(Test Bank) Introduction to Clinical Pharmacology

Edmunds, 8

Medicine

Test Bank

8th Edition

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Test Bank for Introduction to Clinical Pharmacology, The downloadable file consists of 179 pages, and the total size of the file is 1.29 MB. Purchase now only for highly discounted price.

Author(s): Edmunds

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Chapter 1: Pharmacology and the Nursing Process in LPN Practice Edmunds: Introduction to Clinical Pharmacology, 8th Edition MULTIPLE CHOICE 1. A patient states that he occasionally takes an over -the-counter laxative for constipation. What is this inform ation an example of? a. Objective data b. Inspection c. Subjective data d. Alternative therapy ANS: C Subjective data describes the information given by the patient or family and includes the concerns or symptoms felt by the patient. DIF: Cognitive Level: Apply REF: p. 3 OBJ: 2 TOP: The Nursing Process KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 2. Which represents the correct order of the steps of the nursing process? a. Assessment, diagnosis, planning, implementatio n, evaluation b. Planning, assessment, diagnosis, implementation, evaluation c. Assessment, planning, implementation, diagnosis, evaluation d. Diagnosis, planning, implementation, evaluation, assessment ANS: A The nursing process consists of five maj or steps in this order: assessment, diagnosis, planning, implementation, evaluation. DIF: Cognitive Level: Remember REF: pp. 1 -2 | Fig. 1 -1 OBJ: 1 TOP: The Nursing Process KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 3. The statement, ―The patient will be able to self -administer an aerosol nebulizer treatment by the date of discharge,‖ is an example of which step of the nursing process? a. Implementation b. Diagnosis c. Evaluation d. Planning ANS: D The patient -focused care plan should includ e any medications that will be given on either a short -term or a long -term basis. For example, goals may be written to apply ointments or patches or to show the patient how he can give himself an aerosol nebulizer treatment. DIF: Cognitive Level: Apply REF: pp. 4 -5 OBJ: 4 TOP: The Nursing Process KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 4. A medication should be withheld when which is true? a. The physician omits the trade name in the order. b. There has been a change in the patient’s condition. c. The medication improves the patient’s symptoms. d. The patient is asleep. ANS: B You must use good judgment in carrying out a medication order. If, in your judgment, there has been a change in the patient’s condition that r aises concerns about whether a medication should be given, it should be withheld (not given) until your concerns can be answered by the patient’s physician. DIF: Cognitive Level: Remember REF: p. 5 OBJ: 3 TOP: Medication Administration KEY: Nursing Proces s Step: Planning MSC: NCLEX: Physiological Integrity 5. How would a nurse ensure that the medication order is accurate? a. By checking the medication record with the Kardex file b. By comparing the physician’s order with the medication history c. By co mparing the physician’s order to the chief complaint d. By checking the medication record with the original physician’s order ANS: D Once the health care provider orders the medication, the nurse must verify that the order is accurate. Checking the med ication chart or medication record with the physician’s original order usually does this. DIF: Cognitive Level: Remember REF: p. 5 OBJ: 3 TOP: Medication Administration KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 6. What do t he six ―rights‖ of medication administration include? a. Drug, time, dose, doctor, route, and documentation b. Drug, time, dose, patient, route, and documentation c. Drug, diagnosis, time, patient, route, and documentation d. Dose, time, doctor, patient , route, and drug ANS: B There are six ―rights‖ of medication administration that the nurse must always keep in mind. You must give the right drug at the right time, in the right dose, to the right patient, by the right route, and use the right document ation to record that the dose has been given. DIF: Cognitive Level: Remember REF: p. 6 OBJ: 3 TOP: Medication Administration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 7. Which nursing action should ensure that a medic ation is given to the right patient? a. Checking the patient’s identification bracelet b. Verifying the medication record with the chart c. Verifying the room number with the chart d. Asking the patient to state his or her birth date and Social Security number ANS: A Each patient should be asked his or her name as the nurse checks the identification bracelet. In a hospital setting, medication should never be given to a patient who is not wearing an identification bracelet. DIF: Cognitive Level: Under stand REF: p. 7 OBJ: 3 TOP: Medication Administration KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment 8. The nurse should document drug administration at which time? a. At the end of each shift b. As soon as possi ble after administration c. Just before administration d. Any time during the nurse’s shift ANS: B A note about how and when the nurse gave the drug should be made on the patient’s chart as soon as possible after the drug is administered. There is a g reater chance of error if meds are not charted as soon as they are given. DIF: Cognitive Level: Remember REF: p. 8 OBJ: 3 TOP: Medication Administration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 9. Which nursing actio n is an example of the evaluation step in medication administration? a. Obtaining the clotting time results of a patient on an anticoagulant b. Asking the patient if he or she has any allergies to medications c. Checking a drug reference to verify the ac tion of the drug d. Explaining to the patient the possible side effects of the drug ANS: A Evaluation of what happens when the nurse administers a drug helps the health care provider decide whether to continue the same drug or make a change. After admi nistering a drug, an important role of the nurse is following up to evaluate for the desired action (e.g., obtaining results of clotting time tests ordered by the physician for a patient on an anticoagulant). DIF: Cognitive Level: Apply REF: p. 8 OBJ: 4 TOP: Medication Administration KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 10. A nurse must check for which two specific types of patient responses to drug therapy? a. Action coding and