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Pharmacology And the Nursing Process, 8th Edition by Linda Lane Lilley Test Bank
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Pharmacology And the Nursing Process, 8th Edition by Linda Lane Lilley Test Bank
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WITH ANSWERS
Pharmacology And the Nursing Process, 8th Edition by Linda Lane Lilley Test Bank
Chapter 02: Pharmacologic Principles
Lilley: Pharmacology and the Nursing Process, 8th Edition
MULTIPLE CHOICE
- The patient is receiving two different drugs. At current dosages and dosage forms, both drugs are absorbed into the circulation in identical amounts. Which term is used to identify this principle?
| a. | Bioequivalent |
| b. | Synergistic |
| c. | Prodrugs |
| d. | Steady state |
ANS: A
Two drugs absorbed into the circulation in the same amount (in specific dosage forms) have the same bioavailability; thus, they are bioequivalent. A drugs steady state is the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed from each dose. The term synergistic refers to two drugs, given together, with a resulting effect that is greater than the sum of the effects of each drug given alone. A prodrug is an inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 21
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- When given an intravenous medication, the patient says to the nurse, I usually take pills. Why does this medication have to be given in the arm? What is the nurses best answer?
| a. | The medication will cause fewer adverse effects when given intravenously. |
| b. | The intravenous medication will have delayed absorption into the bodys tissues. |
| c. | The action of the medication will begin sooner when given intravenously. |
| d. | There is a lower chance of allergic reactions when drugs are given intravenously. |
ANS: C
An intravenous (IV) injection provides the fastest route of absorption. The IV route does not affect the number of adverse effects, nor does it cause delayed tissue absorption (it results in faster absorption). The IV route does not affect the number of allergic reactions.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 22
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs?
| a. | Parenteral drugs bypass the first-pass effect. |
| b. | Absorption of parenteral drugs is affected by reduced blood flow to the stomach. |
| c. | Absorption of parenteral drugs is faster when the stomach is empty. |
| d. | Parenteral drugs exert their effects while circulating in the bloodstream. |
ANS: A
Drugs given by the parenteral route bypass the first-pass effect. Reduced blood flow to the stomach and the presence of food in the stomach apply to enteral drugs (taken orally), not to parenteral drugs. Parenteral drugs must be absorbed into cells and tissues from the circulation before they can exert their effects; they do not exert their effects while circulating in the bloodstream.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 22
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- When monitoring the patient receiving an intravenous infusion to reduce blood pressure, the nurse notes that the patients blood pressure is extremely low, and the patient is lethargic and difficult to awaken. This would be classified as which type of adverse drug reaction?
| a. | Adverse effect |
| b. | Allergic reaction |
| c. | Idiosyncratic reaction |
| d. | Pharmacologic reaction |
ANS: D
A pharmacologic reaction is an extension of a drugs normal effects in the body. In this case, the antihypertensive drug lowered the patients blood pressure levels too much. The other options do not describe a pharmacologic reaction. An adverse effect is a predictable, well-known adverse drug reaction that results in minor or no changes in patient management. An allergic reaction (also known as a hypersensitivity reaction) involves the patients immune system. An idiosyncratic reaction is unexpected and is defined as a genetically determined abnormal response to normal dosages of a drug.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 32
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drugs half-life?
| a. | The time it takes for the drug to cause half of its therapeutic response |
| b. | The time it takes for one half of the original amount of a drug to reach the target cells |
| c. | The time it takes for one half of the original amount of a drug to be removed from the body |
| d. | The time it takes for one half of the original amount of a drug to be absorbed into the circulation |
ANS: C
A drugs half-life is the time it takes for one half of the original amount of a drug to be removed from the body. It is a measure of the rate at which drugs are removed from the body. The other options are incorrect definitions of half-life.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 27
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these?
