Basic Pharmacology for Nurses 16th Ed by Clayton Willihnganz-Test Bank

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Basic Pharmacology for Nurses 16th Ed by Clayton Willihnganz-Test Bank

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WITH ANSWERS
Basic Pharmacology for Nurses 16th Ed by Clayton Willihnganz-Test Bank

Chapter 2: Basic 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 priority 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

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

 

DIF:    Cognitive Level: Application          REF:   p. 17              OBJ:   7

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. The nurse administers an initial dose of a steroid to a patient with asthma. Thirty minutes after administration, the nurse finds the patient agitated and stating that everyone is out to get me. What is the term for this unusual reaction?
a. Desired action
b. Adverse effect
c. Idiosyncratic reaction
d. Allergic reaction

 

 

ANS:  C

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

 

DIF:    Cognitive Level: Comprehension   REF:   p. 17              OBJ:   7

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. Which is the best description of when drug interactions occur?
a. On administration of toxic dosages of a drug
b. On an increase in the pharmacodynamics of bound drugs
c. On the alteration of the effect of one drug by another drug
d. On increase of drug excretion

 

 

ANS:  C

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

 

DIF:    Cognitive Level: Comprehension   REF:   p. 17              OBJ:   8

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. 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

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

 

DIF:    Cognitive Level: Comprehension   REF:   p. 17              OBJ:   9

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. What do drug blood levels indicate?
a. They confirm if the patient is taking a generic form of a drug.
b. They determine if the patient has sufficient body fat to metabolize the drug.
c. They verify if the patient is taking someone elses medications.
d. They determine if the amount of drug in the body is in a therapeutic range.

 

 

ANS:  D

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

 

DIF:    Cognitive Level: Comprehension   REF:   p. 16              OBJ:   7

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. What is the process by which a drug is transported by circulating body fluids to receptor sites?
a. Osmosis
b. Distribution
c. Absorption
d. Biotransformation

 

 

ANS:  B

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

 

DIF:    Cognitive Level: Comprehension   REF:   p. 13              OBJ:   4

TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. 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

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

 

DIF:    Cognitive Level: Comprehension   REF:   p. 16              OBJ:   7

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. The nurse administers 50 mg of a drug at 6:00 AM that has a half life of 8 hours. What time will it be when 25 mg of the drug has been eliminated from the body?
a. 8:00 AM
b. 11:00 AM
c. 2:00 PM
d. 6:00 PM

 

 

ANS:  C

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

 

DIF:    Cognitive Level: Analysis               REF:   p. 14              OBJ:   6

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. What will the nurse need to determine first in order to mix two drugs in the same syringe?
a. Absorption rate of the drugs
b. Compatibility of the drugs
c. Drug blood level of each drug
d. Medication adverse effects

 

 

ANS:  B

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

 

DIF:    Cognitive Level: Application          REF:   p. 18              OBJ:   9

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. A patient developed hives and itching after receiving a drug for the first time. Which instruction by the nurse is accurate?
a. Stop the medication and encourage the patient to wear a medical alert bracelet that explains the allergy.
b. Explain to the patient that these are signs and symptoms of an anaphylactic reaction.
c. Emphasize to the patient the importance to inform medical personnel that in the future a lower dosage of this drug is necessary.
d. Instruct the patient that it would be safe to take the drug again because this instance was a mild reaction.

 

 

ANS:  A

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

 

DIF:    Cognitive Level: Application          REF:   p. 17              OBJ:   7

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. 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

Liver enzyme systems are the primary site for metabolism of drugs. Intake of a vegetarian diet may affect absorption but not metabolism. Sedentary lifestyle and occupations could affect metabolism (exposure to environmental pollutants), but these do not have the most significant effect on metabolism.

 

DIF:    Cognitive Level: Application          REF:   p. 14              OBJ:   5

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. A physicians order indicates to administer a medication to the patient via the percutaneous route. The nurse can anticipate that the patient will receive this medication:
a. intramuscularly.
b. subcutaneously.
c. topically.
d. rectally.

 

 

ANS:  C

The percutaneous route refers to drugs that are absorbed through the skin and mucous membranes. Methods of the percutaneous route include inhalation, sublingual (under the tongue), or topical (on the skin) administration. The parenteral route bypasses the gastrointestinal (GI) tract by using subcutaneous (subcut), intramuscular (IM), or intravenous (IV) injection. The parenteral route bypasses the GI tract by using subcut, IM, or IV injection. In the enteral route, the drug is administered directly into the GI tract by the oral, rectal, or nasogastric route.

