Chapter 01: The Nursing Process and Patient-Centered Care
McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 11th EditionMULTIPLE CHOICE
- A 5-year-old child with type 1 diabetes mellitus has had repeated hospitalizations for episodes ofhyperglycemia. The parents tell the nurse that they can’t keep track of everything that has to bedone to care for their child. The nurse reviews medications, diet, and symptom management withthe parents and draws up a daily checklist for the family to use. These activities are completed inwhich step of the nursing process?
a. Recognizing cues (assessment)
b. Analyze cues & prioritize hypothesis (analysis)
c. Generate solutions (planning)
d. Take action (nursing interventions)
ANS: D
Taking action through nursing interventions is where the nurse provides patient health teaching,
drug administration, patient care, and other interventions necessary to assist the patient inaccomplishing expected outcomes.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Management of Client Care - All of the following would be considered subjective data, EXCEPT:
a. Patient-reported health history
b. Patient-reported signs and symptoms of their illness
c. Financial barriers reported by the patient’s caregiver
d. Vital signs obtained from the medical record
ANS: D
Subjective data is based on what patients or family members communicate to the nurse. Patientreported health history, signs and symptoms, and caregiver reported financial barriers would beconsidered subjective data. Vital signs obtained from the medical record would be consideredobjective data.
DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: PlanningMSC: NCLEX: Management of Client Care - The nurse is using data collected to define a set of interventions to achieve the most desirableoutcomes. Which of the following steps is the nurse applying?
a. Recognizing cues (assessment)
b. Analyze cues & prioritize hypothesis (analysis)
c. Generate solutions (planning)
d. Take action (nursing interventions)
ANS: C
When generating solutions (planning), the nurse identifies expected outcomes and uses thepatient’s problem(s) to define a set of interventions to achieve the most desirable outcomes.
Recognizing cues (assessment) involves the gathering of cues (information) from the patient
about their health and lifestyle practices, which are important facts that aid the nurse in makingclinical care decisions. Prioritizing hypothesis is used to organize and rank the patient problem(s)identified. Finally, taking action involves implementation of nursing interventions to accomplishthe expected outcomes.
DIF: Cognitive Level: Understanding (Comprehension)
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c. Reviewing dietary guidelines
d. Providing a schedule for medication administration
ANS: C
Non-selective MAO inhibitors have many dietary restrictions with potentially serious adversereactions, so this should be an important part of teaching.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies - The nurse is teaching a patient about taking a once-daily medication that has a side effect of
drowsiness. The nurse learns that the patient works a 7:00 PM to 7:00 AM shift in a hospital. Thenurse will recommend that the patient take this medication at which time of day?
a. 0600
b. 0800
c. 1800
d. 2000
ANS: B
The medication should be given when the patient is at home before sleep.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Planning | Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
MULTIPLE RESPONSE - Which patients are at particularly high risk for drug interactions? (Select all that apply.)
a. Patients who are acutely ill
b. Patients who are taking multiple medications
c. Patients who see several specialists
d. Patients who take supplements and OTC medications
e. Patients who use one pharmacy for several medications
ANS: B, C, D
Patients who have chronic health conditions, take multiple medications, see more than oneprovider, and use supplements and OTC medications are at higher risk for drug interactions.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 04: Pharmacogenetics
McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 11th EditionMULTIPLE CHOICE - Which of the following best describes pharmacogenetics?
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Nurses have a right to administer drugs safely and have the right to stop, think, and be vigilant
when administering medications. Another worker’s desk will be noisy, with many distractions.
Many drugs are used for off-label purposes; having a hospital policy helps ensure safety. Singledose vials are more convenient and help to reduce calculation errors, but multidose vials areoften used; nurses unsure of calculations should check their work with another nurse. Nursesfrequently have to look up information on new drugs, and hospitals should offer reasonableaccess to current information.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies - The nurse is teaching a patient about a new medication that will be administered using an MDI.
To evaluate the patient’s understanding about how to use the device, what will the nurse do?a. Ask the patient to give a return demonstration using the inhaler.
b. Give the patient written instructions to review as needed.
c. Offer the patient an internet web address with information about the product.
d. Provide information about drug effects and adverse reactions.
ANS: A
The nurse should demonstrate skills and evaluate understanding with return demonstrations.
