the most significant role for nurses as defined by state nurse practice acts and by
regulating bodies such as The Joint Commission?
1. Prescribing medication
2. Client teaching
3. Ordering lab tests
4. Discharging clients
Answer: 2
Explanation:
1. Healthcare providers prescribe medications. Administering medications and assessing
the client's response is within the scope of practice for nurses. However, prescribing
medications is not a role of nurses.
2. State nurse practice acts and regulating bodies such as The Joint Commission consider
teaching to be a primary role for nurses, giving it the weight of law and key important
accreditation standards.
3. Healthcare providers prescribe lab tests. Evaluating the results of lab test is within the
scope of practice for nurses. However, prescribing lab tests is not a role of nurses.
4. Healthcare providers determine when a client will be discharged, based on input from
the nurse. Completing client education is within the scope of practice for nurses.
However, discharging a client is not a role of nurses.
Page Ref: 63
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRProvide
ADESMpatient-centered
ORE.COM care with sensitivity and
Standards: QSEN Competencies: I.B.3
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase
of the nursing process for patients receiving medications.
MNL Learning Outcome: 6.3 Recognize key nursing interventions required in the
implementation phase of the nursing process for patients receiving medications.
9
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10) The Joint Commission documented that client education was deficient on several medicalsurgical units of a local hospital. A nursing committee was formed to address this problem.
What is the best intervention to improve client education?
1. Providing educational pamphlets about medications to the clients
2. Asking the healthcare providers to provide medication education to the clients
3. Discussing medications each time they are administered to clients
4. Requesting more frequent pharmacy consults for the clients
Answer: 3
Explanation:
1. Educational pamphlets can be effective but are not as effective as the nurse providing
education to the client.
2. Medication education is considered to be a responsibility of the nurse, not the
healthcare provider.
3. Discussing medications each time they are administered is an effective way to increase
the amount of education provided.
4. Medication education is considered to be a responsibility of the nurse, not the
pharmacist.
Page Ref: 63
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
GRADESperspectives,
MORE.COMand patient preferences in planning,
evidence, clinical judgment, interprofessional
implementing, and evaluating outcomes of care. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase
of the nursing process for patients receiving medications.
MNL Learning Outcome: 6.3 Recognize key nursing interventions required in the
implementation phase of the nursing process for patients receiving medications.
10
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11) The nurse has several educational pamphlets for the client about medications the client is
receiving. Prior to giving the client these pamphlets, what is the most important assessment
by the nurse?
1. Assess the client's ability to pay for the medication.
2. Assess the client's religious attitudes toward medicine.
3. Assess the client's reading level.
4. Assess the client's cultural bias toward taking medicine.
Answer: 3
Explanation:
1. Assessing the client's ability to pay for the medication is important but not the primary
assessment.
2. Assessing the client's religious attitudes is important but not the primary assessment.
3. Educational pamphlets are ineffective if the reading level is above what the client can
understand.
4. Assessing the client's cultural bias is important but not the primary assessment.
Page Ref: 60
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
GRcomprehensive
ADESMORE.and
COfocused
M
Essential Competencies: IX.1 Conduct
physical, behavioral,
psychological, spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate approaches. | NLN
Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase
that are pertinent to medication administration.
MNL Learning Outcome: 6.1 Determine assessment data that is relevant to the care of a
patient taking medications.
11
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12) The nurse is reviewing the steps of the nursing process with a student. The nurse is aware
that it is most important to be accurate in which portion of the nursing process?
1. Evaluation
2. Assessment
3. Diagnosis
4. Planning
Answer: 2
Explanation:
1. While accuracy in evaluation is important, it is more important to be accurate in a
different step of the nursing process.
2. Assessment is the basis for the development of the rest of the steps of the nursing
process. While the nurse always strives to be accurate, inaccuracies in assessment will
translate as inaccuracies in the remaining steps.
3. While accuracy in diagnosis is important, it is more important to be accurate in a
different step of the nursing process.
4. While accuracy in planning is important, it is more important to be accurate in a
different step of the nursing process.
Page Ref: 59
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
GRADESMOand
RE.education;
COM
integration of care; information, communication,
physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral,
psychological, spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate approaches. | NLN
Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 6-1 Compare and contrast the different steps of the nursing process.
MNL Learning Outcome: 6.1 Determine assessment data that is relevant to the care of a
patient taking medications.
12
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13) The nurse is assessing a newly admitted client's current medication. Which of the following
is an example of objective data?
1. The client's wife tells the nurse what medications the client has been receiving.
2. The nurse checks the prescription bottles the client has brought to the hospital.
3. The nurse asks the healthcare provider what medications the client was currently
taking.
4. The client lists the medications that have been prescribed.
Answer: 2
Explanation:
1. A list of medications provided by the client's wife is subjective, not objective, data.
2. Objective data includes information gathered through assessment, and not necessarily,
what the client says or perceives. The most reliable and objective assessment by the
nurse is to check the client's prescription medication bottles.
3. Asking the healthcare provider what medication the client was receiving is subjective
data, and the healthcare provider may not remember all the medication the client was
receiving.
4. A list of medications provided by the client is subjective, not objective, data.
Page Ref: 60
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
GRADESMOand
RE.education;
COM
integration of care; information, communication,
physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral,
psychological, spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate approaches. | NLN
Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase
that are pertinent to medication administration.
MNL Learning Outcome: 6.1 Determine assessment data that is relevant to the care of a
patient taking medications.
13
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14) The nurse is administering medications to an older adult. Which laboratory tests are most
important for the nurse to assess prior to the administration of medication?
1. Complete blood count (CBC) and electrolytes
2. Kidney and liver function tests
3. Arterial blood gases (ABGs) and basic metabolic panel
4. Lipid panel and thyroid function tests
Answer: 2
Explanation:
1. Complete blood count (CBC) and electrolytes are not likely to help in determining the
proper drug dosage.
2. Renal and hepatic function tests are essential for many patients, particularly older
clients and those who are critically ill, as these will be used to determine the proper
drug dosage.
3. Arterial blood gases (ABGs) and a basic metabolic panel are not likely to help in
determining the proper drug dosage.
4. Lipid panel and thyroid function tests are not likely to help in determining the proper
drug dosage.
Page Ref: 60
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
GRADESMOand
RE.education;
COM
integration of care; information, communication,
physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral,
psychological, spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate approaches. | NLN
Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase
that are pertinent to medication administration.
MNL Learning Outcome: 6.1 Determine assessment data that is relevant to the care of a
patient taking medications.
14
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15) The nurse is reviewing the steps of the nursing process with a student. The nurse knows
that the student understands the teaching when the student correctly lists which of the
following as the correct order of the nursing process?
1. Establish nursing diagnosis, assessment, intervene, collaborate, evaluation
2. Establish goals, assessment, intervention, planning, communication
3. Assessment, establish nursing diagnosis, planning, interventions, evaluation
4. Assessment, planning, establish objectives, communication, evaluation
Answer: 3
Explanation:
1. Nursing diagnoses cannot be established until assessment is done.
2. Goals cannot be established until assessment is done.
3. The primary steps (in order) include assessment, establish nursing diagnosis, planning,
interventions, evaluation.
4. Communication is important but is not a primary step of the nursing process.
Page Ref: 59
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: III.1 Explain the interrelationships among theory, practice, and
GRADEand
SMScience:
ORE.CRelationships
OM
research. | NLN Competencies: Knowledge
between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 6-1 Compare and contrast the different steps of the nursing process.
MNL Learning Outcome: 6.4 Recognize how the evaluation phase of the nursing process is used
to measure outcomes and revise care.
15
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16) Place these nursing activities in the correct order of the nursing process.
1. The nurse analyzes the data collected.
2. The nurse documents the time and route of an administered medication.
3. The nurse weighs the client.
4. The nurse writes an individualized nursing intervention.
5. The nurse changes a nursing intervention that is not working.
Answer: 3, 1, 4, 2, 5
Explanation: The order of the steps of the nursing process is assessment, diagnosis, planning,
implementing, and evaluating. Weighing the client is assessment, analyzing data occurs in the
diagnosis step, writing interventions occurs in the planning step, documentation occurs in the
implementation step, and revising interventions occurs in the evaluation step.
Page Ref: 59
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: III.1 Explain the interrelationships among theory, practice, and
research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
GRcontrast
ADESMthe
ORdifferent
E.COMsteps of the nursing process.
Learning Outcome: 6-1 Compare and
MNL Learning Outcome: 6.4 Recognize how the evaluation phase of the nursing process is used
to measure outcomes and revise care.
16
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17) The nurse uses a newly admitted client's armband barcode to identify the client prior to
administering medications. The nurse should use at least ________ other means of
identifying this client. Record your answer rounding to the nearest whole number.
Answer: 2
Explanation: Even though the barcode identification system has improved safety, it is not
foolproof. The nurse should use two other means of identifying the client such as verifying
name and birth date.
Page Ref: 63
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase
of the nursing process for patients receiving medications.
MNL Learning Outcome: 6.3 Recognize key nursing interventions required in the
implementation phase of the nursing process for patients receiving medications.
GRADESMORE.COM
17
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18) Which statement about the nursing process is accurate?
1. Generally, goals are more measurable than outcomes.
2. Goals involve very specific criteria that evaluate interventions.
3. Obtaining the outcomes is essential for goal attainment.
4. After selecting the nursing diagnosis, interventions are completed.
Answer: 3
Explanation:
1. Outcomes are generally more measurable than goals as they are more specific.
2. Goals are more general than specific.
3. Outcomes are specific, measurable criteria that are used to measure goal attainment.
4. The planning phase (including outcomes and goals) follows nursing diagnosis.
Page Ref: 63
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 6-1 Compare and contrast the different steps of the nursing process.
MNL Learning Outcome: 6.3 Recognize key nursing interventions required in the
ADESfor
MOpatients
RE.COreceiving
M
implementation phase of the nursingGR
process
medications.
18
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19) Which nursing intervention would take priority following administration of a new
medication?
1. Evaluating the results of recent labs
2. Monitoring the client's respiratory status
3. Administering additional medications if side effects occur
4. Measuring client's weight daily
Answer: 2
Explanation:
1. Monitoring lab values might be appropriate nursing interventions with some
medications but would not be the priority.
2. Any time a new medication is provided to the client, it is important to monitor for an
allergic reaction. Anaphylaxis, a life-threatening allergic reaction, can impair breathing.
3. It may be necessary to administer additional medications if side effects occur, but the
nurse needs to assess the client first.
4. Measuring weight might be appropriate nursing interventions with some medications
but would not be the priority.
Page Ref: 63
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
GRAof
DEcare.
SMO|RNLN
E.CCompetencies:
OM
implementing, and evaluating outcomes
Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase
of the nursing process for patients receiving medications.
MNL Learning Outcome: 6.3 Recognize key nursing interventions required in the
implementation phase of the nursing process for patients receiving medications.
19
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20) A client with hypertension is receiving medication to lower his blood pressure. Which
nursing action demonstrates the evaluation process related to medication administration?
1. Asking the client if they have adhered to the prescribed treatment
2. Determining that goals were not met 3 days following medication administration
3. Administration of IV antihypertensive agents
4. Determination of the client's baseline blood pressure
Answer: 2
Explanation:
1. Asking about compliance would be the assessment step.
2. Evaluation is the final step in the nursing process where goal attainment is determined.
3. Administering medications is the intervention step.
4. Determining the client's baseline blood pressure would be the assessment step.
Page Ref: 64
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Quality and Safety:
Contribute to assessment of outcome achievement. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 6-6 Explain the importance of the evaluation phase of the nursing process
GRADESMORE.COM
as applied to pharmacotherapy.
MNL Learning Outcome: 6.4 Recognize how the evaluation phase of the nursing process is used
to measure outcomes and revise care.
20
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21) A nurse is assessing a client recently admitted to the unit. The nurse understands that which
assessment identifies the collection of objective data?
1. The client rates his or her pain a 5 on a 0-10 pain scale.
2. The client states he or she is anxious.
3. The client has a wound measured at 5 cm in length.
4. The client informs the nurse that he or she weighs 150 pounds.
Answer: 3
Explanation:
1. Subjective data consist of what the client says or perceives.
2. Subjective data consist of what the client says or perceives.
3. Objective data are gathered through physical assessment, laboratory tests, and other
diagnostic sources.
4. Subjective data consist of what the client says or perceives.
Page Ref: 60
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral,
psychological, spiritual, socioeconomic, and environmental assessments of health and illness
GRADESMand
ORculturally
E.COM appropriate approaches. | NLN
parameters in patients, using developmentally
Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase
that are pertinent to medication administration.
MNL Learning Outcome: 6.1 Determine assessment data that is relevant to the care of a
patient taking medications.
21
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22) When teaching the client about a new medication, the nurse should include which
information?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Adverse effects that can be expected
2. Which adverse effect to report to the healthcare provider
3. The drug's therapeutic action
4. Chemical composition of the drug
5. Name of the drug manufacturer
Answer: 1, 2, 3
Explanation:
1. In order to help the client identify and prevent adverse effects, the client should be
taught the adverse effects.
2. The client should be taught when to notify the healthcare provider of adverse effects.
3. In order to help the client identify and prevent adverse effects, the client should be
taught the therapeutic action of the drug.
4. It is not necessary to teach the client the chemical makeup of the drug.
5. It is not necessary to teach the client the name of the drug manufacturer.
Page Ref: 63
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
GRADESM|OAACN
RE.Essential
COM Competencies: III.6 Integrate
respect for the diversity of human experience.
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase
of the nursing process for patients receiving medications.
MNL Learning Outcome: 6.3 Recognize key nursing interventions required in the
implementation phase of the nursing process for patients receiving medications.
22
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23) A nurse is preparing care for a newly admitted client with diabetes. Which information
would be critical for the nurse to assess?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Medical history
2. Current lab results
3. Medication allergies
4. Use of dietary supplements
5. Number of previous hospitalizations
Answer: 1, 2, 3, 4
Explanation:
1. Medical history may reveal conditions that contraindicate the use of certain drugs.
2. Current lab results may reveal important information about the health of organs, such
as the kidneys and liver, which would be important to metabolism and excretion of
drugs.
3. Allergies to one drug may cross over to another drug and would need to be avoided.
4. Some dietary supplements can interact with drugs.
5. While this is good information, it is not critical to this admission.
Page Ref: 60
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
GRADESMORpreferences,
E.COM values; coordination and
patient-centered care: patient/family/community
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral,
psychological, spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate approaches. | NLN
Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase
that are pertinent to medication administration.
MNL Learning Outcome: 6.1 Determine assessment data that is relevant to the care of a
patient taking medications.
23
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24) A nurse has admitted a new client to the unit. Which concepts should the nurse use when
developing a nursing diagnosis?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Base the nursing diagnosis on the medical diagnosis.
2. Focus on what the nurse needs to help the client return to health.
3. Include the client in the identification of needs.
4. Consider the client's response to the current health problem.
5. Be certain the diagnosis is measurable.
Answer: 3, 4
Explanation:
1. The nursing diagnosis is not dependent on the medical diagnosis.
2. The focus should be on the client's needs.
3. Including the client in the formulation of nursing diagnoses encourages more active
involvement in working toward meeting identified goals.
4. A nursing diagnosis is a clinical judgment concerning human response to health
conditions.
5. Goals and outcomes need to be measurable, not nursing diagnosis.
Page Ref: 61
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
GRADESM|OAACN
RE.Essential
COM Competencies: III.6 Integrate
respect for the diversity of human experience.
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Relationship-Centered
Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing
Process: Diagnosis
Learning Outcome: 6-3 Describe the areas of concern relating to pharmacotherapy that should
be addressed during the diagnosis phase of the nursing process.
MNL Learning Outcome: 6.2 Recognize pharmacotherapeutic factors that contribute to the
diagnosis and planning phase of the nursing process.
24
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25) The nurse who is writing a risk nursing diagnosis will write a ________ part statement.
Record your answer rounding to the nearest whole number.
Answer: 2
Explanation: Since risk diagnoses do not have evidence to support the chosen statement, they
are written in two parts.
Page Ref: 62
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Relationship-Centered
Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing
Process: Diagnosis
Learning Outcome: 6-3 Describe the areas of concern relating to pharmacotherapy that should
be addressed during the diagnosis phase of the nursing process.
MNL Learning Outcome: 6.2 Recognize pharmacotherapeutic factors that contribute to the
diagnosis and planning phase of the nursing process.
GRADESMORE.COM
25
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26) A client returns to the clinic for follow-up after taking a newly prescribed medication for a
month. The nurse recognizes medication teaching was successful when the client makes
which statement?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "I've been taking my medication on an empty stomach like the prescription label said
to."
2. "I take my medication first thing in the morning, just like you said."
3. "I have been able to decrease my medication to every other day and that saves me
some money."
4. "I switched all my medications to one pharmacy like you suggested."
5. "Did you say I need to take this medication with water or milk?"
Answer: 1, 2, 4
Explanation:
1. Some medications must be taken on an empty stomach. This statement indicates the
client is following instruction.
2. This statement indicates the client is following instruction.
3. Changing dosage schedule without direction indicates failure to follow instruction.
4. Filling all prescriptions at the same pharmacy will assist the pharmacist in comparing
current and new medications for interactions. This statement indicates the client is
following the nurse's suggestion.
5. The client is unsure of instructions.
GRADESMORE.COM
Page Ref: 64
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Quality and Safety:
Contribute to assessment of outcome achievement. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 6-6 Explain the importance of the evaluation phase of the nursing process
as applied to pharmacotherapy.
MNL Learning Outcome: 6.4 Recognize how the evaluation phase of the nursing process is used
to measure outcomes and revise care.
26
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WWW.GRADESMORE.COM
27) A nurse is developing a care plan for a client. Which client outcome statements are correctly
formatted?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The client will understand the effects of the medication administered prior to discharge.
2. The nurse will administer all medications within ten minutes of their scheduled time.
3. The client will identify two adverse effects of enoxaprarin (Lovenox) prior to selfadministering the drug.
4. The client will verbalize the storage requirements for NPH insulin prior to discharge.
5. The healthcare provider will discuss the desired effects of discharge medications with
the client the evening before discharge.
Answer: 3, 4
Explanation:
1. "Understand" is not a measurable verb.
2. Client outcome statements are focused on what the client will do, not on what the
nurse will do.
3. "Identify" is a measurable verb, there is a specific measure to be evaluated and a time
line is present.
4. "Verbalize" is a measurable verb, there is a specific measure to be evaluated, and a time
line is present.
5. Client outcome statements are focused on what the client will do, not on what the
healthcare provider will do.
GRADESMORE.COM
Page Ref: 62
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 6-4 Identify the main components of the planning phase of the nursing
process.
MNL Learning Outcome: 6.2 Recognize pharmacotherapeutic factors that contribute to the
diagnosis and planning phase of the nursing process.
27
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28) Place these methods of communicating with a non-English speaking client in order of their
desirability and usefulness.
1. Adult family member interprets
2. Healthcare agency interpreter is present
3. The nurse uses drawings and body language to communicate
4. Child relative interprets
5. No interpretation is attempted
Answer: 2, 1, 4, 3, 5
Explanation: In the ideal situation the nurse will contact an interpreter employed or provided
by the healthcare agency. The next best solution is for an adult family member to interpret with
the third best being a child in the family who has been assessed to be able to handle the
translation. In the absence of these options, the fourth best plan is for the nurse to use
drawings, body language, pictures, and nonverbal clues to communicate. Not using any kind of
interpretation is not desirable and leaves the nurse in the situation of doing something "to" a
client with no explanation.
Page Ref: 63
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: III.6 Integrate
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Knowledge and Science:
GRADEand
SMquality
ORE.and
COMsafe patient care. |
Relationships between knowledge/science
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase
of the nursing process for patients receiving medications.
MNL Learning Outcome: 6.3 Recognize key nursing interventions required in the
implementation phase of the nursing process for patients receiving medications.
28
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29) During evaluation, the nurse, client, and healthcare provider determine that the goals of
antibiotic therapy have not been met. What actions are indicated?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Review the dosage of the medication.
2. Consider checking serum drug levels.
3. Discard the idea that the infection is treatable.
4. Consider prolonging therapy.
5. Consider using a different antibiotic.
Answer: 1, 2, 4, 5
Explanation:
1. The dosage may not be correct for the individual client.
2. In some instances, checking serum drug levels will help identify if the dosing schedule is
adequate.
3. Just because the first evaluation is that the goal is not met does not indicate that the
goal is not a good one or that the therapy is not going to work.
4. The drug may work if given more time.
5. The infection may require use of a second antibiotic.
Page Ref: 64
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
GRADESM|OAACN
RE.Essential
COM Competencies: III.6 Integrate
respect for the diversity of human experience.
evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning,
implementing, and evaluating outcomes of care. | NLN Competencies: Quality and Safety:
Contribute to assessment of outcome achievement. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 6-6 Explain the importance of the evaluation phase of the nursing process
as applied to pharmacotherapy.
MNL Learning Outcome: 6.4 Recognize how the evaluation phase of the nursing process is used
to measure outcomes and revise care.
29
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30) Which information is essential for the nurse to collect when reviewing a client's medication
list?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Drug names
2. Drug manufacturer
3. Dosage being taken
4. Frequency of administration
5. When last refill was obtained
Answer: 1, 3, 4
Explanation:
1. Drug name is essential information for this assessment.
2. It is not necessary to record the name of the drug manufacturer.
3. Dosage being taken is essential information for this assessment.
4. Frequency of administration is essential information for this assessment.
5. It is not necessary to determine when the last prescription refill was obtained.
Page Ref: 60
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
GRADand
ESM
ORE.and
COMtransition and continuity. | AACN
emotional support; involvement of family
friends;
Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral,
psychological, spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate approaches. | NLN
Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase
that are pertinent to medication administration.
MNL Learning Outcome: 6.1 Determine assessment data that is relevant to the care of a
patient taking medications.
30
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Pharmacology for Nurses, 6e (Adams)
Chapter 7 Medication Errors and Risk Reduction
1) The nursing instructor teaches the student nurses about how medication errors can occur.
What information will the nursing instructor include in the presentation?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The nurse miscalculates the medication dose.
2. The nurse does not check the client's identification band.
3. The nurse does not validate an order with the healthcare provider.
4. The nurse misinterprets a healthcare provider's order.
5. The nurse administers the incorrect drug.
Answer: 1, 2, 4, 5
Explanation:
1. Medication errors may be related to miscalculations.
2. The nurse should always check the client's identification band.
3. As long as the nurse understands the healthcare provider's order, there is no need to
validate the order with the healthcare provider.
4. Medication errors may be related to misinterpretations.
5. Medication errors may be related to misadministration.
Page Ref: 68
Cognitive Level: Analyzing
GRADESMORE.COM
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: II.7
Promote factors that create a culture of safety and caring. | NLN Competencies: Quality and
Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 7-2 Identify factors that contribute to medication errors.
MNL Learning Outcome: 7.1 Recognize factors that contribute to medication errors.
1
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2) The nurse recognizes that agency system checks are in place to decrease medication errors.
Who commonly collaborates with the nurse on checking the accuracy of the medication
prior to administration?
1. The nursing supervisor
2. The nursing unit manager
3. The pharmacist
4. The healthcare provider
Answer: 3
Explanation:
1. The nursing supervisor does not commonly collaborate with the nurse on checking the
accuracy of the medication prior to administration.
2. The nursing unit manager does not commonly collaborate with the nurse on checking
the accuracy of the medication prior to administration.
3. Pharmacists and nurses must collaborate on checking the accuracy and appropriateness
of drug orders prior to client administration.
4. The healthcare provider does not commonly collaborate with the nurse on checking the
accuracy of the medication prior to administration.
Page Ref: 68
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: II.7
GR
DESMand
ORcaring.
E.COM
Promote factors that create a culture
ofAsafety
| NLN Competencies: Quality and
Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 7-2 Identify factors that contribute to medication errors.
MNL Learning Outcome: 7.2 Utilize the nursing process to reduce medication errors.
2
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3) The nurse makes a medication error and a client dies. In court, the attorney for the family of
the deceased client asks the nurse if she followed standards of care in administering the
medication. How would the attorney phrase this question?
1. "Did you follow agency guidelines as in previous circumstances?"
2. "Did you follow the healthcare provider's orders and double-check them before
administration?"
3. "Did you do the three checks and follow the five rights as taught in school?"
4. "Did you do what another nurse would have done under similar circumstances?"
Answer: 4
Explanation:
1. Standards of care do not refer to following agency guidelines.
2. Standards of care do not refer to following healthcare provider orders.
3. Standards of care do not refer to doing three checks or five rights.
4. Standards of care refer to the actions that a reasonable and prudent nurse with
equivalent preparation would do under similar circumstances.
Page Ref: 68
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: II.A.2 Describe scopes of practice and roles of healthcare team
members. | AACN Essential Competencies: II.2 Demonstrate leadership and communication
skills to effectively implement patient safety and quality improvement initiatives within the
context of the interprofessional team. | NLN Competencies: Quality and Safety: Commit to a
GRADESMConcepts:
ORE.CONursing
M
generative safety culture. | Nursing/Integrated
Process: Implementation
Learning Outcome: 7-3 Explain the impact of medication errors on patients and healthcare
agencies.
MNL Learning Outcome: 7.1 Recognize factors that contribute to medication errors.
3
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4) A series of category E medication errors have occurred on a hospital unit. When discussing
this trend with the nursing staff, the risk manager would list which characteristics of a
category E error?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The error contributed to the death of a client.
2. A client was harmed.
3. No interventions to sustain life were required as a result of the error.
4. Harm to the client was permanent.
5. The client's hospitalization was prolonged as a result of the error.
Answer: 2, 3
Explanation:
1. Errors that contribute to the death of a client are Category I errors.
2. Category E errors result in harm to the client.
3. Category E errors do not result in the need for interventions to sustain life.
4. Category E errors do not result in permanent harm.
5. Category E errors do not result in prolonged hospitalization.
Page Ref: 68
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: II.7
GR
DESMand
ORcaring.
E.COM
Promote factors that create a culture
ofAsafety
| NLN Competencies: Quality and
Safety: Commit to a generative safety culture. | Nursing/Integrated Concepts: Nursing Process:
Diagnosis
Learning Outcome: 7-1 Define medication error.
MNL Learning Outcome: 7.1 Recognize factors that contribute to medication errors.
4
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5) The nurse in the emergency department administers an adult dose of an antibiotic to a 3month-old baby. As a result, the baby suffers permanent brain damage. What best
describes the effect of this error on the healthcare facility?
1. The professional license of the nurse will be lost.
2. The morale of the staff involved will be decreased.
3. The reputation of the healthcare facility will suffer.
4. The healthcare facility will pay a very large settlement.
Answer: 2
Explanation:
1. The professional license of the nurse may or may not be lost depending on the
circumstances of the case.
2. Medication errors that result in permanent damage increase self-doubt and destroy the
morale of all staff involved; some may choose to leave the nursing profession.
3. The reputation of the facility will probably suffer, but this is not the most important
effect.
4. Payment of a large settlement is not the primary concern.
Page Ref: 68
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: II.A.2 Describe scopes of practice and roles of healthcare team
members. | AACN Essential Competencies: II.2 Demonstrate leadership and communication
skills to effectively implement patient safety and quality improvement initiatives within the
GR|ANLN
DESCompetencies:
MORE.COM Quality and Safety: Commit to a
context of the interprofessional team.
generative safety culture. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 7-3 Explain the impact of medication errors on patients and healthcare
agencies.
MNL Learning Outcome: 7.2 Utilize the nursing process to reduce medication errors.
5
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6) The nurse administers an evening medication to the client in the morning. What is the
nurse's best initial course of action at this time?
1. Change the medication administration time to the morning.
2. Notify the healthcare provider about the error.
3. Tell the evening nurse to hold the evening dose just for tonight.
4. Document the incident in the client's health record.
Answer: 2
Explanation:
1. The time of the medication cannot be changed without an order from the healthcare
provider, if it has been ordered to be given at a particular time (morning vs. evening). If
the healthcare provider prescribes the medication to be given once daily, the nurse
would be able to determine the best time to administer that medication to that client.
However, this is not the initial action of the nurse.
2. Even though the medication went to the correct client, this is still considered a
medication error. The nurse's first priority is to assess the client and contact the
healthcare provider.
3. Telling the evening nurse to hold the evening dose is unethical; an error has been
committed. However, if the nurse is not able to change the time of administration of
this medication to the morning, the client's blood level of the medication will not be as
stable.
4. Completing an incident report and documenting the facts of the situation in the client's
medical record are a lower priority.
GRADESMORE.COM
Page Ref: 70
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: IV.1 Demonstrate skills in using patient
care technologies, information systems, and communication devices that support safe nursing
practice. | NLN Competencies: Quality and Safety: Communicate potential risk factors and
actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 7-4 Describe methods for reporting and documenting medication errors.
MNL Learning Outcome: 7.4 Recognize the role of healthcare agencies in reducing medication
errors.
6
Copyright © 2020 Pearson Education, Inc.
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WWW.GRADESMORE.COM
7) The nurse is preparing medications for a group of clients. Another nurse begins telling the
nurse about her recent engagement. What is the best action by the first nurse?
1. Ask the second nurse to help with administering medications so they can have more
time to talk.
2. Continue to prepare the medications for administration and pretend to listen to the first
nurse.
3. Stop preparing medications until the second nurse has finished talking about her
engagement.
4. Tell the second nurse that the conversation is distracting and she must stop talking
while medications are being prepared.
Answer: 4
Explanation:
1. It is inappropriate to ask another nurse to assist with medications so there is more time
for the nurses to talk.
2. Pretending to listen to the second nurse's conversation will also be distracting.
3. When preparing medications, the nurse must focus entirely on the task at hand and
instruct others who are talking to stop. The nurse cannot stop preparing medications;
the clients must receive them on time. Client care is the highest priority.
4. When preparing medications, the nurse must focus entirely on the task at hand and
instruct others who are talking to stop.
Page Ref: 68
Cognitive Level: Analyzing
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: II.9 Apply quality improvement
processes to effectively implement patient safety initiatives and monitor performance
measures, including nurse-sensitive indicators in the microsystem of care. | NLN Competencies:
Quality and Safety: Commit to a generative safety culture. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 7-5 Describe strategies the nurse can implement to reduce medication
errors and incidents.
MNL Learning Outcome: 7.1 Recognize factors that contribute to medication errors.
7
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GRADESMORE.COM
WWW.GRADESMORE.COM
8) The nurse was very busy and unfamiliar with a new medication, but administered it anyway.
Later the nurse looked up the medication. How does the nurse manager evaluate this
behavior?
1. This was acceptable as long as the nurse looked up the action and side effects of the
drug later.
2. An error could have occurred because the nurse was unfamiliar with the medication.
3. The nurse manager was partially at fault because the nursing unit was understaffed and
the nurse was too busy.
4. An error did occur because the nurse could have administered the medication via the
incorrect route.
Answer: 2
Explanation:
1. It is not acceptable for a nurse to administer an unfamiliar medication and then look up
the action and side effects later; an error could occur.
2. Nurses should never administer a medication unless they are familiar with its uses and
side effects; an error could have occurred because the nurse was unfamiliar with the
medication.
3. There is no information in the stem of the question that the nursing unit was
understaffed, so the nurse manager is not partially at fault.
4. An error did not occur, but could have because the nurse was unfamiliar with the
medication.
Page Ref: 71
GRADESMORE.COM
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: II.9 Apply quality improvement
processes to effectively implement patient safety initiatives and monitor performance
measures, including nurse-sensitive indicators in the microsystem of care. | NLN Competencies:
Quality and Safety: Commit to a generative safety culture. | Nursing/Integrated Concepts:
Nursing Process: Evaluation
Learning Outcome: 7-5 Describe strategies the nurse can implement to reduce medication
errors and incidents.
MNL Learning Outcome: 7.1 Recognize factors that contribute to medication errors.
8
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
9) The nurse commits a medication error. The nurse documents the error in the client's record
and completes the incident report. What does the nurse recognize as the primary reason for
doing this?
1. To verify that the client's safety was protected
2. To protect the client from further harm
3. To protect the healthcare facility from litigation
4. To protect the nurse from liability
Answer: 1
Explanation:
1. Documentation in the client's medical record and completion of an incident report
verify that the client's safety was protected.
2. The client has already been harmed; the documentation will not protect the client from
future harm.
3. Documentation of an error does not necessarily protect the healthcare facility from
litigation.
4. Documentation of an error does not necessarily protect the nurse from liability.
Page Ref: 68
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: IV.1 Demonstrate skills in using patient
care technologies, information systems, and communication devices that support safe nursing
GRand
ADESafety:
SMORCommunicate
E.COM
practice. | NLN Competencies: Quality
potential risk factors and
actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 7-4 Describe methods for reporting and documenting medication errors.
MNL Learning Outcome: 7.1 Recognize factors that contribute to medication errors.
9
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
10) The nurse is working hard to prevent medication errors. What interventions will assist the
nurse in preventing most errors?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Always check the client's identification band prior to administration of medications.
2. Open all of the medications immediately prior to administration.
3. Tell healthcare providers that verbal orders will not be accepted.
4. Record the medication on the medication administration record (MAR) immediately
prior to administration.
5. Validate all orders with another nurse prior to administration of medications.
Answer: 1, 2, 3
Explanation:
1. Ways to reduce medication errors include checking the client's identification band prior
to administration of medications.
2. Ways to reduce medication errors include opening all of the medications immediately
prior to administration.
3. Ways to reduce medication errors include telling healthcare providers that verbal orders
will not be accepted.
4. Medications should be documented on the medication administration record (MAR)
after they have been administered.
5. All orders do not need to be validated with another nurse, only the orders that the
nurse is unsure about.
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Page Ref: 68
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: II.9 Apply quality improvement
processes to effectively implement patient safety initiatives and monitor performance
measures, including nurse-sensitive indicators in the microsystem of care. | NLN Competencies:
Quality and Safety: Commit to a generative safety culture. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 7-5 Describe strategies the nurse can implement to reduce medication
errors and incidents.
MNL Learning Outcome: 7.1 Recognize factors that contribute to medication errors.
10
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GRADESMORE.COM
WWW.GRADESMORE.COM
11) The nurse teaches a class to clients about how to help prevent medication errors when in
the hospital. What is the most important question for the nurse to ask the clients?
1. "Do you know the names of all the medications you take?"
2. "Do you trust your healthcare provider to order the correct medication?"
3. "Do you have a friend to verify that you are receiving the correct medication?"
4. "Do you know what your illness is, and if you will need surgery?"
Answer: 1
Explanation:
1. Knowing the names of all medications taken can reduce drug errors when a client is
admitted to the hospital.
2. Asking the clients if they trust their healthcare providers to order the correct medication
is inappropriate.
3. It is inappropriate for friends of clients to verify medications prior to administration.
4. Knowing the illness and anticipating surgery do not necessarily help prevent medication
errors.
Page Ref: 71
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.7 Provide appropriate patient teaching
that reflects developmental stage, age, culture, spirituality, patient preferences, and health
literacy considerations to foster patient engagement in their care. | NLN Competencies: Quality
GRADculture.
ESMOR|ENursing/Integrated
.COM
and Safety: Commit to a generative safety
Concepts: Nursing
Process: Implementation
Learning Outcome: 7-7 Identify patient teaching information that can be used to reduce
medication errors and incidents.
MNL Learning Outcome: 7.3 Consider how medication reconciliation and patient education
supports safe medication usage.
11
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12) The nurse assesses an adverse effect of a medication that has been administered. Who
should the nurse report this adverse effect to?
1. Food and Drug Administration's (FDA) MedWatch Website.
2. Food and Drug Administration's (FDA) Adverse Event Website.
3. Food and Drug Administration's (FDA) Safe Medicine Website.
4. Food and Drug Administration's (FDA) Med MARX Website.
Answer: 1
Explanation:
1. Adverse events with medication should be reported to the FDA's MedWatch Website.
2. There isn't a Food and Drug Administration's (FDA) Adverse Event Website.
3. There isn't a Food and Drug Administration's (FDA) Safe Medicine Website.
4. There isn't a Food and Drug Administration's (FDA) Med MARX Website.
Page Ref: 71
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: II.11
Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in
the development and initiation of effective plans for the microsystem and/or system-wide
practice improvements that will improve the quality of healthcare delivery. | NLN
Competencies: Quality and Safety: Commit to a generative safety culture. | Nursing/Integrated
Concepts: Nursing Process: Planning
GRADESMand
ORnational
E.COMagencies that track medication
Learning Outcome: 7-9 Identify governmental
errors and incidents and provide information to healthcare providers.
MNL Learning Outcome: 7.4 Recognize the role of healthcare agencies in reducing medication
errors.
12
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
13) The nurse is on a committee to reduce medication errors in a large healthcare facility. What
is a recommendation the nurse proposes that will most likely help to reduce medication
errors?
1. Train medication technicians to administer medications.
2. Use robots to prepare all medications for administration by the nurse.
3. Use automated, computerized cabinets on all nursing units.
4. Designate nurses whose only function is to administer medication.
Answer: 3
Explanation:
1. Healthcare agencies are not planning to have medication technicians administer
medications. Medication technicians are not qualified to assess the client for side
effects.
2. Healthcare agencies are not planning to have robots prepare all medications for
administration by the nurse.
3. To help reduce medication errors, many healthcare agencies are using automated,
computerized, locked cabinets for medication storage on patient care units.
4. Healthcare agencies are not planning to designate nurses who just do medication
administration.
Page Ref: 71
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
RADand
ESMquality.
ORE.C
M Essential Competencies: II.11
standardized practices that support G
safety
|O
AACN
Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in
the development and initiation of effective plans for the microsystem and/or system-wide
practice improvements that will improve the quality of healthcare delivery. | NLN
Competencies: Quality and Safety: Commit to a generative safety culture. | Nursing/Integrated
Concepts: Nursing Process: Implementation
Learning Outcome: 7-8 Explain strategies used by healthcare organizations to reduce the
number of medication errors and incidents.
MNL Learning Outcome: 7.4 Recognize the role of healthcare agencies in reducing medication
errors.
13
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
14) A nurse is administering medications to a group of clients. Which situation is an example of
a medication error?
1. The wrong dose of a medication is drawn up but is caught and corrected prior to
administration.
2. A medication is administered to a client with no allergies, yet an anaphylactic response
occurs.
3. A medication is administered in liquid form instead of tablet form due to the client's
difficulty swallowing.
4. A client experiences unexpected hypotension as a result of medication administration.
Answer: 1
Explanation:
1. A medication error can occur even when it does not reach the client. These are category
A errors.
2. Unexpected reactions to medications are not preventable and would be considered
adverse effects, not medication errors.
3. Altering the form from a tablet to a liquid does not constitute a medication error.
4. Unexpected reactions to medications are not preventable and would be considered
adverse effects, not medication errors.
Page Ref: 68
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
RADand
ESMquality.
ORE.C
M Essential Competencies: II.7
standardized practices that support G
safety
|O
AACN
Promote factors that create a culture of safety and caring. | NLN Competencies: Quality and
Safety: Commit to a generative safety culture. | Nursing/Integrated Concepts: Nursing Process:
Analysis
Learning Outcome: 7-1 Define medication error.
MNL Learning Outcome: 7.1 Recognize factors that contribute to medication errors.
14
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15) A nurse manager is discussing medication errors with a group of nurses. Which statement
by the nurses indicates the teaching was effective?
1. A nurse who observes the five rights will prevent all medication errors from occurring.
2. Nurses are always liable when a medication error occurs.
3. Handwritten orders are more frequently associated with medication errors than are
typed orders.
4. An incorrect dose (based on weight) is ordered, dispensed, and administered to a client.
The administering nurse and ordering clinician would be the only parties held
accountable.
Answer: 3
Explanation:
1. Observing the five rights is essential to avoiding medication errors but will not prevent
all medication errors from occurring.
2. Although the nurse is a major player in medication safety, there are instances when
medication errors occur that do not involve the nurse, such as when clients take
medications at home.
3. Handwritten orders can be illegible, leading to higher medication error rates.
4. The clinician ordering the medication, the nurse administering the medication, and the
pharmacist dispensing the medication would be held accountable.
Page Ref: 68
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRDemonstrate
ADESMOREeffective
.COM use of technology and
Standards: QSEN Competencies: V.B.1
standardized practices that support safety and quality. | AACN Essential Competencies: II.7
Promote factors that create a culture of safety and caring. | NLN Competencies: Quality and
Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 7-2 Identify factors that contribute to medication errors.
MNL Learning Outcome: 7.1 Recognize factors that contribute to medication errors.
15
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GRADESMORE.COM
WWW.GRADESMORE.COM
16) A nurse is reviewing safe medication administration with a student nurse. What should the
nurse plan to include in the teaching?
1. Give medications within the time frame specified by hospital policy.
2. Administer medications intramuscularly when a client refuses to take it orally.
3. Use abbreviations while charting to save time.
4. Discontinue a medication at the request of a client.
Answer: 1
Explanation:
1. Administering medications as specified by agency policy is meeting the standard of care.
2. Changing the route of medication administration requires an order and would not be
appropriate since the client is refusing it.
3. Using abbreviations might save time but is not generally considered meeting a standard
of care.
4. Discontinuing medications is outside the scope of nursing.
Page Ref: 71
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: II.9 Apply quality improvement
processes to effectively implement patient safety initiatives and monitor performance
measures, including nurse-sensitive indicators in the microsystem of care. | NLN Competencies:
Quality and Safety: Commit to a generative safety culture. | Nursing/Integrated Concepts:
GRADESMORE.COM
Nursing Process: Planning
Learning Outcome: 7-5 Describe strategies the nurse can implement to reduce medication
errors and incidents.
MNL Learning Outcome: 7.2 Utilize the nursing process to reduce medication errors.
16
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GRADESMORE.COM
WWW.GRADESMORE.COM
17) A student nurse asks a nursing instructor which federal agency is responsible for reviewing
all medication error reports. What is the nursing instructor's best response?
1. Centers for Disease Control (CDC)
2. Risk Management department at the healthcare facility in which it occurred
3. Medication errors are never acceptable. National Coordinating Council for Medication
Error Reporting and Prevention (NCC MERP)
4. FDA's Division of Medication Error Prevention and Analysis (DMEPA)
Answer: 4
Explanation:
1. Medication errors are not reported to the CDC.
2. If the facility has a risk management department, they will review all medication errors
in that facility. However, this isn't a federal agency.
3. Healthcare professionals are encouraged to report medication errors to NCC MERP,
although it is not a requirement.
4. The federal agency responsible for reviewing all medication error reports is DMEPA.
Page Ref: 70
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: II.7
Promote factors that create a culture of safety and caring. | NLN Competencies: Quality and
Safety: Commit to a generative safety culture. | Nursing/Integrated Concepts: Nursing Process:
GRADESMORE.COM
Implementation
Learning Outcome: 7-9 Identify governmental and national agencies that track medication
errors and incidents and provide information to healthcare providers.
MNL Learning Outcome: 7.4 Recognize the role of healthcare agencies in reducing medication
errors.
17
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18) A nurse is preparing to administer a new drug that was just prescribed by the healthcare
provider. The nurse recognizes that the wrong concentration of the drug was sent by the
pharmacy. What is the nurse's best response?
1. The nurse does not report the error, because the error was caught and corrected prior
to drug administration.
2. The nurse does not report or document the error, since the error did not result in any
harm to the patient.
3. The nurse reports the error to the healthcare provider and the charge nurse but does
not document the error due to possible legal action.
4. The nurse informs the client, documents the error as per hospital policy, and notifies the
healthcare provider.
Answer: 4
Explanation:
1. It is essential to report and document medication errors to identify possible system
failures, even when the error is caught prior to administration.
2. The nurse should report and document all medication errors whether the client was
harmed or not.
3. It is essential to report and document medication errors to identify possible system
failures, even when the error has potential for legal action.
4. The nurse should report and document all medication errors whether the client was
harmed or not.
Page Ref: 71
GRADESMORE.COM
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: II.11
Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in
the development and initiation of effective plans for the microsystem and/or system-wide
practice improvements that will improve the quality of healthcare delivery. | NLN
Competencies: Quality and Safety: Commit to a generative safety culture. | Nursing/Integrated
Concepts: Nursing Process: Implementation
Learning Outcome: 7-8 Explain strategies used by healthcare organizations to reduce the
number of medication errors and incidents.
MNL Learning Outcome: 7.2 Utilize the nursing process to reduce medication errors.
18
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WWW.GRADESMORE.COM
19) Medication reconciliation has been started for a newly admitted client. At which points
would the nurses and others caring for this client check this list?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Each time that medications are administered to the client
2. When initial admission orders are received
3. When the client is transferred to a different unit within the hospital
4. When the client is discharged
5. If a medication error occurs
Answer: 2, 3, 4
Explanation:
1. Medication reconciliation sheets are not the same as medication administration records
(MARs).
2. The list of medications the client takes at home should be checked against admission
orders.
3. Medication reconciliation sheets should be checked when transfers occur.
4. Medication reconciliation sheets should be reviewed when the client is discharged.
5. There are many situations where a medication error might occur in which it is not
necessary to check this list.
Page Ref: 72
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRDemonstrate
ADESMOREeffective
.COM use of technology and
Standards: QSEN Competencies: V.B.1
standardized practices that support safety and quality. | AACN Essential Competencies: IV.3
Apply safeguards and decision making support tools embedded in patient care technologies and
information systems to support a safe practice environment for both patients and healthcare
workers. | NLN Competencies: Quality and Safety: Use technologies that contribute to safety. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 7-6 Explain how effective medication reconciliation can reduce medication
errors.
MNL Learning Outcome: 7.3 Consider how medication reconciliation and patient education
supports safe medication usage.
19
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20) A nurse is planning to teach a client about a new medication. What is the best teaching
method?
1. Instruct the client that their local pharmacy will teach them about this medication.
2. Give the client oral and written drug information and instructions.
3. Provide oral drug information and instructions as opposed to written.
4. Leave written drug information and instructions at the bedside.
Answer: 2
Explanation:
1. Clients may receive these oral and written materials from their pharmacy but should be
supplied initially by the hospital.
2. Clients should be provided with oral and written drug information and instructions prior
to discharge.
3. Oral information alone is insufficient.
4. Written information alone is insufficient.
Page Ref: 73
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.7 Provide appropriate patient teaching
that reflects developmental stage, age, culture, spirituality, patient preferences, and health
literacy considerations to foster patient engagement in their care. | NLN Competencies: Quality
and Safety: Commit to a generative safety culture. | Nursing/Integrated Concepts: Nursing
GRADESMORE.COM
Process: Planning
Learning Outcome: 7-7 Identify patient teaching information that can be used to reduce
medication errors and incidents.
MNL Learning Outcome: 7.3 Consider how medication reconciliation and patient education
supports safe medication usage.
20
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WWW.GRADESMORE.COM
21) The nurse is beginning medication reconciliation for a newly admitted client. What should
the nurse include in this list?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The client takes ibuprofen for an occasional headache.
2. The client mixes a powdered form of vitamin C into his morning orange juice.
3. The client applies essential oils to his forehead to help with his or her allergies.
4. The client drinks milk fortified with vitamin D.
5. The client takes a prescription medication for osteoporosis once a week.
Answer: 1, 2, 3, 5
Explanation:
1. Over-the-counter medications such as ibuprofen are included in this list.
2. The powdered vitamin C is considered a supplement and should be included in the list.
3. Essential oils are an herbal or complementary therapy that should be included on the
list.
4. Milk is standardly fortified with vitamin D so there is no reason to list it on the
medication reconciliation list.
5. Prescription medications should be listed even if they are not taken daily.
Page Ref: 72
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
RADand
ESMquality.
ORE.C
M Essential Competencies: IV.3
standardized practices that support G
safety
|O
AACN
Apply safeguards and decision making support tools embedded in patient care technologies and
information systems to support a safe practice environment for both patients and healthcare
workers. | NLN Competencies: Quality and Safety: Use technologies that contribute to safety. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 7-6 Explain how effective medication reconciliation can reduce medication
errors.
MNL Learning Outcome: 7.3 Consider how medication reconciliation and patient education
supports safe medication usage.
21
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22) The nurse makes a medication error, but the client is not harmed. The client's family asks
the nurse manager what is considered a medication error. How should the nurse manager
respond?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Failure to follow healthcare provider's orders
2. Failure to give the right medication
3. Failure to give a medication at the ordered time
4. Failure to call the pharmacy and report that the medication has been given
5. Failure to give the right dose of the medication
Answer: 1, 2, 3, 5
Explanation:
1. In this medication error, the client does not receive the drug as the healthcare provider
intended it to be given.
2. In this medication error, the client does not receive the drug the healthcare provider
intended to be given.
3. In this medication error, the client does not receive the drug at the time the healthcare
provider intended it to be given.
4. The delivery of the medication is recorded on the medical administration record (MAR);
the nurse does not report to the pharmacy each time a medication has been given.
5. In this medication error, the client does not receive the dose of the drug the healthcare
provider intended to be given.
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Page Ref: 68
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: II.7
Promote factors that create a culture of safety and caring. | NLN Competencies: Quality and
Safety: Commit to a generative safety culture. | Nursing/Integrated Concepts: Nursing Process:
Planning
Learning Outcome: 7-1 Define medication error.
MNL Learning Outcome: 7.1 Recognize factors that contribute to medication errors.
22
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WWW.GRADESMORE.COM
23) A nurse on the medical-surgical unit is caring for several very ill clients. One client says, "I
was supposed to get my medications an hour ago." The nurse recognizes that medication
errors can have what impact?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Medication errors can potentially extend the client's length of hospital stay.
2. Medication errors can result in expensive legal costs to the facility.
3. Medication errors can damage the facility's reputation.
4. Medication errors can be physically devastating to nurse and client.
5. Medication errors cause preventable deaths during hospitalizations.
Answer: 1, 2, 3, 5
Explanation:
1. Medication errors can cause harm, which can extend the client's length of stay.
2. If a medication error causes a client harm, it can result in expensive legal fees for
hospital defense.
3. If the incidence of medication errors is publicized, it can cause the facility to be seen as
unsafe or to be delivering substandard care.
4. Medication errors can be physically devastating to clients but would be emotionally
devastating to the nurse.
5. Medication errors are the most common cause of morbidity and preventable death
within hospitals.
Page Ref: 68
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Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: II.A.2 Describe scopes of practice and roles of healthcare team
members. | AACN Essential Competencies: II.2 Demonstrate leadership and communication
skills to effectively implement patient safety and quality improvement initiatives within the
context of the interprofessional team. | NLN Competencies: Quality and Safety: Commit to a
generative safety culture. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 7-3 Explain the impact of medication errors on patients and healthcare
agencies.
MNL Learning Outcome: 7.1 Recognize factors that contribute to medication errors.
23
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24) A new nurse on the orthopedic floor makes a medication error. Which statements by the
nurse manager foster a safe environment in which nurses will report medication errors?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Many of us have made a medication error in our careers. The most important issue is
to identify why the error occurred."
2. "I know you could not feel any worse than you already do. We need to discuss how this
error happened and how we can prevent it from happening again."
3. "It's really good that your client is OK and did not suffer any harmful effects of this error.
We should discuss why this error occurred and how it can be prevented in the future."
4. "Because you are a new nurse, we should sit down and discuss the procedure you
followed to see what you could have done to prevent this error."
5. "We need to sit down as soon as possible and write up an incident report describing
everything you did incorrectly that caused this error."
Answer: 1, 2, 3, 4
Explanation:
1. All errors should be investigated with the goal of identifying why they occurred. This
investigation should be done in a manner that is not punitive and will encourage staff to
report errors without fear of punishment.
2. All errors should be investigated with the goal of identifying why they occurred. This
investigation should be done in a manner that is not punitive and will encourage staff to
report errors without fear of punishment.
GRAwith
DESthe
MOgoal
RE.ofCidentifying
OM
3. All errors should be investigated
why they occurred. This
investigation should be done in a manner that is not punitive and will encourage staff to
report errors without fear of punishment.
4. All errors should be investigated with the goal of identifying why they occurred. This
investigation should be done in a manner that is not punitive and will encourage staff to
report errors without fear of punishment.
5. An incident report will need to be written, but the nurse who made the error should feel
the report will identify factors contributing to the error rather than place blame.
Page Ref: 70
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: IV.1 Demonstrate skills in using patient
care technologies, information systems, and communication devices that support safe nursing
practice. | NLN Competencies: Quality and Safety: Communicate potential risk factors and
actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 7-4 Describe methods for reporting and documenting medication errors.
MNL Learning Outcome: 7.2 Utilize the nursing process to reduce medication errors.
24
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25) A community health nurse is preparing a teaching plan regarding medications and their
potential adverse effects for a new parent class. The nurse should encourage parents to do
which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Maintain a list of current medications for each child.
2. Be aware of each child's medication allergies.
3. Know what the child's prescribed medication is for, how it should be administered, and
when to expect the child to feel better.
4. Be aware that any leftover medication should be appropriately disposed of, not saved
for future use.
5. Read the prescription label for any foods the child should avoid while taking the
medication and for possible adverse effects to watch out for.
Answer: 1, 2, 3, 4
Explanation:
1. Parents should make a complete list of all prescribed medications, over-the-counter
drugs, and any vitamins the child takes.
2. It is very important that parents be aware of a child's allergies in order to prevent an
unnecessary allergic response.
3. Parents should know what condition the child's medication is prescribed for, and how,
when, and how much to administer. It is also important for parents to know when to
expect the child to feel better so a follow-up visit can be made if the child is not feeling
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better.
4. Parents should be aware that it is not safe to self-diagnose and treat with leftover
medication.
5. Parents should be aware the label often describes food and drinks to avoid. The label
will not describe possible adverse effects; the nurse will need to describe these to the
parents.
Page Ref: 73
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.7 Provide appropriate patient teaching
that reflects developmental stage, age, culture, spirituality, patient preferences, and health
literacy considerations to foster patient engagement in their care. | NLN Competencies: Quality
and Safety: Commit to a generative safety culture. | Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 7-7 Identify patient teaching information that can be used to reduce
medication errors and incidents.
MNL Learning Outcome: 7.4 Recognize the role of healthcare agencies in reducing medication
errors.
25
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26) The nurse is preparing a teaching plan for an older client who is taking multiple
medications. Which principles should the nurse keep in mind during the planning phase?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The client should have all prescriptions filled at the same pharmacy.
2. The client should keep a list of all medications for easy accessibility.
3. Older clients often take multiple drugs which is a common cause of medication errors.
4. Polypharmacy is unique to older clients and is the most common cause of medication
errors.
5. The client should be aware of each prescribed medication, the dose, and possible side
effects.