action transferred b. Drug feedback an d drug uptake c. Therapeutic effects and adverse effects d. Uptime levels and downtime levels ANS: C The nurse checks for two types of responses to drug therapy: therapeutic effects and adverse effects. DIF: Cognitive Level: Remember REF: p. 8 OBJ: 4 TOP: Medication Evaluation KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 11. Which is never administered if prepared by another nurse? a. Written orders b. Daily reports c. Diet selections d. Medications ANS: D It must be stressed that the nurse must never give medication prepared by another nurse. Medications should not be given and orders not carried out. DIF: Cognitive Level: Remember REF: p. 8 OBJ: 3 TOP: Record Keeping KEY: Nursing Process Step: N/A MSC: NCLEX: N/ A 12. As an LVN/LPN, the nurse’s role in the nursing process is to gather information and work with the patient. In carrying out this role, which task can be delegated to the LPN/LVN nurse? a. Interviewing the patient on admission b. Planning and eval uating the patient’s care c. Checking vital signs and medication response d. Carrying out all steps of the nursing process ANS: C It is usually the LPN/LVN who takes vital signs, checks a patient’s response to medications and treatments, and monitors symptoms the patient is having. DIF: Cognitive Level: Understand REF: p. 2 OBJ: 1 TOP: Nursing Process KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 13. When information is reported by the patient, it is considered to be subjective data. Which statement is considered to be objective data? a. The patient tells the nurse, ―I have pain in my lower back.‖ b. Mr. Williams tells the nurse he is having trouble catching his breath. c. Miss Sims has told the doctor she has no hi story of allergies to antibiotics. d. The patient’s skin is warm and dry. ANS: D Objective data are physical findings the nurse can see during careful inspection, palpation, percussion, and auscultation. DIF: Cognitive Level: Understand REF: p. 3 OBJ: 2 TOP: Nursing Process KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 14. The LPN/LVN is a member of the health care team and assists the RN in following a plan of care once the nursing diagnoses are shared with the team. When developing a nursing diagnosis, it can sometimes be difficult to get accurate answers from patients. Which category of patients is most likely to present a problem in this regard? a. Patients who are elderly and sick b. Patients only in for 24 -hour admissions c. Parents whose children are patients d. Bilingual parents whose children are patients ANS: A Getting accurate answers to questions may be harder with children, elderly patients, or people whose language or culture is different from yours. DIF: Cognitive Level: Understand REF: p. 4 OBJ: 4 TOP: Diagnosis KEY: Nursing Process Step: Diagnosis MSC: NCLEX: Physiological Integrity 15. In utilizing the collected information about the patient’s condition before giving medications, what are some important factors to consider? a. The color of the medication in pill form b. Who can administer this medication c. Other drugs that may affect the medication’s route d. The reason and goal of the medications given ANS: D In planning to give a medic ation, the LPN/LVN must understand the reason or goal for each medication to be given; that is, what is this drug supposed to do for the patient? DIF: Cognitive Level: Apply REF: pp. 4 -5 OBJ: 4 TOP: Planning KEY: Nursing Process Step: Planning MSC: NCLEX : Physiological Integrity 16. The nurse collected information for a patient at the beginning of the shift and found that she had a blood pressure of 198/100. After reporting this information to the RN team leader, the nurse gave the patient the scheduled medication, amlodipine (Norvasc), 5 mg PO. Which is considered an appropriate evaluation of the patient’s response after this medication has been administered? a. The therapeutic goal of the drug is met. b. The therapeutic effects and adverse effects are checked. c. The medication was given 30 minutes late. d. The medication was given 30 minutes early. ANS: B The nurse checks for two types of responses to drug therapy: therapeutic effects and adverse effects. Follow -up blood pressure should be checke d to determine if the drug is effective. DIF: Cognitive Level: Apply REF: p. 8 OBJ: 1 TOP: Medication Response KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 17. Many medications have names that sound or look alike. What shou ld a nurse administering two such similar medications do? a. Check the spelling and name of each medication. b. Check the physician’s order only. c. Ask the team leader to check the order with you. d. Ask the patient which one of the medications she tak es. ANS: A It is important to check the spelling of the name and the dose of each medication before any medication is given. DIF: Cognitive Level: Apply REF: p. 6 OBJ: 3 TOP: The Right Drug KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiol ogical Integrity 18. Medications may come in a unit -dose package with a bar code that is scanned by a computer. Which process should the nurse perform before administering unit -dose medication? a. Remove each medication from the packaging. b. Check the medications in alphabetic order. c. Read the drug label at least three times. d. Ask the patient to name each of his or her medications. ANS: C Irrespective of the way the medication comes, the nurse must read the drug label at least three times: (1) before taking the drug from the unit -dose cart or shelf, (2) before preparing or measuring the prescribed dose of medication, and (3) before putting the medication back on the shelf or just before opening the medication at the time you give it to the patie nt. DIF: Cognitive Level: Apply REF: p. 6 OBJ: 3 TOP: The Right Drug KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 19. In some settings, identifying the patient who is at risk for medication error (confused or critically ill) can be accomplished by which process? a. Asking the patient his or her name and room number b. Asking the patient’s roommate for the patient’s name c. Carrying the patient’s chart with you to the room d. Using the portable computer to scan the ide ntification bracelet ANS: D The use of a portable computer to scan the patient’s identification bracelet and the drug is helpful in making sure the correct patient gets the correct medication. DIF: Cognitive Level: Understand REF: p. 7 OBJ: 3 TOP: The Right Patient KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 