NUR 330 Exam 1 Test Questions and Answers_ Latest ,100% CORRECT

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NUR 330 Exam 1 Test Questions and Answers_ Latest Exam 1 CHPT 1, 2, 3, 4, 5, 12, 13, 20, 21 Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E Chapter 1 Question 1 Type: MCMA The... nurse is teaching a pharmacology class to student nurses. What does the nurse include as key events in the history of pharmacology? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Initial drugs included morphine, cocaine, and penicillin. 2. Early researchers used themselves as test subjects. 3. The initial intention of pharmacology was to relieve human suffering. 4. Modern pharmacology began in the early 1600s. 5. Pharmacologists synthesized drugs in the laboratory in the twentieth century. Correct Answer: 2,3,5 Rationale 1: Initial drugs isolated from complex mixtures included morphine, colchicines, curare, and cocaine, but not penicillin. Rationale 2: Some early researchers, such as Friedrich Serturner, used themselves as test subjects. Rationale 3: The early roots of pharmacology included the application of products to relieve human suffering. Rationale 4: Modern pharmacology began in the early 1800s, not the 1600s. Rationale 5: By the twentieth century, pharmacologists could synthesize drugs in the laboratory. Global Rationale: The early roots of pharmacology included the application of products to relieve human suffering, and early researchers used themselves as test subjects. Initial drugs included morphine, colchicines, curare, and cocaine, but not penicillin. Modern pharmacology began in the early 1800s, not the 1600s. By the twentieth century, pharmacologists could synthesize drugs in the laboratory. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-1 Identify key events in the history of pharmacology. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 3 Question 2 Type: MCSA The student nurse asks the nursing instructor why he needs to take anatomy and physiology, as well as microbiology, when he only wants to learn about pharmacology. What is the best response by the instructor? 1. "Because pharmacology is an outgrowth of those subjects." 2. "You must learn all, since those subjects, as well as pharmacology, are part of the curriculum." 3. "Knowledge of all those subjects will prepare you to provide the best patient care, including the administration of medications." 4. "Because an understanding of those subjects is essential to understanding pharmacology." Correct Answer: 4 Rationale 1: Pharmacology is an outgrowth of anatomy, physiology, and microbiology, but this is not the most complete reason for the nurse to learn them. Rationale 2: The nurse must learn anatomy, physiology, and microbiology to understand pharmacology, not because they are part of the curriculum. Rationale 3: Knowledge of anatomy, physiology, and microbiology prepares the nurse to understand pharmacology, not to provide care such as administration of medications. Rationale 4: It is essential for the nurse to have a broad knowledge base of many sciences in order to learn pharmacology. Global Rationale: It is essential for the nurse to have a broad knowledge base of many sciences in order to learn pharmacology. The nurse must learn anatomy, physiology, and microbiology to understand pharmacology, not because they are part of the curriculum. Pharmacology is an outgrowth of anatomy, physiology, and microbiology, but this is not the reason for the nurse to learn them. Knowledge of anatomy, physiology, and microbiology prepares the nurse to understand pharmacology, not to provide care such as administration of medications. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-2 Explain the interdisciplinary nature of pharmacology, giving an example of how knowledge from different sciences impacts the nurse’s role in drug administration. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 3 Question 3 Type: MCMA The nursing instructor is teaching a pharmacology class to student nurses. The current focus is pharmacology and therapeutics. The nursing instructor determines that learning has occurred when the students make which comments? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Pharmacology is the development of medicines." 2. "Pharmacology is the study of medicines." 3. "Therapeutics relates to drug use to treat suffering." 4. "Therapeutics is the study of drug interactions." 5. "Pharmacology is the study of drugs to prevent disease." Correct Answer: 2,3,5 Rationale 1: Pharmacology is not the development of medicines Rationale 2: Pharmacology is the study of medicines. Rationale 3: Therapeutics is the use of drugs in the treatment of suffering. Rationale 4: Therapeutics is not related to study of drug interactions. Rationale 5: Pharmacotherapy is the application of drugs for the purpose of disease prevention. Global Rationale: Pharmacology is the study of medicines and the use of drugs to relieve suffering. Therapeutics is the study of disease prevention and treatment of suffering. Pharmacotherapy is the application of drugs for the purpose of disease prevention. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1-3 Compare and contrast therapeutics and pharmacology. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 4 Question 4 Type: MCSA The nurse administers a vaccine to a child. What is the best understanding of the nurse as it relates to the manufacture of this vaccine? 1. The vaccine is produced by natural plant extracts in the laboratory. 2. The vaccine is naturally produced in animal cells or microorganisms. 3. The vaccine is produced by a combination of animal and plant products. 4. The vaccine is most commonly synthesized in a laboratory. Correct Answer: 2 Rationale 1: Vaccines are not produced by natural plant extracts. Rationale 2: Vaccines are naturally produced in animal cells, microorganisms, or by the body itself. Rationale 3: Vaccines are not produced by a combination of animal and plant products. Rationale 4: Vaccines are not synthesized in a laboratory. Global Rationale: Vaccines are naturally produced in animal cells, microorganisms, or by the body itself. Vaccines are not synthesized in a laboratory. Vaccines are not produced by natural plant extracts. Vaccines are not produced by a combination of animal and plant products. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1-4 Compare and contrast traditional drugs, biologics, and complementary and alternative medicine therapies. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 4 Question 5 Type: MCSA The older adult client has gastrointestinal bleeding. The client says to the nurse, "I don't understand this. All I did was take ibuprofen (Advil) for my arthritis." Which plan would be best as it relates to the nurse's education of this client? 1. A plan to teach the client to use drugs that bypass the gastrointestinal system, like topical drugs 2. A plan to teach the client to substitute safer drugs like acetaminophen (Tylenol) 3. A plan to teach the client to obtain physician approval prior to the use of over-the-counter (OTC) medications 4. A plan to teach the advantages and disadvantages of ibuprofen (Advil) Correct Answer: 4 Rationale 1: The use of topical drugs may be an option, but the drug a client needs may not be available in this form. Rationale 2: Substitution of other drugs may be beneficial, but this cannot be done in all situations. Rationale 3: It is not a realistic plan to expect clients to contact their physician prior to taking any over-the-counter (OTC) medication. Rationale 4: Since elderly clients account for the use of about 40% of all over-the-counter (OTC) medications, it is essential for the nurse to teach clients about the advantages, and the disadvantages, of these medications. Global Rationale: Since older adult clients account for the use of about 40% of all over-the-counter (OTC) medications, it is essential for the nurse to teach clients about the advantages, and the disadvantages, of these medications. Substitution of other drugs may be beneficial, but this cannot be done in all situations. The use of topical drugs may be an option, but the drug a client needs may not be available in this form. It is not a realistic plan to expect clients to contact their physician prior to taking any over-the-counter (OTC) medication. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring. NLN Competencies: Context and Environment: Health promotion/disease prevention. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1-9 Outline the major differences between prescription and over-the-counter drugs. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 6 Question 6 Type: MCSA The nursing instructor teaches the student nurses about the pharmacological classification of drugs. The instructor evaluates that learning has occurred when the students make which response? 1. "An anti-anginal treats angina." 2. "A calcium channel blocker blocks heart calcium channels." 3. "An antihypertensive lowers blood pressure." 4. "An anticoagulant influences blood clotting." Correct Answer: 2 Rationale 1: To say that a drug treats angina addresses the therapeutic usefulness of the drug, not the pharmacological classification. Rationale 2: The pharmacological classification addresses a drug's mechanism of action, or how a drug produces its effect in the body. Rationale 3: To say that a drug lowers blood pressure addresses the therapeutic usefulness of the drug, not the pharmacological classification. Rationale 4: To say that a drug influences blood clotting addresses the therapeutic usefulness of the drug, not the pharmacological classification. Global Rationale: The pharmacological classification addresses a drug's mechanism of action, or how a drug produces its effect in the body. To say that a drug influences blood clotting addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug treats angina addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug lowers blood pressure addresses the therapeutic usefulness of the drug, not the pharmacological classification. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1-5 Explain the basis for placing drugs into therapeutic and pharmacologic class. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 5 Question 7 Type: MCSA The nurse is providing medication education to a client with hypertension. The nurse teaches the client that the physician ordered a diuretic to decrease the amount of fluid in the client’s body. Which statement best describes the nurse's instruction? 1. The nurse provided appropriate medication education. 2. The nurse explained the drug's mechanism of action. 3. The nurse taught the client about a prototype drug. 4. The nurse explained the consequences of not using the drug. Correct Answer: 2 Rationale 1: The education was most likely appropriate, but this response is too vague. Rationale 2: A drug's mechanism of action explains how a drug produces its effect in the body. Rationale 3: There is no drug name present, so it is not known whether this is a prototype drug. Rationale 4: The nurse did not explain the consequences of not using the drug. Global Rationale: A drug's mechanism of action explains how a drug produces its effect in the body. The nurse did not explain the consequences of not using the drug. There is no drug name present, so it is not known whether this is a prototype drug. The education was most likely appropriate, but this response is too vague. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1-7 Describe what is meant by a drug’s mechanism of action. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 5 Question 8 Type: MCSA During pharmacology class, the student nurse asks the nursing instructor how students will ever learn about the individual antibiotic drugs since there are so many. What is the best response by the nursing instructor? 1. "You will learn a little trick called mnemonics." 2. "You will learn how to do a flow chart to enhance memory." 3. "You will learn how to categorize the individual drugs." 4. "You will learn a representative drug from each class." Correct Answer: 4 Rationale 1: Using mnemonics is not the best way to learn about drugs. Rationale 2: Flow charts are not the best way to learn about drugs. Rationale 3: Categorizing individual drugs is not the best way to learn about drugs. Rationale 4: A prototype, or representative, drug is the well-understood drug model from which other drugs in a pharmacological class are compared. Global Rationale: A prototype, or representative, drug is the well-understood drug model from which other drugs in a pharmacological class are compared. Categorizing individual drugs is not the best way to learn about drugs. Using mnemonics is not the best way to learn about drugs. Flow charts are not the best way to learn about drugs. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-6 Discuss the prototype approach to drug classification. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 5 Question 9 Type: MCSA The physician ordered a brand name drug for the client, paroxetine (Paxil). After taking this medication for a year, the client tells the nurse that it is no longer working. What is the best assessment of the nurse at this time? 1. "This sounds like your medication needs changing." 2. "Let's look for interactions with other medications you are taking." 3. "Are you taking Paxil or paroxetine?" 4. "It is time for us to do the Beck Depression assessment again." Correct Answer: 3 Rationale 1: Considering a change in medication is appropriate, but another assessment takes priority. Rationale 2: Assessing for interactions with other drugs is appropriate, but another assessment takes priority. Rationale 3: The bioavailability of a generic drug may not be the same as the bioavailability of a brand name drug. Rationale 4: Assessing for worsening of depression is appropriate, but another assessment takes priority. Global Rationale: The bioavailability of a generic drug may not be the same as the bioavailability of a brand name drug. Assessing for worsening of depression is appropriate, but the nurse should first assess if the client has changed to a generic form of the drug. Assessing for interactions with other drugs is appropriate, but the nurse should first assess if the client has changed to a generic form of the drug. Considering a change in medication is appropriate, but the nurse should first assess if the client has changed to a generic form of the drug. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-10 Explain the differences between trade-name drugs and their generic equivalents. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 7 Question 10 Type: MCSA The student nurse has completed an initial pharmacology course and tells the nursing instructor that it was difficult and she is glad it is over. What is the best response by the nursing instructor? 1. "It may be over, but now you must apply what you have learned to patient care." 2. "Learning is gradual and continuous; we never completely master all areas of pharmacology." 3. "Learning is always painful, but we must continue anyway." 4. "It really isn't over; you should take a graduate course next." Correct Answer: 2 Rationale 1: It is true that the student must apply what has been learned to patient care, but this response implies that learning is over. Rationale 2: Learning pharmacology is a gradual, continuous process that does not end with graduation. Rationale 3: Learning is not always painful. Rationale 4: There is no reason for the student nurse to take a graduate level pharmacology course at this time. Global Rationale: Learning pharmacology is a gradual, continuous process that does not end with graduation. Never does one completely master every facet of drug action and application. There is no reason for the student nurse to take a graduate level pharmacology course at this time. It is true that the student must apply what has been learned to patient care, but this response implies that learning is over. Learning is not always painful. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-2 Explain the interdisciplinary nature of pharmacology, giving an example of how knowledge from different sciences impacts the nurse’s role in drug administration. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 4 Question 11 Type: MCSA The client says to the nurse, "My wife and I take the same drug, but we have different side effects. Are we doing something wrong?" What is the best response by the nurse? 1. "No. Differences such as your sex can result in different side effects." 2. "I'll have to check. What is the name of the drug you were using?" 3. "Possibly. This could happen if one uses generic or brand name drugs." 4. "I'm not sure. Maybe the drug is not the same; you should check it." Correct Answer: 1 Rationale 1: Drugs may elicit different responses depending on individual client factors such as age, sex, body mass, health status, and genetics. Rationale 2: The nurse should not have to check the drug; basic knowledge should include knowing that the sex of clients can result in different side effects. Rationale 3: There are differences between some generic and brand name drugs, but this is not the best answer. Rationale 4: Asking the client to check a medication is fine, but this does not answer the client's question. Global Rationale: Drugs may elicit different responses depending on individual client factors such as age, sex, body mass, health status, and genetics. Asking the client to check a medication is fine, but this does not answer the client's question. There are differences between some generic and brand name drugs, but this is not the best answer. The nurse should not have to check the drug; basic knowledge should include knowing that the sex of clients can result in different side effects. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community. AACN Essential Competencies: II.7 Promote factors that create a culture of safety and caring. NLN Competencies: Relationship Centered Care: Knowledge: Effective communication. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-2 Explain the interdisciplinary nature of pharmacology, giving an example of how knowledge from different sciences impacts the nurse’s role in drug administration. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 4 Question 12 Type: MCSA The client comes to the emergency department with a myocardial infarction. The client's husband tells the nurse that his wife has been taking calcium carbonate (Tums) for years for what she thought was indigestion. What is the best response by the nurse? 1. "Your wife should not have self-diagnosed herself. I hope she will be okay." 2. "Why did you let her do that? She should have seen a doctor." 3. "Well, I am glad she is here, as it certainly wasn't indigestion." 4. "Your wife was self-diagnosing, which is generally not a good idea." Correct Answer: 4 Rationale 1: Telling the husband "I hope she will be okay" is a very frightening response that implies she might die, and this is non-therapeutic. Rationale 2: Asking the husband why he let his wife take Tums is non-therapeutic and too accusatory; do not ask "why" questions. Rationale 3: Telling the husband that "it certainly wasn't indigestion" is judgmental and will alienate the client and husband. Rationale 4: Clients take over-the-counter (OTC) drugs for many reasons. Self-treatment is sometimes ineffective, and the potential for harm may increase if the disease is allowed to progress. Global Rationale: Clients take over-the-counter (OTC) drugs for many reasons. Self-treatment is sometimes ineffective, and the potential for harm may increase if the disease is allowed to progress. Asking the husband why he let his wife take Tums is non-therapeutic and too accusatory; do not ask "why" questions. Telling the husband that "it certainly wasn't indigestion" is judgmental and will alienate the client and husband. Telling the husband "I hope she will be okay" is a very frightening response that implies she might die, and this is non-therapeutic. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.C.1 Value seeing health care situations “through patient’s eyes.” AACN Essential Competencies: IX.4 Communicate effectively with all members of the healthcare team, including the patient and the patient’s support network. NLN Competencies: Relationship Centered Care: Knowledge: Effective communication. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-9 Outline the major differences between prescription and over-the-counter drugs. MNL Learning Outcome: 1.1.4 Examine adverse effects of medication administration and risk reduction. Page Number: 6 Question 13 Type: MCSA The nurse is teaching a class for clients about over-the-counter (OTC) medications. The nurse determines that education has been effective when the clients make which statement? 1. "We should not take any over-the-counter (OTC) medicine without first calling and checking with the doctor's office." 2. "We should always ask the pharmacist about how to take the over-the-counter (OTC) medicine." 3. "We must read all the directions on the label and call the doctor's office if they are not clear." 4. "Medicines that are available over-the-counter (OTC) are really safe, or they would be prescription medicines." Correct Answer: 3 Rationale 1: It is not realistic to expect clients to call the doctor's office before taking any over-the-counter (OTC) medicine. Rationale 2: Asking the pharmacist is a good idea, but does not replace reading the label directions. Also, the pharmacist might not always be in the store when the medicine is purchased. Rationale 3: In most cases, clients may treat themselves safely if they carefully follow instructions included with the medication. Rationale 4: Most OTC medicines have a high margin of safety, but none is considered completely safe. Global Rationale: In most cases, clients may treat themselves safely if they carefully follow instructions included with the medication. It is not realistic to expect clients to call the doctor's office before taking any over-the-counter (OTC) medicine. Most OTC medicines have a high margin of safety, but none is considered completely safe. Asking the pharmacist is a good idea, but does not replace reading the label directions. Also, the pharmacist might not always be in the store when the medicine is purchased. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.A.4 Examine how the safety, quality, and cost effectiveness of health care can be improved through the active involvement of patients and families. AACN Essential Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. NLN Competencies: Quality and Safety: Commit to a generative safety culture. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1-9 Outline the major differences between prescription and over-the-counter drugs. MNL Learning Outcome: 1.1.4 Examine adverse effects of medication administration and risk reduction. Page Number: 6 Question 14 Type: MCSA The physician has prescribed a brand name drug for the client. The client tells the nurse that the medication is too expensive. What is the best plan by the nurse? 1. Help the client receive free medicine through a "patient assistance" program. 2. Ask the physician if a cheaper brand name drug may be substituted. 3. Ask the physician if a generic drug may be substituted. 4. Maintain the client on samples of the brand name drug from the physician's office. Correct Answer: 3 Rationale 1: A patient assistance program is a good idea, but since the client may not qualify for this, it is not the best plan. Rationale 2: Another brand name drug may not be what the client needs for the illness. Rationale 3: Generic drugs are much less costly than brand name drugs. Rationale 4: Providing samples is an option, but the office may temporarily run out of samples and the client will not receive the medication. Global Rationale: Generic drugs are much less costly than brand name drugs. A patient assistance program is a good idea, but since the client may not qualify for this, it is not the best plan. Another brand name drug may not be what the client needs for the illness. Providing samples is an option, but the office may temporarily run out of samples and the client will not receive the medication. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1-10 Explain the differences between trade-name drugs and their generic equivalents. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 7 Question 15 Type: MCSA The client is receiving a very expensive medication. The client asks the nurse why the medicine is so expensive. What is the best response by the nurse? 1. "It is expensive, but your insurance covers it and you have a low co-pay." 2. "Drug companies are allowed to advertise medications and this adds to the cost." 3. "Drug companies must recoup the cost of developing and producing the drug." 4. "I think the drug companies should be more accountable for lowering costs." Correct Answer: 3 Rationale 1: Telling the client that insurance covers the drug doesn't answer the client’s question. Rationale 2: Advertising costs are expensive, but this answer implies the drug company is raising costs unnecessarily. Rationale 3: If the cost of developing a new drug is not recouped by the drug company, there is no impetus for the company to continue drug development. Rationale 4: It is non-therapeutic for the nurse to introduce her own beliefs, such as accountability of drug companies, into a conversation with the client. Global Rationale: Telling the client that insurance covers the drug doesn't answer the client’s question. It is non-therapeutic for the nurse to introduce her own beliefs, such as accountability of drug companies, into a conversation with the client. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-8 Distinguish among a drug’s chemical name, generic name, and trade name. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 6 Question 16 Type: MCSA Modern pharmacology was introduced to the United States by the opening of the first department of pharmacology at the University of Michigan in which year? 1. 1805 2. 1890 3. 1847 4. 1908 Correct Answer: 2 Rationale 1: This event occurred after 1805. Rationale 2: John Jacob Abel, who is considered the father of American pharmacology owing to his many contributions to the field, founded the first pharmacology department in the United States at the University of Michigan in 1890. Rationale 3: This event did not occur in 1847. Rationale 4: This event occurred earlier than 1908. Global Rationale: John Jacob Abel, who is considered the father of American pharmacology owing to his many contributions to the field, founded the first pharmacology department in the United States at the University of Michigan in 1890. Cognitive Level: Remembering Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-1 Identify key events in the history of pharmacology. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 3 Question 17 Type: MCSA The application of drugs for the purpose of treating diseases and treatment of suffering is known as 1. biologics. 2. pharmacotherapeutics. 3. alternative therapies. 4. therapeutics. Correct Answer: 2 Rationale 1: Biologics are agents naturally produced in animal cells, by microorganisms, or by the body itself. Rationale 2: Pharmacotherapeutics is the application of drugs for the purpose of treating disease and the treatment of suffering. Rationale 3: Alternative therapies include natural plant extracts, herbs, vitamins, minerals, dietary supplements, and additional techniques outside the realm of conventional therapeutics. Rationale 4: Therapeutics is concerned with the prevention of disease and treatment of sufferings. Global Rationale: Pharmacotherapeutics is the application of drugs for the purpose of treating disease and the treatment of suffering. Cognitive Level: Remembering Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-3 Compare and contrast therapeutics and pharmacology. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 4 Question 18 Type: MCSA A client with chronic back pain informs the nurse he has been receiving therapeutic touch in addition to his medications. What is the nurse’s best classification of this client’s treatment? 1. pharmacotherapy. 2. drug-absence therapy 3. complementary therapy 4. biologic therapy Correct Answer: 3 Rationale 1: Pharmacotherapy is the application of drugs for the purpose of treating diseases and alleviating human suffering. Rationale 2: The client is using medications as well as an alternative therapy. Rationale 3: The client is using a non-conventional type of treatment (therapeutic touch) that is classified as complementary to his conventional pharmacotherapy. Biologic therapy involves the use of naturally produced substances by microorganisms or within the body. The client is using medications as well as an alternative therapy, which is why complementary therapy is the best choice. Rationale 4: Biologic therapy involves the use of naturally produced substances by microorganisms or within the body. Global Rationale: The client is using a non-conventional type of treatment (therapeutic touch) that is classified as complementary to his conventional pharmacotherapy. Pharmacotherapy is the application of drugs for the purpose of treating diseases and alleviating human suffering. Biologic therapy involves the use of naturally produced substances by microorganisms or within the body. The client is using medications as well as an alternative therapy, which is why complementary therapy is the best choice. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Relationship centered care: Respect the patient’s dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1-4 Compare and contrast traditional drugs, biologics, and complementary and alternative medicine therapies. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 4 Question 19 Type: MCSA The client is receiving a brand name drug and wants to change to the generic form because it is cheaper. What is the best outcome for this client? 1. Client will state two ways a brand name drug differs from a generic name drug. 2. Client will take the brand name drug after speaking with the physician. 3. Client will ask the nurse why brand name drugs are better than generic drugs. 4. Client will state two ways to obtain the medication at a reduced cost. Correct Answer: 1 Rationale 1: The dosage of drugs may be the same with a brand name and generic drug, but the bioavailability may be affected by the inert ingredients and tablet compression. Rationale 2: Referring the client to the physician is inappropriate because the nurse can educate the client about the difference between generic and brand name drugs. Rationale 3: The client asking the nurse a question is not an outcome. Rationale 4: Knowing ways to obtain medication at a reduced cost is an appropriate outcome, but the client will not learn why a brand name drug may be preferable over a generic drug. Global Rationale: The dosage of drugs may be the same with a brand name and generic drug, but the bioavailability may be affected by the inert ingredients and tablet compression. Knowing ways to obtain medication at a reduced cost is an appropriate outcome, but the client will not learn why a brand name drug may be preferable over a generic drug. Referring the client to the physician is inappropriate because the nurse can educate the client about the difference between generic and brand name drugs. The client asking the nurse a question is not an outcome. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1-9 Outline the major differences between prescription and over-the-counter drugs. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 6 Question 20 Type: MCMA The physician orders a brand name drug for the client. The hospital formulary substitutes the generic equivalent of the brand name drug, and the nurse administers the generic drug. Which statement(s) best represent(s) the nurse's action? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse should have contacted the physician prior to administering the drug. 2. The nurse should have called the pharmacist to see if the drugs were bioequivalent. 3. The nurse used good judgment in administering the drug. 4. The nurse was correct; hospital policies allow for this. 5. The nurse should ask the client which brand of drug is used at home. Correct Answer: 3,4 Rationale 1: It is not feasible for the nurse to contact the physician every time there is a generic substitution. Rationale 2: The pharmacist should only fill the prescription with a bioequivalent drug from the approved formulary. Rationale 3: The nurse used good judgment as hospital policies allow for generic substitution of certain drugs. Rationale 4: Use of formularies and negative formularies support the hospital policies allowing substitution. Rationale 5: In most cases, the client will not know which brand of medication is used at home. The brand used at home would be relevant only in very few medications. Global Rationale: The nurse used good judgment as hospital policies allow for generic substitution of certain drugs. It is not feasible for the nurse to contact the physician every time there is a generic substitution. The pharmacist should only fill the prescription with a bioequivalent drug from the approved formulary. Use of formularies and negative formularies support the hospital policies allowing substitution.. In most cases, the client will not know which brand of medication is used at home. The brand used at home would be relevant only in very few medications. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1-10 Explain the differences between trade-name drugs and their generic equivalents. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 7 Question 21 Type: MCMA The nurse is categorizing a client’s list of medications completing a health history. Which agents would be categorized as complementary and alternative medicine? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Garlic 2. Vitamin C 3. Zinc 4. Aspirin 5. Benadryl Correct Answer: 1,2,3 Rationale 1: Garlic is considered an herb, which is considered complementary and alternative medicine therapy. Rationale 2: Vitamins are considered complementary and alternative medicine therapy. Rationale 3: Zinc is a mineral and is considered complementary and alternative medicine therapy. Rationale 4: Aspirin is an over-the-counter medication. Rationale 5: Benadryl is an over-the-counter medication. Global Rationale: Garlic is considered an herb, which is considered complementary and alternative medicine therapy. Vitamins and the mineral zinc are considered complementary and alternative medicine therapies. Aspirin and Benadryl are over-the-counter medications. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Relationship centered care: Respect the patient’s dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-4 Compare and contrast traditional drugs, biologics, and complementary and alternative medicine therapies. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 4 Question 22 Type: MCSA Which type of classification system is being used when drugs are grouped together because they help treat a particular disease or condition? 1. Therapeutic 2. Mechanism of action 3. Chemical 4. Pharmacological Correct Answer: 1 Rationale 1: Therapeutic classification is based on the drug's usefulness in treating a particular disease. Rationale 2: Mechanism of action is how a drug produces its physiological effect in the body. Rationale 3: Chemical classification relates to a substance’s physical and chemical properties. Rationale 4: Pharmacological classification addresses a drug's mechanism of action. Global Rationale: Therapeutic classification is based on the drug's usefulness in treating a particular disease. Mechanism of action is how a drug produces its physiological effect in the body. Chemical classification relates to a substance’s physical and chemical properties. Pharmacological classification addresses a drug's mechanism of action. Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-5 Explain the basis for placing drugs into therapeutic and pharmacologic classes. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 5 Question 23 Type: MCSA An overwhelmed nursing student asks the instructor whether there are any tips that will make learning pharmacology easier. The instructor gives an example of the anticoagulant heparin. The instructor indicates that knowing heparin and comparing other drugs to it will facilitate learning the many anticoagulants. Which approach is the instructor using? 1. Mechanism of action approach 2. Generic name approach 3. Trade name approach 4. Prototype drug approach Correct Answer: 4 Rationale 1: Mechanism of action is how the drug produces its physiological effect in the body. This approach does not limit the number of drugs that must be learned. Rationale 2: Heparin is the generic name, but this does not help the student understand the drug. Rationale 3: Trade names are specific to only one drug, so learning by this approach does not limit the number of drugs that must be examined. Rationale 4: In the prototype approach, the student learns about one well-understood drug from a class of drugs. Learning about this drug helps the student understand the other drugs in the class. Global Rationale: Mechanism of action is how the drug produces its physiological effect in the body. This approach does not limit the number of drugs that must be learned. Heparin is the generic name but this does not help the student understand the drug. Trade names are specific to only one drug, so learning by this approach does not limit the number of drugs that must be examined. In the prototype approach, the student learns about one well-understood drug from a class of drugs. Learning about this drug helps the student understand the other drugs in the class. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-6 Discuss the prototype approach to drug classification. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 5 Question 24 Type: MCSA While discussing antihypertensives, the instructor states that a particular agent causes a reduction in blood pressure by blocking receptor sites. The student wishing to understand this statement would research which drug information? 1. Drug–drug interaction 2. Adverse effects 3. Indication 4. Mechanism of action Correct Answer: 4 Rationale 1: Drug–drug interactions refer to possible adverse reactions from using multiple drugs at the same time. Rationale 2: Adverse effects are what can result from drug use, not a description of how the drug works. Rationale 3: Indications are the reasons the drug is being used. Rationale 4: The instructor is describing how a drug produces an effect within the body, which is known as the mechanism of action. Global Rationale: The instructor is describing how a drug produces an effect within the body, which is known as the mechanism of action. Adverse effects are what can result from drug use, not a description of how the drug works. Indications are the reasons the drug is being used, and drug–drug interactions refer to possible adverse reactions from using multiple drugs at the same time. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-7 Describe what is meant by a drug’s mechanism of action. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 5 Question 25 Type: MCSA Advil, Motrin, and Nuprin are examples of 1. chemical names. 2. combination names. 3. trade names. 4. generic names. Correct Answer: 3 Rationale 1: Advil, Motrin, and Nuprin are not chemical names. Rationale 2: Advil, Motrin, and Nuprin are not combination names. Rationale 3: Advil, Motrin, and Nuprin are trade names for ibuprofen. Rationale 4: Advil, Motrin, and Nuprin are not generic names. Global Rationale: Advil, Motrin, and Nuprin are trade names for ibuprofen. They are not chemical names, combination names, or generic names. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-7 Describe what is meant by a drug’s mechanism of action. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 6 Question 26 Type: MCMA A client says to the admitting nurse, “Why do you need to know the names of all the over-the-counter supplements I take? They aren’t drugs.” Which of the nurse’s responses are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “The admitting physician needs to know everything you are taking.” 2. “You’re right. I’m not sure why the admitting paperwork asks for this information. Would you mind listing them anyway?” 3. “The law requires us to keep a list of over-the-counter drugs and supplements that you are taking.” 4. “It is true that supplements are not considered drugs; however, some of these products can cause adverse effects with prescribed drugs.” 5. “We need to know if you are having an allergic reaction to one of them.” Correct Answer: 1,4 Rationale 1: The health care providers involved in this client’s care will need to know everything she is taking—both prescription and over-the-counter (OTC). Rationale 2: While it is true that supplements are not considered drugs, there is a specific reason why the health care team needs to know this information, which is the reason for the requested list on the paperwork. The nurse’s answer did not address the client’s question appropriately. Rationale 3: No law requires hospitals to keep records of OTC drugs and supplements that clients take. This information is needed, however, for other reasons. Rationale 4: Supplements are not subject to the same regulatory process as drugs, and some of these products can cause adverse effects and interact with medications. Rationale 5: It is possible that this client could be having an allergic reaction, but there is not enough information to determine this, and this is not the main reason why the health care team needs to know what OTC medications she is taking. Global Rationale: The health care providers involved in this client’s care will need to know everything she is taking—both prescription and over-the-counter (OTC). While it is true that supplements are not considered drugs, there is a specific reason why the health care team needs to know this information, which is the reason for the requested list on the paperwork. No law requires hospitals to keep records of OTC drugs and supplements that clients take. Supplements are not subject to the same regulatory process as drugs, and some of these products can cause adverse effects and interact with medications. It is possible that this client could be having an allergic reaction, but there is not enough information to determine this, and this is not the main reason why the health care team needs to know what OTC medications she is taking. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care: patient/family/community preferences, values; coordination and integration of care; information, communication, and education; physical comfort and emotional support; involvement of family and friends; and transition and community. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Relationship centered care: Respect the patient’s dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-4 Compare and contrast traditional drugs, biologics, and complementary and alternative medicine therapies. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 6 Question 27 Type: MCMA A prototype drug is a single drug in a class and can be compared with all other medications in the class. The benefit of studying the prototype drug is that the nurse would be able to predict characteristics of other drugs in the same class, including Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. which drugs have the most favorable safety profile. 2. their therapeutic indications. 3. their actions. 4. their adverse effects. 5. duration of action of drugs in the group. Correct Answer: 2,3,4 Rationale 1: The prototype drug does not provide a safety profile of other drugs in the same class. Rationale 2: The prototype drug has the same therapeutic indications, or clinical use, of other drugs in the same class.Rationale 3: Studying the therapeutic indications of a prototype drug may allow the nurse to predict actions and adverse effects of other drugs in the same group. Rationale 4: Studying the prototype drug may allow the nurse to predict the adverse effects of another drug in the same class. Rationale 5: Drugs in the same class may have different duration of action. Global Rationale: The prototype drug does not provide a safety profile of other drugs in the same class. Studying the therapeutic indications of a prototype drug may allow the nurse to predict actions and adverse effects of other drugs in the same group. The prototype drug has the same therapeutic indications, or clinical use, of other drugs in the same class. By studying the prototype, the nurse can predict the actions and adverse effects of other drugs in the same class. Drugs in the same class may have different duration of action. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1-6 Discuss the prototype approach to drug classification. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 5 Question 28 Type: MCMA Chemical names are assigned for each drug. What are the major reasons that nursing usually does not use the chemical name of the drugs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. They are usually not brief or easy to remember. 2. They are often difficult to pronounce. 3. There is no standard for assigning names. 4. They do not explain the nature of the drug. 5. There is only one chemical name for each drug. Correct Answer: 1,2 Rationale 1: Chemical names are usually not brief or easy to remember. Rationale 2: Chemical names are often difficult to pronounce. Rationale 3: Chemical names are assigned by a standard nomenclature. Rationale 4: Chemical names do explain the nature of the drug. Rationale 5: While it is true each drug has only one chemical name, this is not one of the reasons nurses do not use the chemical name. Global Rationale: Chemical names are usually not brief or easy to remember and are often difficult to pronounce. They are assigned by a standard nomenclature and explain the nature of the drug. While it is true each drug has only one chemical name, this is not one of the reasons nurses do not use the chemical name. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: I.7 Integrate the knowledge and methods of a variety of disciplines to inform decision making. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1-8 Distinguish among a drug’s chemical name, generic name, and trade name. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 5 Question 29 Type: MCMA A client says, “I don’t understand why so much money is spent on trying to find a cure for cancer. I have epilepsy and wish more money went into epilepsy drugs.” What should the nurse consider prior to responding? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. More people are affected by cancer than by epilepsy. 2. Drugs that are effective in treating epilepsy exist. 3. The amounts of money spent on drug development are determined at the federal level. 4. It would be easier to achieve a cure for cancer than to achieve a cure for epilepsy. 5. The client should realize that personal family may develop cancer one day. Correct Answer: 1,2 Rationale 1: According to the tenets of pharmacoeconomics, more money should be spent on development of drugs that will impact the most people. Rationale 2: There are more drugs to successfully treat epilepsy than to cure cancer. Rationale 3: Money spent on drug development is determined at several levels, including individual corporations, universities, and governments. Rationale 4: There is no indication that curing cancer is easier than curing epilepsy. Rationale 5: The nurse should not judge this client’s statement as good or bad, but should attempt to explain the allocation of resources. Global Rationale: According to the tenets of pharmacoeconomics, more money should be spent on development of drugs that will impact the most people. There are more drugs to successfully treat epilepsy than to cure cancer. Money spent on drug development is determined at several levels, including individual corporations, universities, and governments. There is no indication that curing cancer is easier than curing epilepsy. The nurse should not judge this client’s statement as good or bad, but should attempt to explain the allocation of resources. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Planning Learning Outcome: 1-11 Describe how decisions are made relative to drug therapy among groups of patients. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 8 Question 30 Type: MCMA A client with advanced heart disease says, “I read about a new drug that was just released. Do you think my doctor could get it for me?” What should the nurse include in discussion with the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Since the drug is new it is dangerous to use.” 2. “Decisions on using drugs are based on many different variables.” 3. “We certainly can talk to your physician about the drug.” 4. “When drugs are first developed they are very expensive and their use is limited to those who can afford to purchase them.” 5. “People who are very sick often have unrealistic expectations of what drugs can do.” Correct Answer: 2,3 Rationale 1: It is non-therapeutic to tell the client the drug is dangerous. At this point, the nurse has no knowledge of which drug is being discussed. Rationale 2: Use of particular drugs is based on many different variables, including cost-benefit ratio. Rationale 3: The nurse should support the client’s interest in this drug by advocating for a discussion about its use. Rationale 4: The nurse should not assume the drug is expensive or that the client is unable to obtain it. Rationale 5: It is non-therapeutic to tell the client that interest in this drug is unrealistic. Global Rationale: It is non-therapeutic to tell the client the drug is dangerous. At this point, the nurse has no knowledge of which drug is being discussed. Use of particular drugs is based on many different variables, including cost-benefit ratio. The nurse should support the client’s interest in this drug by advocating for a discussion about its use. The nurse should not assume the drug is expensive or that the client is unable to obtain it. It is non-therapeutic to tell the client that interest in this drug is unrealistic. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Implementation Learning Outcome: 1-11 Describe how decisions are made relative to drug therapy among groups of patients. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 8 Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 54/E Chapter 2 Question:1 Type: MCSA The pharmaceutical representative comes to the physician's office and says his company's pharmaceutical laboratory is marketing a drug that does not need approval by the Food and Drug Administration (FDA). What is the best response by the nurse? 1. "Any pharmaceutical laboratory in America must have approval from the Food and Drug Administration (FDA) before marketing a drug." 2. "Is this an over-the-counter (OTC) drug? They do not need approval by the Food and Drug Administration (FDA)." 3. "Is your pharmaceutical laboratory private? Only public pharmaceutical laboratories need approval from the Food and Drug Administration (FDA)." 4. "Your pharmaceutical laboratory must be involved in academic research because they are exempt from approval by the Food and Drug Administration (FDA)." Correct Answer: 1 Rationale 1: Any pharmaceutical laboratorymust obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Rationale 2: Pharmaceutical laboratories that manufacture over-the-counter (OTC) drugs must obtain approval from the Food and Drug Administration (FDA) before marketing these drugs. Rationale 3: Private pharmaceutical laboratories must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Rationale 4: Pharmaceutical laboratories involved in academic research must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Global Rationale: Any pharmaceutical laboratory, whether private, public, or academic, must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Private pharmaceutical laboratories must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Pharmaceutical laboratories involved in academic research must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Pharmaceutical laboratories that manufacture over-the-counter (OTC) drugs must obtain approval from the Food and Drug Administration (FDA) before marketing these drugs. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-2 Discuss the role of the U.S. Food and Drug Administration (FDA) in the drug approval process. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 13 Question 2 Type: MCSA The nurse is employed by the Food and Drug Administration (FDA) and is involved in clinical investigation. What is the primary role of the nurse in this phase of the review and approval process by the FDA? 1. To perform tests on the population-at-large 2. To perform tests on various species of animals 3. To perform tests on human cells cultured in the laboratory 4. To perform tests on human clients Correct Answer: 4 Rationale 1: Performing tests on the population-at-large is the stage of post-marketing surveillance. Rationale 2: Performing tests on various species of animals is the preclinical investigation stage. Rationale 3: Performing tests on human cells cultured in the laboratory is the preclinical investigation stage. Rationale 4: Clinical investigation includes performing tests on healthy volunteers, and later, on selected clients with a particular disease. Global Rationale: Clinical investigation includes performing tests on healthy volunteers, and later, on selected clients with a particular disease. Performing tests on human cells cultured in the laboratory is the preclinical investigation stage. Performing tests on the population-at-large is the stage of post-marketing surveillance. Performing tests on various species of animals is the preclinical investigation stage. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-5 Identify the nurse’s role in the drug approval process and in maintaining safety practices. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 13 Question 3 Type: MCSA The student nurse is taking a pharmacology course and studying about the Food and Drug Administration (FDA). What has the student learned about how the FDA has decreased the amount of time involved in bringing a new drug to the market? 1. The Food and Drug Administration (FDA) is not as strict as it once was with regard to drug approval. 2. Since consumers have demanded more drugs, the Food and Drug Administration (FDA) has streamlined the review/approval process. 3. Drug manufacturers are required to pay yearly user fees, which allow the Food and Drug Administration (FDA) to hire more employees to increase its efficiency. 4. Drug manufacturers are required by the Food and Drug Administration (FDA) to test more drugs on an annual basis. Correct Answer: 3 Rationale 1: The Food and Drug Administration (FDA) is just as strict now as it always was with regard to drug approval. Rationale 2: The Food and Drug Administration (FDA) has not streamlined the review/approval process. Rationale 3: In 1992, the Prescription Drug User Fee Act was passed. This required drug manufacturers to provide yearly product user fees so the Food and Drug Administration (FDA) could restructure, hire more employees, and operate more efficiently. Rationale 4: The Food and Drug Administration (FDA) does not require drug manufacturers to test more drugs on an annual basis. Global Rationale: In 1992, the Prescription Drug User Fee Act was passed. This required drug manufacturers to provide yearly product user fees so the Food and Drug Administration (FDA) could restructure, hire more employees, and operate more efficiently. The Food and Drug Administration (FDA) is just as strict now as it always was with regard to drug approval. The Food and Drug Administration (FDA) has not streamlined the review/approval process. The Food and Drug Administration (FDA) does not require drug manufacturers to test more drugs on an annual basis. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-4 Discuss how the FDA has increased the speed with which new drugs reach consumers. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 15 Question 4 Type: MCSA The client has skin lesions that have not responded to prescription drugs. He tells the nurse he has heard about some research going on with a new drug and questions why he can't take it. What is the best response by the nurse? 1. "I know it is frustrating, but the Food and Drug Administration (FDA) approval process is in place to ensure that drugs are safe." 2. "The Food and Drug Administration (FDA) has very strict rules about new drugs; it is important to be patient regarding the review/approval process." 3. "Your skin lesions really aren't that bad, but maybe the new drug will be available soon." 4. "Maybe you could contact the drug company about becoming involved in a clinical trial." Correct Answer: 1 Rationale 1: Although the public is anxious to receive new drugs, the fundamental priority of the Food and Drug Administration (FDA) is to ensure that drugs are safe. Also, telling the client that the nurse knows he is frustrated is therapeutic because it communicates that the nurse recognizes what he is feeling. Rationale 2: Telling the client to be patient is a condescending response; the client wants relief from the skin condition. Rationale 3: Telling the client his skin lesions "aren't that bad" is a non-therapeutic response; the client's perception is his reality. Rationale 4: The client could contact the drug company, but this response fosters false hope as he may not be a viable candidate for this drug. Global Rationale: Although the public is anxious to receive new drugs, the fundamental priority of the Food and Drug Administration (FDA) is to ensure that drugs are safe. Also, telling the client that the nurse knows he is frustrated is therapeutic because it communicates that the nurse recognizes what he is feeling. The client could contact the drug company, but this response fosters false hope as he may not be a viable candidate for this drug. Telling the client his skin lesions "aren't that bad" is a non-therapeutic response; the client's perception is his reality. Telling the client to be patient is a condescending response; the client wants relief from the skin condition. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-2 Discuss the role of the U.S. Food and Drug Administration (FDA) in the drug approval process. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 13 Question 5 Type: MCSA What percentage of Americans takes at least one prescription drug per year? 1. 50% 2. 10% 3. 40% 4. 25% Correct Answer: 1 Rationale 1: About half of Americans take prescription drugs while about 17% takes at least three prescription drugs. Rationale 2: The percentage of Americans taking at least one prescription drug is higher. Rationale 3: This is not the percentage of Americans taking at least one prescription drug. Rationale 4: This is not the percentage of Americans taking at least one prescription drug. Global Rationale: About half of Americans take prescription drugs while about 17% takes at least three prescription drugs. Cognitive Level: Remembering Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: III.B.4 Read original research and evidence reports related to area of practice. AACN Essential Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2-1 Identify key U.S. drug regulations that have provided guidelines for the safe and effective use of drugs and drug therapy. MNL Learning Outcome:1.1.1 Apply basic concepts related to pharmacology. Page Number: 11 Question 6 Type: MCMA The nurse is teaching a medication class for parents of children with attention-deficit hyperactivity disorder who are receiving stimulant medications. The nurse has reviewed reasons why the medications are restricted. The nurse determines that learning has occurred when the parents make which responses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The use of these medications is restricted so that the pharmacies can track the rate of drug abuse in our city." 2. "The use of these medications is restricted because the physician needs to evaluate our child more often." 3. "The use of these medications is restricted because they have the potential for abuse." 4. "The use of these medications is restricted so that the drug companies can make a bigger profit." 5. "The use of these medications is restricted because this is the current law." Correct Answer: 3,5 Rationale 1: Pharmacies do not track the rate of drug abuse in cities. Rationale 2: More frequent evaluations is a good plan, but this is not the reason for restricted use of stimulant medications. Rationale 3: Medications with abuse potential are restricted. Rationale 4: Drug companies do not make a bigger profit when medications are listed as restricted. Rationale 5: The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances. Global Rationale: The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances. More frequent evaluations is a good plan, but this is not the reason for restricted use of stimulant medications. Drug companies do not make a bigger profit when medications are listed as restricted. Pharmacies do not track the rate of drug abuse in cities. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 2-7 Discuss why drugs are sometimes placed on a restrictive list, and the controversy surrounding this issue. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 17 Question 7 Type: MCSA The client says to the nurse, "My doctor said my drug is a controlled substance; am I considered an addict?" What is the best response by the nurse? 