Pharmacology for Nursing Care 7th Edition by Richard A. Lehne Test Bank

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Pharmacology for Nursing Care 7th Edition by Richard A. Lehne Test Bank

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Lehne: Pharmacology for Nursing Care, 7th Edition

Chapter 8: Individual Variation in Drug Responses

Test Bank

1. A prescriber has ordered a placebo for a patient. Which statement would most accurately reflect the placebo effect of medications?
a. A placebo effect is caused by psychological factors rather than physiological ones.
b. When a placebo effect occurs, it indicates that the patient did not have an illness.
c. A placebo effect is a rare effect seen only with psychotropic medications.
d. A placebo effect is almost always a positive response that facilitates healing.

ANS: A
A placebo effect is caused by psychological factors, not physiological factors.
A placebo effect does not determine whether a patient has an illness.
A placebo is ordered for various reasons; each is individualized and not for specific classifications of drugs only.
A placebo effect may or may not be positive; depending on what the patient believes is the effect on the body.

DIF: Cognitive Level: Comprehension REF: p. 79
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A nurse is preparing to administer a drug to a patient. The nurse understands that the route by which bioavailability would most likely be affected is
a. oral.
b. subcutaneous.
c. intramuscular.
d. intravenous.

ANS: A
Oral drugs must undergo a first-pass effect, and those drugs are subject to the acid in the gut, which may affect bioavailability.
Subcutaneous, intramuscular, and intravenous medications are not subject to the first-pass effect or the acidity of the gut, therefore bioavailability is least likely to be affected by these routes.

DIF: Cognitive Level: Comprehension REF: p. 81
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A nurse is providing patient education regarding the development of drug tolerance. Which statement made by the nurse is correct with regard to the development of drug tolerance?
a. Drug tolerance is most often seen with the use of opioids.
b. The patient will require a greater dosage of drug for the same effect to be achieved if tolerance has developed.
c. Tolerance depends on the patients ability to metabolize the drug.
d. Addiction may develop if the drug is not fully excreted, leading to tolerance.

ANS: B
When a patient is assessed as requiring a greater dosage of a medication to achieve the same effect as with a previously lower dosage, a drug tolerance may have developed.
Drug tolerance may be seen with multiple medications, not only with opiates.
Drug tolerance is not dependent on the patients ability to metabolize the drug.
Addiction typically is related to a physiological or psychological need for a drug, not the requirement of a higher dosage.

DIF: Cognitive Level: Analysis REF: pp. 78-79
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A prescriber is adjusting doses of a particular drug. A nurse understands that the most accurate dose determination can be calculated based on the
a. drugs pharmacokinetics.
b. patients gender.
c. patients basal metabolic index (BMI).
d. patients body surface area.

ANS: D
Body surface area is the most accurate method of dose determination and/or adjustment.
Pharmacokinetics involves absorption, distribution, metabolism, and excretion, but it is not specific to drug dosing.
A patients gender is not the most accurate method of dosing, because each individual is different.
The BMI is an indication of weight and height proportions, not an accurate determinant of drug dosing.

DIF: Cognitive Level: Comprehension REF: p. 77
TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A nurse is providing patient education to a group of women regarding the variability of drug absorption. The nurse is evaluating learning in the group and asks how genetics may influence drug response. Which statement made by a member of the group would indicate a need for further teaching?
a. Prior to 1997, drug companies did many fewer studies involving drugs and women.
b. Certain opioid analgesics are much more effective in women than in men.
c. Men and women respond differently to drugs, but little is known about how and why.
d. Alcohol is metabolized quicker by women than by men.

ANS: D
Women metabolize alcohol at a much slower rate than men do; further teaching is required.
Prior to 1997 drug companies did many fewer studies involving drugs and women; no further education is required. Studies have increased since 1997 to examine the effects of drugs on women as they relate to pregnancy and adverse effects on the fetus.
Certain opioid analgesics are much more effective in women than in men no further education is required.
Men and women respond differently to drugs; no further education is required.

DIF: Cognitive Level: Analysis REF: p. 82
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A nurse is making rounds and performing physical assessments on each of the assigned patients. Which patient would the nurse most likely anticipate developing tachyphylaxis, so that she assesses for it specifically?
a. A patient who has been using opioids for pain relief
b. A patient who has been using opioids for recreational purposes
c. A patient who has been taking large doses of insulin for a long time
d. A patient who has been wearing a nitroglycerin patch for 24 hours

ANS: D
Tachyphylaxis is a form of tolerance that can be defined as a reduction in drug responsiveness brought on by repeated dosing over a short time. When nitroglycerin is administered by means of a transdermal patch, the effects are lost in less than 24 hours if the patch is left in place around the clock. This is why the nitroglycerin patch typically is ordered every 8 to 12 hours on and 8 to 12 hours off, to keep the body from building up tolerance (i.e., tachyphylaxis).
Opioids, whether used for pain relief or recreational purposes, do not cause tachyphylaxis.
Insulin, even when taken in large doses for extended periods, does not cause tachyphylaxis.

DIF: Cognitive Level: Application REF: p. 79
TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

7. A nurse is providing patient education to the community regarding medication compliance. The nurse is correct to state that the most important factors affecting adherence to a drug regimen is(are) (Select all that apply.)
a. genetics.
b. placebo effect.
c. patient education.
d. ability to pay for the medication.
e. manual dexterity.
f. visual acuity.

ANS: C, D, E, F
Patient education, ability to pay for the medication, manual dexterity, and visual acuity
Patient education is essential in medication compliance, because the patient should understand how to take the drug and the reason or reasons for taking it. The ability to pay for the medication is a factor, because a patient who cant afford the drug wont buy it and wont get the benefits of the prescribed medication. Manual dexterity is another factor related to compliance. If the bottle is difficult to open, the patient will not take the medication. Visual acuity may also be an issue. A patient who cannot see the label well may not know what the prescribed drug is, the dosage, or the timing.
Genetics and the placebo effect are not related to medication compliance.

DIF: Cognitive Level: Comprehension REF: p. 83
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

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