Basic Pharmacology For Nurses,15th Edition by Bruce D. Clayton -Test Bank

Basic Pharmacology For Nurses,15th Edition by Bruce D. Clayton -Test Bank

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Basic Pharmacology For Nurses,15th Edition by Bruce D. Clayton -Test Bank

Clayton: Basic Pharmacology for Nurses, 15^th Edition

 

Chapter 2: Principles of Drug Action and Drug Interactions

 

Test Bank

 

MULTIPLE CHOICE

 

1. The nurse assesses hives in a patient started on a new medication. What is the nurses best action?

A.	Notify physician of allergic reaction.
B.	Notify physician of idiosyncratic reaction.
C.	Notify physician of potential teratogenicity.
D.	Notify physician of potential tolerance.

 

 

ANS:   A

 

	Feedback
A	Allergic reactions are a hypersensitivity and manifest with hives and/or urticaria and are easily identified.
B	An idiosyncratic reaction occurs when something unusual or abnormal happens when a drug is first administered.
C	A teratogenic reaction refers to the occurrence of birth defects related to administration of the drug.
D	Tolerance refers to the bodys requirement for increasing dosages to achieve the same effects that a lower dose once did.

 

 

DIF:    Cognitive Level: Comprehension       REF:    21

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

2. The nurse administers an initial dose of a steroid to a patient with asthma. A half hour after administration, the nurse finds the patient agitated and stating that everyone is out to get me. What is the term for this unusual reaction?

A.	Desired action
B.	Adverse effect
C.	Idiosyncratic reaction
D.	Allergic reaction

 

 

ANS:   C

 

	Feedback
A	Desired actions are expected responses to a medication.
B	Adverse effects are reactions that occur in another system of the body; they are usually predictable.
C	Idiosyncratic reactions are unusual, abnormal reactions that occur when a drug is first administered. Patients typically exhibit an overresponsiveness to a medication related to diminished metabolism. These reactions are believed to be related to genetic enzyme deficiencies.
D	Allergic reactions appear after repeated medication dosages

 

 

DIF:    Cognitive Level: Comprehension       REF:    21

TOP:    Nursing Process Step: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

3. What is the definition of cumulative effect of a drug?

A.	Drug toxicity related to overmedication
B.	Drug buildup related to decreased metabolism
C.	The inability to control the ingestion of drugs
D.	The need for higher dosage to produce the same effect as previous lower dosages

 

 

ANS:   B

 

	Feedback
A	Toxicity occurs when adverse effects are severe.
B	Cumulative effects are related to diminished metabolism or excretion of a drug that causes it to accumulate. Cumulative effects can lead to drug toxicity.
C	Inability to control the ingestion of drugs is drug dependence.
D	The need for higher dosage to produce the same effect as previous lower dosages is the definition of tolerance.

 

 

DIF:    Cognitive Level: Knowledge             REF:    23

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

4. Which best describes when drug interactions occur?

A.	On administration of toxic dosages of a drug
B.	On an increase in the pharmacodynamics of bound drugs
C.	On the alteration of the effect of one drug by another drug
D.	On increase of drug excretion

 

 

ANS:   C

 

	Feedback
A	Toxicity of one drug may or may not affect the metabolism of another one.
B	Drug interactions may result from either increased or decreased pharmacodynamics.
C	Drug interactions may be characterized by an increase or decrease in the effectiveness of one or both of the drugs.
D	Drug interactions may result from either increased or decreased excretion.

 

 

DIF:    Cognitive Level: Comprehension       REF:    23

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

5. What occurs when two drugs compete for the same receptor site, resulting in increased activity of the first drug?

A.	Desired action
B.	Synergistic effect
C.	Carcinogenicity
D.	Displacement

 

 

ANS:   D

 

	Feedback
A	An expected response of a drug is the desired action.
B	A synergistic effect is the effect of two drugs being greater than the effect of each chemical individually, or the sum of the individual effects.
C	Carcinogenicity is the ability of a drug to cause cells to mutate and become cancerous.
D	The displacement of the first drug from receptor sites by a second drug increases the amount of the first drug because more unbound drug is available.