20. It is important for the LPN/LVN to be a part of the evaluation process when giving the patient medications. Which factor is considered to be an important par t of the process of evaluating medications once they are given? a. Asking the patient what the medication tasted like b. Asking the patient if swallowing all of the medications at once helped c. Evaluating the therapeutic effects and the adverse effects of the medication d. Evaluating whether more scheduled medication is needed ANS: C The nurse checks for two types of responses to drug therapy: therapeutic effects and adverse effects. DIF: Cognitive Level: Apply REF: p. 8 OBJ: 4 TOP: Evaluating Respo nse to Medication KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 21. An LVN/LPN works on a very busy 35 -bed medical -surgical unit. The RN team leader gives her a syringe with ―pain medication‖ in it and asks the LPN/LVN nurs e to administer this medication to a patient. What should be the nurse’s first action? a. Assist the team leader by giving the medication as requested for this time only. b. Administer the medication this time because it is an emergency. c. Take time and prepare the medication herself and give as prescribed. d. The LVN/LPN doesn’t have to do anything; it is not her patient. ANS: C It must be stressed that the nurse never gives medication prepared by another nurse. Even when a nurse is very busy, when there is an emergency, or when the nurse is interrupted, the nurse cannot assume that all the ―rights‖ are followed unless the person who prepared the medication is the one who gives the medication. DIF: Cognitive Level: Understand REF: p. 8 OBJ: 4 TOP: The Right Documentation KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 22. An LVN/LPN is evaluating the response of a patient 30 minutes after receiving an antihypertensive medication administered by the RN team leader. The LPN/LVN assesses the patient’s blood pressure and notes the patient is now hypotensive. What is this is an example of? a. An adverse effect b. A desired response to a medication c. A therapeutic effect d. An allergic reaction ANS: A An adverse effect is seen when patients do not respond to their medications in the way they should or develop new signs or symptoms. When a patient has an adverse effect, the LPN/LVN should report this immediately to the RN or health care provider. DIF: Cognitive Level: U nderstand REF: p. 8 OBJ: 4 TOP: Evaluating Medication Response KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 23. The LVN/LPN is preparing to administer insulin to a patient with diabetes. What should the nurse assess prior to administering the insulin? a. Blood pressure b. Blood glucose c. Heart rate d. Temperature ANS: B The LVN/LPN should assess the patient’s blood glucose to establish a baseline prior to administering the insulin. A baseline blood glucose may influence the decision to hold or administer the insulin based on the results. DIF: Cognitive Level: Apply REF: pp. 2 -4 OBJ: 4 TOP: Assessment KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity MULTIPLE RESPONSE 24. After drug administra tion, the nurse should monitor for which responses to drug therapy? (Select all that apply .) a. Expected outcomes b. Premedication teaching c. Allergic responses d. Adverse reactions e. Side effects ANS: A, C, D, E It is important to monitor the pat ient for expected outcomes, allergic responses, and any adverse reactions or side effects. DIF: Cognitive Level: Understand REF: p. 8 OBJ: 4 TOP: Medication Response KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 25. When adm inistering medication to a patient whose dose has a bar code on the medication wrapper that must be scanned by the computer, the nurse knows that which protocols must be followed? (Select all that apply .) a. Scan the bar code with the computer; there is no need to do anything else. b. Check the drug before removing it from the unit -dose cart. c. Check the dose before preparing or measuring the medication. d. Check the drug just before you open it and give it to the patient. e. Scan the empty wrapper of a previously given drug since it’s the same drug. ANS: B, C, D Sometimes the medication dose has a bar code that is scanned by a computer, but the nurse must also read the drug label at least three times: (1) before taking the drug from the unit -dose ca rt or shelf, (2) before preparing or measuring the prescribed dose of medication, and (3) before putting the medication back on the shelf or just before opening the medication at the time you give it to the patient. DIF: Cognitive Level: Understand REF: p. 6 OBJ: 3 TOP: The Right Drug KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 26. Getting accurate information from a patient during admission is an important job for the nurse recording this information. The answers to wh ich admission questions will help form the best plan of care for the patient? (Select all that apply .) a. How sick is the patient? b. What medication procedures will the patient require? c. Does the patient know you are an LPN/LVN? d. What special conce rns or cultural beliefs does the patient have? e. Does the patient have health insurance? ANS: A, B, D Think about the problems that led to the patient’s admission to the hospital. How sick is the patient? What procedures or medications will the patien t need? What special knowledge or equipment is required in giving these medications? What special concerns or cultural beliefs does the patient have? How much does this patient understand about the medicine? The answers to these questions are essential to planning the best care for the patient. DIF: Cognitive Level: Remember REF: p. 4 OBJ: 1 TOP: Diagnosis KEY: Nursing Process Step: Diagnosis MSC: NCLEX: Physiological Integrity 27. When performing an initial patient assessment, which would be considered objective data? (Select all that apply.) a. Abdominal pain reported by the patient b. The patient’s vital signs (blood pressure, pulse, temperature, etc.) c. Documents such as old laboratory results, EEG printouts, or x -rays brought in by the patient d. Home medications with patient labels brought in by the patient e. The chief problem or complaint as stated by the patient ANS: B, C, D The patient complaints would be considered ―subjective‖ data. Subjective data include information given by the pati ent or family such as concerns or symptoms felt by the patient. Objective data are obtained when the health care provider gives the patient a physical examination, and also