 

DIF:    Cognitive Level: Application          REF:   p. 12              OBJ:   1

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. A nurse is preparing to administer tetracycline to a patient diagnosed with an infection. Which medication should not be administered with tetracycline?
a. Ativan
b. Tylenol
c. Colace
d. Mylanta

 

 

ANS:  D

Administering tetracycline with Mylanta can provide an antagonistic effect that will result in decreased absorption of the tetracycline. Ativan, Tylenol, and Colace are not contraindicated to administer with tetracycline.

 

DIF:    Cognitive Level: Application          REF:   p. 18              OBJ:   9

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

MULTIPLE RESPONSE

 

  1. Which statement(s) about liberation of drugs is/are true? (Select all that apply.)
a. A drug must be dissolved in body fluids before it can be absorbed into body

tissues.

b. A solid drug taken orally must disintegrate and dissolve in GI fluids to allow for absorption into the bloodstream for transport to the site of action.
c. The process of converting the drug into a soluble form can be controlled to a certain degree by the dosage form.
d. Converting the drug to a soluble form can be influenced by administering the drug with or without food in the patients stomach.
e. Elixirs take longer to be liberated from the dosage form.

 

 

ANS:  A, B, C, D

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

 

DIF:    Cognitive Level: Comprehension   REF:   p. 13              OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. Which are routes of drug excretion? (Select all that apply.)
a. GI tract; feces
b. Genitourinary (GU) tract; urine
c. Lymphatic system
d. Circulatory system; blood/plasma
e. Respiratory system; exhalation

 

 

ANS:  A, B, E

The GI system is a primary route for drug excretion. The GU and the respiratory systems do function in the excretion of drugs. The lymphatic and circulatory systems are involved with drug distribution, not drug excretion.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 14              OBJ:   5

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. Which route(s) enable(s) drug absorption more rapidly than the subcut route? (Select all that apply.)
a. IV route
b. IM route
c. Inhalation/sublingual
d. Intradermal route
e. Enteral route

 

 

ANS:  A, B, C

IV route of administration enables drug absorption more rapidly than the subcut route. IM route of administration enables drug absorption more rapidly because of greater blood flow per unit weight of muscle. Inhalation/sublingual route of administration enables drug absorption more rapidly than the subcut route. Intradermally administered drugs are absorbed more slowly because of the limited available blood supply in the dermis. Enterally administered drugs are absorbed more slowly because of the biotransformation process.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 13              OBJ:   1

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. The nurse recognizes that which factor(s) 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

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

 

DIF:    Cognitive Level: Application          REF:   p. 14              OBJ:   5 | 6

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

 

  1. Which statement(s) about variables that influence drug action is/are true? (Select all that apply.)
a. An older adult will require increased dosage of a drug to achieve the same therapeutic effect as that seen in a younger person.
b. Body weight can affect the therapeutic response of a medication.
c. Chronic smokers may metabolize drugs more rapidly than nonsmokers.
d. A patients attitude and expectations affect the response to medication.
e. Reduced circulation causes drugs to absorb more rapidly.

 

 

ANS:  B, C, D

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

 

DIF:    Cognitive Level: Comprehension   REF:   p. 13              OBJ:   N/A

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. Which factor(s) affect(s) drug actions? (Select all that apply.)
a. Teratogenicity
b. Age
c. Body weight
d. Metabolic rate
e. Illness

 

 

ANS:  B, C, D, E

Age, body weight, metabolic rate, and illness may contribute to a variable response to a medication. Teratogenicity does not contribute to a variable response to a medication.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 14              OBJ:   N/A

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

OTHER

 

  1. A patient receives 200 mg of a medication that has a half life of 12 hours. How many mg of the drug would remain in the patients after 24 hours?

 

ANS:

50

The half life is defined as the amount of time required for 50% of the drug to be eliminated from the body. If a patient is given 200 mg of a drug that has a half life of 12 hours, then 50 mg of the drug would remain in the body after 24 hours.