 

 

DIF:    Cognitive Level: Comprehension       REF:    23-24

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

6. What do drug blood levels indicate?

A.	Confirm if the patient is taking a generic form of a drug
B.	Determine if the patient has sufficient body fat to metabolize the drug
C.	Verify if the patient is taking someone elses medications
D.	Determine if the amount of drug in the body is in a therapeutic range

 

 

ANS:   D

 

	Feedback
A	Generic drugs do not necessarily produce a different drug blood level than proprietary medications.
B	Body fat is not measured by drug blood levels.
C	Drug blood levels only measure the amount of drug in the body; they do not determine the source of the medication.
D	The amount of drug present may vary over time and the blood level must remain in a therapeutic range in order to obtain the desired result.

 

 

DIF:    Cognitive Level: Comprehension       REF:    20

TOP:    Nursing Process Step: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

7. What is the process by which a drug is transported by circulating body fluids to receptor sites?

A.	Osmosis
B.	Distribution
C.	Absorption
D.	Biotransformation

 

 

ANS:   B

 

	Feedback
A	Osmosis is the process of moving solution across a semipermeable membrane to equalize the dilution on each side.
B	Distribution refers to the ways in which drugs are transported by the circulating body fluids to the sites of action (receptors), metabolism, and excretion.
C	Absorption is the process by which a drug is transferred from its site of entry into the body to the circulating fluids for distribution.
D	Biotransformation, also called metabolism, is the process by which the body inactivates drugs.

 

 

DIF:    Cognitive Level: Comprehension       REF:    18

TOP:    Nursing Process Step: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

8. The nurse assesses which blood level to determine the amount of circulating medication in a patient?

A.	Peak
B.	Trough
C.	Drug
D.	Therapeutic

 

 

ANS:   C

 

	Feedback
A	Incorrect A: Peak levels are only those drug blood levels that are at their maximum before metabolism starts to decrease the amount of circulating drug.
B	Trough levels are only those drug blood levels that are at their minimum when metabolism has decreased the amount of circulating drug and before an increase caused by a subsequent dose of the medication.
C	When a drug is circulating in the blood, a blood sample may be drawn and assayed to determine the amount of drug present; this is known as the drug blood level.
D	Therapeutic levels are only those within a prescribed range of blood levels determined to bring about effective action of the medication.

 

 

DIF:    Cognitive Level: Comprehension       REF:    20

TOP:    Nursing Process Step: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

9. Which patient, when compared with the general population, would require a larger dose or more frequent administration of a drug to attain a therapeutic response?

A.	A 29-year-old who has been diagnosed with kidney failure
B.	A 35-year-old obese male who is being evaluated for an exercise program
C.	A 52-year-old diagnosed with hypothyroidism and decreased metabolic rate
D.	A 72-year-old with decreased circulatory status

 

 

ANS:   B

 

	Feedback
A	An individual with kidney failure would require less medication due to decreased excretory ability.
B	An obese individual would require a larger dose of a drug to attain a therapeutic response.
C	Individuals with decreased metabolic rate would metabolize drugs more slowly and require smaller doses or less frequent administration
D	Individuals with decreased circulation would require less medication.

 

 

DIF:    Cognitive Level: Application             REF:    22

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

10. The nurse administers 50 mg of a drug at 6:00 AM that has a half-life of 8 hours. What time will it be when 25 mg of the drug has been eliminated from the body?

A.	8:00 AM
B.	11:00 AM
C.	2:00 PM
D.	6:00 PM

 

 

ANS:   C

 

	Feedback
A	8:00 AM is 2 hours after administration; the half-life is 8 hours.
B	11:00 AM is 4 hours after administration; the half-life is 8 hours.
C	Fifty percent of the medication, or 25 mg, will be eliminated in 8 hours, or at 2:00 PM.
D	6:00 PM is 12 hours after administration; the half-life is 8 hours.

 

 

DIF:    Cognitive Level: Application             REF:    20

TOP:    Nursing Process Step: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

11. What will the nurse need to determine first in order to mix two drugs in the same syringe?

A.	Absorption rate of the drugs
B.	Compatibility of the drugs
C.	Drug blood level of each drug
D.	Medication adverse effects

 

 

ANS:   B

 

	Feedback
A	Knowledge of absorption is important but not in order to mix drugs.
B	In order to mix two drugs, compatibility is determined so there is no deterioration when the drugs are mixed in the same syringe.
C	Drug level does not indicate if it is acceptable to mix medications in the same syringe.
D	Adverse effects are important for the nurse to know, but not in order to mix drugs.

