(Test Bank) Pharmacotherapy A Pathophysiologic Approach

Dipiro, 10

Nursing

Test Bank

10th Edition

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Test Bank for Pharmacotherapy A Pathophysiologic Approach, The downloadable file consists of 403 pages, and the total size of the file is 3.6 MB. Purchase now only for highly discounted price.

Author(s): Dipiro

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Pharmacotherapy A Pathophysiologic Approach 10th Edition Dipiro Talbert Yee Test Bank Chapter 1: Health Literacy and Medication Use 1. What time will the trough blood level need to be drawn if the nurse administers the intravenous medication dose at 9:00 AM? a. 6:30 AM b. 8:30 AM c. 9:30 AM d. 11:30 AM ANS: B Trough blood levels measure the lowest blood level of medicine and are obtained just before the dose is administered. In this case, 6:30 AM is too early to obtain the blood level. The other two times occur after the medication is administered. 2. What will the nurse expect the health care providers order to be when starting an older adult patient on thyroid hormone replacement therapy? a. Administering a loading dose of the drug b. Directions on how to taper the drug c. A dosage that is one third to one half of the regular dosage d. A dosage that is double the regular dosage ANS: C To prevent toxicity, dosages for new medications in older adults should be one third to one half the amount of a standard adult dosage. Loading doses of drugs could cause severe toxicity. Tapering off is characteris tic of discontinuation of medications and is not appropriate for this situation. Older adults generally need a lower medication dosage than younger patients. DIF: Cognitive Level: Application REF: p. 29 OBJ: 3 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 3. Which drugs cause birth defects? a. Teratogens b. Carcinogens c. Metabolites d. Placebos ANS: A Teratogens are drugs that cause birth defects. Carcinogens cause cancer. Metabolites are the end product of metabolism. Placebos are drugs that have no pharmacologic activity. 4. Which life threatening illness may occur as a result of aspirin (salicylate) administration during viral illness to patients younger than 20 years of age? a. Anaphylactic shock b. Reyes syndrome c. Chickenpox d. Influenza A ANS: B Children are susceptible to Reyes syndrome if they ingest aspirin at the time of or shortly after a viral infection of chickenpox or influenza. Anaphylactic shock is caused by a hypersensitivity reaction. Chickenpox is the result of being infected with a virus. Influenza A is caused by a pathogen. 5. Which classification of medications commonly causes allergic reactions in children? a. Antacids b. Analgesics c. Antibiotics d. Anticonvulsants ANS: C Antibiotics, especially penicillins, commonly cause allergic reactions in children. Intravenous antibiotics can cause rapid reactions; therefore, the pediatric patients response to a medication should be assessed and monitored closely. Antacids rarely cause allergic reactions. Children are not particularly allergic to analgesics or anticonvulsants. 6. After giving instructions to an expectant mother about taking medications during pregnancy, which patient statement indicates the need for further teaching? a. I will not take herbal medicines during pregnancy. b. For morning sickness, I will try crackers instead of taking a drug. If I get a cold, I will avoid taking nonprescription medications until I check with my c. physician. d. I will limit my alcohol intake to only one glass of wine weekly. ANS: D Alcohol needs to be eliminated during pregnancy and for 2 to 3 months prior to conception. Limited studies are available regarding the use of herbal medications in general, and thus they should be avoided during pregnancy. Alternative nonpharmacologic treatments are appropriate to use during morning sickness. The pregnant woman should also avoid using nonprescription drugs because few data are available about safe use in pregnancy. Because few medicines can be considered completely safe for use in pregnancy, the physician needs to approve and recommend the use of nonprescription drugs. 7. When is the ideal time for a nursing mother to take her own medications? a. Before the infant latches on to begin to breastfeed b. As soon as the mother wakes up in the morning c. Right before the mother goes to sleep at night d. As soon as the infant finishes breastfeeding ANS: D Taking medications after breastfeeding reduces the amount of the medication that will reach the baby. Medications taken directly before breastfeeding may have a high concentration in the milk and possibly pass on to the baby. The mother must take into cons ideration when her medications are ordered to be taken, and schedule them around breastfeeding. 8. Which age-related change would affect transdermal drug absorption in geriatric patients the most? a. Difficulty swallowing b. Diminished kidney function c. Changes in pigmentation d. Altered circulatory status ANS: D The decreased circulation that occurs with aging will affect transdermal drug absorption. Difficulty swallowing would not affect transdermal drugs being absorbed. Kidney function affects drug excretion. Changes in pigmentation would not affect transdermal drug absorption. 