(Test Bank) Pharmacology And The Nursing Process

Lilley,Collins,Snyder, 10

Nursing

Test Bank

10th Edition

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Test Bank for Pharmacology And The Nursing Process, The downloadable file consists of 331 pages, and the total size of the file is 5.99 MB. Purchase now only for highly discounted price.

Author(s): Lilley, Collins, Snyder

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PRIMEXAM.COM Chapter 01: The Nursing Process and Drug Therapy Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. The nurse is developing a human needs statement for a patient who has a new diagnosis of heart failure. Identification of human needs statements occur with which of these activities? a. Collection of patient data b. Administering interventions c. Deciding on patient outcomes d. Documenting the patient‘s behavior ANS: A Identification of human needs occurs with the collection of patient data. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Human Needs Statement MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. The patient is to receive oral guaifenesin twice a day. Today, the nurse was busy and gave the medication 2 hours after the scheduled dose was due. What type of problem does this represent? a. ―Right tim e‖ b. ―Right dos e‖ c. ―Right rout e‖ d. ―Right medication‖ ANS: A ―Right tim e‖ is correct because the medi cation was given m ore than 30 m inutes after the scheduled dose was due. ―Dose‖ is incorrect bec ause the dose is not related to the time the medi cation administr ation is scheduled. ―Route‖ is incorrect because the route is not affected. ―Medi cation‖ is incorrect because the medi cation ordered will not ch ange. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 3. The nurse has been monitoring the patient‘s progress on a new drug regimen since the first dose and documentin g the patient‘s therapeutic response to the medication. Which phase of the nursing process do these actions illustrate? a. Human needs statement b. Planning c. Implementation d. Evaluation ANS: D Monitoring the patient‘s progress, including the patient‘s response to the medication, is part of the evaluation phase. Planning, implementation, and human needs statement are not illustrated by this example. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation PRIMEXAM.COM MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. The nurse is assigned to a patient who is newly diagnosed with type 1 diabetes mellitus. Which statement best illustrates an outcome criterion for this patient? a. The patient will follow instructions. b. The patient will not experience complications. c. The patient will adhere to the new insulin treatment regimen. d. The patient will demonstrate correct blood glucose testing technique. ANS: D ―Demonstr ating correct blood glucose testing technique‖ is a specific and measurable outcome criterion. ―Following instructions‖ and ―not e xperiencing complic ations‖ are not specific crite ria. ―Adhering to new regimen‖ woul d be difficult to me asure. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. Which activity best reflects the implementation phase of the nursing process for the patient who is newly diagnosed with hypertension? a. Providing education on keeping a journal of blood pressure readings b. Setting goals and outcome criteria with the patient‘s input c. Recording a drug history regarding over-the-counter medications used at home d. Formulating human needs statements regarding deficient knowledge related to the new treatment regimen ANS: A Education is an intervention that occurs during the implementation phase. Setting goals and outcomes reflects the planning phase. Recording a drug history reflects the assessment phase. Formulating human needs statements reflects analysis of data as part of planning. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. The medication order reads, ―Give ondansetron 4 mg, 30 minutes before beginning chemotherapy to prevent nausea.‖ The nurse notes that the route is missing from the order. What is the nurse‘s best action? a. Give the medication intravenously because the patien t might vomit. b. Give the medication orally because the tablets are available in 4 -mg doses. c. Contact the prescriber to clarify the route of the medication ordered. d. Hold the medication until the prescriber returns to make rounds. ANS: C A complete medication order includes the route of administration. If a medication order does not include the route, the nurse must ask the prescriber to clarify it. The intravenous and oral routes are not interchangeable. Holding the medication until the prescriber r eturns would mean that the patient would not receive a needed medication. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care PRIMEXAM.COM 7. When the nurse considers the timing of a drug dose, which factor is appropriate to consider when deciding when to give a drug? a. The patient‘s ability to swallow b. The patient‘s height c. The patient‘s last meal d. The patient‘s allergies ANS: C The nurse must consider specific pharmacokinetic/pharmacodynamic drug properties that may be affected by the timing of the last meal. The patient‘s ability to swallow, height, and allergies are not factors to consider regarding the timing of the drug‘s administration. DIF: Cogni tive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 8. The nurse is performing an assessment of a newly admitted patient. Which is an example of subjective data? a. Weight 155 pounds b. Pulse 72 beats/minute c. The patient reports that he uses the herbal product ginkgo d. The patient‘s complete blood count results ANS: C Subjective data include information shared through the spoken word by any reliable source, such as the pati ent. Objective data may be defined as any information gathered through the senses or that which is seen, heard, felt, or smelled. A patient‘s pulse, weight, and laboratory tests are all examples of objective data. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. When giving medications, the nurse will follow the rights of medication administration. The rights include the right documentation, the right reason, the right response, and the patient‘s right to refuse. Which of these are additional rights? (Select all that apply .) a. Right drug b. Right route c. Right dose d. Right diagnosis e. Right time f. Right patient ANS: A, B, C, E, F Additional rights of medication administration must always include the right drug, right dose, right time, right route, and right patient. The right diagnosis is incorrect. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Implementation PRIMEXAM.COM MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control OTHER 1. Place the phases of the nursing process in the correct order, with 1 as the first phase and 5 as the last phase. a. Planning b. Evaluation c. Assessment d. Implementation e. Human needs statement ANS: C, E, A, D, B The nursing process is an ongoing process that begins with assessing and continues with human needs statement, planning, implementing, and evaluating. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: General MSC: NCLEX: Safe and Effective Care Environment: Management of Care PRIMEXAM.COM Chapter 02: Pharmacologic Principles Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. The patient is receiving two different drugs. At current dosages and dosage forms, both drugs have the same concentration of the active ingredient. Which term is used to identify this principle? a. Bioequi valent 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 drug‘s 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 pro drug 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) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. When given an intravenous m edication, the p atient says to the nurse, ―I usually take pills. Why does this medication have to be given in the arm?‖ What is the nurse‘s best answer? a. ―The medi cation will cause fewer adverse effects when given intr avenous ly.‖ b. ―The intravenous m edication will have delayed absorptio n into the body‘s tissues.‖ c. ―The action of the m edication will begin sooner when given intr avenous ly.‖ d. ―There is a low er chance of allergic reactions when dr ugs are given intr avenous ly.‖ 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 absorpti on). The IV route does not affect the number of allergic reactions. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. 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. PRIMEXAM.COM 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) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. When monitoring the patient receiving an intravenous infusion to reduce blood pressure, the nurse notes that the patient‘s 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 drug‘s normal effects in the body. In this case, the antihypertensive drug lowered the patient‘s blood pressure levels too much. The other options do not describe a pharma cologic 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 patient‘s 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) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacol ogical and Parenteral Therapies 5. The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug‘s 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 circulat ion ANS: C A drug‘s 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) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. 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 PRIMEXAM.COM c. The time it takes for a drug to achieve its maximum therapeutic response d. The time period at which a drug‘s concentration is sufficient to cause a therapeutic response ANS: D Duration of action is the time during which drug‘s concentration is sufficient to elicit a therapeutic response. The other options do not define duration of action. A drug‘s onset o f action is the time it takes for the drug to elicit a therapeutic response. A drug‘s 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) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. 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 drug‘s 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 enzyme‘s 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) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient‘s 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) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The patient is experiencing chest pain and needs to take a buccal form of nitroglycerin. Where does the nurse instruct the patient to place the tablet? a. Under the tongue PRIMEXAM.COM b. On top of the tongue c. At the back of the throat d. In the space between the cheek and the gum ANS: D Drugs administered via the buccal route are placed in the space between the cheek and the gum. Drugs administered via the sublingual route are placed under the tongue. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. 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) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. 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 a dministration when a certain pathologic condition has an uncertain but high likelihood of occurrence based on the patient‘s initial presenting symptoms. Supplemental therapy (or replacement therapy) supplies the body with a substance needed to maintain nor mal function. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The patient is stating that he has 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 PRIMEXAM.COM the nurse suggest? a. A capsule b. A tablet c. A powder d. An enteric -coated tablet ANS: C 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) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse will be injecting a drug into the superficial skin layers immediately underneath the epidermal layer of skin. Which route does this describe? a. Intradermal b. Subcutaneous c. Intra muscular d. Transdermal ANS: A 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 fatty subcutaneous tissue under the dermal layer of skin are referred to as subcutaneous 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) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. Which drugs would be affected by the first -pass effect when administered? ( Select all that apply .) a. Morphine given by IV push injection b. Sublingual nitroglycerin tablet c. Diphenhydramine elixir d. Levothyroxine (Synthroid) tablet e. Transdermal nicotine patches f. Esomeprazole capsule g. Penicillin given by IV piggyback infus ion ANS: C, D, F Orally administered drugs (elixirs, tablets, and 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 p iggyback) 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. PRIMEXAM.COM DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. A drug dose that delivers 10 mg has a half -life of 5 hours. Identify how much drug will remain in the body after one half-life. ANS: 5 mg A drug‘s 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 10 mg equals 5 mg. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies PRIMEXAM.COM Chapter 03: Lifespan Considerations Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. Drug transfer to the fetus is more likely during the last trimester of pregnancy for which reason? a. Decreased fetal surface area b. Increased placental surface area c. Enhanced blood flow to the fetus d. Increased amount of protein -bound drug in maternal circulation ANS: C Drug transfer to the fetus is more likely during the last trimester of pregnancy as a result of enhanced blood flow to the fetus. The other options are incorrect. Increased fetal surface area, not decreased, is a factor that affects drug transfer to the fetus. The placenta‘s surface area does not increase during this time. Drug transfer is increased because of an increased amount of free drug, not protein -bound drug, in the mother‘ s circulation. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Health Promotion and Maintenance 2. The nurse is monitoring a patient who is in the 26th week of pregnancy and has developed gestational diabetes and pneumonia. She is given medications that pose a possible fetal risk, but the potential benefits may warrant the use of the medications in her situation. The nurse recognizes that these medications are in which U.S. Food and Drug Administration pregnancy safety category? a. Category A b. Category B c. Category C d. Category D ANS: D Pregnancy category D fits the description given. Category A indicates no risk to the human fetus; Category B indicates no risk to animal fetus; information for humans is not ava ilable. Category C indicates adverse effects reported in animal fetus; information for humans is not available. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 3. When discussing dosage calculation for pediatric patients with a clinical pharmacist, the nurse notes that which type of dosage calculation is used most commonly in pediatric calculations? a. West nomogram b. Clark rule c. Height -to-weight ratio d. Milligram per kilogram of body weight formula ANS: D The milligram per kilogram formula, based on body weight, is the most common method of PRIMEXAM.COM calculating doses for pediatric patients. Height -to-weight ratio is not used. The other opti ons are available methods but are not the most commonly used. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 4. The nurse is assessing a newly admitted 83-year-old patient and determines that the patient is experiencing polypharmacy. Which statement most accurately illustrates polypharmacy? a. The patient is experiencing multiple illnesses. b. The patient uses one medication for an illness several times per day. c. The patient uses over-the-counter drugs for an illness. d. The patient uses multiple medications simultaneously. ANS: D Polypharmacy usually occurs when a patient has several illnesses and takes medications for each of them, possibly prescribed by differ ent specialists who may be unaware of other treatments the patient is undergoing. The other options are incorrect. Polypharmacy addresses the medications taken, not just the illnesses. Polypharmacy means the patient is taking several different medications, not just one, and can include prescription drugs, over -the-counter medications, and herbal products. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses in an elderly patient who is taking which type of drug? a. Laxatives b. Anticoagulants c. Sedatives d. Antidepressants ANS: C Sedatives and hypnotics often cause confusion, daytime sedation, ataxia, lethargy, forgetfulness, and increased risk for falls in the elderly. Laxatives, anticoagulants, and antidepressants may cause adverse effects in the elderly, b ut not the ones specified in the question. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 6. For accurate medication administration to pediatric patients, the nurse must consider which of these factors? a. Organ maturity b. Renal output c. Body temperature d. Height ANS: A To administer medications to pediatric patients accurately, one must take into account organ maturity, body surface area, age, and weight. The other options are incorrect; renal output and body temperature are not considerations, and height alone is not sufficient. PRIMEXAM.COM DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 7. The nurse recognizes that an elderly patient may experience a reduction in the stomach‘s ability to produce hydrochloric acid. This change may result in which effect? a. Delayed gastric emptying b. Increased gastric acidity c. Decreased gastrointestinal motility d. Altered absorption of some drugs ANS: D Reduction in the stomach‘s ability to produce hydrochloric acid is an aging -related change that results in a decrease in gastric acidity and may alter the absorption of some drugs. The other options are not results of reduced hydrochloric acid production. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 8. The nurse is administering drugs to neonates and will consider which factor may contribute the most to drug toxicity? a. The lungs are immature. b. The kidneys are small. c. The liver is not fully developed. d. Excretion of the drug occurs quickly. ANS: C A neonate‘s liver is not fully developed and cannot detoxify many drugs. The other options are incorrect. The lungs and kidneys do not play major roles in drug metabolism. Renal excretion is slow, not fast, because of organ immaturity, but this is not the factor that contribut es the most to drug toxicity. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning dosage has been double -checked and updated MSC: NCLEX: Health Promotion and Maintenance 9. An 83-year-old woman has been given a thiazide diuretic to treat heart failure. She and her caregiver should be told to watch for which problems? a. Constipation and anorexia b. Fatigue, leg cramps, and dehydration c. Daytime sedation and lethargy d. Edema, nausea, and blurred vision ANS: B Electrolyte imbalance, leg cramps, fatigue, and dehydration are common complications when thiazide diuretics are given to elderly patients. The other options do not describe complications that occur when these drugs are given to the elderly. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies PRIMEXAM.COM 10. An elderly patient with a new diagnosis of hypertension will be receiving a new prescripti on for an antihypertensive drug. The nurse expects which type of dosing to occur with this drug therapy? a. Drug therapy will be based on the patient‘s weight. b. Drug therapy will be based on the patient‘s age. c. The patient will receive the maximum dose that is expected to reduce the blood pressure. d. The patient will receive the lowest possible dose at first, and then the dose will be increased as needed. ANS: D As a general rule, dosi ng for elderly patients should follow the admonition, ―Start low, and go slow,‖ which means to start with the lowest possible dose (often less than an average adult dose) and increase the dose slowly, if needed, based on patient response. The other responses are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The nurse is trying to give a liquid medication to a 2 1/2 -year-old child and notes that the medication has a strong taste. Which technique is the best way for the nurse to give the medication to this child? a. Give the medication with a spoonful of ice cream. b. Add the medication to the child‘s bottle. c. Tell the child you have candy for him. d. Add the medication to a cup of milk. ANS: A Ice cream or another nonessential food disguises the taste of the medication. The other options are incorrect. If the child does not drink the entire contents of the bottle, medication is wasted and the full dose is not administered. Using the word candy with drugs may lead to the child thinking that drugs are actually candy. If the medication is mixed with a cup of milk, the child may not drink the entire cup of milk, and the distasteful drug may cause the child to refuse milk in the future. DIF: Cognitiv e Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The nurse is preparing to give an injection to a 4 -year-old child. Which intervention is age appropriate for this child? a. Give the injection without any advanced preparation. b. Give the injection, and then explain the reason for the procedure afterward. c. Offer a brief, concrete explanation of the procedure at the patient‘s level and with the parent or caregiver present. d. Prepare the child in advance with details about the procedure without the parent or caregiver present. ANS: C PRIMEXAM.COM For a 4 -year-old child, offering a brief, concrete explanation about a procedure just beforehand, with the parent or caregiver present, is appropriate. The other options are incorrect for any age group. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity MULTIPLE RESPONSE 1. Which statements are true regarding pediatric patients and pharmacokinetics? ( Select all that apply .) a. The levels of microsomal enzymes are decreased. b. Perfusion to the kidneys may be decreased and may result in reduced renal function. c. First-pass elimination is increased because of higher portal circulation. d. First-pass elimination is reduced because of the immaturity of the liver. e. Total body water content is much less than in adults. f. Gastric emptying is slowed because of slow or irregular peristalsis. g. Gastric emptying is more rapid because of increased peristaltic activity. ANS: A, B, D, F In children, first -pass elimination by the liver is reduced because of the immaturity of the liver, and microsomal enzymes are decreased. In ad dition, gastric emptying is reduced because of slow or irregular peristalsis. Perfusion to the kidneys may be decreased, resulting in reduced renal function. The other options are incorrect. In addition, remember that total body water content is greater in children than in adults. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 2. Which statements are true regarding the elderly and pharmacokinetics? (Select all that apply .) a. The levels of microsomal enzymes are decreased. b. Fat content is increased because of decreased lean body mass. c. Fat content is decreased because of increased lean body mass. d. The number of intact nephrons is increased. e. The number of intact nephrons is decreased. f. Gastric pH is less acidic. g. Gastric pH is more acidic. ANS: A, B, E, F In the elderly, levels of microsomal enzymes are decreased because the aging liver is less able to produce them; fat content is increased because of decreased lean body mass; the number of intact nephrons is decreased as the result of aging; and gastric pH is less acidic because of a gradual reduction of the production of hydrochloric acid. The other options are incorrect statements. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance COMPLETION