| a. | The time it takes for a drug to elicit a therapeutic response |
| b. | The amount of time needed to remove a drug from circulation |
| c. | The time it takes for a drug to achieve its maximum therapeutic response |
| d. | The time period at which a drugs concentration is sufficient to cause a therapeutic response |
ANS: D
Duration of action is the time during which drug concentration is sufficient to elicit a therapeutic response. The other options do not define duration of action. A drugs onset of action is the time it takes for the drug to elicit a therapeutic response. A drugs peak effect is the time it takes for the drug to reach its maximum therapeutic response. Elimination is the length of time it takes to remove a drug from circulation.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 28
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction. Which of these processes describes selective enzyme interaction?
| a. | The drug alters cell membrane permeability. |
| b. | The drugs effectiveness within the cell walls of the target tissue is enhanced. |
| c. | The drug is attracted to a receptor on the cell wall, preventing an enzyme from binding to that receptor. |
| d. | The drug binds to an enzyme molecule and inhibits or enhances the enzymes action with the normal target cell. |
ANS: D
With selective enzyme interaction, the drug attracts the enzymes to bind with the drug instead of allowing the enzymes to bind with their normal target cells. As a result, the target cells are protected from the action of the enzymes. This results in a drug effect. The actions described in the other options do not occur with selective enzyme interactions.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 29
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patients albumin levels are normal, the nurse would expect which result, as compared to a medication that is not highly protein bound?
| a. | Renal excretion will be faster. |
| b. | The drug will be metabolized quickly. |
| c. | The duration of action of the medication will be shorter. |
| d. | The duration of action of the medication will be longer. |
ANS: D
Drugs that are bound to plasma proteins are characterized by longer duration of action. Protein binding does not make renal excretion faster, does not speed up drug metabolism, and does not cause the duration of action to be shorter.
DIF: COGNITIVE LEVEL: Applying (Application) REF: pp. 24-25
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the nurse instruct the patient to place the tablet?
| a. | Under the tongue |
| b. | On top of the tongue |
| c. | At the back of the throat |
| d. | In the space between the cheek and the gum |
ANS: A
Drugs administered via the sublingual route are placed under the tongue. Drugs administered via the buccal route are placed in the space between the cheek and the gum; oral drugs are swallowed. The other options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 22
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase?
| a. | Absorption |
| b. | Distribution |
| c. | Metabolism |
| d. | Excretion |
ANS: D
The kidneys are the organs that are most responsible for drug excretion. Renal function does not affect the absorption and distribution of a drug. Renal function may affect metabolism of drugs to a small extent.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 26
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- A patient who has advanced cancer is receiving opioid medications around the clock to keep him comfortable as he nears the end of his life. Which term best describes this type of therapy?
| a. | Palliative therapy |
| b. | Maintenance therapy |
| c. | Empiric therapy |
| d. | Supplemental therapy |
ANS: A
The goal of palliative therapy is to make the patient as comfortable as possible. It is typically used in the end stages of illnesses when all attempts at curative therapy have failed. Maintenance therapy is used for the treatment of chronic illnesses such as hypertension. Empiric therapy is based on clinical probabilities and involves drug administration when a certain pathologic condition has an uncertain but high likelihood of occurrence based on the patients initial presenting symptoms. Supplemental (or replacement therapy) supplies the body with a substance needed to maintain normal function.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 30
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The patient is complaining of a headache and asks the nurse which over-the-counter medication form would work the fastest to help reduce the pain. Which medication form will the nurse suggest?
| a. | A capsule |
| b. | A tablet |
| c. | An enteric-coated tablet |
| d. | A powder |
ANS: D
Of the types of oral medications listed, the powder form would be absorbed the fastest, thus having a faster onset. The tablet, the capsule, and, finally, the enteric-coated tablet would be absorbed next, in that order.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 20
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse will be injecting a drug into the fatty tissue of the patients abdomen. Which route does this describe?
| a. | Intradermal |
| b. | Subcutaneous |
| c. | Intramuscular |
| d. | Transdermal |
ANS: B
Injections into the fatty subcutaneous tissue under the dermal layer of skin are referred to as subcutaneous injections. Injections under the more superficial skin layers immediately underneath the epidermal layer of skin and into the dermal layer are known as intradermal injections. Injections into the muscle beneath the subcutaneous fatty tissue are referred to as intramuscular injections. Transdermal drugs are applied to the skin via an adhesive patch.
DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 24
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
MULTIPLE RESPONSE
- Which drugs would be affected by the first-pass effect? (Select all that apply.)
| a. | Morphine given by IV push injection |
| b. | Sublingual nitroglycerin tablets |
| c. | Diphenhydramine (Benadryl) elixir |
| d. | Levothyroxine (Synthroid) tablets |
| e. | Transdermal nicotine patches |
| f. | Esomeprazole (Nexium) capsules |
| g. | Penicillin given by IV piggyback infusion |
ANS: C, D, F
Orally administered drugs (elixirs, tablets, capsules) undergo the first-pass effect because they are metabolized in the liver after being absorbed into the portal circulation from the small intestine. IV medications (IV push and IV piggyback) enter the bloodstream directly and do not go directly to the liver. Sublingual tablets and transdermal patches also enter the bloodstream without going directly to the liver, thus avoiding the first-pass effect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 24
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
COMPLETION
- A drug dose that delivers 250 mg has a half-life of 5 hours. Identify how much drug will remain in the body after one half-life. _______
ANS:
125 mg
A drugs half-life is the time required for one half of an administered dose of a drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced by 50%. Therefore, one half of 250 mg equals 125 mg.
DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 14: Antiepileptic Drugs
Lilley: Pharmacology and the Nursing Process, 8th Edition
MULTIPLE CHOICE
- The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing?
| a. | Levetiracetam (Keppra) |
| b. | Phenobarbital |
| c. | Valproic acid (Depakote) |
| d. | Gabapentin (Neurontin) |
ANS: B
Phenobarbital has the longest half-life of all standard AEDs, including those listed in the other options, so it allows for once-a-day dosing.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 224
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient indicates that the patient has an adequate understanding of the instructions?
| a. | I will need to take extra care of my teeth and gums while on this medication. |
| b. | I can go out for a beer while on this medication. |
| c. | I can skip doses if the side effects bother me. |
| d. | I will be able to stop taking this drug once the seizures stop. |
ANS: A
Scrupulous dental care is necessary to prevent gingival hypertrophy during therapy with phenytoin. Alcohol and other central nervous system depressants may cause severe sedation. Consistent dosing is important to maintain therapeutic drug levels. Therapy with AEDs usually must continue for life and must not be stopped once seizures stop.
DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 225
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction?
| a. | Driving is allowed after 2 weeks of therapy. |
| b. | If seizures recur, take a double dose of the medication. |
| c. | Antacids can be taken with the AED to reduce gastrointestinal adverse effects. |
| d. | Regular, consistent dosing is important for successful treatment. |
ANS: D
Consistent dosing, taken regularly at the same time of day, at the recommended dose, and with meals to reduce the common gastrointestinal adverse effects, is the key to successful management of seizures when taking AEDs. Noncompliance is the factor most likely to lead to treatment failure.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 231
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin (Dilantin) therapy. He is to be NPO (consume nothing by mouth) for surgery in the morning. What will the nurse do about his morning dose of phenytoin?
| a. | Give the same dose intravenously. |
| b. | Give the morning dose with a small sip of water. |
| c. | Contact the prescriber for another dosage form of the medication. |
| d. | Notify the operating room that the medication has been withheld. |
ANS: C
If there are any questions about the medication order or the medication prescribed, contact the prescriber immediately for clarification and for an order of the appropriate dose form of the medication. Do not change the route without the prescribers order. There is an increased risk of seizure activity if one or more doses of the AED are missed.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 231
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse is monitoring a patient who has been taking carbamazepine (Tegretol) for 2 months. Which effects would indicate that autoinduction has started to occur?
| a. | The drug levels for carbamazepine are higher than expected. |
| b. | The drug levels for carbamazepine are lower than expected. |
| c. | The patient is experiencing fewer seizures. |
| d. | The patient is experiencing toxic effects from the drug. |
ANS: B
With carbamazepine, autoinduction occurs and leads to lower than expected drug concentrations. Therefore, the dosage may have to be adjusted with time. The other options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 226
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action is correct when administering this drug?