 

 

DIF:    Cognitive Level: Application             REF:    24

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

12. A patient developed hives and itching after receiving a drug for the first time. Which instruction by the nurse is accurate?

A.	Stop the medication and encourage the patient to wear a medical alert bracelet that explains the allergy.
B.	Explain to the patient that these are signs and symptoms of an anaphylactic reaction.
C.	Emphasize to the patient the importance to inform medical personnel that in the future a lower dosage of this drug is necessary.
D.	Instruct the patient that it would be safe to take the drug again because this instance was a mild reaction.

 

 

ANS:   A

 

	Feedback
A	This initial allergic reaction is mild, and the patient is more likely to have an anaphylactic reaction at the next exposure; a medical alert bracelet is necessary to explain the reaction.
B	Signs and symptoms of an anaphylactic reaction are respiratory distress and cardiovascular collapse.
C	A more severe reaction will occur at the next exposure, and the patient should not receive the drug again.
D	This mild allergic reaction is a warning not to take the drug again because, upon the next exposure to the drug, the patient is more likely to have an anaphylactic reaction.

 

 

DIF:    Cognitive Level: Application             REF:    21-22

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

13. When obtaining a patients health history, which assessment data would the nurse identify as having the most effect on drug metabolism?

A.	History of liver disease
B.	Intake of a vegetarian diet
C.	Sedentary lifestyle
D.	Teacher as an occupation

 

 

ANS:   A

 

	Feedback
A	Liver enzyme systems are the primary site for metabolism of drugs.
B	Intake of a vegetarian diet may affect absorption but not metabolism.
C	Sedentary lifestyle does not affect metabolism the most.
D	Occupations could affect metabolism (exposure to environmental pollutants), but this is not the most significant effect on metabolism.

 

 

DIF:    Cognitive Level: Application             REF:    19

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

MULTIPLE RESPONSE

 

1. Which statements about liberation of drugs are true? (Select all that apply.)

A.	A drug must be dissolved in body fluids before it can be absorbed into body tissues.
B.	A solid drug taken orally must disintegrate and dissolve in GI fluids to allow for absorption into the bloodstream for transport to the site of action.
C.	The process of converting the drug into a soluble form can be controlled to a certain degree by the dosage form.
D.	Converting the drug to a soluble form can be influenced by administering the drug with or without food in the patients stomach.
E.	Elixirs take longer to be liberated from the dosage form.

 

 

ANS:   A, B, C, D

 

	Feedback
Correct	Regardless of the route of administration, a drug must be dissolved in body fluids before it can be absorbed into body tissues. Before a solid drug taken orally can be absorbed into the bloodstream for transport to the site of action, it must disintegrate and dissolve in the GI fluids and be transported across the stomach or intestinal lining into the blood. The process of converting a drug into a soluble form can be partially controlled by the pharmaceutical dosage form used (e.g., solution, suspension, capsules, and tablets with various coatings). The conversion process can also be influenced by administering the drug with or without food in the patients stomach.
Incorrect	Elixirs are already drugs dissolved in a liquid and do not need to be liberated from the dosage form.

 

 

DIF:    Cognitive Level: Comprehension       REF:    18

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

2. Which are routes of drug excretion? (Select all that apply.)

A.	Gastrointestinal (GI) tract; feces
B.	Genitourinary (GU) tract; urine
C.	Lymphatic system
D.	Circulatory system; blood/plasma
E.	Respiratory system; exhalation

 

 

ANS:   A, B, E

 

	Feedback
Correct	The GI system is a primary route for drug excretion The GU system does function in the excretion of drugs. The respiratory system does function in the excretion of drugs.
Incorrect	The lymphatic system is involved with drug distribution, not drug excretion. The circulatory system is involved with drug distribution, not drug excretion.