 

DIF:    Cognitive Level: Analysis               REF:   p. 14              OBJ:   6

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

Chapter 10: Parenteral Administration: Safe Preparation of Parenteral Medications

Test Bank

 

MULTIPLE CHOICE

 

  1. Which part of the syringe contains the calibrations for drug volume measurement?
a. Plunger
b. Tip
c. Luer Lok
d. Barrel

 

 

ANS:  D

The barrel contains the calibrations necessary for measurement. The plunger, the tip, and the Luer Lok do not have the calibrations indicated on them.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 141            OBJ:   1

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

 

  1. Which needle will the nurse use to administer an intramuscular (IM) immunization on an 18 month old child?
a. 18-gauge, 1 inch needle
b. 20-gauge, 1/2 inch needle
c. 27-gauge, 1 1/2 inch needle
d. 25-gauge, 1/2 inch needle

 

 

ANS:  C

The most appropriate needle gauge for pediatric IM injections is a 25- or 27-gauge, 1 1/2 inch needle. An 18 gauge, 1 inch needle is too short and too large in diameter for pediatric injections. A 20-gauge, 1/2 inch needle is too short and too large in diameter for pediatric injections. A 25-gauge, 1/2 inch needle is too short for pediatric IM injections.

 

DIF:    Cognitive Level: Application          REF:   p. 145            OBJ:   2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. Which syringe will the nurse use to administer insulin subcutaneously to a patient?
a. A syringe calibrated in minims
b. A syringe calibrated in units
c. A syringe calibrated in tenths of mL
d. A syringe calibrated in mL

 

 

ANS:  B

A syringe calibrated in units is used for insulin. A tuberculin syringe is not properly calibrated for use with insulin. A syringe calibrated in mL or in tenths of mL would not be an accurate way to measure insulin doses.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 143            OBJ:   5

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. Which action by the nurse is most accurate when drawing up medication from an ampule?
a. Consider the rim of the ampule as sterile.
b. Use a filter needle to withdraw the medication.
c. Wrap a paper towel around the neck of the ampule before breaking it.
d. Inject 0.5 mL of air into the ampule before withdrawing the medication.

 

 

ANS:  B

Filtered needles are used to withdraw the medication and then changed before administration of the injection. The rim of the ampule is considered to be contaminated because of the possible presence of broken glass. Paper towels do not protect the nurse from broken glass. The ampule is not airtight, so no air needs to be injected into it before removing the medication.

 

DIF:    Cognitive Level: Application          REF:   p. 150            OBJ:   8

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. Which action by the nurse is accurate when withdrawing medication into a syringe from a vial?
a. Inject an amount of air equal to the medication into the vial.
b. Break the thin neck of the vial container.
c. Remove the rubber stopper on the top of the vial.
d. Discard the initial 0.5 mL of medication to ensure sterility.

 

 

ANS:  A

An equal amount of air is first injected into the vial to help displace the needed medication upon withdrawal. Vials are not meant to be broken at the neck. Removal of the rubber stopper on a vial is unsafe and not recommended. Medication should not be discarded because it is sterile as long as the vial is airtight and has not been contaminated.

 

DIF:    Cognitive Level: Application          REF:   p. 153            OBJ:   8

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. An adult patient is to receive two medications IM. Which action by the nurse is most important in order to mix the medications in one syringe?
a. Assess for the presence of adequate muscle mass.
b. Ensure that the combined medication amount is less than 2 mL.
c. Determine the compatibility of the medications.
d. Use a needle that is 25 gauge.

 

 

ANS:  C

Compatibility is determined to prevent a reaction between the mixed medications. This is important once the medication will be administered, but first it needs to be determined that the medications can be mixed. IM injections in the adult can exceed 2 mL. A 25-gauge needle is not appropriate for an IM injection.

 

DIF:    Cognitive Level: Analysis               REF:   p. 153            OBJ:   9

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. The nurse is preparing to administer insulin. What does U 100 indicate?
a. 100 mL per unit
b. 10 units per mL
c. 100 units per mL
d. 10 units per 100 mL

 

 

ANS:  C

U 100 means 100 units per mL.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 143            OBJ:   3 | 5

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. After teaching a diabetic patient about proper disposal of used syringes and needles, which statement by the patient indicates a need for further teaching?
a. Even needles with sleeves should be disposed of appropriately.
b. It is unusual that anyone could get a needle injury or disease from used needles.
c. It is important for me to use the designated container to dispose of my syringes and needles.
d. I am going to purchase the Sharps by Mail Disposal System once I am home.

 

 

ANS:  B

The patient needs more education because injury from needlesticks and transfer of pathogens is a health concern. It is accurate that even needles with sleeves should be disposed of appropriately and that a designated container to dispose of syringes and needles should be used. The patient should be encouraged to purchase the Sharps by Mail Disposal System.