| a. | Give the dose as a fast intravenous (IV) bolus. |
| b. | Mix the drug with normal saline, and give it as a slow IV push. |
| c. | Mix the drug with dextrose (D5W), and give it as a slow IV push. |
| d. | Mix the drug with any available solution as long as the administration rate is correct. |
ANS: B
Intravenous phenytoin is given only with normal saline solution to prevent precipitation formation caused by incompatibilities. The IV push dose must be given slowly (not exceeding 50 mg/min in adults), and the patient must be monitored for bradycardia and decreased blood pressure.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 226
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The U.S. Food and Drug Administration has issued a warning for users of antiepileptic drugs. Based on this report, the nurse will monitor for which potential problems with this class of drugs?
| a. | Increased risk of suicidal thoughts and behaviors |
| b. | Signs of bone marrow depression |
| c. | Indications of drug addiction and dependency |
| d. | Increased risk of cardiovascular events, such as strokes |
ANS: A
In December 2008, the U.S. Food and Drug Administration (FDA) required black box warnings on all antiepileptic drugs regarding the risk of suicidal thoughts and behaviors. Patients being treated with antiepileptic drugs for any indication need to be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. The other options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 222
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition?
| a. | Diazepam (Valium) |
| b. | Midazolam (Versed) |
| c. | Valproic acid (Depakote) |
| d. | Carbamazepine (Tegretol) |
ANS: A
Diazepam (Valium) is considered by many to be the drug of choice for status epilepticus. Other drugs that are used are listed in Table 14-3 and do not include the drugs listed in the other options.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 221
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these?
| a. | The safe and the toxic plasma levels of the drug are very close to each other. |
| b. | The phenytoin has a low chance of being effective. |
| c. | There is no difference between safe and toxic plasma levels. |
| d. | A very small dosage can result in the desired therapeutic effect. |
ANS: A
Having a narrow therapeutic index means that there is a small difference between safe and toxic drug levels. These drugs require monitoring of therapeutic plasma levels. The other options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 222
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- A patient has been taking an AED for several years as part of his treatment for partial seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a week until she has a chance to go to the drugstore. What is the nurses best response?
| a. | He is taking another antiepileptic drug, so he can go without the medication for a week. |
| b. | Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away. |
| c. | He can temporarily increase the dosage of his other antiseizure medications until you get the refill. |
| d. | He can stop all medications because he has been treated for several years now. |
ANS: B
Abrupt discontinuation of antiepileptic drugs can lead to withdrawal seizures. The other options are incorrect. The nurse cannot change the dose or stop the medication without a prescribers order.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 220
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- During a routine appointment, a patient with a history of seizures is found to have a phenytoin (Dilantin) level of 23 mcg/mL. What concern will the nurse have, if any?
| a. | The patient is at risk for seizures because the drug level is not at a therapeutic level. |
| b. | The patients seizures should be under control because this is a therapeutic drug level. |
| c. | The patients seizures should be under control if she is also taking a second antiepileptic drug. |
| d. | The drug level is at a toxic level, and the dosage needs to be reduced. |
ANS: D
Therapeutic drug levels for phenytoin are usually 10 to 20 mcg/mL (see Table 14-6). The other options are incorrect.
DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 224
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
- A patient is taking gabapentin (Neurontin), and the nurse notes that there is no history of seizures on his medical record. What is the best possible rationale for this medication order?
| a. | The medication is used for the treatment of neuropathic pain. |
| b. | The medication is helpful for the treatment of multiple sclerosis. |
| c. | The medication is used to reduce the symptoms of Parkinsons disease. |
| d. | The medical record is missing the correct information about the patients history of seizures. |
ANS: A
Gabapentin (Neurontin) is commonly used to treat neuropathic pain. The other options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 227
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
MULTIPLE RESPONSE
- The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate? (Select all that apply.)