Answer: 1, 2, 3, 5
Explanation:
1. It is common for older clients to have medical conditions requiring the use of multiple
medications that could have possible interactions. Using one pharmacy will ensure the
pharmacist will discover any problematic interactions between multiple drugs.
2. Keeping a list available is important for unexpected trips to a healthcare facility.
3. The use of multiple drugs for multiple chronic conditions is a common cause for
medication errors in older clients.
4. Polypharmacy is not unique to older clients, although it is most often seen in this group.
5. Knowing the names, dose, and possible side effects of medications will reduce the risk
for medication errors.
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Page Ref: 73
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.7 Provide appropriate patient teaching
that reflects developmental stage, age, culture, spirituality, patient preferences, and health
literacy considerations to foster patient engagement in their care. | NLN Competencies: Quality
and Safety: Commit to a generative safety culture. | Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 7-7 Identify patient teaching information that can be used to reduce
medication errors and incidents.
MNL Learning Outcome: 7.1 Recognize factors that contribute to medication errors.
26
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27) A nurse is administering medications to a client. The client states, "I've never taken that
yellow pill before." What should the nurse do first?
1. Tell the client that some are made by different pharmaceutical companies and may look
different.
2. Reassure the client that the nurse has triple checked the drug so it is safe to take.
3. Contact the health provider to verify it is the correct medication and dose.
4. Verify the order and double-check the label.
Answer: 4
Explanation:
1. The same medication produced by two different pharmaceutical companies may be a
different shape, size, color, etc. However, the nurse should always verify the medication
order and medication label.
2. Nurses should always check every medication three times before administering it to the
client. However, when a client questions a medication, the nurse should always verify
the medication order and medication label again before administering it to the client.
3. The nurse does not need to contact the healthcare provider at this time. Instead, the
nurse should always verify the medication order and medication label again before
administering it to the client.
4. When a client questions a medication, the nurse should always verify the medication
order and medication label again before administering it to the client to prevent
medication errors.
Page Ref: 71
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Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: II.11
Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in
the development and initiation of effective plans for the microsystem and/or system-wide
practice improvements that will improve the quality of healthcare delivery. | NLN
Competencies: Quality and Safety: Commit to a generative safety culture. | Nursing/Integrated
Concepts: Nursing Process: Implementation
Learning Outcome: 7-5 Describe strategies the nurse can implement to reduce medication
errors and incidents.
MNL Learning Outcome: 7.2 Utilize the nursing process to reduce medication errors.
27
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28) The nurse has been hired to work in the risk management office of a hospital. What
situations would the nurse expect to be included in this job?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Participating in the investigation of a sentinel medication event
2. Using the computer to track data
3. Working with staff nurses to identify work flow problems
4. Meeting with the nurse executive to identify nurses who are prone to medication errors
5. Participating in a committee that will recommend changes to the policy and procedures
regarding medication administration.
Answer: 1, 2, 3, 5
Explanation:
1. The risk management department investigates incidents.
2. Data management and tracking are a big part of the risk manager's job.
3. The risk management department is involved in identifying problems.
4. Risk management departments are not tasked with identifying and reporting on nurses.
5. The risk management department does work to make recommendations to improve
policy and procedures.
Page Ref: 71
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
RADand
ESMquality.
ORE.C
M Essential Competencies: II.11
standardized practices that support G
safety
|O
AACN
Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in
the development and initiation of effective plans for the microsystem and/or system-wide
practice improvements that will improve the quality of healthcare delivery. | NLN
Competencies: Quality and Safety: Commit to a generative safety culture. | Nursing/Integrated
Concepts: Nursing Process: Implementation
Learning Outcome: 7-8 Explain strategies used by healthcare organizations to reduce the
number of medication errors and incidents.
MNL Learning Outcome: 7.4 Recognize the role of healthcare agencies in reducing medication
errors.
28
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29) The risk management department is using a root-cause analysis to improve a nursing unit's
medication administration accuracy. What questions will be used to develop this tool?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "What kind of errors are occurring?"
2. "What is the current medication administration accuracy rate?"
3. "How do the unit nurses rank in the number of errors committed?"
4. "What do the nurses think can be done to prevent errors from continuing?"
5. "What is the impact of changes made to improve accuracy?"
Answer: 1, 2, 4, 5
Explanation:
1. Asking what kind of errors are occurring helps to answer the question, "Why did it
happen?"
2. The current medication administration accuracy rate helps to determine, "What
happened?"
3. Ranking the nurses in order of number of errors is punitive and is not part of the risk
management process.
4. Asking nurses for suggestions helps to answer the question, "What can be done to
prevent it from happening again?"
5. The final question is "Has the risk of recurrence actually been reduced?" which can be
answered by asking what the impact of interventions has been.
Page Ref: 73
GRADESMORE.COM
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
standardized practices that support safety and quality. | AACN Essential Competencies: II.11
Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in
the development and initiation of effective plans for the microsystem and/or system-wide
practice improvements that will improve the quality of healthcare delivery. | NLN
Competencies: Quality and Safety: Commit to a generative safety culture. | Nursing/Integrated
Concepts: Nursing Process: Implementation
Learning Outcome: 7-8 Explain strategies used by healthcare organizations to reduce the
number of medication errors and incidents.
MNL Learning Outcome: 7.4 Recognize the role of healthcare agencies in reducing medication
errors.
29
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
30) The nursing supervisor tells a nurse that the medication error the nurse made yesterday has
been determined to be a sentinel event. What should the nurse expect to occur?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Her employment will be terminated.
2. Her personal malpractice insurance company will be notified.
3. An immediate investigation will occur.
4. Interventions to prevent the error from occurring again will quickly be put in place.
5. A root-cause analysis will be performed.
Answer: 3, 4, 5
Explanation:
1. Termination may occur but is usually unlikely.
2. The hospital's malpractice insurance company may be notified, but the nurse is
responsible for contacting personal companies.
3. The investigation into a sentinel event is immediate.
4. Interventions to prevent the error from happening again will be immediately put into
place.
5. Root-cause analysis is typically used to investigate sentinel events.
Page Ref: 71
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.1 Demonstrate effective use of technology and
RADand
ESMquality.
ORE.C
M Essential Competencies: II.11
standardized practices that support G
safety
|O
AACN
Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in
the development and initiation of effective plans for the microsystem and/or system-wide
practice improvements that will improve the quality of healthcare delivery. | NLN
Competencies: Quality and Safety: Commit to a generative safety culture. | Nursing/Integrated
Concepts: Nursing Process: Implementation
Learning Outcome: 7-8 Explain strategies used by healthcare organizations to reduce the
number of medication errors and incidents.
MNL Learning Outcome: 7.4 Recognize the role of healthcare agencies in reducing medication
errors.
30
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Pharmacology for Nurses, 6e (Adams)
Chapter 8 Drug Administration Throughout the Lifespan
1) The nurse teaches a class about medication used during pregnancy to pregnant women. The
nurse determines that additional instruction is required when a class participant makes
which response?
1. "The baby can only be harmed by medications during the first trimester."
2. "It is important to not take over-the-counter (OTC) drugs during my pregnancy."
3. "Exposure to teratogens can result in my baby's death or in malformations."
4. "If I breastfeed my baby, drugs can come through my breast milk."
Answer: 1
Explanation:
1. A baby can be harmed by medication used throughout the period of gestation.
2. Over-the-counter (OTC) drugs should be avoided during pregnancy.
3. Teratogens can cause fetal demise and congenital malformations.
4. Many drugs are transferred through breast milk.
Page Ref: 78
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
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development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 8-2 Describe the placental transfer of drugs from mother to infant.
MNL Learning Outcome: 8.3 Consider the risks of pharmacotherapy to patients across the
lifespan.
1
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2) The pregnant client plans to breastfeed her baby. She asks the nurse about the use of
herbal products during breastfeeding. What is the best response by the nurse?
1. "Be sure to check the label to see if the herbal product could be used during
breastfeeding."
2. "Most drugs can be transferred to the infant during breastfeeding, so this is not
recommended."
3. "Herbal products are considered natural, so it should be fine to use them during
breastfeeding."
4. "This should be fine, as long as there is at least 12 hours between the time you use the
product and when you breastfeed."
Answer: 2
Explanation:
1. The bottle may not be labeled for breastfeeding, so the client should check with the
nurse.
2. It is best to avoid as many drugs as possible during breastfeeding.
3. Herbal products are drugs.
4. There is no safety time limit established between the use of the product and
breastfeeding.
Page Ref: 78
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
GRADESM|OAACN
RE.Essential
COM Competencies: IX.3 Implement
respect for the diversity of human experience.
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 8-4 Identify factors that influence the transfer of drugs into breast milk.
MNL Learning Outcome: 8.3 Consider the risks of pharmacotherapy to patients across the
lifespan.
2
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3) The nurse plans to teach a safety class to parents of toddlers about household exposure to
medications. What should the nurse include?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Keep the toddler awake and observe for side effects of the medication.
2. Keep all medications locked up and stored out of reach of the toddler.
3. Use syrup of ipecac immediately if the toddler has ingested medication.
4. Call the Poison Control Center for guidance with any medication ingested.
5. Teach the toddler that medications are for adult use only.
Answer: 2, 4
Explanation:
1. The Poison Control Center should be contacted, and they will advise if the child is to be
kept awake.
2. Locking up medications is the safest way to childproof the home.
3. Syrup of ipecac should only be used if recommended by the Poison Control Center.
4. The Poison Control Center should be contacted for any type of medication the toddler
has ingested.
5. It is unrealistic to expect a toddler to understand that medications are for adult use
only.
Page Ref: 78
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRProvide
ADESMpatient-centered
ORE.COM care with sensitivity and
Standards: QSEN Competencies: I.B.3
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 8-7 Discuss the nursing and pharmacologic implications associated with
each pediatric developmental age group.
MNL Learning Outcome: 8.3 Consider the risks of pharmacotherapy to patients across the
lifespan.
3
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4) The nursing instructor teaches student nurses about the Food and Drug Administration
(FDA) Pregnancy Categories. What should the nurse include?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Food and Drug Administration (FDA) Pregnancy Category C is safe to use during
pregnancy.
2. Food and Drug Administration (FDA) Pregnancy categories provide a framework for safe
use of drugs in pregnant women.
3. Food and Drug Administration (FDA) Pregnancy categories for individual drugs seldom
change once they are established.
4. Food and Drug Administration (FDA) Pregnancy categories are based on studies using
clinical human research trials.
5. Food and Drug Administration (FDA) Pregnancy Category X has been associated with
teratogenic effects.
Answer: 2, 5
Explanation:
1. Pregnancy Category C is not necessarily safe, it just means that animal studies have
shown an adverse effect, but well-controlled studies in pregnant women have not been
done.
2. Food and Drug Administration (FDA) Pregnancy Categories provide a framework for safe
use of drugs in pregnant women.
3. Food and Drug Administration (FDA) Pregnancy categories for individual drugs do
GRADonES
MORE.COM
change based on reported effects
fetuses.
4. Food and Drug Administration (FDA) Pregnancy Categories are based on animal studies.
5. Food and Drug Administration (FDA) Pregnancy Category X has been associated with
teratogenic effects.
Page Ref: 79
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: V.7 Examine the roles and
responsibilities of the regulatory agencies and their effect on patient care quality, workplace
safety and the scope of nursing and other health professional's practice. | NLN Competencies:
Knowledge and Science: Relationships between knowledge/science and quality and safe patient
care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 8-3 Identify examples of drugs that fall into the five U.S. Food and Drug
Administration pregnancy risk categories.
MNL Learning Outcome: 8.2 Recognize the pharmacokinetic concerns of drug therapies to
patients across the lifespan.
4
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5) The nurse plans to administer medication to a preschool child. Which approach indicates
the nurse has an understanding of growth and development?
1. The child is often more cooperative if the parent is not in the room.
2. The child does better with verbal instruction than with play instruction.
3. There should be no need to restrain a child of this age.
4. Use a brief rationale, followed by quick administration of the medication.
Answer: 4
Explanation:
1. Having a parent in the room usually promotes more cooperation from the preschool
child.
2. Preschool children do better with play instruction.
3. It may be necessary to restrain a preschool child for medication administration.
4. A brief rationale, followed by quick administration, decreases the child's anxiety and
promotes cooperation with the medication process.
Page Ref: 83
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
GR
ADESMRelationships
ORE.COM between knowledge/science and
| NLN Competencies: Knowledge and
Science:
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 8-7 Discuss the nursing and pharmacologic implications associated with
each pediatric developmental age group.
MNL Learning Outcome: 8.4 Recognize the responsibilities of the nurse in administering
medications to patients across the lifespan.
5
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6) The nurse will administer medication to a school-age child. What is the best action by the
nurse?
1. Teach the child the action and expected side effects of the medication.
2. Tell the child he will not be allowed to go to recess if the medication is not taken.
3. Offer the child a choice of beverage with which to take the medication.
4. Offer to play with the child prior to medication administration.
Answer: 3
Explanation:
1. Teaching the child the action and expected side effects of the medication is too
advanced for the school-age child.
2. Threatening a school-age child is antagonistic; the child will most likely not take the
medication.
3. Offering the child a choice fosters cooperation and compliance.
4. Playing with the child is a preschool child activity.
Page Ref: 83
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
GR
ADESMRelationships
ORE.COM between knowledge/science and
| NLN Competencies: Knowledge and
Science:
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 8-7 Discuss the nursing and pharmacologic implications associated with
each pediatric developmental age group.
MNL Learning Outcome: 8.4 Recognize the responsibilities of the nurse in administering
medications to patients across the lifespan.
6
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7) An adolescent client comes to the school nurse with complaints of vague abdominal pain.
What statement by the student would help to confirm the nurse's suspicion that the
adolescent has body image concerns?
1. "Everyone makes a big deal about what I eat, so don't ask."
2. "I have been sexually active with my boyfriend."
3. "My periods are irregular. Should I see a physician?"
4. "I just can't seem to get along with my parents."
Answer: 1
Explanation:
1. The adolescent could have an eating disorder, which may result from altered body
image.
2. Being sexually active with her boyfriend does not necessarily indicate an altered body
image.
3. Irregular menses do not necessarily indicate an altered body image.
4. Arguments with parents do not necessarily indicate an altered body image.
Page Ref: 84
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
GRcontinuum,
ADESMORacross
E.COlifespan,
M
management across the health-illness
and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 8-7 Discuss the nursing and pharmacologic implications associated with
each pediatric developmental age group.
MNL Learning Outcome: 8.4 Recognize the responsibilities of the nurse in administering
medications to patients across the lifespan.
7
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
8) The nurse provides care for elderly clients in an assisted living facility. What does the nurse
assess as a primary contributing factor for drug toxicity in the elderly?
1. Older adults often abuse alcohol.
2. Older adults are frequently dehydrated.
3. Older adults are frequently constipated.
4. Older adults have decreased stomach acid.
Answer: 2
Explanation:
1. Alcohol abuse could be a factor in medication complications with older adults but is not
as critical as another physiologic change.
2. Fluid deficit is a critical factor in the older adult that can contribute to medication
toxicity.
3. Frequent constipation is not a critical factor with medication complications in older
adults.
4. Older adults have a tendency for decreased stomach acid, which may interfere with
medication absorption.
Page Ref: 85
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
GRADESMmedical
ORE.Cmanagement,
OM
development, pathophysiology, pharmacology,
and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 8-8 Describe physiologic and biochemical changes that occur in the older
adult, and how these affect pharmacotherapy.
MNL Learning Outcome: 8.1 Recognize physiologic differences in patient across the lifespan
and how these differences affect pharmacotherapy.
8
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
9) The pregnant client tells the nurse that her prescribed medication is not as effective as it
was before her pregnancy. What is the best response by the nurse?
1. "This is because your blood volume has increased."
2. "Tell me how you have been taking your medication."
3. "This is because your baby is receiving part of the medication."
4. "Maybe the medication has expired; check the label."
Answer: 1
Explanation:
1. Increased blood volume results in hemodilution and increased excretion of the
medication.
2. Asking the client how she is taking the medication is a good idea, but in this case,
increased blood volume is responsible for decreased drug effect.
3. The medication effectiveness is not reduced because of the baby.
4. The medication has most likely not expired; most clients have it refilled monthly.
Page Ref: 78
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
GR
ADESMRelationships
ORE.COM between knowledge/science and
| NLN Competencies: Knowledge and
Science:
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 8-1 Describe physiological changes during pregnancy that may affect the
absorption, distribution, metabolism, and excretion of drugs.
MNL Learning Outcome: 8.1 Recognize physiologic differences in patient across the lifespan
and how these differences affect pharmacotherapy.
9
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
10) The toddler refuses to take his oral medication. What is the best suggestion to the mother
from the nurse for ensuring the toddler receives his medication?
1. "Tell him you will buy him a toy if he takes the medication."
2. "Crush the tablet and mix it with a small amount of jam."
3. "Crush the tablet and mix it with milk."
4. "Tell him he will be punished if he does not take the medicine."
Answer: 2
Explanation:
1. The parent should not buy the child's compliance with a toy.
2. Mixing the medication in jam will disguise the taste.
3. Parents should avoid placing medication in milk as this may cause the toddler to avoid
healthy foods.
4. Punishment will alienate the child and decrease compliance.
Page Ref: 82
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
GRADESMORConcepts:
E.COM Nursing Process: Implementation
quality and safe patient care. | Nursing/Integrated
Learning Outcome: 8-7 Discuss the nursing and pharmacologic implications associated with
each pediatric developmental age group.
MNL Learning Outcome: 8.4 Recognize the responsibilities of the nurse in administering
medications to patients across the lifespan.
10
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
11) The adolescent is supposed to go to the school nurse at 12:00 to receive his medication for
attention-deficit/ hyperactivity disorder (ADHD). He often does not go for the medication.
What best describes the nurse's understanding of this situation?
1. The adolescent is embarrassed in front of his peers.
2. The adolescent does not understand the need for the medication.
3. The adolescent forgets that he is supposed to take the medication.
4. The adolescent has made a conscious decision not to take the medication.
Answer: 1
Explanation:
1. Adolescents relate strongly to peers and are easily embarrassed; the adolescent does
not want to be made fun of.
2. Most adolescents know why they are receiving medication.
3. The adolescent is most likely not forgetting the medication.
4. Most adolescents receiving attention-deficit/hyperactivity disorder (ADHD) medication
recognize that it helps them.
Page Ref: 84
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
GRcontinuum,
ADESMORacross
E.COlifespan,
M
management across the health-illness
and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 8-7 Discuss the nursing and pharmacologic implications associated with
each pediatric developmental age group.
MNL Learning Outcome: 8.4 Recognize the responsibilities of the nurse in administering
medications to patients across the lifespan.
11
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
12) The nurse is teaching a support group for caretakers of older adult clients. The focus is
medication compliance. The nurse determines that learning has occurred when the
caregivers make which response?
1. "We should crush their medicine and put it in applesauce so they will swallow it."
2. "We should use a medication management box so they won't forget to take it."
3. "We should ask the doctor if all the medication is really necessary."
4. "We should give them more education about the medicine so they will take it."
Answer: 2
Explanation:
1. Many older adults can swallow pills just fine, and many medications cannot be crushed.
2. Most older adult clients will be medication compliant if they have a way to remember to
take the medication; a medication management box is an excellent idea.
3. Asking the healthcare provider about medications is fine, but this will not help the older
adult client to remember when to take it.
4. The problem is not the education; it is that the older adults often forget what
medication to take at what time.
Page Ref: 85
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
GRADESMmedical
ORE.Cmanagement,
OM
development, pathophysiology, pharmacology,
and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 8-9 Develop nursing interventions that maximize pharmacotherapeutic
outcomes in the older adult.
MNL Learning Outcome: 8.4 Recognize the responsibilities of the nurse in administering
medications to patients across the lifespan.
12
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
13) A nurse working in an obstetric practice should consider which fact when discussing
medication use with pregnant clients?
1. Inhaled drugs may be absorbed to a greater extent.
2. Drug excretion rates are lowered.
3. Oral drug absorption rate is lowered.
4. Drugs should not be used during pregnancy.
Answer: 1
Explanation:
1. Increase in tidal volume and pulmonary vasodilation during pregnancy may lead to
inhaled drugs being absorbed to a greater extent.
2. Renal blood flow is increased, leading to higher excretion rates.
3. Gastric emptying is delayed, leading to prolonged oral drug absorption rates.
4. Some circumstances call for drug administration during pregnancy.
Page Ref: 78
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
GRADESMORConcepts:
E.COM Nursing Process: Planning
quality and safe patient care. | Nursing/Integrated
Learning Outcome: 8-1 Describe physiological changes during pregnancy that may affect the
absorption, distribution, metabolism, and excretion of drugs.
MNL Learning Outcome: 8.4 Recognize the responsibilities of the nurse in administering
medications to patients across the lifespan.
13
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
14) A nurse is preparing to administer medications to a pregnant client. Which classification of
drugs would the nurse refuse to administer?
1. Category A
2. Category B
3. Cautionary
4. Teratogenic
Answer: 4
Explanation:
1. Category A drugs are not known to cause birth defects.
2. Category B drugs are not known to cause birth defects.
3. Cautionary is not a term used to describe a drug that causes birth defects.
4. Drugs that are known to cause birth defects are called teratogenic or classified as
category D or category X.
Page Ref: 79
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: V.7 Examine the roles and
responsibilities of the regulatory agencies and their effect on patient care quality, workplace
safety and the scope of nursing and other health professional's practice. | NLN Competencies:
Knowledge and Science: Relationships between knowledge/science and quality and safe patient
care. | Nursing/Integrated Concepts: Nursing Process: Implementation
GRADof
ESdrugs
MORthat
E.Cfall
OMinto the five U.S. Food and Drug
Learning Outcome: 8-3 Identify examples
Administration pregnancy risk categories.
MNL Learning Outcome: 8.3 Consider the risks of pharmacotherapy to patients across the
lifespan.
14
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
15) The nurse teaching a pre-conception class would tell participants that they should be most
careful about exposure to drugs during which stage of pregnancy?
1. Each stage is equal in risk
2. Preimplantation period
3. Third trimester
4. Embryonic
Answer: 4
Explanation:
1. The goal should be to minimize exposure to all drugs for the length of pregnancy, but
exposure during some time periods is more critical than exposure at other times.
2. During the preimplantation phase there is no direct link to the mother so exposure to a
teratogen either causes death or has no effect.
3. The third trimester falls in the fetal period when teratogen exposure is more likely to
impair organ function or delay growth than to cause gross structural malformation.
4. The embryonic phase poses the greatest risk to fetal development as this is a time of
rapid development of internal structures.
Page Ref: 79
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
GRADESMmedical
ORE.Cmanagement,
OM
development, pathophysiology, pharmacology,
and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 8-2 Describe the placental transfer of drugs from mother to infant.
MNL Learning Outcome: 8.3 Consider the risks of pharmacotherapy to patients across the
lifespan.
15
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GRADESMORE.COM
WWW.GRADESMORE.COM
16) A nursing instructor is teaching nursing students about the FDA Pregnancy Drug Categories.
The instructor asks the students to what category a drug for which research has shown an
adverse effect in animals but not in pregnant women would be categorized as. The
instructor knows learning has occurred with which student response?
1. Category A
2. Category B
3. Category D
4. Category C
Answer: 2
Explanation:
1. Category A drugs have shown no adverse effects in women.
2. A drug that has adverse effects in animals but not in pregnant women is a Category B
drug.
3. Category D drugs have demonstrated risk to pregnant women.
4. Category C drugs have had either no animal studies or adverse effects in animal studies
with no adequate studies in women.
Page Ref: 79
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: V.7 Examine the roles and
responsibilities of the regulatory agencies and their effect on patient care quality, workplace
RADhealth
ESMOprofessional's
RE.COM practice. | NLN Competencies:
safety and the scope of nursing and G
other
Knowledge and Science: Relationships between knowledge/science and quality and safe patient
care. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 8-3 Identify examples of drugs that fall into the five U.S. Food and Drug
Administration pregnancy risk categories.
MNL Learning Outcome: 8.2 Recognize the pharmacokinetic concerns of drug therapies to
patients across the lifespan.
16
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GRADESMORE.COM
WWW.GRADESMORE.COM
17) A woman who wishes to become pregnant is concerned about the drugs she must take in
order to treat a serious medical condition. The nurse reviewing the drug list would be most
concerned about which kind of drug?
1. A drug with a long half-life
2. A drug with no active metabolites
3. A drug with high protein-binding ability
4. A drug taken only when needed
Answer: 1
Explanation:
1. Drugs with long half-lives should be avoided because they can accumulate in the infant's
plasma.
2. Drugs with active metabolites should be avoided because they can accumulate in the
infant's plasma.
3. Drugs with high protein-binding ability are not secreted as readily to the milk.
4. If a drug is taken on an as-needed basis, the woman could schedule the drug to be taken
immediately after breastfeeding.
Page Ref: 81
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: IX.7 Provide appropriate patient
teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and
GRpatient
ADESMengagement
ORE.COMin their care. | NLN Competencies:
health literacy considerations to foster
Knowledge and Science: Relationships between knowledge/science and quality and safe patient
care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 8-5 Identify techniques the breast-feeding mother can use to reduce drug
exposure in the newborn.
MNL Learning Outcome: 8.2 Recognize the pharmacokinetic concerns of drug therapies to
patients across the lifespan.
17
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GRADESMORE.COM
WWW.GRADESMORE.COM
18) A nurse is preparing to administer medications to a school-age child. What would the nurse
do?
1. Allow the child to make decisions regarding how medications are taken.
2. Provide a brief explanation on why the medication is important.
3. Administer drugs while holding the child down.
4. Provide a lengthy explanation followed by quick drug administration.
Answer: 1
Explanation:
1. Allowing the child to become a participant in the process of medication administration is
important for this age group.
2. At this age more detail can be included in explanations about the drug.
3. At this age it is unlikely the child will need to be restrained.
4. Lengthy explanations are more appropriate for adolescents.
Page Ref: 83
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
GRADESMORConcepts:
E.COM Nursing Process: Implementation
quality and safe patient care. | Nursing/Integrated
Learning Outcome: 8-7 Discuss the nursing and pharmacologic implications associated with
each pediatric developmental age group.
MNL Learning Outcome: 8.4 Recognize the responsibilities of the nurse in administering
medications to patients across the lifespan.
18
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
19) A nursing student asks a nurse how pharmacotherapy in the older adult is different than a
middle-aged adult. How would the nurse respond?
1. Increased body water can lead to a higher risk of drug toxicity.
2. Plasma levels are increased, leading to a heightened drug response.
3. Generally, drug doses should be increased due to prolonged drug metabolism.
4. Drug absorption is slower due to increased gastric pH.
Answer: 4
Explanation:
1. Body water is reduced, leading to a higher risk of drug toxicity.
2. Plasma levels are lower, causing a diminished drug response.
3. Generally, drug doses are reduced because of prolonged drug metabolism.
4. Older adults have an increase in gastric pH, which slows absorption.
Page Ref: 85
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
GRADESand
MObiochemical
RE.COM changes that occur in the older
Learning Outcome: 8-8 Describe physiologic
adult, and how these affect pharmacotherapy.
MNL Learning Outcome: 8.1 Recognize physiologic differences in patient across the lifespan
and how these differences affect pharmacotherapy.
19
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
20) A client presents with hypotension and bradycardia. The client indicates that one of her
healthcare providers recently prescribed three new medications to her current list of 10
medications per day. Based on this information, which statement would be the most
accurate?
1. The client is having an allergic reaction to one of the new medications.
2. The client is experiencing adverse reactions as a result of polypharmacy.
3. The client is not in compliance with her prescribed medications.
4. The client is experiencing an adverse effect that will go away in time.
Answer: 2
Explanation:
1. Bradycardia and hypotension do not necessarily indicate an allergic reaction.
2. Polypharmacy increases the risk of drug interactions and side effects.
3. The information provided does not reveal anything about client compliance.
4. It is not appropriate to assume the side effects will go away.
Page Ref: 85
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
GR
ADESMRelationships
ORE.COM between knowledge/science and
| NLN Competencies: Knowledge and
Science:
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 8-9 Develop nursing interventions that maximize pharmacotherapeutic
outcomes in the older adult.
MNL Learning Outcome: 8.2 Recognize the pharmacokinetic concerns of drug therapies to
patients across the lifespan.
20
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
21) The nurse understands that drug therapy is postponed until after pregnancy and lactation
when possible. Which of the following acute and chronic conditions may be managed with
drugs during pregnancy?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Epilepsy
2. Serious cystic acne
3. Sexually transmitted infections
4. Gestational diabetes
5. Hypertension
Answer: 1, 3, 4, 5
Explanation:
1. Epilepsy is a preexisting disease. It would not be wise to discontinue therapy during
pregnancy and lactation.
2. Cystic acne may be treated with isotretinoin (Accutane). Isotretinoin is a Class X drug
and can cause fetal brain damage. Other antibiotics such as tetracycline are Class D and
should not be used in pregnancy.
3. Sexually transmitted infections can harm the fetus.
4. Gestational diabetes is a complication related to pregnancy that must be treated for the
safety of both the mother and growing fetus.
5. If hypertension is present prior to pregnancy, it would be unwise to discontinue therapy
during pregnancy and lactation.
GRADESMORE.COM
Page Ref: 78
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 8-1 Describe physiological changes during pregnancy that may affect the
absorption, distribution, metabolism, and excretion of drugs.
MNL Learning Outcome: 8.3 Consider the risks of pharmacotherapy to patients across the
lifespan.
21
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
22) The nurse is preparing a teaching plan for a postpartum mother. The nurse plans to include
which topics regarding breastfeeding?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Most medications are secreted into breast milk.
2. Dietary supplements should be avoided.
3. Herbal products are secreted into breast milk and have the potential to cause harm to
the infant.
4. All tobacco products should be avoided.
5. Most drugs are safe to take right after breastfeeding because they will clear the
bloodstream prior to the next feeding.
Answer: 1, 2, 3, 4
Explanation:
1. The majority of drugs are secreted into breast milk.
2. The safety of these products has not been determined.
3. OTC drugs can be secreted into breast milk and have the potential to harm the infant.
All products should be approved by the provider prior to use.
4. Tobacco products should be avoided during lactation.
5. Drugs should only be taken during breastfeeding if the benefits to the mother outweigh
the risks to the infant.
Page Ref: 80
Cognitive Level: Applying
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 8-5 Identify techniques the breast-feeding mother can use to reduce drug
exposure in the newborn.
MNL Learning Outcome: 8.2 Recognize the pharmacokinetic concerns of drug therapies to
patients across the lifespan.
22
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GRADESMORE.COM
WWW.GRADESMORE.COM
23) The nurse is planning care for a pregnant client prone to substance abuse. When the client
states, "My baby isn't getting my drugs, I am," how does the nurse respond?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Most illicit drugs will cross the placenta and hurt the baby."
2. "Drugs may work longer in your baby."
3. "Some drugs result in your baby not growing enough."
4. "You are correct. You are far enough along in your pregnancy that drugs will not harm
your baby."
5. "If you continue to take drugs, it will make you have a large infant."
Answer: 1, 2, 3
Explanation:
1. Most illicit drugs cross the placenta and can cause premature birth, low birth weight,
birth defects, and withdrawal symptoms.
2. Because the fetus lacks mature metabolic enzymes and efficient excretion mechanisms,
drugs will have a prolonged duration of action within the unborn child.
3. Some drugs result in intrauterine growth retardation.
4. The effect the drug has on the fetus will depend on the stage of fetal development.
There is a greater potential for harm during the first trimester, but nutrients to the fetus
can be compromised by drug abuse during the latter stages of pregnancy.
5. Taking illicit drugs during pregnancy won't increase fetal growth and lead to a large
infant.
GRADESMORE.COM
Page Ref: 79
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 8-8 Describe physiologic and biochemical changes that occur in the older
adult, and how these affect pharmacotherapy.
MNL Learning Outcome: 8.3 Consider the risks of pharmacotherapy to patients across the
lifespan.
23
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24) A pregnant client suspected of drug abuse is admitted to the emergency department. The
nurse plans to teach the client about which complications associated with drug use during
pregnancy?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Preterm birth
2. Low birth weight
3. Birth defects
4. Allergies to narcotics
5. Increased labor
Answer: 1, 2, 3
Explanation:
1. Many illicit drugs can cause preterm birth.
2. Many illicit drugs can cause low birth weight.
3. Many illicit drugs can cause birth defects.
4. No research suggests that drug use can cause allergies to narcotics.
5. No research suggests that drug use can cause increased labor.
Page Ref: 79
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
GRADEanSM
ORE.COM of human growth and
holistic, patient-centered care that reflects
understanding
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 8-8 Describe physiologic and biochemical changes that occur in the older
adult, and how these affect pharmacotherapy.
MNL Learning Outcome: 8.3 Consider the risks of pharmacotherapy to patients across the
lifespan.
24
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25) For which client would the nurse expect the healthcare provider to continue prescribed
medications during pregnancy?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The client recently diagnosed with gonorrhea
2. The client with a history of frequent asthma attacks
3. The client with hypertension
4. The client with frequent insomnia
5. The client with a family history of stroke
Answer: 1, 2, 3
Explanation:
1. Sexually transmitted infections are treated during pregnancy.
2. Asthma is treated during pregnancy.
3. Hypertension is treated during pregnancy.
4. Insomnia would not be treated during pregnancy.
5. This client would not be treated unless she has a history of stroke.
Page Ref: 79
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
GRADESMmedical
ORE.Cmanagement,
OM
development, pathophysiology, pharmacology,
and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 8-1 Describe physiological changes during pregnancy that may affect the
absorption, distribution, metabolism, and excretion of drugs.
MNL Learning Outcome: 8.3 Consider the risks of pharmacotherapy to patients across the
lifespan.
25
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26) The clinic nurse will immediately alert the healthcare provider when which category X drugs
are identified on the medication record of a recently diagnosed pregnant patient?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Tetracycline
2. ACE inhibitor antihypertensive medication
3. Methotrexate
4. Isotretinoin (Accutane)
5. Oral contraceptives
Answer: 3, 4, 5
Explanation:
1. Tetracycline is in category D, not category X. It should be avoided during pregnancy, and
the nurse should alert the healthcare provider.
2. ACE inhibitor antihypertensive drugs are in category C and are considered safe during
pregnancy.
3. Methotrexate is in category X and should be avoided during pregnancy.
4. Isotretinoin is in category X and should be avoided during pregnancy.
5. Oral contraceptives are in category X and should be avoided during pregnancy.
Page Ref: 80
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
GRADESM|OAACN
RE.Essential
COM Competencies: IX.3 Implement
respect for the diversity of human experience.
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 8-4 Identify factors that influence the transfer of drugs into breast milk.
MNL Learning Outcome: 8.3 Consider the risks of pharmacotherapy to patients across the
lifespan.
26
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27) The nurse preparing to transfer to a pediatric hospital would expect to administer
medications to children from birth to age ________ years. Record your answer rounding to
the nearest whole number.
Answer: 16
Explanation: For the purposes of medication administration, the pediatric patient is defined as
being any age from birth to 16 years and weighing less than 50 kg.
Page Ref: 81
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 8-6 Explain how differences in pharmacokinetic variables can affect drug
response in pediatric patients.
MNL Learning Outcome: 8.4 Recognize the responsibilities of the nurse in administering
medications to patients across the lifespan.
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27
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28) A nurse has provided discharge medication instructions to the parents of a child being
released from the emergency department. The nurse evaluates that learning has occurred
when the parents make which statements?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "I should give this antibiotic as prescribed until the bottle is empty."
2. "I should use a spoon to give this medication."
3. "I will keep this medication in the refrigerator as the label directs."
4. "If my child develops any adverse effects, I will discard the rest of the medicine."
5. "This antibiotic should help to clear my child's infection."
Answer: 1, 3, 5
Explanation:
1. Antibiotics should be given until the medication is gone.
2. Medications should be administered with standard devices, not household objects.
3. The label will designate storage instruction.
4. The parent should notify the prescriber, not just discard the medication.
5. The parents should understand the reason the medication is being prescribed.
Page Ref: 82
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
GRADEanSM
ORE.COM of human growth and
holistic, patient-centered care that reflects
understanding
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 8-7 Discuss the nursing and pharmacologic implications associated with
each pediatric developmental age group.
MNL Learning Outcome: 8.4 Recognize the responsibilities of the nurse in administering
medications to patients across the lifespan.
28
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29) A nurse is reviewing medication records of older adults living in extended care. Which
concepts about the pharmacotherapy of older adults should be considered?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Plasma-binding of drugs is greater in those over age 65.
2. Drug distribution is slowed in the older adult.
3. The half-life of many drugs is lessened in older adults.
4. First-pass metabolism is reduced in the older adult.
5. Changes in the kidney may result in decreased drug excretion.
Answer: 2, 4, 5
Explanation:
1. The aging liver produces less albumin, resulting in decreased plasma protein-binding
ability and increased levels of free drug in the bloodstream.
2. The aging cardiovascular system has decreased cardiac output and less efficient blood
circulation, which slow drug distribution.
3. Enzyme production in the liver is decreased and the visceral blood flow is diminished,
resulting in reduced hepatic drug metabolism and increased drug half-life.
4. The decline in hepatic function reduces first-pass metabolism.
5. Changes in the kidney result in decreased drug excretion.
Page Ref: 86
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRProvide
ADESMpatient-centered
ORE.COM care with sensitivity and
Standards: QSEN Competencies: I.B.3
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 8-8 Describe physiologic and biochemical changes that occur in the older
adult, and how these affect pharmacotherapy.
MNL Learning Outcome: 8.1 Recognize physiologic differences in patient across the lifespan
and how these differences affect pharmacotherapy.
29
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30) A nurse is providing care to a client who wears bilateral hearing aids. Which nursing
interventions are indicated?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Speak a bit slower than normal.
2. Speak more loudly than normal.
3. Ensure that verbal and nonverbal communication is congruent.
4. Allow extra time for communication.
5. Use bright lighting in the room.
Answer: 1, 3, 4
Explanation:
1. Speaking clearly and slowly is beneficial when communicating with those with hearing
impairment.
2. It is not necessary to speak loudly.
3. Use of gestures and body language is important, but incongruence between verbal and
nonverbal communication can be very confusing for those with impaired hearing.
4. It is important to allow adequate time for communication and responses.
5. Adequate lighting is necessary in any client encounter, but bright lighting is not always
necessary. The presence of good lighting is not made more essential because the client
has a hearing impairment.
Page Ref: 86
Cognitive Level: Applying
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 8-9 Develop nursing interventions that maximize pharmacotherapeutic
outcomes in the older adult.
MNL Learning Outcome: 8.1 Recognize physiologic differences in patient across the lifespan
and how these differences affect pharmacotherapy.
30
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Pharmacology for Nurses, 6e (Adams)
Chapter 9 Individual Variations in Drug Response
1) The nurse is doing a holistic assessment on a client prior to starting antihypertensive
medication. What should the nurse include in the assessment?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Blood pressure
2. The biologic cause of the hypertension
3. Mood
4. Level of education
5. Belief in a higher power
Answer: 1, 3, 4, 5
Explanation:
1. Holistic healthcare incorporates the whole client to include the biological (blood
pressure) dimension.
2. The biologic cause of the hypertension focuses on a specific disease, its cause, and
treatment; this is a medical model, not a holistic model.
3. Holistic healthcare incorporates the whole client to include the psychological (mood)
dimension.
4. Holistic healthcare incorporates the whole client to include the sociocultural (level of
education) dimension.
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5. Holistic healthcare incorporates the whole client to include the spiritual (belief in a
higher power) dimension.
Page Ref: 90
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Relationship-Centered Care: Respect the patient's
dignity, uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 9-1 Describe fundamental concepts underlying a holistic approach to
patient care and their importance to pharmacotherapy.
MNL Learning Outcome: 9.1 Recognize how psychosocial and spiritual influences can impact
psychotherapeutics.
1
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2) A Hispanic man has been diagnosed with attention-deficit/hyperactivity disorder (ADHD),
and is taking methylphenidate (Ritalin). Even though the drug helps with focus and grades,
the client will not go to the school office at noon for his medication. Which statement best
describes the result of the nurse's evaluation?
1. The adolescent has developed alternative coping mechanisms to increase his focus
during classes.
2. The adolescent is fearful that this drug may be a "gateway drug" and he will abuse other
substances.
3. The adolescent really does not need an additional dose of methylphenidate (Ritalin) at
school.
4. The adolescent is embarrassed about having to take medicine at school; it is a social
stigma.
Answer: 4
Explanation:
1. Attention-deficit/hyperactivity disorder is a brain-based disorder, and the primary
treatment is medication; alternative coping mechanisms will not usually help to increase
focus during classes.
2. Appropriate treatment of attention-deficit/hyperactivity disorder will result in less
addiction to mood-altering substances, not more addiction.
3. Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about
4 hours apart, so the patient must receive a dose during school hours.
4. Some clients believe that having to take drugs in school will cause them to be viewed as
GRAClients
DESMcan
ORalso
E.Cperceive
OM
weak, unhealthy, or dependent.
this as a social stigma.
Page Ref: 91
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences; values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; transitions and continuity. | AACN
Essential Competencies: IX.18 Develop an awareness of patients as well as healthcare
professionals' spiritual beliefs and values and how those beliefs and values impact healthcare. |
NLN Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness,
integrity and self-determination, and his or her own power and self-healing process. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 9-2 Identify psychosocial factors that can affect pharmacotherapeutics.
MNL Learning Outcome: 9.2 Recognize how cultural and ethnic variables can influence
pharmacotherapy.
2
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3) The patient is from an Arab culture and is in labor and delivery. Her husband insists he must
stay with her and will not allow her to receive any analgesia during the experience. What is
the best action by the nurse?
1. Inform the husband that it is his wife's choice whether or not to receive analgesia.
2. Inform the husband that he must sign a release of responsibility to avoid future
litigation against the hospital.
3. Allow the request but inform the husband that the healthcare provider will make the
final decision about analgesia.
4. Allow this request and be available in the event the request changes.
Answer: 4
Explanation:
1. With some cultures, the husband makes the choices, not the wife.
2. When cultural differences are allowed and supported, clients are not as likely to become
involved in litigation.
3. With some cultures, the husband makes the choices, not the healthcare provider.
4. Nurses must allow and support cultural differences. The husband's decisions must be
respected as long as client safety is not involved, and it is not involved in this situation.
Page Ref: 91
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
backgrounds function as sources of patient, family, and community values. | AACN Essential
GRADofES
MOand
RE.quality
COM outcomes of care for diverse
Competencies: II.8 Promote achievement
safe
populations. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic
outcomes.
MNL Learning Outcome: 9.2 Recognize how cultural and ethnic variables can influence
pharmacotherapy.
3
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4) A client is diagnosed with cancer. The healthcare provider has recommended
chemotherapy, which would likely save the client's life. The client tells the nurse, "This is
punishment from God for sins I have committed; some women at my church say so." With
permission from the client, what would the nurse do first?
1. Involve a hospital minister to discuss the client's perspective about cancer.
2. Plan to bring the case before the hospital's board of ethics.
3. Contact the client's minister to discuss the client's perspective about cancer.
4. Meet with family members to discuss the client's perspective about cancer.
Answer: 3
Explanation:
1. Involving a hospital minister may be an option, but it is best to work through the client's
minister initially.
2. Bringing the case before the hospital's board of ethics is premature at this point.
3. When clients have strong religious beliefs, these can affect the outcome of the illness.
The nurse should involve the client's religious leader when possible.
4. Meeting with family might help; however, they may have the same perspective as the
client.
Page Ref: 91
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
backgrounds function as sources of patient, family, and community values. | AACN Essential
GRADofES
MOand
RE.quality
COM outcomes of care for diverse
Competencies: II.8 Promote achievement
safe
populations. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic
outcomes.
MNL Learning Outcome: 9.1 Recognize how psychosocial and spiritual influences can impact
psychotherapeutics.
4
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5) The African American client has panic attacks, is suicidal, and is on an inclient psychiatric
unit. The healthcare professional prescribes sertraline (Zoloft) and clonazepam (Klonopin).
The client refuses the drugs. The client also requests to have herbs and African objects in his
room to "remove the curse." What is the priority action by the nurse?
1. Allow the request without seeking further information from the client.
2. Allow the request as long as the herbs and objects do not pose a safety risk for the client
or other clients.
3. Allow the request after the client signs a release of responsibility to avoid litigation.
4. Allow the request after all members of the treatment team agree to it.
Answer: 2
Explanation:
1. To allow an ethnic request without seeking further information about safety could
jeopardize client safety.
2. Nurses must grant ethnic requests as long as the request does not pose a safety risk to
the client or others.
3. There is no need for the client to sign a release of responsibility to avoid litigation; if
items pose a safety risk, they cannot be allowed on the unit.
4. The treatment team does not need to agree to this request; the nurse can approve it as
long as the items do not pose a safety risk.
Page Ref: 91
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRDescribe
ADESMhow
OREdiverse
.COM cultural, ethnic, and social
Standards: QSEN Competencies: I.A.2
backgrounds function as sources of patient, family, and community values. | AACN Essential
Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse
populations. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic
outcomes.
MNL Learning Outcome: 9.2 Recognize how cultural and ethnic variables can influence
pharmacotherapy.
5
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6) The public health nurse notices that several clients in the hypertension clinic have poorly
controlled hypertension, even though they have been prescribed appropriate
antihypertensive drugs. Which question will best enable the nurse to assess these clients?
1. "Does your religion allow the use of high blood pressure medication?"
2. "Do you think your high blood pressure is a problem?"
3. "Can you afford the high blood pressure medication?"
4. "Does your culture use herbs to treat high blood pressure?"
Answer: 3
Explanation:
1. Religious beliefs could result in the client not taking the medication, but the cost of the
medication is more likely the problem.
2. To ask a client if they think hypertension is a problem should not be necessary; the
nurse could eliminate this by appropriate medication education when the medication is
prescribed for the client.
3. Once treatment is rendered, the cost of prescription drugs may be far too high for
clients on limited incomes.
4. The use of herbs may be important in the client's culture, but the cost of the medication
is more likely the problem.
Page Ref: 92
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
GRADEfamily,
SMORand
E.Ccommunity
OM
backgrounds function as sources of patient,
values. | AACN Essential
Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse
populations. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic
outcomes.
MNL Learning Outcome: 9.2 Recognize how cultural and ethnic variables can influence
pharmacotherapy.
6
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7) The nurse is providing education about warfarin (Coumadin) to a patient of Asian ancestry.
The nurse determines that learning has occurred when the client makes which statement?
1. "I may need to have more frequent blood tests."
2. "I may need to have less frequent blood tests."
3. "I may need more medication than someone from a different ethnic group."
4. "I may need less medication than someone from a different ethnic group."
Answer: 4
Explanation:
1. There is no need for clients of Asian ancestry to have more frequent blood tests than
other clients.
2. There is no need for clients of Asian ancestry to have less frequent blood tests.
3. A client of Asian ancestry may be a poor metabolizer of warfarin (Coumadin), so they
will not require a higher dose.
4. A client of Asian ancestry may be a poor metabolizer of warfarin (Coumadin), so they
will often require lower dosages.
Page Ref: 94
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences; values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; transitions and continuity. | AACN
RAinterrelationships
DESMORE.COMamong theory, practice, and
Essential Competencies: III.1 ExplainGthe
research. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 9-6 Convey how genetic factors can influence pharmacotherapy.
MNL Learning Outcome: 9.3 Recognize how genetic polymorphisms can affect drug action.
7
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8) The nurse is conducting a holistic assessment of a client with alcoholism. What are the
important questions the nurse would ask?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "How is drinking alcohol viewed by your culture?"
2. "Have you ever attended Alcoholics Anonymous meetings?"
3. "Did you see your parents drinking alcohol when you were growing up?"
4. "Have you been in alcohol rehabilitation before now?"
5. "What blood relatives of yours are addicted to alcohol?"
Answer: 1, 3, 5
Explanation:
1. Cultural questions are valid questions to ask during a holistic assessment.
2. Participation in Alcoholics Anonymous meetings refers to treatment and does not have
relevance to a holistic assessment.
3. Environmental questions are valid questions to ask during a holistic assessment.
4. Participation in a rehabilitation program refers to treatment and does not have
relevance to a holistic assessment.
5. Biological questions are valid questions to ask during a holistic assessment.
Page Ref: 90
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
GRADEIII.1
SMO
RE.Cthe
OMinterrelationships among theory,
processes. | AACN Essential Competencies:
Explain
practice, and research. | NLN Competencies: Relationship-Centered Care: Respect the patient's
dignity, uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 9-1 Describe fundamental concepts underlying a holistic approach to
patient care and their importance to pharmacotherapy.
MNL Learning Outcome: 9.1 Recognize how psychosocial and spiritual influences can impact
psychotherapeutics.
8
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9) An American Indian client has been admitted to the hospital for chemotherapy. At any given
time, five family members are in the client's room. The nurse tells the client that according
to hospital policy, only two visitors at a time are allowed. What does the best analysis by
the nurse manager reveal about the nurse's action?
1. The nurse should have assessed the client's preferences about how many family
members she wanted to be present.
2. The nurse should have called the healthcare provider and obtained an order for
additional family members to be present.
3. This was the correct action; the nurse was following protocol by informing the client
about hospital policy.
4. The nurse should have allowed the client to have as many family members as she
wanted to be present.
Answer: 1
Explanation:
1. The nurse should have assessed the client's preference about how many visitors she
wanted in her room before so strictly interpreting the hospital rules.
2. This situation could be resolved by the nurse; there is no need for a healthcare
provider's order at this point.
3. Many hospital rules, such as how many visitors are allowed, are flexible and do not have
to be strictly interpreted; this client is in a private room.
4. The nurse must be realistic with regard to the number of family visitors the client wants
present; five family members is acceptable; twenty would be too many.
GRADESMORE.COM
Page Ref: 91
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
backgrounds function as sources of patient, family, and community values. | AACN Essential
Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse
populations. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic
outcomes.
MNL Learning Outcome: 9.2 Recognize how cultural and ethnic variables can influence
pharmacotherapy.
9
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
10) A healthcare provider has prescribed a chemotherapeutic drug for a client with cancer. This
drug commonly causes loss of hair. The client asks the nurse, "Will all of my hair fall out?"
What is the most therapeutic response by the nurse?
1. "We are not really sure; applying an ice bag to your head may help."
2. "Don't worry, we can recommend an excellent wig company if need be."
3. "Yes, that is one of the expected side effects of this medication."
4. "It might. Have you discussed this with your healthcare provider?"
Answer: 3
Explanation:
1. Ice bags can minimize hair loss with some clients, but the nurse is not honestly
answering the client's question.
2. Telling a client not to worry is one of the most nontherapeutic responses a nurse can
make.
3. The nurse must always be forthright in explaining drug actions and potential side
effects; minimizing potential adverse effects can result in a distrust of the nurse.
4. In this case, the nurse, not the physician, is responsible for answering the client's
questions.
Page Ref: 91
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences; values; coordination and
GRADESMOand
RE.education;
COM
integration of care; information, communication,
physical comfort and
emotional support; involvement of family and friends; transitions and continuity. | AACN
Essential Competencies: IX.18 Develop an awareness of patients as well as healthcare
professionals' spiritual beliefs and values and how those beliefs and values impact healthcare. |
NLN Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness,
integrity and self-determination, and his or her own power and self-healing process. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-2 Identify psychosocial factors that can affect pharmacotherapeutics.
MNL Learning Outcome: 9.1 Recognize how psychosocial and spiritual influences can impact
psychotherapeutics.
10
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WWW.GRADESMORE.COM
11) The client is admitted to the hospital with sepsis following an elective abortion. The
healthcare provider orders antibiotics that the client refuses stating, "I don't deserve them."
What is the best response by the nurse?
1. "I think you need to do what is best for you."
2. "You have a serious infection and really need the drug."
3. "It seems you think you should be punished because you had an abortion"
4. "I'll call your healthcare provider and let him know about your decision."
Answer: 2
Explanation:
1. Telling the client she needs to do what is best is inappropriate; the nurse knows she
needs the drug.
2. Telling the client she needs the drug is providing the best care possible; this must be
done even though the nurse's beliefs may be different from the client's beliefs.
3. Telling the client what she thinks is not appropriate.
4. Calling the healthcare provider is inappropriate; the nurse knows the client needs the
drug.
Page Ref: 90
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
backgrounds function as sources of patient, family, and community values. | AACN Essential
Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse
GRADESMORE.COCare:
M Respect the patient's dignity,
populations. | NLN Competencies: Relationship-Centered
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic
outcomes.
MNL Learning Outcome: 9.1 Recognize how psychosocial and spiritual influences can impact
psychotherapeutics.
11
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
12) The African American client had a myocardial infarction and is receiving atorvastatin
(Lipitor). The nurse assesses the client's diet to be very high in fat. What is the best plan by
the nurse to improve the client's diet and reduce the risk for additional medications?
1. Ask an African American nurse to speak to him about a low-fat diet.
2. Discuss his diet with whomever prepares meals for his family.
3. Give the client information specific to African Americans about low-fat diets.
4. Obtain a consult for dietary services so a dietician can teach the client about low-fat
diets.
Answer: 2
Explanation:
1. Asking the client about having an African American nurse speak to him is racist and
implies that the nurse cannot understand the dietary needs of an African American
client.
2. Every culture has culture-specific diets; the nurse must include the person in the family
who does the meal preparation if a different diet is to be successful.
3. Providing information is a good idea, but the nurse must also teach the client.
4. At this point, a consult by dietary services is premature.
Page Ref: 91
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
backgrounds function as sources of patient, family, and community values. | AACN Essential
GRADofES
MOand
RE.quality
COM outcomes of care for diverse
Competencies: II.8 Promote achievement
safe
populations. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic
outcomes.
MNL Learning Outcome: 9.2 Recognize how cultural and ethnic variables can influence
pharmacotherapy.
12
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GRADESMORE.COM
WWW.GRADESMORE.COM
13) The client is receiving a beta-blocker medication. The nurse has done medication education
and provided the client with printed information to take home. During the next
appointment, the nurse notes that the client is not taking the medication properly. What is
a therapeutic assessment question to ask this client?
1. "Do I have to inform your healthcare provider about your noncompliance?"
2. "Why didn't you take your medicine as we talked about?"
3. "Are you able to read and comprehend the printed information?"
4. "Don't you understand how important it is to take the medicine?"
Answer: 3
Explanation:
1. It is inappropriate to involve the healthcare provider before the nurse assesses the
reason for noncompliance, and this question is threatening.
2. Asking "why" questions puts the client on the defensive, and the nurse might not
receive the most accurate answer.
3. Many English-speaking clients do not have functional literacy, a basic ability to read,
understand, and act on health information. The nurse should ask the client about the
ability to read and understand printed information.