Written instructions and internet sites are helpful but do not give information about patient
understanding and how well the patient can perform a task.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: EvaluationMSC: NCLEX: Health Promotion and Maintenance - The community health nurse is preparing to administer a medication to a patient in the patient’shome. The order reads “amoxicillin as directed BID PO.” The nurse will perform which action?a. Administer the medication as ordered on the prescription label.
b. Ask the patient to take the medication as ordered.
c. Contact the provider to confirm the correct dose and instructions for the
medication.
d. Review the drug information to verify the correct dose.
ANS: C
The home nurse must have a complete order for giving medications, including the name of themedication, dose, route, and frequency, so the nurse should contact the provider to ascertain thedose. The prescription label may be outdated if the provider has changed the regimen.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Health Promotion and Maintenance - The school nurse happens to observe a child pulling a pill out of a backpack and preparing totake it. What action will the nurse take?
a. Ask the child to describe the medication, dose, and reason for taking it.
b. Ask the child to keep all pills in the nurse’s office.
c. Call the child’s provider for a telephone order to give the medication.
59 of 369 - The nurse is preparing to discontinue total parenteral nutrition (TPN) therapy for a patient whohas been receiving TPN for several days. The nurse will contact the provider to discuss an orderfor
a. antibiotics.
b. intravenous insulin.
c. intravenous dextrose.
d. nasogastric feedings.
ANS: C
Abruptly discontinuing TPN can lead to hypoglycemia. Patients should receive dextrose solutionfor 12 to 24 hours after TPN is discontinued to prevent this reaction. Antibiotics are used whensigns of infection are observed. Intravenous insulin would compound hypoglycemia. Nasogastricfeedings are indicated if the patient needs continued feeding therapy and has an intact GI tract.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Planning | Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition - The nurse is caring for a patient with severe burns who will begin receiving total parenteral
nutrition (TPN). The patient asks why TPN is necessary. The nurse explains that TPN is used forwhich reason?
a. To minimize pulmonary complications
b. To prevent hyperglycemia and fluid overload
c. To promote wound healing and maintain cell integrity
d. To restore fluid and electrolyte imbalance
ANS: C
TPN is indicated for patients with severe burns. TPN enhances wound healing and provides thenutrients necessary to prevent cellular catabolism. While some pulmonary complications, such asaspiration pneumonia, do not occur with TPN, there is a risk of air embolism. Hyperglycemiaand fluid overload may occur.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition - The nurse is caring for a non-obese, non-critically ill adult who weighs 60 kg and is scheduled tobegin receiving total parenteral nutrition (TPN). Prior to initiating TPN therapy, the nursereviews the orders. What would be an appropriate energy intake for this patient?
a. 1,800 cal/day
b. 300 cal/day
c. 3,600 cal/day
d. 5,000 cal/day
ANS: A
The recommended energy intake is 25 to 35 cal/kg/day in a nonobese patient. Because thispatient weighs 60 kg, a recommended energy intake would be between 1,500 to 2,100 cal/day.
Adjustments to the TPN solution may be made based on patient-specific considerations.
90 of 369 - The nurse is caring for a patient who is taking chlorpromazine HCl 75 mg BID to treat
schizophrenia. A family member tells the nurse that the patient’s agitation, hallucinations, anddelusions have improved with use of the drug, but the patient continues to withdraw from socialinteraction and won’t bathe unless reminded to do so. The nurse will tell the family member that
a. all symptoms will eventually resolve over time with this medication.
b. the patient may need an increased dose of their current antipsychotic medication.
c. these results may indicate that the patient does not have schizophrenia.
d. they should consider discussing changing the chlorpromazine to an atypical
antipsychotic.
ANS: D
Chlorpromazine is a typical (first generation) antipsychotic medication; drugs in this class
manage positive symptoms rather than the negative symptoms of withdrawal and poor self-care.
It is not likely that the negative symptoms will improve over time with this medication. Atypical(second generation) antipsychotics can help with both positive and negative symptoms, so it
would be worthwhile discussing a change in medication to see if the patient’s negative symptomscould be improved. Increasing the dose will not improve control of negative symptoms. Thispatient exhibits signs of schizophrenia.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Psychosocial Integrity - The nurse is assessing a young adult patient with schizophrenia who recently began takingfluphenazine. The patient is exhibiting spasms of facial muscles along with grimacing, and thenurse notes upward eye movements. The nurse suspects which side effect?
a. Acute dystonia
b. Akathisia
c. Pseudoparkinsonism
d. Tardive dyskinesia
ANS: A
Acute dystonia can occur within days of taking typical antipsychotics, and facial muscle spasms,
grimacing, and upward eye movements are characteristic of this side effect. Akathisia is
characterized by restlessness, pacing, and difficulty standing still. Pseudoparkinsonism is
characterized by stooped posture, pill-rolling, shuffling gait, and tremors at rest. Tardivedyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips, andinvoluntary movement of the body and extremities.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Assessment | Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies - The nurse is preparing to administer loxapine 50 mg to a patient who has schizophrenia. Thepatient has been taking this medication twice daily for 15 months. The nurse notes smacking lipmovements and involuntary movements of all extremities. Which initial action by the nursewould be most appropriate?
a. Administer the medication as ordered to treat these symptoms of psychosis.