| a. | AED therapy can be stopped when seizures are stopped. |
| b. | AED therapy is usually lifelong. |
| c. | Consistent dosing is the key to controlling seizures. |
| d. | A dose may be skipped if the patient is experiencing adverse effects. |
| e. | Do not abruptly discontinue AEDs because doing so may cause rebound seizure activity. |
ANS: B, C, E
Patients need to know that AED therapy is usually lifelong, and compliance (with consistent dosing) is important for effective seizure control. Abruptly stopping AED therapy may cause withdrawal (or rebound) seizure activity.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 232
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
COMPLETION
- A 9-year-old child will be receiving carbamazepine (Tegretol) suspension, 200 mL daily. The medication is available in a strength of 100 mg/5 mL. Identify how many milliliters will the nurse give to the patient for each dose. _______
ANS:
10 mL
DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 28: Diuretic Drugs
Lilley: Pharmacology and the Nursing Process, 8th Edition
MULTIPLE CHOICE
- When monitoring a patient who has diabetes and is receiving a carbonic anhydrase inhibitor for edema, the nurse will monitor for which possible adverse effect?
| a. | Metabolic alkalosis |
| b. | Elevated blood glucose |
| c. | Hyperkalemia |
| d. | Mental alertness |
ANS: B
An undesirable effect of carbonic anhydrase inhibitors is that they elevate the blood glucose level and cause glycosuria in diabetic patients. They induce metabolic acidosis, making their usefulness limited. In addition, hypokalemia and drowsiness may occur.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 453
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics?
| a. | Hydrochlorothiazide (HydroDIURIL) |
| b. | Furosemide (Lasix) |
| c. | Acetazolamide (Diamox) |
| d. | Spironolactone (Aldactone) |
ANS: D
Spironolactone (Aldactone) is a potassium-sparing diuretic, and patients taking this drug must be monitored for signs of hyperkalemia. The other drugs do not cause hyperkalemia but instead cause hypokalemia.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 457
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse will administer this drug using which procedure?
| a. | Intravenously, through a filter |
| b. | By rapid intravenous bolus |
| c. | By mouth in a single morning dose |
| d. | Through a gravity intravenous drip with standard tubing |
ANS: A
Mannitol is administered via intravenous infusion through a filter because of possible crystallization. It is not available in oral form. The other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 456
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- Furosemide (Lasix) is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct?
| a. | Take this medication in the evening. |
| b. | Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates. |
| c. | If you experience weight gain, such as 5 pounds or more per week, be sure to tell your physician during your next routine visit. |
| d. | Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes. |
ANS: D
Orthostatic hypotension is a possible problem with diuretic therapy. Foods high in potassium should be eaten more often, and the drug needs to be taken in the morning so that the diuretic effects do not interfere with sleep. A weight gain of 5 pounds or more per week must be reported immediately.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 459
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- When reviewing the mechanisms of action of diuretics, the nurse knows that which statement is true about loop diuretics?
| a. | They work by inhibiting aldosterone. |
| b. | They are very potent, having a diuretic effect that lasts at least 6 hours. |
| c. | They have a rapid onset of action and cause rapid diuresis. |
| d. | They are not effective when the creatinine clearance decreases below 25 mL/min. |
ANS: C
The loop diuretics have a rapid onset of action; therefore, they are useful when rapid onset is desired. Their effect lasts for about 2 hours, and a distinct advantage they have over thiazide diuretics is that their diuretic action continues even when creatinine clearance decreases below 25 mL/min.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 454
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- When monitoring a patient who is taking hydrochlorothiazide (HydroDIURIL), the nurse notes that which drug is most likely to cause a severe interaction with the diuretic?
| a. | Digitalis |
| b. | Penicillin |
| c. | Potassium supplements |
| d. | Aspirin |
ANS: A
There is an increased risk for digitalis toxicity in the presence of hypokalemia, which may develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have interactions with hydrochlorothiazide.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 458
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- When a patient is receiving diuretic therapy, which of these assessment measures would best reflect the patients fluid volume status?