4. Being confrontational with a "don't you understand" question is as demeaning as asking
a "why" question.
Page Ref: 91
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRDescribe
ADESMhow
OREdiverse
.COM cultural, ethnic, and social
Standards: QSEN Competencies: I.A.2
backgrounds function as sources of patient, family, and community values. | AACN Essential
Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse
populations. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic
outcomes.
MNL Learning Outcome: 9.2 Recognize how cultural and ethnic variables can influence
pharmacotherapy.
13
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GRADESMORE.COM
WWW.GRADESMORE.COM
14) All of the clients listed have cancer and are receiving chemotherapy. Which client does the
nurse evaluate as having the highest probability for a remission?
1. The client with a support group of cancer survivors
2. The client who is also seeing a psychiatrist for treatment of depression
3. The wealthy client who can afford the best medical care available
4. The client who is a former healthcare provider
Answer: 1
Explanation:
1. Positive attitudes and high expectations toward therapeutic outcomes in the client may
influence the success of pharmacotherapy. The support group of cancer survivors would
provide the best support and the highest probability for a positive outcome.
2. Treatment for depression might help the outcome, but this client would not have as
high a probability for remission as the client with another resource.
3. A wealthy client can afford the best medical care, but this client may not have good
psychosocial support.
4. A former healthcare provider may have a sound knowledge base about cancer, but this
client might not have good psychosocial support.
Page Ref: 92
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences; values; coordination and
GRADESMOand
RE.education;
COM
integration of care; information, communication,
physical comfort and
emotional support; involvement of family and friends; transitions and continuity. | AACN
Essential Competencies: IX.18 Develop an awareness of patients as well as healthcare
professionals' spiritual beliefs and values and how those beliefs and values impact healthcare. |
NLN Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness,
integrity and self-determination, and his or her own power and self-healing process. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 9-2 Identify psychosocial factors that can affect pharmacotherapeutics.
MNL Learning Outcome: 9.1 Recognize how psychosocial and spiritual influences can impact
psychotherapeutics.
14
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
15) A nurse is teaching a community group about holistic medicine. Which information should
the nurse include about Western medicine?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Western medicine focuses on the cause of disease.
2. Western medicine is not compatible with holistic medicine.
3. The client is at the center of concern in Western medicine.
4. Disease is often viewed as a malfunction in a specific body system.
5. Western medicine may focus on disease treatment.
Answer: 1, 4, 5
Explanation:
1. Western medicine often focuses on determining which disease is present and what
caused it.
2. Western medicine is compatible with holistic medicine, but this requires that those
providing care remain mindful of the individuality of the client.
3. Disease and treatment are typically at the center of Western medicine.
4. In Western medicine disease is often viewed as a specific malfunction of a body part.
5. Western medicine often focuses on the treatment of a disease, not the care of the client
with the disease.
Page Ref: 90
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRADemonstrate
DESMORE.
COM
Standards: QSEN Competencies: III.A.1
knowledge
of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Relationship-Centered Care: Respect the patient's
dignity, uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-1 Describe fundamental concepts underlying a holistic approach to
patient care and their importance to pharmacotherapy.
MNL Learning Outcome: 9.1 Recognize how psychosocial and spiritual influences can impact
psychotherapeutics.
15
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GRADESMORE.COM
WWW.GRADESMORE.COM
16) A nurse is teaching a group of student nurses. Which of the following best indicates an
ethnic characteristic that can affect pharmacotherapy?
1. Genetic differences
2. Diet
3. Health beliefs
4. Alternative therapies
Answer: 1
Explanation:
1. Ethnicity relates to biology and genetics.
2. Diet is a cultural characteristic.
3. Health belief is a cultural characteristic.
4. Alternative therapies are cultural characteristics.
Page Ref: 93
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Relationship-Centered Care: Respect the patient's
dignity, uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 9-6 Convey how genetic factors can influence pharmacotherapy.
MNL Learning Outcome: 9.3 Recognize how genetic polymorphisms can affect drug action.
GRADESMORE.COM
16
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WWW.GRADESMORE.COM
17) The nurse manager would determine that a nurse understands culturally sensitive care if
which statements are made?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Since all of our clients have the same illnesses, I sometimes get bored."
2. "I have been helping my client understand how to choose foods from our diet menu."
3. "I am concerned because my client needs sterile dressing changes but has no running
water at home."
4. "My client and I worked out a way to get her medications delivered to her at home."
5. "I invited a group from my church to come and sing hymns for our clients."
Answer: 2, 3, 4
Explanation:
1. A nurse who believes that clients who have the same illness are alike is not seeing their
psychosocial needs.
2. Helping the client cope and navigate through the hospital "culture" is a culturally
sensitive action.
3. Cultural sensitivity takes environment into consideration.
4. Helping the client cope and navigate through potential blockers to medication
adherence is a culturally sensitive action.
5. Imposing one's own religious beliefs on others is not culturally sensitive.
Page Ref: 91
Cognitive Level: Analyzing
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Relationship-Centered Care: Respect the patient's
dignity, uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 9-1 Describe fundamental concepts underlying a holistic approach to
patient care and their importance to pharmacotherapy.
MNL Learning Outcome: 9.2 Recognize how cultural and ethnic variables can influence
pharmacotherapy.
17
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
18) A nursing instructor is teaching a nursing student about human DNA sequences. The
student demonstrates understanding by making which of the following statements?
1. "Only 2% of human DNA is different among the different ethnicities."
2. "Due to enzyme polymorphism, Hispanics are less likely to metabolize codeine to
morphine."
3. "Even though human genetic differences are small, significant differences can be seen
with drug metabolism."
4. "Asian Americans are the ethnic group known to be slow acetylators."
Answer: 3
Explanation:
1. Human DNA differences of only 0.2% can produce significant differences in the way
drugs are handled within the body.
2. Asian Americans are less likely to metabolize codeine to morphine.
3. Human DNA differences of only 0.2% can produce significant differences in the way
drugs are handled within the body.
4. Caucasians are known to be slow acetylators.
Page Ref: 92
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Relationship-Centered Care: Respect the patient's
GRADESMORE.and
COhis
M or her own power and self-healing
dignity, uniqueness, integrity and self-determination,
process. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 9-6 Convey how genetic factors can influence pharmacotherapy.
MNL Learning Outcome: 9.3 Recognize how genetic polymorphisms can affect drug action.
18
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
19) A nursing student asks a nurse how gender influences pharmacology. How should the nurse
respond?
1. Women tend to seek medical care earlier than men do.
2. Heart disease has traditionally been thought of as a woman's disease.
3. Since the 1980s, the FDA has mandated that research studies include both male and
female subjects.
4. Studies indicate that men and women suffer from Alzheimer's disease in equal numbers.
Answer: 1
Explanation:
1. Women are quicker to seek medical care than are men.
2. Cardiac disease has traditionally been thought of as a men's issue.
3. In 1993, the FDA mandated that research studies include both male and female
subjects.
4. Studies indicate that more women than men suffer from Alzheimer's disease.
Page Ref: 92
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
backgrounds function as sources of patient, family, and community values. | AACN Essential
Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse
populations. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
GRANursing
DESMOProcess:
RE.COImplementation
M
process. | Nursing/Integrated Concepts:
Learning Outcome: 9-6 Convey how genetic factors can influence pharmacotherapy.
MNL Learning Outcome: 9.4 Recognize how male and females may respond differently to
drugs.
19
Copyright © 2020 Pearson Education, Inc.
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WWW.GRADESMORE.COM
20) The nurse is caring for several clients. Which clients have a psychosocial history that may
affect their outcome?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Older adult who recently suffered a stroke, has an unsteady gait, and lives in a two-story
home
2. Middle-aged client with Down syndrome living in a group home
3. Recently divorced mother of three children with breast cancer
4. Sixteen-year-old requesting birth control without parental consent
5. Seven-year-old with asthma in a foster care home
Answer: 1, 2, 3
Explanation:
1. This client may not be able to return to a home that requires climbing stairs.
2. A client with Down syndrome needs additional care to ensure that treatment outcome
is successful.
3. This client may be the family's sole provider and may have financial concerns.
4. Many teens seek contraception without their parents' consent. This should not have a
negative impact on outcome.
5. Residing in foster care should not have a negative impact on outcome.
Page Ref: 90
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRDescribe
ADESMhow
OREdiverse
.COM cultural, ethnic, and social
Standards: QSEN Competencies: I.A.2
backgrounds function as sources of patient, family, and community values. | AACN Essential
Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse
populations. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-4 Explain how community and environmental factors can affect
healthcare outcomes.
MNL Learning Outcome: 9.1 Recognize how psychosocial and spiritual influences can impact
psychotherapeutics.
20
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WWW.GRADESMORE.COM
21) The nurse in charge of a clinical study welcomes the participants in an open forum. One
client is surprised that there are men and women from several ethnic groups. The nurse
explains that in the past, ethnic variables were largely unknown or ignored for what
reasons?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Clinical trials failed to include ethnically diverse subjects.
2. Clinical trials comprised mostly Caucasian males.
3. Little attention was focused on identifying the different effects drugs had on various
ethnic groups.
4. Research proved there were no differences among ethnic groups.
5. The large majority of clinical trials included Caucasian females.
Answer: 1, 2, 3
Explanation:
1. There was a lack of ethnic diversity in early clinical trials.
2. Until recently, clinical trials comprised mostly Caucasian males.
3. Little attention was focused on identifying the differences in pharmacologic effects in
diverse ethnic groups.
4. There was insufficient research to show differences because little attention was focused
on these differences.
5. The large majority of clinical trials excluded females.
Page Ref: 91
GRADESMORE.COM
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
backgrounds function as sources of patient, family, and community values. | AACN Essential
Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse
populations. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic
outcomes.
MNL Learning Outcome: 9.2 Recognize how cultural and ethnic variables can influence
pharmacotherapy.
21
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GRADESMORE.COM
WWW.GRADESMORE.COM
22) The nurse in the emergency department is caring for several clients from diverse cultures.
Which statement shows the nurse's ability to provide culturally competent care?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "I understand your religion prohibits blood transfusions. Would you consider nonblood
alternatives?"
2. "I just want to make sure you and your spouse understand the risks as you consider the
options."
3. "I don't really understand why you are afraid to take the medication. Do you have any
questions I can answer to alleviate your fear?"
4. "I really don't understand why you won't consider an abortion. Your admission papers
say you are an atheist."
5. "I'm not quite sure why the healthcare provider is giving you these prescriptions. You
didn't get them filled the last time you were here."
Answer: 1, 2, 3
Explanation:
1. This statement shows the nurse is respectful of religious beliefs and open to offering
alternative treatment.
2. This statement shows the nurse is accepting of clients' beliefs.
3. This statement may encourage the client to open up to the nurse about fears.
4. This is a judgmental and insensitive comment. A culturally competent nurse is sensitive
to the client's spiritual beliefs or lack thereof.
GRAD
ESMfactors
ORE.C
OMmay contribute to nonadherence.
5. This statement does not consider
social
that
Page Ref: 91
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences; values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; transitions and continuity. | AACN
Essential Competencies: III.1 Explain the interrelationships among theory, practice, and
research. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-6 Convey how genetic factors can influence pharmacotherapy.
MNL Learning Outcome: 9.1 Recognize how psychosocial and spiritual influences can impact
psychotherapeutics.
22
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
23) A home health nurse's patient caseload is ethnically diverse. Which interventions show
understanding of cultural variables?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Discussing cultural preferences for herbs and spices and possible alternatives when drug
interactions are possible
2. Assessing the client's response to acupuncture for pain
3. Discussing the client's beliefs regarding treatment
4. Notifying the healthcare provider of the client's intentions to consult with a medicine
man for spiritual guidance
5. Removing the client's collection of herbs to decrease the risk of an adverse effect when
taken with Western medicine
Answer: 1, 2, 3
Explanation:
1. It is important to assess the cultural use of herbs and spices and determine if there may
be any interactions with prescribed medications.
2. The nurse can assess the client's response to acupuncture and interpret the effects on
prescribed treatment with respect for the client's culture.
3. Cultures view health and wellness in different ways. An understanding of the client's
cultural beliefs allows the nurse to provide better support and guidance.
4. As long as the medicine man does not "prescribe" any herbs, the nurse does not have to
discuss this with the provider.
GRA
DESbut
MOR
E.Cshould
OM discuss possible adverse effects
5. The nurse need not remove the
herbs
rather
when the herbs are mixed with prescribed medications.
Page Ref: 91
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences; values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; transitions and continuity. | AACN
Essential Competencies: III.1 Explain the interrelationships among theory, practice, and
research. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 9-6 Convey how genetic factors can influence pharmacotherapy.
MNL Learning Outcome: 9.2 Recognize how cultural and ethnic variables can influence
pharmacotherapy.
23
Copyright © 2020 Pearson Education, Inc.
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WWW.GRADESMORE.COM
24) A client asks the nurse why a medication prescribed by the provider "didn't do anything at
all." Which statement by the nurse accurately describes how genetics influence drug action?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Genetic differences can result in significant differences in how each client's body
handles the same medication."
2. "Genetic differences can cause mutations in enzymes, changing the way they function.
This can alter how the body metabolizes and excretes drugs."
3. "Because of genetic differences, medication may accumulate to toxic levels in one client
while in another client may be inactivated before it can have a therapeutic effect."
4. "Genetic differences can be expressed as an alteration in the structure of an enzyme,
which can cause a defective receptor and an allergic response to drugs."
5. "Genetic differences in clients who are biracial result in an allergic response to
medications."
Answer: 1, 2, 3
Explanation:
1. 99.8% of human DNA sequences are identical. The remaining 0.2% can account for
significant differences in people's ability to handle medications.
2. The structure of an enzyme is closely related to its function. A mutation can cause a
change in the structure of the enzyme, resulting in a change in its function.
3. When enzymes are functionally changed by genetics, metabolism and excretion can be
altered, resulting in the drug either accumulating or being inactivated.
GRofAaDprotein
ESMORmay
E.Cresult
OM in a defective receptor that will
4. Small changes in the structure
not accept the drug and the drug not having any therapeutic effect. This is not an
allergic response.
5. Genetic differences can result in mutations of enzymes or proteins, which may result in
changes in function. Being of a certain race may predispose a client to mutations and,
therefore, uncommon responses to medication, but this does not mean the client will
have an allergic response to medications.
Page Ref: 93
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences; values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; transitions and continuity. | AACN
Essential Competencies: III.1 Explain the interrelationships among theory, practice, and
research. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-6 Convey how genetic factors can influence pharmacotherapy.
MNL Learning Outcome: 9.3 Recognize how genetic polymorphisms can affect drug action.
24
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25) A nurse administering medications to a variety of patients on a medical-surgical floor
recognizes which of the following clients may need additional education about medication
adherence?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Fifty-year-old recently remarried male taking antihypertensive medication
2. Thirty-four-year-old female with family history of blood clots taking an estrogen oral
contraceptive
3. Thirty-eight-year-old male recently started on an antidepressant
4. Twenty-eight-year-old female started on acne medication known to cause malepatterned hair growth
5. Seventy-eight-year-old female being treated for shingles
Answer: 1, 2, 3, 4
Explanation:
1. Antihypertensive medications can cause impotence. This client will need additional
education about this possible side effect.
2. Estrogen can cause an increased risk for thrombolytic events, especially in clients who
have a positive family history.
3. Taking an antidepressant may result in the man feeling weak, unhealthy, or dependent.
4. Some acne medications cause increased hair growth in a male pattern, such as on the
face. While controlling acne is a goal, the client may not want the extra hair growth.
5. There is no indication that treatment for shingles requires education in excess of that
which is generally provided. GRADESMORE.COM
Page Ref: 91
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
backgrounds function as sources of patient, family, and community values. | AACN Essential
Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse
populations. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-6 Convey how genetic factors can influence pharmacotherapy.
MNL Learning Outcome: 9.1 Recognize how psychosocial and spiritual influences can impact
psychotherapeutics.
25
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WWW.GRADESMORE.COM
26) A client is a vegan vegetarian and does not eat any animal products. The healthcare
provider has prescribed a medication contained in a gelatin capsule. The nurse understands
that a gelatin capsule is made from animal products. Which nursing actions are indicated?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Do not tell the client the capsule contains gelatin.
2. Collaborate with the prescriber to find an alternative medication.
3. Check to see if the capsule can be opened for administration.
4. Work to convince the client that this application does not violate vegetarian beliefs.
5. Tell the client that the gelatin is an inactive ingredient in the medication.
Answer: 2, 3
Explanation:
1. Withholding information regarding the medication is not ethical.
2. An alternative dosage form that does not require use of a gelatin capsule may be
available.
3. Many capsules can be opened and the contents can be placed in fluid or on soft food for
administration.
4. If the client is strictly vegetarian, the use of a gelatin capsule is a violation of belief. The
nurse should not try to influence the client otherwise.
5. Whether the gelatin is an active ingredient or an inactive ingredient is not relevant.
Page Ref: 90
Cognitive Level: Analyzing
GRAD
ESMORE.COM
Client Need/Sub: Physiological Integrity:
Pharmacological
and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences; values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; transitions and continuity. | AACN
Essential Competencies: IX.18 Develop an awareness of patients as well as healthcare
professionals' spiritual beliefs and values and how those beliefs and values impact healthcare. |
NLN Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness,
integrity and self-determination, and his or her own power and self-healing process. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 9-2 Identify psychosocial factors that can affect pharmacotherapeutics.
MNL Learning Outcome: 9.1 Recognize how psychosocial and spiritual influences can impact
psychotherapeutics.
26
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27) Which patient statements would the nurse evaluate as negatively affecting access to
healthcare?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. An older adult says, "If I tell my doctor that I fall frequently, I might have to go to a
nursing home."
2. A young adult says, "A benefit of my new job is that it pays for my health, dental, and
vision insurance."
3. A client being discharged says, "Can you call my prescriptions in to the pharmacy?"
4. The client's new insurance plan requires a $10 copay for office visits.
5. A client asks to be discharged before noon as he has a 3-hour drive home.
Answer: 1, 4, 5
Explanation:
1. The older adult may not reveal a fall history out of concern for loss of independence and
a change in living conditions.
2. Having a job that pays insurance helps ensure access.
3. Being able to call prescriptions in to the pharmacy helps ensure access.
4. Even a low-cost copay may be difficult for some clients to afford.
5. Living long distances from healthcare sources decreases access.
Page Ref: 92
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRDescribe
ADESMhow
OREdiverse
.COM cultural, ethnic, and social
Standards: QSEN Competencies: I.A.2
backgrounds function as sources of patient, family, and community values. | AACN Essential
Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse
populations. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 9-4 Explain how community and environmental factors can affect
healthcare outcomes.
MNL Learning Outcome: 9.2 Recognize how cultural and ethnic variables can influence
pharmacotherapy.
27
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28) A nurse has been asked to present health promotion information at a community clinic
whose clients are primarily non-Hispanic Black women. After review of health disparity and
inequality statistics the nurse chooses to include information about which disorders?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Stroke
2. Coronary artery disease
3. Diabetes
4. Illicit drug use
5. Prenatal care
Answer: 1, 2, 3, 5
Explanation:
1. The rate of premature death due to stroke is higher among non-Hispanic Blacks than
among non-Hispanic Whites.
2. The rate of premature death due to coronary artery disease is higher among nonHispanic Blacks than among non-Hispanic Whites.
3. Diabetes is highest among non-Hispanic Blacks and Whites.
4. Rates for drug-induced death (from both legal and illegal drugs) is highest among
American Indians, Alaskan Natives, and non-Hispanic Whites.
5. The infant mortality rate for non-Hispanic Black women is more than double that for
non-Hispanic White women.
Page Ref: 91
GRADESMORE.COM
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
backgrounds function as sources of patient, family, and community values. | AACN Essential
Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse
populations. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 9-4 Explain how community and environmental factors can affect
healthcare outcomes.
MNL Learning Outcome: 9.2 Recognize how cultural and ethnic variables can influence
pharmacotherapy.
28
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29) A client's genetic testing indicates the presence of a genetic polymorphism of the CYP 450
enzyme. The nurse expects this difference to be one of which classifications?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Extensive
2. Poor
3. Normal
4. Ultrarapid
5. Inefficient
Answer: 1, 2, 4
Explanation:
1. "Extensive" is one of the classifications used to describe this change in drug metabolism.
2. "Poor" is one of the classifications used to describe this change in drug metabolism
3. Since this client has a change, the metabolism would not be classified as "normal."
4. "Ultrarapid" is one of the classifications used to describe this change in drug
metabolism.
5. "Inefficient" is not used to describe this change.
Page Ref: 94
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences; values; coordination and
GRADESMOand
RE.education;
COM
integration of care; information, communication,
physical comfort and
emotional support; involvement of family and friends; transitions and continuity. | AACN
Essential Competencies: III.1 Explain the interrelationships among theory, practice, and
research. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 9-6 Convey how genetic factors can influence pharmacotherapy.
MNL Learning Outcome: 9.3 Recognize how genetic polymorphisms can affect drug action.
29
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30) A client's genetic testing reveals a change in CYP2A6. The nurse would plan which
interventions based on this discovery?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Teaching the client to avoid caffeine-containing drugs.
2. Planning additional time and interventions to help the client stop smoking.
3. Use of an alternative to the drug warfarin.
4. Increased surveillance for the development of lung cancer.
5. Frequent monitoring of blood pressure.
Answer: 2, 4
Explanation:
1. CYP2A6 is not associated with caffeine.
2. CYP2A6 reduction may make smoking cessation more difficult.
3. CYP2C9 is associated with reduced metabolism of warfarin.
4. CYP2A6 reduction may increase risk of lung cancer.
5. CYP2A6 is not associated with blood pressure level.
Page Ref: 94
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences; values; coordination and
integration of care; information, communication, and education; physical comfort and
GRADand
ESM
ORE.transitions
COM
emotional support; involvement of family
friends;
and continuity. | AACN
Essential Competencies: III.1 Explain the interrelationships among theory, practice, and
research. | NLN Competencies: Relationship-Centered Care: Respect the patient's dignity,
uniqueness, integrity and self-determination, and his or her own power and self-healing
process. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 9-6 Convey how genetic factors can influence pharmacotherapy.
MNL Learning Outcome: 9.3 Recognize how genetic polymorphisms can affect drug action.
30
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WWW.GRADESMORE.COM
Pharmacology for Nurses, 6e (Adams)
Chapter 10 The Role of Complementary and Alternative Therapies in Pharmacology
1) The client confides in the nurse that he or she is drawn to complementary and alternative
medicine because it promotes the "whole person." The client would like spirituality and
prayer included in his or her plan of care. What is the best response by the nurse?
1. "We will include spirituality in your plan. Would you like to say a prayer?"
2. "I think your spiritual concerns are best left up to you and your minister."
3. "What exactly do you mean by spirituality and prayer?"
4. "We usually do not pray with clients; is there something you are worried about?"
Answer: 1
Explanation:
1. Complementary and alternative medicine tends to include the "whole person" more
than traditional medicine does. The nurse should offer to pray with the client if the
client requests this.
2. Refusing to acknowledge the client's spiritual concerns, and referring her to her
minister, does not treat the "whole person." Asking the client to clarify what he or she
means by spirituality and prayer could be appropriate but is not the best.
3. Asking the client to clarify what he or she means by spirituality and prayer could be
appropriate but is not the best answer.
4. Telling the client that the nurse does not usually pray with clients will discourage her
from discussing spirituality.
GRADESMORE.COM
Page Ref: 98
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.17 Develop a beginning understanding of complementary and
alternative modalities and their role in healthcare. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 10-1 Explain the role of complementary and alternative medicine in
promoting patient wellness.
MNL Learning Outcome: 10.1 Recognize the use of complementary and alternative medicine,
including its impact on healthcare and nursing.
1
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2) The nurse plans to teach clients about the difference between herbal preparations and
prescription medications. Which statement describes the best plan by the nurse?
1. "Herbs, like prescription drugs, usually only contain one active ingredient."
2. "The active ingredients in an herb, unlike prescription drugs, may be present in just one
part or many parts."
3. "Most herbs, like prescription drugs, are standardized and regulated by the Food and
Drug Administration (FDA)."
4. "Herbs are considered to be safer than prescription medications as they are natural."
Answer: 2
Explanation:
1. Herbs may actually contain dozens of active chemicals, not just one.
2. Unlike prescription drugs, the active ingredients in an herb may be present in just one
part or many parts.
3. Most herbs have not been standardized and are not regulated by the Food and Drug
Administration (FDA).
4. Herbs are not necessarily safer than prescription medications; they are medications.
Page Ref: 98
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as,
open communication strategies and organizational error reporting systems). | AACN Essential
Competencies: IX.17 Develop a beginning understanding of complementary and alternative
GRA
ESCompetencies:
MORE.COM Knowledge and Science:
modalities and their role in healthcare.
|D
NLN
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 10-3 Identify the parts of an herb that may contain active ingredients and
the types of formulations made from these parts.
MNL Learning Outcome: 10.1 Recognize the use of complementary and alternative medicine,
including its impact on healthcare and nursing.
2
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3) The client tells the nurse that he or she plans to take St. John's wort to treat his or her
depression. What is the best response by the nurse?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "That should be fine as long as you are not suicidal."
2. "St. John's wort is successfully used in Europe for minor depression."
3. "It would be a good idea to try this before paying for a prescription medication."
4. "It would be better to have a psychiatric assessment first."
5. "Herbal preparations can interact with many other medications."
Answer: 4, 5
Explanation:
1. The suicidality of the client should not be a determining factor with using St. John's
wort.
2. Even though St. John's wort is successfully used in Europe, this does not mean it is
appropriate for this client.
3. The cost of the prescription medication should not be a determining factor.
4. Anyone who is depressed should have a psychiatric assessment prior to starting on any
type of medication. Often, there is a physiological cause for the depression that must
also be treated.
5. Herbal preparations do interact with many other medications and can have serious
adverse side effects.
Page Ref: 99
GRADESMORE.COM
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental
stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster
patient engagement in their care. | NLN Competencies: Knowledge and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 10-5 Describe the pharmacologic actions and safety of herbal and dietary
supplements.
MNL Learning Outcome: 10.2 Recognize the standardization and uses of various formulations
of herbal products.
3
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4) The client tells the nurse that he or she has been taking herbal preparations to boost his or
her immune system functioning. He or she does not know the names of the preparations.
What is the best assessment question for the nurse to ask?
1. "Would you please tell your doctor about the herbs during the next visit?"
2. "Would you please ask your spouse to discuss this with me during her next visit?"
3. "Would you please have your spouse bring the bottles to the hospital?"
4. "Would you please ask your spouse to call the hospital pharmacist with the names?"
Answer: 3
Explanation:
1. It is preferable for the nurse to do the assessment rather than to refer to the healthcare
provider.
2. Discussing the herbs with the nurse is the second-best answer, but having objective
data, the bottles, will provide the best information.
3. The best way for the nurse to assess the kinds of herbal preparations the client is taking
is to actually look at the bottles.
4. It is preferable for the nurse to do the assessment rather than to refer to the
pharmacist.
Page Ref: 98
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
GRADESMOand
RE.education;
COM
integration of care; information, communication,
physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.17 Develop a beginning understanding of complementary and
alternative modalities and their role in healthcare. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 10-6 Identify common specialty supplements taken by patients.
MNL Learning Outcome: 10.2 Recognize the standardization and uses of various formulations
of herbal products.
4
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5) The nurse is teaching a class on dietary supplements. The nurse determines that learning
has occurred when the patients make which statement?
1. "Products can make claims based on body structure and function like 'promotes healthy
urinary tract.'"
2. "Dietary supplements must go through rigorous testing prior to being marketed by the
manufacturer."
3. "The Food and Drug Administration (FDA) is not involved with the approval of the
dietary supplement and cannot remove it from the market."
4. "The manufacturer of the dietary supplement has the burden of proof for the safety of
the supplement."
Answer: 1
Explanation:
1. The Dietary Supplement Health and Education Act (DSHEA) of 1994 states that the
supplement label may make claims about the product's effect on body structure and
function such as "promotes healthy urinary tract."
2. The Dietary Supplement Health and Education Act (DSHEA) of 1994 states that dietary
supplements do not have to be tested prior to marketing.
3. The Dietary Supplement Health and Education Act (DSHEA) of 1994 states that the Food
and Drug Administration (FDA) has the power to remove from the market any product
that poses a "significant or unreasonable" risk to the public.
4. The Dietary Supplement Health and Education Act (DSHEA) of 1994 states that the
government has the responsibility to prove that the dietary supplement is unsafe.
GRADESMORE.COM
Page Ref: 98
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.7 Discuss potential and actual impact of national patient
safety resources, initiatives, and regulations. | AACN Essential Competencies: V.1 Demonstrate
basic knowledge of healthcare policy, finance and regulatory environments; including local,
state, national and global healthcare trends. | NLN Competencies: Context and Environment:
Code of ethics; regulatory and professional standards. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 10-4 Analyze the strengths and weaknesses of legislation regulating herbal
and dietary supplements.
MNL Learning Outcome: 10.3 Examine the regulation of herbal products and dietary
supplements.
5
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6) The client uses Ginkgo biloba to enhance memory functioning but has not told the nurse
about this herb. The healthcare provider orders warfarin (Coumadin) for this client. Which
findings may the nurse find upon assessment?
1. Headache, dizziness, sweating, and agitation
2. A blood glucose of 56
3. An international normalized ratio (INR) of 3.0
4. Petechiae and bleeding from the gums
Answer: 4
Explanation:
1. Headache, dizziness, sweating, and agitation, which are signs of serotonin syndrome,
are not the result of an interaction between Ginkgo biloba and warfarin (Coumadin).
2. Hypoglycemia (blood glucose of 56) is not the result of an interaction between Ginkgo
biloba and warfarin (Coumadin).
3. An international normalized ratio (INR) of 3.0 is within a normal range.
4. Ginkgo biloba will interact with warfarin (Coumadin) to promote increased bleeding
potential that may lead to petechiae and bleeding from the gums.
Page Ref: 103
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
GRADand
ESM
ORE.and
COMtransition and continuity. | AACN
emotional support; involvement of family
friends;
Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental
stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster
patient engagement in their care. | NLN Competencies: Knowledge and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts:
Nursing Process: Assessment
Learning Outcome: 10-5 Describe the pharmacologic actions and safety of herbal and dietary
supplements.
MNL Learning Outcome: 10.4 Consider the pharmacological actions of herbal products and
specialty supplements and how they may interact with conventional drugs.
6
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GRADESMORE.COM
WWW.GRADESMORE.COM
7) Which client would be most likely to seek complementary and alternative therapies as a
treatment modality?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. A 48-year-old male who wants to boost his immune system
2. A 22-year-old male athlete who is preparing for the Olympics
3. A 50-year-old female going through menopause
4. A 58-year-old male with prostate problems
5. None of these clients would be wise to seek these therapies.
Answer: 1, 2, 3, 4
Explanation:
1. The 48-year-old male can effectively boost his immune system by using complementary
and alternative therapies.
2. The 22-year-old male athlete who is preparing for the Olympics wants to be in the best
possible condition and may use complementary and alternative therapies.
3. The 50-year-old female going through menopause may want to treat herself with
alternative therapies, as menopause is not an illness.
4. The 58-year-old male client with prostate problems may begin treatment with
alternative therapies.
5. Complementary and alternative therapy includes such modalities as prayer, massage,
and yoga as well as use of herbal remedies. Many, if not most, people participate in at
least one form of these therapies.
GRADESMORE.COM
Page Ref: 100
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.17 Develop a beginning understanding of complementary and
alternative modalities and their role in healthcare. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 10-1 Explain the role of complementary and alternative medicine in
promoting patient wellness.
MNL Learning Outcome: 10.4 Consider the pharmacological actions of herbal products and
specialty supplements and how they may interact with conventional drugs.
7
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GRADESMORE.COM
WWW.GRADESMORE.COM
8) Clients at a senior citizen center have asked the nurse to do a presentation on herbal
preparations. Which statement would be included in the best plan by the nurse?
1. "Herbal preparations are safe as long as you carefully read the label."
2. "As long as the herbal preparation has been tested in the clinical setting, it is safe."
3. "Herbal preparations actually are drugs; you must be careful with them."
4. "Herbal preparations can be dangerous if you are allergic to them."
Answer: 3
Explanation:
1. Reading the label does not mean the herbal preparation is safe; clients do not
commonly recognize the interactions between herbal preparations and prescription
medicines.
2. There isn't any clinical evidence to support that herbal preparations have been tested in
the clinical setting or that they are safe.
3. Herbal preparations are nonprescription drugs that have side effects and can interact
with many other drugs.
4. Herbal preparations can be dangerous for reasons other than an allergy to the
preparation.
Page Ref: 103
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.7 Provide
GRADdevelopmental
ESMORE.COstage,
M age, culture, spirituality,
appropriate patient teaching that reflects
patient preferences, and health literacy considerations to foster patient engagement in their
care. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science
and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 10-2 Analyze reasons why complementary and alternative therapies have
increased in popularity.
MNL Learning Outcome: 10.4 Consider the pharmacological actions of herbal products and
specialty supplements and how they may interact with conventional drugs.
8
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9) The older adult asks the nurse how dietary supplements will help support health. What is
the best response by the nurse?
1. "Fish oil will help to enhance your brain function."
2. "Chromium will help you achieve and maintain optimum weight."
3. "Dietary supplements will help support and maintain hydration."
4. "Soy isoflavone will help prevent Alzheimer's disease."
Answer: 1
Explanation:
1. Omega-3 fatty acids are neuroprotective and will enhance brain function.
2. There isn't any evidence to support that chromium helps with weight maintenance.
3. Dietary supplements do not support and maintain hydration.
4. Soy isoflavone will help reduce the risk of certain types of cancer but will not help
prevent Alzheimer's disease.
Page Ref: 103
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.17 Develop a beginning understanding of complementary and
alternative modalities and their role in healthcare. | NLN Competencies: Knowledge and
GRADESMOREand
.Cquality
OM and safe patient care. |
Science: Relationships between knowledge/science
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 10-6 Identify common specialty supplements taken by patients.
MNL Learning Outcome: 10.2 Recognize the standardization and uses of various formulations
of herbal products.
9
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WWW.GRADESMORE.COM
10) The client takes St. John's wort for depression but does not tell the healthcare provider. The
provider prescribes an SSRI. The nurse should monitor for which of the following?
1. Dizziness
2. Serum glucose level of 340
3. Sedation
4. Serum potassium of 6.0
Answer: 1
Explanation:
1. Dizziness is associated with serotonin syndrome, which may occur when St. John's wort
and SSRIs are given concurrently.
2. Combining St. John's wort and an SSRI does not result in hyperglycemia.
3. It is more likely that concurrent administration of St. John's wort and an SSRI will result
in agitation.
4. Combining St. John's wort and an SSRI will not result in hyperkalemia.
Page Ref: 101
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental
GRpreferences,
ADESMOREand
.Chealth
OM literacy considerations to foster
stage, age, culture, spirituality, patient
patient engagement in their care. | NLN Competencies: Knowledge and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts:
Nursing Process: Assessment
Learning Outcome: 10-5 Describe the pharmacologic actions and safety of herbal and dietary
supplements.
MNL Learning Outcome: 10.4 Consider the pharmacological actions of herbal products and
specialty supplements and how they may interact with conventional drugs.
10
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
11) The client is being treated for a cardiac dysrhythmia with amiodarone (Cordarone). The
client has elevated liver function tests (LFTs). Which assessment finding would the nurse
suspect as contributing to the elevated LFTs?
1. The client was taking Kava-Kava for anxiety.
2. The client was taking Echinacea to treat cold symptoms.
3. The client was taking St. John's wort for depression.
4. The client was taking gingko biloba for memory problems.
Answer: 2
Explanation:
1. There isn't any interaction between Kava and amiodarone (Cordarone).
2. Echinacea and amiodarone (Cordarone) can lead to hepatotoxicity.
3. There isn't any interaction between St. John's wort and amiodarone (Cordarone).
4. There isn't any interaction between gingko biloba and amiodarone (Cordarone).
Page Ref: 101
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental
stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster
GRACompetencies:
DESMORE.CKnowledge
OM
patient engagement in their care. | NLN
and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts:
Nursing Process: Diagnosis
Learning Outcome: 10-5 Describe the pharmacologic actions and safety of herbal and dietary
supplements.
MNL Learning Outcome: 10.4 Consider the pharmacological actions of herbal products and
specialty supplements and how they may interact with conventional drugs.
11
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WWW.GRADESMORE.COM
12) The nurse has been teaching a client about herbal preparations and determines that
additional teaching is required when the client makes which statement?
1. "I should check with you before using an herbal product."
2. "Herbal products usually contain only one active ingredient."
3. "I need to be careful about where I store my herbal product."
4. "Herbal preparations are available in solid and liquid forms."
Answer: 2
Explanation:
1. Clients should check with the nurse before using an herbal product.
2. Herbal products contain multiple active ingredients as opposed to prescription drugs,
which contain only one active ingredient.
3. Where and how an herbal product is stored can affect its potency.
4. Herbal preparations are available in solid and liquid forms.
Page Ref: 100
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as,
open communication strategies and organizational error reporting systems). | AACN Essential
Competencies: IX.17 Develop a beginning understanding of complementary and alternative
modalities and their role in healthcare. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
RADEofSan
MOherb
RE.that
COMmay contain active ingredients and
Learning Outcome: 10-3 Identify theGparts
the types of formulations made from these parts.
MNL Learning Outcome: 10.1 Recognize the use of complementary and alternative medicine,
including its impact on healthcare and nursing.
12
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
13) The nurse prepares to teach clients about the safety and efficacy of herbal preparations.
Which statement would be included in the best plan by the nurse?
1. "Herbal preparations must be tested for safety and efficacy prior to marketing."
2. "The label on the herbal preparation is required by the Dietary Supplement Health and
Education Act (DSHEA) to be accurate."
3. "Herbal preparations have to meet the same safety and efficacy standards as
prescription and over-the-counter (OTC) drugs."
4. "The manufacturer does not have to prove the safety or efficacy of the herbal
preparation."
Answer: 4
Explanation:
1. The federal government does not require herbal preparations to be tested for safety
and efficacy prior to marketing.
2. The Dietary Supplement Health and Education Act (DSHEA) does not regulate the
accuracy of the label; the product may or may not contain the product listed, in the
amounts claimed.
3. Herbal preparations do not have to meet the same safety standards as prescription and
over-the-counter (OTC) drugs.
4. Herbal products are not regulated by the Food and Drug Administration (FDA) for safety
standards. They are regulated by a far less rigorous law, the Dietary Supplement Health
and Education Act (DSHEA) of 1994, which does not require the manufacturer to
demonstrate efficacy or safety of the herbal product.
GRADESMORE.COM
Page Ref: 101
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.7 Discuss potential and actual impact of national patient
safety resources, initiatives, and regulations. | AACN Essential Competencies: V.1 Demonstrate
basic knowledge of healthcare policy, finance and regulatory environments; including local,
state, national and global healthcare trends. | NLN Competencies: Context and Environment:
Code of ethics; regulatory and professional standards. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 10-4 Analyze the strengths and weaknesses of legislation regulating herbal
and dietary supplements.
MNL Learning Outcome: 10.3 Examine the regulation of herbal products and dietary
supplements.
13
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GRADESMORE.COM
WWW.GRADESMORE.COM
14) The client takes several prescription medications and asks the nurse about using
complementary and alternative medicine (CAM). What is the best reply by the nurse?
1. "CAM is a good idea that you should discuss with your healthcare provider."
2. "CAM is an approach that might reduce your need for medications."
3. "CAM might help, but you will still need your medications."
4. "CAM has not been demonstrated to help with your kind of symptoms."
Answer: 2
Explanation:
1. The nurse can answer the client's questions; they do not need to be referred to the
healthcare provider.
2. From a pharmacology perspective, much of the value of complementary and alternative
medicine (CAM) therapies lies in their ability to reduce the need for medications.
3. Complementary and alternative medicine (CAM) often reduces the need for prescription
medications.
4. Complementary and alternative medicine (CAM) has been demonstrated to alleviate
many client symptoms.
Page Ref: 98
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
GRADand
ESM
ORE.and
COMtransition and continuity. | AACN
emotional support; involvement of family
friends;
Essential Competencies: IX.17 Develop a beginning understanding of complementary and
alternative modalities and their role in healthcare. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 10-1 Explain the role of complementary and alternative medicine in
promoting patient wellness.
MNL Learning Outcome: 10.1 Recognize the use of complementary and alternative medicine,
including its impact on healthcare and nursing.
14
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GRADESMORE.COM
WWW.GRADESMORE.COM
15) A pregnant client asks the nurse about changing from her prescription antidepressant
medication to St. John's wort because it is natural. What is the best response by the nurse?
1. "It should be okay because your baby has been exposed to an antidepressant."
2. "St. John's wort is a drug, and this should be discussed with your healthcare provider."
3. "No, herbal preparations are just not safe to take during pregnancy."
4. "Yes, you can change, but let your doctor know at your next appointment."
Answer: 2
Explanation:
1. St. John's wort is not okay because the baby has not been exposed to it specifically.
2. All herbal preparations are drugs, and their use should be discussed with the healthcare
provider when a client is pregnant.
3. Some herbal preparations may be safe during pregnancy.
4. It is not safe to tell a pregnant woman she can change antidepressants.
Page Ref: 104
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.7 Provide
appropriate patient teaching that reflects developmental stage, age, culture, spirituality,
patient preferences, and health literacy considerations to foster patient engagement in their
care. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science
and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process:
GRADESMORE.COM
Implementation
Learning Outcome: 10-7 Discuss the role of the nurse in teaching patients about
complementary and alternative therapies.
MNL Learning Outcome: 10.1 Recognize the use of complementary and alternative medicine,
including its impact on healthcare and nursing.
15
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WWW.GRADESMORE.COM
16) A nurse is planning to teach a client about the relationship of complementary and
alternative therapies to pharmacology What should the nurse include?
1. They are more effective than medication use.
2. They can reduce client medication needs.
3. They serve as competitors and should not be promoted.
4. They have little-to-no value in disease prevention and treatment.
Answer: 2
Explanation:
1. They are not generally more effective than medications but do have value in disease
prevention and treatment.
2. Complementary and alternative therapies can reduce client medication needs and
therefore lower the risk of adverse effects.
3. Both complementary/alternative therapies and pharmacology should be used together
to provide holistic client care.
4. They are not generally more effective than medications but do have value in disease
prevention and treatment.
Page Ref: 98
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
GRADand
ESM
ORE.and
COMtransition and continuity. | AACN
emotional support; involvement of family
friends;
Essential Competencies: IX.17 Develop a beginning understanding of complementary and
alternative modalities and their role in healthcare. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 10-2 Analyze reasons why complementary and alternative therapies have
increased in popularity.
MNL Learning Outcome: 10.1 Recognize the use of complementary and alternative medicine,
including its impact on healthcare and nursing.
16
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GRADESMORE.COM
WWW.GRADESMORE.COM
17) A client asks a nurse why herbal remedies are popular now. What is the nurse best
response?
1. They are being marketed very aggressively.
2. Most insurance policies cover them.
3. They are more effective for treating bacterial infections.
4. Their popularity is decreasing, not increasing.
Answer: 1
Explanation:
1. The popularity of herbs and alternative therapies has increased since the 1970s due to
several factors, including aggressive marketing.
2. They are generally not covered under insurance policies.
3. They are not more effective than antibiotics for treating bacterial infections.
4. The popularity of herbs and alternative therapies has increased since the 1970s.
Page Ref: 98
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
backgrounds function as sources of patient, family, and community values. | AACN Essential
Competencies: IX.17 Develop a beginning understanding of complementary and alternative
modalities and their role in healthcare. | NLN Competencies: Content and Environment: Show
respect for other's values; appreciate diversity. | Nursing/Integrated Concepts: Nursing Process:
Assessment
GRADwhy
ESMcomplementary
ORE.COM and alternative therapies have
Learning Outcome: 10-2 Analyze reasons
increased in popularity.
MNL Learning Outcome: 10.1 Recognize the use of complementary and alternative medicine,
including its impact on healthcare and nursing.
17
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GRADESMORE.COM
WWW.GRADESMORE.COM
18) A nurse is teaching a student nurse about the active ingredients of herbal medicines. Which
of the following indicates that teaching was effective?
1. Can be found in all parts of the herb
2. Are found only in the root system
3. Are found only in the rhizome
4. Are found only in the stems and leaves
Answer: 1
Explanation:
1. The active ingredients of herbs can be found in all of their parts.
2. The active ingredients of herbs are not limited to the root system.
3. The active ingredients of herbs are not limited to the rhizome.
4. The active ingredients of herbs are not found only in the stems and leaves.
Page Ref: 100
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.5 Describe factors that create a culture of safety (such as,
open communication strategies and organizational error reporting systems). | AACN Essential
Competencies: IX.17 Develop a beginning understanding of complementary and alternative
modalities and their role in healthcare. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 10-3 Identify the parts of an herb that may contain active ingredients and
RADEparts.
SMORE.COM
the types of formulations made fromGthese
MNL Learning Outcome: 10.1 Recognize the use of complementary and alternative medicine,
including its impact on healthcare and nursing.
18
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
19) A nursing instructor is planning to discuss the Dietary Supplement Health and Education Act
(DSHEA) of 1994 with a group of nursing students. The instructor plans to include which of
the following?
1. It ensures that herbal products provide proof of their intended effects.
2. It mandates that herbal product labels state that the products are not intended to
diagnose, treat, cure, or prevent disease.
3. It mandates that herbal product labels contain accurate information.
4. It requires that herbal products undergo the same rigorous testing as drugs do under
the FDA.
Answer: 2
Explanation:
1. The DSHEA does not require herbal products to offer proof of their intended effects. It
does require that herbal product labels state that they are not intended to diagnose,
treat, cure, or prevent disease.
2. It does require that herbal product labels state that they are not intended to diagnose,
treat, cure, or prevent disease.
3. The DSHEA does not require herbal products to conform to the same standards the FDA
requires of drugs. It does require that herbal product labels state that they are not
intended to diagnose, treat, cure, or prevent disease. It does not mandate labeling
accuracy.
4. The DSHEA does not require herbal products to conform to the same standards the FDA
requires of drugs.
GRADESMORE.COM
Page Ref: 101
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.7 Discuss potential and actual impact of national patient
safety resources, initiatives, and regulations. | AACN Essential Competencies: V.1 Demonstrate
basic knowledge of healthcare policy, finance and regulatory environments; including local,
state, national and global healthcare trends. | NLN Competencies: Context and Environment:
Code of ethics; regulatory and professional standards. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 10-4 Analyze the strengths and weaknesses of legislation regulating herbal
and dietary supplements.
MNL Learning Outcome: 10.3 Examine the regulation of herbal products and dietary
supplements.
19
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GRADESMORE.COM
WWW.GRADESMORE.COM
20) A nurse is caring for a client being treated for seizures. The nurse would be most concerned
if the client is also taking which herbal product?
1. Feverfew
2. Goldenseal
3. Ginger
4. Ginkgo
Answer: 4
Explanation:
1. Feverfew does not have potential for decreasing the effects of anticonvulsants.
2. Goldenseal does not have potential for decreasing the effects of anticonvulsants.
3. Ginger does not have potential for decreasing the effects of anticonvulsants.
4. Of the listed herbs, ginkgo has the greatest potential for decreasing the effects of
anticonvulsants.
Page Ref: 101
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental
stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster
GRACompetencies:
DESMORE.CKnowledge
OM
patient engagement in their care. | NLN
and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 10-5 Describe the pharmacologic actions and safety of herbal and dietary
supplements.
MNL Learning Outcome: 10.4 Consider the pharmacological actions of herbal products and
specialty supplements and how they may interact with conventional drugs.
20
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WWW.GRADESMORE.COM
21) A client asks a nurse what the common complications are due to drug-herbal interactions.
How would the nurse respond?
1. Hair growth
2. Urine output
3. Vision loss
4. Blood coagulation
Answer: 4
Explanation:
1. Hair growth might be seen but is not as common as a different interaction.
2. Changes in urine output might be seen but is not as common as a different interaction.
3. Hair growth might be seen but is not as common as a different interaction.
4. Many herbal products increase bleeding potential and reduce the effects of
anticoagulant drugs.
Page Ref: 102
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental
stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster
GRACompetencies:
DESMORE.CKnowledge
OM
patient engagement in their care. | NLN
and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 10-5 Describe the pharmacologic actions and safety of herbal and dietary
supplements.
MNL Learning Outcome: 10.4 Consider the pharmacological actions of herbal products and
specialty supplements and how they may interact with conventional drugs.
21
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GRADESMORE.COM
WWW.GRADESMORE.COM
22) A student nurse asks a nurse how specialty supplements differ from herbal products. What
is the nurse's best response?
1. Specialty supplements must be prescribed.
2. Herbal products are more specific in their actions.
3. Specialty supplements are generally targeted for more general conditions.
4. Specialty supplements can come from animal sources.
Answer: 4
Explanation:
1. Prescriptions are not required.
2. They are generally more specific than herbs.
3. They are generally more specific than herbs and targeted for a smaller number of
conditions.
4. Specialty supplements can come from animal and plant sources.
Page Ref: 103
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.17 Develop a beginning understanding of complementary and
alternative modalities and their role in healthcare. | NLN Competencies: Knowledge and
GRADESMOREand
.Cquality
OM and safe patient care. |
Science: Relationships between knowledge/science
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 10-6 Identify common specialty supplements taken by patients.
MNL Learning Outcome: 10.4 Consider the pharmacological actions of herbal products and
specialty supplements and how they may interact with conventional drugs.
22
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
23) A client experiencing occasional minor digestive problems asks the nurse about herbal
therapy. What is the best response by the nurse?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Wheat grass
2. Green tea
3. Ginger
4. Grape seed
5. Stevia
Answer: 1, 2, 3
Explanation:
1. Wheat grass is used to improve digestion.
2. Green tea is used to decrease nausea and vomiting.
3. Ginger is used to decrease nausea.
4. Grape seed is an antioxidant.
5. Stevia is a natural sweetener.
Page Ref: 99
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
backgrounds function as sources of patient, family, and community values. | AACN Essential
Competencies: IX.17 Develop a beginning understanding of complementary and alternative
GRA
ESCompetencies:
MORE.COM Content and Environment: Show
modalities and their role in healthcare.
|D
NLN
respect for other's values; appreciate diversity. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 10-1 Explain the role of complementary and alternative medicine in
promoting patient wellness.
MNL Learning Outcome: 10.2 Recognize the standardization and uses of various formulations
of herbal products.
23
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GRADESMORE.COM
WWW.GRADESMORE.COM
24) A postmenopausal client with a history of stroke is told she cannot take female hormones
because of the risk for future thromboembolic events. The client asks about
nonpharmacologic ways to manage her symptoms. Which herbs does the nurse suggest as
alternatives?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Soy
2. Black cohosh
3. Evening primrose
4. Saw palmetto
5. Acai
Answer: 1, 2, 3
Explanation:
1. Soy is used to alleviate postmenopausal symptoms.
2. Black cohosh is used to alleviate postmenopausal symptoms.
3. Evening primrose is used to alleviate postmenopausal symptoms.
4. Saw palmetto is used to decrease prostate hyperplasia.
5. Acai is used as an antioxidant and for weight loss.
Page Ref: 98
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
GRADEfamily,
SMORand
E.Ccommunity
OM
backgrounds function as sources of patient,
values. | AACN Essential
Competencies: IX.17 Develop a beginning understanding of complementary and alternative
modalities and their role in healthcare. | NLN Competencies: Content and Environment: Show
respect for other's values; appreciate diversity. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 10-1 Explain the role of complementary and alternative medicine in
promoting patient wellness.
MNL Learning Outcome: 10.2 Recognize the standardization and uses of various formulations
of herbal products.
24
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GRADESMORE.COM
WWW.GRADESMORE.COM
25) A client with a family history of heart disease asks the nurse to recommend herbs that
decrease the risk for heart disease. The nurse suggests the client discuss which herbs with
the healthcare provider?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Flaxseed
2. Green tea
3. Soy
4. Milk thistle
5. Acai
Answer: 1, 2, 3
Explanation:
1. Flaxseed is believed to reduce the risk of heart disease.
2. Green tea is believed to decrease LDL and cholesterol, which may reduce the risk for
heart disease.
3. Soy is believed to help prevent cardiovascular disease.
4. Milk thistle is believed to be an antitoxin.
5. Acai is an antioxidant.
Page Ref: 98
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
GRADEfamily,
SMORand
E.Ccommunity
OM
backgrounds function as sources of patient,
values. | AACN Essential
Competencies: IX.17 Develop a beginning understanding of complementary and alternative
modalities and their role in healthcare. | NLN Competencies: Content and Environment: Show
respect for other's values; appreciate diversity. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 10-1 Explain the role of complementary and alternative medicine in
promoting patient wellness.
MNL Learning Outcome: 10.2 Recognize the standardization and uses of various formulations
of herbal products.
25
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GRADESMORE.COM
WWW.GRADESMORE.COM
26) A client with inflammatory arthritis asks about adding an anti-inflammatory herb to the
medication regimen to decrease the use of prescription drugs. The nurse suggests the client
discuss the efficacy of which herbs with the healthcare provider?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Evening primrose
2. St. John's wort
3. Ginger
4. Ginseng
5. Bilberry
Answer: 1, 2, 3
Explanation:
1. Evening primrose may be helpful in the relief of rheumatoid arthritis and other
inflammatory symptoms.
2. St. John's wort is believed to reduce inflammation.
3. Ginger is thought to reduce inflammation.
4. Ginseng is used to enhance the immune system.
5. Bilberry is an antioxidant.
Page Ref: 100
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social
GRADEfamily,
SMORand
E.Ccommunity
OM
backgrounds function as sources of patient,
values. | AACN Essential
Competencies: IX.17 Develop a beginning understanding of complementary and alternative
modalities and their role in healthcare. | NLN Competencies: Content and Environment: Show
respect for other's values; appreciate diversity. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 10-1 Explain the role of complementary and alternative medicine in
promoting patient wellness.
MNL Learning Outcome: 10.2 Recognize the standardization and uses of various formulations
of herbal products.
26
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27) A client who is considering taking a dietary supplement recommended by the nurse asks
how to determine if the supplement is safe. The nurse explains that the Dietary Supplement
and Nonprescription Drug Consumer Protection Act of 2007 requires that companies
marketing herbal and dietary supplements do which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Include their contact information on the label so consumers can report adverse effects.
2. Notify the Food and Drug Administration (FDA) within 15 days of receiving a report of an
adverse effect.