9. Which intervention would be considered to reduce accumulation of a drug i n a patient who has decreased liver function? a. Decreasing the time interval between dosages b. Reducing the dosage c. Administering the medication intravenously d. Changing the drug to one that has a longer half life ANS: B Dosages must be reduced to prevent accumulation. Decreasing the time interval between dosages would increase the accumulation of the drug. The intravenous route has the fastest absorption and with liver dysfunction would increase the accumulation of the drug. A similar drug with a longer half life would stay in the system longer; with impaired liver function, the result would be increased accumulation. 10. The nurse is teaching an elderly patient with difficulty swallowing about his medications. Which explanation by the nurse is most helpful? a. Enteric coated tablets can be crushed and taken with applesauce. b. Tablets that are scored can be broken in half. c. Medications labeled SR can be crushed. d. Avoid taking medications in liquid form. ANS: B It is acceptable to break scored tablets in half to facilitate swallowing of the medication. Enteric coated tables should never be crushed because of the effect on the absorption rate and potential for toxicity. Medications labeled SR indicate sustained release and should not be crushed because of the effect on the absorption rate. Medication in liquid form may be easier to swallow. 11. The nurse is administering an antibiotic intravenously. Which blood level determines the lowest amount of medication present in the patient? a. Peak b. Serum c. Therapeutic d. Trough ANS: D The lowest amount of a medication in the blood is the trough. The peak is the highest amount of medication in the blood. Serum level identifies the amount of medication present. Therapeutic levels identify the range in which a medication is effective. 12. Which patient would the nurse identify as having the lowest rate of absorption of enteral medications? a. A 5-year-old boy b. An 18-year-old woman c. A 55-year-old man d. An 85-year-old woman ANS: A Males stomachs empty more rapidly; children have increased motility, resulting in decreased absorption time. As one gets older, gastrointestinal (GI) motility is decreased, allowing for increased absorption time; women have slower gastric emptying, resulting in more time for absorp tion. Males stomachs empty more rapidly; however, as one gets older, GI motility is decreased, resulting in an increase in absorption time. As one gets older, GI motility is decreased, allowing for increased absorption time; women have slower gastric empty ing, resulting in more time for absorption. 13. What is the definition of cumulative effect of a drug? a. Drug toxicity related to overmedication b. Drug buildup related to decreased metabolism c. The inability to control the ingestion of drugs d. The need for higher dosage to produce the same effect as previous lower dosages ANS: B Cumulative effects are related to diminished metabolism or excretion of a drug that causes it to accumulate. Cumulative effects can lead to drug toxicity. Toxicity occurs when advers e effects are severe. Inability to control the ingestion of drugs is drug dependence. The need for higher dosage to produce the same effect as previous lower dosages is the definition of tolerance. 14. Which patient, when compared with the general population, would require a larger dose or more frequent administration of a drug to attain a therapeutic response? a. A 29 year old who has been diagnosed with kidney failure b. A 35 year old obese male who is being evaluated for an exercise program c. A 52 year old diagnosed with hypothyroidism and decreased metabolic rate d. A 72 year old with decreased circulatory status ANS: B An obese individual would require a larger dose of a drug to attain a therapeutic response. An individual with kidney failure would require less medication because of decreased excretory ability. Individuals with decreased metabolic rate would metabolize drugs more slowly and require smaller doses or less frequent administration. Individuals with decreased circulation would require less medication. 15. A resident in a long term care facility reports difficulty swallowing enteric coated aspirin and asks the nurse to crush it prior to administration. The most appropriate action for the nurse to take is to: a. crush the tablet and mix with applesauce. b. encourage the resident to swallow the tablet with a full glass of water. c. hold the medication and notify the physician. d. substitute a regular aspirin for the enteric coated tablet. ANS: C The medication should be held and the physician notified. The physician has the authority to determine how to proceed in this situation. Enteric coated tablets should not be crushed because this will increase the absorption rate and the potential for toxicity. Geriatric patients may have difficulty swallowing and are at risk for choking and aspira tion. They should not be encouraged to swallow medications if they report difficulty swallowing. The physician must determine if