include verifiable information from a patient’s prescription drug bottles and old t est results along with results of recent laboratory tests and diagnostic procedures. DIF: Cognitive Level: Apply REF: p. 3 OBJ: 2 TOP: The Nursing Process KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance Chapter 2: Patie nt Teaching and Health Literacy Edmunds: Introduction to Clinical Pharmacology, 8th Edition MULTIPLE CHOICE 1. A patient comes into the clinic and is started on a new antihypertensive medication. In the past, this patient has not been taking the medicat ion on a daily basis as per the drug treatment plan. Which strategy should the nurse use to get the patient to take the prescribed medication? a. Tell the patient to follow the plan of care. b. Tell the patient he will have a stroke if he does not take hi s medication. c. Discuss with the patient the reasons that he is not taking his medication. d. Tell the patient he will have to see a doctor to get more medication. ANS: C When the nurse teaches the patient, the nurse should discuss the patient’s reas ons for not taking the medication and help the patient set goals so the patient can make informed decisions about taking the medication. DIF: Cognitive Level: Apply REF: p. 11 OBJ: 2 TOP: Compliance, Noncompliance, and Concordance KEY: Nursing Process St ep: Assessment MSC: NCLEX: Physiological Integrity 2. A patient is a newly diagnosed diabetic who has been incorrectly taking the medication prescribed. Which is the most likely reason? a. The patient feels the dose of medication is not enough. b. The p atient feels the dose of medication is too much. c. The patient does not understand the medication dosage. d. The patient cannot swallow the medication. ANS: C There are two basic reasons a patient has difficulty meeting treatment goals: (1) the patie nt does not understand what to do, or (2) the patient understands what to do but fails to do it. When teaching the patient, discuss both of these reasons with the goal of helping the patient make informed decisions about properly taking medications. DIF: Cognitive Level: Apply REF: p. 11 OBJ: 2 TOP: Compliance KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 3. Poor literacy is a problem that interferes with a patient’s ability to deal with the health care setting. What can contribute to a patient’s literacy problems? a. The patient is hearing -impaired. b. The patient cannot read health content. c. The patient’s family is not involved. d. The patient lives alone. ANS: B Inability to read health content often means that patients cannot read the information nurses or doctors send home with them about their disease, the medications they are taking, and important things they need to know. Recent research suggests that written information given to most patients should be writ ten at a fifth - to seventh -grade level to make it more likely that they will understand. DIF: Cognitive Level: Understand REF: p. 12 OBJ: 2 TOP: Communicating with Patient KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 4. The nurse needs to teach a patient about the side effects of a medication she is taking. By what means will the nurse know whether the patient has learned the information she needs to know about her medication? a. The patient can repeat the information. b. The patient learns the information in her mind. c. The patient remembers most of the information given. d. The patient is selective with the information given. ANS: A Have the patient repeat information back, show a procedure, or follow up on a behavior to determine how well the material has been learned. Return demonstration or discussion is the only way to measure a patient’s understanding. DIF: Cognitive Level: Understand REF: p. 13 OBJ: 3 TOP: Assess Learning Needs KEY: Nursing Process Step: Impleme ntation MSC: NCLEX: Physiological Integrity 5. The nurse is planning the teaching/learning objectives for a patient who comes into the clinic to learn about hormonal therapy and is experiencing stress. What will help the patient’s learning process? a. Covering as many topics as possible at one time b. Timing the teaching to coincide with visiting hours c. Teaching the patient while a favorite television program is playing in the background d. Systematic teaching in a quiet, unhurried setting ANS: D Teaching needs to be given in a systematic manner to decrease stress. It needs to be provided in a timely way and in a quiet, unhurried setting that gives the patient a chance to ask questions. If the patient appears to be anxious or in pain, stop and resc hedule the session. DIF: Cognitive Level: Apply REF: p. 14 OBJ: 3 TOP: Teaching Plan KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 6. Television ads that are created by drug companies cannot always answer patients’ ques tions. What is the term for television ads created for patients? a. Direct -to-consumer advertising b. Direct visual teaching advertising c. Limited -content advertising d. Limited -focus advertising ANS: A Television ads created by drug companies for p atients are called direct -to-consumer advertising. Patients may have many questions or inaccurate information because they have seen these ads. DIF: Cognitive Level: Understand REF: p. 16 OBJ: 3 TOP: Audiovisual Resources KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 7. The nurse used a combination of spoken and written information to teach a patient about the medications he will be taking when he leaves the hospital. What is another teaching resource available to the patient that can provide him with the latest information once he is home? a. A direct phone number to an on -call nurse b. A website’s navigational address c. All written informational material in a neat folder d. A list of journal articles with direct information ANS: B The Internet is becoming a source of up -to-date health information, not only for nurses but for patients as well. Many Internet sites meet the needs of both. Patients should be aware that not all information presented on the Internet is accurate or appropriate. DIF: Cognitive Level: Apply REF: p. 16 OBJ: 3 TOP: Internet Use KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 8. The nurse is teaching a patient about blood pressure control along with diet and weight reduction. How will the nurse be reassured that the patient understands this learning session? a. The patient takes a few notes. b. The patient repeats back some of the information given. c. The patient is on time for every teaching session. d. The patient takes