 

 

DIF:    Cognitive Level: Knowledge             REF:    19

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

3. Which routes enable drug absorption more rapidly than the subcutaneous route? (Select all that apply.)

A.	Intravenous route
B.	Intramuscular route
C.	Inhalation/sublingual
D.	Intradermal route
E.	Enteral route

 

 

ANS:   A, B, C

 

	Feedback
Correct	Intravenous route of administration enables drug absorption more rapidly than the subcutaneous route. Intramuscular route of administration enables drug absorption more rapidly due to greater blood flow per unit weight of muscle. Inhalation/sublingual route of administration enables drug absorption more rapidly than the subcutaneous route.
Incorrect	Intradermally administered drugs are absorbed more slowly due to the limited available blood supply in the dermis. Enterally administered drugs are absorbed more slowly due to the biotransformation process.

 

 

DIF:    Cognitive Level: Comprehension       REF:    18

TOP:    Nursing Process Step: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

4. The nurse recognizes that which factors would contribute to digoxin toxicity in a 92-year-old patient? (Select all that apply.)

A.	Taking the medication with meals
B.	Prolonged half-life of the drug digoxin
C.	Impaired renal function
D.	Diminished mental capacity

 

 

ANS:   B, C

 

	Feedback
Correct	Impaired renal and hepatic function in older adults impairs metabolism and excretion of drugs, thus prolonging the half-life of a medication. Impaired renal and hepatic function in older adults impairs metabolism and excretion of drugs, thus prolonging the half-life of a medication.
Incorrect	Food would decrease the absorption of the drug. Diminished mental capacity does not contribute to drug toxicity unless it is due to administration errors.

 

 

DIF:    Cognitive Level: Application             REF:    22

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

 

5. Which statements about variables that influence drug action are true? (Select all that apply.)

A.	An older adult will require increased dosage of a drug to achieve the same therapeutic effect as that seen in a younger person.
B.	Body weight can affect the therapeutic response of a medication.
C.	Chronic smokers may metabolize drugs more rapidly than nonsmokers.
D.	A patients attitude and expectations affect the response to medication.
E.	Reduced circulation causes drugs to absorb more rapidly.

 

 

ANS:   B, C, D

 

	Feedback
Correct	Body weight can affect response to medications; typically, obese patients require an increase in dosage and underweight patients a decrease in dosage. Chronic smoking enhances metabolism of drugs. Attitudes and expectations play a major role in an individuals response to drugs.
Incorrect	Older adults require decreased dosages of drugs to achieve a therapeutic effect. Decreased circulation causes drugs to absorb more slowly.

 

 

DIF:    Cognitive Level: Comprehension       REF:    22

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

6. Which factors affect drug actions? (Select all that apply.)

A.	Teratogenicity
B.	Age
C.	Body weight
D.	Metabolic rate
E.	Illness

 

 

ANS:   B, C, D, E

 

	Feedback
Correct	Age may contribute to a variable response to a medication. Body weight may contribute to a variable response to a medication. Metabolic rate may contribute to a variable response to a medication. Illness may contribute to a variable response to a medication.
Incorrect	Teratogenicity does not contribute to a variable response to a medication.

 

 

DIF:    Cognitive Level: Comprehension       REF:    22

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

Clayton: Basic Pharmacology for Nurses, 15^th Edition

 

Chapter 14: Sedative-Hypnotics

 

Test Bank

 

MULTIPLE CHOICE

 

1. The nurse finds that a patient is extremely agitated, yelling out frequently, and attempting to get out of bed without assistance. What is the nurses initial action?

A.	Administer zolpidem after taking the patients vital signs.
B.	Close the patients door for privacy after administering Tylenol.
C.	Administer benzodiazepine before calling the health care provider.
D.	Spend uninterrupted time listening to the patient.

 

 

ANS:   D

 

	Feedback
A	The nurse must assess the patient before medication can be administered.
B	The nurse must assess the patient before medication can be administered.
C	The nurse must assess the patient before medication can be administered.
D	Assessing the patients level of anxiety is important. The patient may only need someone to listen to what stressors he or she is facing.

 

 

DIF:    Cognitive Level: Analysis                  REF:    212

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

2. An older adult patient received a hypnotic agent at 9:00 PM. At 2:00 AM, the nurse discovers that the patient has removed her gown and is attempting to get out of bed without assistance. What type of medication effect is the patient exhibiting?

A.	Allergic
B.	Hypersensitivity
C.	Paradoxical
D.	Therapeutic

 

 

ANS:   C

 

	Feedback
A	Allergies to medications tend to manifest in skin or respiratory symptoms.
B	A patient who is hypersensitive to a hypnotic would be difficult to rouse.
C	A paradoxical effect may occur in older adult patients. This includes periods of excitement, confusion, restlessness, and euphoria.
D	A therapeutic effect for a hypnotic would be sedation.