a substitution can be ordered. Prescribing is not in the nurses scope of practice. Chapter 2: Cultural Competency 1. What are compelling reasons for needing cultural competency in healthcare? A. Health disparities are declining and are no longer relevant B. The diversity of patients encountered in the U.S. has plateaued C. Health professional shortages are no longer present improving provider -patient concordance D. Medication errors can be reduced by improving linguistic competency in an organization 2. Based on the cultural competency models addressed in the chapter, which of the following is true? A. The LEARN model describes providers as going through distinct stages of change ranging from cultural destructiveness to cultural proficiency B. Cultural competency is achieved through experience, skills, knowledge, and a positive attitude C. The Purnell model describes providers as progressing through a continuum of cultural consciousness ranging from the unconsciously incompetent to the unconsciously competent D. Cultural humility plays a minor role in connecting the skills, encounters, and desire to work across cultures 3. According to the 2000 Executive Order 13166 of Title VI of the Civil Rights Act, which of the following services should a healthcare organization meet to receive federal funding (eg, Medicare)? A. Recruit, retain, and promote a diverse staff and leadership representative of the service area demographics B. Offer and provide meaningful access to languag e services at a nominal cost to patients with limited English proficiency C. Make easy -to-understand printed materials available in languages used frequently in the population served D. Using family or minors as interpreters may be used if requested by the patient 4. The Patient Explanatory model includes: A. Explaining the pathophysiologic process of diseases B. Identifying potential causes of illness C. Involving the family and community in deciding the treatment for a patient D. Navigating between spiritual and family leaders to help the patient improve 5. The "4 Cs" method to elicit patients' understanding of their health and illnesses includes asking patients… A. What they think will cure their condition B. When they completed their last course of medication C. What will the problem cost the patient D. What concerns they have about their health situation 6. Healthcare providers must be more knowledgeable about CAM therapies, cultural practices, and their choice to use traditional medicine. When inquiring about CAM, the provider should A. recognize that nearly 75% of the US population document CAM use B. consider that herbal products from the US must follow current Good Manufacturing Practices C. ask targeted questions of patients such as "Do you use herbs?" to get a straight -forward answers D. understand that patients often have low disclosure rates of use of CAM 7. When striving toward cultural competency, which of the following statements about stereotypes, generalizations, and patient care is true? A. Generalizations can help to provide a framework for understanding how patients may respond to a health -related situation B. Stereotypes can help to form reasonable assumptions about how patients from different cultures will behave in the healthcare setting C. Stereotypes and generalizations can be helpful to creating a positive healthcare environment D. Stereotypes and generalizations are not useful in understanding how a patient may react in a healthcare setting 8. Which of the following is an example of healthcare beliefs or practices that have been found in various racial and ethnic groups in the United States? A. "Culture -bound syndromes" or folk-illnesses can be found in Western cultures B. Trust in the U.S. healthcare system exists because of previous efforts for equality (eg, Tuskegee syphilis study) C. Illness and disease are synonymous D. Physical signs of bruises or welts on the skin are often signs of physical abuse, particularly in cultures of Asian descent 9. To better understand individual patient health behaviors in the healthcare setting, a healthcare provider can… A. Rely on chart documentation to learn about the family and cultural health traditions of the patient B. Understand socioeconomic status and immigration issues faced in the community C. Explore the social and cultural networks of the community D. All of the above E. B and C only 10. Examples of communication styles that work across cultures include: A. Shaking hands as a form of respect B. Providing ample distance to show respect of interpersonal space C. Using the first name to address a patient D. Observing patient behaviors and trying to follow them 11. Of the following choices, the most appropriate way to determine how to communicate with a patient from a different culture and language than your own is to: A. Provide as much information as possible to demonstrate professional competency B. Use a variety of written resources about the culture of the patient before the visit and use only this information to conclude your treatment approach C. Talk to the bilingual staff members and ask how they would want to be treated D. Treat the patient as they would