 

DIF:    Cognitive Level: Application          REF:   p. 140 | pp. 146-147

OBJ:   1                    TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. Which nursing action is accurate when administering parenteral medication?
a. Adjust the route of the medication, if needed.
b. Document the response to PRN medications at the end of the shift.
c. Request the pharmacist to provide education about the medication to the patient.
d. Use clinical judgment when rescheduling missed doses of a medication.

 

 

ANS:  D

The nurse must exercise clinical judgment about the scheduling of new drug orders, missed dosages, modified drug orders or substitution of therapeutically equivalent medicines by the pharmacy, or changes in the patients condition that require consultation with the physician, health care provider, or pharmacist. Adjusting the route is not within the role of the nurse. Documenting the response to PRN medications at the end of the shift is not an acceptable timeframe. Educating the patient about the medication is within the nurses role.

 

DIF:    Cognitive Level: Application          REF:   p. 140            OBJ:   N/A

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

 

  1. What is an advantage of administering a drug parenterally?
a. The duration of action is longer.
b. Medications given by this route are inexpensive.
c. The onset of action is more rapid.
d. The dose is usually larger than an oral dose.

 

 

ANS:  C

The onset of drug action is generally more rapid but of shorter duration. Duration of action is not affected by administering a drug parenterally. Parenteral administration can be expensive. The dose of parenteral medications is typically smaller than an oral dose.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 140            OBJ:   1

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

 

  1. Which information provided by the nurse is most important to include when teaching a patient about the use of an EpiPen?
a. Hold the syringe at a 45-degree angle against the skin.
b. Monitor the expiration date of this medication.
c. After using the EpiPen, lie down for 1 hour.
d. Place the syringe in a cartridge prior to using.

 

 

ANS:  B

It is important to monitor the expiration date of this medication on a regular basis. The syringe is held perpendicular to the skin. The patient should go to the emergency department after use of an EpiPen. Placing the syringe into a cartridge is not accurate for use of an EpiPen.

 

DIF:    Cognitive Level: Application          REF:   p. 144            OBJ:   6

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

 

  1. Which type of parenteral medication container is made of glass, is scored, and needs to be broken open before withdrawing the medication?
a. Ampule
b. Carpuject
c. Mix-O-Vial
d. Vial

 

 

ANS:  A

Ampules are glass containers that need to be broken open before withdrawing medication. Carpujects are prefilled syringes. Mix-O-Vial containers have two compartments for mixing medications and are not scored. Vials are glass or plastic containers that are not broken open.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 149            OBJ:   8

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. The operating room (OR) nurse is preparing medications for use in a sterile field during a surgical procedure. While preparing these medications, the nurse will:
a. save unused portions of medication for use in another procedure.
b. differentiate between sterile and nonsterile medications to be used in the OR.
c. ensure the scrub (sterile) nurse retrieves the medication from storage.
d. read the label aloud for verification against the order from the surgeon.

 

 

ANS:  D

It is best to read the label aloud to ensure that both individuals are verifying the contents against the verbal order from the surgeon. Unused portions of medication should not be saved for use in another procedure. All medication during an operative procedure must remain sterile. The circulating (nonsterile) nurse retrieves the medication from storage.

 

DIF:    Cognitive Level: Application          REF:   p. 155            OBJ:   8

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity

 

  1. The mother of a 6-year-old child informs the school nurse that the child is allergic to insect stings and requires an EpiPen. If the child is stung by an insect while in school, the nurse must:
a. hold the EpiPen perpendicularly against the thigh and activate.
b. provide additional care in the nurses office prior to sending the child back to class.
c. call the physician prior to administration.
d. provide a second dose within 2 minutes following initial dose.

 

 

ANS:  A

When held perpendicularly against the thigh and activated, the needle of the EpiPen penetrates the skin and a single dose of epinephrine is injected into the muscle. Once the epinephrine is administered, the person should go to a hospital emergency department because additional treatment may be necessary. The physician does not have to be notified prior to administration. A second dose should not be provided at this time.

 

DIF:    Cognitive Level: Application          REF:   p. 144            OBJ:   6

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

MULTIPLE RESPONSE

 

  1. Which principle(s) is/are correct for mixing insulin? (Select all that apply.)
a. Insulin orders and calculations must be checked with another nurse.
b. Air is injected into the vial of the shorter acting insulin first.
c. The longer acting insulin is drawn up first.
d. The nurse must verify the compatibility of the insulin types.
e. Withdraw the shorter acting insulin first.