 

 

DIF:    Cognitive Level: Application             REF:    215

TOP:    Nursing Process Step: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

3. For what conditions are benzodiazepines prescribed?

A.	Chronic amnesia
B.	Chronic insomnia
C.	Preoperative sedation
D.	Psychotic episodes

 

 

ANS:   C

 

	Feedback
A	Benzodiazepines are not recommended for long-term use and do not affect amnesia.
B	Benzodiazepines are a poor choice for the treatment of chronic insomnia because of their risk for habituation.
C	The sedative-hypnotic effect of benzodiazepines facilitates surgical sedation. Short-acting benzodiazepines are administered intramuscularly for preoperative sedation. They are also given intravenously for conscious sedation before short diagnostic procedures or for the induction of general anesthesia.
D	Benzodiazepines do not have an antipsychotic effect.

 

 

DIF:    Cognitive Level: Knowledge             REF:    216

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

4. A patient receiving diazepam (Valium) is complaining of nausea and vomiting and is becoming jaundiced. Which type of blood work will be performed?

A.	Renal function tests
B.	Liver function tests
C.	Clotting times
D.	Electrolyte panels

 

 

ANS:   B

 

	Feedback
A	Benzodiazepines do not affect the kidneys.
B	Liver function tests will be performed because nausea, vomiting, and jaundice can be indicative of hepatotoxicity. Abnormal liver function test results (i.e., elevated bilirubin, aspartate transaminase [AST], alanine transaminase [ALT], gamma glutamyl transferase [GGT], and alkaline phosphatase levels, and prothrombin time) are indicative of hepatotoxicity.
C	Benzodiazepines do not affect clotting times.
D	Benzodiazepines do not affect electrolytes.

 

 

DIF:    Cognitive Level: Application             REF:    218

TOP:    Nursing Process Step: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

5. In addition to facilitating sleep, what is another benefit of sedatives?

A.	Increased pain control postoperatively
B.	Reduced bronchial secretions
C.	Decreased patient anxiety
D.	Increased patient alertness

 

 

ANS:   C

 

	Feedback
A	Sedatives are not long-acting enough to affect postoperative pain control.
B	Sedatives do not affect bronchial secretions.
C	Preoperatively, sedatives will help decrease patient anxiety and facilitate sleep.
D	Sedatives diminish patient alertness.

 

 

DIF:    Cognitive Level: Knowledge             REF:    211

TOP:    Nursing Process Step: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

6. Which two phases make up normal sleep?

A.	Hypnogogic and hypnopompic
B.	REM and non-REM
C.	Alpha and beta
D.	Delta and theta

 

 

ANS:   B

 

	Feedback
A	Hypnogogic is the state between waking and sleeping; hypnopompic is the transition between sleeping and waking states.
B	Normal sleep can be divided into two phases, nonrapid eye movement and rapid eye movement (REM).
C	Beta waves are those associated with day-to-day wakefulness. During periods of relaxation while still awake, our brain waves become slower, increase in amplitude and become more synchronous. These types of waves are called alpha waves.
D	The first stage of sleep is characterized by theta waves. During a normal nights sleep, a sleeper passes from the theta waves of stage 1 and 2 to the delta waves of stage 3 and 4. Delta waves are the slowest and highest amplitude brain waves.

 

 

DIF:    Cognitive Level: Knowledge             REF:    210

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

7. Which sleep pattern stage diminishes as an effect of aging?

A.	Stage I
B.	Stage II
C.	Stage III
D.	Stage IV

 

 

ANS:   D

 

	Feedback
A	Two percent to 5% of sleep is stage I.
B	Stage II comprises about 50% of normal sleep time.
C	Stage III is a transition between lighter sleep and deeper sleep.
D	As we age, stage IV sleep diminishes. Many people older than 75 years do not demonstrate any stage IV sleep patterns.

 

 

DIF:    Cognitive Level: Knowledge             REF:    210

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

8. A patient has been prescribed lorazepam (Ativan), a benzodiazepine used to treat insomnia. Which action will the nurse take?