his blood pressure and weighs him self. ANS: D Teaching that is active and which provides sensory involvement like handling things, hearing things, eating something, and so forth allows more effective learning to take place. The more senses involved, the better the chance that the patie nt will remember. DIF: Cognitive Level: Apply REF: p. 17 OBJ: 3 TOP: Evaluation of Learning KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 9. The nurse is teaching a patient from a general teaching plan that has been set up fo r all patients with type 2 diabetes. What should be the nurse’s first consideration if this patient is unable to perform her blood glucose test without assistance? a. The patient has not accepted her diagnosis. b. The patient feels the test strip is wrong for testing her blood. c. The patient is having problems understanding the process. d. The learning objectives should be less specific for this patient. ANS: C Sometimes the process breaks down when a patient does not understand what to do, cannot afford the treatment plan, or loses confidence in her ability to change. Whatever the problem, the nurse must attempt to discover where the process went wrong. DIF: Cognitive Level: Apply REF: pp. 16 -17 OBJ: 3 TOP: Evaluation of Learning KEY: Nursing Proces s Step: Evaluation MSC: NCLEX: Physiological Integrity 10. An elderly patient tells the nurse he is unable to read some of the instructions about his medication. The nurse’s first response is to do which of the following? a. Give the patient verbal instr uctions for the medication. b. Read the instructions with the patient and then have the patient repeat them back to the nurse. c. Stop the medication until the patient can get an appointment in the clinic. d. Do nothing and tell the patient to take the medication as prescribed. ANS: B Have the patient repeat information back, show a procedure, or follow through on behavior to determine how well he has learned the material. Giving feedback to the patient helps the patient realize what he has learned or identify areas in which he still needs help. Try to assess why he can’t read the instructions. It may be that the print is too small. A magnifying glass may help. DIF: Cognitive Level: Apply REF: p. 13 OBJ: 1 TOP: Assessment of Patient Education Needs KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 11. It is important for the nurse and the patient to communicate effectively. The inability of a patient to read and write can interfere with effective communication and place her in ―health disparity.‖ Which factor can help the patient’s treatment plan? a. Teaching the patient to read and write b. Teaching the patient about his drugs and disease process c. Teaching the patient to call the drug company for information about prescr iption drugs d. Giving instructions only in written form ANS: B It is clear that there is no more important teaching than that which the nurse gives to the patient about his disease and its drug treatment. DIF: Cognitive Level: Apply REF: p. 12 OBJ: 2 TOP: Communicating with Patient KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 12. The nurse is teaching an elderly man who has hearing challenges. What is the best way to help this patient meet those challenges? a. Speak loudly into the patient’s ear. b. Give the information to the patient’s family. c. Stand to the patient’s side and speak normally. d. Give the patient written information. ANS: D A growing number of patients are elderly and may present certain challe nges to the nurse in ensuring that they can hear, understand, and accept suggestions. Although speaking clearly to patients is important, much of the teaching patients need will be given in writing. How and what is written are very important if we wish to send the right message. DIF: Cognitive Level: Apply REF: p. 11 OBJ: 2 TOP: Communicating with Patient KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 13. The nurse is teaching a patient about her oral diabetic medication th at is taken daily. The patient has specific goals that have been set with regard to glucose control. What specific learning objectives would be a teaching guide for this patient? a. Take blood sugar with fingerstick at 12 noon and repeat at supper daily. b. Fingerstick glucose will be 85 mg/dL to 125 mg/dL 2 hours after meals daily. c. Fingerstick blood sugar will be normal after breakfast and lunch daily. d. Blood sugar will be normal before breakfast and lunch and after supper daily. ANS: B The best objectives are clearly stated by describing the desired performance and what makes it adequate. DIF: Cognitive Level: Apply REF: p. 14 OBJ: 3 TOP: Preparing a Teaching Plan KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 14. The nurse is teaching a patient with a new diagnosis of hypothyroidism. The patient is anxious and fears gaining weight with this condition. Which of the following would help this patient’s learning process? a. Allow the patient to go home and read the information. b. Let the patient watch television for 2 hours before teaching. c. Give the teaching sessions in a systematic manner. d. Only tell the patient what he wants to hear. ANS: C To avoid creating more stress for the patient, teaching needs t o be given in a systematic manner. It needs to be provided in a timely, unhurried, and quiet setting, allowing the patient to ask questions. DIF: Cognitive Level: Apply REF: p. 14 OBJ: 3 TOP: Preparing a Teaching Plan KEY: Nursing Process Step: Implementa tion MSC: NCLEX: Physiological Integrity 15. A patient begins medication therapy for hypertension. Which reason is most likely to make the scheduled teaching plan change for this patient? a. The patient’s outlook for her condition changes. b. The patien t writes down some of the information. c. The patient has no questions after being taught. d. The patient’s systolic blood pressure falls below 60 mm Hg with therapy. ANS: D Additional teaching will be required when changes in the patient’s condition warrant further adjustment in therapy. DIF: Cognitive Level: Apply REF: p. 13 OBJ: 3 TOP: Preparing a Teaching Plan KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 16. When giving the patient key written information about his d ischarge, the nurse will include which of the following? a. Prescriptions written by the physician b. The questionnaire found at the bedside c. The unit -dose package given at discharge d. Drug inserts and booklets prepared for medications ANS: D Written information can include special labels for prescription