Basic Pharmacology for Nurses 17th Ed by Clayton Willihnganz-Test Bank

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Basic Pharmacology for Nurses 17th Ed by Clayton Willihnganz-Test Bank

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WITH ANSWERS
Basic Pharmacology for Nurses 17th Ed by Clayton Willihnganz-Test Bank

Chapter 02: Basic Principles of Drug Action and Drug Interactions

Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition

 

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:   Page 17          OBJ:   4

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  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: Knowledge          REF:   Page 18          OBJ:   4

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education; Clinical Judgment; Caregiving; Safety; Sensory Perception

 

  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:   Page 18          OBJ:   5

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Safety; Patient Education; Clinical Judgment

 

  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:   Page 19          OBJ:   6

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Safety; Patient Education

 

  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:   Page 17          OBJ:   4

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  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:   Page 15          OBJ:   3

TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education; Clinical Judgment; Safety

 

  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:   Page 17          OBJ:   3

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education; Clinical Judgment; Safety

 

  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:   Page 15          OBJ:   2

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Elimination; Health Promotion

 

  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:   Page 19          OBJ:   6

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  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:   Page 18          OBJ:   4

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education; Clinical Judgment; Safety

 

  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:   Page 16          OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education; Clinical Judgment; Safety

 

  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:   Page 14          OBJ:   1

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education; Clinical Judgment; Safety

 

  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:   Page 18          OBJ:   5 | 6

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education; Clinical Judgment; Safety

 

MULTIPLE RESPONSE

 

  1. Which statement(s) about liberation of drugs is/are true? (Select all that apply.)
a. A drug must be dissolved in body fluids before it can be absorbed into body tissues.
b. A solid drug taken orally must disintegrate and dissolve in GI fluids to allow for absorption into the bloodstream for transport to the site of action.
c. The process of converting the drug into a soluble form can be controlled to a certain degree by the dosage form.
d. Converting the drug to a soluble form can be influenced by administering the drug with or without food in the 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:   Page 14          OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education; Clinical Judgment; Safety

 

  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:   Page 15          OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education; Clinical Judgment; Safety; Elimination

 

  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:   Page 14          OBJ:   1 | 3

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education; Clinical Judgment; Safety

 

  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:   Page 15          OBJ:   2 | 3 | 7

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

NOT:  CONCEPT(S): Patient Education; Clinical Judgment; Safety

 

  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:   Page 16 | Page 17

OBJ:   5 | 6 | 7           TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education; Clinical Judgment; Safety

 

  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:   Page 16 | Page 17

OBJ:   7                    TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education; Clinical Judgment; Safety

 

COMPLETION

 

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

 

ANS:

50

 

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

 

DIF:    Cognitive Level: Analysis               REF:   Page 15          OBJ:   2 | 3

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

Chapter 10: Parenteral Administration: Intradermal, Subcutaneous, and Intramuscular Routes

Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition

 

MULTIPLE CHOICE

 

  1. The nurse is educating a patient about diabetes. Based on recommendations from the American Diabetes Association, which statement by the nurse is best regarding site rotation?
a. Insulin injection sites should always be in the abdomen to ensure absorption into the stomach.
b. It is important to rotate injection sites systematically within one area before progressing to a new site for injection.
c. Following exercise, site rotation is not indicated because the circulation in the muscles will absorb the medication efficiently.
d. If you aspirate, site rotation can be done every other day to avoid developing problems with absorption.

 

 

ANS:  B

The American Diabetes Association Clinical Practice recommendations include rotating injections systematically at one site before progressing to another. Insulin is not absorbed into the stomach. Failure to rotate sites can result in lipohypertrophy or lipoatrophy. When subcutaneous (subcut) insulin is administered, aspiration should never be performed.

 

DIF:    Cognitive Level: Application          REF:   Page 132        OBJ:   2

TOP:   Nursing Process Step: Implementation

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

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education

 

  1. Which technique by the nurse is accurate when administering heparin to a thin, older adult patient?
a. Aspirate before injecting the medication.
b. Inject at a 45-degree angle.
c. Inject at a 90-degree angle.
d. Massage site following injection.