3. Keep records of adverse effects for at least 6 years and make these records available for
inspection by the Food and Drug Administration (FDA).
4. Demonstrate product effectiveness prior to release of the product to the public.
5. State which conditions the product is intended to cure or prevent.
Answer: 1, 2, 3
Explanation:
1. This legislation requires that the marketing company's contact information be listed on
the label.
2. The marketing company must notify the FDA of any reported adverse effects within 15
days.
3. The marketing company must keep records of reported adverse effects for at least 6
years and make those records available to the FDA for inspection.
4. The marketing company is not required to demonstrate the effectiveness of a product
prior to release to the public.GRADESMORE.COM
5. The marketing company cannot make the claim that a product can cure or prevent any
conditions.
Page Ref: 101
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.7 Discuss potential and actual impact of national patient
safety resources, initiatives, and regulations. | AACN Essential Competencies: V.1 Demonstrate
basic knowledge of healthcare policy, finance and regulatory environments; including local,
state, national and global healthcare trends. | NLN Competencies: Context and Environment:
Code of ethics; regulatory and professional standards. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 10-4 Analyze the strengths and weaknesses of legislation regulating herbal
and dietary supplements.
MNL Learning Outcome: 10.3 Examine the regulation of herbal products and dietary
supplements.
27
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28) The nurse is teaching clients in a senior center about complementary and alternative
therapies. Which statement by a client indicates understanding of the information the nurse
has presented?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "I see now that 'natural' doesn't really mean 'safe,' and I should ask my healthcare
provider about any supplements I want to take."
2. "I didn't realize some herbal supplements may be just as strong as a prescription drug. I
will need to discuss any supplements I want to try with my doctor."
3. "I understand now that when I choose to use a natural product over a prescription
medication, I could be delaying my recovery."
4. "It's good to know that herbs contain ingredients that are as powerful as a prescribed
medication and are an option for safe and effective therapy."
5. "I'm allergic to many foods. It's good to know that because herbal products are natural, I
don't have to worry about an allergic reaction."
Answer: 1, 2, 3
Explanation:
1. Many herbal products are not standardized and may contain dozens of active chemicals,
many of which have not been identified and studied, making these products potentially
unsafe.
2. Some herbs contain active chemicals that are just as powerful as approved prescription
medications.
RAan
DE
SMORE.
COM
3. Any time a client chooses to G
use
unproven
alternative
therapy instead of an
established, effective medical treatment, healing may be delayed.
4. Herbs may or may not be a safe option. The active ingredients can cause interactions
with other prescribed drugs.
5. It is not unusual for an herbal supplement to contain dozens of chemicals from the
flowers, leaves, or roots of the plant. Clients who have food allergies should consult with
their health provider before using any herbal product.
Page Ref: 104
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.7 Provide
appropriate patient teaching that reflects developmental stage, age, culture, spirituality,
patient preferences, and health literacy considerations to foster patient engagement in their
care. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science
and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 10-7 Discuss the role of the nurse in teaching patients about
complementary and alternative therapies.
MNL Learning Outcome: 10.1 Recognize the use of complementary and alternative medicine,
including its impact on healthcare and nursing.
28
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29) The client says, "I am convinced that the mind-body interventions I am using are improving
my health." The nurse would ask additional questions about which complementary and
alternative therapies that belong to this category?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Yoga
2. Massage
3. Dance
4. Herbal therapies
5. Biofeedback
Answer: 1, 2, 3, 5
Explanation:
1. Yoga is a type of mind-body intervention.
2. Massage is a type of mind-body intervention.
3. Dance is a type of mind-body intervention.
4. Herbal therapies are a type of biologic-based therapy.
5. Biofeedback is a type of mind-body intervention.
Page Ref: 98
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
GRADESMOand
RE.education;
COM
integration of care; information, communication,
physical comfort and
emotional support; involvement of family and friends; and transition and continuity. | AACN
Essential Competencies: IX.17 Develop a beginning understanding of complementary and
alternative modalities and their role in healthcare. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 10-1 Explain the role of complementary and alternative medicine in
promoting patient wellness.
MNL Learning Outcome: 10.1 Recognize the use of complementary and alternative medicine,
including its impact on healthcare and nursing.
29
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30) The client asks if there are any supplements that would help improve or preserve his
memory. Which supplements would the nurse discuss?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Carnitine
2. Coenzyme Q10
3. Glucosamine
4. DHEA
5. Selenium
Answer: 1, 4
Explanation:
1. Carnitine is used to improve memory.
2. Coenzyme Q10 is used to prevent heart disease and to provide antioxidant therapy.
3. Glucosamine is used to reduce symptoms of arthritis and other joint problems.
4. DHEA is used to improve memory.
5. Selenium is used to reduce risk of certain types of cancer.
Page Ref: 103
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of
patient-centered care: patient/family/community preferences, values; coordination and
integration of care; information, communication, and education; physical comfort and
GRADand
ESM
ORE.and
COMtransition and continuity. | AACN
emotional support; involvement of family
friends;
Essential Competencies: IX.17 Develop a beginning understanding of complementary and
alternative modalities and their role in healthcare. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 10-6 Identify common specialty supplements taken by patients.
MNL Learning Outcome: 10.1 Recognize the use of complementary and alternative medicine,
including its impact on healthcare and nursing.
30
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Pharmacology for Nurses, 6e (Adams)
Chapter 11 Emergency Preparedness and Poisonings
1) The nurse is teaching the importance of drugs for emergency preparedness to local firemen.
The nurse determines that learning has occurred when the firemen make which
statements?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "The vendor-managed inventory (VMI) package can reach any community within 24 to
36 hours."
2. "Our local hospital is supposed to be stockpiling antibiotics."
3. "The push package can reach any community within 12 hours of an attack."
4. "The Strategic National Stockpile is located at the Centers for Disease Control and
Prevention (CDC) in Atlanta."
5. "Our country's drug stockpile is managed by the Centers for Disease Control and
Prevention (CDC)."
Answer: 1, 3, 5
Explanation:
1. The vendor-managed inventory (VMI) package can reach any community within 24 to 36
hours.
2. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates
on the antibiotics.
GRADESMORE.COM
3. The push package can reach any community within 12 hours of an attack.
4. The Strategic National Stockpile is located at various sites throughout the country.
5. The Strategic National Stockpile is managed by the Centers for Disease Control and
Prevention (CDC).
Page Ref: 110
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 11-3 Identify the purpose and components of the Strategic National
Stockpile (SNS).
MNL Learning Outcome: 11.1 Examine the role of the professional nurse and the Strategic
National Stockpile in emergency preparedness.
1
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2) The nurse works for the Centers for Disease Control and Prevention (CDC). In planning for a
bioterrorist attack, what will the best plan of the nurse include?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Learn the signs and symptoms of chemical and biological agents.
2. Obtain a listing of health and law enforcement contacts.
3. Assist in the stockpiling of medications.
4. Obtain current knowledge of emergency management.
5. Assist in triage at local hospitals.
Answer: 1, 2, 4
Explanation:
1. The key roles of nurses in meeting the challenge of a potential bioterrorist event include
diagnosis and treatment (signs and symptoms of chemical and biological agents).
2. The key roles of nurses in meeting the challenge of a potential bioterrorist event include
resources (health and law enforcement contacts).
3. Stockpiling of medications is discouraged.
4. The key roles of nurses in meeting the challenge of a potential bioterrorist event include
education (knowledge).
5. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention
(CDC) would have a broader role than assisting local hospitals with triage.
Page Ref: 111
Cognitive Level: Applying
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 11-2 Discuss the role of the nurse in preparing for and responding to
worldwide epidemics and bioterrorist activity.
MNL Learning Outcome: 11.1 Examine the role of the professional nurse and the Strategic
National Stockpile in emergency preparedness.
2
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3) The client comes to the emergency department with an anxiety attack. He or she tells the
nurse he heard that there was another anthrax attack in the capitol, and is concerned about
running out of medications. What is the best response by the nurse?
1. "You don't need to worry about another attack at all; I think our government can take
care of us."
2. "Your health is in danger due to the anxiety; we really need to focus on reducing your
anxiety now."
3. "The Centers for Disease Control and Prevention (CDC) maintains a large stockpile of
medications for us in case that occurs."
4. "I'm sure the Centers for Disease Control and Prevention (CDC) has contingency plans in
the event of an anthrax attack."
Answer: 3
Explanation:
1. Telling the client not to worry is a nonspecific and patronizing response.
2. Reducing anxiety is important, but this response does not answer the client's concern.
3. The Centers for Disease Control and Prevention (CDC) maintains a stockpile of
antibiotics, vaccines, medical/surgical supplies, and other client-support supplies in the
event of a bioterrorist attack.
4. Telling the client that the Centers for Disease Control and Prevention (CDC) has
contingency plans is too vague and nonspecific.
Page Ref: 110
Cognitive Level: Applying
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 11-2 Discuss the role of the nurse in preparing for and responding to
worldwide epidemics and bioterrorist activity.
MNL Learning Outcome: 11.2 Consider biologic, chemical, and physical agents of terrorism and
treatment recommendations.
3
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4) The nurse is teaching a class on anthrax to a group of emergency response workers. The
nurse plans to include which of the following?
1. Anthrax is a deadly bacterium; the most common and deadly form is gastrointestinal
anthrax.
2. Cutaneous anthrax is the most common form, but inhaled anthrax is the most lethal
form.
3. Anthrax most commonly affects wild rodents such as mice, rats, squirrels, and
chipmunks.
4. Cutaneous anthrax is serious because it quickly spreads by person-to-person contact.
Answer: 2
Explanation:
1. Gastrointestinal anthrax is a rare form of anthrax.
2. Cutaneous anthrax is the most common, but inhalation anthrax is the most dangerous
form of anthrax.
3. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses.
4. Cutaneous anthrax cannot be spread by person-to-person contact.
Page Ref: 111
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
GRADEContext
SMOREand
.COEnvironment:
M
emergency situations. | NLN Competencies:
Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 11-4 Identify specific agents that would likely be used in a bioterrorist
attack.
MNL Learning Outcome: 11.1 Examine the role of the professional nurse and the Strategic
National Stockpile in emergency preparedness.
4
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5) The client has been exposed to anthrax. The nurse anticipates administering which of the
following drugs?
1. Penicillin (Bicillin LA) and vancomycin (Vancocin).
2. Tetracycline (Sumycin) and erythromycin (Erythrocin).
3. Ampicillin (Principen) and cefepime (Maxipime).
4. Ciprofloxacin (Cipro) and doxycycline (Vibramycin).
Answer: 4
Explanation:
1. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of
anthrax.
2. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the
treatment of anthrax.
3. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of
anthrax.
4. The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro)
and doxycycline (Vibramycin) in combination for treatment of anthrax.
Page Ref: 111
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
GRADEContext
SMOREand
.COEnvironment:
M
emergency situations. | NLN Competencies:
Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 11-6 Discuss the clinical manifestations and treatment of anthrax exposure.
MNL Learning Outcome: 11.3 Examine the pharmacologic management of poisoning, including
the pharmacologic profiles and considerations of prototype drugs presented.
5
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6) The client was exposed to cutaneous anthrax 2 weeks ago. What will the nurse see when
assessing the client's skin?
1. Large pustules and later, reddish scabs
2. Small, fluid-filled vesicles, and later, small skin erosions
3. Ulcerated areas and later, keloids
4. Small skin lesions and later, black scabs
Answer: 4
Explanation:
1. Large pustules and later, reddish scabs are not seen with cutaneous anthrax.
2. Small, fluid-filled vesicles and later, small skin erosions are not seen with cutaneous
anthrax.
3. Ulcerated areas and later, keloids are not seen with cutaneous anthrax.
4. Cutaneous anthrax manifests as small skin lesions that develop and turn into black
scabs.
Page Ref: 111
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
GRProcess:
ADESMAssessment
ORE.COM
Nursing/Integrated Concepts: Nursing
Learning Outcome: 11-6 Discuss the clinical manifestations and treatment of anthrax exposure.
MNL Learning Outcome: 11.2 Consider biologic, chemical, and physical agents of terrorism and
treatment recommendations.
6
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7) The nursing instructor is teaching student nurses about the use of viruses in a bioterrorism
attack. The nurse determines that learning has occurred when the students make which
statement?
1. "The Centers for Disease Control and Prevention (CDC) has a plan to vaccinate
Americans against most viruses."
2. "Actually, a bigger concern is a nuclear weapon exploding in a city."
3. "Most Americans have already been vaccinated against the lethal viruses."
4. "A bioterrorist attack with viruses is a real threat to Americans."
Answer: 4
Explanation:
1. The CDC does not have a plan to vaccinate Americans against most viruses.
2. At this time, a nuclear weapon does not pose a bigger threat to American citizens than
does a bioterrorism attack.
3. Most Americans have not been vaccinated against viruses.
4. There are no effective therapies for treating clients infected by most types of viruses
used in a bioterrorist attack.
Page Ref: 119
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
GRADEContext
SMOREand
.COEnvironment:
M
emergency situations. | NLN Competencies:
Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 11-4 Identify specific agents that would likely be used in a bioterrorist
attack.
MNL Learning Outcome: 11.1 Examine the role of the professional nurse and the Strategic
National Stockpile in emergency preparedness.
7
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GRADESMORE.COM
WWW.GRADESMORE.COM
8) The client tells the nurse that she is concerned about terrorist activity and questions if
everyone should be immunized against smallpox. What is the best response by the nurse?
1. "The vaccine has side effects, which are serious and could kill many people."
2. "I really do not think our country has enough vaccine to do this."
3. "Don't be so concerned; if an attack comes, we will immunize people then."
4. "The vaccine has some serious side effects, but this is probably a good idea."
Answer: 1
Explanation:
1. An estimated 75,000 Americans could die if all Americans were vaccinated against
smallpox.
2. There is enough vaccine for all Americans to be vaccinated against smallpox.
3. Telling a client not to be concerned is a condescending and nontherapeutic response.
4. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate
everyone against smallpox.
Page Ref: 113
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
GRProcess:
ADESMImplementation
ORE.COM
Nursing/Integrated Concepts: Nursing
Learning Outcome: 11-8 Explain the advantages and disadvantages of vaccination as a means
of preventing illness due to bioterrorist threats.
MNL Learning Outcome: 11.2 Consider biologic, chemical, and physical agents of terrorism and
treatment recommendations.
8
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9) A nurse who is presenting community education states, "Drugs are among our most
powerful weapons for emergency preparedness." What additional statements, made by the
nurse, would support this statement?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Drugs help us treat the diseases that could be caused by bioterrorism."
2. "We can use drugs to neutralize our enemies."
3. "If we control the manufacture and distribution of drugs, we will control global politics."
4. "Without drugs, we might be quickly overwhelmed by a bioterrorist attack."
5. "Drugs can be used in chemical or nuclear attacks."
Answer: 1, 4, 5
Explanation:
1. Drugs are a major treatment option for the types of diseases used in bioterrorism.
2. The nurse would not have knowledge of this level of emergency planning.
3. The nurse has no part in manufacture and distribution.
4. If there were no drugs to treat a bioterrorist-released organism, the medical systems
would soon become overwhelmed.
5. Drugs can be used to treat the results of chemical or nuclear warfare as well as
bioterrorism.
Page Ref: 108
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRDemonstrate
ADESMOREeffective
.COM use of strategies to reduce risk of
Standards: QSEN Competencies: V.B.2
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 11-1 Explain why drugs are important in the context of emergency
preparedness.
MNL Learning Outcome: 11.1 Examine the role of the professional nurse and the Strategic
National Stockpile in emergency preparedness.
9
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10) The client has been exposed to a nerve agent. For which symptoms will the nurse most
likely assess?
1. Salivation and involuntary urination
2. Dilated pupils and increased heart rate
3. Pinpoint pupils and decreased blood pressure
4. Rapid Tachypnea and cold, clammy skin
Answer: 1
Explanation:
1. Symptoms of nerve gas exposure are related to overstimulation of acetylcholine and can
result in salivation, involuntary urination, and convulsions. The nerve agent blocks
acetylcholinesterase.
2. Dilated pupils and increased blood pressure and heart rate are symptoms of
sympathetic nervous system stimulation.
3. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms
of overstimulation of acetylcholine.
4. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of
acetylcholine.
Page Ref: 113
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionGRADEcare
SMO
RE.Cdisaster,
OM mass casualty and other
making skills in appropriate, timely nursing
during
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 11-10 List top substances that represent human poison exposures.
MNL Learning Outcome: 11.2 Consider biologic, chemical, and physical agents of terrorism and
treatment recommendations.
10
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11) A nurse is caring for a client who has been exposed to a nerve agent. Which antidote will
the nurse plan to administer?
1. Apomorphine
2. Atropine
3. Acetate of ammonia
4. Hydroxyzine (Vistaril)
Answer: 2
Explanation:
1. Apomorphine will not reverse the symptoms of acetylcholine overstimulation.
2. Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine
overstimulation.
3. Acetate of ammonia will not reverse the symptoms of acetylcholine overstimulation.
4. Hydroxyzine (Vistaril) will not reverse the symptoms of acetylcholine overstimulation.
Page Ref: 114
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Implementation
GRADEantidotes
SMORE.used
COMto treat common overdosed
Learning Outcome: 11-12 Describe specific
substances and toxins.
MNL Learning Outcome: 11.3 Examine the pharmacologic management of poisoning, including
the pharmacologic profiles and considerations of prototype drugs presented.
11
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12) A small nuclear weapon has been detonated in a nearby city. Which immediate symptoms
of radiation sickness will the nurse assess in clients who have been exposed?
1. Dilated pupils and aggression
2. Nausea, vomiting, and diarrhea
3. Weight loss and fatigue
4. Anorexia and fatigue
Answer: 2
Explanation:
1. Dilated pupils and aggression are not signs of radiation sickness.
2. The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea.
3. Weight loss and fatigue are late symptoms of radiation sickness.
4. Anorexia and fatigue are not signs of radiation sickness.
Page Ref: 114
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 11-9 Describe the symptoms of acute radiation exposure and the role of
GRADEcancer.
SMORE.COM
potassium iodide (KI) in preventing thyroid
MNL Learning Outcome: 11.1 Examine the role of the professional nurse and the Strategic
National Stockpile in emergency preparedness.
12
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
13) The nurse administers potassium iodide (KI) tablets to a client who has been exposed to
radiation from a nuclear weapon. What is the rationale for administering potassium iodide
(KI) to this client?
1. Prevent thyroid cancer
2. Prevent brain cancer
3. Prevent liver cancer
4. Prevent renal cancer
Answer: 1
Explanation:
1. Potassium iodide (KI) can prevent up to 100% of the radioactive iodine from entering
the thyroid gland.
2. Potassium iodide (KI) will not protect the brain from the effects of radioactive iodine.
3. Potassium iodide (KI) will not protect the liver from the effects of radioactive iodine.
4. Potassium iodide (KI) will not protect the kidneys from the effects of radioactive iodine.
Page Ref: 114
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
GRProcess:
ADESMImplementation
ORE.COM
Nursing/Integrated Concepts: Nursing
Learning Outcome: 11-12 Describe specific antidotes used to treat common overdosed
substances and toxins.
MNL Learning Outcome: 11.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for poisoning or overdose.
13
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WWW.GRADESMORE.COM
14) The nurse conducts a seminar in a local community center on how citizens can be affected
by radiation from a nuclear attack. The nurse determines that the education is effective
when the clients make which statement?
1. "I can protect myself from cancers by taking potassium iodide (KI)."
2. "I need to stay inside my house for at least 2 days after the attack to be safe."
3. "I need to take at least four showers every day or I will develop skin ulcers."
4. "I am at risk to develop leukemia as a result of radiation exposure."
Answer: 4
Explanation:
1. Potassium iodide (KI) will only protect against thyroid cancer.
2. Radiation will not dissipate in 2 days.
3. Showers will not always protect the skin.
4. Leukemia is one of the long-term effects of radiation.
Page Ref: 114
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
GRsymptoms
ADESMOof
REacute
.COradiation
M
Learning Outcome: 11-9 Describe the
exposure and the role of
potassium iodide (KI) in preventing thyroid cancer.
MNL Learning Outcome: 11.1 Examine the role of the professional nurse and the Strategic
National Stockpile in emergency preparedness.
14
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GRADESMORE.COM
WWW.GRADESMORE.COM
15) The nurse is preparing an educational plan for parents about how to protect their children if
a bioterrorist attack occurs. What is the best information to include?
1. "Don't worry, the Centers for Disease Control and Prevention (CDC) has everything
under control."
2. "Plan to call the Centers for Disease Control and Prevention (CDC) if an attack occurs."
3. "Follow the Centers for Disease Control and Prevention (CDC) guidelines for
immunizations."
4. "Realistically, there is nothing that can be done."
Answer: 3
Explanation:
1. Telling parents not to worry and that the CDC has everything under control is
nontherapeutic and condescending information.
2. Phone lines to the CDC would be overwhelmed during an attack, so calling them would
elicit no information.
3. One of the roles of the Centers for Disease Control and Prevention (CDC) is to publicize
recommendations for immunizations.
4. Telling the parents that nothing can be done is not true and would leave the parents
feeling very powerless.
Page Ref: 109
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
GRACompetencies:
DESMORE.CVII.9
OM Use clinical judgment and decisionharm to self or others. | AACN Essential
making skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 11-2 Discuss the role of the nurse in preparing for and responding to
worldwide epidemics and bioterrorist activity.
MNL Learning Outcome: 11.1 Examine the role of the professional nurse and the Strategic
National Stockpile in emergency preparedness.
15
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WWW.GRADESMORE.COM
16) A student nurse asks a nurse what items are found within the Strategic National Stockpile
(SNS). What is the nurse's best response?
1. Two-way radios
2. Prepared meals
3. Drinking water
4. Antibiotics
Answer: 4
Explanation:
1. Two-way radios are not included in the SNS.
2. Prepared meals are not included in the SNS.
3. Drinking water is not included in the SNS.
4. The SNS consists of antibiotics, vaccines and medical, surgical and patient support
supplies such as bandages, airway supplies, and IV equipment.
Page Ref: 110
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Planning
RADESand
MORcomponents
E.COM of the Strategic National
Learning Outcome: 11-3 Identify theGpurpose
Stockpile (SNS).
MNL Learning Outcome: 11.1 Examine the role of the professional nurse and the Strategic
National Stockpile in emergency preparedness.
16
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GRADESMORE.COM
WWW.GRADESMORE.COM
17) A nurse is planning a presentation regarding anthrax. What should the nurse include?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Anthrax can spread easily.
2. There are three basic types of anthrax.
3. Anthrax is killed by heat.
4. The main area affected by inhalation anthrax is the lung periphery.
5. Anthrax causes the release of multiple toxins, each affecting a different part of the body.
Answer: 1, 2
Explanation:
1. Anthrax spreads easily.
2. The types of anthrax are cutaneous, gastrointestinal, and inhalation.
3. Anthrax is spore forming and is not killed by drying, heat, or many harsh chemicals. It
can live in soil for hundreds or thousands of years.
4. The main area affected by inhalation anthrax is the mediastinum.
5. There are two toxins emitted by the bacterium.
Page Ref: 111
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
GRADEContext
SMOREand
.COEnvironment:
M
emergency situations. | NLN Competencies:
Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 11-5 Explain the threat of anthrax contamination and how anthrax is
transmitted.
MNL Learning Outcome: 11.2 Consider biologic, chemical, and physical agents of terrorism and
treatment recommendations.
17
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WWW.GRADESMORE.COM
18) Following a bioterrorism attack, the nurse finds that the victims are suffering from small,
black lesions on their forearms. The nurse collaborates with the healthcare provider to treat
exposure to which agent?
1. Cutaneous anthrax
2. Phosgene gas
3. Gastrointestinal anthrax
4. Hydrogen cyanide
Answer: 1
Explanation:
1. Cutaneous anthrax produces small, black lesions on the skin.
2. Phosgene gas causes frostbite-type lesions.
3. Gastrointestinal anthrax causes sore throat, difficulty swallowing, cramping, diarrhea,
and abdominal swelling.
4. Hydrogen cyanide causes flushing of the skin.
Page Ref: 111
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
GRProcess:
ADESMImplementation
ORE.COM
Nursing/Integrated Concepts: Nursing
Learning Outcome: 11-6 Discuss the clinical manifestations and treatment of anthrax exposure.
MNL Learning Outcome: 11.3 Examine the pharmacologic management of poisoning, including
the pharmacologic profiles and considerations of prototype drugs presented.
18
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WWW.GRADESMORE.COM
19) A nurse is planning a discussion of emergency preparedness with newly hired nurses. Which
events would this nurse use as historical examples of terrorism?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The death of a client in a Texas hospital was confirmed to be due to the Ebola virus.
2. Many people died as a result of sarin gas exposure in a Tokyo subway.
3. Twenty-two confirmed or suspected cases of anthrax infection occurred as a result of
the bacillus being sent through U.S. mail.
4. There is typically a marked increase in overdoses during winter holidays.
5. More people are contracting H1N1 avian influenza.
Answer: 2, 3
Explanation:
1. The client had been exposed to Ebola while traveling overseas. No bioterrorism was
suspected.
2. The release of sarin gas was determined to be intentional and was called an act of
terrorism.
3. The exposure of persons to anthrax via contaminated mail was determined to be an act
of domestic terrorism.
4. The increase in overdoses is typically due to holiday strain put on persons with fragile
mental health.
5. As far as is known, H1N1 avian influenza's crossover to humans is related to natural
mutations.
GRADESMORE.COM
Page Ref: 111
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 11-4 Identify specific agents that would likely be used in a bioterrorist
attack.
MNL Learning Outcome: 11.1 Examine the role of the professional nurse and the Strategic
National Stockpile in emergency preparedness.
19
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WWW.GRADESMORE.COM
20) A client is admitted to the emergency department with suspected exposure to anthrax. The
nurse anticipates the healthcare provider will prescribe which medication?
1. Anthrax vaccination
2. Atropine
3. Ciprofloxacin
4. Antiviral agents
Answer: 3
Explanation:
1. Anthrax vaccine is available to a limited population but would not be used for treatment
after exposure.
2. Atropine is not indicated for bacterial infections.
3. Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax.
4. Antiviral agents are not indicated for bacterial infections.
Page Ref: 112
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Planning
GRADEofStreatments
MORE.COthat
M might be applied during a
Learning Outcome: 11-7 Provide examples
bioterrorism incident.
MNL Learning Outcome: 11.3 Examine the pharmacologic management of poisoning, including
the pharmacologic profiles and considerations of prototype drugs presented.
20
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WWW.GRADESMORE.COM
21) A nurse is teaching a student nurse about common treatments for victims of bioterrorism.
The nurse tells the student that atropine would be most useful for a victim of bioterrorism
exposed to which of the following?
1. Ionizing radiation
2. Nerve gas
3. Bacterial agents
4. Viral agents
Answer: 2
Explanation:
1. Atropine is not useful as treatment for exposure to ionizing radiation.
2. Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine.
Atropine blocks the attachment of this neurotransmitter to receptor sites.
3. Atropine is not useful as treatment for exposure to bacterial agents.
4. Atropine is not useful as treatment for exposure to viral agents.
Page Ref: 113
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
GRProcess:
ADESMImplementation
ORE.COM
Nursing/Integrated Concepts: Nursing
Learning Outcome: 11-12 Describe specific antidotes used to treat common overdosed
substances and toxins.
MNL Learning Outcome: 11.3 Examine the pharmacologic management of poisoning, including
the pharmacologic profiles and considerations of prototype drugs presented.
21
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GRADESMORE.COM
WWW.GRADESMORE.COM
22) A nurse is caring for a client following a bioterrorism attack. The client has experienced
initial nausea and vomiting followed by weight loss and eventual thyroid cancer. What was
the most likely causative agent?
1. Chemical agent
2. Viral agent
3. Bacterial agent
4. Ionizing radiation
Answer: 4
Explanation:
1. Exposure to chemical agents is likely to cause convulsions and loss of consciousness.
2. Exposure to viral agents may cause nausea, vomiting, and weight loss, but cancer
development is not expected.
3. Exposure to bacterial agents may cause nausea, vomiting, and weight loss, but cancer
development is not expected.
4. Exposure to radiation causes weight loss and eventual thyroid cancer.
Page Ref: 113
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
GR
ADESMOREby.ambiguity
COM
support decision making in situations
characterized
and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 11-9 Describe the symptoms of acute radiation exposure and the role of
potassium iodide (KI) in preventing thyroid cancer.
MNL Learning Outcome: 11.2 Consider biologic, chemical, and physical agents of terrorism and
treatment recommendations.
22
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
23) A client was exposed to ionizing radiation. The nurse plans to administer which of the
following medications?
1. Potassium-iodine tablets
2. Calcium tablets
3. Antibiotics
4. Salt tablets
Answer: 1
Explanation:
1. Potassium-iodine tablets are the only recognized therapy for radiation exposure.
2. Calcium tablets are not recognized therapy for radiation exposure.
3. Antibiotics are not recognized therapy for radiation exposure.
4. Salt tablets are not recognized therapy for radiation exposure.
Page Ref: 113
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 11-9 Describe the symptoms of acute radiation exposure and the role of
GRADEcancer.
SMORE.COM
potassium iodide (KI) in preventing thyroid
MNL Learning Outcome: 11.3 Examine the pharmacologic management of poisoning, including
the pharmacologic profiles and considerations of prototype drugs presented.
23
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
24) A nurse is admitting a client to the emergency department who has overdosed on a
benzodiazepine. The nurse should anticipate the healthcare provider will prescribe which of
the following drugs?
1. Acetylcysteine
2. Digibind
3. Romazicon
4. Acetaminophen
Answer: 3
Explanation:
1. Acetylcysteine (Acetadote) is the antidote for acetaminophen overdose.
2. Digibind is the antidote for digoxin overdose.
3. Flumazenil (Romazicon) is the antidote for benzodiazepine overdose.
4. Acetaminophen is not an antidote for poisoning.
Page Ref: 116
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Planning
GRADEantidotes
SMORE.used
COMto treat common overdosed
Learning Outcome: 11-12 Describe specific
substances and toxins.
MNL Learning Outcome: 11.3 Examine the pharmacologic management of poisoning, including
the pharmacologic profiles and considerations of prototype drugs presented.
25) A nurse working in the emergency department is told that the smallpox virus was
aerosolized at a parade attended by thousands of people. The nurse explains to the student
nurse that the vaccine for this virus provides a high level of protection if given within
________ days of exposure.
Answer: 3
Explanation: The variola vaccine provides a high level of protection if given prior to exposure or
up to 3 days after exposure.
Page Ref: 113
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 11-8 Explain the advantages and disadvantages of vaccination as a means
24
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GRADESMORE.COM
WWW.GRADESMORE.COM
of preventing illness due to bioterrorist threats.
MNL Learning Outcome: 11.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for poisoning or overdose.
26) A student nurse asks a nurse what is included in the Strategic National Stockpile (SNS). The
nurse explains that the SNS includes which of the following supplies?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply
1. Intravenous administration equipment
2. Antibiotics
3. Life-support medications
4. Chemical antidotes
5. Hospital beds
Answer: 1, 2, 3, 4
Explanation:
1. The Strategic National Stockpile (SNS), a national repository of medical equipment,
includes intravenous (IV) administration equipment.
2. The Strategic National Stockpile (SNS), a national repository of medical equipment,
includes antibiotics.
3. The Strategic National Stockpile (SNS), a national repository of medical equipment,
includes life-support medications.
4. The Strategic National Stockpile (SNS), a national repository of medical equipment,
includes chemical antidotes. GRADESMORE.COM
5. The Strategic National Stockpile (SNS), a national repository of medical equipment, does
not include hospital beds.
Page Ref: 110
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 11-3 Identify the purpose and components of the Strategic National
Stockpile (SNS).
MNL Learning Outcome: 11.1 Examine the role of the professional nurse and the Strategic
National Stockpile in emergency preparedness.
25
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
27) A nurse is caring for a client that was exposed to radiation. The client asks the nurse what
factors increase the amount of radiation that a person is exposed to. What should the nurse
include in responding to the client's question?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The amount of exposure
2. The long-lasting effects
3. The amount of cellular death
4. The gender of the client exposed
5. The amount of naloxone (Narcan) ingested after exposure
Answer: 1, 2, 3
Explanation:
1. Radiation exposure can cause mass casualty deaths at the point of impact and create
residual ionizing radiation for miles around the site. Some radioisotopes emit radiation
for decades and even centuries.
2. Death may not be immediate but may result from long-lasting effects.
3. When exposed to large amounts of radiation, or to small amounts over many decades,
clients tend to develop certain malignancies (cellular death) such as leukemia or thyroid
cancer.
4. Gender is not a determinant of radiation exposure danger.
5. Naloxone (Narcan) is not used to treat radiation exposure.
Page Ref: 113
GRADESMORE.COM
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 11-9 Describe the symptoms of acute radiation exposure and the role of
potassium iodide (KI) in preventing thyroid cancer.
MNL Learning Outcome: 11.2 Consider biologic, chemical, and physical agents of terrorism and
treatment recommendations.
26
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
28) A client has been admitted to the emergency department for treatment of poison ingestion.
Gastric lavage and placement of activated charcoal has been prescribed. The nurse would
withhold this treatment and collaborate with the prescriber if which instances occur?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The client vomits.
2. The client becomes unconscious.
3. The client discloses that lithium was the drug taken.
4. Paramedics report that it has been 2 hours since the drug was taken.
5. The client begins to pass copious amounts of watery diarrhea.
Answer: 2, 3, 4
Explanation:
1. It is not possible to determine if all the drug has been vomited or how much has already
passed into the intestine.
2. If protective airway reflexes are lost, gastric lavage is contraindicated.
3. Activated charcoal does not bind well to lithium.
4. Both of these interventions are more effective if performed within 1 hour of ingestion.
5. It is unknown if the drug is passing in the diarrhea.
Page Ref: 115
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
GRACompetencies:
DESMORE.CVII.9
OM Use clinical judgment and decisionharm to self or others. | AACN Essential
making skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 11-11 Explain fundamental elements of toxicity treatment provided by the
nurse.
MNL Learning Outcome: 11.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for poisoning or overdose.
27
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WWW.GRADESMORE.COM
29) A nurse is caring for a client admitted to the emergency department following a drug
overdose. The nurse anticipates which of the following prescriptions to enhance removal of
the poison from the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Administering activated charcoal
2. Changing the pH of urine
3. Preparing the client for enemas
4. Inserting a nasogastric tube
5. Preparing corticosteroids for administration
Answer: 1, 2, 3, 4
Explanation:
1. Charcoal works by binding with the poison agent.
2. Changing the pH of the urine may help to increase excretion.
3. Whole bowel irritation may be considered.
4. A nasogastric tube might be needed for lavage of stomach contents.
5. Corticosteroids are not used to enhance the removal of poison from the body.
Page Ref: 114
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionGRADEcare
SMO
RE.Cdisaster,
OM mass casualty and other
making skills in appropriate, timely nursing
during
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 11-11 Explain fundamental elements of toxicity treatment provided by the
nurse.
MNL Learning Outcome: 11.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for poisoning or overdose.
28
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30) A client who has traveled to an area where Ebola is present is hospitalized with fever and
malaise. The nurse anticipates this client will be considered potentially infectious for the
length of the ________ day incubation period.
Answer: 21
Explanation: The incubation period for Ebola is 21 days.
Page Ref: 109
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of
harm to self or others. | AACN Essential Competencies: VII.9 Use clinical judgment and decisionmaking skills in appropriate, timely nursing care during disaster, mass casualty and other
emergency situations. | NLN Competencies: Context and Environment: Apply evidence to
support decision making in situations characterized by ambiguity and uncertainty. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 11-7 Provide examples of treatments that might be applied during a
bioterrorism incident.
MNL Learning Outcome: 11.2 Consider biologic, chemical, and physical agents of terrorism and
treatment recommendations.
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29
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Pharmacology for Nurses, 6e (Adams)
Chapter 12 Cholinergic Drugs Affecting the Autonomic Nervous System
1) A client's heart rate is 72 beats per minute with a regular rhythm. How does the nurse
interpret this data in relation to the client's peripheral nervous system?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The sympathetic system is in control.
2. The parasympathetic system is dominating.
3. Both parasympathetic and sympathetic systems are influencing cardiac status.
4. The autonomic nervous system is affecting cardiac status.
5. The somatic nervous system is affecting cardiac status.
Answer: 2, 3, 4
Explanation:
1. If the sympathetic system was in control, the heart rate would be accelerated.
2. Restful cardiac response indicates that the primary input is from the parasympathetic
system.
3. These two systems work in tandem to regulate the cardiac response.
4. Both the sympathetic and parasympathetic systems are part of the autonomic system.
5. The somatic system is separate from the autonomic system.
Page Ref: 121
Cognitive Level: Analyzing
GRADESMORE.COM
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 12-2 Identify important divisions of the peripheral nervous system.
MNL Learning Outcome: 12.1 Examine the branches and communications of the nervous
system and how they relate to the neuropharmacology of the autonomic nervous system.
1
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2) A nurse is reading about the development of drugs that inhibit the parasympathetic nervous
system. The nurse would look for articles about which drug classes?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Anticholinergics
2. Parasympathomimetics
3. Parasympatholytics
4. Cholinergics
5. Muscarinic blockers
Answer: 1, 3, 5
Explanation:
1. Anticholinergics inhibit the parasympathetic nervous system.
2. Parasympathomimetic drugs stimulate the parasympathetic nervous system.
3. Parasympatholytic drugs inhibit the parasympathetic nervous system.
4. Cholinergic drugs stimulate the parasympathetic nervous system.
5. Muscarinic blockers inhibit the parasympathetic nervous system.
Page Ref: 126
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
GRApatient
DESMOcare.
RE.|CNursing/Integrated
OM
knowledge/science and quality and safe
Concepts: Nursing
Process: Implementation
Learning Outcome: 12-6 Discuss the classification and naming of cholinergic drugs based on
possible actions.
MNL Learning Outcome: 12.2 Recognize how autonomic drugs exert their effects by acting at
synapses and how they are classified.
2
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3) Which is an adrenergic receptor associated with the sympathetic nervous system?
1. Beta
2. Dopamine
3. Muscarinic
4. Norepinephrine
Answer: 1
Explanation:
1. The adrenergic receptors associated with the sympathetic nervous system include both
beta and alpha receptors.
2. A dopamine is a neurotransmitter in the brain.
3. Muscarinic receptors are cholinergic receptors in the parasympathetic system.
4. Norepinephrine is a chemical in the body that is both a stress hormone and a
neurotransmitter.
Page Ref: 121
Cognitive Level: Remembering
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 12-4 Explain how information is transmitted throughout the nervous
GRADEStoMO
REparasympathetic
.COM
system and the neurotransmitters important
the
nervous system.
MNL Learning Outcome: 12.1 Examine the branches and communications of the nervous
system and how they relate to the neuropharmacology of the autonomic nervous system.
3
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4) A client has been prescribed an oral drug containing atropine. The nurse would hold the
drug and contact the prescriber if the client states which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "I would like to wait a few minutes to take this as I just drank some aloe juice."
2. "Can I take this at the same time as my procainamide?"
3. "I have had a headache this morning."
4. "I am allergic to penicillin."
5. "My gallbladder surgery is scheduled for next week."
Answer: 1, 2
Explanation:
1. Atropine should be used with caution in those who use aloe.
2. There is a drug-drug interaction between atropine and procainamide.
3. Headache does not prevent use of atropine.
4. Allergy to penicillin does not prevent use of atropine.
5. Gallbladder surgery for next week would not prevent use of atropine.
Page Ref: 128
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
GRADESMOacross
RE.Cthe
OMhealth-illness continuum, across
medical management, and nursing management
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 12-8 For each of the drug classes listed in Drugs at a Glance, discuss
representative drugs and explain their mechanism of action, primary actions, and important
adverse effects.
MNL Learning Outcome: 12.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with cholinergic agonist and antagonist agents.
4
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5) The nurse has completed medication education about pyridostigmine (Mestinon), an
indirect cholinergic drug, for a client with myasthenia gravis. The nurse determines that
learning has occurred when the client makes which statement?
1. "My heart may beat slower while I am on this drug."
2. "I will need to increase my fluid intake with this medication."
3. "I must take this medication immediately before eating a full meal."
4. "It is really important to take my medication on time."
Answer: 4
Explanation:
1. Heart rate is typically increased by anticholinergic drugs.
2. There is no reason to increase fluid intake with this drug.
3. There is no reason this drug should be taken immediately prior to eating a full meal.
4. Maintaining an optimum blood level of the drug is crucial in promoting muscle
functioning, so it is important for the client to take his medication on time and as
directed.
Page Ref: 128
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
GRADESMORE.COM
Process: Evaluation
Learning Outcome: 12-9 Apply the nursing process to care for patients receiving
pharmacotherapy with cholinergic drugs and cholinergic-blocking drugs.
MNL Learning Outcome: 12.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with cholinergic agonist and antagonist agents.
5
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6) The healthcare provider has ordered bethanechol (Urecholine), a cholinergic drug, for the
client with urinary retention. The client also has an enlarged prostate gland. What is the
priority action by the nurse?
1. Hold the drug and prepare to catheterize the client.
2. Administer the drug and measure urinary output.
3. Administer the drug and push fluids.
4. Hold the drug and contact the healthcare provider.
Answer: 4
Explanation:
1. There should be no need for catheterization.
2. Measuring urinary output is not the best answer.
3. Pushing fluids would exacerbate the problem.
4. Bethanechol (Urecholine) relaxes the urinary sphincter and increases voiding pressure.
It is contraindicated with any physical obstruction of the urinary tract, such as an
enlarged prostate gland.
Page Ref: 127
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
GRcontinuum,
ADESMORacross
E.COlifespan,
M
management across the health-illness
and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 12-7 Describe the nurse's role in the pharmacologic management of
patients receiving drugs affecting the parasympathetic nervous system.
MNL Learning Outcome: 12.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with cholinergic agonist and antagonist agents.
6
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7) A preoperative client will be receiving glycopyrrolate (Robinul), which is an anticholinergic
drug. The client asks the nurse, "Why do I need to take that medication?" What is the best
response by the nurse?
1. "It will decrease your respiratory secretions during surgery."
2. "It will increase your urinary output during surgery."
3. "It will help you breathe better during surgery."
4. "It will help maintain your blood pressure during surgery."
Answer: 1
Explanation:
1. Anticholinergics dry secretions; a decrease in respiratory secretions is indicated prior to
surgery.
2. Anticholinergic drugs do not increase urinary output.
3. Anticholinergic drugs do not facilitate respirations.
4. Anticholinergic drugs do not maintain blood pressure.
Page Ref: 132
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Implementation
GRADEprocess
SMORE
COMfor patients receiving
Learning Outcome: 12-9 Apply the nursing
to.care
pharmacotherapy with cholinergic drugs and cholinergic-blocking drugs.
MNL Learning Outcome: 12.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with cholinergic agonist and antagonist agents.
7
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8) The nurse is preparing to administer benztropine (Cogentin), which is an anticholinergic
drug. The nurse understands this drug is contraindicated in which client?
1. The client with a fractured femur
2. The client with tachycardia
3. The client with an irritable colon
4. The client with diarrhea
Answer: 2
Explanation:
1. There is no contraindication with a fractured femur and anticholinergic drugs.
2. Anticholinergic drugs increase the heart rate; a client with tachycardia should not
receive benztropine (Cogentin).
3. Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with an irritable
colon.
4. Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with diarrhea.
Page Ref: 132
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Planning
GRADEprocess
SMORE
COMfor patients receiving
Learning Outcome: 12-9 Apply the nursing
to.care
pharmacotherapy with cholinergic drugs and cholinergic-blocking drugs.
MNL Learning Outcome: 12.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with cholinergic agonist and antagonist agents.
8
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9) The nurse is preparing to administer medications to a group of clients. One of the
medications is atropine, an anticholinergic drug. This drug is contraindicated in which
client?
1. The client with glaucoma
2. The client with hyperthyroidism
3. The client with a hiatal hernia
4. The client with lung cancer
Answer: 1
Explanation:
1. Anticholinergic drugs can increase pressure in the eye; they must be avoided in clients
with glaucoma.
2. Anticholinergic drugs are not contraindicated in clients with hyperthyroidism.
3. Anticholinergic drugs are not contraindicated in clients with a hiatal hernia.
4. Anticholinergic drugs are not contraindicated in clients with lung cancer.
Page Ref: 132
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
GRADEand
SMquality
ORE.and
COMsafe patient care. |
Relationships between knowledge/science
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 12-8 For each of the drug classes listed in Drugs at a Glance, discuss
representative drugs and explain their mechanism of action, primary actions, and important
adverse effects.
MNL Learning Outcome: 12.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with cholinergic agonist and antagonist agents.
9
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10) The healthcare provider orders dicyclomine (Bentyl), an anticholinergic drug, for a client.
What is the nurse's priority assessment prior to administering this drug?
1. Does the client have light sensitivity?
2. Is the client able to urinate?
3. Does the client have a history of alcoholism?
4. Is the client dizzy upon standing?
Answer: 2
Explanation:
1. Anticholinergic drugs are not contraindicated in a client with light sensitivity.
2. Anticholinergic drugs can cause or increase urinary hesitancy or retention.
3. Anticholinergic drugs are not contraindicated in a client with a history of alcoholism.
4. Anticholinergic drugs are not contraindicated in a client who is dizzy.
Page Ref: 129
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 12-9 Apply the nursing process to care for patients receiving
pharmacotherapy with cholinergic drugs and cholinergic-blocking drugs.
RAD
ESMOprocess
RE.COinMthe care of patients receiving
MNL Learning Outcome: 12.4 UtilizeGthe
nursing
pharmacotherapy with cholinergic agonist and antagonist agents.
11) The client is quadriplegic and receives the anticholinergic drug oxybutynin (Ditropan) to
increase his bladder capacity. What is an important assessment of this client by the nurse?
1. Is he irritable?
2. Is he constipated?
3. Is he gaining weight?
4. Is he lethargic?
Answer: 2
Explanation:
1. Anticholinergic drugs do not cause irritability.
2. Anticholinergics slow gastrointestinal (GI) motility and can increase the risk for
constipation.
3. Anticholinergic drugs do not cause weight gain.
4. Anticholinergic drugs do not cause lethargy.
Page Ref: 132
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
10
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GRADESMORE.COM
WWW.GRADESMORE.COM
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 12-9 Apply the nursing process to care for patients receiving
pharmacotherapy with cholinergic drugs and cholinergic-blocking drugs.
MNL Learning Outcome: 12.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with cholinergic agonist and antagonist agents.
12) The nursing instructor teaches the student nurses about the nervous system. The instructor
determines that learning has occurred when the students make which statement(s)?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "The central nervous system includes the brain and spinal cord."
2. "The peripheral nervous system has mainly sensory functions."
3. "The somatic nervous system gives us voluntary control over our gastrointestinal (GI)
tract."
4. "The nervous system helps us react to environmental changes."
5. "The somatic nervous system gives us voluntary control over moving."
Answer: 1, 4, 5
Explanation:
1. The central nervous system includes the brain and spinal cord.
2. The peripheral nervous system has both sensory and motor divisions.
3. The somatic nervous system gives voluntary control over skeletal muscles.
RADESto
MOenvironmental
RE.COM changes.
4. The nervous system providesGreaction
5. The somatic nervous system provides voluntary control over moving.
Page Ref: 123
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 12-2 Identify important divisions of the peripheral nervous system.
MNL Learning Outcome: 12.1 Examine the branches and communications of the nervous
system and how they relate to the neuropharmacology of the autonomic nervous system.
11
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WWW.GRADESMORE.COM
13) The nursing instructor teaches the student nurses about the autonomic nervous system.
The instructor determines that learning has occurred when the students make which
statement(s)?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "The sympathetic and parasympathetic systems are not always opposite in their
effects."
2. "The parasympathetic nervous system is the 'fight-or-flight' response."
3. "Sympathetic stimulation causes dilation of arterioles."
4. "The parasympathetic nervous system causes bronchial constriction."
5. "The sympathetic nervous system is activated under stress."
Answer: 1, 4, 5
Explanation:
1. The sympathetic and parasympathetic systems are not always opposite in their effects.
2. The parasympathetic nervous system is the rest-and-digest response.
3. Sympathetic stimulation causes constriction of arterioles.
4. The parasympathetic nervous system causes bronchial constriction.
5. The sympathetic nervous system is activated under stress.
Page Ref: 124
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
GRADEIII.1
SMO
RE.Cthe
OMinterrelationships among theory,
processes. | AACN Essential Competencies:
Explain
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 12-3 Compare and contrast the actions of the parasympathetic and
sympathetic divisions of the autonomic nervous system.
MNL Learning Outcome: 12.1 Examine the branches and communications of the nervous
system and how they relate to the neuropharmacology of the autonomic nervous system.
12
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14) The student nurse asks the nursing instructor, "Do medications actually make more
neurotransmitters?" What is the best response by the nursing instructor?
1. "No, but medications can heal diseases of the autonomic nervous system."
2. "Yes, some of the newer medications are very good at doing this."
3. "Yes, but the newer drugs that do this have some serious side effects."
4. "No, medications can only increase or decrease the action of neurotransmitters."
Answer: 4
Explanation:
1. There are virtually no diseases of the autonomic nervous system to heal.
2. Even the newest medications cannot manufacture new neurotransmitters.
3. Medications cannot manufacture new neurotransmitters, even if they have serious side
effects.
4. Medications cannot manufacture new neurotransmitters; they can only increase or
decrease their action.
Page Ref: 124
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Implementation
GRinformation
ADESMORisEtransmitted
.COM
Learning Outcome: 12-4 Explain how
throughout the nervous
system and the neurotransmitters important to the parasympathetic nervous system.
MNL Learning Outcome: 12.1 Examine the branches and communications of the nervous
system and how they relate to the neuropharmacology of the autonomic nervous system.
13
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15) A student nurse asks a nursing instructor which part of the nervous system primarily
regulates the ability of a person to use his arm muscles to lift a weight. What is the
instructor's best response?
1. Somatic nervous system
2. Sympathetic nervous system
3. Autonomic nervous system
4. Parasympathetic nervous system
Answer: 1
Explanation:
1. The somatic nervous system (a division of the peripheral nervous system) controls
voluntary movement such as lifting a weight.
2. The sympathetic nervous system is a division of the autonomic nervous system.
3. The autonomic nervous system involves involuntary responses.
4. The parasympathetic nervous system is a division of the autonomic nervous system.
Page Ref: 122
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Implementation
GRcontrast
ADESMO
REactions
.COMof the parasympathetic and
Learning Outcome: 12-3 Compare and
the
sympathetic divisions of the autonomic nervous system.
MNL Learning Outcome: 12.1 Examine the branches and communications of the nervous
system and how they relate to the neuropharmacology of the autonomic nervous system.
14
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16) A nursing instructor is teaching student nurses about the sympathetic nervous system. The
instructor recognizes that learning has occurred when the students say which of the
following responses are regulated by the sympathetic nervous system?
1. Bronchial constriction
2. Stimulates salivation
3. Sex organ stimulation
4. Pupil dilation
Answer: 4
Explanation:
1. The sympathetic nervous system increases heart rate, but the parasympathetic system
constricts bronchioles.
2. Parasympathetic innervation dilates peripheral arteries and stimulates digestion.
3. The sympathetic system inhibits salivation and stimulates sex organs.
4. Relaxation of the bladder and pupil dilation is regulated by the sympathetic nervous
system.
Page Ref: 123
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
GRADESMORE.COM
Process: Evaluation
Learning Outcome: 12-3 Compare and contrast the actions of the parasympathetic and
sympathetic divisions of the autonomic nervous system.
MNL Learning Outcome: 12.1 Examine the branches and communications of the nervous
system and how they relate to the neuropharmacology of the autonomic nervous system.
15
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17) A nurse is working with a student nurse. The nurse explains what a client would experience
if the adrenergic receptors are activated. Which of the following comments by the student
nurse indicates that the education was effective?
1. Fight-or-flight effects
2. Rest-and-digest effects
3. Increased blood volume
4. Bronchial constriction
Answer: 1
Explanation:
1. Adrenergic receptors are found within the sympathetic nervous system. Sympathetic
nervous system activation produces the fight-or-flight response.
2. Adrenergic receptors are found within the sympathetic nervous system.
Parasympathetic nervous system activation produces the rest-and-digest response.
3. Blood volume increases are not specifically controlled by the nervous system, but
distribution of blood is under nervous system control.
4. Adrenergic receptors are found within the sympathetic nervous system.
Parasympathetic nervous system activation initiates bronchial constriction.
Page Ref: 122
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
GRADESKnowledge
MORE.COand
M Science: Relationships between
practice, and research. | NLN Competencies:
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 12-3 Compare and contrast the actions of the parasympathetic and
sympathetic divisions of the autonomic nervous system.
MNL Learning Outcome: 12.1 Examine the branches and communications of the nervous
system and how they relate to the neuropharmacology of the autonomic nervous system.
16
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18) A student nurse is reviewing the autonomic nervous system. The student understands that
which substance would inhibit the function of the autonomic nervous system?
1. Drugs that bind and then stimulate the postsynaptic neuron
2. Drugs that prohibit neurotransmitter reuptake
3. Drugs that increase neurotransmitter synthesis
4. Drugs that prevent the storage of neurotransmitter in vesicles
Answer: 4
Explanation:
1. Stimulation of the postsynaptic neuron would enhance function.
2. Prohibiting neurotransmitter intake would lower the amount available.
3. Increasing neurotransmitter synthesis would decrease the amount available.
4. The more neurotransmitter available, the greater the function/stimulation of the
autonomic nervous system.
Page Ref: 124
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 12-5 Compare and contrast the types of responses that occur when drugs
GRADESMORE.COM
activate nicotinic or muscarinic receptors.
MNL Learning Outcome: 12.2 Recognize how autonomic drugs exert their effects by acting at
synapses and how they are classified.
17
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19) A nursing instructor is reviewing receptor types with a nursing student. The instructor
identifies that learning has occurred when the student responds that which type of receptor
is found at the ganglionic synapse of both the sympathetic and parasympathetic nervous
systems?
1. Alpha receptors
2. Muscarinic
3. Nicotinic
4. Beta receptors
Answer: 3
Explanation:
1. The term alpha is not used for these receptors.
2. Muscarinic receptors are found at the ganglionic synapse of the parasympathetic
nervous system.
3. Nicotinic receptors are found at the ganglionic synapse of both sympathetic and
parasympathetic nervous systems.
4. The term beta is not used for these receptors.
Page Ref: 123
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
GRApatient
DESMOcare.