bottles, inserts from drug packages, and booklets prepared about medications. DIF: Cognitive Level: Remember REF: pp. 14 -15 OBJ: 3 TOP: Teaching Plan KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 17. A teaching plan is scheduled to deliver specific content during a session. Which is the appropriate response to unrelated but important questions interrupting the planned content of the session? a. A quick response is acceptable during the session. b. The plan must be closely followed with no interruptions. c. Interruptions are only allowed at break time. d. Unrelated content questions can only be answered at the end of the session. ANS: A In the clinic or hosp ital, teaching often happens in response to a patient’s questions, and the nurse may need to respond quickly without time to prepare, plan, or consider overall what the patient needs to know. DIF: Cognitive Level: Apply REF: p. 14 OBJ: 2 TOP: Teaching Pla n KEY: Nursing Process Step: Implementation MSC: NCLEX: N/A 18. The nurse and other health care providers are legally obligated to provide which kind of information to the patient for the purpose of informed consent? a. A lot of technical and scienti fic information b. Legal information for the patient and family c. Reasonable specifics d. Information in the patient’s own language and jargon ANS: C The law requires that the amount and type of information provided to the patient be ―reasonable.‖ DIF: Cognitive Level: Remember REF: p. 14 OBJ: 2 TOP: Patient Understanding KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 19. Which efforts suggested by researchers in patient education are useful for nurses to follow to increas e a patient’s medication compliance? a. Short verbal responses are easy to learn. b. Limited visual material with more verbal responses may be helpful. c. Flash cards are very useful for visualization. d. A variety of teaching methods, including written information and audiotapes, are useful. ANS: D Research suggests that to increase medication compliance in patients, the nurse should use a variety of means to give necessary instructions. These methods include telling patients the necessary informatio n and using written information, audiotapes, videotapes, and the computer. DIF: Cognitive Level: Apply REF: p. 14 OBJ: 2 TOP: Teaching Plan KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 20. The term concordance is somet imes preferred over compliance or noncompliance when speaking of a patient following a prescribed plan of care for which reason? a. It is judgmental. b. It is nonjudgmental. c. It is caring. d. It is uncaring. ANS: B A term that does not judge the pa tient is concordance . Instead, this term emphasizes the collaboration among the patient, family, health care provider, and pharmacist. DIF: Cognitive Level: Remember REF: p. 11 OBJ: 2 TOP: Compliance, Noncompliance, and Concordance KEY: Nursing Process St ep: N/A MSC: NCLEX: N/A 21. When a patient is first diagnosed with a disease, education should start with which of the following? a. Describing what has gone wrong and what is likely to happen b. Determining why the problem took so long to develop c. Deciding who caused this problem d. Discussing what the patient should have done differently ANS: A When a patient is first diagnosed with a problem, education must start with what has gone wrong and what is likely to happen. DIF: Cognitive Level: Re member REF: p. 13 OBJ: 3 TOP: Patient Education KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 22. The nurse is teaching the patient an activity the patient needs to learn by the time this teaching session is over. Which objecti ves for this patient clarify that learning has taken place? a. The patient’s face shows understanding while the nurse is explaining. b. The patient smiles after each instruction is given during the teaching session. c. The patient describes the informati on at the end of the session. d. The patient looks the nurse directly in the face during the session. ANS: C The best objectives are clearly stated by describing the desired patient performance and what makes it acceptable. Feedback is essential to det ermine whether learning has taken place. DIF: Cognitive Level: Apply REF: p. 14 OBJ: 3 TOP: Teaching Plan KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 23. When teaching a patient about her plan of care, which action will c onfirm for the nurse that learning has taken place? a. Ask the patient if she understands the information. b. Have the patient repeat the information learned. c. Allow the patient to take the lead. d. Let the patient evaluate her own level of learning. ANS: B Have the patient repeat information back, show a procedure, or follow through on a behavior to determine how well she has learned the material. DIF: Cognitive Level: Remember REF: p. 13 OBJ: 3 TOP: Patient Education KEY: Nursing Process Step: I mplementation MSC: NCLEX: Physiological Integrity 24. The LPN is teaching a patient about the side effects of his hypertension medication. Research has shown that the nurse should tell the patient about all the side effects of this medication for which reason? a. Medications are hard to recognize by color and shape only. b. Patients want to be able to discuss their medications. c. Patients must be able to recognize side effects correctly. d. Medication names are easier to pronounce. ANS: C Research has shown that those patients who are given more information are better able to correctly recognize side effects should they occur. DIF: Cognitive Level: Apply REF: p. 12 OBJ: 3 TOP: Patient Education KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 25. The nurse talks with a clinic patient by phone and discovers the patient is not taking her medication as instructed. The patient was given only verbal instructions in her teaching session. The nurse should now have the patien t do which of the following? a. Listen to the nurse as the nurse repeats the instructions by phone. b. Call every day, and the nurse will repeat the instructions until learned. c. Return to the clinic to receive other teaching methods. d. Have a family member take the instructions by phone. ANS: C Using a variety of teaching methods is more effective for learning than use of a single teaching method. In this case, the verbal teaching has not been effective so other methods should be employed. DIF: Cognitive Level: Apply REF: p. 13 OBJ: 3 TOP: Patient Education KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 26. There are three patients in the class the nurse is