 

 

ANS:  B

For thin individuals, the skin may need to be pinched and a 45-degree angle used to avoid administration into the muscle. Heparin should never be aspirated. Subcut injections are properly administered at a 45-degree angle. The injection site of heparin should never be massaged.

 

DIF:    Cognitive Level: Application          REF:   Page 136        OBJ:   2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Development

 

  1. The nurse is preparing to administer kindergarten immunizations at the local health clinic. Which anatomic site would be best for the injection of the immunizations containing 0.5 mL?
a. Rectus femoris
b. Dorsogluteal
c. Deltoid
d. Ventrogluteal

 

 

ANS:  C

The deltoid muscle is often used because of its easy access and the fact that it can tolerate 0.5 mL of medication volume. Having the child disrobe is not efficient in this setting.

 

DIF:    Cognitive Level: Application          REF:   Page 138 | Page 139

OBJ:   5                    TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Development

 

  1. A 65-year-old man who weighs 180 lb (81.8 kg) is to receive 1.5 mL of a viscous antibiotic by intramuscular (IM) injection. Which needle and syringe will be used?
a. 5/8 inch, 25-gauge needle with 5 mL syringe
b. 1 inch, 28-gauge needle with 4 mL syringe
c. 1 inch, 21-gauge needle with 3 mL syringe
d. 3 inch, 16-gauge needle with 1.5 mL syringe

 

 

ANS:  C

It is important to correlate the syringe size to the size of the patient and the tissue mass. The usual amount injected intramuscularly is 0.5 to 2 mL. Needle lengths commonly used for adults are 1 to 1 inches long. A longer needle may be used for a significantly obese adult. Commonly used needle gauges for IM injections are 20 to 22 gauge. A 5/8 inch, 25-gauge needle is too short and too small to administer a viscous medication. A 1 inch, 28-gauge needle is too small to administer a viscous medication. A 3 inch, 16-gauge needle is too large and too long to administer medication to a patient this size.

 

DIF:    Cognitive Level: Application          REF:   Page 136        OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. Which is the preferred IM site for injecting a 6-month-old child?
a. Dorsogluteal
b. Abdominal
c. Vastus lateralis
d. Deltoid muscle

 

 

ANS:  C

The vastus lateralis is generally the preferred IM site in infants because it has the largest muscle mass for that age group. The muscles are not well developed in other areas for this age group. The dorsogluteal muscle is not developed well enough in a child this age to provide a safe site for injection. The abdominal muscles are not appropriate for IM injection. The deltoid muscle is not developed well enough in a child this age to provide a safe site for injection.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 137        OBJ:   5

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Development

 

  1. Which angle is appropriate when administering an IM medication in the dorsogluteal site to a 46-year-old obese man?
a. 45 degrees
b. 60 degrees
c. 75 degrees
d. 90 degrees

 

 

ANS:  D

A 90-degree angle is used to reach the IM area of the dorsogluteal site. A 45-, 60-, or 75-degree angle does not ensure that the needle will penetrate to the muscle in an obese patient.

 

DIF:    Cognitive Level: Application          REF:   Page 138        OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. Which parenteral route has the longest absorption time?
a. Intradermal
b. Subcut
c. IM
d. Intravenous (IV)

 

 

ANS:  A

Absorption rate is determined by the proximity of the medication to the vascular system. Medication injected into an intradermal site is farther away from the vascular system than the other sites. Therefore, absorption in this site is the slowest. Subcut tissue is more vascular than intradermal tissue. IM tissue is more vascular than intradermal tissue. IV administration places medication directly into the vascular system.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 132        OBJ:   1

TOP:   Nursing Process Step: Assessment

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

NOT:  CONCEPT(S): Clinical Judgment; Safety; Care Coordination

 

  1. Which site is identified by the posterior superior iliac spine and greater trochanter?
a. Ventrogluteal
b. Dorsogluteal
c. Vastus lateralis
d. Rectus femoris

 

 

ANS:  B

The dorsogluteal site is identified by drawing an imaginary line from the posterior superior iliac spine to the greater trochanter of the femur. The injection is then administered at any point between the imaginary straight line and below the curve of the iliac crest (hipbone).