RE.|CNursing/Integrated
OM
knowledge/science and quality and safe
Concepts: Nursing
Process: Evaluation
Learning Outcome: 12-5 Compare and contrast the types of responses that occur when drugs
activate nicotinic or muscarinic receptors.
MNL Learning Outcome: 12.1 Examine the branches and communications of the nervous
system and how they relate to the neuropharmacology of the autonomic nervous system.
18
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WWW.GRADESMORE.COM
20) A client is prescribed an anticholinergic drug. What discharge instructions should the nurse
provide?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Wear sunglasses in bright light.
2. Limit fluid intake.
3. Increase fiber intake.
4. Avoid hot showers.
5. Avoid milk and dairy products.
Answer: 1, 3, 4
Explanation:
1. Anticholinergic drugs may cause photosensitivity.
2. Fluids should be increased.
3. Use of anticholinergics increases risk for constipation. Fiber intake should be increased.
4. Use of anticholinergics reduces ability of clients to sweat and self-regulate temperature.
Hot environments, including hot showers and baths, should be avoided.
5. There is no reason to avoid dairy products.
Page Ref: 129, 130
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
GRADESKnowledge
MORE.COand
M Science: Relationships between
practice, and research. | NLN Competencies:
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 12-9 Apply the nursing process to care for patients receiving
pharmacotherapy with cholinergic drugs and cholinergic-blocking drugs.
MNL Learning Outcome: 12.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with cholinergic agonist and antagonist agents.
19
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21) A nursing instructor is planning to teach nursing students about exogenous acetylcholine.
The instructor should include which information?
1. Acetylcholine has almost no therapeutic effects because it is rapidly destroyed once
given.
2. Acetylcholine is broken down rapidly within the body, preventing it from producing
adverse effects.
3. Acetylcholine will cause the heart rate to increase and blood pressure to drop.
4. When given in small amounts, acetylcholine will produce profound parasympathetic
effects.
Answer: 1
Explanation:
1. Exogenous acetylcholine is not generally administered, because it is rapidly destroyed
by the body.
2. It does produce many adverse effects.
3. Acetylcholine can lower blood pressure, but it also lowers heart rate.
4. Exogenous acetylcholine is not generally administered.
Page Ref: 125
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
GRApatient
DESMOcare.
RE.|CNursing/Integrated
OM
knowledge/science and quality and safe
Concepts: Nursing
Process: Planning
Learning Outcome: 12-4 Explain how information is transmitted throughout the nervous
system and the neurotransmitters important to the parasympathetic nervous system.
MNL Learning Outcome: 12.3 Examine the pharmacologic profiles and uses of cholinergic
agonist and antagonists prototype drugs presented.
20
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22) A student nurse asks a nurse how atropine (Atropair) increases heart rate. What is the
nurse's best response?
1. Blocking the beta receptors of the parasympathetic nervous system
2. Directly stimulating the sympathetic nervous system
3. Potentiating the effects of acetylcholine on nicotinic receptors
4. Blocking the effects of acetylcholine by occupying muscarinic receptors
Answer: 4
Explanation:
1. Atropine occupies muscarinic receptors.
2. Atropine blocks parasympathetic actions of acetylcholine.
3. Atropine does not potentiate acetylcholine effects on nicotinic receptors.
4. Atropine is a cholinergic-blocking agent that occupies muscarinic receptors.
Page Ref: 124
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
RADESMORand
E.naming
COM of cholinergic drugs based on
Learning Outcome: 12-6 Discuss theGclassification
possible actions.
MNL Learning Outcome: 12.3 Examine the pharmacologic profiles and uses of cholinergic
agonist and antagonists prototype drugs presented.
21
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23) A student nurse asks a nurse which client situations are considered involuntary responses to
autonomic nervous system control? What is the nurse's best response(s)?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Sweating when hot
2. Stepping over a chair to prevent falling
3. Complaining of nausea
4. Salivating at the smell of food
5. Breathing deeper when running
Answer: 1, 4, 5
Explanation:
1. Sweating is an involuntary response that is controlled by the sympathetic nervous
system.
2. Muscle movement is controlled by the somatic nervous system.
3. Complaining of nausea is a result of sensory neuron input and is not part of the
autonomic system.
4. Salivation is involuntary and is controlled by the autonomic nervous system.
5. Breathing deeper when running is controlled by the autonomic nervous system. The act
of running is controlled by the somatic nervous system.
Page Ref: 122
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
GRADemonstrate
DESMORE.
COM
Standards: QSEN Competencies: III.A.1
knowledge
of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 12-3 Compare and contrast the actions of the parasympathetic and
sympathetic divisions of the autonomic nervous system.
MNL Learning Outcome: 12.1 Examine the branches and communications of the nervous
system and how they relate to the neuropharmacology of the autonomic nervous system.
22
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24) A client has sustained a large blood loss. During the assessment, the nurse realizes that
which findings are under the control of the nervous system?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Heart rate
2. Blood pressure
3. Pupil size
4. Bowel sounds
5. Fluid volume
Answer: 1, 2, 3, 4
Explanation:
1. The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to
accomplish minute-to-minute changes in essential functions such as heart rate.
2. The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to
accomplish minute-to-minute changes in essential functions such as blood pressure.
3. The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to
accomplish minute-to-minute changes in essential functions such as pupil size.
4. The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to
accomplish minute-to-minute changes in essential functions such as intestinal motility.
5. Although the brain, spinal cord, and peripheral nerves act as a smoothly integrated
whole to accomplish minute-to-minute changes in essential functions, fluid volume is
not under the control of the nervous system.
GRADESMORE.COM
Page Ref: 123
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 12-1 Identify the basic functions of the nervous system.
MNL Learning Outcome: 12.1 Examine the branches and communications of the nervous
system and how they relate to the neuropharmacology of the autonomic nervous system.
23
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25) The nurse is caring for a client with multisystem organ failure. Which client assessment
findings are under the control of the sympathetic nervous system?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Blood glucose level 210 mg/dL
2. Blood pressure 180/90 mmHg
3. Extremities are cool
4. Respiratory rate 14 and regular
5. Hyperactive bowel sounds
Answer: 1, 2, 3
Explanation:
1. Metabolic effects such as an increase in blood glucose are a sympathetic nervous
system function.
2. The constriction and relaxation of arterioles are controlled entirely by the sympathetic
nervous system.
3. The sympathetic nervous system controls release of epinephrine and norepinephrine,
which result in peripheral vasoconstriction.
4. The respiratory rate would be faster and deeper when under sympathetic nervous
system control.
5. When under sympathetic nervous system control, peristalsis is temporarily suspended.
Page Ref: 122
Cognitive Level: Analyzing
GRAD
ESMORE.Adaptation
COM
Client Need/Sub: Physiological Integrity:
Physiological
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 12-3 Compare and contrast the actions of the parasympathetic and
sympathetic divisions of the autonomic nervous system.
MNL Learning Outcome: 12.1 Examine the branches and communications of the nervous
system and how they relate to the neuropharmacology of the autonomic nervous system.
24
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WWW.GRADESMORE.COM
26) A student nurse is learning about a medication that affects the autonomic nervous system.
When instructing the student about the effects of this medication, the nurse will begin by
explaining the basic structures of this system. What does this include?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The preganglionic neuron
2. The postganglionic neuron
3. The synaptic cleft
4. Norepinephrine
5. Dopamine
Answer: 1, 2, 3
Explanation:
1. The basic unit of the autonomic nervous system is a two-neuron chain. The first neuron,
called the preganglionic neuron, originates in the central nervous system.
2. The preganglionic neuron connects with the second nerve in the autonomic nervous
system two-neuron chain through the ganglia, which contains the postganglionic
neuron.
3. Autonomic messages must cross the synaptic cleft.
4. Acetylcholine is the neurotransmitter released at cholinergic receptors.
5. Dopamine is a neurotransmitter within the limbic system and hypothalamus and not the
autonomic nervous system.
Page Ref: 124
GRADESMORE.COM
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 12-4 Explain how information is transmitted throughout the nervous
system and the neurotransmitters important to the parasympathetic nervous system.
MNL Learning Outcome: 12.1 Examine the branches and communications of the nervous
system and how they relate to the neuropharmacology of the autonomic nervous system.
25
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WWW.GRADESMORE.COM
27) The nurse educator is reviewing the process of synaptic transmission following the
sympathetic pathway. In which order will the nurse explain the steps of synaptic
transmission?
1. Action potential encounters adrenergic receptors
2. Action potential encounters cholinergic receptors
3. Action potential travels across the preganglionic neuron
4. Action potential travels across the postganglionic neuron
5. Target tissue is reached.
Answer: 3, 2, 4, 1, 5
Explanation: In the sympathetic pathway, the action potential travels down the preganglionic
neuron, encounters cholinergic receptors where it crosses the first ganglionic synapse, travels
down the postganglionic neuron, encounters adrenergic receptors, and then reaches target
tissues.
Page Ref: 125
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 12-4 Explain how information is transmitted throughout the nervous
GRADEStoMO
REparasympathetic
.COM
system and the neurotransmitters important
the
nervous system.
MNL Learning Outcome: 12.1 Examine the branches and communications of the nervous
system and how they relate to the neuropharmacology of the autonomic nervous system.
26
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
28) A client is prescribed a medication that will block muscarinic receptors. The nurse realizes
that this medication has implications for which body systems?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Eyes
2. Respiratory
3. Cardiac
4. Endocrine
5. Metabolic
Answer: 1, 2, 3
Explanation:
1. Medications that block muscarinic receptors are used during ophthalmic procedures.
2. Medications that block muscarinic receptors are used in the pharmacologic treatment of
asthma.
3. Medications that block muscarinic receptors are used in the pharmacologic treatment of
bradycardia.
4. Medications that block muscarinic receptors are not used in the treatment of endocrine
disorders.
5. Medications that block muscarinic receptors are not used in the treatment of metabolic
disorders.
Page Ref: 124
Cognitive Level: Analyzing
GRAD
ESMORE.Adaptation
COM
Client Need/Sub: Physiological Integrity:
Physiological
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 12-5 Compare and contrast the types of responses that occur when drugs
activate nicotinic or muscarinic receptors.
MNL Learning Outcome: 12.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with cholinergic agonist and antagonist agents.
27
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WWW.GRADESMORE.COM
29) A client has been prescribed scopolamine (Transderm-Scop) for the prevention of motion
sickness. The nurse should teach the client to immediately report which adverse effects?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Slow heart rate
2. Cardiac palpitations
3. Decreased urinary output
4. Development of tremors
5. Diarrhea
Answer: 2, 3, 4
Explanation:
1. Tachycardia is the adverse effect associated with scopolamine (Transderm-Scop).
2. Dysrhythmia is an adverse effect of this drug.
3. Decreased urinary output is an adverse effect of this drug.
4. Tremors are an adverse effect of this drug.
5. Diarrhea is not an expected adverse effect of this drug.
Page Ref: 127
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
GRApatient
DESMOcare.
RE.|CNursing/Integrated
OM
knowledge/science and quality and safe
Concepts: Nursing
Process: Implementation
Learning Outcome: 12-9 Apply the nursing process to care for patients receiving
pharmacotherapy with cholinergic drugs and cholinergic-blocking drugs.
MNL Learning Outcome: 12.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with cholinergic agonist and antagonist agents.
28
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WWW.GRADESMORE.COM
30) A client who has myasthenia gravis (MG) presents to the emergency department with
abrupt onset of increased muscle weakness and difficulty swallowing. An attempt to
distinguish worsening of the MG symptoms from overdose of the client's prescribed
anticholinergic is planned. What medications should the nurse obtain for use in this
procedure?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Donepezil (Aricept)
2. Pyridostigmine (Mestinon)
3. Neostigmine (Prostigmin)
4. Edrophonium (Edrophonium Injectable)
5. Atropine (Atropine Injectable)
Answer: 4, 5
Explanation:
1. Donepezil (Aricept) is prescribed for the treatment of Alzheimer's disease and would not
be used in this situation.
2. Pyridostigmine (Mestinon) is prescribed for the treatment of MG but would not be used
to determine if this client is having increased symptoms or excessive medication.
3. Neostigmine (Prostigmin) is prescribed for the treatment of MG but would not be used
to determine if this client is having increased symptoms or excessive medication.
4. Edrophonium (Edrophonium Injectable) is given as a test dose. If muscular symptoms
improve, the client is having a myasthenic crisis.
GRisAgiven
DESifMthe
OREtest
.Cresults
OM in a cholinergic crisis.
5. Atropine (Atropine Injectable)
Page Ref: 126
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 12-7 Describe the nurse's role in the pharmacologic management of
patients receiving drugs affecting the parasympathetic nervous system.
MNL Learning Outcome: 12.3 Examine the pharmacologic profiles and uses of cholinergic
agonist and antagonists prototype drugs presented.
29
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Pharmacology for Nurses, 6e (Adams)
Chapter 13 Adrenergic Drugs Affecting the Autonomic Nervous System
1) The client receives methyldopa (Aldomet). Which statement below indicates the patient is
experiencing side effects?
1. "Will you check my pupils? I can't see very well at all."
2. "I am so thirsty; will you please bring me another pitcher of water?"
3. "I am so anxious; I really need to walk around the room."
4. "I feel so sleepy that I don't think I can eat my dinner."
Answer: 3
Explanation:
1. Adrenergic drugs dilate the pupils, so vision should not be affected.
2. Anticholinergic, not adrenergic, drugs dry secretions, therefore the patient would not be
thirsty.
3. Adrenergic drugs mimic the effect of the sympathetic nervous system (SNS). This can
result in anxiety and restlessness.
4. Adrenergic drugs increase alertness, so the patient would not be sleepy.
Page Ref: 141
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
GRADESMORE.COM
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 13-1 Compare and contrast the types of responses that occur when drugs
activate alpha1-, alpha2-, beta1-, beta2-, or beta3- adrenergic receptors.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
1
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2) The nurse notes that a client prescribed carteolol (Cartrol), routinely takes metaproterenol
(Alupent). Which should the nurse be concerned with?
1. The client is at risk for a hypertensive crisis.
2. The effects of metaproterenol (Alupent) will be decreased.
3. The drugs are compatible; there will not be any adverse effects.
4. The effects of metaproterenol (Alupent) will be increased.
Answer: 2
Explanation:
1. A hypertensive crisis is unlikely.
2. Beta-adrenergic blockers block the receptors that are stimulated by adrenergic drugs;
the effects of metaproterenol (Alupent) would be decreased.
3. The drugs are not compatible.
4. The effects of metaproterenol (Alupent) would not be increased.
Page Ref: 140
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 13-3 Describe the nurse's role in the pharmacologic management of
ADESMORnervous
E.COMsystem.
patients receiving drugs affecting theGR
sympathetic
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
2
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WWW.GRADESMORE.COM
3) The nurse has provided the education for the client prescribed atenolol (Tenormin). Which
statement made by the client indicates an understanding of the information?
1. "I need to take my pulse every day."
2. "If I have any side effects, I will stop the medication."
3. "I cannot take this drug if I develop glaucoma."
4. "I cannot continue to have my morning cup of coffee."
Answer: 1
Explanation:
1. Beta blockers slow the heart rate; therefore, the patient must monitor his pulse every
day.
2. Beta blockers should not be stopped suddenly.
3. Adrenergic blockers, not beta blockers, are used to treat glaucoma.
4. Caffeine is not prohibited with beta blockers.
Page Ref: 143, 145
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
GRADESMORConcepts:
E.COM Nursing Process: Implementation
quality and safe patient care. | Nursing/Integrated
Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs
and adrenergic-blocking drugs.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
3
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4) A client is prescribed prazosin (Minipress). Which information should the nurse include in
the client education?
1. Instruct the client to not take OTC herbal preparations containing saw palmetto.
2. Instruct the client to not take tub baths.
3. Instruct the client to decrease his intake of sodium.
4. Instruct the client to wear sunglasses when outdoors.
Answer: 1
Explanation:
1. A hypotensive response may occur when saw palmetto is taken concurrently.
2. Patients should be careful when taking tub baths, especially if the drug causes dizziness,
but such baths are not prohibited.
3. There is no relationship between alpha blockers and sodium intake.
4. Alpha blockers do not cause photophobia; sunglasses are not required with this drug.
Page Ref: 146
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
GRADESMORConcepts:
E.COM Nursing Process: Implementation
quality and safe patient care. | Nursing/Integrated
Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs
and adrenergic-blocking drugs.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
4
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5) A client has been prescribed an alpha1 adrenergic agonist drug. The nurse would plan to
monitor for effects from which organs?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Kidneys
2. Eyes
3. Heart
4. Bowels
5. Lungs
Answer: 1, 2, 4, 5
Explanation:
1. Alpha1 receptors have potential to affect the renal system.
2. Alpha1 receptors result in dilation of the pupils.
3. Alpha1 receptors do not affect receptors in the heart.
4. Alpha1 receptors have potential to affect receptors in the gastrointestinal tract.
5. Alpha1 receptors have potential to affect receptors in the respiratory system.
Page Ref: 138
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies:
GRADESKnowledge
MORE.COand
M Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 13-1 Compare and contrast the types of responses that occur when drugs
activate alpha1-, alpha2-, beta1-, beta2-, or beta3- adrenergic receptors.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
5
Copyright © 2020 Pearson Education, Inc.
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WWW.GRADESMORE.COM
6) A client is prescribed a drug that activates alpha2 receptors. Which physiological response
should the nurse anticipate when planning care for the client?
1. Inhibition of norepinephrine release
2. Absence of monoamine oxidase
3. Increased lipolysis
4. Destruction of presynaptic nerve terminals
Answer: 1
Explanation:
1. The action of alpha2 receptors is to inhibit release of norepinephrine.
2. Alpha2 receptors do not destroy monoamine oxidase.
3. Alpha2 receptors do not increase lipolysis.
4. Alpha2 receptors do not destroy presynaptic nerve terminals.
Page Ref: 138
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 13-1 Compare and contrast the types of responses that occur when drugs
activate alpha1-, alpha2-, beta1-, beta2-,
orEbeta3GRAD
SMORadrenergic
E.COM receptors.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
6
Copyright © 2020 Pearson Education, Inc.
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WWW.GRADESMORE.COM
7) Which client conditions should the nurse anticipate to be treated with a beta 2 agonists?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Heart failure
2. Asthma
3. COPD
4. Overactive bladder
5. Nasal congestion
Answer: 2, 3
Explanation:
1. Beta1 agonists are most likely to be given to patients with heart failure.
2. Beta2 agonists are useful in the treatment of asthma.
3. Beta2 agonists are useful in the treatment of COPD.
4. Beta3 agonists are most likely to be given to patients with overactive bladder.
5. Alpha1 agonists are most likely to be given to patients with nasal congestion.
Page Ref: 141
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe
Concepts: Nursing
GRApatient
DESMOcare.
RE.|CNursing/Integrated
OM
Process: Planning
Learning Outcome: 13-1 Compare and contrast the types of responses that occur when drugs
activate alpha1-, alpha2-, beta1-, beta2-, or beta3- adrenergic receptors.
MNL Learning Outcome: 13.2 Examine the actions and uses of adrenergic agonists and
antagonists, including the pharmacologic profiles of prototype drugs presented.
7
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WWW.GRADESMORE.COM
8) Which substance is used in the initial production of catecholamines?
1. Norepinephrine
2. Tyrosine
3. Dopamine
4. L-dopa
Answer: 2
Explanation:
1. The synthesis of catecholamines begins with tyrosine then moves to L-dopa, dopamine,
norepinephrine, and ends with the synthesis of epinephrine.
2. The synthesis of catecholamines begins with tyrosine then moves to L-dopa, dopamine,
norepinephrine, and ends with the synthesis of epinephrine.
3. The synthesis of catecholamines begins with tyrosine then moves to L-dopa, dopamine,
norepinephrine, and ends with the synthesis of epinephrine.
4. The synthesis of catecholamines begins with tyrosine then moves to L-dopa, dopamine,
norepinephrine, and ends with the synthesis of epinephrine.
Page Ref: 139
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
GRADESMORE.COM
Process: Assessment
Learning Outcome: 13-2 Discuss the classification and naming of adrenergic drugs.
MNL Learning Outcome: 13.1 Recognize the classifications and mechanisms of action of
adrenergic agonists and antagonists.
8
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9) A client who is in heart failure is administered a beta1 agonist. Which assessment finding
indicates the prescription is effective?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Heart rate increases
2. Pulse becomes stronger
3. Pupils dilate
4. Dysrhythmias dissipate
5. Blood pressure drops
Answer: 1, 2
Explanation:
1. One of the effects of beta1 agonists is to increase the heart rate.
2. One of the effects of beta1 agonists is to increase force of cardiac contraction, which
would be felt as a stronger pulse.
3. Pupil dilation is an effect of alpha1 drugs.
4. Beta1 antagonists are given to control dysrhythmias.
5. Beta1 antagonists are given to control hypertension.
Page Ref: 141
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies:
Explain
GRADEIII.1
SMO
RE.Cthe
OMinterrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 13-1 Compare and contrast the types of responses that occur when drugs
activate alpha1-, alpha2-, beta1-, beta2-, or beta3- adrenergic receptors.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
9
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
10) A client has been prescribed isoproterenol (Isuprel). The nurse understands that which
receptors will be stimulated?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Alpha1
2. Alpha2
3. Beta1
4. Beta2
5. Beta3
Answer: 3, 4
Explanation:
1. The prescription does not affect alpha1 receptors.
2. The prescription does not affect alpha2 receptors.
3. Isoproterenol (Isuprel) is a nonselective drug that stimulates beta1 receptors.
4. Isoproterenol (Isuprel) is a nonselective drug that stimulates beta2 receptors.
5. This prescription does not affect beta3 receptors.
Page Ref: 141
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
GRADESKnowledge
MORE.COand
M Science: Relationships between
practice, and research. | NLN Competencies:
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 13-1 Compare and contrast the types of responses that occur when drugs
activate alpha1-, alpha2-, beta1-, beta2-, or beta3- adrenergic receptors.
MNL Learning Outcome: 13.3 Examine the pharmacologic profiles and uses of the adrenergic
antagonist and antagonist prototype drugs presented.
10
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GRADESMORE.COM
WWW.GRADESMORE.COM
11) The nurse has provided teaching about the use of an auto injection of epinephrine. Which
statement made by the client indicates further teaching is required?
1. "I will call 911 before I inject the epinephrine."
2. "I will use my auto-injector immediately if I think I am having an allergic reaction."
3. "I will make sure I have my auto-injector available at all times."
4. "I will notify my healthcare provider after I inject the epinephrine."
Answer: 1
Explanation:
1. Emergency response should be activated before the auto-injector is used.
2. The auto-injector should be used immediately if the patient thinks they are having an
allergic reaction.
3. The auto-injector should be available at all times.
4. The healthcare provider should be notified if the auto-injector is needed and has been
used.
Page Ref: 145
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
GR
ADESMRelationships
ORE.COM between knowledge/science and
| NLN Competencies: Knowledge and
Science:
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 13-3 Describe the nurse's role in the pharmacologic management of
patients receiving drugs affecting the sympathetic nervous system.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
11
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12) The nurse is preparing to provide instructions on the use of an epinephrine auto-injector.
Which information should the nurse include?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. If you need to use this pen, seek medical advice as follow-up.
2. You can dispose of a used EpiPen in your regular trash.
3. Keep an extra EpiPen on hand.
4. Store this device in your refrigerator.
5. Carry an EpiPen in your car's glovebox.
Answer: 1, 3
Explanation:
1. If it is necessary to use the EpiPen, it is important to seek immediate follow-up by calling
911 or the provider.
2. To avoid exposing another to an injury from a used needle, the used EpiPen should be
disposed of properly.
3. It is recommended that the patient have an extra EpiPen on hand in case of emergency
or failure of the original unit.
4. It is not necessary to refrigerate the EpiPen.
5. The EpiPen should be kept in a cool, dark place. The temperature of a glovebox in a car
may become too hot.
Page Ref: 145
Cognitive Level: Applying
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 13-3 Describe the nurse's role in the pharmacologic management of
patients receiving drugs affecting the sympathetic nervous system.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
12
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
13) A client has been prescribed phenylephrine (Neo-Synephrine) spray for nasal congestion.
Which information about adverse effects should the nurse provide in discharge teaching?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "This drug may cause some stinging or burning in your nose."
2. "You may notice that your nasal secretions take on a slightly orange tint."
3. "You may feel like your blood pressure is low for the first few times you use this spray."
4. "Rebound congestion may occur if the prescription is used more than a few days."
5. "Do not drink herbal teas while taking this medication."
Answer: 1, 4
Explanation:
1. Intranasal use of this drug can cause burning of the mucosa.
2. Orange-tinted nasal secretions are not an expected adverse effect.
3. Intranasal medications, if used properly, should have little or no effect on blood
pressure.
4. Rebound congestion is likely to occur if the drug is used for over 3-5 days.
5. There are no known drug-herbal interactions with this drug.
Page Ref: 142
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
RADEand
SMOdevelopment,
RE.COM pathophysiology, pharmacology,
reflects an understanding of human G
growth
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 13-4 For each of the drug classes listed in Drugs at a Glance, know
representative drugs and explain their mechanism of action, primary actions, and important
adverse effects.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
13
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WWW.GRADESMORE.COM
14) The nurse is preparing to administer an adrenergic drug intravenously. Which should the
nurse include in the plan of care?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Give the drug as rapidly as possible by intravenous push.
2. Dilute the drug before administration.
3. Use an infusion pump to control rate of administration.
4. Monitor for blanching at the infusion site.
5. Advise the patient that a sweet taste may occur as the drug is being given.
Answer: 2, 3, 4
Explanation:
1. These drugs should be administered slowly.
2. These drugs should be diluted prior to administration.
3. Infusion of these drugs should be controlled via an infusion pump.
4. Blanching at the infusion site indicates probable extravasation. The drip should be
stopped.
5. There is no evidence that a sweet taste will occur.
Page Ref: 144
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
GRADEanSM
ORE.COM of human growth and
holistic, patient-centered care that reflects
understanding
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 13-3 Describe the nurse's role in the pharmacologic management of
patients receiving drugs affecting the sympathetic nervous system.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
14
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
15) The nurse is reviewing routine medications for a client prescribed phenylephrine (NeoSynephrine). Which medications are most concerning?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. MAO inhibitors
2. Tricyclic antidepressants
3. Iron supplements
4. Digoxin
5. Aspirin
Answer: 1, 2, 3, 4
Explanation:
1. Concurrent use with MAO inhibitors may result in hypertensive crisis.
2. Tricyclic antidepressants can potentiate the effects of phenylephrine (Neo-Synephrine).
3. Iron supplements are incompatible with phenylephrine (Neo-Synephrine).
4. Dysrhythmias may occur when phenylephrine (Neo-Synephrine) and digoxin are used
concurrently.
5. There is no incompatibility with aspirin.
Page Ref: 143
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
RADEand
SMOdevelopment,
RE.COM pathophysiology, pharmacology,
reflects an understanding of human G
growth
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 13-4 For each of the drug classes listed in Drugs at a Glance, know
representative drugs and explain their mechanism of action, primary actions, and important
adverse effects.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
15
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GRADESMORE.COM
WWW.GRADESMORE.COM
16) A client recently prescribed an adrenergic drug states to the nurse, "I am so nervous and I
cannot sleep." Based on the client's statement, which questions should the nurse ask?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "How much coffee do you drink?"
2. "Have you recently increased your intake of dairy products?"
3. "Do you eat chocolate?"
4. "When was the last time you ate pickled foods or aged cheese?"
5. "How much wine or other alcoholic beverages do you drink?"
Answer: 1, 3
Explanation:
1. The caffeine in coffee may cause excessive nervousness, insomnia, and tremors.
2. There are no drug-food interactions with dairy products.
3. The caffeine in chocolate may cause excessive nervousness, insomnia, and tremors.
4. There are no drug-food interactions with pickled foods or aged cheese.
5. There are no drug-food interactions with beverages that contain alcohol.
Page Ref: 143
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
GRADESMmedical
ORE.Cmanagement,
OM
development, pathophysiology, pharmacology,
and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs
and adrenergic-blocking drugs.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
16
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
17) A client who has used an adrenergic nasal spray for 2 weeks states to the nurse, "I am more
stuffed up now than I was when I was sick." Which information should the nurse provide
the patient?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "You are having an allergic reaction to the nasal spray. Stop using it immediately."
2. "You probably have developed a secondary infection."
3. "Try increasing the amount of fluids you are drinking."
4. "Switch to a saline-based nasal spray."
5. "Continue to use your current nasal spray until the congestion goes away."
Answer: 3, 4
Explanation:
1. There is no evidence that an allergic reaction has occurred.
2. There is no evidence that a secondary infection has occurred.
3. Increasing oral fluids may help to thin secretions for easier removal.
4. The client is most likely experiencing rebound congestion. Switching from the adrenergic
spray to a saline spray will keep the mucosa moist and more comfortable until the
effects of the adrenergic spray subside.
5. The client is most likely experiencing rebound congestion. Continued use of the
prescription is contraindicated.
Page Ref: 143
Cognitive Level: Applying
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs
and adrenergic-blocking drugs.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
17
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
18) An older adult has received adrenergic eye drops prior to a retinal exam. Which information
should the nurse include in the client's discharge teaching?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Do not drive until the effects of the eye drops have worn off."
2. "Wear sunglasses when in bright light."
3. "You may be more comfortable in a darkened room."
4. "You may experience burning in your eyes for a couple of days."
5. "Do not eat or drink anything for at least an hour after discharge."
Answer: 1, 2, 3
Explanation:
1. Older adults may notice blurring of vision after receiving drops to dilate the eyes. The
patient should not drive until vision is clear.
2. Photosensitivity is a common effect, and protective eyewear should be worn.
3. Photosensitivity is a common effect, and the patient may be more comfortable in a
darkened room or with a soft cloth covering the eyes.
4. The burning associated with these drops should be transient. It should not last for "a
couple of days."
5. There is no reason for the patient to be NPO.
Page Ref: 145
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRProvide
ADESMpatient-centered
ORE.COM care with sensitivity and
Standards: QSEN Competencies: I.B.3
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs
and adrenergic-blocking drugs.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
18
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
19) A client has been prescribed an adrenergic nasal spray. Which information should the nurse
include in the teaching?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Do not share this spray with anyone."
2. "Sit upright while using this spray."
3. "Only use this spray for 3-5 days."
4. "Do not shake the bottle before using this spray."
5. "Keep this spray refrigerated."
Answer: 1, 2, 3
Explanation:
1. Sharing nasal sprays may spread infection.
2. The client should sit upright to use this medication so that it is delivered appropriately,
avoiding overdosage.
3. Adrenergic nasal sprays may cause rebound congestion if used more that 3-5 days.
4. There is no indication that the bottle should not be shaken.
5. There is no indication that the medication should be refrigerated.
Page Ref: 144
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
GRADEanSM
ORE.COM of human growth and
holistic, patient-centered care that reflects
understanding
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs
and adrenergic-blocking drugs.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
19
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
20) Which statement is accurate concerning drugs classified as adrenergic antagonists?
1. They are also known as anticholinergics.
2. The actions will block the neurotransmitter acetylcholine.
3. The actions are the opposite of those of sympathomimetics.
4. They will stimulate the sympathetic nervous system.
Answer: 3
Explanation:
1. Adrenergic antagonists are also known as sympatholytics.
2. Adrenergic antagonists block adrenergic receptors, not cholinergic receptors.
3. Adrenergic antagonists inhibit the actions of the sympathetic nervous system.
4. Adrenergic antagonists inhibit the actions of the sympathetic nervous system.
Page Ref: 144
Cognitive Level: Understanding
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 13-2 Discuss the classification and naming of adrenergic drugs.
MNL Learning Outcome: 13.3 Examine the pharmacologic profiles and uses of the adrenergic
antagonist and antagonist prototype drugs presented.
GRADESMORE.COM
20
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WWW.GRADESMORE.COM
21) A client with preexisting conditions states to the nurse, "I took my blood pressure at home
and it was high so I have been taking my husband's propranolol (Inderal) for the last week."
Based on the client's statement, which preexisting conditions should the nurse be most
concerned with?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Obesity
2. Diabetes mellitus
3. COPD
4. Asthma
5. Rheumatoid arthritis
Answer: 2, 3, 4
Explanation:
1. While obesity may be contributing to the clients's hypertension, use of propranolol
(Inderal) is not contraindicated.
2. Beta blockers may cause hyperglycemia or hypoglycemia and may mask the symptoms
of hypoglycemia in clients with diabetes.
3. Beta blockers may cause significant bronchial constriction.
4. Beta blockers may cause significant bronchial constriction.
5. Beta blockers are not contraindicated for use in clients with rheumatoid arthritis.
Page Ref: 145
Cognitive Level: Applying
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 13-3 Describe the nurse's role in the pharmacologic management of
patients receiving drugs affecting the sympathetic nervous system.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
21
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22) A client states to the nurse, "I stopped taking that beta blocker last week because it made
me so tired." Which are the priority nursing assessments?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Blood pressure
2. Heart rhythm
3. Urinary output
4. Presence of chest pain
5. Presence of respiratory crackles
Answer: 1, 2, 4
Explanation:
1. Abruptly discontinuing beta blockers may result in acute resurgence of symptoms such
as hypertension.
2. Abruptly discontinuing beta blockers may result in acute resurgence of symptoms such
as dysrhythmia.
3. Abruptly discontinuing beta blockers should not have an immediate effect on urinary
output.
4. Abruptly discontinuing beta blockers may result in chest pain.
5. Abruptly discontinuing beta blockers should not result in pulmonary complications.
Page Ref: 145
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRProvide
ADESMpatient-centered
ORE.COM care with sensitivity and
Standards: QSEN Competencies: I.B.3
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 13-3 Describe the nurse's role in the pharmacologic management of
patients receiving drugs affecting the sympathetic nervous system.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
22
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
23) A client has been prescribed prazosin (Minipress). Which information should the nurse
provide?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Stay out of the sun until you determine if you become sun-sensitive."
2. "Take this medication just before you go to bed."
3. "This medication may make you dizzy."
4. "This medication may slow your heart rate noticeably."
5. "Do not take this medication with milk."
Answer: 2, 3
Explanation:
1. There is no indication that this medication will make the patient sensitive to the sun.
2. This medication should be taken just before bedtime as it may cause drowsiness or
light-headedness.
3. Dizziness is a common adverse effect of this drug.
4. Tachycardia is the expected adverse effect.
5. There is no reason to avoid milk when taking this drug.
Page Ref: 146
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
RADEand
SMOdevelopment,
RE.COM pathophysiology, pharmacology,
reflects an understanding of human G
growth
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 13-4 For each of the drug classes listed in Drugs at a Glance, know
representative drugs and explain their mechanism of action, primary actions, and important
adverse effects.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
23
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24) A client who was administered prazosin (Minipress) became unconscious 30 minutes after
the first dose. Which prescriptions should the nurse prepare for resuscitation?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Normal saline
2. Dobutamine
3. Atenolol (Tenormin)
4. Carvedilol (Coreg)
5. Propranolol (Inderal)
Answer: 1, 2
Explanation:
1. Unconsciousness after the first dose of prazosin (Minipress) is typically due to severe
hypotension. Normal saline can be used as a volume expander.
2. Unconsciousness after the first dose of prazosin (Minipress) is typically due to severe
hypotension. Treatment with a vasopressor such as dobutamine may be indicated.
3. Atenolol (Tenormin) is an adrenergic blocker and would exacerbate the problem.
4. Carvedilol (Coreg) is an adrenergic blocker and would exacerbate the problem.
5. Propranolol (Inderal) is an adrenergic blocker and would exacerbate the problem.
Page Ref: 146
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
GRADESM|OAACN
RE.Essential
COM Competencies: IX.3 Implement
respect for the diversity of human experience.
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 13-3 Describe the nurse's role in the pharmacologic management of
patients receiving drugs affecting the sympathetic nervous system.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
24
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
25) A client has been prescribed an adrenergic-blocker for treatment of hypertension. Which
information should the nurse provide?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Rise from a sitting position slowly."
2. "Sit on the side of the bed a few moments before you stand."
3. "If you feel dizzy, add more salt to your diet."
4. "If you feel dizzy, sit or lie down until the dizziness passes."
5. "Dizziness is expected so just continue your daily activities."
Answer: 1, 2, 4
Explanation:
1. Patients who are starting on adrenergic-blocking drugs should move slowly from the
sitting position.
2. Sitting on the side of the bed will help blood pressure normalize before standing.
3. Additional salt is not indicated for people who have hypertension.
4. If the patient feels dizzy, sitting down or lying down will help to prevent falls.
5. The patient should monitor dizziness and should take safety precautions until
acclimated to the medication.
Page Ref: 147
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
GRADESM|OAACN
RE.Essential
COM Competencies: IX.3 Implement
respect for the diversity of human experience.
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs
and adrenergic-blocking drugs.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
25
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26) A client has returned to the clinic for follow-up after being prescribed an adrenergicblocking medication for benign prostatic hypertrophy (BPH.) Which assessment questions
should the nurse ask?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "What color is your urine?"
2. "Do you have any difficulty starting to urinate?"
3. "Do you have the feeling that your bladder is full?"
4. "When was your last bowel movement?"
5. "Have you noticed being more hungry than usual?"
Answer: 2, 3
Explanation:
1. Adrenergic blockers do not change the color of the urine.
2. Adrenergic blockers may result in hesitancy.
3. Adrenergic blockers may result in retention of urine.
4. Questions about time of last BM are not indicated.
5. Adrenergic blockers do not affect appetite.
Page Ref: 147
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
GRADEanSM
ORE.COM of human growth and
holistic, patient-centered care that reflects
understanding
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs
and adrenergic-blocking drugs.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
26
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WWW.GRADESMORE.COM
27) The nurse should classify which sympathomimetics as binding to and activating adrenergic
receptors?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Epinephrine
2. Dopamine
3. Amphetamine
4. Cocaine
5. Ephedrine
Answer: 1, 2, 5
Explanation:
1. Epinephrine is an endogenous catecholamine that acts directly by binding to and
activating adrenergic receptors.
2. Dopamine is an endogenous catecholamine that acts directly by binding to and
activating adrenergic receptors.
3. Amphetamine acts indirectly by affecting norepinephrine release.
4. Cocaine acts indirectly by affecting norepinephrine release.
5. Ephedrine acts both directly and indirectly.
Page Ref: 140
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
GRADEIII.1
SMO
RE.Cthe
OMinterrelationships among theory,
processes. | AACN Essential Competencies:
Explain
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 13-2 Discuss the classification and naming of adrenergic drugs.
MNL Learning Outcome: 13.2 Examine the actions and uses of adrenergic agonists and
antagonists, including the pharmacologic profiles of prototype drugs presented.
27
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28) A client is being assessed for the presence of pheochromocytoma. Which interventions
should the nurse implement?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Monitoring blood pressure
2. Monitoring bowel sounds
3. Administration of phentolamine (Regitine)
4. Rapid administration of normal saline
5. Urinary catheterization to bypass prostatic enlargement
Answer: 1, 3
Explanation:
1. Pheochromocytoma affects blood pressure, so continuous monitoring is necessary.
2. While monitoring bowel sounds is part of all ongoing assessment, it is not particular to
pheochromocytoma.
3. Sudden and marked reduction of blood pressure results when a patient with
pheochromocytoma is administered phentolamine (Regitine) parenterally.
4. Rapid administration of normal saline is treatment for hypotension. This patient will be
hypertensive.
5. A urinary catheter may be inserted, but this is not because of prostatic enlargement.
Page Ref: 143
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRProvide
ADESMpatient-centered
ORE.COM care with sensitivity and
Standards: QSEN Competencies: I.B.3
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 13-3 Describe the nurse's role in the pharmacologic management of
patients receiving drugs affecting the sympathetic nervous system.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
28
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
29) The nurse suspects a client has received too much phenylephrine (Neo-Synephrine). Which
findings support the nurse's suspicion?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The client's heart rate has increased from 72 bpm to 114 bpm.
2. The client reports feeling anxious.
3. The client's blood pressure has increased from 140/86 mmHg to 180/98 mmHg.
4. The client's stools are dark and tarry.
5. The client reports burning at the injection site.
Answer: 1, 3
Explanation:
1. An overdose of phenylephrine (Neo-Synephrine) will result in tachycardia.
2. Feelings of anxiety and restlessness are expected adverse effects of phenylephrine
(Neo-Synephrine).
3. Overdosage of phenylephrine (Neo-Synephrine) will result in hypertension.
4. Dark and tarry stools are not related to phenylephrine (Neo-Synephrine).
5. Burning at the injection site would indicate possible extravasation, not overdose.
Page Ref: 142
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
RADEand
SMOdevelopment,
RE.COM pathophysiology, pharmacology,
reflects an understanding of human G
growth
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 13-4 For each of the drug classes listed in Drugs at a Glance, know
representative drugs and explain their mechanism of action, primary actions, and important
adverse effects.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
29
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
30) A 48-year-old male client tells the nurse he wants to stop taking his prazosin (Minipress).
Which questions should the nurse ask the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Are you experiencing impotence?"
2. "Are you experiencing nasal congestion?"
3. "Do you feel tired?"
4. "Do you feel nervousness?"
5. "Do you feel like you heart rate slows down?"
Answer: 1, 2, 3
Explanation:
1. Some alpha blockers result in impotence or inhibition of ejaculation.
2. Nasal congestion is a common adverse effect of alpha blockade.
3. Drowsiness may occur with alpha blockers.
4. Anxiety is not a common adverse effect of this drug.
5. Reflex tachycardia may occur, but bradycardia is not expected.
Page Ref: 146
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
GRADESMOacross
RE.Cthe
OMhealth-illness continuum, across
medical management, and nursing management
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 13-4 For each of the drug classes listed in Drugs at a Glance, know
representative drugs and explain their mechanism of action, primary actions, and important
adverse effects.
MNL Learning Outcome: 13.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy with adrenergic agonists and antagonists.
30
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Pharmacology for Nurses, 6e (Adams)
Chapter 14 Drugs for Anxiety and Insomnia
1) A client tells the nurse that he or she worries about everything all day, feels confused,
restless. Which should the nurse suspect the client is experiencing?
1. Generalized anxiety
2. Social anxiety
3. Post-traumatic stress disorder (PTSD)
4. Panic disorder
Answer: 1
Explanation:
1. Generalized anxiety disorder is characterized by excessive anxiety but not to panic
levels. Other symptoms include restlessness, muscle tension, and loss of focus and
ability to concentrate. Relaxation techniques are effective in reducing anxiety.
2. Social anxiety disorder is characterized by "performance anxiety," (i.e., extreme fear
when a patient is in a social situation); there is no information to support that this is
what the patient is experiencing. Also, telling the patient to "calm down" is
nontherapeutic.
3. Post-traumatic stress disorder is situational anxiety that develops in response to reexperiencing a previous traumatic life event; there is no information that the patient has
experienced a trauma.
4. Panic disorder is characterized by intense feelings of apprehension, terror, and
GRADESMORE.COM
impending doom and increased autonomic nervous system anxiety; the patient does not
have these symptoms.
Page Ref: 152
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Coping Mechanisms
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 14-1 Identify the major types of anxiety disorders.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
1
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2) The nurse has completed group education for clients with anxiety disorders. Which
statement made be a client indicates an understanding of the education?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Relaxation techniques will often decrease anxiety."
2. "Antianxiety medicine should be used until anxiety is gone."
3. "Antianxiety medicine should not be used indefinitely."
4. "Therapy may help identify where this anxiety comes from."
5. "Different medications are required for treating anxiety than for treating difficulty
sleeping."
Answer: 1, 3, 4
Explanation:
1. Nonpharmacological techniques such as relaxation techniques are effective in reducing
some levels of anxiety.
2. Absence of anxiety is an unrealistic goal because all individuals will have some level of
anxiety during their lifetime.
3. For most patients, antianxiety medication is intended for short-term use.
4. Clients with anxiety disorders should be encouraged to uncover the cause of the anxiety
through cognitive behavioral therapy or other counseling techniques.
5. Often, the same medication can be used for anxiety as well as insomnia.
Page Ref: 152-154
Cognitive Level: Analyzing
GRACoping
DESMOMechanisms
RE.COM
Client Need/Sub: Psychosocial Integrity:
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: VII.4 Use
behavioral change techniques to promote health and manage illness. | NLN Competencies:
Knowledge and Science: Relationships between knowledge/science and quality and safe patient
care. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 14-3 Discuss factors contributing to anxiety and explain some
nonpharmacologic therapies used to cope with this disorder.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
2
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3) A client ask the nurse which part of the brain controls anxiety and insomnia. Which
response should the nurse provide?
1. "The limbic system and reticular activating system control anxiety and insomnia."
2. "The frontal lobes and limbic system control anxiety and insomnia."
3. "The thalamus and reticular activating system control anxiety and insomnia."
4. "The limbic system and hypothalamus control anxiety and insomnia."
Answer: 1
Explanation:
1. Neural systems associated with anxiety and restlessness include the limbic system and
the reticular activating system. The reticular activating system is responsible for sleeping
and wakefulness and performs an alerting function for the entire cerebral cortex.
2. The frontal lobes are not responsible for anxiety and sleep.
3. The thalamus is not responsible for anxiety and sleep.
4. The hypothalamus is not responsible for anxiety and sleep.
Page Ref: 152-153
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Therapeutic Communication
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.2 Synthesize theories and concepts from liberal
education to build an understanding of human experience. | NLN Competencies: Knowledge
and Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
RADESofMthe
OREbrain
.COassociated
M
Learning Outcome: 14-2 Identify theGregions
with anxiety, sleep, and
wakefulness.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
3
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4) A client asks the nurse why he or she is prescribed different types of medications for his or
her anxiety and insomnia. Which response should the nurse provide the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "You will be taking medications known as sedative-hypnotics."
2. "You will be taking medications known as antidepressants."
3. "You will be taking a medication known as paraldehyde."
4. "You will be taking medications known as barbiturates."
5. "You will be taking medications known as benzodiazepines."
Answer: 1, 2, 5
Explanation:
1. The three categories of medications used to treat anxiety and sleep disorders include
the sedative-hypnotics.
2. The three categories of medications used to treat anxiety and sleep disorders include
the antidepressants.
3. Paraldehyde is no longer used for anxiety or insomnia because of significant side effects
and the availability of more effective medications.
4. Barbiturates are no longer used for anxiety or insomnia because of significant side
effects and the availability of more effective medications.
5. The three categories of medications used to treat anxiety and sleep disorders include
the benzodiazepines.
Page Ref: 156
GRADESMORE.COM
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 14-4 Identify the three classes of medications used to treat anxiety and
sleep disorders.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
4
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5) A client with a generalized anxiety disorder asks the nurse if he or she will need medication
for treatment. Which response should the nurse provide the client?
1. "A prescription is a common treatment for clients with anxiety disorders."
2. "A prescription is necessary initially; followed by therapy."
3. "You most likely will not require a prescription."
4. "A prescription is necessary when anxiety interferes with your quality of life."
Answer: 4
Explanation:
1. A prescription is not necessarily a common treatment for anxiety disorders. Many
anxiety disorders can be managed without a prescription.
2. A prescription combined with therapy is considered the best approach for treatment of
anxiety disorders.
3. The nurse does not have enough information to tell the patient that a prescription will
probably not be necessary.
4. It is more beneficial to the client to identify and treat the cause of anxiety than to use a
prescription. When anxiety becomes severe enough to significantly interfere with the
patient's quality of life, pharmacotherapy is indicated.
Page Ref: 154
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Therapeutic Communication
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
GRADESKnowledge
MORE.COand
M Science: Relationships between
practice, and research. | NLN Competencies:
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 14-5 Explain the pharmacologic management of anxiety and insomnia.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
5
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6) A client has taken different prescriptions over the past two years that have been
unsuccessful in treating his or her insomnia. Which condition should the nurse suspect the
client may be experiencing?
1. Sleep apnea
2. Anxiety disorder
3. Addiction
4. Personality disorder
Answer: 1
Explanation:
1. Sleep apnea is a medical condition that must be treated to relieve the insomnia
associated with the disorder. Medications such as benzodiazepines depress respiratory
drive and exacerbate sleep apnea.
2. It is unlikely that a client with an anxiety disorder would sell their medication.
3. There is no information that suggests the client may have an addiction.
4. There is no information that suggest the client might have a personality disorder.
Page Ref: 155
Cognitive Level: Applying
Client Need/Sub: Physiological Adaptation: Alterations in body systems
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic
elements of the research process and models for applying evidence to clinical practice. | NLN
Competencies: Knowledge and Science: Relationships between knowledge/science and quality
GRADEConcepts:
SMORE.Nursing
COM Process: Assessment
and safe patient care. | Nursing/Integrated
Learning Outcome: 14-7 Identify normal sleep patterns and explain how these might be
affected by anxiety and stress.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
6
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7) A client asks the nurse to describe NREM stage 3 sleep. Which response should the nurse
provide the client?
1. "This is the lightest stage of sleep and is profoundly affected by anxiety."
2. "Dreaming occurs here; without dreams you will be irritable and paranoid."
3. "This is the deepest stage of sleep; without it you will be tired and depressed."
4. "This is also called paradoxical sleep."
Answer: 3
Explanation:
1. NREM stage 3 is not the lightest stage of sleep.
2. Dreaming occurs in REM sleep, not NREM sleep.
3. NREM stage 3 sleep is the deepest stage of sleep. Clients who are deprived of it
experience depression and a feeling of apathy and fatigue.
4. REM sleep is often called paradoxical sleep.
Page Ref: 155
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Rest and Sleep
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic
elements of the research process and models for applying evidence to clinical practice. | NLN
Competencies: Knowledge and Science: Relationships between knowledge/science and quality
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 14-7 Identify normal sleep patterns and explain how these might be
GRADESMORE.COM
affected by anxiety and stress.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
7
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WWW.GRADESMORE.COM
8) A client who has been taking lorazepam (Ativan) for 2 years presents to the clinic and tells
the nurse that he or she stopped taking his or her medication 3 days prior. Which
assessment findings should the nurse anticipate?
1. Increased heart rate, fever, and muscle cramps
2. Nothing different; it is safe to abruptly stop lorazepam (Ativan)
3. Pinpoint pupils, constipation, and urinary retention
4. A sense of calmness and lack of anxiety
Answer: 1
Explanation:
1. Many central nervous system (CNS) depressants can cause physical and psychological
dependence. The withdrawal syndrome for some central nervous system (CNS)
depressants can include fever, seizures, increased pulse, anorexia, muscle cramps,
disorientation, etc.
2. It is not safe to abruptly stop lorazepam (Ativan); withdrawal symptoms will occur.
3. Pinpoint pupils, constipation, and urinary retention are signs of opioid use.
4. The patient would be anxious, not calm, during benzodiazepine withdrawal.
Page Ref: 158
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
GRApatient
DESMOcare.
RE.|CNursing/Integrated
OM
knowledge/science and quality and safe
Concepts: Nursing
Process: Implementation
Learning Outcome: 14-5 Explain the pharmacologic management of anxiety and insomnia.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
8
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
9) A client presents to the emergency department suspected of overdosing on lorazepam
(Ativan). Which prescription should the nurse prepare to administer?
1. Pralidoxime (Protopam)
2. Naloxone (Narcan)
3. Flumazenil (Romazicon)
4. Nalmefene (Revex)
Answer: 3
Explanation:
1. Pralidoxime (Protopam) is indicated for treatment of organophosphate poisoning.
2. Naloxone (Narcan) is indicated for treatment of opiate overdose.
3. Should an overdose of benzodiazepines occur, flumazenil (Romazicon) is a specific
benzodiazepine receptor antagonist that can be administered to reverse central nervous
system (CNS) depression.
4. Nalmefene (Revex) is indicated for treatment of opiate overdose.
Page Ref: 158
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
GRADEand
SMquality
ORE.and
COMsafe patient care. |
Relationships between knowledge/science
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 14-9 For each of the drug classes listed in Drugs at a Glance, know
representative drugs and explain their mechanisms of action, primary actions, and important
adverse effects.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
9
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WWW.GRADESMORE.COM
10) Which client should the nurse be most concerned with taking benzodiazepines?
1. An 87-year-old client who uses a cane for ambulation
2. A 9-year-old child with panic attacks
3. A 42-year-old businessman who travels internationally
4. A 32-year-old mother of two preschool children
Answer: 1
Explanation:
1. Benzodiazepines should be used with caution in older adults due to their adverse effects
of drowsiness and sedation. This puts older adults at risk of falls.
2. Benzodiazepines must be used with caution in children, but these patients are not at as
high risk as older adults.
3. There is minimal concern with benzodiazepine use in a 42-year-old patient.
4. There is minimal concern with benzodiazepine use in a 32-year-old patient.
Page Ref: 164
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Assessment
GRnurse's
ADESrole
MORinEthe
.COpharmacologic
M
Learning Outcome: 14-6 Describe the
management of anxiety
and insomnia.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
10
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
11) The nurse has completed the education for a client prescribed buspirone (BuSpar). Which
statement made by the client indicates further teaching is required?
1. "The side effects I might experience include dizziness, headache, and drowsiness."
2. "I can take this prescription when I feel anxious and it will relax me."
3. "This prescription should be taken on a regular basis for it to help me."
4. "I don't need to worry about becoming dependent on this prescription."
Answer: 2
Explanation:
1. Side effects of buspirone (BuSpar) include dizziness, headache, and drowsiness.
2. Buspirone (BuSpar) works by altering levels of neurotransmitters and takes a few weeks
to achieve optimal anxiety reduction. It cannot be used as an "as needed" (prn)
medication.
3. Buspirone (BuSpar) works by altering levels of neurotransmitters and takes a few weeks
to achieve optimal anxiety reduction. The drug must be taken consistently for this to
occur.
4. Dependence and withdrawal are less of a concern with buspirone (BuSpar) than with
some other antianxiety drugs.
Page Ref: 161
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
GRADE
SMacute
OREand
.COchronic
M
interventions as appropriate for managing
the
care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 14-6 Describe the nurse's role in the pharmacologic management of anxiety
and insomnia.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
11
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WWW.GRADESMORE.COM
12) A client is prescribed zolpidem (Ambien) for treatment of short-term insomnia. Which is the
primary safety concern of the nurse?
1. Dizziness and daytime sedation
2. Nausea
3. Diarrhea
4. Sleepwalking
Answer: 4
Explanation:
1. Dizziness and daytime sedation are common side effects of zolpidem (Ambien) and
usually subside after a few days on the medication.
2. Nausea is a common side effect of zolpidem (Ambien) and usually subsides after a few
days on the medication.
3. Diarrhea is a common side effect of zolpidem (Ambien) and usually subsides after a few
days on the medication.