want to be treated and use a trained interpreter 12. If you do not speak the same language as your patients, what would be the optimal way to conduct the patient visit? A. Use a family member to interpret B. Ask a bilingual staff person to interpret for you C. Use a trained interpreter D. All of the above 13. Which of the following best describes social determinants of health and their relationship to cultural competency? A. Socioeconomic status, age, race, ethnicity, and communities are factors that influence health B. Training in cultural competency has helped to decrease health disparities in healthcare C. Communities have little effect on the healthcare outcomes of individuals and families D. All of the above 14. Assessment of organizational values and beliefs about diversity and culture are important to providing a positive and open environment for patient care and should be conducted: A. When an organization is expecting an accreditation or licensure survey B. On an as-needed basis for performance improvement C. If patient satisfaction surveys reveal poor outcomes D. Periodically, as needed, and with long-term considerations for the organization 15. Steps for organizational self-assessment include: A. Involving community collaborations and partnerships after decisions are made at an organizational level B. Disseminating positive results to demonstrate the high competency of the organization C. Getting "buy -in" from only the organizational personnel D. Including personnel and fiscal resources to promote cultural competency in the annual budget ANSWERS 1. D. 2. C. 3. C. 4. B. 5. D. 6. D. 7. A. 8. A. 9. E. 10. D. 11. D. 12. C. 13. . 14. D. 15. D. Chapter 3: Medication Safety Principles and Practices 1. Where would the procedures and treatments directed by the health care provider be found? a. Summary sheet b. Physicians order form c. Physicians progress notes d. History and physical examination form ANS: B The physicians order form contains all procedures and treatments ordered by the health care provider. A summary sheet provides a brief overview of the hospital course at discharge. Physicians progress notes provide regular observations on the patients course of treatment and response. A history and physical examination form provides information a bout baseline information from the patient. 2. Which action will the nurse take when it is determined that the narcotic count is incorrect while obtaining a medication from the narcotic area? a. Determine the cause of the discrepancy at the end of the shift. b. Notify the health care provider stat. c. Call the nurse from the previous shift to determine if there was a discrepancy earlier. d. Report the discrepancy to the charge nurse immediately. ANS: D Reporting the discrepancy to the charge nurse immediately enables the supervisory staff to narrow the time frame during which a medication was taken and not documented. The discrepancy needs to be addressed immediately, and therefore determining the cause of the discrepancy at the end of the shift is not the most appropriate action for the nurse to take. It is not appropriate to contact the health care provider for an incorrect narcotic count. The count would have been verified at shift change; calling the nurse from the previous shift is not an appropriate action for the nurse to take. 3. Which action will the nurse take if a dosage is unclear on a health care providers order? a. Ask the patient what dosage was given in the past. b. Ask another physician to determine the correct dosage. c. Tell the patient that the medication will not be given. d. Contact the health care provider to verify the correct dosage. ANS: D Any questionable orders should be verified by the health care provider who wrote the orders. The patient is not a reliable source of verification. The physician who wrote the order should verify it. It would be a medication error to withhold the dose instead of verifying it. 4. What is the most reliable method to calculate a pediatric patients medication dosage? a. Age b. Height c. Body surface area (BSA) d. Placement on a growth scale ANS: C The most reliable method is by proportional amount of BSA or body weight. Because of the differences in weight among children, age is not a reliable method. Because of the differences in height among children, this is not a reliable method. Placement on a grow th scale identifies how the child corresponds to other children on a percentile. Although it is determined by a specific measurement, the percentile identified would not be a specific measurement; therefore, this is not a reliable method. 5. Which medication route provides the most rapid onset of a medication, but also poses the greatest risk of adverse effects? a. Intradermal b. Subcutaneous (subcut) c. Intramuscular (IM) d. Intravenous (IV) ANS: D IV medications are delivered directly into the bloodstream and avoid the first pass effect of the liver. Intradermal, subcut, and IM administration have a slower absorption rate. 6. Which is known as the fifth vital sign? a. Temperature b. Respirations c. Pain d. Pulse ANS: C Pain is known as the fifth vital sign. 7. Which is true regarding the unit dose drug distribution system? a. The inventory is delivered to each nursing unit on a regular and recurring basis. The system delivers one dose of each medication to be administered until the subsequent b. delivery of inventory. The use of single dose packages of drugs dispensed to fill each dose requirement as it is c. ordered. d. The amount of inventory needed to dose all patients on the unit for a 24 hour interval. ANS: C The unit dose drug distribution system uses single unit packages of drugs dispensed to fill each dose requirement as it is ordered. 