teaching about insulin injections. Two of the patients have de monstrated the ability to draw up and inject the insulin correctly. One patient has problems drawing up the insulin and injecting the medication after it is in the syringe. Which represents the next step the nurse could take to meet this patient’s learning needs? a. Teach a family member to do the injections. b. Teach each activity separately on different days. c. Show the patient a film on giving injections. d. Let the patient read about each activity, then do the procedures together. ANS: B Differen t teaching skills may be needed at different times for the same patient. Teaching should be carried out in small amounts over several meetings. DIF: Cognitive Level: Apply REF: p. 13 OBJ: 3 TOP: Patient Education KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 27. Before educating a patient about his discharge medications, the nurse should do what? a. Discuss where the patient will be staying after discharge. b. Determine which pharmacy will fill the patient’s prescription . c. Assess the patient’s specific learning needs. d. Select a teaching method. ANS: C Before the nurse begins to educate the patient, the nurse should first assess the patient’s specific learning needs. This allows the nurse to take into account not only the patient’s specific learning needs but also the patient’s knowledge, reading ability, beliefs, and experiences. DIF: Cognitive Level: Remember REF: p. 13 OBJ: 3 TOP: Patient Education KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiolo gical Integrity MULTIPLE RESPONSE 28. Patients may have difficulty in meeting treatment goals for which reasons? ( Select all that apply .) a. Lack of understanding of the goals b. Incongruity between patient and nursing goals c. Compliance with all asp ects of the treatment plan d. Limited financial resources e. Limited time available ANS: A, B, D, E Some reasons patients have difficulty in meeting treatment goals are lack of understanding, different beliefs about treatment, different goals for trea tment, and financial and time limitations. The nurse must determine the cause of the patient’s difficulty and develop a plan to address it. DIF: Cognitive Level: Understand REF: p. 11 OBJ: 2 TOP: Compliance KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 29. What are essential steps in the patient -teaching process? ( Select all that apply. ) a. Develop a single teaching strategy. b. Assess the specific needs of the patient. c. Select the teaching method. d. Determine how well the material has been learne d. e. Assess the patient’s willingness to learn. ANS: B, C, D, E The patient -teaching process begins with an assessment of the needs of the patient and validation of the patient’s willingness to learn. Then the method of teaching is selected, and a var iety of teaching strategies are developed. The nurse also determines how well the material has been learned by the patient. DIF: Cognitive Level: Understand REF: p. 13 OBJ: 3 TOP: Patient Education KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 30. Health literacy is a problem for which reasons? (Select all that apply.) a. Age b. Inability to read a map c. Inability to read a prescription d. Lack of financial resources e. Little knowledge of diseases ANS: B, C, D Health literacy is the ability to understand and use information that is important in keeping healthy. If a person cannot read a prescription to learn how many pills he should take, cannot read a map to find out how to get to the next appointment, or cannot understand his disease proces s, he has problems with health literacy. DIF: Cognitive Level: Understand REF: p. 12 OBJ: 2 TOP: Patient Education KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 31. Which are basic reasons a treatment plan may be ineffective? ( Select all that apply. ) a. Goal content focuses on medical facts. b. Goal content is not in a handout. c. Goal content has four objectives. d. Goal content is measurable. e. Goal content focuses on behavior. ANS: A, B, C Focus on behavior rather than medical facts. Be su re the goals of the handout are stated. There should be one or two objectives. DIF: Cognitive Level: Understand REF: p. 15 OBJ: 2 TOP: Patient Communication KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 32. What factors may contribute to patient medi cation errors? ( Select all that apply .) a. Only two objectives, instead of four, are included in the treatment plan discussed with the patient. b. The nurse fails to provide patients with information about both the desirable effects and the possible side effects of prescribed medication so that they can make an informed decision about the treatment plan. c. Medication -related teaching materials sent home with patients are written at a higher than eighth -grade reading level. d. Medication -related teaching materials sent home contain long sentences and medical terms rather than common or familiar words. e. The nurse gives patients with new prescriptions verbal instructions only, rather than talking to patients and giving them written information or talking to patients along with showing audiovisual aids. ANS: B, C, D, E Patients tend to be more compliant and comfortable with taking their medication the more information they have about it, including both desirable (therapeutic) effects and possible side effects. Medication teaching materials should be written at the fifth - to seventh -grade reading level to ensure that most patients will be able to read and comprehend the information. Also, short sentences composed of common or familiar words, rather than a lot of medical jargon, make these educational tools easier to understand for the vast majority of people. It is particularly important to use both verbal and visual information when discussing new prescription medication with patients. DIF: Cognitive Lev el: Understand REF: pp. 12 -13 | pp. 15 -16 OBJ: 1 TOP: Assessment of Patient Education Needs KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment 33. Which key points should the nurse include when providing patient educatio n for a patient receiving medications? ( Select all that apply.) a. Common side effects b. Intended use c. Drug brand name only d. Expected actions e. Any special directions ANS: A, B, D, E When providing patient education for medication administrati on the nurse should include information such as common side effects, intended use and expected actions, generic and brand names of the drug, and any special directions such as take