 

 

ANS:  A, D, E

Two nurses should verify orders and prepared insulin amounts to prevent inaccuracy in administration. When two medications are mixed in the same syringe, compatibility must be determined. The shorter acting insulin is withdrawn first and air is injected into the longer acting insulin first.

 

DIF:    Cognitive Level: Application          REF:   p. 153            OBJ:   9

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. Which risk factor(s) should be considered when administering medications by injection? (Select all that apply.)
a. Trauma at the site of the needle puncture
b. Possibility of infection
c. Irretrievability of the medication once administered
d. Delayed absorption
e. Delayed onset of action
f. Chance of allergic reaction

 

 

ANS:  A, B, C, F

Injecting medications involves risk for trauma, infection, and allergic reaction and increases the difficulty of treating adverse reactions or errors because of the inability to retrieve the medication. Delayed absorption and onset of action are not risks of injecting medications.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 140            OBJ:   N/A

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. When preparing parenteral medications, the nurse should perform which intervention(s)? (Select all that apply.)
a. Check the expiration date.
b. Use sterile technique throughout the entire procedure.
c. Check the drug dose form ordered against the source available.
d. Prepare the drug in a clean well lighted area.
e. Check calculations.

 

 

ANS:  A, C, D, E

The standard procedure for preparing all parenteral medications includes checking the expiration date on the medication container, checking the drug dose form ordered against the source available, preparing the drug in a clean well lighted area, and checking calculations for accuracy. Aseptic technique is used at times during preparation. The primary rule is sterile to sterile and unsterile to unsterile.

 

DIF:    Cognitive Level: Application          REF:   p. 150            OBJ:   8

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

Chapter 20: Drugs Used for Pain Management

Test Bank

 

MULTIPLE CHOICE

 

  1. The nurse is completing an assessment on a nonverbal adult patient. Which type of pain scale assessment tool is the most accurate to use?
a. TPPPS
b. FLACC
c. POCIS
d. MOPS

 

 

ANS:  B

The Face, Legs, Activity, Cry, Consolability (FLACC) scale would be used to assess pain in the nonverbal patient. The Toddler Preschooler Postoperative Pain Scale (TPPPS), Pain Observation Scale for Young Children (POCIS), and Modified Objective Pain Scale (MOPS) would not be appropriate for this patient.

 

DIF:    Cognitive Level: Application          REF:   p. 314            OBJ:   2

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. Which action will the nurse take when a patient receiving morphine sulfate via percutaneous coronary angioplasty (PCA) has a shallow, irregular respiratory rate of 6 breaths/min?
a. Elevate the patients head of bed to facilitate lung expansion.
b. Increase the patients primary intravenous (IV) flow rate.
c. Complete the FLACC scale.
d. Notify the health care provider and prepare to administer naloxone (Narcan).

 

 

ANS:  D

The patient is exhibiting signs of respiratory depression. Administration of the antidote naloxone would be the most appropriate nursing intervention. Lung expansion or increasing the primary IV infusion rate would not relieve respiratory depression. Assessing the patients pain at this point is a lesser priority than treating the respiratory depression.

 

DIF:    Cognitive Level: Application          REF:   p. 326            OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. Which patient assessment would indicate to the nurse that salicylate toxicity is occurring?
a. Gastrointestinal (GI) bleeding
b. Increased bleeding times
c. Tinnitus
d. Occasional nausea

 

 

ANS:  C

Symptoms of salicylism include ringing in the ears (tinnitus), impaired hearing, dimming of vision, sweating, fever, lethargy, dizziness, mental confusion, nausea, and vomiting. Although salicylates may cause GI bleeding over time, it is not a symptom associated with toxicity. Increased bleeding time is an effect associated with the treatment of clots. Occasional nausea is a common adverse effect of treatment with salicylates; it is not a sign of toxicity.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 330            OBJ:   6

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. What is the advantage of taking a nonsteroidal anti inflammatory drug (NSAID) that is a COX 2 inhibitor?
a. The medication is cheaper than aspirin.
b. There are fewer GI adverse effects.
c. They are more effective than COX 1 inhibitors.
d. They have no known adverse effects.