8. The nursing assessment identifies that the client is nauseated and cannot take acetaminophen (Tylenol) orally. Which is true regarding the substitution of this medication to suppository form? a. It is standard practice when the patient is unable to take the ordered medication. b. It is acceptable if the patient agrees to the altered route form. c. It is preferable to having the patient miss a dose of the medication. d. It is contraindicated without an order from the health care provider. ANS: D One dosage form of medication should never be substituted for another unless the prescriber is consulted; there can be a great variation in the absorption rate of the medication through different routes of administration. The substitution of one form for another is not stand ard practice, and is not acceptable or preferable without the prescribers order. 9. Which medication order requires nursing judgment and means administer if needed? a. Morphine 4 mg IV stat b. Morphine 4 mg IV prior to procedure c. Morphine 4 mg IV four times a day d. Morphine 4 mg IV every 4 hours PRN ANS: D PRN indicates for the nurse to administer morphine every 4 hours if needed and requires nursing judgment. Stat means the dose of morphine would be given immediately, not as needed. The orders for the dose of morphine to be given prior to the patients scheduled procedure and four times a day, do not indicate to give the dose as needed. 10. What is medication reconciliation? Comparing the patients current medication orders to all of the medications actually being a. b. c. d. ANS: A taken The administration of high alert medications that have been ordered on admission to an acute care facility The completion of an incident report following a variance that resulted in a serious complication A printout of computerized patient data that identifies the times that all of the ordered medications are to be administered Medication reconciliation is the process of comparing a patients current medication orders to all of the medications that the patient is actually taking. Administering high alert medications and completing an incident report are not the same as medication reconciliation. A printout of computerized patient data that identifies the times that all of the ordered medications are to be administered is a description of the medication administration record (MAR), not a description of medication reconciliation. 11. Which example best demonstrates safe drug administration by the nurse? a. Administering an oral medication with the patient sitting upright b. Asking children to say their name before administering the medication c. Leaving the medications on the bedside stand after verifying patient identification d. Returning the unused portion of a medication to a stock supply bottle ANS: A itting the patient upright for oral medication s is safe medication practice. Children should never be asked their names as a means of positive identification. Remaining with a patient until the drug is swallowed is safe practice. Returning an unused portion of medication to the stock supply bottle is not safe medication practice. 12. The nurse determines that a prescribed medication has not been administered as ordered on the previous shift. What action will the nurse take? a. Administer the medication immediately. b. Complete an incident report. c. Notify the nurse responsible for the error. d. Record the occurrence in the nurses notes. ANS: B An incident report is completed when a medication error occurs. Depending on the medication and frequency of administration, the medication may not be given immediately. It is not the nurses responsibility to notify another nurse of the error. Medication errors are not recorded in the nurses notes. DIF: Cognitive Level: Application REF: p. 100 OBJ: 6 | 11 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 13. A patients liquid cough medicine has been discontinued with one half of the bottle remaining. The home health nurse is aware that according to the U.S. Food and Drug Administration (FDA) guidelines on prescription medication disposal, the next step should be to: a. save the remainder for another patient with the same prescription. b. flush the remainder down the toilet. c. read the drug label for specific disposal instructions. d. pour remaining medication into a hazardous waste container. ANS: C The nurse must follow specific disposal instructions on the drug label or in the patient information leaflet that accompanies the medication. Prescription medications should not be shared among patients. Prescription drugs should not be flushed down the toilet unless specifically instructed to do so by the manufacturer. The first action to be taken is to follow disposal instructions on the label. If the drug label indicates it should be emptied into a hazardous waste container, measures should be taken to prevent leaking and/or accidental ingestion. 