 

DIF:    Cognitive Level: Comprehension   REF:   Page 138        OBJ:   4

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment

 

  1. Which nursing action is accurate when administering an IM injection using the Z track method?
a. Use a 1-inch needle.
b. Add 0.5 mL of air to the syringe.
c. Vigorously massage the injection site.
d. Pinch up the skin.

 

 

ANS:  B

Adding 0.5 mL of air ensures that the drug will clear the needle. A 1-inch needle may not ensure deep muscle penetration. Massaging the injection site could cause the medication to leak into the muscle tissue. The skin should be stretched, not pinched up.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 140        OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment

 

  1. Which gauge needles are used for subcut injections?
a. 14 to 16 gauge
b. 18 to 21 gauge
c. 22 to 24 gauge
d. 25 to 29 gauge

 

 

ANS:  D

Commonly used gauges for subcut injection are 25 to 29 gauge. Needles that are 14 to 16 gauge are used for administration of blood or large volumes of fluid in a short period of time. Needles that are 18 to 21 gauge are used for routine parenteral fluid administration. Needles that are 22 to 24 gauge are used for administering fluids or medication via small veins.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 135        OBJ:   2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. When is it acceptable to use the deltoid muscle as an injection site for infants?
a. Medication is irritating.
b. Dose is a long-acting medication.
c. Child is combative.
d. Volume is quite small.

 

 

ANS:  D

The deltoid site should be used in infants only when the volume is quite small, the medication is nonirritating, and the dose will be quickly absorbed. Irritating and long-acting medications should be injected in deep muscle tissue such as the vastus lateralis. A combative child should be adequately restrained and injected in a fairly large muscle mass.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 138        OBJ:   5

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. Which action by the nurse is most accurate when administering an intradermal injection?
a. Insert the needle at a 45-degree angle.
b. Inject 0.1 mL.
c. Use a 22-gauge needle.
d. Wipe the site with alcohol after injection.

 

 

ANS:  B

Small volumes, usually 0.1 mL, are injected. The needle is inserted at a 15-degree angle. A 26-gauge needle is used. After injection, the site should not be wiped with alcohol.

 

DIF:    Cognitive Level: Application          REF:   Page 133        OBJ:   1

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. Which assessment by the nurse is most important to obtain prior to performing allergy sensitivity testing?
a. Identify areas of loose connective tissue.
b. Question the patient about frequency of exercise.
c. Determine if the patient is using aspirin.
d. Palpate and measure the size of induration.

 

 

ANS:  C

It is important to determine if the patient has taken any antihistamines or anti-inflammatory agents for 24 to 48 hours prior to allergy testing. Loose connective tissue is assessed prior to administering injections subcutaneously. Exercise routine is not significant prior to allergy testing. Palpation and measurement of the size of induration are done after the procedure.

 

DIF:    Cognitive Level: Application          REF:   Page 132        OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. The nurse administers a skin prick test (SPT) to a patient at 9:00 AM. The earliest time the nurse can expect to read the test is
a. the next day at 9:00 AM.
b. by 9:00 PM the same day.
c. by 9:10 AM the same day.
d. one week from the date and time of administration.

 

 

ANS:  C

The SPT can be read in 10 to 20 minutes after administration, depending on protocol.

 

DIF:    Cognitive Level: Application          REF:   Page 134        OBJ:   1

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Care Coordination

 

  1. The nurse cleansing the skin surface of a patient prior to injection will start at the
a. periphery and work inward in a back and forth motion.
b. periphery and work inward in a cyclical motion.
c. injection site and work outward in a straight line.
d. injection site and work outward in a circular motion.