4. During sleepwalking, a patient may leave the home and cause injury to self.
Page Ref: 162
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
GR|ANLN
DESCompetencies:
MORE.COM Knowledge and Science:
lifespan, and in all healthcare settings.
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 14-9 For each of the drug classes listed in Drugs at a Glance, know
representative drugs and explain their mechanisms of action, primary actions, and important
adverse effects.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
12
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
13) A client experiencing nervousness asks the nurse why escitalopram was prescribed. Which
response should the nurse provide the client?
1. "The same brain chemicals are involved with anxiety and depression."
2. "You are really depressed; it is just manifested as anxiety. These medications are safer
than benzodiazepines."
3. "Your doctor thinks that this is the best treatment for your anxiety, and these
medications are safer than benzodiazepines."
4. "The two disorders are similar, and if you treat depression, the anxiety goes away."
Answer: 1
Explanation:
1. Antidepressants are frequently used to treat symptoms of anxiety. They reduce anxiety
by altering levels of norepinephrine and serotonin. These neurotransmitters are also
associated with depression.
2. The client is being treated for generalized anxiety; this is different from depression.
3. Telling the client that the doctor knows best is a condescending reply and does not
answer the patient's question.
4. Depression and anxiety are two separate disorders.
Page Ref: 158-160
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
RADEand
SMOdevelopment,
RE.COM pathophysiology, pharmacology,
reflects an understanding of human G
growth
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 14-9 For each of the drug classes listed in Drugs at a Glance, know
representative drugs and explain their mechanisms of action, primary actions, and important
adverse effects.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
13
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
14) A client presents to the clinic with symptoms of hyperthermia and diaphoresis. The client's
prescription history includes escitalopram (Lexapro), St. John's wort, levothyroxine, and
acetaminophen. Which should the nurse suspect has occurred?
1. The patient may be experiencing serotonin syndrome.
2. The patient may have contracted a virus.
3. The patient may be experiencing withdrawal.
4. The patient may be experiencing thyroid toxicosis.
Answer: 1
Explanation:
1. The use of St. John's wort combined with escitalopram places the patient at risk for
serotonin syndrome. Symptoms of serotonin syndrome include hyperthermia and
diaphoresis.
2. There is no indication the patient has a virus.
3. Escitalopram, St. John's wort, levothyroxine, or acetaminophen are not associated with
withdrawal symptoms.
4. The primary cause of thyroid toxicosis is an overactive thyroid gland. The client is
prescribed levothyroxine to replace thyroid hormone due to an underactive thyroid
gland.
Page Ref: 160
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
GRIX.3
ADImplement
ESMORE.holistic,
COM patient-centered care that
care. | AACN Essential Competencies:
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 14-9 For each of the drug classes listed in Drugs at a Glance, know
representative drugs and explain their mechanisms of action, primary actions, and important
adverse effects.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
14
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
15) The nurse has provided teaching for a client prescribed clonazepam (Klonopin). Which is an
important outcome when evaluating the client's understanding of the teaching?
1. The client will verbalize the signs of developing Stevens-Johnson rash.
2. The client will verbalize the importance of dietary restrictions related to this drug.
3. The client will verbalize the importance of having routine laboratory work.
4. The client will verbalize the consequences of abruptly stopping the drug.
Answer: 4
Explanation:
1. Stevens-Johnson rash is not a side effect of benzodiazepines.
2. There aren't any diet restrictions with the use of benzodiazepines.
3. Routine blood work is not required with the use of benzodiazepines.
4. Abrupt discontinuation of benzodiazepines like clonazepam (Klonopin) can result in
serious withdrawal symptoms.
Page Ref: 157
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 14-8 Categorize drugs used for anxiety and insomnia based on their
GRADESMORE.COM
classification and mechanism of action.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
15
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WWW.GRADESMORE.COM
16) Which condition is a client most likely experiencing who tells the nurse he or she is having
difficulty sleeping because he or she has two final exams approaching?
1. Situational anxiety
2. Social anxiety
3. Obsessive-compulsive disorder
4. Performance anxiety
Answer: 1
Explanation:
1. The final examination is a temporary event that is the cause of the anxiety. Once the
examination is over, it is likely that the situational anxiety will end.
2. Social anxiety is a fear of crowds.
3. Obsessive-compulsive disorder (OCD) involves recurrent, intrusive thoughts or repetitive
behaviors that interfere with normal activities or relationships.
4. Although the situation presented required the student to perform on the exam, it is best
defined as situational anxiety.
Page Ref: 152
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Coping Mechanisms
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
GRADESMORE.COM
Process: Assessment
Learning Outcome: 14-1 Identify the major types of anxiety disorders.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
16
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
17) Which should the nurse recommend to a client as a primary approach to managing stress?
1. A combined approach using a prescription and nonpharmacological strategies
2. The use of an anxiolytic
3. The practice of meditation
4. To determine the cause of the anxiety
Answer: 4
Explanation:
1. A combined approach using a prescription and nonpharmacological strategies is not a
primary approach to managing stress.
2. The use of medications alone is not a primary approach.
3. Meditation may or may not be useful for specific individuals.
4. Stress is generally a symptom of an underlying disorder. It is more productive to uncover
and address the cause than to treat the symptoms.
Page Ref: 154
Cognitive Level: Understanding
Client Need/Sub: Psychosocial Integrity: Coping Mechanisms
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: VII.4 Use
behavioral change techniques to promote health and manage illness. | NLN Competencies:
Knowledge and Science: Relationships between knowledge/science and quality and safe patient
care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 14-3 Discuss factors contributing to anxiety and explain some
RADwith
ESMthis
OREdisorder.
.COM
nonpharmacologic therapies used toGcope
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
18) Which area of the brain is primarily responsible for maintaining sleep and wakefulness?
1. Reticular activating system
2. Cerebral cortex
3. Limbic system
4. Cerebellum
Answer: 1
Explanation:
1. The reticular activating system is responsible for sleeping and wakefulness.
2. The primary functions of the cerebral cortex do not include sleep and wakefulness.
3. The limbic system is responsible for emotional expression, learning, and memory.
4. The primary functions of the cerebellum do not include sleep and wakefulness.
Page Ref: 154
Cognitive Level: Remembering
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: VII.4 Use
behavioral change techniques to promote health and manage illness. | NLN Competencies:
Knowledge and Science: Relationships between knowledge/science and quality and safe patient
17
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 14-3 Discuss factors contributing to anxiety and explain some
nonpharmacologic therapies used to cope with this disorder.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
19) Which drug category can be used for treating anxiety?
1. Antitussives
2. Anticoagulants
3. Seizure drugs
4. Antibiotics
Answer: 3
Explanation:
1. Antitussives are used as cough suppressants.
2. Anticoagulants are used to prevent blood clots from forming.
3. In addition to antidepressants, several other drug classes are used to treat anxiety,
including seizure drugs.
4. Antibiotics are used primarily for bacterial infections.
Page Ref: 157
Cognitive Level: Remembering
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
GRADEIII.1
SMO
RE.Cthe
OMinterrelationships among theory,
processes. | AACN Essential Competencies:
Explain
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 14-5 Explain the pharmacologic management of anxiety and insomnia.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
18
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
20) A client with anxiety and insomnia asks the nurse about the benefits of treatment with a
benzodiazepine. Which response should the nurse provide the client?
1. "Benzodiazepines are the most effective."
2. "Benzodiazepines have the lowest risk of dependency and tolerance."
3. "Benzodiazepines are most likely to be covered under insurance premiums."
4. "Benzodiazepines are most affordable."
Answer: 2
Explanation:
1. Benzodiazepines are not necessarily more effective than other drugs.
2. Benzodiazepines have a lower risk of dependency and tolerance than do other drugs
used for anxiety and insomnia (such as the barbiturates).
3. Benzodiazepines are not necessarily more likely to be covered under insurance
premiums. Although economics is an important factor in pharmacology, drug safety
should be considered.
4. Benzodiazepines are not necessarily more affordable. Although economics is an
important factor in pharmacology, drug safety should be considered.
Page Ref: 156-157
Cognitive Level: Understanding
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
GRApatient
DESMOcare.
RE.|CNursing/Integrated
OM
knowledge/science and quality and safe
Concepts: Nursing
Process: Planning
Learning Outcome: 14-5 Explain the pharmacologic management of anxiety and insomnia.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
19
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
21) The nurse is preparing the education for a client prescribed a selective serotonin reuptake
inhibitors (SSRI). Which adverse effects should the nurse include in the teaching?
1. Drowsiness and coma
2. Weight gain and sexual dysfunction
3. Headache and nausea
4. Dry mouth and urine retention
Answer: 2
Explanation:
1. Drowsiness or coma is not a common adverse effect.
2. Weight gain or sexual dysfunction are common adverse effects and may result in poor
medication adherence.
3. Headache is not a common adverse effect.
4. Although anticholinergic effects such as dry mouth and urine retention could occur, they
are not as common as another set of adverse effects.
Page Ref: 159
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Implementation
RADESMOREmanagement
.COM
Learning Outcome: 14-5 Explain theGpharmacologic
of anxiety and insomnia.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
22) Which information should the nurse include in the teaching for a client prescribed
ramelteon?
1. Daytime drowsiness is common.
2. There is an increased risk of physical dependence.
3. Relatively short onset of action.
4. The primary action is to induce a deep sleep state.
Answer: 3
Explanation:
1. Ramelteon has less of a residual of daytime drowsiness.
2. Ramelteon does not result in physical dependence.
3. Ramelteon has a relatively short onset of action.
4. Ramelteon is a melatonin receptor agonist that has been shown to mainly improve sleep
induction.
Page Ref: 160-161
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
20
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 14-5 Explain the pharmacologic management of anxiety and insomnia.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
23) Which statement regarding the use of zolpidem (Ambien) for insomnia is accurate?
1. Clients using Ambien should avoid foods that contain tyramine.
2. Ambien will take longer to produce an effect when taken with food.
3. Ambien is contraindicated during pregnancy but can be taken by breastfeeding mothers.
4. Ambien is classified as a benzodiazepine.
Answer: 2
Explanation:
1. Clients using MAOIs (not Ambien) should avoid foods high in tyramine.
2. The absorption of Ambien is slowed when taken with food.
3. It is classified as pregnancy category B and should be avoided by breastfeeding mothers.
Patients using MAOIs (not Ambien) should avoid foods high in tyramine.
4. It is classified as a nonbenzodiazepine CNS depressant.
Page Ref: 162
Cognitive Level: Understanding
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRDelineate
ADESMOgeneral
RE.COcategories
M
Standards: QSEN Competencies: V.A.4
of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 14-9 For each of the drug classes listed in Drugs at a Glance, know
representative drugs and explain their mechanisms of action, primary actions, and important
adverse effects.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
21
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
24) Which explanation best explains why barbiturates are rarely used to treat anxiety and
insomnia?
1. They have a greater associated cost.
2. They have a high risk of producing an allergic response.
3. They are seldom effective.
4. They produce many serious adverse effects.
Answer: 4
Explanation:
1. Barbiturates are not necessarily more expensive.
2. Allergic reactions can occur, but are rare, and are not a primary reason they are no
longer used for anxiety and/or insomnia.
3. Barbiturates can be effective.
4. Barbiturates were the drug of choice for anxiety and insomnia prior to the discovery of
safer drug alternatives.
Page Ref: 161-162
Cognitive Level: Understanding
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Evaluation
RADEclasses
SMORof
E.medications
COM
Learning Outcome: 14-4 Identify theGthree
used to treat anxiety and
sleep disorders.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
22
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WWW.GRADESMORE.COM
25) Which should the nurse recognize is a benefit of obtaining a thorough history from a client
who is experiencing anxiety?
1. Pharmacotherapy can be prescribed.
2. The type of counseling can be prescribed based on the history.
3. The category of anxiety disorder can be identified.
4. The treatment plan can be created.
Answer: 1
Explanation:
1. Pharmacotherapy can be prescribed by the healthcare provider based on the history of
the client.
2. The type of counseling a patient may require is not prescribed based on a health history.
3. A health history is not used to determine the category of anxiety disorder.
4. A treatment plan is not created based on a health history.
Page Ref: 156
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.8 Implement
evidence-based nursing interventions as appropriate for managing the acute and chronic care
of patients and promoting health across the lifespan. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Assessment
GRADprocess
ESMORto
E.care
COM
Learning Outcome: 14-10 Use the nursing
for patients receiving
pharmacotherapy for anxiety and insomnia.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
23
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GRADESMORE.COM
WWW.GRADESMORE.COM
26) Which assessment findings should the nurse anticipate if a client is diagnosed with posttraumatic stress disorder?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Tachycardia
2. Panic attacks
3. Inability to focus
4. A fear of exposure to germs
5. Hallucinations
Answer: 1, 2, 3, 5
Explanation:
1. PTSD is a type of extreme situational anxiety. Tachycardia is a symptom of anxiety.
2. PTSD is a type of extreme situational anxiety. Extreme nervousness or panic attacks are
symptoms of anxiety.
3. PTSD is a type of extreme situational anxiety. Symptoms of anxiety include inability to
focus.
4. A fear of exposure to germs is typical of obsessive-compulsive disorder.
5. In post-traumatic stress disorder the person re-experiences traumatic events, which can
take the form of nightmares, hallucinations, or flashbacks.
Page Ref: 152
Cognitive Level: Analyzing
Client Need/Sub: Psychosocial Integrity: Coping Mechanisms
GRProvide
ADESMpatient-centered
ORE.COM care with sensitivity and
Standards: QSEN Competencies: I.B.3
respect for the diversity of human experience. | AACN Essential Competencies: VII.4 Use
behavioral change techniques to promote health and manage illness. | NLN Competencies:
Knowledge and Science: Relationships between knowledge/science and quality and safe patient
care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 14-3 Discuss factors contributing to anxiety and explain some
nonpharmacologic therapies used to cope with this disorder.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
24
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
27) A client has been in the intensive care unit for a week receiving various procedures
throughout the day and night. Currently the client, though physiologically stable, is irritable
and paranoid and complains of vivid dreams when dozing off to sleep. Which are the best
actions for the nurse to take at this time?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Check the client's oxygen status.
2. Request a prescription for a sleep hypnotic.
3. Assess the client's vital signs.
4. Turn down the lights at night and reduce noise to a minimum.
5. Schedule all tests and procedures before 9 p.m. or after 7 a.m.
Answer: 2, 4, 5
Explanation:
1. The client is physiologically stable.
2. Since it is important for the patient to get rest, an order for sleep medication would be
appropriate.
3. It is not necessary to assess the patient's vital signs, since the patient is physiologically
stable.
4. Turning down the lights and reducing noises will help support sleep.
5. Scheduling tests and procedures so as to not disturb the client's sleep is indicated.
Page Ref: 163-164
Cognitive Level: Analyzing
GRATherapeutic
DESMORE.Environment
COM
Client Need/Sub: Psychosocial Integrity:
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.8 Implement
evidence-based nursing interventions as appropriate for managing the acute and chronic care
of patients and promoting health across the lifespan. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 14-10 Use the nursing process to care for patients receiving
pharmacotherapy for anxiety and insomnia.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
25
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
28) Which nonpharmacological interventions should the nurse recommend for a client who is
having difficulty sleeping?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Make certain your bedroom is nice and warm."
2. "There are alternative methods to treat insomnia, such as yoga, meditation, and
massage therapy."
3. "Eating a large meal at bedtime will help induce sleep."
4. "Avoid caffeinated beverages, nicotine, and alcohol immediately prior to bedtime."
5. "Play your favorite type of music when you go to sleep."
Answer: 2, 4
Explanation:
1. Sleep disturbances may be related to sleeping in a room that is too warm.
2. Acupuncture, aromatherapy, yoga, prayer, massage, meditation, biofeedback therapy,
hypnosis, guided imagery, and music therapy are alternative treatments for anxiety and
insomnia.
3. Eating a large meal prior to bedtime is a secondary cause of insomnia.
4. Amphetamines, cocaine, caffeinated beverages, corticosteroids, sympathomimetics,
antidepressants, alcohol use, nicotine, and tobacco use are secondary causes of
insomnia.
5. Music may contribute to environmental stimuli.
Page Ref: 154-155
GRADESMORE.COM
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Rest and Sleep
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.2 Demonstrate an understanding of the basic
elements of the research process and models for applying evidence to clinical practice. | NLN
Competencies: Knowledge and Science: Relationships between knowledge/science and quality
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 14-7 Identify normal sleep patterns and explain how these might be
affected by anxiety and stress.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
26
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GRADESMORE.COM
WWW.GRADESMORE.COM
29) A client asks the nurse if there are any over-the-counter herbs or nonprescription
medications that can be used to improve insomnia. Which response should the nurse
provide the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Ginger root is commonly taken to improve sleep."
2. "Ginkgo is an herb commonly taken to improve sleep."
3. "Diphenhydramine (Benadryl) and doxylamine are over-the-counter meds sometimes
taken to produce drowsiness."
4. "Valerian and melatonin are herbs commonly taken to improve sleep."
5. "Kava is an herb taken to improve sleep."
Answer: 3, 4
Explanation:
1. Ginger root is not used to improve sleep.
2. Ginkgo is not used to improve sleep.
3. Diphenhydramine and doxylamine are two antihistamines frequently used to produce
drowsiness.
4. An herbal product with demonstrated efficacy in promoting relaxation is valerian root.
Supplemental melatonin at bedtime is alleged to decrease the time required to fall
asleep and to produce a deep and restful sleep.
5. High doses of kava can damage the liver and should not be used unless recommended
by a healthcare provider.
GRADESMORE.COM
Page Ref: 155, 161
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.8 Implement
evidence-based nursing interventions as appropriate for managing the acute and chronic care
of patients and promoting health across the lifespan. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 14-10 Use the nursing process to care for patients receiving
pharmacotherapy for anxiety and insomnia.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
27
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
30) A client asks the nurse which prescriptions are commonly used to treat insomnia. Which
pharmacological agents should the nurse discuss with the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Diphenhydramine (Benadryl)
2. Valerian root
3. Ramelteon (Rozerem)
4. Flurazepam (Dalmane)
5. Zolpidem (Ambien)
Answer: 3, 4, 5
Explanation:
1. Diphenhydramine (Benadryl) can be obtained over the counter and does not need a
prescription to obtain. It does promote getting to sleep.
2. Valerian is an herbal product that does not need a prescription to obtain. It does
promote getting to sleep.
3. Rozerem is a newer, nonbenzodiazepine hypnotic approved to treat chronic insomnia in
people who have problems falling asleep.
4. Benzodiazepines are drugs of choice for generalized anxiety disorder and the short-term
therapy of insomnia. Flurazepam (Dalmane) should be taken at bedtime because it
quickly produces significant drowsiness.
5. Ambien is a sedative-hypnotic approved for short-term treatment of insomnia.
Page Ref: 155, 161
GRADESMORE.COM
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.8 Implement
evidence-based nursing interventions as appropriate for managing the acute and chronic care
of patients and promoting health across the lifespan. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 14-10 Use the nursing process to care for patients receiving
pharmacotherapy for anxiety and insomnia.
MNL Learning Outcome: 14.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for anxiety and sleep disorders.
28
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
Pharmacology for Nurses, 6e (Adams)
Chapter 15 Drugs for Seizures
1) A client diagnosed with epilepsy asks the nurse why he or she will have to take a
prescription. Which response should the nurse provide the client?
1. "The prescription will decrease the intensity of the seizures."
2. "You will need a prescription for a little while to cure the seizures."
3. "You will need to take a prescription on a continual basis to control the seizures."
4. "You might not need a prescription; the epilepsy may be controlled with a ketogenic
diet."
Answer: 3
Explanation:
1. The prescription is intended to prevent seizure activity.
2. Epilepsy and associated seizures are not curable with medications.
3. Epilepsy is a condition for which seizures may occur on a chronic basis. Once seizures
are controlled, patients will continue indefinitely on the antiseizure prescription.
4. The ketogenic diet is used when seizures cannot be controlled through
pharmacotherapy or when there are unacceptable side effects to the prescriptions.
Page Ref: 169-170
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
GRADESMORE.COM
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 15-2 Recognize possible causes of seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
1
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2) The nurse has provided education for a client diagnosed with epilepsy. Which statement
made by the client indicates an understanding of the information?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Excessive stress levels cause disruptions in how the brain receives oxygen, leading to
epilepsy."
2. "Epilepsy may be caused by a head injury."
3. "Eating disorders, like anorexia nervosa, increase the risk for developing epilepsy."
4. "A stroke, or brain attack, could increase the risk for developing epilepsy."
5. "With some cases of epilepsy, the cause is never determined."
Answer: 2, 4, 5
Explanation:
1. Excessive levels of stress cannot disrupt cerebral oxygen to the extent that epilepsy
would occur.
2. Head trauma is a known cause of seizures.
3. There is no known correlation with anorexia nervosa and the development of epilepsy.
4. Changes in cerebral perfusion such as hypotension; strokes or brain attacks; and shock
may be causes of seizures.
5. In some cases, the exact etiology may not be identified.
Page Ref: 169
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRADemonstrate
DESMORE.
COM
Standards: QSEN Competencies: III.A.1
knowledge
of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 15-2 Recognize possible causes of seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
2
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GRADESMORE.COM
WWW.GRADESMORE.COM
3) A client asks the nurse about the characteristics of absence seizures. Which explanation
should the nurse provide the client?
1. "Absence seizures are basically the same kind of seizures as grand mal, but they are less
frequent."
2. "This type of seizure is characterized by staring into space for a few seconds."
3. "Absence seizures are characterized by twitching of the arms and legs."
4. "This type of seizure is similar to drop attacks."
Answer: 2
Explanation:
1. Grand mal, or tonic-clonic, seizures are different from absence or petit mal seizures;
they are different forms of epilepsy.
2. Absence seizures last a few seconds and are characterized by staring into space.
3. Simple partial seizures are characterized by twitching of the arms and legs.
4. Drop attacks or atonic seizures last a few seconds and are characterized by stumbling or
falling for no reason.
Page Ref: 176
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical,
behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health
and illness parameters in patients, using developmentally and culturally appropriate
GRADESM
ORScience:
E.COMIntegration of knowledge from
approaches. | NLN Competencies: Knowledge
and
nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 15-3 Relate signs and symptoms to specific types of seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
3
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GRADESMORE.COM
WWW.GRADESMORE.COM
4) A client with epilepsy who has been seizure free and prescribed phenytoin (Dilantin) asks
the nurse why he or she needs to still have blood testing. Which response should the nurse
provide the client?
1. "Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic
dose."
2. "Phenytoin (Dilantin) can cause blood-thinning in some patients."
3. "Phenytoin (Dilantin) can cause Stevens-Johnson syndrome, which can be detected
through blood testing."
4. "Phenytoin (Dilantin) can deplete your system of potassium."
Answer: 1
Explanation:
1. Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic
dose; blood levels must be monitored to ensure a therapeutic level and to prevent
toxicity.
2. Phenytoin (Dilantin) is not an anticoagulant and does not cause thinning of the blood.
3. Stevens-Johnson syndrome is a severe skin reaction that can be an adverse outcome
with phenytoin (Dilantin), but it is monitored by skin assessment, not blood tests.
4. There isn't any evidence to support that phenytoin (Dilantin) causes potassium
depletion.
Page Ref: 177
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRADemonstrate
DESMORE.
COM
Standards: QSEN Competencies: III.A.1
knowledge
of basic scientific methods and
processes. | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health
teaching, health counseling, screening, outreach, disease and outbreak investigation, referral
and follow-up throughout the lifespan. | NLN Competencies: Context and Environment: Chronic
disease management. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 15-5 Explain the importance of patient drug compliance in the
pharmacotherapy of epilepsy and seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
4
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GRADESMORE.COM
WWW.GRADESMORE.COM
5) The nurse has provided a client education on the pharmacologic management of epilepsy.
Which statement made by the client indicates an understanding of the treatment?
1. "I understand that I will take an antiseizure prescription indefinitely."
2. "I will avoid foods with tyramine while taking my antiseizure prescription."
3. "I will be on a ketogenic diet combined with an antiseizure prescription."
4. "I will remain on an antiseizure prescription for 1 year after my last seizure.
Answer: 1
Explanation:
1. Once seizures have been controlled, patients are continued indefinitely on the
antiseizure drug.
2. A tyramine-free diet is indicated for patients receiving monoamine oxidase inhibitor
medications.
3. A ketogenic diet is indicated when seizures cannot be controlled through
pharmacotherapy or when there are unacceptable side effects to the medications.
4. It is unknown how long antiseizure drugs will be necessary, but many patients require a
lifetime regimen.
Page Ref: 170-172
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health
teaching, health counseling, screening, outreach, disease and outbreak investigation, referral
GRA
DESCompetencies:
MORE.COM Context and Environment: Chronic
and follow-up throughout the lifespan.
| NLN
disease management. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 15-5 Explain the importance of patient drug compliance in the
pharmacotherapy of epilepsy and seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
5
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GRADESMORE.COM
WWW.GRADESMORE.COM
6) The nurse has administered intravenous (IV) diazepam (Valium) for the client in status
epilepticus. Which initial assessment should the nurse perform?
1. Respirations
2. Level of consciousness
3. Heart rate
4. Blood pressure
Answer: 1
Explanation:
1. Respiratory depression is common when diazepam is given intravenously (IV). Assessing
the respirations is the most important.
2. Assessing the level of consciousness is important, but not the most important.
3. Although tachycardia is a side effect of intravenous diazepam (Valium), assessing the
patient's heart rate is not the most important.
4. Although hypotension is an effect of intravenous diazepam (Valium), the blood pressure
is not the most important assessment.
Page Ref: 174
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
GR|ANLN
DESCompetencies:
MORE.COM Context and Environment: Chronic
lifespan, and in all healthcare settings.
disease management. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 15-6 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples and explain their mechanism of drug action, primary actions, and
important adverse effects.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
6
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
7) The nurse is preparing to administer phenytoin (Dilantin). Which route should the nurse
anticipate to administer the prescription?
1. Intramuscular
2. Central venous catheter
3. Intravenously
4. Subcutaneous
Answer: 3
Explanation:
1. Phenytoin is not administered intramuscularly. The prescription is a soft-tissue irritant
that causes local tissue damage following extravasation.
2. Phenytoin should not be administered through a central venous catheter.
3. Phenytoin is administered intravenously.
4. Phenytoin is not administered subcutaneously. The prescription is a soft-tissue irritant
that causes local tissue damage following extravasation.
Page Ref: 178
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Context and Environment: Chronic
GRADEConcepts:
SMORE.Nursing
COM Process: Evaluation
disease management. | Nursing/Integrated
Learning Outcome: 15-6 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples and explain their mechanism of drug action, primary actions, and
important adverse effects.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
7
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GRADESMORE.COM
WWW.GRADESMORE.COM
8) The healthcare provider has prescribed intravenous phenytoin (Dilantin) IV piggyback. The
client is currently receiving 5% dextrose in water (D5W) intravenously (IV). Which action
should the nurse take?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Use a large vein for the infusion.
2. Use an intravenous (IV) line with a filter.
3. Flush the intravenous (IV) line with saline.
4. Monitor the patient for hypertension.
5. Monitor the patient for Stevens-Johnson syndrome.
Answer: 2, 3
Explanation:
1. Phenytoin (Dilantin) is a soft-tissue irritant that will cause local tissue damage if
extravasation occurs, so a large vein must be used for infusion.
2. An intravenous filter will trap any precipitate that occurs.
3. Intravenous lines of 5% dextrose in water (D5W) must be flushed with saline, as traces
of dextrose can cause microscopic precipitate formations that become emboli, if
infused.
4. Patients receiving phenytoin (Dilantin) are at risk for hypotension, not hypertension.
5. Stevens-Johnson syndrome is a side effect of phenytoin (Dilantin), but occurs over the
course of several days.
Page Ref: 177
GRADESMORE.COM
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Context and Environment: Chronic
disease management. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 15-6 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples and explain their mechanism of drug action, primary actions, and
important adverse effects.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
8
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GRADESMORE.COM
WWW.GRADESMORE.COM
9) The client receiving valproic acid (Depakene) for treatment of seizures has been taking
81mg aspirin daily. For which should the nurse monitor the client?
1. Increased seizure activity
2. Stevens-Johnson syndrome
3. Migraine headaches
4. Bruising of the skin
Answer: 4
Explanation:
1. Valproic acid (Depakene) and aspirin do not increase the risk of seizure activity.
2. Stevens-Johnson syndrome is a side effect of valproic acid (Depakene); its occurrence is
not increased with concomitant aspirin use.
3. Valproic acid (Depakene) and aspirin use are not associated with migraine headaches.
4. Valproic acid (Depakene) can prolong bleeding time; concomitant aspirin use can cause
severe bleeding.
Page Ref: 179
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Context and Environment: Chronic
GRADEConcepts:
SMORE.Nursing
COM Process: Assessment
disease management. | Nursing/Integrated
Learning Outcome: 15-6 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples and explain their mechanism of drug action, primary actions, and
important adverse effects.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
9
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GRADESMORE.COM
WWW.GRADESMORE.COM
10) A client with epilepsy prescribed Phenobarbital (Luminal) tells the nurse she is planning a
pregnancy. Which statement should the nurse provide the client?
1. "Your medication dose will need to be decreased during your pregnancy."
2. "Please talk to your doctor; this drug is contraindicated in pregnancy."
3. "Your medication dose will need to be increased during your pregnancy."
4. "Please talk to your doctor; you will need a safer drug like valproic acid (Depakene)."
Answer: 2
Explanation:
1. The medication does not need to be decreased; it might need to be stopped.
2. Phenobarbital (Luminal) falls under Pregnancy Category D and is contraindicated in
pregnancy.
3. The medication does not need to be increased; it might need to be stopped.
4. Valproic acid (Depakene) is also a Pregnancy Category D drug and is contraindicated
during pregnancy.
Page Ref: 175
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Context and Environment: Chronic
GRADEConcepts:
SMORE.Nursing
COM Process: Implementation
disease management. | Nursing/Integrated
Learning Outcome: 15-6 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples and explain their mechanism of drug action, primary actions, and
important adverse effects.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
10
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GRADESMORE.COM
WWW.GRADESMORE.COM
11) A client that has been taking phenytoin (Dilantin) tells the nurse they want to stop taking
the medication due to the side effects. Which response should the nurse provide the client?
1. "Please do not stop the prescription abruptly, as you will have withdrawal seizures."
2. "Side effects are a problem, but they are not as bad as the seizures you were having."
3. "Another prescription can be added to decrease the side effects."
4. "Your seizures have been controlled so I will let your healthcare provider know that you
no longer will be taking the prescription."
Answer: 1
Explanation:
1. Seizures are likely to occur with abrupt withdrawal of antiseizure prescription. The
prescription must be withdrawn over a period of 6 to 12 weeks.
2. Telling a client that prescription side effects are not as bad as seizures is an
inappropriate and nontherapeutic response that does not address the patient's
concerns.
3. There is no other prescription that can be added to decrease the side effects associated
with phenytoin (Dilantin).
4. It is not within the nurse's scope of practice to determine if a client has been taking a
medication long enough. The client must be informed of the consequences of abruptly
stopping the medication.
Page Ref: 177
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRADemonstrate
DESMORE.
COM
Standards: QSEN Competencies: III.A.1
knowledge
of basic scientific methods and
processes. | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health
teaching, health counseling, screening, outreach, disease and outbreak investigation, referral
and follow-up throughout the lifespan. | NLN Competencies: Context and Environment: Chronic
disease management. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 15-5 Explain the importance of patient drug compliance in the
pharmacotherapy of epilepsy and seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
11
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
12) A client with type I diabetes mellitus has been prescribed phenytoin (Dilantin). Based on the
client's medical history, which should the nurse anticipate to be included in the treatment
plan?
1. A decrease in the patient's insulin
2. An increase the patient's insulin
3. Monitor coagulation studies
4. Implement fall precautions
Answer: 2
Explanation:
1. Phenytoin (Dilantin) can increase serum glucose levels.
2. Phenytoin (Dilantin) can increase serum glucose levels resulting in the need for
additional insulin.
3. All clients receiving phenytoin (Dilantin) are at risk for petechiae, epistaxis, and
hematuria; this is not specific to the patient with type 1 diabetes mellitus.
4. All clients receiving phenytoin (Dilantin) are at risk for dizziness and ataxia; this is not
specific to the client with type 1 diabetes mellitus.
Page Ref: 179
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
GR
DECompetencies:
SMORE.COMContext and Environment: Chronic
promoting health across the lifespan.
|A
NLN
disease management. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 15-4 Describe the nurse's role in the pharmacologic management of
seizures of an acute nature and epilepsy.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
12
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
13) The nurse has provided the education to the parent of a young child prescribed valproic
acid (Depakene) syrup. Which statement made by the parent indicates an understanding of
the teaching?
1. "I should not mix this with carbonated beverages."
2. "If my child gets a headache from this, I can administer a baby aspirin."
3. "I can still give the clonazepam (Klonopin) prescribed by the psychiatrist for sleep."
4. "I can give this on a full stomach or an empty stomach."
Answer: 1
Explanation:
1. Mixing valproic acid (Depakene) syrup with carbonated beverages will trigger immediate
release of the drug, which causes severe mouth and throat irritation.
2. Aspirin can increase valproic acid (Depakene) toxicity, and aspirin should not be given to
children because of Reye syndrome.
3. Clonazepam (Klonopin) given with valproic acid (Depakene) can induce absence
seizures.
4. Valproic acid (Depakene) is a gastrointestinal (GI) irritant and should be given with food.
Page Ref: 179
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
GRADESMOacross
RE.Cthe
OMhealth-illness continuum, across
medical management, and nursing management
lifespan, and in all healthcare settings. | NLN Competencies: Context and Environment: Chronic
disease management. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 15-6 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples and explain their mechanism of drug action, primary actions, and
important adverse effects.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
13
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GRADESMORE.COM
WWW.GRADESMORE.COM
14) A client taking phenobarbital (Luminal) for seizure control asks the nurse how the
prescription can control seizures. Which response should the nurse provide the client?
1. "Phenobarbital (Luminal) stops seizures by decreasing the calcium in the brain, which is
responsible for the seizures."
2. "Phenobarbital (Luminal) stops seizures by increasing a chemical called glutamate that
calms down the excitability in the brain."
3. "Phenobarbital (Luminal) stops seizures by decreasing the sodium in the brain, which is
responsible for the seizures."
4. "Phenobarbital (Luminal) stops seizures by increasing a chemical called GABA that calms
down the excitability in the brain."
Answer: 4
Explanation:
1. Succinimides, not phenobarbital (Luminal), suppress calcium influx.
2. Glutamate is the primary excitatory neurotransmitter in the brain; enhancing this
neurotransmitter will increase the likelihood of seizures.
3. Hydantoins and phenytoin-like drugs, not phenobarbital (Luminal), suppress sodium
influx.
4. Phenobarbital (Luminal) acts biochemically in the brain by enhancing the action of the
neurotransmitter GABA, which is responsible for suppressing abnormal neuronal
discharges that can cause epilepsy.
Page Ref: 175
Cognitive Level: Applying
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Context and Environment: Chronic disease
management. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 15-7 Categorize drugs used in the treatment of seizures based on their
classification and mechanism of action.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
14
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
15) An older adult is prescribed phenobarbital (Luminal) for seizure control. Which assessment
should the nurse recognize is the most important?
1. Fluid intake
2. Electrolyte balance
3. Respiratory function
4. Nutritional status
Answer: 3
Explanation:
1. Fluid intake is often decreased in older adults but is not a side effect of barbiturates.
2. Barbiturates do not affect electrolyte balance.
3. Older adults are at risk for cumulative effects of barbiturates due to diminished hepatic
and renal function. Central nervous system (CNS) depression can lead to suppression of
respiratory function.
4. Nutritional status is important with older adult patients but is not the primary concern.
Page Ref: 175
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Context and Environment: Chronic
disease management. | Nursing/Integrated Concepts: Nursing Process: Assessment
GRnurse's
ADESrole
MORinEthe
.COpharmacologic
M
Learning Outcome: 15-4 Describe the
management of
seizures of an acute nature and epilepsy.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
15
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
16) The nurse is providing information about seizures to a client. Which statement should the
nurse include in the discussion?
1. "Convulsions are a symptom of the underlying seizure disorder."
2. "Bacterial infections can cause seizures."
3. "Epilepsy is an acute disorder characterized by nonconvulsive seizures."
4. "All seizures involve convulsions."
Answer: 2
Explanation:
1. Convulsions are a type of seizure, and seizures are a symptom of an underlying disorder.
2. Seizures can be caused by bacterial infections of the nervous system.
3. Epilepsy is generally chronic and can present with convulsive seizures.
4. Not all seizures involve convulsions.
Page Ref: 169
Cognitive Level: Understanding
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 15-1 Compare and contrast the terms seizures, convulsions, and epilepsy.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
GRADESMORE.COM
16
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GRADESMORE.COM
WWW.GRADESMORE.COM
17) The nurse observes a client that stops talking mid-sentence and has a blank stare for 5
seconds. Which should the nurse suspect has occurred?
1. Simple partial seizure
2. Status epilepticus
3. Petit mal seizure
4. Drop attack
Answer: 3
Explanation:
1. Simple partial seizures manifest in olfactory, auditory, or visual hallucinations; intense
emotions; or twitching of arms, legs, and face.
2. Status epilepticus is continuous seizure activity, which can lead to coma or death.
3. The symptoms presented indicate a general (absence) or petit mal seizure.
4. Drop attacks are manifested by falling or stumbling for no reason. These attacks
typically last a few seconds.
Page Ref: 171
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical,
behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health
and illness parameters in patients, using developmentally and culturally appropriate
approaches. | NLN Competencies: Knowledge and Science: Integration of knowledge from
GRADESMORConcepts:
E.COM Nursing Process: Assessment
nursing and other disciplines. | Nursing/Integrated
Learning Outcome: 15-3 Relate signs and symptoms to specific types of seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
17
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
18) A parent states, "The doctors all say that my son's problem is epilepsy, but I don't think that
is correct. I have never seen him jerk or thrash." Which information should the nurse
include in a response to the parent?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "The episodes of jerking and thrashing are called convulsions."
2. "Seizures take many forms."
3. "Your son may have seizures, but not epilepsy."
4. "Seizures can be a sign that epilepsy is present."
5. "If there is no physical movement, epilepsy is ruled out."
Answer: 1, 2, 4
Explanation:
1. Convulsions are the involuntary, violent spasms of the large skeletal muscles of the face,
neck, arms, and legs. It is important to provide this parent with correct terminology.
2. There are many types of seizures.
3. It is inappropriate to lead the parent to believe that the diagnosis is incorrect. The nurse
does not have all the necessary information.
4. Epilepsy is any disorder that is characterized by recurrent seizures.
5. Many seizures do not include physical movement, yet the patient still is diagnosed with
epilepsy.
Page Ref: 169
Cognitive Level: Analyzing
GRAD
ESMORE.Adaptation
COM
Client Need/Sub: Physiological Integrity:
Physiological
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 15-1 Compare and contrast the terms seizures, convulsions, and epilepsy.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
18
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
19) A client has been prescribed several different prescriptions for seizure control without any
improvement. Which initial question should the nurse ask the client?
1. "Have you thought about taking a nontypical prescription?"
2. "Have you noticed any decrease in the amount of seizures you have?"
3. "Do you take your medication as prescribed?
4. "Do you drink alcohol?"
Answer: 3
Explanation:
1. Another drug might be indicated, but compliance should be assessed first.
2. There is no indication there is an improvement in seizure control.
3. Compliance with the prescription should be initially assessed for a patient that has not
had an improvement in seizure control after taking several different prescriptions for
seizure control.
4. Alcohol does not increase the risk of seizures for a patient prescribed an antileptic.
Page Ref: 180
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health
teaching, health counseling, screening, outreach, disease and outbreak investigation, referral
and follow-up throughout the lifespan. | NLN Competencies: Context and Environment: Chronic
disease management. | Nursing/Integrated Concepts: Nursing Process: Assessment
RADESMOofRE
.COMdrug compliance in the
Learning Outcome: 15-5 Explain theGimportance
patient
pharmacotherapy of epilepsy and seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
19
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
20) For which adverse effect should the nurse monitor a client prescribed phenytoin (Dilantin)?
1. Vitamin B deficiency
2. Leg edema
3. Bleeding
4. Hypoglycemia
Answer: 3
Explanation:
1. Dilantin affects the metabolism of vitamin K, which can lead to blood dyscrasias.
Hyperglycemia is more common than hypoglycemia, and leg edema is not generally
experienced as an adverse effect. Vitamin B deficiency is not the most common
complication.
2. Leg edema is not generally experienced as an adverse effect.
3. Dilantin affects the metabolism of vitamin K, which can lead to blood dyscrasias.
4. Hyperglycemia is more common than hypoglycemia.
Page Ref: 179
Cognitive Level: Understanding
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Context and Environment: Chronic
GRADEConcepts:
SMORE.Nursing
COM Process: Assessment
disease management. | Nursing/Integrated
Learning Outcome: 15-6 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples and explain their mechanism of drug action, primary actions, and
important adverse effects.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
20
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
21) The nurse is preparing to review the records for a client with petit mal seizures. Which
prescription should the nurse anticipate the client has been prescribed?
1. Diazepam (Valium)
2. Carbamazepine (Tegretol)
3. Phenytoin (Dilantin)
4. Ethosuximide (Zarontin)
Answer: 4
Explanation:
1. Diazepam can be effective for tonic-clonic seizures.
2. Carbamazepine (Tegretol) is used to treat partial and tonic-clonic seizure disorders.
3. Dilantin can be effective for tonic-clonic seizures.
4. Ethosuximide is a succinimide that is indicated for petit mal seizures.
Page Ref: 178-179
Cognitive Level: Remembering
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Context and Environment: Chronic disease
management. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 15-7 Categorize drugs used in the treatment of seizures based on their
classification and mechanism of action.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
GRADESMORE.COM
disorders.
21
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GRADESMORE.COM
WWW.GRADESMORE.COM
22) The educator is discussing the adverse effects of prescriptions used to treat seizure
disorders. Which prescription should the educator refer to when discussing the risk for
extravasation?
1. Phenobarbital (Luminal)
2. Phenytoin (Dilantin)
3. Ethosuximide (Zarontin)
4. Clonazepam (Klonopin)
Answer: 2
Explanation:
1. Phenobarbital is primarily administered orally and is infrequently administered
intravenously.
2. Dilantin is frequently administered intravenously due to slow and variable absorption
rates when given orally. Dilantin results in serious soft tissue damage if extravasation
occurs.
3. Zarontin is an oral medication.
4. Klonopin is an oral medication.
Page Ref: 179
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
GR
DECompetencies:
SMORE.COMContext and Environment: Chronic
promoting health across the lifespan.
|A
NLN
disease management. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 15-4 Describe the nurse's role in the pharmacologic management of
seizures of an acute nature and epilepsy.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
22
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
23) The nurse is preparing to assess a client that had a tonic-clonic seizure. Which assessment
findings should the nurse anticipate?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Incontinence of urine.
2. The client is in a deep sleep.
3. Confusion in relation to place and time.
4. The client reports an odd taste in the mouth.
5. The client attempts to remove their hospital gown.
Answer: 2, 3
Explanation:
1. Incontinence of bowel or bladder is common during a tonic-clonic seizure but is not
indicative of a postictal state.
2. Deep sleep after the seizure is a finding associated with the postictal state.
3. Patients who are in the postictal state may be confused and disoriented.
4. An odd taste, specific odor or noise, or other sensory change known as an aura often
occurs prior to a seizure.
5. During complex partial seizures, patients sometimes fumble with or attempt to remove
clothing.
Page Ref: 171
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
GRADemonstrate
DESMORE.knowledge
COM
Standards: QSEN Competencies: III.A.1
of basic scientific methods and
processes. | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical,
behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health
and illness parameters in patients, using developmentally and culturally appropriate
approaches. | NLN Competencies: Knowledge and Science: Integration of knowledge from
nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 15-3 Relate signs and symptoms to specific types of seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
23
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
24) The nurse has completed the education for the parents of a child with tonic-clonic seizures.
Which statements made by the parents indicate further education is needed?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Some of the times when I thought he was ignoring me may have actually been seizure
activity."
2. "He just needs to focus more to prevent these attacks."
3. "I know he will outgrow these seizures with time."
4. "I hope we can help our son identify his seizure aura."
5. "We will watch for the development of status epilepticus."
Answer: 1, 2, 3
Explanation:
1. Behavior that manifests as the child ignoring outside stimuli is most likely absence
seizure, which is different from tonic-clonic seizure.
2. The patient who suffers seizure disorder cannot prevent seizure occurrence by focusing
harder.
3. The patient with tonic-clonic seizure disorder is less likely to outgrow them than the
patient with absence seizure disorder.
4. Many patients experience an aura prior to the tonic-clonic phase. Identifying the aura
can provide time for the patient to move to a safe area, notify another person of the
impending seizure, and to prepare.
5. Status epilepticus is a medical emergency that may occur in the patient who suffers with
tonic-clonic seizure disorder.GRADESMORE.COM
Page Ref: 171
Cognitive Level: Evaluating
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.1 Conduct comprehensive and focused physical,
behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health
and illness parameters in patients, using developmentally and culturally appropriate
approaches. | NLN Competencies: Knowledge and Science: Integration of knowledge from
nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 15-3 Relate signs and symptoms to specific types of seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
24
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
25) A client prescribed valproic acid (Depakene) for seizure control is planning a pregnancy.
Which statements should the nurse include in a discussion with the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Since your epilepsy may be exacerbated by a pregnancy, your healthcare provider will
most likely prescribe a second antiepileptic prescription."
2. "Thankfully, the current generation of antiepileptic prescriptions will not interfere with
you getting pregnant."
3. "Your current antiepileptic prescription should not be used when you are pregnant."
4. "Folic acid supplementation is important for you."
5. "You should consider adopting a baby instead since there are so many problems
associated with epilepsy and pregnancy."
Answer: 3, 4
Explanation:
1. Due to the increased side effects of the antiepileptic prescriptions, single drug therapy is
the goal for a pregnant client.
2. Women who have epilepsy have a reduced fertility rate, and some do not ovulate.
3. Valproic acid (Depakene) is Pregnancy Category D.
4. Folic acid supplementation is important for all women who are, or wish to become,
pregnant. This is especially true of women who are epileptic because many antiepileptic
prescriptions cause folic acid deficiency.
5. Women who are epileptic can conceive and deliver healthy babies. The nurse should not
GRAprovide
DESMOinformation
RE.COM to the patient and then support
discourage this client, but should
the client's choice.
Page Ref: 179
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Context and Environment: Chronic disease management. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 15-8 Use the nursing process to care for patients receiving
pharmacotherapy for epilepsy and seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
25
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
26) The nurse is preparing to educate a client on prescribed antiepileptic drug (AED). Which
information should the nurse include in the teaching?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The prescription should be taken at the same time every day.
2. When a dose of the prescription is missed, take both doses together when the next dose
is due.
3. Take an additional dose of the prescription if experiencing a seizure aura.
4. When experiencing side effects skip the next dose of the prescription.
5. Avoid the use of dietary supplements containing kava while taking the prescription.
Answer: 1, 5
Explanation:
1. Stable blood levels of prescription are important in the control of seizure activity;
therefore, the prescription should be taken at the same time daily.
2. The client should take a missed dose of the prescription as soon as they remember. Two
doses of the prescription should not be taken at the same time or close together.
3. Oral prescriptions are not delivered rapidly to the system, so taking an additional dose
of the prescription when an aura occurs is not effective in controlling the impending
seizure.
4. The client should never abruptly discontinue or skip doses of the prescription.
5. Kava interferes with many AEDs, often adding to their sedative effects.
Page Ref: 170-171
GRADESMORE.COM
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Context and Environment: Chronic disease management. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 15-8 Use the nursing process to care for patients receiving
pharmacotherapy for epilepsy and seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
26
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
27) The nurse is providing education to a parent of a 5-year-old that experienced a febrile
seizure. Which information should the nurse include?
1. After a febrile seizure the child returns to consciousness slowly.
2. High temperatures rarely induce seizures in children.
3. A five-year-old is too old for febrile seizures.
4. Seizure medications are usually prescribed for febrile seizures.
Answer: 2
Explanation:
1. After a febrile seizure the child returns to consciousness rapidly.
2. Many children experience high temperatures without experiencing seizures.
3. Febrile seizures usually occur between 3 months and 5 years of age.
4. The best course of action for febrile seizures is prevention by using acetaminophen to
prevent onset of fever.
Page Ref: 171
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 15-2 Recognize possible causes of seizures.
GRA
DESMORdrugs
E.Cpresented
OM
MNL Learning Outcome: 15.3 Examine
prototype
prescribed for seizure
disorders.
27
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28) The nurse has provided education for a client prescribed ethosuximide (Zarontin). For which
information offered by the client should the nurse notify the healthcare provider?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Did I mention that I used to take phenobarbital for my seizures?"
2. "I forgot to tell the doctor that I am allergic to penicillin."
3. "I take ginkgo to help improve my memory."
4. "My husband and I plan to have a baby in a couple of years."
5. "My husband and I are leading a 20-mile bicycle tour next weekend for the company we
have just started."
Answer: 3, 5
Explanation:
1. There is no indication that previous phenobarbital use is problematic with the use of
ethosuximide (Zarontin).
2. There is no indication of cross sensitivity with penicillin.
3. Ginkgo may reduce the therapeutic effects of ethosuximide (Zarontin).
4. Ethosuximide (Zarontin) is Pregnancy Category C.
5. The most common adverse effects of ethosuximide (Zarontin) include dizziness, ataxia,
and fatigue. These side effects place the client at risk for injury while cycling.
Page Ref: 180
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRProvide
ADESMpatient-centered
ORE.COM care with sensitivity and
Standards: QSEN Competencies: I.B.3
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Context and Environment: Chronic disease management. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 15-8 Use the nursing process to care for patients receiving
pharmacotherapy for epilepsy and seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
28
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29) A client has been prescribed ketogenic diet to supplement pharmacotherapy for a seizure
disorder. Which food items should the nurse encourage the client to consume?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Foods high in fat
2. Salty foods
3. Foods high in vitamin K
4. Low protein foods
5. Low carbohydrate foods
Answer: 1, 4, 5
Explanation:
1. The ketogenic diet is high in fat.
2. The presence of salt is not a determining factor in inclusion of foods in a ketogenic diet.
3. The presence of high amounts of vitamin K is not a determining factor in inclusion of
foods in a ketogenic diet.
4. The ketogenic diet is low in protein.
5. The ketogenic diet is low in carbohydrates.
Page Ref: 175
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Nutrition and Oral Hydration
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: VII.5 Use evidence-based practices to guide health
GRoutreach,
ADESMOdisease
RE.COand
M outbreak investigation, referral
teaching, health counseling, screening,
and follow-up throughout the lifespan. | NLN Competencies: Context and Environment: Chronic
disease management. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 15-5 Explain the importance of patient drug compliance in the
pharmacotherapy of epilepsy and seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
29
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30) The nurse is obtaining a history from a client that experienced an atonic seizure. Which
information is the most important for the nurse to obtain?
1. "What method of birth control do you use?"
2. "Are your periods regular?"
3. "Do you have a history of infertility?"
4. "Have you ever been pregnant?"
Answer: 1
Explanation:
1. Atonic seizures can be treated with barbiturates such as phenobarbital. Barbiturates
decrease the effectiveness of oral contraceptives and additional forms of contraception
should be used.
2. Obtaining a menstrual cycle history is important, but not the most important.
3. Assessing a patient for infertility is important information to obtain, but not the most
important.
4. Assessing a patient's history of pregnancy is important information to obtain, but not
the most important.
Page Ref: 180-182
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
GRADESMmedical
ORE.Cmanagement,
OM
development, pathophysiology, pharmacology,
and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Context and Environment: Chronic disease management. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 15-8 Use the nursing process to care for patients receiving
pharmacotherapy for epilepsy and seizures.
MNL Learning Outcome: 15.3 Examine prototype drugs presented prescribed for seizure
disorders.
30
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GRADESMORE.COM
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Pharmacology for Nurses, 6e (Adams)
Chapter 16 Drugs for Emotional Mood and Behavioral Disorders
1) A client asks the nurse about bipolar disorder. Which response should the nurse provide?
1. "Bipolar disorder is just another type of depression, except the depression occurs in
cycles."
2. "Bipolar disorder is a type of depression that includes attention deficit disorder
symptoms."
3. "Bipolar disorder just means that the mood alternates with the seasons, and becomes
worse in the winter."
4. "Bipolar disorder means you have cycles of depression as well as hyperactivity, or
mania."
Answer: 4
Explanation:
1. Bipolar disorder must include either mania or hypomania, not just depression.
2. Bipolar disorder must include depression with either mania or hypomania, not
attention-deficit/hyperactivity disorder.
3. A mood change that becomes worse in the winter is called seasonal affective disorder.
4. Clients with bipolar disorder may shift from emotions of extreme depression to extreme
rage and agitation. Mania may include grandiosity, decreased need for sleep, pressured
speech, racing thoughts, buying sprees, and sexual indiscretions.
Page Ref: 195
GRADESMORE.COM
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 16-1 Identify the two major categories of mood disorders and their
symptoms.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
1
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2) A parent tells the nurse they are concerned because their child is easily distracted in school,
cannot complete assignments on time, and interrupts other children while they are
speaking. Which response should the nurse provide the parent?
1. "This sounds like your child is depressed; depression looks different in children and is
very serious."
2. "This sounds like bipolar disorder; you might want to have your child tested by a child
psychiatrist."
3. "This could be attention-deficit/hyperactivity disorder (ADHD); you might want to have
your child tested."
4. "This sounds like typical 7-year-old behaviors to me; if they do not resolve, have your
child tested."
Answer: 3
Explanation:
1. The characteristics of depression are different in children, but the symptoms described
by the parent are not symptoms of depression.
2. Easy distraction, inability to complete assignments, and interrupting other children are
not symptoms of bipolar disorder.
3. Symptoms of attention-deficit/hyperactivity disorder (ADHD) include difficulty paying
attention and focusing on tasks, hyperactivity, distractibility, impulsivity, and talking
excessively.
4. Easy distraction, inability to complete assignments, and interrupting other children are
not common behaviors of a 7-year-old child.
GRADESMORE.COM
Page Ref: 199
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 16-2 Identify the symptoms of attention deficit/hyperactivity disorder.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
2
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3) The nurse has provided education for a patient with depression. Which statement made by
the patient indicates an understanding of the teaching?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Depression has many causes which include brain-based disorders."
2. "Depression can be an inherited illness."
3. "We really don't know what causes depression."