14. Who defines the standards of care for the practice of nursing? (Select all that apply.) a. State boards of nursing b. Hospital policy and procedures c. Federal laws regulating health care facilities d. The Joint Commission e. Professional nursing associations ANS: A, C, D, E Standards of care are defined by state boards of nursing, federal laws regul ating health care facilities, The Joint Commission, and professional nursing associations such as the American Nurses Association. Individual hospital policies and procedures incorporate federal and state guidelines into their respective policies and proce dures and are often more stringent than state and federal regulations. 15. What must the nurse have before administering any medication? (Select all that apply.) a. A current license to practice b. A medication order signed by a practitioner licensed with prescription privileges c. Knowledge of the medication d. Consultation with a pharmacist e. Knowledge of the clients diagnosis ANS: A, B, C, E Physicians must be licensed to prescribe medications; nurses must be licensed to administer medications. Safe medication administration includes knowledge of the medication, pathophysiology of patient diagnoses, and pharmacodynamics of the ordered medication on the pathophysiology. It is not necessary for the nurse to consult with a pharmacist each time medication is to be administered to a patient. 16. Which advantage(s) does the unit dose drug distribution system include? (Select all that apply.) a. There is decreased participation by the pharmacy. The pharmacist is able to analyze prescribed medications for each client for drug b. interactions and contraindications. c. There is less waste of medications. d. The time spent by nursing personnel preparing these medications is increased. e. Credit is given to the patient for unused medications. ANS: B, C, E Because the pharmacist has a profile of all m edications for each patient, he or she is able to analyze prescribed medications for each patient for drug interactions and contraindications. This is an advantage of the unit dose drug distribution system. Less waste of medications is an advantage of the unit dose drug distribution system. Because each dose is individually packaged, credit can be given to the patient for unused medications. There is increased pharmacist involvement and better use of his or her extensive drug knowledge and nursing personnel time is decreased with this method. 17. Which statement(s) is/are true regarding the types of medication orders? (Select all that apply.) a. Stat orders are the same as single dose orders. b. Standing orders indicate the number of specified doses of a medication to be given. c. Renewal orders facilitate physician review before continuance of high risk medications. PRN medications will designate a mandatory number of times the medication is to be d. administered. e. Verbal orders should be used as much as possible. ANS: B, C Standing orders state the frequency of medication dosages to be administered or indicate the time frame of administration. Renewal orders require the physician to review medications that have expired orders, as determined by facility policy. Renewal policies facilitate physician verification of the necessity to continue a medication beyond a usual time frame and help ensure patient safety. Single dose and stat orders are not the same. PRN medications are not ordered a mandatory number of times, although a maximum number might be specified. Verbal orders should be avoided whenever possible. 18. Which stateme nt(s) is/are true regarding computerized prescriber order entry (CPOE)? (Select all that apply.) a. Integrates the ordering system with the pharmacy, laboratory, and nurses stations b. Provides instant access to online information to facilitate patient care needs c. Facilitates review of ordered medications for potential drug interactions d. Facilitates review of drugs for appropriateness of dosages e. Alleviates the need to perform mathematical computations ANS: A, B, C, D CPOE systems integrate patient information, provide instant access, facilitate review of ordered medications for potential drug interactions, and facilitate review of drugs for appropriateness of dosages. Alleviation of the need to perform mathematical computations is not a component of the CPOE system. Chapter 4: Clinical Pharmacokinetics and Pharmacodynamics 1. Clearance determines A. the time to reach steady -state B. the loading dose required to achieve the desired steady -state concentration C. the maintenance dose required to achieve the desired steady state concentration D. the dosage interval E. a and d 2. Volume of distribution determines A. the time to reach steady -state B. the loading dose required to achieve the desired steady -state concentration C. the maintenance dose required to achieve the desired steady state concentration D. the dosage interval