 

 

ANS:  D

The skin surface is cleansed prior to injection starting at the injection site and working outward in a circular motion toward the periphery.

 

DIF:    Cognitive Level: Application          REF:   Page 139        OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Infection

 

MULTIPLE RESPONSE

 

  1. The nurse is preparing to administer allergy sensitivity testing to a patient. Which statement(s) pertain(s) to this type of administration? (Select all that apply.)
a. Allergy sensitivity testing requires the intradermal route.
b. Injections are made into the loose connective tissue.
c. Equipment needed includes gloves, antiseptic pledget, metric ruler, and physicians order sheet.
d. Record of previous injection sites is needed.
e. The needle should be inserted at a 15-degree angle with the needle bevel up.

 

 

ANS:  A, C, E

Allergy sensitivity testing requires the intradermal route. Before administering allergy testing, gathering of equipment and physicians orders are necessary. This route is injected into the dermal layer of skin, using a 15-degree angle. Connective tissue, having poor blood supply, is not appropriate for injection of medication. Previous injection sites would not factor into the decision about where to conduct allergy testing.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 132        OBJ:   1

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. Which statement(s) about administering medications parenterally is/are true? (Select all that apply.)
a. Subcut absorption is slower than intradermal absorption.
b. Two mL or less should be administered in a subcut site.
c. The gluteal area is recommended for children.
d. Needles 1 to 1 inches in length are common for IM injections.
e. The scapular areas of the back may be used for intradermal injections.

 

 

ANS:  B, D, E

No more than 2 mL of medication should be injected into a subcut site. Needle length of 1 to 1 inches is common for IM injections. The upper chest, scapular areas of the back, and the inner aspect of the forearms are commonly used as sites for intradermal injections. Subcutaneous absorption is faster than intradermal absorption. Because of the undeveloped muscle mass in children, the gluteal area is not recommended for IM injection.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 132        OBJ:   1 | 2 | 3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety

 

  1. The vastus lateralis muscle is appropriate for injections for which patient(s)? (Select all that apply.)
a. Children younger than 3 years of age
b. Elderly
c. Debilitated
d. Nonambulatory
e. Ambulatory
f. Healthy

 

 

ANS:  A, E, F

Children younger than 3 years of age, ambulatory patients, and otherwise healthy patients may receive injections in the vastus lateralis. Elderly, debilitated, and nonambulatory patients may have reduced muscle mass in the vastus lateralis and therefore poor absorption of injected medications.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 132 | Page 134

OBJ:   4 | 5                TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Development

 

  1. The nurse administers B12 IM to a patient in a long-term care facility. After administering this medication, the nurse will (Select all that apply.)
a. carefully recap the needle.
b. identify the patient.
c. massage site of injection.
d. dispose of the used needle according to policy.
e. apply a small bandage to the site.

 

 

ANS:  D, E

After administering an IM injection, the nurse should dispose of used needles according to policy and apply a small bandage to the site. Needles should never be recapped following use. The patient requires identification before the injection is given. After the needle is removed, gentle pressure should be applied to the site. Massage can increase the pain if the muscle mass is stressed by the amount of medication given.

 

DIF:    Cognitive Level: Application          REF:   Page 136 | Page 137

OBJ:   3                    TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment| NCLEX Client Needs Category: Physiological Integrity                    NOT:  CONCEPT(S): Clinical Judgment; Safety

Chapter 20: Introduction to Cardiovascular Disease and Metabolic Syndrome

Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition

 

MULTIPLE CHOICE

 

  1. A patient with a body mass index (BMI) of 25 would be considered to be in which weight category?
a. Underweight
b. Normal weight
c. Overweight
d. Obese

 

 

ANS:  C

A BMI of less than 18.5 is considered underweight. A BMI of 18.5 to 24.9 is considered normal weight. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 to 34.9 is considered obesity, class I; 35 to 39.9 is considered obesity, class II; and more than 40 is considered extreme obesity.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 319        OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Nutrition; Health Promotion