A.	Advise the patient to take the medication with food.
B.	Assess the patients blood pressure in sitting and lying positions.
C.	Inform the patient to discontinue the medication once sleep improves.
D.	Instruct the patient to lie down before taking the medication.

 

 

ANS:   B

 

	Feedback
A	Ativan does not have to be taken with food.
B	Measuring blood pressure in sitting in lying positions is important to assess for transient hypotension.
C	Rapid discontinuance of the medication after long-term use may result in symptoms similar to those of alcohol withdrawal. Gradual withdrawal of benzodiazepines is over 2 to 4 weeks.
D	Medications should be taken sitting up.

 

 

DIF:    Cognitive Level: Application             REF:    216

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

9. Which disease is associated with insufficient sleep?

A.	Cancer
B.	Glaucoma
C.	Myocardial infarction
D.	Renal failure

 

 

ANS:   C

 

	Feedback
A	Cancer is not associated with lack of sleep.
B	Glaucoma is not associated with lack of sleep.
C	Individuals who sleep less than 5 hours a night have a threefold increased risk of heart attacks.
D	Renal failure is not associated with lack of sleep.

 

 

DIF:    Cognitive Level: Knowledge             REF:    210

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

 

10. The nurse is caring for an older patient recently admitted to an assisted living center who is experiencing insomnia associated with the recent relocation. At bedtime, which nursing action will assist the patient to sleep?

A.	Offering the patient hot tea
B.	Encouraging the patient to ambulate in the hallway
C.	Performing back massage
D.	Administering an analgesic

 

 

ANS:   C

 

	Feedback
A	Avoid products containing caffeine, such as coffee, tea, soft drinks, and chocolate.
B	A quiet unwinding activity before bedtime is helpful for sleep promotion.
C	Providing a back rub will promote relaxation and reduce anxiety associated with a new environment. This would also provide an opportunity for the nurse to encourage the patient to express feelings.
D	Administering an analgesic is not an appropriate action.

 

 

DIF:    Cognitive Level: Application             REF:    213

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

 

11. The nurse is explaining the use of medications to a patient with insomnia. Which statement about sedatives is true?

A.	A sedative will produce sleep.
B.	Sedatives increase the total time in REM sleep.
C.	Increased relaxation occurs with sedatives.
D.	Sedatives are more potent than hypnotics.

 

 

ANS:   C

 

	Feedback
A	A sedative quiets the patient and gives a feeling of relaxation and rest, not necessarily accompanied by sleep.
B	Sedatives do not increase the total time in REM sleep.
C	A hypnotic is a drug that produces sleep; a sedative quiets the patient and gives a feeling of relaxation and rest, not necessarily accompanied by sleep.
D	A small dose of a drug may act as a sedative, whereas a larger dose of the same drug may act as a hypnotic and produce sleep.

 

 

DIF:    Cognitive Level: Comprehension       REF:    211

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological integrity

 

12. The nurse is assessing a patient who is being evaluated in an outpatient clinic for complaints of back pain. The patient reports taking diphenhydramine for insomnia related to job stress. Which statement by the nurse is accurate regarding this medication?

A.	This medication should only be taken for 1 week.
B.	This medication can cause nausea.
C.	The medication should not be taken after eating a high-fat meal.
D.	This is an herbal medication that has been used for hundreds of years.

 

 

ANS:   A

 

	Feedback
A	Antihistamines (particularly diphenhydramine and doxylamine) have sedative properties that may be used for short-term treatment of mild insomnia. They are common ingredients in over-the-counter (OTC) sleep aids. Tolerance develops after only a few nights of use; increasing the dose actually causes a more restless and irregular sleep pattern.
B	Diphenhydramine does not cause nausea.
C	There is no restriction on taking diphenhydramine after a high-fat meal.
D	Diphenhydramine is not an herbal medication.

 

 

DIF:    Cognitive Level: Application             REF:    219

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological integrity

 

MULTIPLE RESPONSE

 

1. Why are benzodiazepines often preferred over barbiturates? (Select all that apply.)

A.	They have selective action at specific receptor sites.
B.	There is a wide range of safety between therapeutic and lethal levels.
C.	REM sleep is decreased to a lesser extent.
D.	Accidental overdoses are well tolerated.
E.	There are no hypotensive episodes when rising to a sitting position.