with meals. DIF: Cognitive Level: Remember REF: pp. 12 -14| Box 2 -1 OBJ: 3 TOP: Preparing a Teaching Plan KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance Chapter 3: Legal Aspects Affecting the Administration of Medications Edmunds: Introduction to Clinical Pharmacology, 8th Edition MULT IPLE CHOICE 1. Which medication is an example of a controlled substance? a. Birth control pills b. An antibiotic c. Codeine d. A laxative ANS: C Controlled substances include major pain killers (narcotics) and some sedatives or tranquilizers that c an be prescribed by someone with a special license. Codeine is a Schedule II controlled substance. DIF: Cognitive Level: Remember REF: Table 3 -2 OBJ: 2 TOP: Controlled Substances KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 2. Which health care prof essional is licensed to prescribe controlled substances? a. LPN/LVN b. Physical therapist c. Pharmacist d. Physician ANS: D Federal and state laws make it a crime for anyone to possess controlled substances without a prescription. Each state has a pr actice act that lists which health care providers may dispense and write prescriptions for controlled substances. Physicians may write prescriptions for controlled substances. DIF: Cognitive Level: Remember REF: p. 21 OBJ: 2 TOP: Controlled Substances KEY : Nursing Process Step: N/A MSC: NCLEX: N/A 3. A patient brings his multivitamins to the hospital and asks the LPN/LVN if he can take them. Which is the nurse’s best response? a. ―Yes, but I must keep them in the medication room.‖ b. ―No, I have to ob tain a doctor’s order first.‖ c. ―Yes, let me put them in your bedside stand for you.‖ d. ―Not until the pharmacist adds them to your medication record.‖ ANS: B Over -the-counter (OTC) medications do not require a prescription for purchase, but a physi cian’s order is required before they may be taken in the hospital. OTC medications may interact with a patient’s prescribed medications. Therefore, the physician must be aware of all the meds the patient is taking. DIF: Cognitive Level: Apply REF: p. 22 OBJ: 3 TOP: Over -the-Counter Medications KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 4. Which drug distribution system is commonly used when ordering medication in an agency? a. Multidose system b. Health care system c. Welfare system d. Ward stock system ANS: D Each agency has its own way of ordering and administering medications distributed to nurses. The floor or ward stock system is one of the systems. DIF: Cognitive Level: Understand REF: p. 26| Box 3 -2 OBJ: 3 TOP: Drug Distribution Systems KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 5. Which is a document that is considered to be a legal record and hospital property? a. Kardex b. Medication card c. Armband d. Patient chart ANS: D The patient’s chart is a legal record. It is the major source of information about the patient and the care received while in the hospital. The Kardex card is thrown away when the patient is discharged. It is not a legal document. DIF: Cognitive Level: Remember REF: p. 24 OBJ: 7 TOP: Patient Charts KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 6. What should the nurse do first if a controlled substance is accidentally spilled or contaminated? a. Obtain another dose from the narcotic control system. b. Document the occ urrence in the medication record. c. Clean up the spill and notify the supervisor. d. Ask another nurse to cosign the inventory record describing the situation. ANS: D If the ordered dose is smaller than the dose provided (so that some medication must be discarded), or if the medication is accidentally dropped, contaminated, spilled, or otherwise made unusable and unreturnable, two nurses must sign the inventory report and describe the situation. DIF: Cognitive Level: Understand REF: p. 28 OBJ: 4 TOP: Controlled Substances KEY: Nursing Process Step: Assessment MSC: NCLEX: N/A 7. As the nurse is coming on duty to take over the day shift, the night nurse tells the nurse that she has already counted the controlled drugs for the day shift. What should the nurse do in this situation? a. Do nothing; this is standard procedure. b. Accept the keys and recount the drugs. c. Recount the drugs with another nurse. d. Count the drugs at the end of your shift. ANS: C At the end of each shift, the contents o f the locked cabinet are counted together by one nurse from each shift. A nurse who is willing to take the word of another nurse from the previous shift, without verifying the count, risks being held accountable for any shortages or discrepancies, and may be found guilty of falsifying records. If you go along with her, you are falsifying records. DIF: Cognitive Level: Apply REF: p. 28 OBJ: 4 TOP: Narcotics Control KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 8. What is t he missing component of the following medication order: Atropine 1 mg IV ? a. Frequency b. Indication c. Route d. Dilution ANS: A Regardless of whether the prescription is for a hospitalized patient or not, the order must contain the same information: patient’s full name, date, name of drug, route of administration, dose, frequency, duration, and signature of prescriber. DIF: Cognitive Level: Apply REF: p. 29 OBJ: 5 TOP: Drug Orders KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 9. The order reads, Theochron 200 mg PO qid . The nurse understands that this is which type of medication order? a. Priority b. Standing c. Flexible d. Indefinite ANS: B Medication orders may be classed into one of four types. A standing order indicates that the drug is to be administrated until discontinued or for a certain number of doses. DIF: Cognitive Level: Apply REF: p. 30 | Table 3 -3 OBJ: 6 TOP: Drug Orders KEY: Nursing Process Step: N/A MSC: NCLEX: N/A 10. Meperidine, 75 mg IV push, is ordered by the physic ian to be given stat. The nurse understands that this is which type of order? a. Standing b. Immediate c. Flexible d. Indefinite ANS: B A stat order is a type of medication order that is a one -time order to be given immediately. DIF: Cognitive Level : Apply REF: p. 30 | Table 3 -3 OBJ: 7 TOP: Types of Medication Orders KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 11. A nurse has administered the wrong medication to a patient. Which is the highest -priority nursing action at this time? a. Document the occurrence in the patient record. b. Notify the immediate supervisor of the error. c. Complete an incident report and submit it to the nurse manager. d. Evaluate the patient’s condition and notify the physician.