| a. | Blood pressure and pulse |
| b. | Serum potassium and sodium levels |
| c. | Intake, output, and daily weight |
| d. | Measurements of abdominal girth and calf circumference |
ANS: C
Urinary intake and output and daily weights are the best reflections of a patients fluid volume status.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 461
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A patient is being discharged to home on a single daily dose of a diuretic. The nurse instructs the patient to take the dose at which time so it will be least disruptive to the patients daily routine?
| a. | In the morning |
| b. | At noon |
| c. | With supper |
| d. | At bedtime |
ANS: A
It is better to take the diuretic medication early in the morning to prevent urination during the night. Taking the diuretic at the other times may cause nighttime urination and disrupt sleep.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 461
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
- A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is likely to be used initially?
| a. | Loop diuretics |
| b. | Osmotic diuretics |
| c. | Thiazide diuretics |
| d. | Potassium-sparing diuretics |
ANS: C
The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) guidelines reaffirmed the role of thiazide diuretics as one of the first-line treatment for hypertension. The other drug classes are not considered first-line treatments.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 452
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- A patient in the neurologic intensive care unit is being treated for cerebral edema. Which class of diuretic is used to reduce intracranial pressure?
| a. | Loop diuretics |
| b. | Osmotic diuretics |
| c. | Thiazide diuretics |
| d. | Vasodilators |
ANS: B
Mannitol, an osmotic diuretic, is commonly used to reduce intracranial pressure and cerebral edema resulting from head trauma.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 456
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- A 79-year-old patient is taking a diuretic for treatment of hypertension. This patient is very independent and wants to continue to live at home. The nurse will know that which teaching point is important for this patient?
| a. | He should take the diuretic with his evening meal. |
| b. | He should skip the diuretic dose if he plans to leave the house. |
| c. | If he feels dizzy while on this medication, he needs to stop taking it and take potassium supplements instead. |
| d. | He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls. |
ANS: D
Caution must be exercised in the administration of diuretics to the older adults because they are more sensitive to the therapeutic effects of these drugs and are more sensitive to the adverse effects of diuretics, such as dehydration, electrolyte loss, dizziness, and syncope. Taking the diuretic with the evening meal may disrupt sleep because of nocturia. Doses should never be skipped or stopped without checking with the prescriber.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 460
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- A patient on diuretic therapy calls the clinic because hes had the flu, with terrible vomiting and diarrhea, and he has not kept anything down for 2 days. He feels weak and extremely tired. Which statement by the nurse is correct?
| a. | Its important to try to stay on your prescribed medication. Try to take it with sips of water. |
| b. | Stop taking the diuretic for a few days, and then restart it when you feel better. |
| c. | You will need an increased dosage of the diuretic because of your illness. Let me speak to the physician. |
| d. | Please come into the clinic for an evaluation to make sure there are no complications. |
ANS: D
Vomiting and diarrhea cause fluid and electrolyte loss. The patient must not continue to take the diuretic until these problems have stopped. He needs to be checked for possible hypokalemia and dehydration. The other options are incorrect responses.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 462
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
MULTIPLE RESPONSE
- When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which would include what symptoms? (Select all that apply.)
| a. | Dyspnea |
| b. | Constipation |
| c. | Tinnitus |
| d. | Muscle weakness |
| e. | Anorexia |
| f. | Lethargy |
ANS: D, E, F
Symptoms of hypokalemia include anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension. The other symptoms are not associated with hypokalemia.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 462
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
COMPLETION
- A patient is to receive hydrochlorothiazide (HydroDIURIL) via a percutaneous endoscopic gastrostomy (PEG) tube. The order reads, Give hydrochlorothiazide, 25 mg, per PEG tube once daily. The medication is available in a liquid form, 50 mg/5 mL. Identify how many milliliters will the nurse administer for each dose. _______
ANS:
DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The order for a child reads, Give furosemide (Lasix) 2 mg/kg IV STAT. The child weighs 33 pounds. Identify how many milligrams will the child receive for this dose. _______
ANS:
30 mg
First, convert 33 pounds to kilograms:
Next, calculate mg/kg:
DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 42: Antifungal Drugs
Lilley: Pharmacology and the Nursing Process, 8th Edition
MULTIPLE CHOICE
- During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do first?