4. "Depression results from unresolved conflicts in your childhood."
5. "Depression results from parental neglect."
Answer: 1, 2
Explanation:
1. Depression has many causes which include brain-based disorders.
2. Depression is a genetic condition.
3. Depression has been studied extensively.
4. Environmental influences are only one of the causes of depression; this answer does not
include the biological basis for depression.
5. Depression could result from cold and distant parents, but this answer does not include
the biological basis for depression.
Page Ref: 187
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
GRADEIII.1
SMO
RE.Cthe
OMinterrelationships among theory,
processes. | AACN Essential Competencies:
Explain
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 16-3 Explain the etiology of major depressive disorder.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
3
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4) A client is brought to the emergency department suspected of overdosing on imipramine
(Tofranil). Which is the nurse's priority assessment?
1. Cardiac function
2. Liver function
3. Renal function
4. Neurological function
Answer: 1
Explanation:
1. Tricyclic antidepressants are cardiotoxic. An overdose could result in a fatal
dysrhythmia. Cardiac status is the primary assessment.
2. Liver function is not the priority assessment.
3. Renal function is not the priority assessment.
4. The neurologic function may be affected but is not the primary assessment.
Page Ref: 193
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
GRProcess:
ADESMAssessment
ORE.COM
Nursing/Integrated Concepts: Nursing
Learning Outcome: 16-5 For each of the drug classes listed in Drugs at a Glance, recognize
representative drug examples, and explain their mechanism of action, primary actions, and
important adverse effects.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
4
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5) A client taking amitriptyline (Elavil) for 2 weeks tells the nurse the prescription is not
working. Which response should the nurse provide the client?
1. "The prescription can take several weeks to have an effect."
2. "You might still feel depressed, but you are looking much better."
3. "This may not be the best prescription for you; I will notify your healthcare provider"
4. "You may need additional pharmacotherapy."
Answer: 1
Explanation:
1. The therapeutic effects of tricyclic antidepressants may take 2 to 6 weeks to occur.
2. Telling a depressed client he or she looks better does not address the client's feelings or
provide the appropriate information.
3. It is not appropriate for the nurse to notify the healthcare provider at this time.
4. It is not appropriate to suggest additional pharmacotherapy; the therapeutic effects
may take 2 to 6 weeks to occur.
Page Ref: 193
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
GRProcess:
ADESMPlanning
ORE.COM
Nursing/Integrated Concepts: Nursing
Learning Outcome: 16-4 Describe the nurse's role in the pharmacologic management of
patients with depression, bipolar disorder, or attention-deficit/hyperactivity disorder.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
5
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6) A client prescribed sertraline (Zoloft) reports to the nurse that he is experiencing delayed
ejaculation. Which response should the nurse provide the client?
1. "I will let your healthcare provider know and most likely your prescription will be
changed."
2. "This is a side effect of the prescription, but treating your depression is the priority."
3. "I am concerned that you may become suicidal if you stop the prescription."
4. "Continue to take the prescription, as this usually goes away after a few months."
Answer: 1
Explanation:
1. One of the most common side effects of the selective serotonin reuptake inhibitors
(SSRIs) relates to sexual dysfunction; up to 70% or men and women can experience this.
In men, delayed ejaculation and impotence may occur.
2. It is inappropriate to tell a client that his depression is a higher priority; sexual
functioning is important to clients.
3. The client could become suicidal if he stops the prescription, but this response does not
address the client's immediate concern.
4. Sexual dysfunction does not usually subside after a few months of taking the
prescription.
Page Ref: 191
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
GRADESMORIX.8
E.CImplement
OM
transition of care. | AACN Essential Competencies:
evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 16-4 Describe the nurse's role in the pharmacologic management of
patients with depression, bipolar disorder, or attention-deficit/hyperactivity disorder.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
6
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
7) A client is to be prescribed an antidepressant. Which question is most important when
performing the initial assessment?
1. "How much alcohol do you consume during the week?"
2. "Are you allergic to any medications?"
3. "How long have you been depressed?"
4. "Have you had any thoughts about killing yourself?"
Answer: 4
Explanation:
1. Assessing for alcohol intake is important but is not the priority safety issue.
2. Asking about allergies is an important safety question, but there are very few allergies to
antidepressant medication. This is not the priority question.
3. The length of the client's depression is important but is not a safety issue.
4. The nurse should always assess for suicidal ideation in any depressed client who is about
to begin antidepressant treatment. The medication takes several weeks before the full
benefit is obtained.
Page Ref: 188
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science:
GRADEand
SMquality
ORE.and
COMsafe patient care. |
Relationships between knowledge/science
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 16-4 Describe the nurse's role in the pharmacologic management of
patients with depression, bipolar disorder, or attention-deficit/hyperactivity disorder.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
7
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8) The nurse has completed medication education for a client prescribed phenelzine (Nardil).
Which statements made by the client indicate an understanding of the teaching?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "I am really going to miss my morning coffee and sweet roll."
2. "I'll have to give up my beer at the football games."
3. "I can't eat fried chicken and gravy."
4. "I am not supposed to have processed meats or cheese."
5. "I really shouldn't eat at a restaurant; too many foods are on my restricted list."
Answer: 2, 4
Explanation:
1. Coffee and a sweet roll are not high in tyramine and are considered safe.
2. Beer is high in tyramine. Combining tyramine-rich foods with a monoamine oxidase
inhibitor can result in a hypertensive crisis.
3. Fried chicken and gravy are not high in tyramine and are considered safe.
4. Processed meats and cheese are high in tyramine. Combining tyramine-rich foods with a
monoamine oxidase inhibitor can result in a hypertensive crisis.
5. There are many foods that are safe to eat; the client can safely eat at a restaurant.
Page Ref: 195-196
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
GRIX.3
ADImplement
ESMORE.holistic,
COM patient-centered care that
care. | AACN Essential Competencies:
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 16-5 For each of the drug classes listed in Drugs at a Glance, recognize
representative drug examples, and explain their mechanism of action, primary actions, and
important adverse effects.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
8
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
9) The patient has bipolar disorder and is in a manic phase. The physician prescribes lithium
(Eskalith). The client's current lithium level is 0.4. Which assessment findings should the
nurse anticipate?
1. A return to baseline behavior
2. Hyperactivity and pressured speech
3. Signs and symptoms of depression
4. A decrease in manic behavior
Answer: 2
Explanation:
1. The client will not return to baseline behavior but will continue in the manic phase until
the lithium level is within a therapeutic range.
2. A therapeutic lithium level is 0.6 to 1.5. Since this client's level is low, behaviors will
indicate mania (i.e., hyperactivity and pressured speech).
3. The client will not exhibit signs and symptoms of depression but will continue in the
manic phase until the lithium level is within a therapeutic range.
4. There will be no decrease in manic behavior because the lithium level is not within
range.
Page Ref: 196
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
RADEand
SMOdevelopment,
RE.COM pathophysiology, pharmacology,
reflects an understanding of human G
growth
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 16-5 For each of the drug classes listed in Drugs at a Glance, recognize
representative drug examples, and explain their mechanism of action, primary actions, and
important adverse effects.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
9
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GRADESMORE.COM
WWW.GRADESMORE.COM
10) The nurse has completed the education for a client prescribed lithium (Eskalith). Which
should the nurse anticipate is a priority outcome of the treatment?
1. The client will be able to work a normal work schedule and will receive adequate sleep.
2. The client will identify signs of lithium (Eskalith) toxicity and verbalize measures to avoid
it.
3. The client will engage in activities of daily living and report enjoyment with them.
4. The client will report stabilization of mood, including absence of mania or depression.
Answer: 2
Explanation:
1. Working a normal work schedule and receiving adequate sleep are important but are
not the priority outcome.
2. Lithium (Eskalith) has a narrow therapeutic range. In order to avoid toxicity, clients must
understand the signs of toxicity and measures to avoid it.
3. Engaging in activities of life and enjoying them are important but are not the priority
outcome.
4. Stabilization of mood is important but is not the priority outcome.
Page Ref: 196-197
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
GRADESMOacross
RE.Cthe
OMhealth-illness continuum, across
medical management, and nursing management
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 16-5 For each of the drug classes listed in Drugs at a Glance, recognize
representative drug examples, and explain their mechanism of action, primary actions, and
important adverse effects.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
10
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GRADESMORE.COM
WWW.GRADESMORE.COM
11) A client prescribed lithium (Eskalith) asks the nurse why they should continue to use salt.
Which response should the nurse provide the client?
1. "You should use sea salt to avoid lithium (Eskalith) toxicity.
2. "You must use table salt or your kidneys will retain lithium (Eskalith), and you will
become toxic."
3. "The amount of salt is not important; just increase your table salt if you notice signs of
lithium (Eskalith) toxicity."
4. "Salt is very important to avoid lithium (Eskalith) toxicity, but not as important as
drinking 1 to 1.5 L of water per day."
Answer: 2
Explanation:
1. There is no evidence to support the claim that sea salt is more effective than any other
kind of salt.
2. The kidneys are responsible for maintaining normal sodium levels. If there is sodium
depletion, the kidneys will conserve any salt, in this case lithium. This will lead to lithium
toxicity.
3. Increasing the salt intake does not treat lithium toxicity after it has occurred.
4. Drinking 1 to 1.5 L of water per day is important but is not a substitute for adequate
sodium chloride.
Page Ref: 197
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRProvide
ADESMpatient-centered
ORE.COM care with sensitivity and
Standards: QSEN Competencies: I.B.3
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 16-7 Use the nursing process to care for patients receiving
pharmacotherapy for mood, emotional, and behavioral disorders.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
11
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GRADESMORE.COM
WWW.GRADESMORE.COM
12) Which is the priority outcome for a 6-year-old child that has been prescribed
methylphenidate (Ritalin)?
1. The child will avoid altercations with peers.
2. The child will be able to complete age-appropriate chores at home.
3. The child will use age-appropriate play with peers.
4. The child will maintain weight within norms for this age group.
Answer: 3
Explanation:
1. Avoiding altercations with peers does not address a decrease in ADHD-related
behaviors.
2. Completing age-appropriate chores at home does not address the interaction and play
with peers, which is crucial during this developmental stage.
3. Children with attention-deficit/hyperactivity disorder have difficulty engaging in play
with peers due to their distractibility, impulsiveness, and hyperactivity.
Methylphenidate (Ritalin) increases their focus and decreases their distractibility,
impulsiveness, and hyperactivity. Age-appropriate play with peers is fundamental to
healthy development with school-age children.
4. Maintaining weight does not address the interaction and play with peers, which is
crucial during this developmental stage.
Page Ref: 193, 201-202
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRProvide
ADESMpatient-centered
ORE.COM care with sensitivity and
Standards: QSEN Competencies: I.B.3
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 16-7 Use the nursing process to care for patients receiving
pharmacotherapy for mood, emotional, and behavioral disorders.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
12
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
13) A parent of an 8-year-old child prescribed methylphenidate (Ritalin) tells the nurse the child
will not eat. Which response should the nurse provide the parent?
1. "It sounds like your child may be experiencing depression."
2. "Administer the prescription after meals and encourage snacks between meals."
3. "Your child may require an appetite stimulant."
4. "I will get you a consult with a nutritionist."
Answer: 2
Explanation:
1. There is no evidence to support that the child has become depressed.
2. Methylphenidate (Ritalin) is an appetite suppressant. The best approach is to have the
child take the prescription after meals and consume nutritious snacks between meals.
3. Other strategies to increase the appetite should be initiated before discussing the use of
an appetite stimulant.
4. A referral to a nutritionist is premature at this time.
Page Ref: 201
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
GRADEand
SMquality
ORE.and
COMsafe patient care. |
Relationships between knowledge/science
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 16-5 For each of the drug classes listed in Drugs at a Glance, recognize
representative drug examples, and explain their mechanism of action, primary actions, and
important adverse effects.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
13
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WWW.GRADESMORE.COM
14) A client prescribed sertraline (Zoloft) calls the clinic reporting increased moodiness and
feeling disconnected from life. Which response should the nurse provide the client?
1. "Try taking diphenhydramine (Benadryl) to help you relax."
2. "It is important that you come into the clinic today."
3. "Do not take your prescription until your mood improves."
4. "Double the prescribed dose of sertraline (Zoloft) today."
Answer: 2
Explanation:
1. Diphenhydramine (Benadryl) is not used to treat the client's symptoms.
2. Sertraline (Zoloft) increases the risk of suicidal thinking and behavior. The client should
be assessed in the clinic as soon as possible.
3. It is not appropriate for the nurse to instruct the client to stop taking their prescription.
4. It is not appropriate for the nurse to instruct the client to double the dose of the
prescription.
Page Ref: 191
Cognitive Level: Analyzing
Client Need/Sub: Psychological Integrity: Mental Health Concepts
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
GR
ADESMRelationships
ORE.COM between knowledge/science and
| NLN Competencies: Knowledge and
Science:
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 16-7 Use the nursing process to care for patients receiving
pharmacotherapy for mood, emotional, and behavioral disorders.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
14
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WWW.GRADESMORE.COM
15) The nurse is caring for a client suspected of having bipolar disorder. Which assessment
findings that have occurred over the period of a week support the nurse's suspicion?
1. Difficulty sleeping, obsession with death, hallucinations
2. Delusions, unkempt appearance, fatigue
3. Abnormal eating patterns, feelings of despair, flight of ideas
4. Increased goal-directed behavior and talkativeness, distractibility
Answer: 3
Explanation:
1. Difficulty sleeping, obsession with death, and hallucinations are symptoms of
depression.
2. Delusions, unkempt appearance, and fatigue are symptoms of depression.
3. Bipolar disorder involves periods of mania and depression. Abnormal eating patterns
and feelings of despair are symptoms of depression, whereas flight of ideas is a
symptom of mania.
4. Increased goal-directed behavior, talkativeness, and distractibility are symptoms of
mania.
Page Ref: 195
Cognitive Level: Remembering
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
RADESMORE.CO
M
from nursing and other disciplines. |GNursing/Integrated
Concepts:
Nursing Process:
Assessment
Learning Outcome: 16-1 Identify the two major categories of mood disorders and their
symptoms.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
15
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WWW.GRADESMORE.COM
16) Which statement is accurate regarding attention-deficit/hyperactivity disorder (ADHD)?
1. ADHD is characterized by periods of mania and periods of depression.
2. Anxiety and social withdrawal are more frequently seen in girls than in boys.
3. There is a higher incidence of ADHD in girls than in boys.
4. ADHD is generally diagnosed later in life.
Answer: 2
Explanation:
1. Periods of mania and periods of depression are more characteristic with bipolar
disorder, not ADHD.
2. Girls show less aggression but more social withdrawal and anxiety.
3. ADHD generally occurs in boys more frequently than in girls.
4. ADHD is generally diagnosed in childhood.
Page Ref: 199
Cognitive Level: Remembering
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 16-2 Identify the symptoms of attention deficit/hyperactivity disorder.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
GRADESMORE.COM
disorder.
17) A client tells the nurse they feel depressed during the winter. Which type of depression
should the nurse suspect the client is experiencing?
1. Baby blues
2. Bipolar disorder
3. Seasonal affective disorder
4. Obsessive-compulsive disorder
Answer: 3
Explanation:
1. Baby blues are associated with mothers who have recently had a baby.
2. Bipolar disorder involves periods of mania and periods of depression.
3. Seasonal affective disorder is frequently experienced during the winter months.
4. Obsessive-compulsive disorder involves doing certain tasks repetitively.
Page Ref: 187
Cognitive Level: Remembering
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Assessment
16
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WWW.GRADESMORE.COM
Learning Outcome: 16-3 Explain the etiology of major depressive disorder.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
18) Which classification of prescription used to treat depression works by preventing enzymatic
destruction of the neurotransmitter norepinephrine?
1. Serotonin-norepinephrine reuptake inhibitors (SNRIs)
2. Selective serotonin reuptake inhibitors (SSRIs)
3. Tricyclic antidepressants (TCAs)
4. Monoamine oxidase inhibitors (MAOIs)
Answer: 4
Explanation:
1. SNRIs inhibit the reabsorption of serotonin and norepinephrine and elevate mood.
2. SSRIs slow the reuptake of serotonin.
3. TCAs inhibit neurotransmitter reuptake.
4. MAOIs limit the breakdown of norepinephrine by inhibiting the enzyme monoamine
oxidase.
Page Ref: 194
Cognitive Level: Remembering
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
GRADEIII.1
SMO
RE.Cthe
OMinterrelationships among theory,
processes. | AACN Essential Competencies:
Explain
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Assessment
Learning Outcome: 16-6 Categorize drugs used for mood, emotional, and behavioral disorders
based on their classification and drug action.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
17
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WWW.GRADESMORE.COM
19) Which classification of prescription is often used as a first-line treatment for depression due
to their safety profile?
1. Monoamine oxidase inhibitors (MAOIs)
2. Beta-adrenergic blockers
3. Tricyclic antidepressants (TCAs)
4. Selective serotonin reuptake inhibitors (SSRIs)
Answer: 4
Explanation:
1. MAOIs have a low safety margin.
2. Currently beta blockers are more commonly used for treatment of hypertension.
3. TCAs have some unpleasant and serious side effects.
4. SSRIs are the most favorable due to their safety profile.
Page Ref: 191-192
Cognitive Level: Remembering
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Assessment
Learning Outcome: 16-6 Categorize drugs used for mood, emotional, and behavioral disorders
based on their classification and drug action.
GRA
DEpharmacologic
SMORE.COMprofiles and considerations of
MNL Learning Outcome: 16.3 Examine
the
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
18
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
20) Which food items should the nurse advise a client taking a monoamine oxidase inhibitor
(MAOI) to avoid?
1. Orange juice, cottage cheese, and turkey
2. Spring water, ice cream, and salmon
3. Chocolate, wine, and fava beans
4. Spinach, rice, and venison
Answer: 3
Explanation:
1. Orange juice, cottage cheese, and turkey are not contraindicated.
2. Spring water, ice cream, and salmon are not contraindicated.
3. Chocolate, wine, and fava beans are high in tyramine, which can cause severe
hypertension in patients taking MAOIs.
4. Spinach, rice, and venison are not contraindicated.
Page Ref: 195
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
GRnurse's
ADESrole
MORinEthe
.COpharmacologic
M
Learning Outcome: 16-4 Describe the
management of
patients with depression, bipolar disorder, or attention-deficit/hyperactivity disorder.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
19
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WWW.GRADESMORE.COM
21) Which should the nurse recognize are the traditionally prescribed drug classifications used
to treat attention-deficit/hyperactivity disorder (ADHD)?
1. CNS depressants
2. Parasympathomimetics
3. CNS stimulants
4. Sympathomimetics
Answer: 3
Explanation:
1. CNS depressants are not traditionally the drug of choice for treating ADHD.
2. Parasympathomimetics are not traditionally the drug of choice for treating ADHD.
3. CNS stimulants have traditionally been the drug of choice for treating ADHD.
4. Sympathomimetics are not traditionally the drug of choice for treating ADHD.
Page Ref: 200-202
Cognitive Level: Remembering
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Assessment
Learning Outcome: 16-6 Categorize drugs used for mood, emotional, and behavioral disorders
based on their classification and drug action.
GRA
DEpharmacologic
SMORE.COMprofiles and considerations of
MNL Learning Outcome: 16.3 Examine
the
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
20
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
22) Which statement best explains the action of the prescriptions used to treat attentiondeficit/hyperactivity disorder (ADHD)?
1. Neurotransmitters are blocked, limiting the effects they can produce within the PNS.
2. Activation of certain areas of the brain causes increased attention and ability to focus.
3. Neurotransmitter levels are reduced, which produces a calming effect within the CNS.
4. Certain areas of the brain are deactivated, resulting in a calming effect.
Answer: 2
Explanation:
1. Neurotransmitters such as epinephrine and serotonin are released, not blocked.
2. CNS stimulants activate the reticular activating system, causing higher levels of
attention and ability to focus.
3. Neurotransmitters such as epinephrine and serotonin are released, not reduced.
4. Areas of the brain are not deactivated.
Page Ref: 200-202
Cognitive Level: Understanding
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Assessment
Learning Outcome: 16-6 Categorize drugs used for mood, emotional, and behavioral disorders
GR
ADESMORE.COM
based on their classification and drug
action.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
21
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GRADESMORE.COM
WWW.GRADESMORE.COM
23) Which prescription should the nurse recognize would most benefit a client experiencing
periods of mania and depression?
1. Atomoxetine (Strattera)
2. Amitriptyline (Elavil)
3. Methylphenidate (Ritalin)
4. Carbamazepine (Tegretol)
Answer: 4
Explanation:
1. Atomoxetine is indicated for ADHD. Amitriptyline is indicated for depression.
2. Amitriptyline is indicated for depression.
3. Methylphenidate is indicated for ADHD. Amitriptyline is indicated for depression.
4. Antiseizure drugs such as carbamazepine (Tegretol) are often used in the treatment of
bipolar disorder.
Page Ref: 196
Cognitive Level: Remembering
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Assessment
Learning Outcome: 16-6 Categorize drugs used for mood, emotional, and behavioral disorders
GR
ADESMORE.COM
based on their classification and drug
action.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
22
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
24) Which symptoms should the nurse assess a client for who is at risk for mania?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Decreased sleep
2. Weight loss
3. Sluggish activity
4. Muscle pain
5. Increased talkativeness
Answer: 1, 2, 5
Explanation:
1. Decreased need for sleep is a symptom of the manic phase of bipolar disorder.
2. Decreased need for food is a symptom of the manic phase of bipolar disorder.
3. Sluggish activity is not a symptom of the manic phase of bipolar disorder.
4. Complaints of muscle pain are not a symptom of the manic phase of bipolar disorder.
5. Increased talkativeness is a symptom of the manic phase of bipolar disorder.
Page Ref: 195
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
GRADESMORE.COM
Assessment
Learning Outcome: 16-2 Identify the symptoms of attention deficit/hyperactivity disorder.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
23
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WWW.GRADESMORE.COM
25) A client asks the nurse what causes bipolar disorder. Which neurotransmitters should the
nurse include when discussing the manic phase of the disorder?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Excessive glutamate
2. Excessive norepinephrine
3. Deficiency of gamma-aminobutyric acid
4. Deficiency of dopamine
5. Excessive serotonin
Answer: 1, 2, 3
Explanation:
1. Mania may involve an excess of excitatory neurotransmitters such as glutamate.
2. Mania may involve an excess of excitatory neurotransmitters such as norepinephrine.
3. Mania may involve a deficiency of inhibitory neurotransmitters such as gammaaminobutyric acid (GABA).
4. Dopamine is not associated with the manic phase of bipolar disorder.
5. Serotonin is not associated with the manic phase of bipolar disorder.
Page Ref: 195-197
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
GRADESKnowledge
MORE.COand
M Science: Integration of knowledge
practice, and research. | NLN Competencies:
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 16-3 Explain the etiology of major depressive disorder.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
24
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GRADESMORE.COM
WWW.GRADESMORE.COM
26) The nurse is preparing to assess an older adult for depression. Which questions should the
nurse include in the assessment?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "How often do you go out to socialize with friends?"
2. "Can you tell me about your self-care activities."
3. "How much alcohol do you consume every day?"
4. "How is living with your oldest daughter and her family working out for you?"
5. "Are you feeling depressed?"
Answer: 1, 2, 3, 4
Explanation:
1. Asking about socialization is an assessment for social isolation which can indicate the
patient is experiencing depression or at risk for depression.
2. Depression may result in the lack of interest in personal appearance and self-care
activities.
3. An older adult may overuse alcohol or combine it with other prescriptions, which can
further result in depression.
4. Factors that contribute to depression in the older adult include loss of independence
when it becomes necessary to move in with other family members because of health
status or finances.
5. Depression is significantly underdiagnosed among older adults. A contributing factor is
the reluctance to admit feeling depressed because it can be seen as a sign of weakness
GRAD
ESMO
RE.Cdirectly
OM if they feel depressed will not
or an inability to care for oneself.
Asking
clients
likely elicit the desired information.
Page Ref: 187-188
Cognitive Level: Analyzing
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 16-7 Use the nursing process to care for patients receiving
pharmacotherapy for mood, emotional, and behavioral disorders.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
25
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
27) Which assessment findings should the nurse associated with a risk for suicide?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The client states that "suicide is always an option."
2. The client describes a previous unsuccessful attempt at suicide by aspirin overdose.
3. The client states that the prescribed medication is not working and that feelings of
depression are worse.
4. The client requests prescriptions for pain medication and a sleeping aid.
5. The client expresses interest in meeting with friends more often.
Answer: 1, 2, 3, 4
Explanation:
1. If a client verbalizes committing suicide, this must be taken seriously.
2. A client who has had a previous suicide attempt is at higher risk for suicide and must be
monitored carefully.
3. Worsening symptoms of depression must be reported immediately because these may
indicate that the drug is not working or that the client is not compliant with
pharmacotherapy.
4. All prescription drugs must be monitored because suicidal clients often take overdoses.
Therapy with multiple central nervous system depressants is discouraged because these
agents produce additive sedation.
5. This information would not indicate a worsening of depression or the risk for suicide.
Page Ref: 188
GRADESMORE.COM
Cognitive Level: Analyzing
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 16-7 Use the nursing process to care for patients receiving
pharmacotherapy for mood, emotional, and behavioral disorders.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
26
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
28) A client asks the nurse which types of therapies are most helpful for depression. Which
therapies should the nurse plan to discuss with the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Behavioral therapy
2. Interpersonal therapy
3. Cognitive-behavioral therapy
4. Psychodynamic therapy
5. Crisis therapy
Answer: 1, 2, 3, 4
Explanation:
1. Behavioral therapies help clients unlearn the behavioral patterns that contribute to or
result from their depression.
2. Interpersonal therapy focuses on a client's disturbed personal relationships that both
cause and exacerbate depression.
3. Cognitive-behavioral therapies help clients change negative styles of thought and
behavior that are often associated with depression.
4. Psychodynamic therapies focus on resolving the client's internal conflicts by looking at
the influence of past experiences on current behavior and how behavior is influenced by
emotional factors.
5. Crisis therapy is not a type of therapy for depression.
Page Ref: 188
GRADESMORE.COM
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 16-4 Describe the nurse's role in the pharmacologic management of
patients with depression, bipolar disorder, or attention-deficit/hyperactivity disorder.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
27
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
29) The nurse is providing client teaching about the side effects of amitriptyline (Elavil). Which
information should the nurse include in the teaching to promote prescription adherence?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Use ice chips to help alleviate dry mouth.
2. Chew gum or use hard candy to help alleviate dry mouth.
3. Avoid alcohol-based mouthwash to help alleviate dry mouth.
4. Use "dry eye" drops to help with eye dryness.
5. Request the pharmacist to fill the prescription from a different manufacturer.
Answer: 1, 2, 3, 4
Explanation:
1. Amitriptyline (Elavil) is a tricyclic antidepressant (TCA). TCA's have anticholinergic-like
side effects. Using ice chips helps to alleviate dry mouth.
2. Amitriptyline (Elavil) is a tricyclic antidepressant (TCA). TCA's have anticholinergic-like
side effects. Chewing gum or sucking on hard candy helps to alleviate dry mouth.
3. Alcohol-based mouthwash can increase the feeling of dry mouth associated with the
prescription.
4. Amitriptyline (Elavil) is a tricyclic antidepressant (TCA). TCA's have anticholinergic-like
side effects. The use of "dry eye" ocular drops can help alleviate eye dryness.
5. The client should use the same manufacturer's brand each time the prescription is filled.
Page Ref: 190
Cognitive Level: Analyzing
GRAD
ESMORE.COand
M Parenteral Therapies
Client Need/Sub: Physiological Integrity:
Pharmacological
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 16-7 Use the nursing process to care for patients receiving
pharmacotherapy for mood, emotional, and behavioral disorders.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
28
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WWW.GRADESMORE.COM
30) A parent of a child pharmacologically treated for ADHD asks the nurse to explain a "drug
holiday." Which information should the nurse provide about the treatment option?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Drug holidays may be used to reduce dependence on medications or to assess
symptoms."
2. "If you feel like the medication is sedating your child too much, you can hold doses for
up to 3 or 4 days."
3. "Drug holidays are used when the dosage will be increased to assess the patient's
tolerance to the prescription."
4. "You should not consider using a drug holiday until you have discussed that option with
your healthcare provider."
5. "Drug holidays require careful scheduling."
Answer: 1, 4, 5
Explanation:
1. Some medications used for treatment of ADHD may result in dependence. Drug holidays
are used to reduce risk of dependence and to assess for level of symptoms without
medications.
2. Drug holidays are not initiated by the parent without guidance.
3. Dosage increases are not associated with a drug holiday.
4. Drug holidays should be undertaken only after careful consideration and discussion with
the provider.
GRADaround
ESMORtimes
E.Cthat
OM increased symptoms of ADHD will
5. Drug holidays should be scheduled
not interfere with school or other important activities.
Page Ref: 203
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 16-7 Use the nursing process to care for patients receiving
pharmacotherapy for mood, emotional, and behavioral disorders.
MNL Learning Outcome: 16.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for depression, bipolar disorder, and attention deficit/hyperactivity
disorder.
29
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Pharmacology for Nurses, 6e (Adams)
Chapter 17 Drugs for Psychoses
1) A client asks the nurse what causes schizophrenia. Which contributing factors should the
nurse include in the client teaching?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Biological brain disorder
2. Alcohol use during pregnancy
3. Stressful environment
4. Genetic link
5. Abnormal levels of neurotransmitters in the brain
Answer: 1, 4, 5
Explanation:
1. Theories explaining the cause of schizophrenia include imbalances in neurotransmitters
in specific areas of the brain.
2. There is no evidence that links alcohol use during pregnancy to schizophrenia.
3. A stressful environment will exacerbate the symptoms of schizophrenia but does not
cause the illness.
4. Theories explaining the cause of schizophrenia include a genetic component.
5. Theories explaining the cause of schizophrenia include overactive dopaminergic
pathways in the basal nuclei.
GRADESMORE.COM
Page Ref: 209
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 17-1 Explain theories for the etiology of schizophrenia.
MNL Learning Outcome: 17.1 Examine the etiology, pathogenesis, clinical manifestations, and
diagnosis of psychotic disorders.
1
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2) A client with schizophrenia sits quietly in a chair and minimally responds to the
environment. Which of the following assessment findings should the nurse interpret?
1. The client is most likely very depressed.
2. The client is most likely hearing voices.
3. The client is experiencing positive symptoms.
4. The client is experiencing negative symptoms.
Answer: 4
Explanation:
1. There isn't any evidence to support that the client is very depressed.
2. There isn't any evidence to support that the client is hearing voices.
3. Positive symptoms include hallucinations, delusions, and a disorganized thought or
speech pattern.
4. Negative symptoms are those that subtract from normal behavior. These symptoms
include a lack of interest, motivation, responsiveness, or pleasure in daily activities.
Page Ref: 209-210
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Mental Health Concepts
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
GRcontrast
ADESMO
REpositive
.COM and negative symptoms of
Learning Outcome: 17-2 Compare and
the
schizophrenia.
MNL Learning Outcome: 17.1 Examine the etiology, pathogenesis, clinical manifestations, and
diagnosis of psychotic disorders.
2
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3) Which is a priority outcome for a client with schizophrenia that has been prescribed
haloperidol (Haldol)?
1. The client will consume adequate fluids and a high-fiber diet.
2. The client will be compliant with taking the medication as prescribed.
3. The client will report a decrease in auditory hallucinations.
4. The client will report symptoms of restlessness.
Answer: 2
Explanation:
1. Adequate fluids and fiber will decrease the side effect of constipation, but this is not the
priority outcome.
2. Medication compliance is a priority for clients with schizophrenia. Relapse of symptoms
will occur without the medications.
3. A decrease in auditory hallucinations is an expected effect of haloperidol (Haldol), but
this is not the priority outcome.
4. The symptom of restlessness is known as akathisia. This is an important finding to report
but is not the priority outcome.
Page Ref: 211-215
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
GRADESMmedical
ORE.Cmanagement,
OM
development, pathophysiology, pharmacology,
and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 17-9 Use the nursing process to care for patients receiving
pharmacotherapy for psychoses.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
3
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4) The nurse is assessing a client with schizophrenia prescribed a phenothiazine for
anticholinergic side effects. Which finding should the nurse immediately report to the
healthcare provider?
1. Acute dystonia
2. Complaint of a severe headache
3. Hypertension
4. Urinary retention
Answer: 4
Explanation:
1. Acute dystonia must be reported immediately to the provider but this is not an
anticholinergic side effect.
2. Headaches are not anticholinergic side effects.
3. Hypotension, not hypertension, is a cardiac side effect, not an anticholinergic side
effect.
4. Urinary retention is an anticholinergic side effect of conventional antipsychotics. This
must be reported immediately to the physician.
Page Ref: 212
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
GRADESMmedical
ORE.Cmanagement,
OM
development, pathophysiology, pharmacology,
and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 17-9 Use the nursing process to care for patients receiving
pharmacotherapy for psychoses.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
4
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5) The nurse is preparing to assess a client suspected of experiencing tardive dyskinesia. Which
findings should the nurse anticipate that support the diagnosis?
1. Tremor, muscle rigidity, and a shuffling gait
2. Severe muscle spasms of the back, neck, and tongue
3. An inability to rest or relax, and restlessness
4. Unusual facial movements and lip smacking
Answer: 4
Explanation:
1. Tremor, muscle rigidity, and a shuffling gait are symptoms associated with
parkinsonism.
2. Severe muscle spasms of the back, neck, and tongue are symptoms associated with
acute dystonia.
3. An inability to rest or relax and restlessness are symptoms associated with akathisia.
4. Tardive dyskinesia is characterized by unusual tongue and face movements, such as lip
smacking, and wormlike motions of the tongue.
Page Ref: 212
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
GR|ANLN
DESCompetencies:
MORE.COM Knowledge and Science:
lifespan, and in all healthcare settings.
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 17-6 Explain the symptoms associated with extrapyramidal symptoms of
antipsychotic drugs.
MNL Learning Outcome: 17.1 Examine the etiology, pathogenesis, clinical manifestations, and
diagnosis of psychotic disorders.
5
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6) During an assessment, the nurse notes that the client prescribed risperidone (Risperdal) has
a temperature of 102°F. Which should the nurse suspect has occurred?
1. Neuroleptic malignant syndrome
2. Acute urinary infection
3. Bacterial pneumonia
4. Extrapyramidal side effects
Answer: 1
Explanation:
1. Neuroleptic malignant syndrome includes symptoms of elevated temperature, unstable
blood pressure, profuse sweating, dyspnea, muscle rigidity, and incontinence.
2. Clients with acute urinary infections do have elevated temperatures; however, when the
client is receiving an antipsychotic drug and has an elevated temperature, a different
condition must be considered first.
3. Clients with bacterial pneumonias do not necessarily have elevated temperatures;
however, when the client is receiving an antipsychotic drug and has an elevated
temperature, a different condition must be considered first.
4. An elevated temperature is not an extrapyramidal side effect.
Page Ref: 212
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
RADEand
SMOdevelopment,
RE.COM pathophysiology, pharmacology,
reflects an understanding of human G
growth
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 17-6 Explain the symptoms associated with extrapyramidal symptoms of
antipsychotic drugs.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
6
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7) A client has been receiving clozapine (Clozaril) for the treatment of schizophrenia. Which
statement made by the client indicates the prescription is effective?
1. "I will start going to group therapy."
2. "I think I am ready for discharge, as I feel better."
3. "I am not hearing the voices anymore."
4. "I promise not to skip breakfast anymore."
Answer: 3
Explanation:
1. A client stating he or she will go to group therapy is not an indication that psychotic
symptoms are in remission.
2. A client stating he or she feels better and is ready for discharge does not indicate the
psychotic symptoms are in remission.
3. Therapeutic effects of clozapine (Clozaril) include remission of a range of psychotic
symptoms to include delusions, paranoia, auditory hallucinations, and irrational
behavior.
4. A client stating he or she will not skip breakfast does not indicate the remission of any
psychotic symptoms.
Page Ref: 210-215
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
GRADE
SMacute
OREand
.COchronic
M
interventions as appropriate for managing
the
care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 17-5 Describe the nurse's role in the pharmacologic management of
schizophrenia.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
7
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8) The nurse provided education for a client prescribed risperidone (Risperdal). Which
statement made by the client indicates an understanding of the teaching?
1. "I must call my healthcare provider if I start to have a lot of nightmares."
2. "I must have my blood work done while taking this medication."
3. "I must call my healthcare provider if I start to lose a lot of weight."
4. "I must call my healthcare provider if I notice any a metallic taste in my mouth."
Answer: 2
Explanation:
1. Nightmares are not a side effect of risperidone (Risperdal).
2. Agranulocytosis can be a life-threatening side effect of risperidone, which may also
suppress bone marrow and lower infection-fighting ability. It is very important,
therefore, that the patient have regular blood work evaluated while on this medication.
Risperidone also may cause increased serum prolactin levels and increased alanine
aminotransferase (ALT) and aspartate aminotransferase (AST) liver enzyme levels.
3. Weight gain, not weight loss, is a serious side effect of risperidone.
4. A metallic taste is not a side effect of risperidone.
Page Ref: 216
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
GRADESMOacross
RE.Cthe
OMhealth-illness continuum, across
medical management, and nursing management
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 17-7 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples and explain their mechanism of action, primary actions, and
important adverse effects.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
8
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GRADESMORE.COM
WWW.GRADESMORE.COM
9) The nurse is preparing the education for a client prescribed risperidone (Risperdal). For
which condition should the nurse inform the client to immediately notify the healthcare
provider?
1. Narrowing of the field of vision
2. Joint pain or swelling
3. Sore throat or an infection
4. Yellowish halos around lights
Answer: 3
Explanation:
1. Narrowing of the field of vision is not a side effect of risperidone (Risperdal).
2. Joint pain or swelling is not a side effect of risperidone (Risperdal).
3. Signs of a sore throat or an infection could indicate agranulocytosis, which is a lifethreatening side effect of risperidone (Risperdal).
4. Yellowish halos around lights are not a side effect of risperidone (Risperdal).
Page Ref: 216
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
GRADEand
SMquality
ORE.and
COMsafe patient care. |
Relationships between knowledge/science
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 17-7 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples and explain their mechanism of action, primary actions, and
important adverse effects.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
9
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10) A client with schizophrenia whose symptoms have been controlled with a liquid prescription
has reported both positive and negative symptoms have returned over the last week. Which
questions should the nurse ask the patient?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Have you mixed your prescription in any liquids?"
2. "Have you changed pharmacies?"
3. "What was your last fasting blood glucose?"
4. "Have you the started smoking again?"
5. "Are you consuming more dairy products than usual?"
Answer: 1, 2, 4
Explanation:
1. Mixing the prescription in cola, tea, or caffeine-containing liquids may change
effectiveness.
2. The client should not switch brands of medication.
3. Blood glucose management is important but does not cause these symptoms the client
is experiencing.
4. Smoking may decrease effectiveness of some prescriptions.
5. Consuming more dairy products does not affect the absorption of the prescription.
Page Ref: 217-219
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRProvide
ADESMpatient-centered
ORE.COM care with sensitivity and
Standards: QSEN Competencies: I.B.3
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 17-9 Use the nursing process to care for patients receiving
pharmacotherapy for psychoses.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
10
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11) The nurse has completed the dietary education for a patient prescribed an antipsychotic.
Which food identified by the client has to be eliminated indicates an understanding of the
teaching?
1. Meats with a high-fat content
2. Beverages with caffeine
3. Refined breads and desserts
4. Shellfish and peanuts
Answer: 2
Explanation:
1. Although unhealthy, high-fat meats do not affect the action of antipsychotic
medications.
2. The use of caffeine-containing substances will decrease the effect of antipsychotic
medications.
3. Although unhealthy, refined breads and desserts do not affect the action of
antipsychotic medications.
4. Many individuals are allergic to shellfish and peanuts, but they do not affect the action
of antipsychotic medications.
Page Ref: 217-219
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote
GRADESMOKnowledge
RE.COM and Science: Relationships
health and manage illness. | NLN Competencies:
between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts:
Nursing Process: Evaluation
Learning Outcome: 17-4 Explain the importance of patient drug adherence in the
pharmacotherapy of schizophrenia.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
11
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WWW.GRADESMORE.COM
12) A client prescribed an antipsychotic tells the nurse he or she has not had a bowel
movement for 2 days. Which initial action should the nurse take?
1. Hold the prescription until the client has a bowel movement.
2. Have the client drink prune juice and additional fluids.
3. Request a prescription for a Fleet Enema.
4. Obtain a prescription for a stool softener.
Answer: 2
Explanation:
1. Antipsychotic prescriptions should not be held because of constipation.
2. Constipation is a common side effect of antipsychotic prescriptions. The best approach
is to have the client increase dietary fiber and fluids and to exercise to prevent
constipation.
3. Contacting the healthcare provider to request a prescription for a Fleet Enema is
premature.
4. Contacting the healthcare provider to request a prescription for a stool softener is
premature.
Page Ref: 218
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
GRADESMmedical
ORE.Cmanagement,
OM
development, pathophysiology, pharmacology,
and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 17-9 Use the nursing process to care for patients receiving
pharmacotherapy for psychoses.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
12
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WWW.GRADESMORE.COM
13) A client refuses his or her antipsychotic and tells the nurse he or she frequently experiences
a dry mouth. Which response should the nurse provide?
1. "Can you tell me why you are refusing the medicine?"
2. "I can give you another prescription to help with the dry mouth."
3. "I will let your healthcare provider know about your dry mouth."
4. "A dry mouth is common, but drinking more water will help."
Answer: 4
Explanation:
1. Asking the client why they are refusing their medication is an inappropriate question, as
the nurse knows the client is experiencing a dry mouth. The question should be
rephrased to clarify if the dry mouth is the reason the client is refusing the medication.
2. Administering another prescription for the dry mouth does not address the immediate
problem.
3. A dry mouth is a common side effect that can be alleviated with nursing interventions,
not necessarily by the healthcare provider.
4. The symptom of dry mouth is very common with antipsychotic prescriptions. The best
approach is to have the client suck on sugarless candy, chew gum, or have frequent
drinks of water.
Page Ref: 218
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
GRADESM|OAACN
RE.Essential
COM Competencies: IX.3 Implement
respect for the diversity of human experience.
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 17-9 Use the nursing process to care for patients receiving
pharmacotherapy for psychoses.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
13
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14) A client prescribed quetiapine (Seroquel) asks the nurse how the prescription works. Which
response should the nurse provide the client?
1. "Quetiapine (Seroquel) decreases norepinephrine in the brain, which decreases your
auditory hallucinations."
2. "Quetiapine (Seroquel) increases norepinephrine in the brain, which decreases the
feelings of depression."
3. "Quetiapine (Seroquel) decreases dopamine in the brain, which decreases your
symptoms."
4. "Quetiapine (Seroquel) increases dopamine in the brain, which helps to think more
clearly."
Answer: 3
Explanation:
1. Quetiapine (Seroquel) does not decrease norepinephrine in the brain.
2. Quetiapine (Seroquel) does not increase norepinephrine in the brain.
3. Quetiapine (Seroquel) acts by interfering with the binding of dopamine to its receptors
in the brain.
4. Quetiapine (Seroquel) does not increase dopamine in the brain.
Page Ref: 215-216
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
GRADESKnowledge
MORE.COand
M Science: Relationships between
practice, and research. | NLN Competencies:
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 17-8 Categorize drugs used for psychoses based on their classification and
drug action.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
14
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15) The educator is discussing the symptoms of schizophrenia with a nurse. Which receptor site
should the educator associate with the symptoms?
1. Dopamine type 2
2. Adrenergic
3. Beta 2
4. Cholinergic
Answer: 1
Explanation:
1. Although other receptor sites can be involved, it appears that dopamine type 2
receptors are the most responsible.
2. There is another site thought to be more responsible for these effects.
3. There is another site thought to be more responsible for these effects.
4. There is another site thought to be more responsible for these effects.
Page Ref: 209-210
Cognitive Level: Remembering
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Assessment
Learning Outcome: 17-1 Explain theories for the etiology of schizophrenia.
GRA
DEetiology,
SMOREpathogenesis,
.COM
MNL Learning Outcome: 17.1 Examine
the
clinical manifestations, and
diagnosis of psychotic disorders.
16) A client with a psychiatric history is attempting to communicate with the nurse using madeup words. Which condition is the client most likely exhibiting?
1. Symptom of depression
2. Positive symptom of schizophrenia
3. Negative symptom of schizophrenia
4. Symptom of bipolar disorder
Answer: 2
Explanation:
1. Making up words is not a symptom of depression.
2. The use of made-up words is a demonstration of the positive symptoms of
schizophrenia.
3. Making up words is not a negative symptom of schizophrenia.
4. Making up words is not a symptom of bipolar disorder.
Page Ref: 209
Cognitive Level: Understanding
Client Need/Sub: Psychosocial Integrity: Sensory/Perceptual Alterations
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
15
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Assessment
Learning Outcome: 17-2 Compare and contrast the positive and negative symptoms of
schizophrenia.
MNL Learning Outcome: 17.1 Examine the etiology, pathogenesis, clinical manifestations, and
diagnosis of psychotic disorders.
17) Which atypical antipsychotic should the nurse anticipate a client with schizophrenia
demonstrating both positive and negative symptoms will be prescribed?
1. Thioridazine HCL (Mellaril)
2. Haloperidol (Haldol)
3. Clozapine (Clozaril)
4. Chlorpromazine (Thorazine)
Answer: 3
Explanation:
1. Conventional antipsychotic agents like thioridazine HCL (Mellaril) are indicated for
positive symptoms.
2. Conventional antipsychotic agents like haloperidol (Haldol) are indicated for positive
symptoms.
3. Clozaril is an atypical antipsychotic indicated for positive and negative symptoms of
schizophrenia.
4. Conventional antipsychotic agents like chlorpromazine (Thorazine) are indicated for
GRADESMORE.COM
positive symptoms.
Page Ref: 215
Cognitive Level: Understanding
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 17-3 Discuss the rationale for selecting a specific antipsychotic drug for the
treatment of schizophrenia.
MNL Learning Outcome: 17.2 Consider the management and pharmacotherapy for psychotic
disorders.
16
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18) Which existing pharmacological treated condition should the nurse be most concerned
about for a client prescribed haloperidol (Haldol)?
1. Severe depression
2. Hypothyroidism
3. Diabetes mellitus
4. Urinary tract infection
Answer: 1
Explanation:
1. Contraindications for a client prescribed a phenothiazine includes a patient receiving a
prescription for severe depression.
2. Pharmacological treatment for hypothyroidism is not contraindicated with a
phenothiazine.
3. Pharmacological treatment for diabetes mellitus is not contraindicated with a
phenothiazine.
4. Pharmacological treatment for a urinary tract infection is not contraindicated with a
phenothiazine.
Page Ref: 214
Cognitive Level: Remembering
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: VII.4 Use behavioral change techniques to promote
health and manage illness. | NLN Competencies: Knowledge and Science: Relationships
GRAand
DESsafe
MOR
E.COcare.
M | Nursing/Integrated Concepts:
between knowledge/science and quality
patient
Nursing Process: Assessment
Learning Outcome: 17-4 Explain the importance of patient drug adherence in the
pharmacotherapy of schizophrenia.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
17
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19) A client prescribed haloperidol (Haldol) is observed making wormlike movements with their
tongue. Which should the nurse associate this finding with?
1. An adverse effect likely caused by the medication
2. A normal reaction to the medication that will resolve within a few weeks
3. An indication that the patient has not taken the prescription
4. A symptom of the underlying psychosis
Answer: 1
Explanation:
1. Tardive dyskinesia is an adverse effect of the prescription that is characterized by
wormlike movements of the tongue.
2. This reaction will not resolve within a few weeks.
3. While this effect does indicate the patient is taking the medication, it is not desirable.
4. This symptom is not associated with psychosis.
Page Ref: 212, 214
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
GRProcess:
ADESMAssessment
ORE.COM
Nursing/Integrated Concepts: Nursing
Learning Outcome: 17-6 Explain the symptoms associated with extrapyramidal symptoms of
antipsychotic drugs.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
18
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20) The nurse observes a client with extrapyramidal symptoms having difficulty relaxing. Which
should the nurse record in the client's record?
1. Dystonia
2. Tardive dyskinesia
3. Akathisia
4. Secondary parkinsonism
Answer: 3
Explanation:
1. Dystonia involves severe muscle spasms, particularly of the back, neck, tongue, and
face.
2. Tardive dyskinesia is characterized by unusual tongue and face movements, such as lip
smacking.
3. The inability to relax is associated with akathisia.
4. Secondary parkinsonism includes tremor, muscle rigidity, stooped posture, and a
shuffling gait.
Page Ref: 212
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
GR|ANLN
DESCompetencies:
MORE.COM Knowledge and Science:
lifespan, and in all healthcare settings.
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 17-6 Explain the symptoms associated with extrapyramidal symptoms of
antipsychotic drugs.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
19
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21) A client overdosed approximately 20 minutes prior on risperidone (Risperdal). Which
intervention should the nurse be prepared to perform?
1. Administer a CNS depressant
2. Administer anticholinergic
3. Administer activated charcoal
4. Provide symptom management
Answer: 3
Explanation:
1. CNS depressants will likely worsen symptoms.
2. Anticholinergic agents will likely worsen symptoms.
3. Activated charcoal will bind the Risperdal that has not been absorbed and prevent
absorption into the bloodstream.
4. Symptom management might be warranted; however, the overdose occurred only 20
minutes prior so administering activated charcoal is a more effective treatment.
Page Ref: 216
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
GRADEand
SMquality
ORE.C
OMsafe patient care. |
Relationships between knowledge/science
and
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 17-7 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples and explain their mechanism of action, primary actions, and
important adverse effects.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
20
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22) A client who has been treated with an antipsychotic agent develops an elevated blood
pressure, dyspnea, and an elevated temperature. Which disorder should the nurse suspect
has occurred?
1. Akathisia
2. Extrapyramidal side effects
3. Acute dystonia
4. Neuroleptic malignant syndrome
Answer: 4
Explanation:
1. Akathisia is an inability to rest or relax.
2. Extrapyramidal side effects include dystonia, akathisia, secondary parkinsonism, and
tardive dyskinesia.
3. Acute dystonias involve severe muscle spasms, particularly of the back, neck, tongue,
and face.
4. Symptoms associated with neuroleptic malignant syndrome include an elevated blood
pressure, dyspnea, and a high fever.
Page Ref: 212
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.15 Communicate care provided and needed at each
transition of care. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
GR
DECompetencies:
SMORE.COMKnowledge and Science:
promoting health across the lifespan.
|A
NLN
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 17-5 Describe the nurse's role in the pharmacologic management of
schizophrenia.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
21
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23) Which barriers make it difficult to treat a client with schizophrenia demonstrating negative
symptoms?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The client feels that their behavior is normal.
2. Family members feel the client is going through a period of depression.
3. The client is suspicious of the motives of the healthcare provider.
4. Family members have labeled the patient as lazy.
5. The client is indifferent to obtaining help.
Answer: 2, 4, 5
Explanation:
1. Clients with a psychosis rather than the negative symptoms of schizophrenia are often
unaware that their bizarre behavior is not normal.
2. Negative symptoms of schizophrenia are often mistaken for depression.
3. Suspicion that someone is trying to do harm is characteristic of delusions.
4. Negative symptoms of schizophrenia are often mistaken for laziness.
5. Negative symptoms are characteristic of the indifferent personality.
Page Ref: 209
Cognitive Level: Analyzing
Client Need/Sub: Psychosocial Integrity: Sensory/Perceptual Alterations
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
GRADESKnowledge
MORE.COand
M Science: Integration of knowledge
practice, and research. | NLN Competencies:
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 17-2 Compare and contrast the positive and negative symptoms of
schizophrenia.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
22
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24) The nurse is admitting a client that hears voices telling him to harm himself. Which
questions should the nurse ask the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Do you have a family history of first-degree relative with schizophrenia?"
2. "Do you use any street drugs?"
3. "Have you recently experienced any episodes of anxiety?"
4. "Do you have a family history of heart disease?"
5. "Have you experienced any emotional or physical abuse?"
Answer: 1, 2, 5
Explanation:
1. There is a greater risk of schizophrenia if a first-degree relative has the disorder.
2. Use of drugs such as cocaine can produce hallucinations or paranoia.
3. A history of anxiety is not associated with the development of schizophrenia.
4. A family history of heart disease is not associated with the development of
schizophrenia.
5. Family dynamics can affect coping skills, which can influence the onset of schizophrenia.
Page Ref: 209-210
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Therapeutic Communication
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
GRADEanSM
ORE.COM of human growth and
holistic, patient-centered care that reflects
understanding
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 17-9 Use the nursing process to care for patients receiving
pharmacotherapy for psychoses.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
23
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25) A client with a history of schizophrenia has stopped his or her prescribed clozapine (Clozaril)
after 4 weeks of therapy. Which should the nurse recognize may have contributed to the
client abruptly stopping their prescription?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Feeling sedated
2. Significant weight gain
3. Agitation
4. Fatigue and headache
5. Uncontrollable sexual urges
Answer: 1, 2, 3, 4
Explanation:
1. Clients do not like the side effect of sedation.
2. Substantial weight gain has been reported in some clients taking this medication
resulting in discounting the prescription.
3. Agitation may be an extrapyramidal symptom of treatment with this medication and is
an unwanted adverse effect.
4. Fatigue and headache are possible side effects of this medication.
5. Side effects include loss of libido, not uncontrollable sexual urges.
Page Ref: 215
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
GRA
DESMORE.care
COMprovided and needed at each
Standards: QSEN Competencies: I.B.15
Communicate
transition of care. | AACN Essential Competencies: IX.8 Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients and
promoting health across the lifespan. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 17-5 Describe the nurse's role in the pharmacologic management of
schizophrenia.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
24
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26) The nurse is assessing a female client who has been taking chlorpromazine. Which should
the nurse include in the assessment?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Ask the client if she is taking any herbal medicine.
2. Obtain a lipid profile.
3. Ask the client questions regarding amount of alcohol intake.
4. Determine the date of her last menstrual period.
5. Assess thyroid function with laboratory work.
Answer: 2, 3, 4
Explanation:
1. St. John's wort and Kava may increase the risk and severity of dystonia.
2. Antipsychotic drugs have cardiometabolic effects. A lipid profile should be drawn at
each visit.
3. It is important to assess for alcohol use as this could cause excessive drowsiness.
4. It is important to assess for pregnancy as this drug is Pregnancy Category C.
5. There is no indication that antipsychotics affect thyroid function, and nothing in the
scenario indicates the need to check thyroid function.