 

  1. What is the most critical approach to the treatment of metabolic syndrome?
a. Psychotherapy
b. Pharmacotherapy
c. Lifestyle management
d. Patient education

 

 

ANS:  C

Lifestyle management is critical for managing metabolic syndrome; other approaches will not be effective without it. Psychotherapy, pharmacotherapy, and patient education are not the most critical approaches to treating metabolic syndrome.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 317 | Page 320

OBJ:   2                    TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Nutrition; Health Promotion

 

  1. Healthy diets should include no more than which percentage of saturated fat based on total calories?
a. 30%
b. 10%
c. 7%
d. 2%

 

 

ANS:  C

A healthy diet should have no more than 7% of calories from saturated fat. A diet with 30% or 10% saturated fat would not be considered a healthy diet. A diet can have up to 7% saturated fat before it is considered unhealthy.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 320        OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Nutrition; Health Promotion

 

  1. Which ethnic group or gender is at greatest risk for developing metabolic syndrome?
a. Hispanic women
b. Asian men
c. African American men
d. White women

 

 

ANS:  A

Hispanic women have the highest incidence rate of metabolic syndrome at 27%. Asian men, African American men, and white women are not at the highest risk for metabolic syndrome.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 318        OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Nutrition; Health Promotion

 

  1. What is the incidence of metabolic syndrome in the United States?
a. 1 in 3000
b. 1 in 300
c. 1 in 30
d. 1 in 3

 

 

ANS:  D

The incidence of metabolic syndrome in the United States is 1 in 3, or about 50 million adults. One in 3000, 1 in 300, and 1 in 30 are each less than the incidence of metabolic syndrome in the United States.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 318        OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Nutrition; Health Promotion

 

  1. Which is the mechanism of action demonstrated by exercise in managing blood glucose levels?
a. Exercise causes release of glucose and promotes a reduced blood glucose level.
b. Exercise on a regular basis causes a reduction in lean body mass, which helps regulate blood glucose levels.
c. Increased muscle mass and less fat tends to normalize blood glucose levels because glucose is used by muscle cells when exercising.
d. Exercise stimulates the liver, the primary storage and utilization site of glucose, to release glucose.

 

 

ANS:  C

Exercise leads to more muscle and less fat, so blood glucose levels tend to return to normal. Exercise increases the rate of glucose uptake in the contracting skeletal muscles. Exercise on a regular basis prevents reduction in lean body mass and protein wasting. The liver is not the primary storage and utilization site of glucose.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 321        OBJ:   3

TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Nutrition; Health Promotion

 

  1. Which instruction by the nurse is accurate to include in a patients care to manage metabolic syndrome?
a. Encourage the client to exercise 20 minutes every day.
b. Eliminate alcohol intake.
c. Increase simple carbohydrates in the diet.
d. Reduce stress.

 

 

ANS:  D

Stress reduction is important in the management of metabolic syndrome. Twenty minutes of exercise is not adequate. Alcohol intake needs to be restricted but does not have to be eliminated. Complex carbohydrates are appropriate in the management of metabolic syndrome.

 

DIF:    Cognitive Level: Application          REF:   Page 320        OBJ:   2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Nutrition; Health Promotion; Patient Education

 

MULTIPLE RESPONSE

 

  1. What lifestyle choice(s) may aggravate metabolic syndrome? (Select all that apply.)
a. Excessive tobacco smoking
b. Inadequate hydration
c. Excessive exercise
d. Inadequate caloric intake
e. Excessive consumption of alcohol

 

 

ANS:  A, E

Smoking and excessive consumption of alcohol may aggravate metabolic syndrome. Metabolic syndrome is not directly affected by inadequate hydration. Metabolic syndrome is directly affected by a sedentary lifestyle, not excessive exercise. Metabolic syndrome is directly affected by increased, not inadequate, caloric intake.

 

DIF:    Cognitive

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