| a. | Discontinue the infusion immediately. |
| b. | Reduce the infusion rate gradually until the adverse effects subside. |
| c. | Administer the medication by rapid IV infusion to reduce these effects. |
| d. | Nothing; these are expected side effects of this medication. |
ANS: A
Once the intravenous infusion of amphotericin B has begun, vital signs must be monitored frequently to assess for adverse reactions such as cardiac dysrhythmias, visual disturbances, paresthesias (numbness or tingling of the hands or feet), respiratory difficulty, pain, fever, chills, and nausea. If these adverse effects or a severe reaction occur, the infusion must be discontinued (while the patient is closely monitored) and the prescriber contacted. The other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 676
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- If a patient is taking fluconazole (Diflucan) with an oral anticoagulant, the nurse will monitor for which possible interaction?
| a. | Reduced action of oral anticoagulants |
| b. | Increased effects of oral anticoagulants |
| c. | Hypokalemia |
| d. | Decreased effectiveness of the antifungal drug |
ANS: B
Azole antifungal drugs increase the effects of oral anticoagulants. As a result, increased bleeding may occur. The other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 675
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse is preparing an infusion of amphotericin B for a patient who has a severe fungal infection. Which intervention is appropriate regarding the potential adverse effects of amphotericin B?
| a. | Discontinuing the infusion immediately if fever, chills, or nausea occur |
| b. | Gradually increasing the infusion rate until the expected adverse effects occur |
| c. | If fever, chills, or nausea occur during the infusion, administering medications to treat the symptoms |
| d. | Before beginning the infusion, administering an antipyretic and an antiemetic drug |
ANS: D
Almost all patients given the drug intravenously experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. For this reason, pretreatment with an antipyretic (acetaminophen), antihistamines, and antiemetics may be conducted to decrease the severity of the infusion-related reaction. The other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 672
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
- The nurse is administering one of the lipid formulations of amphotericin B. When giving this drug, which concept is important to remember?
| a. | The lipid formulations may be given in oral form. |
| b. | The doses are much lower than the doses of the older drugs. |
| c. | The lipid formulations are associated with fewer adverse effects than the older drugs. |
| d. | There is no difference in cost between the newer and older forms. |
ANS: C
Newer lipid formulations of amphotericin B have been developed in an attempt to decrease the incidence of its adverse effects and increase its efficacy. However, the lipid formulations are more costly.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 673
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse is reviewing instructions for vaginal antifungal drugs with a patient. Which statement by the nurse is an appropriate instruction regarding these drugs?
| a. | The medication can be stopped when your symptoms are relieved. |
| b. | Discontinue this medication if menstruation begins. |
| c. | Daily douching is part of the treatment for vaginal fungal infections. |
| d. | Abstain from sexual intercourse until the treatment has been completed and the infection has resolved. |
ANS: D
Female patients taking antifungal medications for the treatment of vaginal infections need to abstain from sexual intercourse until the treatment has been completed and the infection has resolved. The medication needs to be taken for as long as prescribed. Instruct patients to continue to take the medication even if they are actively menstruating. Douching is not an appropriate intervention.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 677
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- A patient is infected by invasive aspergillosis, and the medical history reveals that the patient has not been able to tolerate several antifungal drugs. The nurse anticipates an order for which medication to treat this infection?
| a. | Fluconazole (Diflucan) |
| b. | Micafungin (Mycamine) |
| c. | Caspofungin (Cancidas) |
| d. | Nystatin (Mycostatin) |
ANS: C
Caspofungin is used for treating severe infection by Aspergillus species (invasive aspergillosis) in patients who are intolerant of or refractory to other drugs.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 674
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
- A patient with a severe fungal infection has orders for voriconazole (Vfend). The nurse is reviewing the patients medical record and would be concerned if which assessment finding is noted?
| a. | Decreased breath sounds in the lower lobes |
| b. | History of cardiac dysrhythmias |
| c. | History of type 2 diabetes |
| d. | Potassium level of 4.0 mEq/L |
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