Page Ref: 213
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
GRADESM|OAACN
RE.Essential
COM Competencies: IX.3 Implement
respect for the diversity of human experience.
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 17-9 Use the nursing process to care for patients receiving
pharmacotherapy for psychoses.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
25
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27) A client taking risperidone (Risperdal) for schizophrenia is experiencing signs of hypotension
with certain activities. Which information should the nurse provide the client?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Avoid being outside in the heat of the day.
2. Avoid hot baths or hot showers.
3. Avoid vitamin C-containing preparations.
4. Change positions slowly, especially from lying or sitting to standing.
5. Take frequent naps during the day.
Answer: 1, 2, 4
Explanation:
1. The client should avoid any situation that might cause overheating, especially in hot
weather, to reduce the risk of hypotension.
2. Hot baths and hot showers should be avoided to decrease the chance of hypotension.
3. There is no association between vitamin C-containing products and hypotension.
4. Changing positions slowly will help reduce orthostatic hypotension.
5. Frequent naps will not affect the symptoms of hypotension.
Page Ref: 217
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
RADEand
SMOdevelopment,
RE.COM pathophysiology, pharmacology,
reflects an understanding of human G
growth
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 17-7 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples and explain their mechanism of action, primary actions, and
important adverse effects.
MNL Learning Outcome: 17.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for psychotic disorders.
26
Copyright © 2020 Pearson Education, Inc.
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WWW.GRADESMORE.COM
28) Which statements made by the client indicate he or she may be experiencing psychosis?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "The servants need to be disciplined."
2. "The voice told me to cut myself."
3. "I have not had an appetite for weeks."
4. "Close the door so that man can't get to me."
5. "I have not been able to get any sleep for months."
Answer: 1, 2, 4
Explanation:
1. This statement is an example of a grandiose delusion.
2. This statement is an example of an auditory hallucination.
3. A loss of appetite is not a symptom of psychosis.
4. This statement is an example of a delusion in which someone is trying to harm the
patient.
5. The lack of sleep is not a symptom of psychosis.
Page Ref: 209
Cognitive Level: Analyzing
Client Need/Sub: Psychosocial Integrity: Sensory/Perceptual Alterations
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
RADESMORE.CO
M
from nursing and other disciplines. |GNursing/Integrated
Concepts:
Nursing Process:
Assessment
Learning Outcome: 17-2 Compare and contrast the positive and negative symptoms of
schizophrenia.
MNL Learning Outcome: 17.1 Examine the etiology, pathogenesis, clinical manifestations, and
diagnosis of psychotic disorders.
27
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29) While conducting a health history for a client with schizophrenia, which behaviors
associated with positive signs of schizophrenia should the nurse anticipate?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Disorganized sentence structure
2. Kicking the nurse
3. Not responding to questions
4. Difficulty following instructions
5. Stating that God wants the patient to go home
Answer: 1, 2, 5
Explanation:
1. Disorganized speech is a positive symptom of schizophrenia.
2. Combativeness is a positive symptom of schizophrenia.
3. Lack of responsiveness is a negative symptom of schizophrenia.
4. Difficulty following instructions is not a positive symptom of schizophrenia.
5. A delusion is a positive symptom of schizophrenia.
Page Ref: 209
Cognitive Level: Applying
Client Need/Sub: Psychosocial Integrity: Sensory/Perceptual Alterations
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
RADESMORE.CO
M
from nursing and other disciplines. |GNursing/Integrated
Concepts:
Nursing Process:
Assessment
Learning Outcome: 17-2 Compare and contrast the positive and negative symptoms of
schizophrenia.
MNL Learning Outcome: 17.1 Examine the etiology, pathogenesis, clinical manifestations, and
diagnosis of psychotic disorders.
28
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30) The nurse is preparing to administer chlorpromazine intramuscularly. Which anatomical
location should the nurse administer the medication?
1. Gluteal
2. Deltoid
3. Vastus lateralis
4. Ventrogluteal
Answer: 1
Explanation:
1. Chlorpromazine should be administered intramuscularly deep into the gluteal.
2. Chlorpromazine is not administered in the deltoid.
3. Chlorpromazine is not administered in the vastus lateralis.
4. Chlorpromazine is not administered in the ventrogluteal.
Page Ref: 213
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Relationships between
knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 17-9 Use the nursing process to care for patients receiving
pharmacotherapy for psychoses.
RAD
ESMOprocess
RE.COinMthe care of patients receiving
MNL Learning Outcome: 17.4 UtilizeGthe
nursing
pharmacotherapy for psychotic disorders.
29
Copyright © 2020 Pearson Education, Inc.
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Pharmacology for Nurses, 6e (Adams)
Chapter 18 Drugs for the Control of Pain
1) The nurse has provided client education about the use of nonpharmacological techniques
for pain management. Which statements indicate the client understands the information?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "Nonpharmacological techniques are a good adjunct to pharmacotherapy."
2. "Nonpharmacological techniques have not reached mainstream yet."
3. "Nonpharmacological techniques may be used in place of drugs."
4. "Nonpharmacological techniques include an aerobic exercise."
5. "Nonpharmacological techniques are not usually valued by nurses."
Answer: 1, 3
Explanation:
1. Nonpharmacological techniques may be used as an adjunct to pharmacotherapy.
2. Nonpharmacological techniques have reached mainstream and are commonly used.
3. Nonpharmacological techniques may be used in place of drugs.
4. An aerobic exercise is not considered a nonpharmacological technique for relief of pain.
5. Nonpharmacological techniques are valued and used by most nurses.
Page Ref: 226
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Basic Care and Comfort
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Standards: QSEN Competencies: I.B.7 Initiate effective treatments to relieve pain and suffering
in light of patient values, preferences and expressed needs. | AACN Essential Competencies: I.1
Integrate theories and concepts from liberal education into nursing practice. | NLN
Competencies: Knowledge and Science: Relationships between knowledge/science and quality
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 18-4 Describe the role of complementary and alternative therapies in pain
management.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
1
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2) The educator is reviewing the neural mechanisms of pain with a nurse. Which information
should the educator provide about substance P?
1. Substance P modifies sensory information in the spinal cord.
2. Substance P is also known as an endogenous opioid.
3. Substance P stimulates pain receptors in the spinal cord.
4. Substance P controls which pain signals reach the brain.
Answer: 4
Explanation:
1. Endogenous opioids, not substance P, modify sensory information at the level of the
spinal cord.
2. Substance P is not an endogenous opioid.
3. Substance P does not stimulate pain receptors in the spinal cord.
4. Spinal substance P is critical because it controls whether pain signals will continue to the
brain.
Page Ref: 225
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal
education into nursing practice. | NLN Competencies: Knowledge and Science: Integration of
knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
RADEmechanisms
SMORE.COatMthe level of the spinal cord
Learning Outcome: 18-2 Explain theGneural
responsible for pain.
MNL Learning Outcome: 18.1 Recognize the assessment, classification, and pathophysiology of
pain, including the etiologies and characteristics of migraines.
2
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3) A client asks the nurse how methadone (Dolophine) can help with a heroin dependence.
Which response should the nurse provide?
1. "Methadone (Dolophine) will cause illness if heroin is used."
2. "Methadone (Dolophine) does not cause euphoria like heroin does."
3. "Methadone (Dolophine) can cure an addiction to heroin."
4. "Methadone (Dolophine) causes an allergic reaction to heroin."
Answer: 2
Explanation:
1. Methadone (Dolophine) will not cause a person to become ill if they use heroin.
2. Methadone (Dolophine) does not cause the euphoria of heroin. It is a substitute
prescription that allows the patient to be productive.
3. Methadone (Dolophine) does not cure heroin addiction.
4. Methadone (Dolophine) does not cause an allergic reaction to heroin.
Page Ref: 229, 234
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: VII.4 Use
behavioral change techniques to promote health and manage illness. | NLN Competencies:
Knowledge and Science: Relationships between knowledge/science and quality and safe patient
care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 18-7 Describe the long-term treatment of opioid dependence.
RAD
ESMOprocess
RE.COinMthe care of patients receiving
MNL Learning Outcome: 18.4 UtilizeGthe
nursing
pharmacotherapy for pain and migraines.
3
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4) A nurse is preparing to provide education on the use of heroin. Which information should
the nurse include?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Heroin is an opioid drug.
2. Heroin is a narcotic drug.
3. Heroin causes CNS agitation.
4. Heroin is the same drug as morphine.
5. Heroin is not as dangerous as oxycodone.
Answer: 1, 2
Explanation:
1. Heroin is classified as an opioid.
2. Heroin is an illegal drug. Narcotic is the term often used to describe such drugs.
3. Heroin causes CNS depression, not agitation.
4. Morphine and heroin are in the same class but are different drugs.
5. Heroin is addictive and dangerous—as dangerous, if not more dangerous, as oxycodone.
Page Ref: 230
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Chemical and Other Dependencies/Substance Use
Disorder
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal
GRCompetencies:
ADESMORE.Knowledge
COM
education into nursing practice. | NLN
and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 18-10 Categorize drugs used in the treatment of pain based on their
classification and mechanism of action.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
4
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5) A client asks the nurse how morphine will control pain. Which response should the nurse
provide the client?
1. "Inhibits the primary pain neurotransmitters in your brain."
2. "Stimulates the receptors that secrete endorphins in your brain."
3. "Interacts with receptors in your body that produce analgesia."
4. "Promotes the primary pleasure neurotransmitters in your brain."
Answer: 3
Explanation:
1. Opioids do not inhibit neurotransmitters responsible for pain.
2. Opioids do not promote secretion of endorphins.
3. Opioids exert their actions by interacting with the mu and kappa receptors in the brain.
Drugs that stimulate these receptors are opioid agonists.
4. Opioids do not promote release of the pleasurable neurotransmitters. Opioids do not
promote secretion of endorphins.
Page Ref: 225, 229
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.7 Initiate effective treatments to relieve pain and suffering
in light of patient values, preferences and expressed needs. | AACN Essential Competencies: I.1
Integrate theories and concepts from liberal education into nursing practice. | NLN
Competencies: Knowledge and Science: Relationships between knowledge/science and quality
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
GRcontrast
ADESMO
REtypes
.COof
M opioid receptors and their
Learning Outcome: 18-5 Compare and
the
importance in effective management of pain.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
5
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6) The educator has discussed with a nurse the protocol for the immediate availability of
naloxone for a client with a patient-controlled analgesia PCA pump. Which statement made
by the nurse indicates an understanding of the information?
1. "Naloxone (Narcan) enhances the effect of the opioid in the patient-controlled analgesia
(PCA) pump and increases analgesia."
2. "Naloxone (Narcan) is the antidote if an anaphylactic reaction to the opioid in the
patient-controlled analgesia (PCA) pump occurs."
3. "Naloxone (Narcan) is available to treat any systemic side effects, like constipation, of
the opioid in the patient-controlled analgesia (PCA) pump."
4. "Naloxone (Narcan) will reverse the effects of the narcotic in the patient-controlled
analgesia (PCA) pump if an overdose occurs."
Answer: 4
Explanation:
1. Naloxone (Narcan) does not enhance the effects of opioids.
2. Naloxone (Narcan) is not used to treat anaphylactic reactions.
3. Naloxone (Narcan) is not used to treat opioid-related constipation.
4. Naloxone (Narcan) is an opioid antagonist and will reverse the effects of the narcotic in
the pump if an overdose occurs.
Page Ref: 231
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.7 Initiate effective treatments to relieve pain and suffering
GR
ADexpressed
ESMOREneeds.
.COM| AACN Essential Competencies:
in light of patient values, preferences
and
IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth
and development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 18-6 Explain the role of opioid antagonists in the diagnosis and treatment
of acute opioid toxicity.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
6
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7) Which question should the nurse ask a postsurgical client prior to the administration of an
opioid analgesic?
1. "Have you ever been addicted to prescription pain medications?"
2. "Do you understand how this pain prescription works?"
3. "Would you like me to help you change your position for comfort?"
4. "Would you please rate your pain on a scale of 1 to 10?"
Answer: 4
Explanation:
1. Administration of pain medication postoperatively is a priority; this is not the time to
assess if the client has a history of addiction.
2. Instead of asking a postoperative client if they understand how the pain medication
works, the nurse should provide appropriate patient teaching for the prescription.
3. Repositioning should be implemented after the client has received their pain
prescription.
4. A client's level of pain is always assessed prior to the administration of an analgesic.
Page Ref: 232
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Basic Care and Comfort
Standards: QSEN Competencies: I.B.4 Assess presence and extent of pain and suffering. | AACN
Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral,
psychological, spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate approaches. | NLN
GRARelationships
DESMORE.between
COM knowledge/science and quality
Competencies: Knowledge and Science:
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18-1 Relate the importance of pain assessment to effective
pharmacotherapy.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
7
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8) A postoperative client has a prescription for morphine 2 mg IV push every 2 hours and
hydrocodone 5 mg every 6 hours. The client received the morphine 2 hours ago and is
requesting hydrocodone. Which initial action should the nurse take?
1. Administer another dose of morphine.
2. Administer 5 mg of hydrocodone.
3. Encourage the use of distraction techniques.
4. Using a pain scale assess the patient's level of pain.
Answer: 4
Explanation:
1. The client's level of pain should be assessed prior to the administration of any analgesic.
2. The client's level of pain should be assessed prior to the administration of any analgesic.
3. The client's level of pain should be assessed prior to the administration of any analgesic.
Distraction techniques are appropriate but should not take the place of other
interventions.
4. The client's level of pain should be assessed prior to the administration of any analgesic.
Page Ref: 226
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Basic Care and Comfort
Standards: QSEN Competencies: I.B.4 Assess presence and extent of pain and suffering. | AACN
Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral,
psychological, spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate approaches. | NLN
GRARelationships
DESMORE.between
COM knowledge/science and quality
Competencies: Knowledge and Science:
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18-1 Relate the importance of pain assessment to effective
pharmacotherapy.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
8
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9) A client that experienced head trauma asks the nurse why they cannot have an opioid
analgesic. Which response should the nurse provide?
1. "The use of an opioid analgesic can significantly decrease blood pressure."
2. "You may not be able to notice any changes you are experiencing."
3. "Opioids are not effective for the management of pain associated with head trauma."
4. "Opioids can mask changes in the level of consciousness."
Answer: 4
Explanation:
1. A decrease in blood pressure may occur, but this is not as critical as a masking of
changes in the level of consciousness.
2. A client may not be able to effectively notice any changes they are experiencing, but this
is not as critical as a masking of changes in the level of consciousness.
3. Opioids are effective in managing pain, but this is not as critical as a masking of changes
in the level of consciousness.
4. Opioids are central nervous system (CNS) depressants and can mask the client's level of
consciousness. A client with head trauma should be monitored for changes in the level
of consciousness, which may indicate a worsening condition.
Page Ref: 229
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.7 Initiate effective treatments to relieve pain and suffering
in light of patient values, preferences and expressed needs. | AACN Essential Competencies:
GRADcare
ESM
ORreflects
E.COMan understanding of human growth
IX.3 Implement holistic, patient-centered
that
and development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 18-11 Use the nursing process to care for patients receiving
pharmacotherapy for pain and for migraines.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
9
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10) Which comment by the client receiving morphine should the nurse recognize as an adverse
effect?
1. "My ears are constantly ringing."
2. "My heart feels like it is skipping beats."
3. "I feel like I am going to throw up."
4. "I feel cold shivers all over."
Answer: 3
Explanation:
1. Tinnitus is not associated with morphine.
2. Heart palpitations are not associated with morphine.
3. Nausea is a common side effect of morphine.
4. Feeling cold shivers is not associated with morphine.
Page Ref: 230
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Assessment
RAdrug
DESclasses
MORE.listed
COMin Drugs at a Glance, know
Learning Outcome: 18-9 For each ofGthe
representative drug examples, and explain the mechanisms of drug action, primary actions, and
important adverse effects.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
10
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11) Which statement made by a client prescribed acetylsalicylic acid (aspirin) indicates the
client is experiencing an adverse reaction?
1. "My stools have been dark in color."
2. "My nose is stuffed up."
3. "Bright lights give me a headache."
4. "I have to get up a lot at night to urinate."
Answer: 1
Explanation:
1. Aspirin may result in ulceration and bleeding, which is characterized by stools that are
darker than normal.
2. There isn't any relationship between aspirin and nasal congestion.
3. Aspirin does not cause photophobia.
4. There isn't any relationship between aspirin and nocturnal renal output.
Page Ref: 234-235
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
GRProcess:
ADESMAssessment
ORE.COM
Nursing/Integrated Concepts: Nursing
Learning Outcome: 18-9 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples, and explain the mechanisms of drug action, primary actions, and
important adverse effects.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
11
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12) For which client is acetaminophen (Tylenol) contraindicated?
1. A 2-year-old with a high fever
2. A 65-year-old with osteoarthritis
3. A 19-year-old with a bladder infection
4. A 55-year old who drinks alcohol
Answer: 4
Explanation:
1. Acetaminophen (Tylenol) is the prescription of choice for a child with a fever.
2. Acetaminophen (Tylenol) is not contraindicated for a client with osteoarthritis, but
aspirin is a more effective prescription.
3. Acetaminophen (Tylenol) is not contraindicated with a bladder infection.
4. Acetaminophen (Tylenol) is hepatotoxic and may cause problems in clients who
consume alcohol.
Page Ref: 235
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal
education into nursing practice. | NLN Competencies: Knowledge and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts:
Nursing Process: Planning
Learning Outcome: 18-10 Categorize drugs used in the treatment of pain based on their
GRADESMORE.COM
classification and mechanism of action.
MNL Learning Outcome: 18.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for pain and migraines.
12
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13) Which instruction should the nurse include for a client prescribed acetaminophen (Tylenol)?
1. "Check your gums for bleeding when taking acetaminophen (Tylenol)."
2. "Do not take any narcotics with acetaminophen (Tylenol)."
3. "You may experience diarrhea while taking acetaminophen (Tylenol)."
4. "Acetaminophen (Tylenol) can cause your mouth to become dry."
Answer: 4
Explanation:
1. Bleeding in the gums is an effect of aspirin, not acetaminophen (Tylenol).
2. There is no contraindication between acetaminophen (Tylenol) and narcotics; they are
often combined for more effective pain relief.
3. Constipation is a more common effect of acetaminophen (Tylenol).
4. Acetaminophen (Tylenol) can cause the mouth to become dry.
Page Ref: 235
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal
education into nursing practice. | NLN Competencies: Knowledge and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts:
Nursing Process: Planning
Learning Outcome: 18-10 Categorize drugs used in the treatment of pain based on their
classification and mechanism of action.
RAD
ESMOprocess
RE.COinMthe care of patients receiving
MNL Learning Outcome: 18.4 UtilizeGthe
nursing
pharmacotherapy for pain and migraines.
13
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14) Which information should the nurse include in the education for a client prescribed
sumatriptan (Imitrex)?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Do not drive until the effects of the medication are known.
2. Avoid pseudoephedrine (Sudafed) while taking the prescription.
3. Take the prescription with a meal high in protein.
4. Take the prescription with food.
5. Increase fluid intake.
Answer: 1, 2
Explanation:
1. Drowsiness and dizziness can occur with sumatriptan (Imitrex).
2. Pseudoephedrine (Sudafed) is a vasoconstrictor as is sumatriptan (Imitrex). The
combination could dramatically increase the patient's blood pressure.
3. Sumatriptan (Imitrex) does not need to be taken with protein.
4. Sumatriptan (Imitrex) does not need to be taken with food.
5. It is not necessary to increase fluid intake.
Page Ref: 240
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that
GRADEspirituality,
SMORE.C
OM preferences, and health literacy
reflects developmental stage, age, culture,
patient
considerations to foster patient engagement in their care. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 18-8 Compare the pharmacotherapeutic approaches of preventing
migraines with those of aborting migraines.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
14
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15) A client tells the nurse he or she has a dull, aching pain in his or her lower back. Which type
of pain should the nurse recognize the client is experiencing?
1. Acute
2. Somatic
3. Neuropathic
4. Visceral
Answer: 4
Explanation:
1. There is not enough information provided to determine if this pain is acute.
2. Somatic pain is sharp and localized.
3. The nurse cannot determine if this pain is neuropathic in origin.
4. Visceral pain is defined as a dull, throbbing, or aching pain.
Page Ref: 224
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Basic Care and Comfort
Standards: QSEN Competencies: I.B.4 Assess presence and extent of pain and suffering. | AACN
Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral,
psychological, spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate approaches. | NLN
Competencies: Knowledge and Science: Relationships between knowledge/science and quality
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18-1 Relate the importance of pain assessment to effective
GRADESMORE.COM
pharmacotherapy.
MNL Learning Outcome: 18.1 Recognize the assessment, classification, and pathophysiology of
pain, including the etiologies and characteristics of migraines.
15
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16) Which statement should the educator use to describe to the nurse the neural mechanism
responsible for signaling sharp pain?
1. "Once the pain impulse reaches the spinal cord, the neurotransmitters speed up the
signal for sharp pain."
2. "Alpha fibers are wrapped in myelin that speeds up the signal resulting in the sensation
of sharp pain."
3. "Both the alpha and beta fibers in the spinal cord work together to signal sharp pain."
4. "Unmyelinated fibers carry the pain signal faster resulting in the feeling of sharp pain."
Answer: 2
Explanation:
1. The nerve impulse signaling the pain is sent to the spinal cord along two types of
sensory neurons, called Aδ and C fibers. Aδ fibers are thinly wrapped in myelin, a fatty
substance that speeds up nerve transmission. They signal sharp, well-defined pain.
2. The nerve impulse signaling the pain is sent to the spinal cord along two types of
sensory neurons, called Aδ and C fibers. Aδ fibers are thinly wrapped in myelin, a fatty
substance that speeds up nerve transmission. They signal sharp, well-defined pain.
3. The nerve impulse signaling the pain is sent to the spinal cord along two types of
sensory neurons, called Aδ and C fibers. Aδ fibers are thinly wrapped in myelin, a fatty
substance that speeds up nerve transmission. They signal sharp, well-defined pain.
4. C fibers are unmyelinated; thus, they carry nerve impulses more slowly and conduct
dull, poorly localized pain.
Page Ref: 224
GRADESMORE.COM
Cognitive Level: Remembering
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal
education into nursing practice. | NLN Competencies: Knowledge and Science: Integration of
knowledge from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Evaluation
Learning Outcome: 18-2 Explain the neural mechanisms at the level of the spinal cord
responsible for pain.
MNL Learning Outcome: 18.1 Recognize the assessment, classification, and pathophysiology of
pain, including the etiologies and characteristics of migraines.
16
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17) The educator is discussing pain transmission with the nurse. Which statement made by the
nurse indicates an understanding of the process?
1. "The transmission process begins with the activation of substance P."
2. "The transmission process begins with the A and C fibers."
3. "The transmission process begins with the nociceptors."
4. "The transmission process begins with the sensory neurons in the spinal cord."
Answer: 3
Explanation:
1. Substance P is thought to be responsible for continuing the pain message after the
signals reach the spinal cord. Substance P also controls whether the pain signals will
continue to the brain.
2. The nerve impulse signaling the pain is sent to the spinal cord along two types of
sensory neurons, called Aδ and C fibers after the nociceptors are stimulated.
3. The transmission process begins with the nociceptors.
4. The nociceptors send the nerve impulse signaling pain to the spinal cord along the
sensory neurons Aδ and C.
Page Ref: 224
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal
education into nursing practice. | NLN Competencies: Knowledge and Science: Integration of
GRADESM|ONursing/Integrated
RE.COM
knowledge from nursing and other disciplines.
Concepts: Nursing Process:
Implementation
Learning Outcome: 18-2 Explain the neural mechanisms at the level of the spinal cord
responsible for pain.
MNL Learning Outcome: 18.1 Recognize the assessment, classification, and pathophysiology of
pain, including the etiologies and characteristics of migraines.
17
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18) The educator has discussed the types of opioid receptors with a nurse. Which statement
made by the nurse indicates an understanding of the information?
1. "The sigma and kappa receptors have been traditionally targeted for pain
management."
2. "Drugs that block opioid receptors inhibit the pain impulse."
3. "Opioid agonists will activate mu and kappa receptors, producing an analgesic effect."
4. "Opioids exert their actions by interacting with three different receptors."
Answer: 3
Explanation:
1. From the perspective of pain management, the mu receptors and kappa receptors have
been the ones traditionally targeted.
2. Opioid antagonists do not inhibit the pain impulse.
3. Opioid agonists stimulate mu and kappa receptors, resulting in a variety of effects,
including analgesia.
4. There are four major types of opioid receptors.
Page Ref: 227
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.7 Initiate effective treatments to relieve pain and suffering
in light of patient values, preferences and expressed needs. | AACN Essential Competencies: I.1
Integrate theories and concepts from liberal education into nursing practice. | NLN
Competencies: Knowledge and Science: Relationships between knowledge/science and quality
GRADEConcepts:
SMORE.Nursing
COM Process: Implementation
and safe patient care. | Nursing/Integrated
Learning Outcome: 18-5 Compare and contrast the types of opioid receptors and their
importance in effective management of pain.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
18
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19) A client with an oxycodone overdose has a respiratory rate of 8 and is difficult to arouse.
Which prescribed treatment should the nurse anticipate administering?
1. Administering activated charcoal
2. Administering an opioid agonist
3. Administering opioid antagonist
4. Preparing for intubation and mechanical ventilation
Answer: 3
Explanation:
1. Administering activated charcoal is not indicated when the client is nonresponsive.
2. Administering an opioid agonist would worsen the situation. Opioid agonists are used to
relieve pain.
3. Opioid antagonists such as naloxone (Narcan) block opioid activity.
4. Intubation and mechanical ventilation may be necessary, but reversing the effect of the
opioid narcotic is a priority.
Page Ref: 231
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.7 Initiate effective treatments to relieve pain and suffering
in light of patient values, preferences and expressed needs. | AACN Essential Competencies:
IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth
and development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
GR
ADESMRelationships
ORE.COM between knowledge/science and
| NLN Competencies: Knowledge and
Science:
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 18-6 Explain the role of opioid antagonists in the diagnosis and treatment
of acute opioid toxicity.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
19
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20) The nurse has administered naloxone (Narcan) intravenously to a client receiving morphine
experiencing respiratory depression. Which should the nurse anticipate?
1. A peak effect of 10 to 20 minutes
2. An onset of action of 1 to 2 minutes
3. An onset of action of 2 to 5 minutes
4. A peak effect of 5 to 10 minutes
Answer: 2
Explanation:
1. The peak effect of naloxone is 5 to 15 minutes.
2. The onset of action after administering naloxone intravenously is 1 to 2 minutes.
3. The onset of action after administering naloxone subcutaneously is 2 to 5 minutes.
4. The peak effect of naloxone is 5 to 15 minutes.
Page Ref: 231
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Assessment
RAdrug
DESclasses
MORE.listed
COMin Drugs at a Glance, know
Learning Outcome: 18-9 For each ofGthe
representative drug examples, and explain the mechanisms of drug action, primary actions, and
important adverse effects.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
20
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21) The nurse has provided education for a client prescribed opioid treatment. Which
statement made by the client indicates an understanding of the education?
1. "I will make sure I take stool softeners."
2. "I will use a laxative if I need to."
3. "I will increase my fluid intake."
4. "I will increase my physical activity."
Answer: 3
Explanation:
1. The client should increase his or her fluid intake to 2 L per day and to increase their
dietary fiber. If the client experiences severe constipation, he or she should be
instructed to contact their healthcare provider to discuss the use of stool softeners and
laxatives.
2. The client should increase his or her fluid intake to 2 L per day and to increase their
dietary fiber. If the client experiences severe constipation, he or she should be
instructed to contact their healthcare provider to discuss the use of stool softeners and
laxatives.
3. The client should increase his or her fluid intake to 2 L per day and to increase their
dietary fiber. If the client experiences severe constipation, he or she should be
instructed to contact their healthcare provider to discuss the use of stool softeners and
laxatives.
4. The client should increase his or her fluid intake to 2 L per day and to increase their
dietary fiber. Increasing physical activity while taking an opioid places the client at risk
GRADESMORE.COM
for injury.
Page Ref: 232
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: I.1 Integrate theories and concepts from liberal
education into nursing practice. | NLN Competencies: Knowledge and Science: Relationships
between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts:
Nursing Process: Assessment
Learning Outcome: 18-11 Use the nursing process to care for patients receiving
pharmacotherapy for pain and for migraines.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
21
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22) The nurse has administered sumatriptan (Imitrex) to a client. Which effects should the
nurse monitor the patient for?
1. Hypotension
2. Urinary retention
3. Muscle weakness
4. Decreased level of consciousness
Answer: 4
Explanation:
1. Sumatriptan has a systemic vasoconstrictor activity that may cause hypertension.
2. Sumatriptan is not associated with urinary retention.
3. Muscle weakness is not directly associated with the administration of sumatriptan.
4. Sumatriptan selectively reduces carotid arterial blood flow which may result in a change
in the level of consciousness and seizures.
Page Ref: 240
Cognitive Level: Understanding
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that
reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy
considerations to foster patient engagement in their care. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Evaluation
GRpharmacotherapeutic
ADESMORE.COM approaches of preventing
Learning Outcome: 18-8 Compare the
migraines with those of aborting migraines.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
22
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23) For which client should the nurse recognize a prescription for sumatriptan (Imitrex) may be
beneficial?
1. A 73-year-old with angina pectoris
2. A 36-year-old female with preeclampsia
3. A 45-year-old diabetic male
4. A 27-year-old asthmatic male
Answer: 4
Explanation:
1. Sumatriptan is contraindicated in patients with angina.
2. Sumatriptan is a Pregnancy Category C drug.
3. Sumatriptan is contraindicated in patients with diabetes.
4. Sumatriptan may be beneficial for a client with asthma.
Page Ref: 240
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care. |
Nursing/Integrated Concepts: Nursing Process: Planning
RAdrug
DESclasses
MORE.listed
COMin Drugs at a Glance, know
Learning Outcome: 18-9 For each ofGthe
representative drug examples, and explain the mechanisms of drug action, primary actions, and
important adverse effects.
MNL Learning Outcome: 18.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for pain and migraines.
23
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24) Which statement is accurate when prescribing acetylsalicylic acid (aspirin) for the treatment
of pain?
1. High doses are necessary (1 g) to achieve anticoagulant effects.
2. Enteric-coated capsules are available to reduce GI side effects.
3. Increase consumption of herbs such as garlic and ginger to potentiate the antiinflammatory effects.
4. Low doses (325 mg) can significantly reduce inflammation.
Answer: 2
Explanation:
1. Aspirin can cause bleeding in low doses.
2. Enteric-coated capsules can help prevent bleeding.
3. Avoiding certain herbs such as ginger and garlic should be advised to reduce the risk of
bleeding.
4. The anti-inflammatory effects of aspirin occur in high doses.
Page Ref: 234, 237
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
GRADEand
SMquality
ORE.and
COMsafe patient care. |
Relationships between knowledge/science
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 18-9 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples, and explain the mechanisms of drug action, primary actions, and
important adverse effects.
MNL Learning Outcome: 18.2 Relate aspects of pharmacotherapy to the management of pain
and migraines.
24
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25) Which selective serotonin reuptake inhibitors (SSRIs) are prescribed as adjuvant analgesics?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Desipramine (Norpramin)
2. Fluvoxamine (Luvox)
3. Imipramine (Tofranil)
4. Sertraline (Zoloft)
5. Fluoxetine (Prozac)
Answer: 2, 3, 4
Explanation:
1. Desipramine is a tricyclic antidepressant.
2. Fluvoxamine is an SSRI that can be prescribed as an adjuvant analgesic.
3. Imipramine is a tricyclic antidepressant.
4. Sertraline is an SSRI that can be prescribed as an adjuvant analgesic.
5. Fluoxetine is an SSRI that can be prescribed as an adjuvant analgesic.
Page Ref: 238
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Basic Care and Comfort
Standards: QSEN Competencies: I.B.4 Assess presence and extent of pain and suffering. | AACN
Essential Competencies: IX.1 Conduct comprehensive and focused physical, behavioral,
psychological, spiritual, socioeconomic, and environmental assessments of health and illness
parameters in patients, using developmentally and culturally appropriate approaches. | NLN
GRARelationships
DESMORE.between
COM knowledge/science and quality
Competencies: Knowledge and Science:
and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18-1 Relate the importance of pain assessment to effective
pharmacotherapy.
MNL Learning Outcome: 18.2 Relate aspects of pharmacotherapy to the management of pain
and migraines.
25
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26) A parent asks the nurse why his or her 8-year-old child cannot have cough syrup with
codeine to help the child rest. Prior to responding to the parent, which should the nurse
understand?
1. The child can become addicted to the cough syrup.
2. Codeine is contraindicated in children.
3. Children are more likely to have an allergic reaction to the codeine.
4. Codeine will exacerbate the child's condition.
Answer: 2
Explanation:
1. The child will not become addicted to the cough syrup.
2. Codeine is contraindicated in children below 12 years of age.
3. Children are not more likely to have an allergic reaction to the codeine.
4. Codeine will not exacerbate the child's illness.
Page Ref: 228
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.7 Initiate effective treatments to relieve pain and suffering
in light of patient values, preferences and expressed needs. | AACN Essential Competencies:
IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth
and development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
GRADESMORConcepts:
E.COM Nursing Process: Planning
quality and safe patient care. | Nursing/Integrated
Learning Outcome: 18-11 Use the nursing process to care for patients receiving
pharmacotherapy for pain and for migraines.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
26
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27) The nurse is preparing to review the records of a client with cancer prescribed buccal
fentanyl. Which findings should the nurse anticipate?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. The client is already prescribed fentanyl.
2. The client is opioid naïve.
3. The client is experiencing breakthrough pain.
4. The client has a history of migraine headaches.
5. The client is being weaned off of intravenous fentanyl.
Answer: 1, 3
Explanation:
1. Buccal fentanyl is used only for clients who are already receiving fentanyl.
2. The opioid naïve client would not be started on buccal fentanyl.
3. Buccal fentanyl is used for breakthrough cancer pain.
4. Buccal fentanyl is not used for migraine headaches.
5. Buccal fentanyl is not used to wean a client off of intravenous fentanyl.
Page Ref: 229
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.7 Initiate effective treatments to relieve pain and suffering
in light of patient values, preferences and expressed needs. | AACN Essential Competencies:
IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth
RADESMOREmedical
.COM management, and nursing
and development, pathophysiology,Gpharmacology,
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 18-11 Use the nursing process to care for patients receiving
pharmacotherapy for pain and for migraines.
MNL Learning Outcome: 18.2 Relate aspects of pharmacotherapy to the management of pain
and migraines.
27
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28) Which information should the nurse include in the teaching for a client with a prescription
for migraines?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Use the medication at the first sign of migraine.
2. Overusing this medication may result in rebound headaches.
3. Instill the spray into one nostril only.
4. Increase dietary intake of tyramine-containing foods.
5. Pain relief will not begin for up to an hour after administration.
Answer: 1, 2, 3
Explanation:
1. In order to be most effective, these prescriptions should be used at the first sign of
migraine.
2. Overuse of these prescriptions may result in rebound headache.
3. Proper administration of nasal prescriptions includes instillation into one nostril only.
4. The client should avoid tyramine-containing foods.
5. Pain relief should begin within several minutes of use.
Page Ref: 241-242
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.7 Initiate effective treatments to relieve pain and suffering
in light of patient values, preferences and expressed needs. | AACN Essential Competencies:
GRADcare
ESM
ORreflects
E.COMan understanding of human growth
IX.3 Implement holistic, patient-centered
that
and development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 18-11 Use the nursing process to care for patients receiving
pharmacotherapy for pain and for migraines.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
28
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29) A client with terminal cancer has a respiratory rate of 10 and requests a dose of prescribed
morphine. Which action should the nurse take?
1. Hold the dose until the respirations are above 12.
2. Administer the dose of morphine.
3. Implement nonpharmacological interventions.
4. Administer the prescribed NSAID.
Answer: 2
Explanation:
1. For terminal cancer pain, morphine is not standardly withheld for a respiratory rate
below 12.
2. The dose of morphine will be administered to the patient unless specified otherwise by
the healthcare provider.
3. For terminal cancer pain, the morphine may not be held with a respiratory rate below
12. Nonpharmacological interventions may also be implemented in conjunction with the
morphine to help manage the pain.
4. NSAIDs are not used to relieve pain related to cancer. NSAIDs have antipyretic and antiinflammatory effects. Nonpharmacological interventions may also be implemented in
conjunction with the morphine to help manage the pain.
Page Ref: 232
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.7 Initiate effective treatments to relieve pain and suffering
GR
ADexpressed
ESMOREneeds.
.COM| AACN Essential Competencies:
in light of patient values, preferences
and
IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth
and development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Relationships between knowledge/science and
quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 18-11 Use the nursing process to care for patients receiving
pharmacotherapy for pain and for migraines.
MNL Learning Outcome: 18.4 Utilize the nursing process in the care of patients receiving
pharmacotherapy for pain and migraines.
29
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WWW.GRADESMORE.COM
30) Which prescription should the nurse anticipate to be included in the treatment of a client
experiencing mild migraine headaches?
1. Ibuprofen
2. Sumatriptan (Imitrex)
3. Ergotamine (Ergostat)
4. Amitriptyline (Elavil)
Answer: 1
Explanation:
1. NSAIDs are often effective for mild migraines.
2. Sumatriptan is a serotonin receptor agonist and is usually used only for moderate to
severe migraines.
3. Ergotamine is an ergot alkaloid that is a serotonin receptor agonist. This prescription is
used only with moderate to severe migraines.
4. Amitriptyline is used to prevent migraines, not to reduce pain once they occur.
Page Ref: 238
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: IX.7 Provide appropriate patient teaching that
reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy
considerations to foster patient engagement in their care. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. |
GRProcess:
ADESMPlanning
ORE.COM
Nursing/Integrated Concepts: Nursing
Learning Outcome: 18-8 Compare the pharmacotherapeutic approaches of preventing
migraines with those of aborting migraines.
MNL Learning Outcome: 18.3 Examine the pharmacologic profiles and considerations of
prototype drugs prescribed for pain and migraines.
30
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Pharmacology for Nurses, 6e (Adams)
Chapter 19 Drugs for Local and General Anesthesia
1) The educator is preparing to discuss the classifications of local anesthetics. Which should
the educator include when discussing amides?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. Amides have fewer side effects than esters.
2. Amides block potassium entry into the cell.
3. Amides are similar in structure to cocaine.
4. Amides tend to last longer than esters.
5. Amides block calcium entry into the cell.
Answer: 1, 4
Explanation:
1. Amides have largely replaced esters because they produce fewer side effects.
2. Amides block sodium, not potassium, entry into the cell.
3. Cocaine is a natural ester, not an amide.
4. Amides have largely replaced esters because they generally have a longer duration of
action.
5. Amides block sodium, not calcium, entry into the cell.
Page Ref: 248
Cognitive Level: Applying
GRADESMORE.COM
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 19-2 Describe differences between the two major chemical classes of local
anesthetics.
MNL Learning Outcome: 19.1 Relate the types of anesthesia, purposes and stages of general
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
1
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2) The nurse is preparing to assess a client in Stage 3 of general anesthesia. Which assessment
findings should the nurse anticipate?
1. Irregular heart and respiratory rate
2. Loss of general sensation during consciousness
3. Temporary smooth muscle paralysis
4. Respiratory stabilization and slow eye movements
Answer: 4
Explanation:
1. The heart rate and breathing become irregular in Stage 2.
2. Loss of general sensation while still conscious occurs in Stage 1.
3. Paralysis of the skeletal muscle occurs in Stage 3.
4. Stage 3 is characterized by relaxation of the skeletal muscles, stabilization of the
cardiovascular and breathing activities, and decreased eye movements are slow.
Page Ref: 250
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Assessment
Learning Outcome: 19-6 Identify the four stages of general anesthesia.
RAD
ESMofOR
E.COM purposes and stages of general
MNL Learning Outcome: 19.1 RelateGthe
types
anesthesia,
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
2
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3) The nurse has provided education for a client prescribed a topical anesthetic. Which
statements made by the client indicate an understanding of the information?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select
all that apply.
1. "This lotion should only be used on small areas of skin."
2. "I will wear gloves when I apply the lotion."
3. "This lotion will work well on cuts too."
4. "I will wash my hands before touching my eyes."
5. "I will be mindful of the expiration date on the prescription."
Answer: 1, 4, 5
Explanation:
1. Injury may result if topical anesthetics are applied to large areas of skin.
2. The nurse should wear gloves when applying topical anesthetics; this is not applicable to
the client.
3. Topical anesthetics should be applied to intact skin only.
4. Topical anesthetics must be kept away from the eyes unless they are ophthalmic
preparations.
5. Prescriptions should not be used past the expiration date.
Page Ref: 251-252
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
GRADEIX.7
SMO
RE.Cappropriate
OM
processes. | AACN Essential Competencies:
Provide
patient teaching that
reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy
considerations to foster patient engagement in their care. | NLN Competencies: Knowledge and
Science: Integration of knowledge from nursing and other disciplines. | Nursing/Integrated
Concepts: Nursing Process: Evaluation
Learning Outcome: 19-9 Use the nursing process to care for patients who are receiving
pharmacotherapy with anesthetic agents.
MNL Learning Outcome: 19.1 Relate the types of anesthesia, purposes and stages of general
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
3
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4) Which should the nurse monitor the client for who has received a volatile liquid inhalation
anesthesia?
1. Hypertension
2. Pneumonia
3. Malignant hyperthermia
4. Increased intracranial pressure
Answer: 3
Explanation:
1. Hypotension is more likely to occur than hypertension.
2. Pneumonia specifically is not an immediate complication.
3. Malignant hyperthermia is rare, but it is fatal if not treated immediately.
4. Increased intracranial pressure is not a common adverse effect but can be treated.
Page Ref: 255
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Assessment
Learning Outcome: 19-4 Identify the actions of general anesthetics on the central nervous
system.
RAD
ESMofOR
E.COM purposes and stages of general
MNL Learning Outcome: 19.1 RelateGthe
types
anesthesia,
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
4
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5) Which is the priority nursing assessment for the client that has received succinylcholine
(Anectine)?
1. Spontaneous bleeding
2. Respiratory paralysis
3. Anaphylactic shock
4. Delirium
Answer: 2
Explanation:
1. Spontaneous bleeding is not a complication related to the administration of
succinylcholine.
2. Succinylcholine (Anectine) is a neuromuscular blocker that paralyzes muscles, including
those of respiration.
3. Allergic reactions, such as anaphylactic shock, are uncommon with the use of
succinylcholine.
4. Delirium is not related to the use of succinylcholine.
Page Ref: 259
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
GR|ANLN
DESCompetencies:
MORE.COM Knowledge and Science:
lifespan, and in all healthcare settings.
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Planning
Learning Outcome: 19-7 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples, and explain their mechanisms of action, primary actions, and
important adverse effects.
MNL Learning Outcome: 19.1 Relate the types of anesthesia, purposes and stages of general
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
5
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6) The educator is preparing to discuss the actions of succinylcholine (Anectine) with a nurse.
Which information should the educator include?
1. "It causes the patient to rapidly lose consciousness."
2. "It increases cardiac output by raising the heart rate."
3. "It interferes with impulse transmission, resulting in total anesthesia from the pain of
surgery."
4. "It reduces the amount of general anesthetic needed for procedures."
Answer: 4
Explanation:
1. The patient does not lose consciousness and is wide awake.
2. Heart rate is not increased.
3. The changes to impulse transmission do not result in pain control or anesthesia.
4. Succinylcholine (Anectine) does decrease the amount of general anesthetic needed.
Page Ref: 259
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
medical management, and nursing management across the health-illness continuum, across
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Implementation GRADESMORE.COM
Learning Outcome: 19-7 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples, and explain their mechanisms of action, primary actions, and
important adverse effects.
MNL Learning Outcome: 19.1 Relate the types of anesthesia, purposes and stages of general
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
6
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7) Which should the nurse understand is the purpose of the epinephrine added to local
anesthetics?
1. Extension of the duration of the action of the local anesthetic
2. Decrease the amount of pain experienced
3. Promotion of patient relaxation
4. Promotion of blood flow to the area
Answer: 1
Explanation:
1. Epinephrine is often added to local anesthetics to constrict blood vessels and extend the
duration of action of the drug.
2. Epinephrine does not decrease pain.
3. Epinephrine does not promote relaxation in the patient.
4. The use of epinephrine results in vasoconstriction.
Page Ref: 247-249
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 19-3 Explain why epinephrine and sodium bicarbonate are sometimes
included in local anesthetic cartridges.
RAD
ESMofOR
E.COM purposes and stages of general
MNL Learning Outcome: 19.1 RelateGthe
types
anesthesia,
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
7
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8) For which client receiving an inhalation anesthesia should the nurse be most concerned?
1. A 15-year-old with diabetes mellitus
2. A 6-year-old with no chronic health problems
3. A 79-year-old with arteriosclerosis
4. A 55-year-old with a serious neck injury
Answer: 3
Explanation:
1. Adolescents are not at a high risk for an adverse reaction to inhalation anesthesia.
2. Children are more sensitive to inhalation anesthesia than adults, but a 6-year-old child
that is healthy is not at high risk for an adverse reaction.
3. Older adults are more sensitive to the effects of inhalation anesthesia. Cardiovascular
diseases such as arteriosclerosis is an additional risk factor.
4. Adults are not at a high risk for an adverse reaction to inhalation anesthesia. The use of
this type of anesthesia is not contraindicated for the patient with a neck injury.
Page Ref: 254
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
GR
ADESMIntegration
ORE.COof
M knowledge from nursing and other
| NLN Competencies: Knowledge and
Science:
disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 19-9 Use the nursing process to care for patients who are receiving
pharmacotherapy with anesthetic agents.
MNL Learning Outcome: 19.1 Relate the types of anesthesia, purposes and stages of general
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
8
Copyright © 2020 Pearson Education, Inc.
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WWW.GRADESMORE.COM
9) The nurse is caring for a client in Stage 2 of general anesthesia. Which is a priority nursing
intervention?
1. Assist the anesthesiologist in repositioning the client.
2. Complete the surgical scrub.
3. Keep the environment quiet and calm.
4. Insert the indwelling urinary catheter.
Answer: 3
Explanation:
1. It is not appropriate to reposition the client during Stage 2 of anesthesia.
2. It is not appropriate to complete the surgical scrub during Stage 2 of anesthesia.
3. The client is hyperexcitable in Stage 2 of anesthesia so the environment must be kept
quiet to minimize stimulation.
4. It is not appropriate to insert an indwelling urinary catheter during Stage 2 of
anesthesia.
Page Ref: 250
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
RADstages
ESMOofRE
.COManesthesia.
Learning Outcome: 19-6 Identify theGfour
general
MNL Learning Outcome: 19.1 Relate the types of anesthesia, purposes and stages of general
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
9
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
10) A pregnant client requiring a skin biopsy expresses concern about the anesthesia that will
be administered. Which response should the nurse provide?
1. "You will most likely have an epidural so there is no risk to your baby."
2. "There are newer general anesthetics available that are safe for your baby."
3. "You will most likely receive local anesthesia so this will not affect your baby."
4. "Inhalation anesthetics are safe because they remain in your lungs and will not affect
the baby."
Answer: 3
Explanation:
1. Epidural anesthesia is not indicated in this situation.
2. There are not any general anesthetics that are considered safe, and this client will most
likely have local anesthesia.
3. Local anesthetics are most commonly used to remove lesions. They stay in the
treatment area and do not impact the baby.
4. Inhalation anesthesia is not indicated in this situation, and even though it remains
primarily in the lungs, it can affect the baby.
Page Ref: 247
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in
care. | AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that
reflects an understanding of human growth and development, pathophysiology, pharmacology,
GRADESMOacross
RE.Cthe
OMhealth-illness continuum, across
medical management, and nursing management
lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and Science:
Integration of knowledge from nursing and other disciplines. | Nursing/Integrated Concepts:
Nursing Process: Implementation
Learning Outcome: 19-7 For each of the drug classes listed in Drugs at a Glance, know
representative drug examples, and explain their mechanisms of action, primary actions, and
important adverse effects.
MNL Learning Outcome: 19.1 Relate the types of anesthesia, purposes and stages of general
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
10
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
11) The nurse is preparing education for a client who will receive anesthesia for a surgical
procedure. Which statement should the nurse include in the teaching?
1. "If the inhaled agent is ineffective, an intravenous agent will be administered."
2. "An inhaled agent is used to induce sleep, followed by an intravenous agent for
relaxation."
3. "Usually all that is required is an intravenous agent to induce sleep."
4. "An intravenous agent will be initially administered to induce sleep followed by an
inhaled agent."
Answer: 4
Explanation:
1. Inhaled agents are administered after intravenous agents to maintain anesthesia.
2. An intravenous agent is used to induce sleep.
3. Clients require more anesthesia for general surgery than just intravenous anesthesia.
4. Intravenous agents are usually administered initially because they act within a few
seconds. After the client loses consciousness, inhaled agents are administered to
maintain the effects of the anesthesia.
Page Ref: 250
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
RADESMORE.CO
M
from nursing and other disciplines. |GNursing/Integrated
Concepts:
Nursing Process:
Implementation
Learning Outcome: 19-5 Compare and contrast the two primary ways that general anesthesia
may be induced.
MNL Learning Outcome: 19.1 Relate the types of anesthesia, purposes and stages of general
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
11
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WWW.GRADESMORE.COM
12) The nurse is preparing to assist a healthcare provider suture a laceration on a 2-year-old
child. Prior to the procedure, which initial intervention should the nurse anticipate?
1. Wrapping the child in a blanket for restraint and safety during suturing
2. Applying a topical anesthetic prior to administering a local anesthetic with a needle
3. Administering a small dose of lorazepam (Ativan)
4. Requesting the parents to leave the room prior to the procedure
Answer: 2
Explanation:
1. Restraining the child is unnecessary.
2. The topical anesthetic will provide a decreased sensation in pain to the area that will
require a local anesthetic prior to the repair of the laceration.
3. Lorazepam (Ativan) is not to be administered to 2-year-old child.
4. The presence of parents usually decreases a child's anxiety and increases cooperation.
Page Ref: 247
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 19-8 Categorize drugs used before, during, and after anesthesia based on
their classification and drug action. GRADESMORE.COM
MNL Learning Outcome: 19.1 Relate the types of anesthesia, purposes and stages of general
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
12
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GRADESMORE.COM
WWW.GRADESMORE.COM
13) A client with gastroesophageal reflux disease receives lidocaine viscous prior to an
endoscopy. Which is the nurse's priority assessment after the procedure?
1. Assess for a return of the gag reflex.
2. Assess for nausea and vomiting.
3. Assess for any damage to the teeth or gums.
4. Assess for a headache.
Answer: 1
Explanation:
1. The gag reflex must be assessed before giving the client anything to eat or drink.
2. Nausea and vomiting are not common after an endoscopy.
3. Damage to the teeth or gums is rare following an endoscopy.
4. Headaches are not common after an endoscopy.
Page Ref: 249, 252
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and
respect for the diversity of human experience. | AACN Essential Competencies: IX.3 Implement
holistic, patient-centered care that reflects an understanding of human growth and
development, pathophysiology, pharmacology, medical management, and nursing
management across the health-illness continuum, across lifespan, and in all healthcare settings.
| NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other
disciplines. | Nursing/Integrated Concepts: Nursing Process: Assessment
GRADprocess
ESMOto
REcare
.COfor
M patients who are receiving
Learning Outcome: 19-9 Use the nursing
pharmacotherapy with anesthetic agents.
MNL Learning Outcome: 19.1 Relate the types of anesthesia, purposes and stages of general
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
13
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
14) Which type of local anesthesia should the nurse anticipate will be administered to a
laboring client?
1. Nerve block
2. Topical
3. Infiltration
4. Epidural
Answer: 4
Explanation:
1. A nerve block is not a form of anesthesia commonly used for women during labor and
delivery.
2. Topical anesthesia is not used to relieve the discomfort of a laboring patient.
3. Infiltration is not a form of anesthesia used for women during labor and delivery.
4. Anesthesia via the epidural route is the most common for women during labor and
delivery.
Page Ref: 247
Cognitive Level: Remembering
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
from nursing and other disciplines. | Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 19-1 Compare and contrast the five major clinical techniques for
GRADESMORE.COM
administering local anesthetics.
MNL Learning Outcome: 19.1 Relate the types of anesthesia, purposes and stages of general
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
14
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
15) The nurse asks the educator how local anesthetics work. Which response should the
educator provide the nurse?
1. Enhancing the influx of calcium into the cell
2. Occupy potassium receptors
3. Increase nerve impulse transmission
4. Block the sodium channels
Answer: 4
Explanation:
1. Local anesthetics work by blocking the sodium channels resulting in diminished motor
and sensory impulse transmission.
2. Local anesthetics work by blocking the sodium channels resulting in diminished motor
and sensory impulse transmission.
3. Local anesthetics work by blocking the sodium channels resulting in diminished motor
and sensory impulse transmission.
4. Local anesthetics work by blocking the sodium channels resulting in diminished motor
and sensory impulse transmission.
Page Ref: 246
Cognitive Level: Remembering
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and
processes. | AACN Essential Competencies: III.1 Explain the interrelationships among theory,
practice, and research. | NLN Competencies: Knowledge and Science: Integration of knowledge
RADESMORE.CO
M
from nursing and other disciplines. |GNursing/Integrated
Concepts:
Nursing Process: Planning
Learning Outcome: 19-8 Categorize drugs used before, during, and after anesthesia based on
their classification and drug action.
MNL Learning Outcome: 19.1 Relate the types of anesthesia, purposes and stages of general
anesthesia, and the drug classes to produce general and local anesthesia to patient comfort.
15
Copyright © 2020 Pearson Education, Inc.
GRADESMORE.COM
WWW.GRADESMORE.COM
16) Which local anesthetic agent should the nurse recognize has the lowest rate of adverse
effects?
1. Tetracaine (Pontocaine)
2. Procaine (Novocain)
3. Lidocaine (Xylocaine)
4. Chloroprocaine (Nesacaine)
Answer: 3
Explanation:
1. Tetracaine (Pontocaine) is classified as an ester, which has more side effects than an
amide.
2. Procaine (Novocain) is classified as an ester, which has more side effects than an amide.
3. Lidocaine is classified as an amide, and amides produce fewer side effects than do
esters.
4. Chloroprocaine (Nesacaine) is classified as an ester, which has more side effects than an
amide.
Page Ref: 249
Cognitive Level: Understanding
Client Need/Sub: Physiologica