 

 

ANS:  B

COX 2 inhibitor NSAIDs have fewer GI adverse effects than salicylates or COX 1 inhibitors. Aspirin is one of the least expensive analgesics available. The anti inflammatory actions of NSAIDs are caused by COX 2 inhibition; the unwanted adverse effects are caused by inhibition of COX 1. All these medications have adverse effects.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 335            OBJ:   9

TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. An 86 year old patient who was admitted with GI bleeding as a result of salicylate therapy is being discharged. As the nurse reviews the discharge medication list, the patient states that she doesnt understand why Tylenol doesnt work as well as the aspirin she had been taking. What would be the nurses best response?
a. Tylenol and aspirin are chemically the same drug.
b. Tylenol is appropriate for only minor pain.
c. Tylenol does not help with inflammatory discomfort.
d. A therapeutic blood level must be established with Tylenol.

 

 

ANS:  C

Acetaminophen (Tylenol) is effective as an analgesic or antipyretic. Tylenol does not possess any anti inflammatory activity and is therefore ineffective in relieving symptoms related to inflammation. Tylenol and aspirin are distinctly different drugs. Tylenol can be useful in the relief of moderate pain. Tylenol can be effective in a single dose, without needing treatment over a period of time.

 

DIF:    Cognitive Level: Application          REF:   p. 329            OBJ:   7

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

 

  1. What term is used to define an awareness of pain?
a. Tolerance
b. Threshold
c. Perception
d. Sensation

 

 

ANS:  C

Pain perception, also known as nociception, is an individuals awareness of the feeling of pain. Pain tolerance is an individuals ability to endure pain. Pain threshold is the point at which an individual first acknowledges or interprets a sensation as being painful. Pain is a sensation characterized by a group of unpleasant perceptual and emotional experiences that trigger autonomic, psychological, and somatomotor responses.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 310            OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. Which statement is true about neuropathic pain?
a. This pain is the result of a stimulus to pain receptors.
b. Patients describe it as dull and aching.
c. It commonly originates in the abdominal region.
d. The pain is a result of nerve injury.

 

 

ANS:  D

Neuropathic pain results from injury to the peripheral or central nervous system, such as trigeminal neuralgia. Nociceptive pain is the result of a stimulus to pain receptors. Nociceptive pain is usually described as dull and aching. Visceral pain originates from the abdominal and thoracic regions.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 311            OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. How long after the administration of a parenteral pain medication will the nurse complete the next pain assessment to evaluate the effectiveness of the medication?
a. 10 minutes
b. 30 minutes
c. 1 hour
d. 2 hours

 

 

ANS:  B

Evaluation of pain effectiveness of parenteral pain medications needs to occur within 15 to 30 minutes of administration. Ten minutes, 1 hour, and 2 hours are not accurate time frames to evaluate the effectiveness of parenteral medications.

 

DIF:    Cognitive Level: Application          REF:   p. 314            OBJ:   2

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. Which sign or symptom displayed by a patient would be indicative of opiate withdrawal?
a. Bradycardia
b. Diarrhea
c. Lethargy
d. Hypothermia

 

 

ANS:  B

Symptoms of opiate withdrawal include muscular spasms; severe aches in the back, abdomen, and legs; abdominal and muscle cramps; hot and cold flashes; insomnia; nausea, vomiting, and diarrhea; severe sneezing; and increases in body temperature, blood pressure, and respiratory and heart rates. Bradycardia is not a sign of opiate withdrawal; increased heart rate is a sign of opiate withdrawal. Lethargy is not a sign of opiate withdrawal; restlessness is a sign of opiate withdrawal. Hypothermia is not a sign of opiate withdrawal; fever is a sign of opiate withdrawal.

 

DIF:    Cognitive Level: Application          REF:   p. 323            OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. Which medication is contraindicated when a patient is taking warfarin (Coumadin)?
a. Aspirin
b. Acetaminophen (Tylenol)
c. Propoxyphene (Darvon)
d. Morphine (Roxanol)

 

 

ANS:  A

Salicylates enhance the anticoagulant effect of warfarin. Acetaminophen, propoxyphene, and morphine are not contraindicated with warfarin use.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 333            OBJ:   6

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

  1. What is the best way for the nurse to evaluate the effectiveness of the patients opiate agonist?
a. Ability of the patient to tolerate more activity
b. Increased sleep time throughout the night
c. Reduction of respiratory rate from 24 to 18 breaths/min
d. Verbal report of 2 on a 1 to 10 scale

 

 

ANS:  D

A verbal report is the best indicator because pain is individually perceived and using a pain rating scale is a consistent manner of assessment. Toleration of activity and an increased sleep pattern are not the most accurate methods of pain evaluation. Reduction of respiratory rate is not an appropriate measurement of pain control.

 

DIF:    Cognitive Level: Application          REF:   p. 314            OB

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