 

 

ANS:   A, B, C, D

 

	Feedback
Correct	The selectivity of specific drugs at receptor sites accounts for the wide variety of uses. There is a wide safety margin between the therapeutic and lethal dosages for these drugs. Benzodiazepines decrease REM sleep to a lesser extent. Intentional and unintentional overdoses of benzodiazepines are often well tolerated and not fatal.
Incorrect	There are transient hypotensive episodes with benzodiazepine therapy.

 

 

DIF:    Cognitive Level: Comprehension       REF:    215-216

TOP:    Nursing Process Step: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

2. Which are common adverse effects of barbiturates? (Select all that apply.)

A.	Residual daytime sedation
B.	Headache
C.	Hyperactivity
D.	Blurred vision
E.	Impaired coordination

 

 

ANS:   A, B, D, E

 

	Feedback
Correct	The long half-life of a barbiturate medication often causes residual daytime sedation. Headache is a general adverse effect of barbiturates. Blurred vision is an adverse effect associated with the hypnotic dosages of long-acting barbiturates. Impaired coordination is an adverse effect of barbiturates.
Incorrect	Hyperactivity is not generally an adverse effect of barbiturates unless the patient is experiencing a paradoxical response.

 

 

DIF:    Cognitive Level: Knowledge             REF:    215

TOP:    Nursing Process Step: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

3. What can occur as a result of rapid withdrawal from long-term use of barbiturate therapy? (Select all that apply.)

A.	Anxiety
B.	Delirium
C.	Weakness
D.	Grand mal seizures
E.	Severe pain

 

 

ANS:   A, B, C, D

 

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Correct	Anxiety can be a symptom of rapid withdrawal from long-term use of barbiturate therapy. Delirium can be a symptom of rapid withdrawal from long-term use of barbiturate therapy. Weakness can be a symptom of rapid withdrawal from long-term use of barbiturate therapy. Grand mal seizures can be a symptom of rapid withdrawal from long-term use of barbiturate therapy.
Incorrect	Severe pain is not a symptom of rapid withdrawal from long-term use of barbiturate therapy.

 

 

DIF:    Cognitive Level: Knowledge             REF:    214-215

TOP:    Nursing Process Step: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

Clayton: Basic Pharmacology for Nurses, 15^th Edition

 

Chapter 34: Drugs Used to Treat Nausea and Vomiting

 

Test Bank

 

MULTIPLE CHOICE

 

1. A patient is beginning the second round of high-dose cisplatin. Severe, chemotherapy-induced nausea and vomiting (CINV) occurred following the first treatment, requiring 72 hours of continuous IV hydration. In addition to her chemotherapy regimen, which medication would be best to administer?

A.	Prochlorperazine (Compazine) suppository daily, the day of treatment, and the next 3 days
B.	Anticholinergic agents, such as diphenhydramine or meclizine
C.	Parenteral ondansetron 1 hour before chemotherapy, with oral ondansetron to continue for the next 4 days
D.	Parenteral ondansetron during chemotherapy, with prochlorperazine suppositories daily for 1 week

 

 

ANS:   C

 

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A	Prochlorperazine is not indicated for the treatment of CINV.
B	Anticholinergic agents are not used for the treatment of CINV.
C	With the patients first treatment history and the emetogenic chemotherapy agent, cisplatin, ondansetron has shown to be the most effective for prevention of severe nausea and vomiting.
D	The ondansetron should be administered 1 hour before the chemotherapy and continued for the next several days to prevent vomiting and dehydration associated with chemotherapy administration. Prochlorperazine is not indicated for the treatment of CINV.

 

 

DIF:    Cognitive Level: Application             REF:    542

TOP:    Nursing Process Step: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity

 

2. A patient expresses concerns about motion sickness. Which medication is most effective in preventing motion sickness?

A.	Serotonin antagonists
B.	Phenothiazines
C.	Corticosteroids
D.	Anticholinergics

 

 

ANS:   D

 

 

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A	Serotonin antagonists are used in the treatment of emesis associated with cancer chemotherapy, radiation therapy, and postoperative nausea and vomiting.
B	Phenothiazines are used in the treatment of mild to moderate nausea and vomiting associated with anesthesia and surgery, radiation therapy, and cancer chemotherapy.