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ANS: D
Pruritus is a common opioid side effect and can be managed with diphenhydramine. Patientsdeveloping anaphylaxis will have urticaria and hypotension, and these patients will needepinephrine and resuscitation. Respiratory depression is a sign of morphine overdose, which willrequire naloxone.
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: EvaluationMSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies - The nurse administers nalbuphine to a patient who is experiencing severe pain. Which statement
by the patient indicates a need for further teaching about this drug?
a. “I may experience unusual dreams while taking this medication.”
b. “I may need to use a laxative when taking this drug.”
c. “I should ask for assistance when I get out of bed.”
d. “I should expect to have more frequent urination.”
ANS: D
A common side effect of opioid agents is urinary retention. Patients should notify the nurse if
they cannot void. Side effects may include unusual dreams, constipation, and dizziness.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Planning | Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies - The nurse is caring for a patient who was admitted with a fractured leg and for observation of aclosed head injury after a motor vehicle accident. The patient reports having pain at a level of 3on a 1 to 10 pain scale. The nurse will expect the provider to order which analgesic medicationfor this patient?
a. Acetaminophen PO
b. Hydromorphone IM
c. Morphine sulfate PCA
d. Transdermal fentanyl
ANS: A
Opioid analgesics should be used with extreme caution in patients with head injuries because ofthe risk of increased intracranial pressure. If opioids are necessary because of severe pain, theymust be given in reduced doses. This patient is experiencing mild pain, so acetaminophen is anappropriate analgesic.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Planning | Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies - Which patient may require a higher than expected dose of an opioid analgesic?
a. A patient with cancer
b. A patient with a concussion
c. A patient with hypotension
d. A patient 3 days after surgery
158 of 369 - A patient will take an anthelmintic medication and asks the nurse about common side effects.
The nurse will tell the patient that anthelmintic drugs
a. can cause hepatic toxicity.
b. most commonly cause orthostatic hypotension.
c. most commonly result in gastrointestinal (GI) side effects.
d. have many serious adverse reactions.
ANS: C
Anthelmintic drugs have many GI side effects, including anorexia, nausea, vomiting, diarrhea,
and cramps. Adverse reactions do not occur frequently given the short treatment duration of 1-3days.
DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: PlanningMSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies - A child is being treated for pinworms, and the parent asks the nurse how to prevent spreadingthis to other family members. What will the nurse tell the parent?
a. “Give your child baths every day.”
b. “Obtain a daily stool specimen from your child.”
c. “Change sheets, bedclothes, towels and underwear weekly.”
d. “Your child should wash hands well before meals and after using the toilet.”
ANS: D
To prevent the spread of pinworms, good hand washing after toileting is recommended. Patientsshould take showers, not baths. It is not necessary to get regular stool specimens. Sheets,
bedclothes, towels and underwear should ideally be changed daily.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies - A child is prescribed pyrantel pamoate. The nurse understands that this is most likely prescribedto treat which condition?
a. Candidiasis
b. Schistosomiasis
c. Pinworms
d. Liver flukes
ANS: C
Pyrantel pamoate is used to treat pinworms. Schistosomiasis and liver flukes are better treatedwith other anthelmintic products indicated to treat these conditions. Candidiasis would be treatedwith an antifungal agent.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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c. To minimize gastrointestinal upset
d. To prevent hepatotoxicity
ANS: B
Nitroglycerin is given sublingually to avoid first-pass metabolism by theliver, which wouldoccur if thedrug is swallowed, and to increase therate of absorption. It does not prevent
hypotension. Gastrointestinal upset and hepatotoxicity usually do not occur.
DIF: Cognitive Level: Understanding (Comprehension) TOP:
Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies - A patient who has been taking nitroglycerin for angina has developed variant angina, andtheprovider has added verapamil to thepatient’s regimen. thenurse will explain that verapamil isgiven for which purpose?
a. To facilitate oxygen use by theheart
b. To improve renal perfusion
c. To increase cardiac contractility
d. To relax coronary arteries
ANS: D
Verapamil is a calcium channel blocker and is used to relax coronary artery spasm in patientswith variant angina. It does not facilitate coronary muscle oxygen use, improve renal function, orincrease cardiac contractility.
DIF: Cognitive Level: Understanding (Comprehension) TOP:
Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies - A patient who has begun taking nifedipine to treat variant angina has had a recurrent bloodpressure of 90/60 mm Hg or less. thenurse will anticipate that theprovider will do which of
thefollowing?
a. Add digoxin to thedrug regimen.
236 of 369 - A patient who recently began having mild symptoms of gastroesophageal reflux disease (GERD)is reluctant to take medication. What non-pharmacological measures will the nurse recommendto minimize this patient’s symptoms? (Select all that apply.)
a. Avoiding hot, spicy foods
b. Avoiding tobacco products
c. Drinking a glass of red wine with dinner
d. Eating a snack before bedtime
e. Taking ibuprofen with food
f. Using a small pillow for sleeping
g. Wearing tight-fitted clothing
ANS: A, B, E
Hot, spicy foods aggravate gastric upset, tobacco increases gastric secretions, and ibuprofen onan empty stomach increases gastric secretions, so patients should be taught to avoid theseactions. Alcohol should be avoided since it increases gastric secretions. Eating at bedtimeincreases reflux, as does laying relatively flat to sleep, or wearing tight-fitted clothing.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 47: Eye and Ear Disorders
McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 11th EditionMULTIPLE CHOICE - The nurse is caring for a patient who has increased intraocular pressure. The provider has
ordered levobunolol 0.5% ophthalmic solution. The nurse will perform a thorough health historyto make sure the patient does not have a history of which condition?
a. Asthma
b. Diabetes
c. Hypertension
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Bethanechol is used to increase the tone of the detrusor muscle and increase the bladder tone tostimulate urination. It stimulates the parasympathetic nerves. It increases smooth muscle tone inthe urinary tract. It does not alleviate dysuria.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies - An older woman has urgent urinary incontinence related to an overactive bladder. Whichmedication does the nurse expect the provider to order?
a. Dimethylsulfoxide (DMSO)
b. Mirabegron (Myrbetriq)
c. Phenazopyridine HCl (Pyridium)
d. Tolterodine tartrate (Detrol)
ANS: D
Detrol is used to treat overactive bladder. Dimethyl sulfoxide (DMSO) is a urinary analgesic.
Mirabegron (Myrbetriq) is a urinary antispasmodic. Phenazopyridine HCl (Pyridium) is used toalleviate the pain and burning sensation during urination that is experienced with chronic cystitis.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies - The nurse assumes care for a patient who is experiencing urinary tract spasms and is ordered toreceive flavoxate HCl (Urispas). When reviewing this patient’s history, which condition wouldcause the nurse to notify the provider?
a. Chronic obstructive pulmonary disorder
b. Diabetes
c. Glaucoma
d. Hypotension
ANS: C
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MULTIPLE CHOICE - A 50-year-old male patient reports having decreased libido and testicular atrophy. The nurse willanticipate that the provider may order which medication to treat these symptoms?
a. Testosterone (Androderm)
b. Finasteride (Proscar)
c. Gonadotropin-releasing hormone (Gn-RH)
d. Sildenafil (Viagra)
ANS: A
Testosterone is given patients who have low testosterone, evidenced by decreased libido andtesticular atrophy in adult men. Finasteride is given to treat benign prostatic hypertrophy. Gn-RHis used to inhibit testosterone production. Sildenafil is used to treat erectile dysfunction.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies - The nurse is teaching the parents of a boy who has inadequate pituitary function and delayedpuberty about testosterone cypionate injections. Which statement by the parents indicates a needfor further teaching?
a. “He will need radiographs (x-rays) of his hands every 4-6 months.”
b. “Injections will be given deep into his gluteal muscles.”
c. “Sexual development will occur in 3–4 months.”
d. “His serum testosterone levels will need to be monitored.”
ANS: C
It takes 3–4 years for sexual development to occur with androgen therapy for hypogonadism, soparents should be reminded of this. X-rays are needed every 4-6 months to assess bone effects.
Injections are given deep intramuscularly into gluteal muscles. Serum testosterone levels will
need to be monitored to maintain normal levels and direct changes in testosterone dosing.
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