1. "Are you concerned about becoming an addict? We can discuss this in more detail if you would like to." 2. "You are not an addict; the Drug Enforcement Administration (DEA) restricts the use of drugs with a high potential for abuse." 3. "Why do you ask about becoming an addict? Not many of our clients have asked this question." 4. "You are not an addict, but the Drug Enforcement Administration (DEA) will monitor you for this." Correct Answer: 2 Rationale 1: It is premature at this time to ask the client if he is concerned about addiction; there is no information to support an addiction. Rationale 2: Drugs that have a high potential for addiction are considered controlled substances. Rationale 3: "Why" questions are considered non-therapeutic because they put the client on the defensive. Rationale 4: The Drug Enforcement Administration (DEA) does not monitor clients for addiction when they receive controlled substances. Global Rationale: Drugs that have a high potential for addiction are considered controlled substances. The Drug Enforcement Administration (DEA) does not monitor clients for addiction when they receive controlled substances. It is premature at this time to ask the client if he is concerned about addiction; there is no information to support an addiction. "Why" questions are considered non-therapeutic because they put the client on the defensive. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies:V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies:V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies:Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-6 Explain the U.S. Controlled Substance Act of 1970 and the role of the U.S. Drug Enforcement Administration in controlling drug abuse and misuse. MNL Learning Outcome:1.1.1 Apply basic concepts related to pharmacology. Page Number: 17 Question 8 Type: MCSA The client is receiving methadone (Dolophine), a Schedule II drug. The client says to the nurse, "A pharmacist told me the pharmacy must register with the Drug Enforcement Administration (DEA) to give me this drug; will DEA agents be snooping around my house?" What is the best response by the nurse? 1. "It is probably unlikely that Drug Enforcement Administration (DEA) agents will be bothering you." 2. "No, the Drug Enforcement Administration (DEA) restricts drugs that have a high potential for abuse." 3. "No. I think our system should be more like Europe; they have fewer controlled drugs." 4. "That's an interesting question. Are you worried about the Drug Enforcement Administration (DEA)?" Correct Answer: 2 Rationale 1: Telling the client that Drug Enforcement Administration (DEA) agents will "probably" not bother him can lead the client to think DEA agents might bother him. Rationale 2: The Controlled Substance Act of 1970 restricts the use of drugs that have a high potential for abuse. Hospitals and pharmacies must register with the Drug Enforcement Administration (DEA) to obtain a specific registration number that will enable them to purchase controlled drugs. Rationale 3: By saying that our system should be more like Europe's, the nurse is introducing her beliefs and this is non-therapeutic; the client may not agree. Rationale 4: Asking the client if he is worried about the Drug Enforcement Administration (DEA) puts him on the defensive and is non-therapeutic. Global Rationale: The Controlled Substance Act of 1970 restricts the use of drugs that have a high potential for abuse. Hospitals and pharmacies must register with the Drug Enforcement Administration (DEA) to obtain a specific registration number that will enable them to purchase controlled drugs. Telling the client that Drug Enforcement Administration (DEA) agents will "probably" not bother him can lead the client to think DEA agents might bother him. Asking the client if he is worried about the Drug Enforcement Administration (DEA) puts him on the defensive and is non-therapeutic. By saying that our system should be more like Europe's, the nurse is introducing her beliefs and this is non-therapeutic; the client may not agree. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies:V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies:V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies:Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-6 Explain the U.S. Controlled Substance Act of 1970 and the role of the U.S. Drug Enforcement Administration in controlling drug abuse and misuse. MNL Learning Outcome:1.1.1 Apply basic concepts related to pharmacology. Page Number: 17 Question 9 Type: MCSA During the admission assessment, the client tells the nurse "Sure I smoke a little weed (marijuana) to manage my stress. Doesn't everyone?" What is the best assessment question for the nurse to ask? 1. "What other ways do you think you might use to help you to manage your stress?" 2. "That is a Schedule I drug; aren't you afraid of going to jail for a long time?" 3. "Do you really believe that everyone smokes marijuana to manage stress?" 4. "How often do you smoke marijuana, and how much each time?" Correct Answer: 4 Rationale 1: Stress management is not the main concern during the admission assessment. Rationale 2: Asking the client if he is afraid of going to jail is not an assessment question and is not the issue during the admission assessment. Rationale 3: Asking the client if he really believes something is not an assessment question and can lead to an argument with the client. Rationale 4: The nurse must assess the amount and frequency of any drug the client uses, including illegal drugs. Global Rationale: The nurse must assess the amount and frequency of any drug the client uses, including illegal drugs. Asking the client if he really believes something is not an assessment question and can lead to an argument with the client. Stress management is not the main concern during the admission assessment. Asking the client if he is afraid of going to jail is not an assessment question and is not the issue during the admission assessment. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-9 Identify the five drug schedules and give examples of drugs at each level. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 17 Question 10 Type: MCSA The mother of an adolescent receiving methylphenidate (Concerta) for attention-deficit hyperactivity disorder tells the nurse that her son is better and asks why she can't just get refills on the prescription. What is the best response by the nurse? 1. "Just drop by and I will get a prescription for you without seeing your son." 2. "We can't do that; maybe you can find another doctor's office that will do it." 3. "The law does not allow us to give you refills on this medication." 4. "The medication can be addictive so your son needs a monthly medical evaluation." Correct Answer: 4 Rationale 1: Schedule II medications cannot be refilled without the client being seen by the physician. Rationale 2: Referring the mother to another office is non-therapeutic and implies that other medical offices violate the law. Rationale 3: Telling the mother about the law is accurate, but it is a non-therapeutic response; the mother needs an explanation. Rationale 4: Telling the mother the reason for monthly evaluations is a therapeutic response that is correct and answers the mother's question. Global Rationale: Telling the mother the reason for monthly evaluations is a therapeutic response that is correct and answers the mother's question. Schedule II medications cannot be refilled without the client being seen by the physician. Telling the mother about the law is accurate, but it is a non-therapeutic response; the mother needs an explanation. Referring the mother to another office is non-therapeutic and implies that other medical offices violate the law. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-7 Discuss why drugs are sometimes placed on a restrictive list, and the controversy surrounding this issue. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 18 Question 11 Type: MCSA A client who is terminally ill reports hearing about a drug that is in preclinical investigation. The client asks the nurse if the drug will be available to the public soon. What should the nurse consider when formulating an answer to this question? 1. After preclinical investigation the drug has one more step before being released for public use. 2. The average length of preclinical investigation is 18 months. 3. When the drug reaches the clinical investigation stage it is usually released within 2 years. 4. The drug will not be available until after the post-marketing studies are done. Correct Answer: 2 Rationale 1: Preclinical investigation is the first of three stages the drug must go through before being released for use. Rationale 2: Preclinical investigation may last 1 to 3 years with 18 months being the average. Rationale 3: Clinical investigation may last 2 to 10 years with 5 years being the average. Rationale 4: Post-marketing studies are started as soon as the NDA review is completed and may continue for years after drug release. Global Rationale: Preclinical investigation is the first of three stages the drug must go through before being released for use.Preclinical investigation may last 1 to 3 years with 18 months being the average.Clinical investigation may last 2 to 10 years with 5 years being the average.Post-marketing studies are started as soon as the NDA review is completed and may continue for years after drug release. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biologic drugs. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 14 Question 12 Type: MCSA The nurse provides medication education to a client with terminal cancer. The physician has ordered morphine (MS Contin), a Schedule II drug, for the client. The nurse determines that learning has occurred when the client makes which statement? 1. "I need to call the office for a refill before my medication runs out." 2. "This drug is addictive so I should only take it when my pain becomes severe." 3. "Maybe my doctor could change me to a Schedule IV drug." 4. "I need to see my doctor before my prescription runs out so I can get a refill." Correct Answer: 4 Rationale 1: Schedule II drugs cannot be refilled by phone order. Rationale 2: Not taking pain medication until the pain becomes severe is an inappropriate use of pain medication for a client with terminal cancer. Rationale 3: A Schedule IV drug may not effectively relieve the client's pain. Rationale 4: The client must see the physician for a refill. Global Rationale: Schedule II drugs cannot be refilled by phone order. Not taking pain medication until the pain becomes severe is an inappropriate use of pain medication for a client with terminal cancer. The client must see the physician for a refill. A Schedule IV drug may not effectively relieve the client's pain. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-7 Discuss why drugs are sometimes placed on a restrictive list, and the controversy surrounding this issue. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 18 Question 13 Type: MCSA A drug manufacturer that is performing the effects of a drug on laboratory animals would be in which phase of the new drug development timeline? 1. Clinical Investigation 2. Preclinical Investigation 3. New Drug Application Review 4. Post-marketing Studies Correct Answer: 2 Rationale 1: Clinical investigation involves testing the drug on human subjects. Rationale 2: Preclinical investigation involves laboratory research on nonhuman subjects. Rationale 3: New Drug Application review occurs during human clinical trials. Rationale 4: Post-marketing Studies occur after the drug is being used by the general population. Global Rationale: Clinical investigation involves testing the drug on human subjects. Preclinical investigation involves laboratory research on nonhuman subjects. New Drug Application review occurs during human clinical trials.Post-marketing Studies occur after the drug is being used by the general population. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biologic drugs. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 14 Question 14 Type: MCMA While reading a medication package insert, the nurse notes the information contained within the “black box.” What is the significance of this information to the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The drug can cause “special problems.” 2. It identifies extreme adverse drug reactions. 3. It differentiates a prescribed medication from an over-the-counter medication. 4. It highlights the cost of the medication. 5. It signifies the medication is generic. Correct Answer: 1,2 Rationale 1: The FDA created boxed warnings in order to regulate drugs with “special problems.” Rationale 2: The black box warning is a primary alert for identifying extreme adverse drug reactions. Rationale 3: Black box warnings are not a mechanism to differentiate a prescribed medication from an over-the-counter medication. Rationale 4: It does not highlight the cost of the medication. Rationale 5: It does not signify the medication as being generic. Global Rationale: The FDA created boxed warnings in order to regulate drugs with “special problems.” The black box warning is a primary alert for identifying extreme adverse drug reactions. Black box warnings are not a mechanism to differentiate a prescribed medication from an over-the-counter medication, do not highlight the cost of the medication, and do not signify the medication as being generic. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-1 Identify key U.S. drug regulations that have provided guidelines for the safe and effective use of drugs and drug therapy. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 13 Question 15 Type: MCMA The nurse is participating in the New Drug Review step for a new therapeutic agent. Which activities will the nurse most likely perform during this phase of the drug approval process? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Attend meetings to finalize the brand name for the drug. 2. Check on the results of animal testing. 3. Survey for harmful effects in a larger population. 4. Evaluate the results of the drug on cultured cells. 5. Provide the medication to large groups of people with a particular disease. Correct Answer: 1,2 Rationale 1: During the NDA or the third stage of the drug approval process, the drug’s brand name is finalized. Rationale 2: During the NDA stage of the drug approval process, animal testing may continue. Rationale 3: Surveying for harmful effects in a larger population occurs during the post-marketing surveillance step of the drug approval process. Rationale 4: Evaluation of the results of the drug on cultured cells occurs during the preclinical investigation step of the drug approval process. Rationale 5: Providing the medication to large groups of people with a particular disease occurs during the clinical phase trials, which is in the second stage of the drug approval process. Global Rationale: During the NDA or the third stage of the drug approval process, the drug’s brand name is finalized. Animal testing may continue during this stage. Surveying for harmful effects in a larger population occurs during the post-marketing surveillance step of the drug approval process. Evaluation of the results of the drug on cultured cells occurs during the preclinical investigation step of the drug approval process. Providing the medication to large groups of people with a particular disease occurs during the clinical phase trials, which is in the second stage of the drug approval process. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biologic drugs. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 14 Question 16 Type: MCMA Which statements regarding the role of the U.S. Food and Drug Administration (FDA) are true? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The FDA is responsible for improving the health of Americans. 2. The FDA publishes a summary of the standards of drug purity and strength. 3. The FDA ensures the availability of effective drugs. 4. The FDA takes action against any supplement that is deemed to be unsafe. 5. The FDA facilitates the availability of safe drugs. Correct Answer: 1,3,4,5 Rationale 1: The FDA mission is to protect public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biologic products, medical devices, the nation’s food supply, cosmetics, and products that emit radiation. Rationale 2: It is the role of the U.S. Pharmacopeia (USP) to publish a summary of drug standards (purity and strength). Rationale 3: Ensuring the availability of effective drugs is one of the FDA’s roles. Rationale 4: It is the FDA’s role to take action against any supplement that is deemed to be unsafe. Rationale 5: It is the role of the FDA to facilitate the availability of safe drugs. Global Rationale: One of the missions of the CDER branch of the FDA is to improve the health of Americans. It is the role of the U.S. Pharmacopeia (USP) to publish a summary of drug standards (purity and strength). Ensuring the availability of effective drugs is one of the FDA’s roles. It is the FDA’s role to take action against any supplement that is deemed to be unsafe. It is the role of the FDA to facilitate the availability of safe drugs. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-1 Identify key U.S. drug regulations that have provided guidelines for the safe and effective use of drugs and drug therapy. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 13 Question 17 Type: MCMA Which statements regarding the preclinical research stage of drug development are true? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Most drugs do not proceed past the preclinical stage because they are found to be too toxic or just ineffective. 2. At the end of the preclinical research stage, client variability is determined and potential drug-to-drug interactions are examined. 3. The preclinical stage of research involves extensive testing on animals in the laboratory to determine if the drug will cause harm to humans. 4. Preclinical research results are always inconclusive. 5. The Food and Drug Administration (FDA) is responsible for extensive testing for safety before the pharmaceutical company can begin the preclinical research stage of development. Correct Answer: 1,3,4 Rationale 1: Most drugs do not proceed past the preclinical research stage of development because they are found to be either too toxic or just ineffective. Rationale 2: Client variability and potential drug-to-drug interactions are examined in Phase 3 of the clinical investigation process after Food and Drug Administration (FDA) approval. Rationale 3: The preclinical stage involves extensive testing on human, microbial cells, and animals to determine drug action and to predict whether the drug will cause harm to humans. Rationale 4: Because lab tests cannot accurately predict human response to a drug, these results are always inconclusive. Rationale 5: This extensive testing is done by the pharmaceutical company in the preclinical research stage of drug development, not the FDA. Global Rationale: Most drugs do not proceed past the preclinical research stage of development because they are found to be either too toxic or just ineffective.Client variability and potential drug-to-drug interactions are examined in Phase 3 of the clinical investigation process after Food and Drug Administration (FDA) approval.The preclinical stage involves extensive testing on human, microbial cells, and animals to determine drug action and to predict whether the drug will cause harm to humans.Because lab tests cannot accurately predict human response to a drug, these results are always inconclusive.This extensive testing is done by the pharmaceutical company in the preclinical research stage of drug development, not the FDA. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biologic drugs. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 13 Question 18 Type: Sequencing The nurse developing a time line of drug regulations and standards would list the following events in which chronological order? 1. Passage of the Sherley Amendment 2. Passage of the Childhood Vaccine Act 3. Development of the U.S. Pharmacopoeia 4. Passage of the Prescription Drug User Fee Act 5. Passage of the Biologics Control Act Answer: 3, 5, 1, 2, 4 Rationale: The U.S. Pharmacopoeia was established in 1820 and served as the first comprehensive publication of drug standards. The Biologics Control Act was passed in 1902 and controlled the quality of serums and other blood-related products. Passed in 1912, the Sherley Amendment made medicines safer by prohibiting the sale of drugs labeled with false therapeutic claims. The Childhood Vaccine Act was passed in 1986 and allowed the FDA to acquire information about clients taking vaccines, to recall biologics, and to recommend civil penalties if guidelines regarding biologic use were not followed. Lastly, in 1992 the Prescription Drug User Fee Act was passed requiring that nongeneric drug and biologic manufacturers pay fees to be used for improvements in the drug review process. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-1 Identify key U.S. drug regulations that have provided guidelines for the safe and effective use of drugs and drug therapy. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 17 Question 19 Type: MCSA Which drug has the highest dependency potential? 1. Acetaminophen 2. Codeine 3. Heroin 4. Diazepam Correct Answer: 3 Rationale 1: Acetaminophen does not have a high abuse potential. Rationale 2: Codeine is a Schedule III drug. Rationale 3: Heroin is a Schedule I drug and has the highest potential for abuse, physical dependence, and psychological dependence of the drugs listed. Rationale 4: Diazepam is a Schedule IV drug. Global Rationale: Heroin is a Schedule I drug and has the highest potential for abuse, physical dependence, and psychological dependence of the drugs listed.Acetaminophen does not have a high abuse potential.Codeine is a Schedule III drug.Diazepam is a Schedule IV drug. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nursing/Integrated Concepts: Nursing Process: Assessment QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 29 Identify the five drug schedules and give examples of drugs at each level. MNL Learning Outcome:1.1.1 Apply basic concepts related to pharmacology. Page Number: 17 Question 20 Type: MCSA A drug is withdrawn from a client who has been taking it routinely for many years. The client has developed muscle tremors. How would the nurse characterize this event? 1. As an adverse effect 2. As evidence that the client had psychological dependence on the drug 3. As an expected therapeutic effect of no longer taking the drug 4. As an assessment finding associated with physical dependence on a drug Correct Answer: 4 Rationale 1: Adverse effects are seen while the drug is being taken, not after it is withdrawn. Rationale 2: With psychological dependence, few physical signs are seen. Rationale 3: Therapeutic effects are seen while drugs are being used, not after they have been removed. Rationale 4: The presence of physical withdrawal symptoms (muscle tremors) is seen when a person is physically dependent on a drug and the drug is removed. Global Rationale: The presence of physical withdrawal symptoms (muscle tremors) is seen when a person is physically dependent on a drug and the drug is removed. With psychological dependence, few physical signs are seen. Therapeutic effects are seen while drugs are being used, not after they have been removed. Adverse effects are the seen while the drug is being taken, not after it is withdrawn. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.5 Assess levels of physical and emotional comfort. AACN Essential Competencies: IX.5 Deliver compassionate, patient-centered, evidence-based care that respects patient and family preference. NLN Competencies: Context and Environment: Chronic disease management. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2-8 Explain the meaning of a controlled substance and teratogenic risk in pregnancy. MNL Learning Outcome: 1.1.4 Examine adverse effects of medication administration and risk reduction. Page Number: 7 Question 21 Type: MCSA The nurse reviewing prescription refill request messages would collaborate with the physician regarding a request for which drug? 1. Morphine 2. Cannabis 3. Meperidine 4. An anabolic steroid Correct Answer: 4 Rationale 1: Morphine is a Schedule II drug. Telephone prescription requests are not allowed. The client must be examined by a physician prior to a new prescription being written. Rationale 2: Cannabis is a Schedule I drug. Telephone prescriptions requests are not allowed. Rationale 3: Meperidine is a Schedule II drug. Telephone prescription requests are not allowed. Rationale 4: Anabolic steroids are Schedule III drugs. Telephone prescription refills are allowed. Global Rationale: Schedule I and II drugs cannot be ordered via the telephone. The client must been examined by a physician prior to a new prescription being written.Morphine and meperidine are Schedule II drugs.Cannabis is a Schedule I drug.Anabolic steroids are Schedule III drugs. Telephone prescription refills are allowed. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-5 Identify the nurse’s role in the drug approval process and in maintaining safety practices. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 17 Question 22 Type: Hot Spot A nurse is administering a medication to a group of volunteers and is assessing for the development of adverse effects. The nurse is working in which phase of the development of this drug? 1. A 2. B 3. C 4. D Answer: A Rationale: Investigation and development of drugs follows a predetermined and rigorous process. Clinical investigation is the second phase of this development and consists of clinical phase trials numbered I, II, and III. The Clinical Phase Trial I is when investigators first begin to administered the drug to volunteers to determine proper dosage and to asses for adverse effects. Preclinical investigation is done on human and microbial cells. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-3 Explain the four phases of approval for therapeutic and biologic drugs. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 13 Question 23 Type: MCMA A client has been chosen to participate in the clinical trial of a medication to treat chemotherapy-induced nausea. When the nurse takes the informed consent form to the bedside the client says, “I am glad there is finally a medication to cure my cancer.” How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Who told you the medication would cure your cancer?” 2. “What questions do you have about this medication?” 3. “Let me explain how this medication works.” 4. “Has anyone explained the research trial to you?” 5. “So am I. This research has been intense.” Correct answer: 2,4 Rationale 1: It is not important to discover who specifically gave the client this information. Rationale 2: The nurse should be certain the client has no questions prior to having the consent signed. Rationale 3: It is not the nurse’s responsibility to explain how the medication works. It is the responsibility of the researcher or health care provider. The nurse should refer questions to those individuals. Rationale 4: It is the nurse’s responsibility to ensure that the client has been provided with facts about the medication and the clinical trial prior to having the consent signed. Rationale 5: The nurse should identify that this client does not fully understand the purpose of this medication and should collaborate with the researcher or health care provider regarding this misunderstanding. Global Rationale: The nurse should be certain the client has no questions prior to having the consent signed.It is the nurse’s responsibility to ensure that the client has been provided with facts about the medication and the clinical trial prior to having the consent signed.The nurse should identify that this client does not fully understand the purpose of this medication and should collaborate with the researcher or health care provider regarding this misunderstanding.It is not the nurse’s responsibility to explain how the medication works. It is the responsibility of the researcher or health care provider. It is not important to discover who specifically gave the client this information. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.12 Facilitate informed patient consent for care. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-5 Identify the nurse’s role in the drug approval process and in maintaining safety practices. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 15 Question 24 Type: FIB While the nurse is completing a medication history the older adult client says, “My medication costs so much. I am in the doughnut hole right now. Can’t the government do something to help?” The nurse replies, “I understand how difficult this can be. There are plans under way to close the doughnut hole completely by ________.” Standard Text: Record your answer rounding to the nearest whole number. Correct Answer: 2020 Rationale:The U.S. Affordable Care Act of 2010 includes benefits to reduce this gap in coverage for seniors with the goal of closing it completely by 2020. Global Rationale:The U.S. Affordable Care Act of 2010 includes benefits to reduce this gap in coverage for seniors with the goal of closing it completely by 2020. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-5 Identify the nurse’s role in the drug approval process and in maintaining safety practices. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 16 Question 25 Type: Hot Spot All nurses who administer medications participate in which portion of the drug development and approval timeline? 1. A 2. B 3. C 4. D Answer: 4 Rationale: Post-marketing studies investigate the development of adverse effects. It may take months or years for such effects to be recognized. All nurses who administer medications should monitor for therapeutic effects and adverse reactions. Therefore, all nurses who administer medications are participating in Post-marketing Studies. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-5 Identify the nurse’s role in the drug approval process and in maintaining safety practices. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 13 Question 26 Type: FIB A client says, “This morning’s nurse told me that my pain medication is a scheduled drug. Aren’t all drugs given on a schedule?” The nurse explains that in the United States controlled substances such as some common pain medications are classified into one of _______ categories or schedules. Standard Text: Record your answer rounding to the nearest whole number. Correct Answer: 5 Rationale:Drugs with a significant potential for abuse are classified into five schedules or categories. These drugs are called “scheduled drugs.” Global Rationale:Drugs with a significant potential for abuse are classified into five schedules or categories. These drugs are called “scheduled drugs.” Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-9 Identify the five drug schedules and give examples of drugs at each level. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 16 Question 27 Type: Hot Spot A nurse teaches the client that the newly prescribed medication has a very high risk of causing fetal abnormalities and that reliable measures to prevent pregnancy are essential while taking the medication. The nurse has described a medication that falls into which category? 1. A 2. B 3. C 4. D Answer: D Rationale: Category X drugs have animal and human studies that show fetal abnormalities. The drug is contraindicated in women who are or may become pregnant. Reliable pregnancy prevention measures must be followed. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-10 Identify the five categories of teratogenic drug classification. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 18 Question 28 Type: MCMA The nurse is providing preconception teaching to a group of women who wish to become pregnant. The nurse informs the group that which classifications of medications have shown no confirmed risk for fetal abnormalities if taken while pregnant? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Category A 2. Category B 3. Category C 4. Category D 5. Category X Correct Answer: 1,2 Rationale 1: Category A drugs are those in which controlled studies have failed to show a risk to the fetus and the possibility of fetal harm appears unlikely. Rationale 2: Category B drugs are those in which animal-reproduction studies have not shown a fetal risk or adverse effect. Risks have not been confirmed in controlled studies in women. Rationale 3: Category C drugs are those in which either studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women or studies in women and animals are not advisable. Rationale 4: Category D drugs are those in which there is confirmation of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used). Rationale 5: Category X drugs are those in which animal and human studies have shown fetal abnormalities. The drug is contraindicated in women who are or may become pregnant. Global Rationale: Category A drugs are those in which controlled studies have failed to show a risk to the fetus and the possibility of fetal harm appears unlikely. Category B drugs are those in which animal-reproduction studies have not shown a fetal risk or adverse effect. Risks have not been confirmed in controlled studies in women.Category C drugs are those in which either studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women or studies in women and animals are not advisable.Category D drugs are those in which there is confirmation of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used).Category X drugs are those in which animal and human studies have shown fetal abnormalities. The drug is contraindicated in women who are or may become pregnant. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-10 Identify the five categories of teratogenic drug classification. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 13 Question 29 Type: MCMA A client at 14-weeks gestation is seen in the clinic with a sprained ankle. The physician prescribes a mild analgesic, rest, compression, and application of an ice bag. The client is very concerned about taking the prescribed medication, telling the nurse, “I don’t want to hurt my baby.” How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “The most dangerous time for birth defects is probably in the first semester and you are past that now.” 2. “You are wise to avoid all drugs. I would only use the rest, compression, and ice.” 3. “Let me check with the physician to see if he remembered you are pregnant.” 4. “This is a category A drug, so there is very little risk to your baby.” 5. “Don’t worry, it will all be okay. You need to take care of yourself first.” Correct Answer: 1,4 Rationale 1: The time of highest risk of birth defects is probably in the first trimester, and this client is past that time. It is not possible to predict that there is no risk from drug consumption. Rationale 2: While drug avoidance is preferred, in some cases it is necessary. If the nurse has concerns about the drug prescribed, collaboration with the prescriber is indicated. Rationale 3: Without further information about which drug was prescribed, it is non-therapeutic to make the client doubt the prescriber’s choice of therapy. Rationale 4: With category A drugs, the risk of fetal harm is unlikely. Rationale 5: This statement is non-therapeutic and dismisses the client’s concern. Global Rationale: The time of highest risk of birth defects is probably in the first trimester, and this client is past that time. It is not possible to predict that there is no risk from drug consumption.With category A drugs, the risk of fetal harm is unlikely.While drug avoidance is preferred, in some cases it is necessary. If the nurse has concerns about the drug prescribed, collaboration with the prescriber is indicated. The statement of “don’t’ worry” is non-therapeutic and dismisses the client’s concern. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-8 Explain the meaning of a controlled substance and teratogenic risk in pregnancy. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 13 Question 30 Type: MCMA A nurse suspects a client has had an allergic reaction to a recently prescribed antibiotic. The nurse is responsible for providing emergency treatment and for reporting this suspected reaction to which persons? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. FDA 2. The prescriber 3. Hospital pharmacist 4. Medicare 5. Hospital risk management Correct Answer: 2,3,5 Rationale 1: While it may be necessary to report this reaction to the FDA, it is not the bedside nurse’s responsibility to do so. Rationale 2: The prescriber should be notified as this is an unexpected event. A change in therapy is likely to be required. Rationale 3: The hospital pharmacist should be advised of this possible reaction. Rationale 4: There is no reason for the bedside nurse to notify Medicare. Rationale 5: Hospital risk management should be notified of this event. A variance report may be required. Global Rationale: While it may be necessary to report this reaction to the FDA, it is not the bedside nurse’s responsibility to do so. The prescriber should be notified as this is an unexpected event. A change in therapy is likely to be required. The hospital pharmacist should be advised of this possible reaction. There is no reason for the bedside nurse to notify Medicare. Hospital risk management should be notified of this event. A variance report may be required. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: V.4 Examine legislative and regulatory processes relevant to the provision of health care. NLN Competencies: Quality and Safety: Policies and procedures. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2-5 Identify the nurse’s role in the drug approval process and in maintaining safety practices. MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology. Page Number: 16 Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E Chapter 3 Question 1 Type: MCMA The physician has ordered several medications for the patient. What does the nurse recognize as responsibilities regarding administration of medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Knowing whether or not the medication is on the hospital formulary 2. Knowing the reason the medication was prescribed for this patient 3. Knowing how the medication is to be administered 4. Knowing how the medication is supplied by the pharmacy 5. Knowing the name of the medication Correct Answer: 2,3,4,5 Rationale 1: Whether or not a drug is on a hospital formulary list is not a primary responsibility of the nurse. Rationale 2: Knowing the reason the medication was prescribed for the patient is the responsibility of the nurse regarding medication administration. Rationale 3: Knowing how the medication is to be administered is the responsibility of the nurse regarding medication administration. Rationale 4: Knowing how the medication is to be administered is the responsibility of the nurse regarding medication administration. Rationale 5: Knowing how the medication is supplied by the pharmacy is the responsibility of the nurse regarding medication administration. Global Rationale: How the medication is supplied by the pharmacy, how the medication is to be administered, the name of the medication, and the reason the medication was prescribed for the patient are the responsibilities of the nurse regarding medication administration. Whether or not a drug is on a hospital formulary list is not a primary responsibility of the nurse. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3-2 Describe the roles and responsibilities of nurses regarding safe drug administration. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 21 Question 2 Type: MCMA The nurse is preparing medications prior to administration. To promote patient safety, the nurse uses "rights" of drug administration. What do these "rights" include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The right medication 2. The right time of delivery 3. The right dose 4. The right route of administration 5. The right nurse Correct Answer: 1,2,3,4 Rationale 1: The right medication is an essential consideration of medication administration and is considered one of the five rights. Rationale 2: The right time of delivery is an essential consideration of medication administration and is considered one of the five rights. Rationale 3: The right dose is an essential consideration of medication administration and is considered one of the five rights. Rationale 4: The right route of delivery is an essential consideration of medication administration and is considered one of the five rights. Rationale 5: The right nurse is not one of the listed rights of medication delivery. Global Rationale: The five rights of drug administration are the right patient, the right medication, the right dose, the right route of administration, and the right time of delivery. The right nurse is not one of the listed rights. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: IX.12 Create a safe environment that results in high quality patient outcomes. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3-3 Explain how the five rights of drug administration affect patient safety. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 22 Question 3 Type: MCSA The nurse suspects that the patient has not been taking his prescribed antihypertensive medication because the patient's blood pressure remains elevated. What is the best therapeutic question the nurse can ask that will assess noncompliance? 1. "Taking medication is difficult for many people. What are some of your concerns about the medication?" 2. "Your blood pressure is really high; do you realize the serious consequences of not taking your medication?" 3. "I really doubt that you are taking your medication. What would you think about talking to the doctor?" 4. "You are one of my favorite patients and I want you to be safe. Are you really taking your medication?" Correct Answer: 1 Rationale 1: The most therapeutic question informs the patient that compliance is difficult for many people, and does not directly challenge the patient about not taking the medication. Rationale 2: Telling the patient his blood pressure is high and there are serious consequences is using the "scare tactic," and is non-therapeutic; the patient most likely is aware of the consequences. Rationale 3: Telling the patient that the nurse doubts he is taking the medication directly challenges him, and recommending that he see the physician is threatening. Rationale 4: Telling the patient that he is a favorite is manipulating. Global Rationale: The most therapeutic question informs the patient that compliance is difficult for many people, and does not directly challenge the patient about not taking the medication. Telling the patient that the nurse doubts he is taking the medication directly challenges him, and recommending that he see the physician is threatening. Telling the patient his blood pressure is high and there are serious consequences is using the "scare tactic," and is non-therapeutic; the patient most likely is aware of the consequences. Telling the patient that he is a favorite is manipulating. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.1 Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. AACN Essential Competencies: IX.5 Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. NLN Competencies: Relationship centered care: Respect the patient’s dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-4 Give specific examples of how nurses can increase patient compliance in taking medications. MNL Learning Outcome: 1.3.3 Implement the nursing process in the administration of medications. Page Number: 23 Question 4 Type: MCSA The patient is having chest pain. The physician orders sublingual nitroglycerine STAT. The nurse obtains the medication from the pharmacy and administers it to the patient 30 minutes later. Which statement best describes the nurse's action? 1. The medication should have been administered immediately. 2. The physician should have specified the time frame for the medication. 3. The medication should have been administered within a 5-minute time frame. 4. The nursing action was correct because the medication was not on the unit. Correct Answer: 3 Rationale 1: Although the drug does not need to be administered immediately, there is a time limit in which it should be administered. Rationale 2: For a STAT order, the time frame between writing the order and administering the drug should be 5 minutes or less. Not having a drug on the unit is not an excuse, as commonly ordered STAT medications should be kept in stock. Although the drug does not need to be administered immediately, it should be done within 5 minutes. By using the abbreviation STAT, the physician has specified the time frame for the medication. Rationale 3: For a STAT order, the time frame between writing the order and administering the drug should be 5 minutes or less. Rationale 4:Not having a drug on the unit is not an excuse, as commonly ordered STAT medications should be kept in stock. Global Rationale: For a STAT order, the time frame between writing the order and administering the drug should be 5 minutes or less.Although the drug does not need to be administered immediately, there is a time limit in which it should be administered.By using the abbreviation STAT, the physician has specified the time frame for the medication.Not having a drug on the unit is not an excuse, as commonly ordered STAT medications should be kept in stock. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 3-5 Interpret drug orders that contain abbreviations. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 24 Question 5 Type: MCSA The nurse uses the nursing process prior to administering any medications. Which step will ensure the best patient safety? 1. Assess the patient's developmental level. 2. Assess the patient's medical history. 3. Assess the patient's disease process. 4. Assess the patient's learning needs. Correct Answer: 2 Rationale 1: Assessing the patient's developmental level is important for medication education, but not for safely administering medications. Rationale 2: An assessment of the patient's medical history, which includes allergies, is the most important assessment prior to administering medications. Rationale 3: Assessing the patient's disease process is important in evaluating the effects of the medications, but not for safely administering medications. Rationale 4: Assessing the patient's learning needs is important for medication education, but not for safely administering medications. Global Rationale: An assessment of the patient's medical history, which includes allergies, is the most important assessment prior to administering medications. Assessing the patient's learning needs is important for medication education, but not for safely administering medications. Assessing the patient's developmental level is important for medication education, but not for safely administering medications. Assessing the patient's disease process is important in evaluating the effects of the medications, but not for safely administering medications. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3-1 Discuss drug administration as a component of safe, effective nursing care, using the nursing process. MNL Learning Outcome:1.3.3 Implement the nursing process in the administration of medications. Page Number: 21 Question 6 Type: MCSA The physician prescribes an oral medication for the patient. What is the primary nursing assessment of the patient prior to receiving this medication? 1. The patient's understanding of the medication 2. The patient's ability to swallow 3. The patient's allergies 4. The patient's eyesight Correct Answer: 2 Rationale 1: The patient's understanding is important, but not a priority. Rationale 2: The ability of the patient to swallow is a safety issue to prevent aspiration of the medication. Rationale 3: The patient's allergies are important, but if the patient cannot swallow the medication, then the allergies are not significant. Rationale 4: The patient's eyesight is not significant. Global Rationale: The ability of the patient to swallow is a safety issue to prevent aspiration of the medication. The patient's understanding is important, but not a priority. The patient's eyesight is not significant. The patient's allergies are important, but if the patient cannot swallow the medication, then the allergies are not significant. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and parenteral drugs. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 26 Question 7 Type: MCSA The physician ordered an oral medication. The nurse incorrectly administered the medication intravenously. What does the best analysis of the nurse's action reveal? 1. An antidote cannot be given. 2. The nurse will be terminated from her job. 3. The medication cannot be retrieved. 4. A lawsuit by the patient will be impending. Correct Answer: 3 Rationale 1: Antidotes may be given, but this must be done very quickly. Rationale 2: The nurse may be terminated, but patient safety is the main concern. Rationale 3: When a medication is given intravenously, its effects cannot be reversed because it is already in the bloodstream. Rationale 4: A lawsuit may occur, but this is not the primary concern; patient safety is the primary concern. Global Rationale: When a medication is given intravenously, its effects cannot be reversed because it is already in the bloodstream. A lawsuit may occur, but this is not the primary concern; patient safety is the primary concern. The nurse may be terminated, but patient safety is the main concern, and the effect of the medication cannot be reversed. Antidotes may be given, but this must be done very quickly. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essential Competencies: VIII.12 Act to prevent unsafe, illegal, or unethical care practices. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and parenteral drugs. MNL Learning Outcome: 1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 35 Question 8 Type: MCSA What is the best plan as the nurse prepares to administer a topical medication? 1. Check the medication for interactions with other medications. 2. Take the patient's vital signs. 3. Educate the patient to not disturb the patch. 4. Assess the patient's skin where the medication will be applied. Correct Answer: 4 Rationale 1: Checking for drug interactions is important, but it is not the priority. Rationale 2: Vital signs are not always indicated; it depends on the medication. Rationale 3: Patient education is important, but is not the priority. Rationale 4: Planning to assess the patient's skin is imperative; if it is cracked, dry, or irritated, the medication may not be properly absorbed. Global Rationale: Planning to assess the patient's skin is imperative; if it is cracked, dry, or irritated, the medication may not be properly absorbed. Patient education is important, but is not the priority. Vital signs are not always indicated; it depends on the medication. Checking for drug interactions is important, but it is not the priority. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and parenteral drugs. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 29 Question 9 Type: MCSA The physician ordered an intravenous medication for a patient with nausea. The patient asks the nurse how it will help his nausea. What is the best response by the nurse? 1. "We have more intravenous drugs for nausea than we do oral drugs." 2. "If you take an oral medication, you will just vomit it up." 3. "This will work much faster for your nausea." 4. "You can't have anything by mouth, so you will receive the medication intravenously." Correct Answer: 3 Rationale 1: Telling the patient that the nurse has more intravenous drugs than oral drugs does not answer the patient's question. Rationale 2: Telling the patient that he will vomit the medication is non-therapeutic. Rationale 3: The intravenous route provides the quickest route of medication absorption. Rationale 4: There is no evidence that the patient cannot have anything by mouth. Global Rationale: The intravenous route provides the quickest route of medication absorption. Telling the patient that he will vomit the medication is non-therapeutic. Telling the patient that the nurse has more intravenous drugs than oral drugs does not answer the patient's question. There is no evidence that the patient cannot have anything by mouth. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-8 Compare and contrast the advantages and disadvantages of each route of drug administration. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 34 Question 10 Type: MCSA The physician orders enteric-coated aspirin, 300 mg every day, for the patient with a nasogastric tube. What is the priority action by the nurse? 1. Crush the tablet, dissolve it in 30 mL of water, and administer through the tube. 2. Put the tablet in the tube, "milk" it down the tube, and then flush the tube with 60 mL of water. 3. Withhold the medication and contact the physician. 4. Substitute plain aspirin, dissolve it in 30 mL of water, and administer through the tube. Correct Answer: 3 Rationale 1: Crushing the tablet destroys the enteric coating. Rationale 2: Putting the tablet in the tube will result in clogging of the tube. Rationale 3: The only option is to withhold the medication and contact the physician. Rationale 4: The nurse cannot substitute plain aspirin; this requires a physician's order. Global Rationale: The only option is to withhold the medication and contact the physician. Crushing the tablet destroys the enteric coating. Putting the tablet in the tube will result in clogging of the tube. The nurse cannot substitute plain aspirin; this requires a physician's order. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and parenteral drugs. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 26 Question 11 Type: MCSA The patient is receiving a sustained-release capsule for his cardiac condition. The patient tells the nurse there is no way he can swallow such a large pill. What is the best response by the nurse? 1. "Let me contact your physician to see if a change can be made." 2. "Place the capsule on the back of your tongue, and drink a full glass of water." 3. "I will open the capsule and sprinkle the contents over some applesauce for you to eat." 4. "It may be difficult, but try to swallow the capsule as it is the best medicine for your heart condition." Correct Answer: 1 Rationale 1: The only option is to contact the physician. Rationale 2:Placing the capsule on the back of the patient's tongue and having him drink a full glass of water may cause the patient to aspirate the capsule and/or the water. Rationale 3: Sustained-release medications cannot be opened and sprinkled on food. Rationale 4: Encouraging the patient to try to swallow the capsule is coercive and may result in the patient choking on the medication. Global Rationale: The only option is to contact the physician. Sustained-release medications cannot be opened and sprinkled on food. Placing the capsule on the back of the patient's tongue and having him drink a full glass of water may cause the patient to aspirate the capsule and/or the water. Encouraging the patient to try to swallow the capsule is coercive and may result in the patient choking on the medication. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and parenteral drugs. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 27 Question 12 Type: MCSA While in the hospital, the pediatric patient has been receiving amoxicillin 10 mL orally bid, pc. The child will be going home on this medication. What is the best instruction by the nurse for the parents? 1. Give 2 teaspoons by mouth, 3 times a day, on an empty stomach. 2. Give 2 teaspoons by mouth, twice a day, after meals. 3. Give 2 teaspoons by mouth, 3 times a day, after meals. 4. Give 2 teaspoons by mouth, twice a day, with meals. Correct Answer: 2 Rationale 1: Giving 2 teaspoons by mouth, 3 times a day, on an empty stomach is incorrect. Rationale 2: Giving 2 teaspoons by mouth, twice a day, after meals is correct. Rationale 3:Giving 2 teaspoons by mouth, 3 times a day, after meals is incorrect. Rationale 4: Giving 2 teaspoons by mouth, twice a day, with meals is incorrect. Global Rationale: Giving 2 teaspoons by mouth, twice a day, after meals is correct. Giving 2 teaspoons by mouth, 3 times a day, after meals is incorrect. Giving 2 teaspoons by mouth, twice a day, with meals is incorrect. Giving 2 teaspoons by mouth, 3 times a day, on an empty stomach is incorrect. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-5 Interpret drug orders that contain abbreviations. MNL Learning Outcome: 1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 24 Question 13 Type: MCSA The patient is 3 days postop, and the physician orders an oral pain medication. The patient asks the nurse if it wouldn't be better to get the medication in the intravenous (IV) line. What is the best response by the nurse? 1. "No, because you could not medicate yourself intravenously (IV) at home." 2. "No, because pills are more effective than intravenous (IV) medications." 3. "No, because pills are safer than intravenous (IV) medications." 4. "No, because we are going to take your intravenous (IV) line out." Correct Answer: 3 Rationale 1: There is no evidence that the patient will be going home with an intravenous line, so this answer is incorrect. Rationale 2: Oral medications are not more effective than IV medications. Rationale 3: Oral medications are safer than intravenous (IV) medications. Rationale 4: Telling the patient that she cannot have the medication intravenously because the intravenous line is to be removed does not answer the patient's question. Global Rationale: Oral medications are safer than intravenous (IV) medications. Telling the patient that she cannot have the medication intravenously because the intravenous line is to be removed does not answer the patient's question. There is no evidence that the patient will be going home with an intravenous line, so this answer is incorrect. Oral medications are not more effective than IV medications. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-8 Compare and contrast the advantages and disadvantages of each route of drug administration. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 26 Question 14 Type: MCSA The nurse plans to administer heparin by drawing the heparin up in an appropriate syringe, donning gloves, prepping the patient's abdominal area, inserting the needle, aspirating for blood, and injecting the medication. Which statement best describes the nurse's plan? 1. The nurse does not need to wear gloves. 2. The nurse should not aspirate for blood. 3. The nurse does not need to prep the skin. 4. The nurse performed the injection correctly. Correct Answer: 2 Rationale 1: Gloves must always be worn for invasive techniques. Rationale 2: When performing heparin injections, the nurse should not aspirate for blood as this may cause bruising or bleeding. Rationale 3: The skin should be prepped with alcohol prior to administering an injection. Rationale 4: The nurse did not perform the correct technique. Global Rationale: When performing heparin injections, the nurse should not aspirate for blood as this may cause bruising or bleeding. Gloves must always be worn for invasive techniques. The nurse did not perform the correct technique. The skin should be prepped with alcohol prior to administering an injection. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and parenteral drugs. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 33 Question 15 Type: MCSA The order is for a pain medication to be given prn. Which statement, by the nurse, correctly teaches the client about this medication order? 1. “I can give you this medication anytime you need it, so I will be asking you about your pain level frequently.” 2. ”This medication will be given to you at a set time every day, probably just before your bath.” 3. “You will be given this medication at bedtime each night so that you can rest.” 4. “This medication may upset your stomach, so always take it with food or milk.” Correct Answer: 1 Rationale 1: The abbreviation PRN is used to designate as needed. Rationale 2: PRN does not mean every day. Rationale 3: PRN does not mean at bedtime. Rationale 4: PRN does not mean with food. Global Rationale: PRN does not mean every day, at bedtime, or with food. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-5 Interpret drug orders that contain abbreviations. MNL Learning Outcome: 1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 24 Question 16 Type: MCSA A patient has an increased reaction to a drug following a change in her dietary habits. Which change would most likely be the cause? 1. Increased intake of grapefruit juice 2. Reduced intake of alcohol 3. Increased fiber intake 4. Reduced intake of citrus fruit Correct Answer: 1 Rationale 1: Grapefruit juice lowers the activity of enzymes in the GI system that break down medications. This in turn results in higher medication absorption into the bloodstream. Rationale 2: A reduced intake of alcohol would not likely produce an increased reaction to a drug. Rationale 3: A reduced intake of fiber would not likely produce an increased reaction to a drug. Rationale 4: A reduction in citrus fruit intake would likely cause a lowered drug reaction. Global Rationale: Grapefruit juice lowers the activity of enzymes in the GI system that break down medications. This in turn results in higher medication absorption into the bloodstream. A reduction in citrus fruit intake would likely cause a lowered drug reaction. A reduced intake of alcohol or fiber would not likely produce an increased reaction to a drug. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 3-1 Discuss drug administration as a component of safe, effective nursing care, using the nursing process. MNL Learning Outcome:1.3.3 Implement the nursing process in the administration of medications. Page Number: 24 Question 17 Type: MCSA The nurse administers an oral preparation of liquid Tylenol 650 mg as ordered. Afterward, the patient indicates he had been receiving Tylenol 650 mg in pill form. Which statement is accurate in regards to the five rights? 1. The nurse failed to deliver the correct dose. 2. The nurse failed to administer the right medication. 3. The nurse did not violate the five rights. 4. The nurse failed to give the medication via the correct route. Correct Answer: 3 Rationale 1: The correct dose was administered. Rationale 2: The correct medication was administered. Rationale 3: Nothing in the question depicts a violation of the five rights. Both forms of the medication are oral preparations. Rationale 4: The correct route was used. Global Rationale: Nothing in the question depicts a violation of the five rights. Both forms of the medication are oral preparations. The correct dose, medication, and route were used. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: IX.12 Create a safe environment that results in high quality patient outcomes. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 3-3 Explain how the five rights of drug administration affect patient safety. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 26 Question 18 Type: MCSA A young patient has been receiving five milliliters of liquid antibiotic three times each day. The nurse providing discharge instructions would teach the parents to use a standard measuring spoon to administer which amount for each dose? 1. 2 tablespoons 2. 1 fluid ounce 3. 15 drops 4. 1 teaspoon Correct Answer: 4 Rationale 1: Five milliliters is not equivalent to two tablespoons. Rationale 2: A fluid ounce is equal to 30–32 milliliters. Rationale 3: Five milliliters is equal to about 60 drops. Rationale 4: One standard teaspoon is equal to 4 or 5 milliliters, so this is the best answer. Global Rationale: Liquid medications should be measured using a standardized instrument. One standard teaspoon is equal to 4 or 5 milliliters. The other measurements are not accurate and would result in large overdoses or underdoses. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-6 Compare and contrast the three systems of measurement used in pharmacology. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 25 Question 19 Type: MCSA Placement of a tablet between the cheek and gum would be which route? 1. Buccal 2. Oral 3. Transdermal 4. Sublingual Correct Answer: 1 Rationale 1: Buccal is the term used to describe a medication placed between the cheek and gum. Rationale 2: An oral medication is swallowed. Rationale 3: A transdermal medication is applied to the skin. Rationale 4: A sublingual medication is placed under the tongue. Global Rationale: Buccal is the term used to describe a medication placed between the cheek and gum.An oral medication is swallowed.A transdermal medication is applied to the skin.A sublingual medication is placed under the tongue. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and parenteral drugs. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 27 Question 20 Type: FIB A client will receive a liter of fluid intravenously to treat dehydration. The client says, “I don’t understand the metric system, how much is that?” The nurse responds, “It is about ______ cups of fluid.” Standard Text: Record your answer rounding to the nearest whole number. Correct Answer: 4 Rationale:The household measurement most nearly equivalent to 1 liter is 4 cups or 1 quart. Global Rationale:The household measurement most nearly equivalent to 1 liter is 4 cups or 1 quart. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies:III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies:IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Best Practices. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3.6 Compare and contrast the three systems of measurement used in pharmacology. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page number: 25 Question 21 Type: MCSA Which statement is accurate regarding medication administration via the intradermal route? 1. Injections should be limited to 1–2 milliliters. 2. Hairy sites should be avoided. 3. Usual administration sites include the upper and lower abdomen. 4. Medications should be injected into the epidermis skin layer. Correct Answer: 2 Rationale 1: Intradermal injection involves administering small amounts (0.1–0.2 milliliters) of medication. Rationale 2: Usual sites of intradermal administration include nonhairy surfaces. Rationale 3: Usual sites of intradermal administration include the forearm, upper chest, and scapulae. Rationale 4: Intradermal injection involves administering small amounts of medication into the dermis layer of skin. Global Rationale: Usual sites of intradermal administration include nonhairy surfaces, including the forearm, upper chest, and scapulae. Intradermal injection involves administering small amounts (0.1–0.2 milliliters) of medication into the dermis layer of skin. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and parenteral drugs. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 29 Question 22 Type: MCMA Which patients should the nurse be concerned about regarding nonadherence to prescribed medication regimens? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A 70-year-old male patient with hypertension who has a prescription for a diuretic and is complaining that his medication is keeping him up all night 2. A 30-year-old college student who has a prescription for birth control pills and tells the nurse she has had breakthrough bleeding this past cycle 3. A 45-year-old patient with diabetes who has a prescription for insulin and whose blood sugar is within the normal range 4. A 57-year-old day laborer who has a prescription for Lipitor for high cholesterol and a prescription card for a free health clinic 5. An 18-year-old male with a prescription for an acne medication that must be taken 4 times a day Correct Answer: 1,5 Rationale 1: This patient has been taking his diuretic in the evening instead of in the morning and is most likely experiencing increased urination at night that is disrupting his sleep. Adverse side effects are common causes for nonadherence. Rationale 2: Birth control pills often cause midcycle bleeding. This does not raise any red flags for nonadherence. Rationale 3: The fact that this patient's blood sugar is within the normal range may be evidence that the patient is taking insulin as directed. Rationale 4: The means to pay for medication (free clinic prescription card) decreases the patient's risk for nonadherence. Rationale 5: One of the most common reasons for nonadherence is forgetting a dose, particularly with drugs that must be taken more than twice a day. Global Rationale: This patient has been taking his diuretic in the evening instead of in the morning and is most likely experiencing increased urination at night that is disrupting his sleep. Adverse side effects are common causes for nonadherence.One of the most common reasons for nonadherence is forgetting a dose, particularly with drugs that must be taken more than twice a day.Birth control pills often cause midcycle bleeding. This does not raise any red flags for nonadherence.The fact that this patient's blood sugar is within the normal range may be evidence that the patient is taking insulin as directed.The means to pay for medication (free clinic prescription card) decreases the patient's risk for nonadherence. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.1 Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. AACN Essential Competencies: IX.5 Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. NLN Competencies: Relationship Centered Care: Respect the patient’s dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 3.4 Give specific examples of how nurses can increase patient compliance in taking medications. MNL Learning Outcome: 1.3.3 Implement the nursing process in the administration of medications. Page Number: 23 Question 23 Type: MCMA A patient admitted to the hospital tells the nurse she is very nervous about getting all her medications while she is in the hospital because her health care provider has her on a very "strict" schedule. Which principles describe how medication dosing schedules are determined? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The physical and biologic characteristics of a drug may determine dosing schedule. 2. Specific times may improve effectiveness and decrease risk of adverse effects. 3. Some drugs must be taken a certain time prior to an event or immediately after an event. 4. Dosing may be set for the convenience of patient and nurse. 5. Hospitals have routine dosing intervals so that all patients receive medications at the same time each day. Correct Answer: 1,2,3,4 Rationale 1: The properties of a medication will determine how often it must be given to keep the drug at a therapeutic level in the body. Rationale 2: Some medications are administered at certain times of day to improve effectiveness or decrease adverse effects. Rationale 3: Some medications are taken to prevent or to cause an effect. For example, insulin should be given 30 minutes prior to eating to promote glucose usage. Rationale 4: If the drug does not have a characteristic that relies on a certain event to take place, then the drug can be given at the convenience of patient and/or nurse. Rationale 5: While most hospitals do have specific times of day (agency protocol) when medications are administered, this is not a principle that determines any specific dosing schedule. Global Rationale: The properties of a medication will determine how often it must be given to keep the drug at a therapeutic level in the body.Some medications are administered at certain times of day to improve effectiveness or decrease adverse effects.Some medications are taken to prevent or to cause an effect. For example, insulin should be given 30 minutes prior to eating to promote glucose usage.If the drug does not have a characteristic that relies on a certain event to take place, then the drug can be given at the convenience of patient and/or nurse.While most hospitals do have specific times of day (agency protocol) when medications are administered, this is not a principle that determines any specific dosing schedule. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essential Competencies: IX.12 Create a safe environment that results in high quality patient outcomes. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-3 Explain how the five rights of drug administration affect patient safety. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 24 Question 24 Type: MCMA A patient at a community health center has been prescribed oral medications and tells the nurse that medications were administered intravenously when the patient was in the hospital. The nurse discusses the benefits and disadvantages of oral medications, including which facts? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The oral route is considered the second safest route, after the intradermal route. 2. Tablets that are scored may be crushed for easier swallowing. 3. Enteric-coated drugs are designed to dissolve in the stomach, not the small intestine. 4. A major disadvantage of oral medications is that the patient must be conscious and able to swallow. 5. Enteric-coated drugs should be crushed to help facilitate dissolving by the stomach acid. Correct Answer: 2,4 Rationale 1: The oral route is considered the safest because the skin barrier is not compromised; if an overdose occurs, drugs remaining in the stomach can be evacuated with stomach contents. Rationale 2: The purpose of scoring a tablet is the greater ease of cutting the tablet in half or quarters. These same tablets may be crushed, if needed. Rationale 3: Some drugs irritate the stomach lining and are coated to prevent being dissolved in the stomach. These drugs go on to the small intestine and are dissolved in the alkaline environment. Rationale 4: The fact that the patient must be conscious and able to swallow is a major disadvantage of oral medications. Rationale 5: Enteric-coated drugs are designed specifically to bypass the stomach's acidic environment and continue to the alkaline environment of the small intestine. Global Rationale: The purpose of scoring a tablet is the greater ease of cutting the tablet in half or quarters. These same tablets may be crushed, if needed.The fact that the patient must be conscious and able to swallow is a major disadvantage of oral medications.The oral route is considered the safest because the skin barrier is not compromised; if an overdose occurs, drugs remaining in the stomach can be evacuated with stomach contents.Enteric-coated drugs are designed specifically to bypass the stomach's acidic environment and continue to the alkaline environment of the small intestine. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-8 Compare and contrast the advantages and disadvantages of each route of drug administration. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 26–27 Question 25 Type: MCMA The nurse has finished teaching a patient's husband how to administer drugs and enteral feeding through a gastrostomy tube. The nurse knows the husband understands the use of the tube when he makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "My wife has a gastrostomy tube instead of a nasogastric tube because she will have the tube for a long time." 2. "I will need to use liquid medications. If any of the medications are in pill form, I will use the pill crusher to crush them and mix them with water before putting them in the tube." 3. "This medication says it is enteric coated. I'm not supposed to crush this kind of medication. I will need to ask the doctor to substitute another medication that is liquid or can be crushed." 4. "There's a big difference in how the drugs work in the body when they're taken orally and when they're administered through the tube. That's why my wife has to have this tube." 5. "I have to be very careful to flush the tube after I put medication in it. If I don't, the tube could get clogged." Correct Answer: 1,2,3,5 Rationale 1: Nasogastric tubes are used for short-term care while gastrostomy tubes are placed in patients who will need long-term care. Rationale 2: Most health care providers order drugs in liquid form for NG and G tube patients. If a medication does not come in liquid form, the solid form will need to be crushed and mixed with water prior to administration unless there is a contraindication for crushing the medication. Rationale 3: Enteric-coated medications should not be crushed. To do so would expose the drug to the acid in the stomach when it is intended to bypass the stomach acid and be dissolved in the alkaline environment of the small intestine. Rationale 4: Drugs administered via gastrostomy tube are affected by the same physiological processes as those given orally. Rationale 5: While solid drugs may be crushed and dissolved in water prior to being administered, they tend to clog the tubes if the tubes are not routinely flushed. Global Rationale: Nasogastric tubes are used for short-term care while gastrostomy tubes are placed in patients who will need long-term care.Most health care providers order drugs in liquid form for NG and G tube patients. If a medication does not come in liquid form, the solid form will need to be crushed and mixed with water prior to administration unless there is a contraindication for crushing the medication.Enteric-coated medications should not be crushed. To do so would expose the drug to the acid in the stomach when it is intended to bypass the stomach acid and be dissolved in the alkaline environment of the small intestine.While solid drugs may be crushed and dissolved in water prior to being administered, they tend to clog the tubes if the tubes are not routinely flushed.Drugs administered via gastrostomy tube are affected by the same physiological processes as those given orally. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and parenteral drugs. MNL Learning Outcome:1.3.3 Implement the nursing process in the administration of medications. Page Number: 28 Question 26 Type: MCMA The nurse is caring for a patient who has been involved in a motor vehicle crash. The health care provider has written orders for a transdermal patch for pain. The nurse knows that. Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. the transdermal patch should not be applied to areas of abrasion. 2. transdermal medications undergo the first-pass effect in the liver. 3. transdermal medications completely bypass digestive enzymes. 4. the actual dose received by the patient from this pain patch may vary. 5. transdermal patches are not considered an effective means of delivering medications because the rate of delivery and actual dose can vary. Correct Answer: 1,3,4 Rationale 1: Applying transdermal patches to skin that has abrasions may unintentionally increase the dose of the medication. Rationale 2: Transdermal medications avoid the first-pass effect. Rationale 3: Transdermal medications never come into contact with digestive enzymes but go straight into the bloodstream. Rationale 4: While transdermal patches do contain a specific amount of medication, the rate of delivery may vary for each patient. Rationale 5: It is true that the rate of delivery and actual dose received can vary, but this route is an effective means of delivering many medications such as birth control medications and nitroglycerin for angina. Global Rationale: Applying transdermal patches to skin that has abrasions may unintentionally increase the dose of the medication.Transdermal medications never come into contact with digestive enzymes but go straight into the bloodstream.While transdermal patches do contain a specific amount of medication, the rate of delivery may vary for each patient.Transdermal medications avoid the first-pass effect.It is true that the rate of delivery and actual dose received can vary, but this route is an effective means of delivering many medications such as birth control medications and nitroglycerin for angina. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-8 Compare and contrast the advantages and disadvantages of each route of drug administration. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 29 Question 27 Type: MCMA Twenty minutes after receiving a dose of antibiotic, the patient develops a red, itchy rash. What nursing actions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse should plan to watch for a rash after the next dose is administered. 2. The nurse should contact the prescriber and relay this assessment information. 3. The nurse should contact the pharmacy. 4. The nurse should place an allergy bracelet on the patient. 5. The nurse should document the presence of the rash in the medical record. Correct Answer: 2,3,4,5 Rationale 1: Giving another dose of the antibiotic is not indicated and could have a serious outcome. Rationale 2: The nurse should discuss this finding with the prescriber as an allergy likely exists. Rationale 3: Because there is a strong possibility of an allergy, the nurse should contact the pharmacy. Rationale 4: The nurse should place an allergy bracelet on the patient. If it is determined that the rash is from some other etiology, the bracelet can be removed. Rationale 5: The nurse should always document the presence of an unexpected finding. Global Rationale: The nurse should discuss this finding with the prescriber as an allergy likely exists. Because there is a strong possibility of an allergy, the nurse should contact the pharmacy. The nurse should place an allergy bracelet on the patient. If it is determined that the rash is from some other etiology, the bracelet can be removed. The nurse should always document the presence of an unexpected finding. Giving another dose of the antibiotic is not indicated and could have a serious outcome. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-2 Describe the roles and responsibilities of nurses regarding safe drug administration. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 21 Question 28 Type: Hot Spot The nurse is to administer an intramuscular injection. The end of the needle should be inserted to which level? 1. A 2. B 3. C 4. D Answer: 4 Rationale: Intramuscular injections must go into the muscle itself. In this diagram, the muscle is the lowest layer or layer D. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies:III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies:IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Best Practices. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and parenteral drugs. MNL Learning Outcome: 1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number:33 Question 29 Type: FIB The nurse is preparing to administer a subcutaneous injection. The needle should be inserted at an angle of ______ degrees. Standard Text: Record your answer rounding to the nearest whole number. Correct Answer: 45 Rationale: The correct angle for injection of a subcutaneous medication is 45 degrees. Global Rationale: The correct angle for injection of a subcutaneous medication is 45 degrees. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies:III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies:IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Current best practices. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3-7 Explain the proper methods of administering enteral, topical, and parenteral drugs. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page Number: 34 Question 30 Type: FIB At the end of the shift, the patient reports drinking 4 cups of water during the day. The nurse would include this ______ mL of fluid with the patient’s oral intake amount. Standard Text: Record your answer rounding to the nearest whole number. Correct Answer: 960 Rationale : Each cup the patient drank should be counted as 240 mL, making 4 cups equivalent to 960 mL. Global Rationale: Each cup the patient drank should be counted as 240 mL, making 4 cups equivalent to 960 mL. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies:III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essential Competencies:IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Quality and Safety: Best Practices. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3.6 Compare and contrast the three systems of measurement used in pharmacology. MNL Learning Outcome:1.3.2 Apply the correct principles and procedures for safe administration of medications to clients. Page number: 25 Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E Chapter 4 Question 1 Type: MCSA The nurse is conducting medication education for patients with hypertension. The focus of the education is on enhancing the absorption of their medications. The nurse determines that learning has occurred when the patients make which statement? 1. "We can safely take the drug for at least 6 months beyond the expiration date." 2. "We don't need to worry about storage of the drug, it won't lose potency." 3. "We should not take our medications with milk or dairy products." 4. "We need to be careful about taking the medication with certain foods." Correct Answer: 4 Rationale 1: Patients should be taught to avoid taking medications beyond the expiration date. Rationale 2: Storage can affect the medication's strength and may affect how it responds in the body. Rationale 3: There are many more foods that will alter the absorption of medications other than milk and dairy products. Rationale 4: Food can alter the absorption of many medications. Global Rationale: Food can alter the absorption of many medications. Storage can affect the medication's strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. Patients should be taught to avoid taking medications beyond the expiration date. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4.4 Discuss factors affecting drug absorption. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 41 Question 2 Type: MCSA The physician ordered a loading dose of medication for the patient; it is to be followed by a lower dose. When the patient receives the lower dose, she says to the nurse, "I think my doctor made a mistake; my medication dose is too low." What is the best response by the nurse? 1. "The initial dose shortened the half-life, so the medication would work more quickly." 2. "We always give medications this way; the doctor did not make a mistake." 3. "You had a larger dose initially so that the medication would work more quickly." 4. "Giving a larger dose initially will reduce the chance of side effects." Correct Answer: 3 Rationale 1: Loading doses do not shorten the half-life of a drug. Rationale 2: Not all medications are initiated with a loading dose. Rationale 3: Loading doses of medications are used to quickly induce a therapeutic response. Rationale 4: Loading doses do not reduce the occurrence of side effects. Global Rationale: Loading doses of medications are used to quickly induce a therapeutic response. Loading doses do not shorten the half-life of a drug. Not all medications are initiated with a loading dose. Loading doses do not reduce the occurrence of side effects. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-12 Differentiate between loading and maintenance doses. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 47 Question 3 Type: MCSA The patient has meningitis. The physician initially prescribed a water-soluble drug. Another physician changed the order to a lipid-soluble drug. The patient is confused about this. Which plan best resolves the patient's concern? 1. Teach the patient that lipid-soluble drugs are better because of protein binding. 2. Teach the patient that lipid-soluble drugs are more effective in treating his illness. 3. Teach the patient that lipid-soluble drugs are better because they have fewer side effects. 4. Teach the patient that lipid-soluble drugs are more effective because they are excreted at a slower rate. Correct Answer: 2 Rationale 1: Not all lipid-soluble drugs are protein bound. Rationale 2: Drug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. Rationale 3: Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs are protein bound. Rationale 4: Lipid solubility does not affect drug excretion. Global Rationale: Drug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs are protein bound. Lipid solubility does not affect drug excretion. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 4-6 Discuss factors affecting drug absorption. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 41 Question 4 Type: MCSA The patient is malnourished and has a low serum albumin. The physician has ordered aspirin, a highly protein-bound drug, for the patient. Which evaluation by the nurse best describes the effect this will have on the patient? 1. The patient will be at risk to experience a decreased effectiveness of the drug. 2. The patient will be at risk to experience toxic effects of the drug. 3. The patient's kidneys will excrete the drug at a faster rate. 4. The patient's serum globulin is more important than serum albumin. Correct Answer: 2 Rationale 1: Effects from the drug will not be decreased because there is less protein for aspirin to bind with and more free drug available. Rationale 2: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic effects from the drug because there is less protein for aspirin to bind with and more free drug available. Rationale 3: The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Rationale 4: Serum albumin plays a major role, more than serum globulin. Global Rationale: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic, not decreased, effects from the drug because there is less protein for aspirin to bind with and more free drug available. The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Serum albumin plays a major role, more than serum globulin. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4-7 Describe how plasma proteins affect drug distribution. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 41 Question 5 Type: MCSA The patient is admitted to the hospital in chronic renal failure and is on several medications. What best describes the nurse's assessment of this patient? 1. The patient's liver may compensate for renal failure; the drugs may be effective. 2. The patient may have drug toxicity from all the drugs. 3. The patient may have drug toxicity only if the drugs are excreted by the kidneys. 4. The patient may have decreased effectiveness of the drugs. Correct Answer: 2 Rationale 1: The liver cannot compensate for renal failure; the patient is at risk for drug toxicity. Rationale 2: Since the kidneys are the primary route of excretion for many drugs, chronic renal failure puts the patient at risk for drug toxicity. Rationale 3: The patient in chronic renal failure will more likely have drug toxicity than decreased effectiveness of the drugs. Rationale 4: Since the majority of drugs are excreted by the kidneys, the patient will most likely have drug toxicity. Global Rationale: Since the kidneys are the primary route of excretion for many drugs, chronic renal failure puts the patient at risk for drug toxicity. The patient in chronic renal failure will more likely have drug toxicity than decreased effectiveness of the drugs. The liver cannot compensate for renal failure; the patient is at risk for drug toxicity. Since the majority of drugs are excreted by the kidneys, the patient will most likely have drug toxicity. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-8 Identify major processes by which drugs are excreted. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 44 Question 6 Type: MCSA The patient comes to the emergency department following an overdose of aspirin, an acidic drug. What will the best plan of the nurse include? 1. Administration of intravenous fluids to flush the kidneys 2. Administration of ammonium chloride to the patient 3. Administration of sodium bicarbonate to the patient 4. Administration of intravenous proteins to bind the aspirin Correct Answer: 3 Rationale 1: Administering intravenous (IV) fluids will not increase the excretion of aspirin from the body. Rationale 2: Ammonium chloride will acidify the urine and cause reabsorption of the aspirin. Rationale 3: Sodium bicarbonate will alkalinize the urine and increase the excretion of aspirin from the body. Rationale 4: Administering proteins will not help with the excretion of aspirin from the body. Global Rationale: : Sodium bicarbonate will alkalinize the urine and increase the excretion of aspirin from the body. Administering intravenous (IV) fluids will not increase the excretion of aspirin from the body. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin. Administering proteins will not help with the excretion of aspirin from the body. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 4-8 Identify major processes by which drugs are excreted. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 44 Question 7 Type: MCSA The patient is complaining of a severe headache. The physician orders aspirin. Which action by the nurse will result in the fastest relief of the patient's headache? 1. Administer the aspirin with an alkaline food, like cottage cheese. 2. Administer the aspirin in an enteric-coated formulation. 3. Administer the aspirin with a high-fat food, like peanut butter. 4. Administer the aspirin on an empty stomach. Correct Answer: 4 Rationale 1: Cottage cheese will slow absorption and increase the time for the drug's effect. Rationale 2: Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal irritation, but will increase the time for the drug's effect. Rationale 3: Peanut butter will slow absorption and increase the time for the drug's effect. Rationale 4: Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the aspirin should be administered on an empty stomach. Global Rationale: Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal irritation, but will increase the time for the drug's effect. Peanut butter and cottage cheese will slow absorption and increase the time for the drug's effect. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4-4 Discuss factors affecting drug absorption. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 41 Question 8 Type: MCSA The patient is receiving lithium (Eskalith) and asks the nurse why he has to have blood drawn so often. What is the best response by the nurse? 1. "To detect side effects before they become a problem." 2. "To be sure the medication is working properly." 3. "To determine if your body is responding as it should." 4. "To be sure you have the correct amount of medication in your system." Correct Answer: 4 Rationale 1: Side effects are best determined by patient assessment. Rationale 2: A lab test will not confirm that the medication is working properly; assessment of the patient confirms this. Rationale 3: Body response to the medication is best determined by patient assessment. Rationale 4: Medications, such as lithium (Eskalith), with a narrow therapeutic range must be monitored with lab tests; this is how the correct dosage is determined. Global Rationale: Medications, such as lithium (Eskalith), with a narrow therapeutic range must be monitored with lab tests; this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly; assessment of the patient confirms this. Body response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-11 Explain how a drug reaches and maintains its therapeutic range in the plasma. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 45 Question 9 Type: MCSA The nursing mother asks the nurse if it is all right to take St. John's wort for mild depression. What is the best response by the nurse? 1. "No, it will probably cause your baby to have more allergies." 2. "No, because it might decrease the amount of milk you produce." 3. "No, it could be excreted in your milk and affect the baby." 4. "No, it will affect the taste of your milk, and your baby might reject nursing." Correct Answer: 3 Rationale 1: Taking St. John's wort is not likely to cause the baby to have more allergies. Rationale 2: Taking St. John's wort is not likely to decrease the amount of milk the mother produces. Rationale 3: Many drugs are excreted in breast milk and can affect the nursing infant. Rationale 4: Taking St. John's wort may affect the taste of the mother's milk, but this is not the most important response. Global Rationale: Many drugs are excreted in breast milk and can affect the nursing infant. Taking St. John's wort is not likely to cause the baby to have more allergies. Taking St. John's wort is not likely to decrease the amount of milk the mother produces. Taking St. John's wort may affect the taste of the mother's milk, but this is not the most important response. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-8 Identify major processes by which drugs are excreted. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 44 Question 10 Type: MCMA The nursing instructor is teaching pharmacology to student nurses. What will the nursing instructor include as the four major components of pharmacokinetics? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. How drugs move from the site of administration to circulating fluids 2. How drugs are converted to a form that is easily removed from the body 3. How drugs change body illnesses and pathogens 4. How drugs are transported throughout the body 5. How drugs are removed from the body Correct Answer: 1,2,4,5 Rationale 1: Absorption describes how drugs move from the site of administration to circulating fluids. Rationale 2: Metabolism describes how drugs are converted to a form that is easily removed from the body. Rationale 3: Pharmacodynamics describes how drugs change body illnesses and pathogens. Rationale 4: Distribution describes how drugs are transported throughout the body. Rationale 5: Excretion describes how drugs are removed from the body. Global Rationale: Absorption describes how drugs move from the site of administration to circulating fluids. Distribution describes how drugs are transported throughout the body. Metabolism describes how drugs are converted to a form that is easily removed from the body. Excretion describes how drugs are removed from the body. Pharmacodynamics describes how drugs change body illnesses and pathogens. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-2 Identify the four components of pharmacokinetics. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 39 Question 11 Type: MCSA The patient is scheduled to receive a medication that is an enzyme inducer of the P450 system. What best describes the effect of this medication on the patient? 1. In time, the patient will experience no effect from other medications. 2. In time, the patient will experience increased effects from other medications. 3. In time, the patient will experience a reduced effect from this medication. 4. In time, the patient will experience an increased effect from this medication. Correct Answer: 3 Rationale 1: The patient will experience a reduced effect from other medications, not an absence of effect. Rationale 2: An enzyme inhibitor will result in an increased effect from other medications. Rationale 3: An enzyme inducer will increase the rate of its own metabolism, thereby reducing its effectiveness. Rationale 4: An enzyme inhibitor will result in an increased effect of this medication. Global Rationale: An enzyme inducer will increase the rate of its own metabolism, thereby reducing its effectiveness. An enzyme inhibitor will result in an increased effect of this medication. An enzyme inhibitor will result in an increased effect from other medications. The patient will experience a reduced effect from other medications, not an absence of effect. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4-5 Explain the metabolism of drugs and its applications to pharmacotherapy. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 43 Question 12 Type: MCMA The patient tells the nurse that he is on many medications and questions how they all get to the right places. What are the best responses by the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "It depends on how much protein you have in your body." 2. "It depends on the health of your kidneys." 3. "It depends on whether they are fat based or water based." 4. "It depends on the amount of blood flow to your body tissues." 5. "It depends on the health of your liver." Correct Answer: 1,3,4 Rationale 1: Distribution of drugs depends on protein binding. Rationale 2: The health of the kidneys refers to excretion, not distribution. Rationale 3: Distribution of drugs depends on the lipid solubility of the drug. Rationale 4: Distribution of drugs depends on the amount of blood flow to body tissues. Rationale 5: The health of the liver refers to metabolism, not distribution. Global Rationale: Distribution of drugs depends on the amount of blood flow to body tissues, the lipid solubility of the drug, and protein binding. The health of the liver refers to metabolism, not distribution. The health of the kidneys refers to excretion, not distribution. Cognitive Level: Evaluating Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-6 Discuss how drugs are distributed throughout the body. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 41 Question 13 Type: MCSA The patient receives a drug that is excreted in the bile. What will the best nursing assessment of the effect of this drug on the patient include? 1. The effect of the drug will be a prolonged action. 2. The effect of the drug will be increased side effects. 3. The effect of the drug will be decreased side effects. 4. The effect of the drug will be decreased. Correct Answer: 1 Rationale 1: Most bile is circulated back to the liver so drugs secreted into the bile will be recirculated numerous times with the bile, resulting in a prolonged action of the drug. Rationale 2: Side effects may or may not be increased; this is dose dependent. Rationale 3: Bile-excreted drugs do not have decreased side effects. Rationale 4: Bile-excreted drugs do not have a decreased effect. Global Rationale: Most bile is circulated back to the liver so drugs secreted into the bile will be recirculated numerous times with the bile, resulting in a prolonged action of the drug. Bile-excreted drugs do not have a decreased effect, nor are side effects decreased. Side effects may or may not be increased; this is dose dependent. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-9 Explain how enterohepatic recirculation might affect drug activity. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 44 Question 14 Type: MCSA The nurse administers medications by various routes of delivery. The nurse recognizes which route of administration as requiring higher dosages of drugs to achieve a therapeutic effect? 1. Intravenous route 2. Oral route 3. Rectal route 4. Sublingual route Correct Answer: 2 Rationale 1: Intravenously administered drugs are not affected by the "first-pass effect." Rationale 2: Oral medications pass into the hepatoportal circulation and may be completely metabolized before reaching the general circulation. This so-called "first pass effect" may necessitate the use of higher dosages of oral medications to achieve a therapeutic effect. Rationale 3: Rectally administered drugs are not affected by the "first-pass effect." Rationale 4: Sublingually administered drugs are not affected by the "first-pass effect." Global Rationale: Oral medications pass into the hepatoportal circulation and may be completely metabolized before reaching the general circulation. This so-called "first pass effect" may necessitate the use of higher dosages of oral medications to achieve a therapeutic effect. None of the other routes, sublingual, rectal, or intravenous, are affected by the "first-pass effect." Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 4-5 Explain the metabolism of drugs and its applications to pharmacotherapy. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 43 Question 15 Type: MCSA Enzymatic activity that changes a medication into a less active form is an example of 1. pharmacodynamics. 2. active transport. 3. pharmacokinetics. 4. diffusion. Correct Answer: 3 Rationale 1: Pharmacodynamics involves how drugs change the body. Rationale 2: Active transport is the movement of a chemical against concentration or gradient. Rationale 3: Pharmacokinetics describes how drugs are handled within the body. Rationale 4: Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Global Rationale: Pharmacokinetics describes how drugs are handled within the body. Pharmacodynamics involves how drugs change the body. Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-1 Explain the applications of pharmacokinetics to clinical practice. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 39 Question 16 Type: MCSA Which of the following are the four categories of pharmacokinetics? 1. Diffusion, active transport, interspersing, and storage 2. Ingestion, metabolism, interspersing, and excretion 3. Absorption, distribution, metabolism, and excretion 4. Ingestion, settling, movement, and storage Correct Answer: 3 Rationale 1: Diffusion, active transport, interspersing, and storage are not the four categories of pharmacokinetics. Rationale 2: Ingestion, metabolism, interspersing, and excretion are not the four categories of pharmacokinetics. Rationale 3: The four categories of pharmacokinetics are absorption, distribution, metabolism, and excretion. Rationale 4: Ingestion, settling, movement, and storage are not the four categories of pharmacokinetics. Global Rationale: The four categories of pharmacokinetics are absorption, distribution, metabolism, and excretion. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-2 Identify the four components of pharmacokinetics. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 39 Question 17 Type: MCSA Following ingestion, a drug crosses a membrane from an area of higher concentration to an area of lower concentration. This is an example of 1. active transport. 2. osmosis. 3. diffusion. 4. metabolism. Correct Answer: 3 Rationale 1: Active transport is the movement of a chemical against concentration or gradient. Rationale 2: Osmosis involves the movement of water. Rationale 3: Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Rationale 4: Metabolism involves chemical conversion. Global Rationale: Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. Osmosis involves the movement of water, and metabolism involves chemical conversion. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-3 Explain how substances travel across plasma membranes. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 39 Question 18 Type: MCSA Aspirin is ionized as it enters the small intestine. Which statement is accurate regarding the absorption of aspirin in the small intestine? 1. Absorption is decreased. 2. Absorption is increased. 3. Ionization has nothing to do with the absorption rate. 4. Aspirin must travel past the small intestine for absorption to occur. Correct Answer: 1 Rationale 1: The small intestine is a more alkaline environment. Aspirin is an acidic drug that is ionized in the small intestine and will have lower absorption rates. Rationale 2: Higher rates of absorption occur in the stomach (an acidic environment). Rationale 3: Ionization state affects absorption rate. Rationale 4: Absorption of aspirin occurs in the stomach. Global Rationale: The small intestine is a more alkaline environment, which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ionized in the small intestine and will have lower absorption rates. Higher rates of absorption occur in the stomach (an acidic environment). Absorption of aspirin occurs in the stomach. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-4 Discuss factors affecting drug absorption. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 41 Question 19 Type: MCSA Which statement regarding medication distribution within the body is accurate? 1. The blood–brain barrier inhibits rapid crossing of all medications. 2. Body organs with high levels of blood flow are more difficult organs to which to deliver drugs. 3. Medications that are lipid-soluble are more completely distributed. 4. Drug–protein complexes must form prior to crossing capillary membranes. Correct Answer: 3 Rationale 1: Some medications (sedatives) are able to rapidly cross the blood–brain barrier. Rationale 2: Body organs with low levels of blood flow are more difficult organs to which to deliver drugs. Rationale 3: Lipid-soluble medications are absorbed and distributed quicker and more quickly than those that are not. Rationale 4: When medications bind to proteins, their size increases, preventing them from passing through capillary membranes. Global Rationale: Lipid-soluble medications are absorbed and distributed quicker and more quickly than those that are not. Body organs with low levels of blood flow are more difficult organs to which to deliver drugs. When medications bind to proteins, their size increases, preventing them from passing through capillary membranes. Some medications (sedatives) are able to rapidly cross the blood–brain barrier. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-6 Discuss how drugs are distributed throughout the body. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 41–42 Question 20 Type: MCSA Which organ is the most responsible for the first-pass effect? 1. Bladder 2. Kidneys 3. Liver 4. Stomach Correct Answer: 3 Rationale 1: The bladder is not the organ most responsible for the first-pass effect. Rationale 2: The kidneys are not the organs most responsible for the first-pass effect. Rationale 3: The first pass effect occurs in the liver. Rationale 4: The stomach is not the organ most responsible for the first-pass effect. Global Rationale: The first pass effect occurs in the liver. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-5 Explain the metabolism of drugs and its applications to pharmacotherapy. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 43 Question 21 Type: MCSA Which substance has the lowest rate of crossing renal tubular membranes and would therefore be excreted in the urine? 1. Lipid-soluble drugs 2. Volatile drugs 3. Ionized drugs 4. Non-ionized drugs Correct Answer: 3 Rationale 1: Lipid-soluble drugs cross renal tubular membranes easily and return to the circulation. Rationale 2: Volatile drugs are eliminated through respiration. Rationale 3: Ionized and water-soluble drugs are less likely to cross renal tubular walls and will therefore be excreted. Rationale 4: Non-ionized drugs cross the renal tubular membranes easily and return to circulation. Global Rationale: Ionized and water-soluble drugs are less likely to cross renal tubular walls and will therefore be excreted. Non-ionized and lipid-soluble drugs cross renal tubular membranes easily and return to the circulation. Volatile drugs are eliminated through respiration. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4-8 Identify major processes by which drugs are excreted. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 44 Question 22 Type: MCSA Which statement is accurate regarding medications that end up being secreted in bile? 1. All medications secreted in bile are excreted in the feces. 2. Some medications are excreted in the feces while others can be recirculated to the liver many times. 3. Most medications secreted in bile are metabolized in the gallbladder. 4. Generally, medications are not secreted in the bile. Correct Answer: 2 Rationale 1: Some bile (and medications within) is excreted in the feces. Rationale 2: Most bile is circulated back to the liver by enterohepatic circulation, where medications are metabolized in the liver. Rationale 3: Medications are not metabolized in the gallbladder. Rationale 4: Some medications are secreted in bile. Global Rationale: Most bile is circulated back to the liver by enterohepatic circulation, where medications are metabolized in the liver. Some bile (and medications within) is excreted in the feces. Medications are not metabolized in the gallbladder. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 4-9 Explain how enterohepatic recirculation might affect drug activity. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 44 Question 23 Type: MCSA Which finding would most accurately indicate that a therapeutic range for a medication had been reached? 1. No serious adverse effects are experienced following administration. 2. The indication for administration was achieved without serious side effects. 3. A pre-specified amount (in milligrams) was administered. 4. The medication was effective, but the patient experienced a lethal dysrhythmia. Correct Answer: 2 Rationale 1: Lack of serious adverse effects does not indication therapeutic range has been reached. Rationale 2: The therapeutic range of a drug is between the minimum effective concentration and the toxic concentration. Rationale 3: Standard doses of medications are determined by expected therapeutic range, not vice versa. Rationale 4: Effective medication is desired, but not at the expense of a lethal dysrhythmia. Global Rationale: The therapeutic range of a drug is between the minimum effective concentration and the toxic concentration. Lack of serious adverse effects does not indicate therapeutic range has been reached. Standard doses of medications are determined by expected therapeutic range, not vice versa. Effective medication is desired, but not at the expense of a lethal dysrhythmia. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-11 Explain how a drug reaches and maintains its therapeutic range in the plasma. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 45 Question 24 Type: MCMA The nurse is teaching a patient the importance of taking the medication as prescribed. Patient teaching is guided by the nurse's knowledge of which principles of pharmacokinetics? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A medication taken by injection must cross the membranes of the gastrointestinal tract to get to the bloodstream before it can be distributed throughout the body. 2. A drug may be exposed to several physiological processes while en route to target cells. 3. Liver enzymes may chemically change the drug. 4. Excretion organs such as kidneys and intestines must be healthy enough to eliminate the drug. 5. Many processes to which drugs are exposed are destructive, thereby helping facilitate the drug's movement throughout the body. Correct Answer: 2,3,4,5 Rationale 1: Medications taken by mouth must cross the membranes of the GI tract to get to the bloodstream in order to be distributed throughout the body. This is not the case for medications administered by injection. Rationale 2: Drugs taken orally are often exposed to physiological processes such as stomach acid and digestive enzymes. Rationale 3: Enzymes in the liver may chemically change some drugs. Rationale 4: Drugs will continue to act on the body until they are either metabolized to an inactive form or are excreted. Pathologic states such as kidney disease can increase the drug's action on the body. Rationale 5: Many destructive processes, such as when stomach acid breaks down food, can break down the drug molecule before it can reach the target cells. This will facilitate the drug's movement throughout the body. Global Rationale: Medications taken by mouth must cross the membranes of the GI tract to get to the bloodstream in order to be distributed throughout the body. This is not the case for medications administered by injection. Drugs taken orally are often exposed to physiological processes such as stomach acid and digestive enzymes. Enzymes in the liver may chemically change some drugs. Drugs will continue to act on the body until they are either metabolized to an inactive form or are excreted. Pathologic states such as kidney disease can increase the drug's action on the body. Many destructive processes, such as when stomach acid breaks down food, can break down the drug molecule before it can reach the target cells. This will facilitate the drug's movement throughout the body. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-1 Explain the applications of pharmacokinetics to clinical practice. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 39 Question 25 Type: MCMA The nurse is reviewing the role of diffusion in the distribution of medications. Drugs that cannot be distributed by simple diffusion include those with which characteristics? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Large molecules 2. Ionization 3. Water-soluble agents 4. Alcohol 5. Urea Correct Answer: 1,2,3 Rationale 1: Large molecules have difficulty crossing plasma membranes by simple diffusion. Rationale 2: Ionized drugs have difficulty crossing plasma membranes by simple diffusion. These drugs may require carrier, or transport, proteins to cross membranes. Rationale 3: Water-soluble agents have difficulty crossing plasma membranes by simple diffusion. Rationale 4: Diffusion assumes that the chemical is able to freely cross the plasma membrane. Drugs may also enter through open channels in the plasma membrane; however, the molecule must be very small, such as alcohol. Rationale 5: Diffusion assumes that the chemical is able to freely cross the plasma membrane. Drugs may also enter through open channels in the plasma membrane; however, the molecule must be very small, such as urea. Global Rationale: Large molecules have difficulty crossing plasma membranes by simple diffusion. Ionized drugs have difficulty crossing plasma membranes by simple diffusion. These drugs may require carrier, or transport, proteins to cross membranes. Water-soluble agents have difficulty crossing plasma membranes by simple diffusion. Diffusion assumes that the chemical is able to freely cross the plasma membrane. Drugs may also enter through open channels in the plasma membrane; however, the molecule must be very small, such as alcohol or urea. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-3 Explain how substances travel across plasma membranes. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 39 Question 26 Type: MCMA A patient who has received an oral medication for treatment of hives says, “How long will it be before my skin clears and quits itching?” Which concepts should the nurse consider when formulating a response? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The amount of time between administration and the drug taking effect is known as onset of action. 2. Peak plasma levels rarely occur with oral medications. 3. Duration of action is the amount of time a drug is effective. 4. Peak plasma level is dependent on the drug’s plasma half-life (t1/2). 5. Drugs with short half-lives are ineffective in treating systemic illnesses. Correct answer: 1,3 Rationale 1: Onset of drug action represents the amount of time it takes to produce a therapeutic effect after drug administration. Rationale 2: All medications have a peak plasma level. Rationale 3: Duration of drug action is the amount of time a drug maintains its therapeutic effect. Rationale 4: Peak plasma level and plasma half-life (t1/2) are related but not strictly dependent on one another. Rationale 5: The effectiveness of a drug is not dependent on half-life as long as dosing frequency is correct. Global Rationale: Onset of drug action represents the amount of time it takes to produce a therapeutic effect after drug administration. All medications have a peak plasma level. Duration of drug action is the amount of time a drug maintains its therapeutic effect. Peak plasma level and plasma half-life (t1/2) are related but not strictly dependent on one another.The effectiveness of a drug is not dependent on half-life as long as dosing frequency is correct. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4-10 Explain the applications of a drug’s onset, peak, and plasma half-life (t1/2) to duration of pharmacology. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 46 Question 27 Type: MCMA Prior to administering a newly prescribed antibiotic, the nurse asks the patient if any other drugs have been taken today. The patient responds, “Why do you need to know?” Which nursing responses are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “I need to be certain you are not taking another antibiotic.” 2. “Some drugs block the action of others.” 3. “Some drugs increase the activity of other drugs.” 4. “The antibiotic I am about to give you is a prodrug.” 5. “We don’t want to increase first-pass effect.” Correct answer: 2,3 Rationale 1: There are many instances when a patient is prescribed more than one antibiotic at a time. Rationale 2: Some drug–drug interactions are antagonistic, blocking or opposing the effects of the drugs taken. Rationale 3: Some drug–drug interactions are synergistic, resulting in a potentiated effect. Rationale 4: Prodrugs have no pharmacologic activity unless they are first metabolized to their active form by the body. This is not dependent on whether or not other drugs are present in the system. Rationale 5: This question has nothing to do with first-pass effect. Global Rationale: There are many instances when a patient is prescribed more than one antibiotic at a time. Some drug–drug interactions are antagonistic, blocking or opposing the effects of the drugs taken, and some are synergistic, resulting in a potentiated effect.Prodrugs have no pharmacologic activity unless they are first metabolized to their active form by the body. This is not dependent on whether or not other drugs are present in the system.This question has nothing to do with first-pass effect. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4-6 Discuss how drugs are distributed throughout the body. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 42 Question 28 Type: MCMA The nurse recognizes that medications can be excreted by which routes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Fecal 2. Gastric 3. Glandular 4. Pulmonary 5. Renal Correct Answer: 1,3,4,5 Rationale 1: Drugs can be excreted via feces. Rationale 2: Drugs are not excreted through the gastric system. Rationale 3: Drugs can be secreted glandularly. Rationale 4: Drugs can be secreted via the lungs. Rationale 5: Drugs can be excreted by the renal route. Global Rationale: Drugs can be excreted via feces, the glandular system, the lungs, and the kidneys. They are not excreted through the gastric tissues. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-8 Identify major processes by which drugs are excreted. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 44 Question 29 Type: MCMA A patient asks the nurse why he experiences a metallic taste after taking certain medications. The nurse explains that some medications are secreted by glandular activity. The nurse would identify which substances as examples of this excretion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Saliva 2. Sweat 3. Breast milk 4. Urine 5. Feces Correct Answer: 1,2,3 Rationale 1: Water-soluble drugs may be secreted into the saliva, which can cause a "funny taste" after the administration of a medication. Rationale 2: Water-soluble drugs may be secreted into the sweat, which may cause an odor to be emitted by the person who has taken a medication. Rationale 3: Water-soluble drugs may be secreted into the breast milk. Breastfeeding mothers must use caution in regards to medications while lactating as the medications can be passed to their infants via the breast milk. Rationale 4: Urine is excreted by the kidneys and does not play a role in glandular activity. Rationale 5: Feces are excreted by the gastrointestinal system and do not play a role in glandular activity. Global Rationale: Water-soluble drugs may be secreted into the saliva, which can cause a "funny taste" after the administration of a medication. Water-soluble drugs may be secreted into the sweat, which may cause an odor to be emitted by the person who has taken a medication. Water-soluble drugs may be secreted into the breast milk. Breastfeeding mothers must use caution in regards to medications while lactating as the medications can be passed to their infants via the breast milk. Urine is excreted by the kidneys and does not play a role in glandular activity. Feces are excreted by the gastrointestinal system and do not play a role in glandular activity. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4-8 Identify major processes by which drugs are excreted. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 44 Question 30 Type: MCMA Which values must be known in order to determine a drug’s therapeutic range? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Toxic concentration 2. Onset of action 3. Peak plasma level 4. Absorption rate 5. Minimal effective concentration Correct answer: 1,5 Rationale 1: Toxic concentration is an essential determinant of therapeutic range. Rationale 2: Onset of action is not related to therapeutic range. Rationale 3: Peak plasma level is not related to therapeutic range. Rationale 4: Absorption rate is not related to therapeutic range. Rationale 5: Minimal effective concentration is an essential determinant of therapeutic range. Global Rationale: Therapeutic range is the area between toxic concentration and minimum effective concentration. Onset of action, peak plasma level, and absorption rate are not related to therapeutic range. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4-11 Explain how a drug reaches and maintains its therapeutic range in the plasma. MNL Learning Outcome 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 44 Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E Chapter 5 Question 1 Type: MCSA A patient looks up the drug he is taking in a drug guide. The patient asks the nurse why the physician prescribed a medication that has a lethal dose measure. What is the best response by the nurse? 1. "It just refers to what is done in research; it is not used by doctors prescribing drugs." 2. "It is a value determined during research, which helps to determine the safe dose to give." 3. "All that means is that the drug could be lethal, but I will watch you for side effects." 4. "Don't worry about that, I'll have your doctor explain it to you." Correct Answer: 2 Rationale 1: The lethal dose measure is used by doctors prescribing drugs. Rationale 2: The difference between a median effective dose and a median lethal dose is a measure of a drug's safety margin, which helps determine the safest dose to give. Rationale 3: Telling a patient that the drug could be lethal, but he will be observed for side effects, will frighten him and most likely result in refusal of the medication. Rationale 4: Telling a patient not to worry is non-therapeutic; this is a condescending response. Global Rationale: The difference between a median effective dose and a median lethal dose is a measure of a drug's safety margin, which helps determine the safest dose to give. The lethal dose measure is used by doctors prescribing drugs. Telling a patient not to worry is non-therapeutic; this is a condescending response. Telling a patient that the drug could be lethal, but he will be observed for side effects, will frighten him and most likely result in refusal of the medication. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 11.7 Promote factors that create a culture of safety and caring. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-4 Compare and contrast median lethal dose (LD50) to nursing practice. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 52 Question 2 Type: MCSA Prior to administering medications, the student nurse reviews the therapeutic index. Which statement best describes the student's understanding of therapeutic index? 1. The student is able to determine if the physician prescribed the best drug for the patient. 2. The student is able to determine if the patients are receiving safe doses of the medications. 3. The student is able to identify interactions among the drugs each patient is receiving. 4. The student is able to identify the patients who will need to have serum blood levels monitored. Correct Answer: 4 Rationale 1: The therapeutic index will not help to determine if the physician prescribed the best drug for the patient. Rationale 2: The therapeutic index will give some information about safe doses, but this is not the most complete response. Rationale 3: The therapeutic index will not help to identify interactions among the drugs the patients receive. Rationale 4: Drugs with a narrow therapeutic index have a low safety margin and the concentration of the drug should be monitored by regular serum tests. Global Rationale: Drugs with a narrow therapeutic index have a low safety margin and the concentration of the drug should be monitored by regular serum tests. The therapeutic index will give some information about safe doses, but this is not the most complete response. The therapeutic index will not help to determine if the physician prescribed the best drug for the patient. The therapeutic index will not help to identify interactions among the drugs the patients receive. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essentials Competencies: 11.7 Promote factors that create a culture of safety and caring. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5-5 Discuss how a drug’s therapeutic index is related to its margin of safety. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 52 Question 3 Type: MCSA The nursing instructor prepares to teach student nurses about how mean effective doses of medications are related to clinical practice. As a result of the instruction, what is the best understanding of the student nurses? 1. About 50% of patients will experience severe side effects from the drug. 2. Some patients will respond differently depending on their ethnic background. 3. About 50% of patients will not experience any effect from the drug. 4. Some patients will require more or less than the average dose of the drug. Correct Answer: 4 Rationale 1: The mean effective dose does not predict how many patients will experience severe side effects from the drug. Rationale 2: The mean effective dose is not related to ethnicity. Rationale 3: The mean effective dose does not predict that 50% of patients will not experience any effect of the drug. Rationale 4: The mean effective dose predicts how 50% of the population will respond to the average dose of the drug. Some patients will require more or less of the drug. Global Rationale: The mean effective dose predicts how 50% of the population will respond to the average dose of the drug. Some patients will require more or less of the drug. The mean effective dose is not related to ethnicity. The mean effective dose does not predict how many patients will experience severe side effects from the drug. The mean effective dose does not predict that 50% of patients will not experience any effect of the drug. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 5-3 Explain the importance of the median effective dose (ED50) to nursing practice. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 51 Question 4 Type: MCSA The patient receives antibiotics for a serious infection. The patient asks the nurse, "Why don't you just give me more of that drug to cure this infection faster?" What is the best response by the nurse? 1. "I will check with the doctor to see if it is time to increase the medication." 2. "You are at a maximum dose; taking more will cause interactions with other medications." 3. "You must stay on this drug for 2 more weeks before it can be increased." 4. "You are at a maximum dose; taking more will not help." Correct Answer: 4 Rationale 1: Telling the patient the nurse will check with the physician is inappropriate because the plateau of the drug has been reached; the physician will not change the dosage. Rationale 2: An increase in dosage may cause interactions with other medications, but this is not the best answer. Rationale 3: Once the plateau of a drug has been reached, there is no time frame for an increase in dosage because an increase in dosage will not produce a greater effect. Rationale 4: When the plateau of a drug has been reached, administering more of the drug will not produce additional benefit. Once the plateau of a drug has been reached, there is no time frame for an increase in dosage because an increase in dosage will not produce a greater effect. Telling the patient the nurse will check with the physician is inappropriate because the plateau of the drug has been reached; the physician will not change the dosage. An increase in dosage may cause interactions with other medications, but this is not the best answer. Global Rationale: When the plateau of a drug has been reached, administering more of the drug will not produce additional benefit. Once the plateau of a drug has been reached, there is no time frame for an increase in dosage because an increase in dosage will not produce a greater effect. Telling the patient the nurse will check with the physician is inappropriate because the plateau of the drug has been reached; the physician will not change the dosage. An increase in dosage may cause interactions with other medications, but this is not the best answer. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-6 Explain the significance of the graded dose-response relationship to nursing practice. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 53 Question 5 Type: MCSA The nurse administers narcotics to surgical patients. Which statement represents the nurse's best understanding as it relates to the potency of different narcotics? 1. Codeine is less potent than morphine; it will not produce an allergic reaction. 2. Morphine is more potent than codeine; a lesser dose will be required. 3. Morphine is more potent than codeine; it will produce more adverse effects. 4. Codeine is less potent than morphine; it will not relieve pain as well. Correct Answer: 2 Rationale 1: The potency of a drug is not related to its ability to cause an allergic reaction. Rationale 2: A drug that is more potent will produce a therapeutic effect at a lower dose. Rationale 3: Potency does not mean the drug will produce more adverse effects. Rationale 4: Less potent narcotics can be very effective with pain relief. Global Rationale: A drug that is more potent will produce a therapeutic effect at a lower dose. Potency does not mean the drug will produce more adverse effects. Less potent narcotics can be very effective with pain relief. The potency of a drug is not related to its ability to cause an allergic reaction. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5-7 Compare and contrast the terms potency and efficacy. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 53 Question 6 Type: MCSA The nurse is conducting medication education about the difference between potency and efficacy to a group of patients. The nurse correctly determines that learning has occurred when the patients makes which response? 1. "The best drug for us is the one with the highest potency." 2. "The best drug for us is the one with the greatest efficacy." 3. "Drugs with the greatest efficacy will produce the least side effects." 4. "Low-potency drugs have efficacy and do not produce side effects." Correct Answer: 2 Rationale 1: Potency refers to the dose of the drug; high-potency drugs do not necessarily provide the best response in the patient. Rationale 2: Efficacy means the magnitude of maximal response that can be produced from a particular drug. Rationale 3: Efficacious drugs do produce side effects. Rationale 4: Low-potency drugs do produce side effects. Global Rationale: Efficacy means the magnitude of maximal response that can be produced from a particular drug. Potency refers to the dose of the drug; high-potency drugs do not necessarily provide the best response in the patient. Efficacious drugs and low-potency drugs do produce side effects. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5-7 Compare and contrast the terms potency and efficacy. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 53 Question 7 Type: MCMA The patient has had hypertension for many years. The physician orders an antihypertensive drug that has just come on the market. The nurse teaches the patient that this drug works more effectively than his prior drug and has fewer side effects. The patient asks how this can be. What is the best response by the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Newer drugs are altered to affect your cells' receptors in a different way." 2. "Receptors tend to ‘burn-out,’ so newer drugs are required." 3. "Research into receptors helps ‘fine-tune’ drugs to be more effective." 4. "Changing the response of the drug to protein receptor-complexes produces fewer side effects." 5. "It is a process of trial and error with receptors until the new drug proves effective." Correct Answer: 1,3 Rationale 1: Receptor research results in the development of new medications that activate very specific receptors to produce a greater therapeutic response as well as fewer side effects. Rationale 2: Receptors do not "burn-out." Rationale 3: Research into receptors has resulted in the "fine-tuning" of medications that are more effective with fewer side effects. Rationale 4: There is no such thing as a protein receptor-complex. Rationale 5: Research is not a process of trial and error with receptors. Global Rationale: Receptor research results in the development of new medications that activate very specific receptors to produce a greater therapeutic response as well as fewer side effects. Research into receptors has resulted in the "fine-tuning" of medications that are more effective with fewer side effects. Research is not a process of trial and error with receptors. Receptors do not "burn-out." There is no such thing as a protein receptor-complex. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-9 Explain the relationship between receptors and drug action. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 55 Question 8 Type: Hot Spot Indicate the spot of the median effective dose on the frequency distribution curve. 1. A 2. B 3. C 4. D Answer: 3 Rationale: The dose in the middle of the frequency distribution curve represents the drug’s median effective dose. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 5-3 Explain the importance of the median effective dose (ED50) to nursing practice. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 51 Question 9 Type: MCSA The patient and his wife receive the same medication for hypertension. The patient's wife asks the nurse why she is receiving a higher amount of the medication. What is the best response by the nurse? 1. "Females have a higher metabolism, so you need more medication." 2. "Everyone is unique and responds differently to medications." 3. "Your hormones are different from your husband's, so you need more medication." 4. "You have a greater percentage of body fat, so more medication is needed." Correct Answer: 2 Rationale 1: Females do not necessarily have higher metabolic rates than men. Rationale 2: Many variables will influence how patients will respond to medications; each patient must be individually evaluated for response to medications. Rationale 3: Hormone status is only one of the variables involved in the patient's response to medications and may not pertain to this drug. Rationale 4: The percentage of body fat is only one of the variables involved in the patient's response to medications and may not pertain to this medication. Global Rationale: Many variables will influence how patients will respond to medications; each patient must be individually evaluated for response to medications. The percentage of body fat, hormones, and the patient's rate of metabolism are only a few of the variables involved in the patient's response to medications. These factors may or may not pertain to the medication in question. Females do not necessarily have higher metabolic rates than men. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 111.5 Participate in the process of retrieval, appraisal, and synthesis of evidence in collaboration with other members of the healthcare team to improve patient outcomes. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-2 Discuss how frequency distribution curves may be used to explain how patients respond differently to medications. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 51 Question 10 Type: MCSA The student nurse has been reading about the Human Genome Project and asks the nursing instructor how this will impact future pharmacological therapies. What is the best response by the instructor? 1. "We will be able to alter genes so we will not need drugs." 2. "We will be able to standardize drug doses to make prescribing easier." 3. "It will help prevent disease through gene manipulation but will not impact drugs." 4. "It will help to individualize drug therapy for people in a more effective way." Correct Answer: 4 Rationale 1: Altering genes to prevent illness is a possibility, but we will always need medications. Rationale 2: Individuals will still respond differently to medications; not all drugs will have standardized doses. Rationale 3: Medications will be very much impacted by this research. Rationale 4: The goal of pharmacogenetics is to help individualize drug therapy for people in a more effective way. Global Rationale: The goal of pharmacogenetics is to help individualize drug therapy for people in a more effective way. Altering genes to prevent illness is a possibility, but we will always need medications. Individuals will still respond differently to medications; not all drugs will have standardized doses. Medications will be very much impacted by this research. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-10 Explain possible future developments in the field of pharmacogenetics. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 56 Question 11 Type: MCSA The home health nurse notes that the elderly patient doubled up on his pain medication, even though the prescribed dose was at a therapeutic level. The patient says, "If one pill is good, two pills are better." Which statement best describes the result of the patient's action? 1. The patient develops tolerance and does not experience any difference. 2. The patient experiences more pain relief from the additional dose. 3. The patient develops tolerance and will need increased doses of the drug. 4. The patient is more likely to exhibit side effects from the additional dose. Correct Answer: 4 Rationale 1: Tolerance may occur but is not the primary issue here. Rationale 2: Once the plateau of a drug has been reached, increased doses will not provide added therapeutic benefit, such as more pain relief. Rationale 3: Tolerance may occur but is not the primary issue here. Rationale 4: Once the plateau of a drug has been reached, increasing the dose may produce adverse effects. Global Rationale: Once the plateau of a drug has been reached, increasing the dose may produce adverse effects. Once the plateau of a drug has been reached, increased doses will not provide added therapeutic benefit, such as more pain relief. Tolerance may occur but is not the primary issue here. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-6 Explain the significance of the graded dose-response relationship to nursing practice. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 53 Question 12 Type: MCSA The patient was receiving haloperidol (Haldol), a dopamine antagonist. The psychiatrist changed the order to aripiprazole (Abilify), a partial dopamine antagonist. Which statement best describes the effect of the change of medication on the patient? 1. The patient is more compliant in taking his medication. 2. The patient experiences greater efficacy. 3. The patient experiences a greater reduction in symptoms. 4. The patient experiences fewer side effects. Correct Answer: 4 Rationale 1: The patient will not necessarily be more compliant in taking the medicine. Rationale 2: The patient will not necessarily experience greater efficacy. Rationale 3: Experiencing a greater reduction in symptoms is the same as greater efficacy. Rationale 4: Partial blocking of dopamine results in fewer side effects than complete blocking of dopamine. Global Rationale: Partial blocking of dopamine results in fewer side effects than complete blocking of dopamine. The patient will not necessarily experience greater efficacy or be more compliant in taking the medicine. Experiencing a greater reduction in symptoms is the same as greater efficacy. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-8 Distinguish among an agonist, a partial agonist, and an antagonist. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 55 Question 13 Type: MCMA The student nurse asks the nursing instructor why drug plateaus occur with medications. What are the best responses by the nursing instructor? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "It could be that all of the receptors for the drug are occupied." 2. "It may mean that the drug has brought 100% relief to the patient." 3. "It means that the patient has developed resistance and needs another drug." 4. "It probably means that the drug is losing efficacy." 5. "It means that the patient needs a higher dose of the drug." Correct Answer: 1,2 Rationale 1: Drug plateaus occur with medications because all the receptors for the drug are occupied. Rationale 2: Drug plateaus occur with medications when the drug has brought 100% relief to the patient. Rationale 3:Drug plateaus are not associated with resistance. Rationale 4: A drug plateau is not related to efficacy of the drug. Rationale 5: When a drug has reached its plateau, giving additional amounts will not result in an increased therapeutic effect. Global Rationale: Drug plateaus occur with medications because all the receptors for the drug are occupied; the drug has brought 100% relief to the patient. A drug plateau is not related to efficacy of the drug. When a drug has reached its plateau, giving additional amounts will not result in an increased therapeutic effect.Drug plateaus are not associated with resistance. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-6 Explain the significance of the graded dose-response relationship to nursing practice. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 53 Question 14 Type: MCSA When administering a standard or median effective dose to a patient, the nurse explains that this amount of drug will have which effect? 1. It will produce an effect without the presence of adverse effects. 2. It will be metabolized within 24 hours. 3. It will be effective in half of the population. 4. It will be effective in the majority of patients. Correct Answer: 3 Rationale 1: The median effective dose may result in toxicity in some patients. Rationale 2: Rate of metabolism is not a specific factor in determining median effective dose. Rationale 3: The median effective dose is the amount of a drug that produces an effect in 50% of a group of patients. Rationale 4: Median does not refer to a value in excess of 50%. Global Rationale: The median effective dose is the amount of a drug that produces an effect in 50% of a group of patients.The median effective dose may result in toxicity in some patients.Rate of metabolism is not a specific factor in determining median effective dose.Median does not refer to a value in excess of 50%. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-3 Explain the importance of the median effective dose (ED50) to nursing practice. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 51 Question 15 Type: MCSA Drug X has a median lethal dose of 30 mg and a median effective dose of 10. Drug Y has a therapeutic index of 4, while drug Z has a therapeutic index of 3. Which statement is accurate based on this information? 1. Drugs X and Y are safer than drug Z. 2. The therapeutic index of drug X is 20. 3. Drug Y is the safest of the three. 4. Drug Z is the safest of the three. Correct Answer: 3 Rationale 1: Drugs X and Z have the same therapeutic index and are more dangerous than drug Y. Rationale 2: The therapeutic index of drug X is 30/10 or 3. Rationale 3: Since drug Y has the highest therapeutic index, it is the safest drug. Rationale 4: Drugs X and Z have the same therapeutic index and are more dangerous than drug Y. Global Rationale: Since drug Y has the highest therapeutic index, it is the safest drug. Drugs X and Z have the same therapeutic index and are more dangerous than drug Y.The therapeutic index of drug X is 30/10 or 3. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essentials Competencies: 11.7 Promote factors that create a culture of safety and caring. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5-5 Discuss how a drug’s therapeutic index is related to its margin of safety. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 52 Question 16 Type: MCSA When reading about a drug, the nurse learns it has a median toxic dose of 50 mg. The patient has been receiving 60 mg of the drug. What analysis does the nurse make? 1. It is likely the drug will not produce the desired effect. 2. The efficacy and potency of this drug have not been well defined. 3. The patient will be at greater risk of adverse effects. 4. This amount of drug would have been lethal to half the population. Correct Answer: 3 Rationale 1: This information is insufficient to predict if the drug will produce the desired effect. Rationale 2: The median toxicity dose is not a measure of efficacy and potency. Rationale 3: Since the dose exceeds the median toxicity for this drug, the patient is at greater risk of developing adverse effects. Rationale 4: Median toxicity dose has to do with development of toxicity, not lethality. Global Rationale: Since the dose exceeds the median toxicity for this drug, the patient is at greater risk of developing adverse effects.This information is insufficient to predict if the drug will produce the desired effect.The median toxicity dose is not a measure of efficacy and potency.Median toxicity dose has to do with development of toxicity, not lethality. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 11.7 Promote factors that create a culture of safety and caring. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5-4 Compare and contrast median lethal dose (LD50) to nursing practice. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 52 Question 17 Type: MCSA Graded dose-response curves are most useful for determining 1. response intensity within an individual. 2. response intensity within a large group of people with different characteristics. 3. response intensity within a large group of people with similar characteristics. 4. response intensity within a small group of people with similar characteristics. Correct Answer: 1 Rationale 1: Graded dose-response curves are used to determine response intensity within an individual. Rationale 2: Frequency distribution curves are used to visualize patient differences in response to medication in a population. Rationale 3: Frequency distribution curves are used to visualize patient differences in response to medication in a population. Rationale 4: Frequency distribution curves are used to visualize patient differences in response to medication in a population. Global Rationale: Graded dose-response curves are used to determine response intensity within an individual. Frequency distribution curves are used to visualize patient differences in response to medication in a population. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-6 Explain the significance of the graded dose-response relationship to nursing practice. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 53 Question 18 Type: MCSA At a dose of 10 mg, drug X lowers total cholesterol by 50 mg/dL, while a maximum drop in cholesterol of 65 mg/dL is achieved at 40 mg. At a dose of 5 mg, drug Y lowers cholesterol by 50 mg/dL, while a maximum drop in cholesterol of 55 mg/dL is achieved at 10 mg. What can be concluded about the efficacy and potency of these two drugs? 1. Drug X is more potent, and drug Y has a higher efficacy. 2. Drug X is more potent and has higher efficacy. 3. Drug Y is more potent and has higher efficacy. 4. Drug Y is more potent, and drug X has a higher efficacy. Correct Answer: 4 Rationale 1: Drug X is not more potent. Drug Y does not have higher efficacy. Rationale 2: Drug X is not more potent. Rationale 3: Drug Y does not have higher efficacy. Rationale 4: Drug Y causes a greater drop in cholesterol at lower doses (higher potency), whereas drug X causes the highest drop in total cholesterol (efficacy). Global Rationale: Drug Y causes a greater drop in cholesterol at lower doses (higher potency), whereas drug X causes the highest drop in total cholesterol (efficacy). Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5-7 Compare and contrast the terms potency and efficacy. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 53 Question 19 Type: MCSA A drug has been prescribed to decrease the effects of an endogenous chemical. The nurse would place this drug in which category? 1. An agonist 2. A partial agonist 3. An antagonist 4. An agonist-antagonist Correct Answer: 3 Rationale 1: An agonist drug produces the same type of response as the endogenous substance. Rationale 2: A partial agonist produces a weaker, or less efficacious, response than an agonist. Rationale 3: An antagonist occupies receptor sites, preventing them from being activated by the medication. This prevents the endogenous chemical from acting. Rationale 4: An agonist-antagonist produces a weaker, or less efficacious, response than an agonist. Global Rationale: An antagonist occupies receptor sites, preventing them from being activated by the medication. This prevents the endogenous chemical from acting.An agonist drug produces the same type of response as the endogenous substance.A partial agonist produces a weaker, or less efficacious, response than an agonist.An agonist-antagonist produces a weaker, or less efficacious, response than an agonist. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-8 Distinguish among an agonist, a partial agonist, and an antagonist. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 55 Question 20 Type: MCSA Pharmacogenetics is a relatively new area within pharmacology. Which statement best describes the potential of this new area? 1. To customize drugs and prevent idiosyncratic responses 2. To reduce the overall number of drugs and their associated adverse effects 3. To reduce medication errors and provide optimal drug choices 4. To provide cost-effective pharmacotherapy and higher drug efficacy Correct Answer: 1 Rationale 1: Pharmacogenetics explores the role of heredity in drug response. It might be useful to customize drugs based on genetic makeup and reduce idiosyncratic responses. Rationale 2: Reducing the number of drugs might occur but is not the best descriptive statement. Rationale 3: Pharmacogenetics will not reduce medication errors. Rationale 4: Currently, increased cost is a deterrent. Global Rationale: Pharmacogenetics explores the role of heredity in drug response. It might be useful to customize drugs based on genetic makeup and reduce idiosyncratic responses. Pharmacogenetics will not reduce medication errors. Currently, increased cost is a deterrent. Reducing the number of drugs might occur but is not the best descriptive statement. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-10 Explain possible future developments in the field of pharmacogenetics. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 56 Question 21 Type: FIB From a transcription error, a patient received an overdose of a prescribed medication. If the therapeutic index of the medication is 10 and the median effective dose is 2, the nurse would calculate as the median lethal dose for the medication as _____. Standard Text: Record your answer rounding to the nearest whole number. Correct Answer: 20 Rationale: 10 = x/2; solving for x, the median lethal dose would be 20. Global Rationale: 10 = x/2; solving for x, the median lethal dose would be 20. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essentials Competencies: 11.7 Promote factors that create a culture of safety and caring. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5-5 Discuss how a drug’s therapeutic index is related to its margin of safety. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 52 Question 22 Type: MCMA The nurse is participating in the clinical trial of a new medication for the treatment of hypertension. To assess the effectiveness of the medication, which interventions would the nurse perform to help determine whether the average dose is effective for the patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Monitoring blood pressure 2. Monitoring heart rate 3. Interpreting laboratory values 4. Monitoring diet 5. Monitoring sleep habits Correct Answer: 1,2,3 Rationale 1: By monitoring the patient's vital signs, the nurse helps to determine whether the average dose is effective for the patient. Rationale 2: By monitoring the patient's vital signs, the nurse helps to determine whether the average dose is effective for the patient. Rationale 3: By interpreting any associated laboratory data, the nurse helps to determine whether the average dose is effective for the patient. Rationale 4: Monitoring the patient's diet will not help determine if the average dose of a medication is effective for the patient. Rationale 5: Monitoring the patient's sleep habits will not help determine if the average dose of a medication is effective for the patient. Global Rationale: By monitoring the patient's vital signs and associated laboratory data, the nurse helps to determine whether the average dose is effective for the patient.Monitoring the patient's diet and sleeping habits will not help determine if the average dose of a medication is effective for the patient. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.B.1 Participate effectively in appropriate data collection and other research activities. AACN Essentials Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-1 Explain the applications of pharmacodynamics to nursing process. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 51 Question 23 Type: MCMA The nurse explains to a student nurse that the median lethal dose of drugs is often determined in laboratory preclinical trials because Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. it would be unethical to determine these values in human subjects. 2. the safety of the medication must be determined prior to clinical trials. 3. it is difficult to obtain sufficient participants for clinical trials. 4. clinical trials determine only the effective dose of a drug. 5. it is too costly to conduct the studies during clinical trials. Correct Answer: 1,2 Rationale 1: Laboratory animals are used in clinical trials to determine the LD50, or the dose that kills 50% of the subjects. It would be unethical to kill human subjects. Rationale 2: Before a drug is released for trials in human subjects, its safety must be determined. Rationale 3: It can be challenging to obtain sufficient subjects at times, but this is not the reason for doing lethal studies during preclinical trials. Rationale 4: Clinical trials determine not only the effectiveness of a drug, but also its adverse and toxic effects. Rationale 5: The cost of the trials is the reason they are conducted with animal subjects. Global Rationale: Laboratory animals are used in clinical trials to determine the LD50, or the dose that kills 50% of the subjects. It would be unethical to kill human subjects.Before a drug is released for trials in human subjects, its safety must be determined.It can be challenging to obtain sufficient subjects at times, but this is not the reason for doing lethal studies during preclinical trials.Clinical trials determine not only the effectiveness of a drug, but also its adverse and toxic effects.The cost of the trials is the reason they are conducted with animal subjects. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: 11.7 Promote factors that create a culture of safety and caring. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5-4 Compare and contrast median lethal dose (LD50) to nursing practice. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 52 Question 24 Type: FIB The nurse is preparing to administer a medication to a patient on a medical-surgical unit. The median lethal dose of the drug is 40 mg, and the median effective dose is 10 mg. The nurse calculates the therapeutic index to be _____. Standard Text: Record your answer rounding to the nearest whole number. Correct Answer: 4 Rationale: The therapeutic index is calculated by dividing the median lethal dose (LD50) by the median effective dose (ED50). Global Rationale: The therapeutic index is calculated by dividing the median lethal dose (LD50) by the median effective dose (ED50). Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essentials Competencies: 11.7 Promote factors that create a culture of safety and caring. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5-5 Discuss how a drug’s therapeutic index is related to its margin of safety. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 52 Question 25 Type: MCMA A patient with hypertension is taking a potent antihypertensive without results. The patient is concerned when the health care provider orders a new drug. The nurse explains, Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The drug you took is very potent, and a higher dose is needed." 2. "The new drug has greater efficacy, so it will help reduce your blood pressure." 3. "The prescriber must have made an error in the orders." 4. "Efficacy in treating your hypertension is more important than potency." 5. "You are correct. I think the prescriber meant to order both drugs." Correct Answer: 2,4 Rationale 1: A higher dose of a potent drug may cause more serious adverse effects without greater efficacy. Rationale 2: Efficacy is more important than potency in providing blood pressure control. Rationale 3: This is not an appropriate response by the nurse. Rationale 4: Efficacy is more important than potency in pharmacologic treatment. Rationale 5: This is not an appropriate response, and the nurse cannot assume the order was supposed to be for two drugs. Global Rationale: Efficacy is more important than potency in providing blood pressure control.Efficacy is more important than potency in pharmacologic treatment.A higher dose of a potent drug may cause more serious adverse effects without greater efficacy. Statements regarding the prescriber are not appropriate. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5-7 Compare and contrast the terms potency and efficacy. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 53 Question 26 Type: MCMA The nurse is reviewing the medication administration record for a group of patients and recognizes that which agents have nonspecific cellular responses? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Ethyl alcohol 2. General anesthetics 3. Osmotic diuretics 4. Calcium channel blockers 5. Alpha-adrenergic antihypertensives Correct Answer: 1,2,3 Rationale 1: Ethyl alcohol is an example of an agent that acts by nonspecific mechanisms, independently of cellular receptors. Rationale 2: General anesthetics are an example of agents that act by nonspecific mechanisms, independently of cellular receptors. Rationale 3: Osmotic diuretics are an example of agents that act by nonspecific mechanisms, independently of cellular receptors. Rationale 4: Calcium channel blockers have a specific mechanism of action. Rationale 5: Alpha-adrenergic antihypertensives have a specific mechanism of action. Global Rationale: Ethyl alcohol is an example of an agent that acts by nonspecific mechanisms, independently of cellular receptors.General anesthetics are an example of agents that act by nonspecific mechanisms, independently of cellular receptors.Osmotic diuretics are an example of agents that act by nonspecific mechanisms, independently of cellular receptors.Calcium channel blockers have a specific mechanism of action.Alpha-adrenergic antihypertensives have a specific mechanism of action. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-8 Distinguish among an agonist, a partial agonist, and an antagonist. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 55 Question 27 Type: Hot Spot Mark the location of the beginning of the plateau phase on this dose-response relationship curve. 1. A 2. B 3. C 4. D Answer: 4 Rationale: The plateau phase occurs when increasing the drug dose produces no additional therapeutic response. It is represented on this curve as the horizontal line at the top right of the curve. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5-6 Explain the significance of the graded dose-response relationship to nursing practice. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 53 Question 28 Type: FIB Literature review reveals that a new drug has a median lethal dose of 10 and a median effective dose of 5. The nurse determines that an error in which _____ times the correct dose is given could be lethal. Standard Text: Record your answer rounding to the nearest whole number. Correct Answer: 2 Rationale: x = 10/5; solving for x, the therapeutic index would be 2. This means it would only take an error in magnitude of approximately 2 times the average dose to be lethal. Global Rationale: x = 10/5; solving for x, the therapeutic index would be 2. This means it would only take an error in magnitude of approximately 2 times the average dose to be lethal. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality. AACN Essentials Competencies: 11.7 Promote factors that create a culture of safety and caring. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5-5 Discuss how a drug’s therapeutic index is related to its margin of safety. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 52 Question 29 Type: MCMA During assessment, the patient mentions that he recently “sent off to a company for pharmacogenomic testing.” What nursing responses are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Have you changed your medications any?” 2. “Have you talked with your physician about the results?” 3. “Why did you do that?” 4. “Was that test expensive?” 5. “Who told you about the testing?” Correct Answer: 1,2 Rationale 1: The most important question is if the patient has changed therapy secondary to test results. Rationale 2: It is important for the patient to discuss the results of the tests and any indicated changes with the health care provider. Rationale 3: Asking a “why” question is confrontational and is likely to result in the patient not sharing more information. Rationale 4: The nurse may be curious as to the expense of the test, but the cost is not pertinent to this discussion. Rationale 5: Asking who suggested the test is confrontational and is likely to result in the patient not sharing more information. Global Rationale: The most important question is if the patient has changed therapy secondary to test results.It is important for the patient to discuss the results of the tests and any indicated changes with the health care provider.Asking a “why” question or asking who suggested the test is confrontational and is likely to result in the patient not sharing more information.The nurse may be curious as to the expense of the test, but the cost is not pertinent to this discussion. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.2 Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-10 Explain possible future developments in the field of pharmacogenetics. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 56 Question 30 Type: MCMA The nurse reads that a newly discovered drug is a functional antagonist for some commonly administered medications. The nurse interprets this information as indicating the new drug could have which actions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Blocks alpha receptors 2. Enhances drug excretion 3. Blocks beta receptors 4. Speeds drug metabolism 5. Inhibits protein synthesis Correct Answer: 2,4 Rationale 1: Functional antagonists do not block alpha receptors. Rationale 2: Functional antagonists change pharmacokinetic factors such as excretion. Rationale 3: Functional antagonists do not block beta receptors. Rationale 4: Functional antagonists change pharmacokinetic factors such as metabolism. Rationale 5: Drugs that bind with DNA may inhibit protein synthesis. Global Rationale: Functional antagonists change pharmacokinetic factors such as excretion and metabolism.They do not block alpha or beta receptors.Drugs that bind with DNA may inhibit protein synthesis. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-9 Explain the relationship between receptors and drug action. MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug. Page Number: 55 Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E Chapter 12 Question 1 Type: MCMA A patient’s heart rate is found to be 72 beats per minute and regular. The nurse evaluates which situation in the patient’s peripheral nervous system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The sympathetic system is in control. 2. The parasympathetic system is dominating. 3. Both parasympathetic and sympathetic systems are influencing cardiac status. 4. The autonomic nervous system is affecting cardiac status. 5. The somatic nervous system is affecting cardiac status. Correct Answer: 2,3,4 Rationale 1: If the sympathetic system was in control, the heart rate would be accelerated. Rationale 2: Restful cardiac response indicates that the primary input is from the parasympathetic system. Rationale 3: These two systems work in tandem to regulate the cardiac response. Rationale 4: Both the sympathetic and parasympathetic systems are part of the autonomic system. Rationale 5: The somatic system is separate from the autonomic system. Global Rationale: Restful cardiac response indicates that the primary input is from the parasympathetic system.These two systems work in tandem to regulate the cardiac response.Both the sympathetic and parasympathetic systems are part of the autonomic system.If the sympathetic system was in control, the heart rate would be accelerated.The somatic system is separate from the autonomic system. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-2 Identify important divisions of the peripheral nervous system. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 130 Question 2 Type: MCMA A nurse is reading about the development of drugs that inhibit the parasympathetic nervous system. The nurse would look for articles about which drug classes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Anticholinergics 2. Parasympathomimetics 3. Parasympatholytics 4. Cholinergics 5. Muscarinic blockers Correct Answer: 1,3,5 Rationale 1: Anticholinergics inhibit the parasympathetic nervous system. Rationale 2: Parasympathomimetic drugs stimulate the parasympathetic nervous system. Rationale 3: Parasympatholytic drugs inhibit the parasympathetic nervous system. Rationale 4: Cholinergic drugs stimulate the parasympathetic nervous system. Rationale 5: Muscarinic blockers inhibit the parasympathetic nervous system. Global Rationale: Anticholinergics, parasympatholytics, and muscarinic blockers inhibit the parasympathetic nervous system.: Parasympathomimetic drugs and cholinergic drugs stimulate the parasympathetic nervous system. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-6 Discuss the classifications and naming of cholinergic drugs based on possible actions. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 134 Question 3 Type: Hot Spot Mark the site of the ganglionic synapse on this diagram. 1. A 2. B 3. C 4. D Answer: 3 Rationale: The ganglionic synapse is the gap between the preganglionic neuron and the postganglionic neuron. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-4 Explain how information is transmitted throughout the nervous system and the neurotransmitters important to the parasympathetic nervous system. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 131 Question 4 Type: MCMA A patient has been prescribed an oral drug containing atropine. The nurse would hold the drug and contact the prescriber if which patient statements are made? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “I would like to wait a few minutes to take this as I just drank some aloe juice.” 2. “Can I take this at the same time as my procainamide?” 3. “I have had a headache this morning.” 4. “I am allergic to penicillin.” 5. “My gallbladder surgery is scheduled for next week.” Correct Answer: 1,2 Rationale 1: Atropine should be used with caution in those who use aloe. Rationale 2: There is a drug–drug interaction between atropine and procainamide. Rationale 3: Headache does not prevent use of atropine. Rationale 4: Allergy to penicillin does not prevent use of atropine. Rationale 5: Gallbladder surgery for next week would not prevent use of atropine. Global Rationale: Atropine should be used with caution in those who use aloe.There is a drug–drug interaction between atropine and procainamide.Headache, allergy to penicillin, and gallbladder surgery scheduled for next week do not prevent use of atropine. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A. 4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-8 For each of the drug classes listed in Drugs at a Glance, discuss representative drugs and explain their mechanism of action, primary actions, and important adverse effects. MNL Learning Outcome: 2.2.2 Compare the classes of cholinergic agonist drugs. Page Number: 140 Question 5 Type: MCSA The nurse has completed medication education about pyridostigmine (Mestinon), an indirect cholinergic drug, for the patient with myasthenia gravis. The nurse determines that learning has occurred when the patient makes which statement? 1. "My heart may beat slower while I am on this drug." 2. "I will need to increase my fluid intake with this medication." 3. "I must take this medication immediately before eating a full meal." 4. "It is really important to take my medication on time." Correct Answer: 4 Rationale 1: Heart rate is typically increased by anticholinergic drugs. Rationale 2: There is no reason to increase fluid intake with this drug. Rationale 3: There is no reason this drug should be taken immediately prior to eating a full meal. Rationale 4: Maintaining an optimum blood level of the drug is crucial in promoting muscle functioning, so it is important for the patient to take his medication on time and as directed. Global Rationale: Maintaining an optimum blood level of the drug is crucial in promoting muscle functioning, so it is important for the patient to take his medication on time and as directed.Heart rate is typically increased by anticholinergic drugs.There is no reason to increase fluid intake with this drug.There is no reason this drug should be taken immediately prior to eating a full meal. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 12-9 Apply the nursing process to care for patients receiving pharmacotherapy with cholinergic drugs and cholinergic-blocking drugs. MNL Learning Outcome: 2.2.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 138 Question 6 Type: MCSA The physician has ordered bethanechol (Urecholine), a cholinergic drug, for the patient with urinary retention. The patient also has an enlarged prostate gland. What is the priority action by the nurse? 1. Hold the drug and prepare to catheterize the patient. 2. Administer the drug and measure urinary output. 3. Administer the drug and push fluids. 4. Hold the drug and contact the physician. Correct Answer: 4 Rationale 1: There should be no need for catheterization. Rationale 2: Measuring urinary output is not the best answer. Rationale 3: Pushing fluids would exacerbate the problem. Rationale 4: Bethanechol (Urecholine) relaxes the urinary sphincter and increases voiding pressure. It is contraindicated with any physical obstruction of the urinary tract, such as an enlarged prostate gland. Global Rationale: Bethanechol (Urecholine) relaxes the urinary sphincter and increases voiding pressure. It is contraindicated with any physical obstruction of the urinary tract, such as an enlarged prostate gland. Measuring urinary output is inappropriate; the patient should not receive the drug. There should be no need for catheterization as long as the drug is not given. The drug should not be given; pushing fluids would exacerbate the problem. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-7 Describe the nurse’s role in the pharmacologic management of patients receiving drugs affecting the parasympathetic nervous system. MNL Learning Outcome: 2.2.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 135 Question 7 Type: MCSA The preop patient will be receiving glycopyrrolate (Robinul), an anticholinergic drug, and asks the nurse, "Why do I need to have that shot?" What is the best response by the nurse? 1. "It will decrease your respiratory secretions during surgery." 2. "It will increase your urinary output during surgery." 3. "It will help you breathe better during surgery." 4. "It will help maintain your blood pressure during surgery." Correct Answer: 1 Rationale 1: Anticholinergics dry secretions; a decrease in respiratory secretions is indicated prior to surgery. Rationale 2: Anticholinergic drugs do not increase urinary output. Rationale 3: Anticholinergic drugs do not facilitate respirations. Rationale 4: Anticholinergic drugs do not maintain blood pressure. Global Rationale: Anticholinergics dry secretions; a decrease in respiratory secretions is indicated prior to surgery. Anticholinergic drugs do not maintain blood pressure, facilitate respirations, or increase urinary output. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-9 Apply the nursing process to care for patients receiving pharmacotherapy with cholinergic drugs and cholinergic-blocking drugs. MNL Learning Outcome: 2.2.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 137 Question 8 Type: MCSA The nurse is preparing to administer medications to a group of patients. One of the medications is benztropine (Cogentin), an anticholinergic drug. This drug is contraindicated in which patient? 1. The patient with a fractured femur 2. The patient with tachycardia 3. The patient with an irritable colon 4. The patient with diarrhea Correct Answer: 2 Rationale 1: There is no contraindication with a fractured femur and anticholinergic drugs. Rationale 2: Anticholinergic drugs increase the heart rate; a patient with tachycardia should not receive benztropine (Cogentin). Rationale 3: Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with an irritable colon. Rationale 4: Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with diarrhea. Global Rationale: Anticholinergic drugs increase the heart rate; a patient with tachycardia should not receive benztropine (Cogentin). Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with an irritable colon. Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with diarrhea. There is no contraindication with a fractured femur and anticholinergic drugs. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-9 Apply the nursing process to care for patients receiving pharmacotherapy with cholinergic drugs and cholinergic-blocking drugs. MNL Learning Outcome: 2.2.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 137 Question 9 Type: MCSA The nurse is preparing to administer medications to a group of patients. One of the medications is atropine, an anticholinergic drug. This drug is contraindicated in which patient? 1. The patient with glaucoma 2. The patient with hyperthyroidism 3. The patient with a hiatal hernia 4. The patient with lung cancer Correct Answer: 1 Rationale 1: Anticholinergic drugs can increase pressure in the eye; they must be avoided in patients with glaucoma. Rationale 2: Anticholinergic drugs are not contraindicated in patients with hyperthyroidism. Rationale 3: Anticholinergic drugs are not contraindicated in patients with a hiatal hernia. Rationale 4: Anticholinergic drugs are not contraindicated in patients with lung cancer. Global Rationale: Anticholinergic drugs can increase pressure in the eye; they must be avoided in patients with glaucoma. Anticholinergic drugs are not contraindicated in patients with a hiatal hernia. Anticholinergic drugs are not contraindicated in patients with hyperthyroidism. Anticholinergic drugs are not contraindicated in patients with lung cancer. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A. 4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-8 For each of the drug classes listed in Drugs at a Glance, discuss representative drugs and explain their mechanism of action, primary actions, and important adverse effects. MNL Learning Outcome: 2.2.2 Compare the classes of cholinergic agonist drugs. Page Number: 140 Question 10 Type: MCSA The physician orders dicyclomine (Bentyl), an anticholinergic drug, for a patient. What is the nurse's priority assessment prior to administering this drug? 1. Does the patient have light sensitivity? 2. Is the patient able to urinate? 3. Does the patient have a history of alcoholism? 4. Is the patient dizzy upon standing? Correct Answer: 2 Rationale 1: Anticholinergic drugs are not contraindicated in a patient with light sensitivity. Rationale 2: Anticholinergic drugs can cause or increase urinary hesitancy or retention. Rationale 3: Anticholinergic drugs are not contraindicated in a patient with a history of alcoholism. Rationale 4: Anticholinergic drugs are not contraindicated in a patient who is dizzy. Global Rationale: Anticholinergic drugs can cause or increase urinary hesitancy or retention. Anticholinergic drugs are not contraindicated in a patient with light sensitivity. Anticholinergic drugs are not contraindicated in a patient with a history of alcoholism. Anticholinergic drugs are not contraindicated in a patient who is dizzy. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-9 Apply the nursing process to care for patients receiving pharmacotherapy with cholinergic drugs and cholinergic-blocking drugs. MNL Learning Outcome: 2.2.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 140 Question 11 Type: MCSA The patient is quadriplegic and receives oxybutynin (Ditropan), an anticholinergic drug, to increase his bladder capacity. What is an important assessment of this patient by the nurse? 1. Is he irritable? 2. Is he constipated? 3. Is he gaining weight? 4. Is he lethargic? Correct Answer: 2 Rationale 1: Anticholinergic drugs do not cause irritability. Rationale 2: Anticholinergics slow gastrointestinal (GI) motility and can increase the risk for constipation. Rationale 3: Anticholinergic drugs do not cause weight gain. Rationale 4: Anticholinergic drugs do not cause lethargy. Global Rationale: Anticholinergics slow gastrointestinal (GI) motility and can increase the risk for constipation. Anticholinergic drugs do not cause lethargy. Anticholinergic drugs do not cause weight gain. Anticholinergic drugs do not cause irritability. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-9 Apply the nursing process to care for patients receiving pharmacotherapy with cholinergic drugs and cholinergic-blocking drugs. MNL Learning Outcome: 2.2.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 142 Question 12 Type: MCMA The nursing instructor teaches the student nurses about the nervous system. The instructor determines that learning has occurred when the students make which statement(s)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The central nervous system includes the brain and spinal cord." 2. "The peripheral nervous system has mainly sensory functions." 3. "The somatic nervous system gives us voluntary control over our gastrointestinal (GI) tract." 4. "The nervous system helps us react to environmental changes." 5. "The somatic nervous system gives us voluntary control over moving." Correct Answer: 1,4,5 Rationale 1: The central nervous system includes the brain and spinal cord. Rationale 2: The peripheral nervous system has both sensory and motor divisions. Rationale 3: The somatic nervous system gives voluntary control over skeletal muscles. Rationale 4: The nervous system provides reaction to environmental changes. Rationale 5: The somatic nervous system provides voluntary control over moving. Global Rationale: The central nervous system includes the brain and spinal cord. The somatic nervous system provides voluntary control over moving. The nervous system provides reaction to environmental changes. The peripheral nervous system has both sensory and motor divisions. The somatic nervous system gives voluntary control over skeletal muscles. Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 12-1 Identify the basic functions of the nervous system. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 129 Question 13 Type: MCMA The nursing instructor teaches the student nurses about the autonomic nervous system. The instructor determines that learning has occurred when the students make which statement(s)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The sympathetic and parasympathetic systems are not always opposite in their effects." 2. "The parasympathetic nervous system is the "fight-or-flight" response." 3. "Sympathetic stimulation causes dilation of arterioles." 4. "The parasympathetic nervous system causes bronchial constriction." 5. "The sympathetic nervous system is activated under stress." Correct Answer: 1,4,5 Rationale 1: The sympathetic and parasympathetic systems are not always opposite in their effects. Rationale 2: The parasympathetic nervous system is the rest-and-digest response. Rationale 3: Sympathetic stimulation causes constriction of arterioles. Rationale 4: The parasympathetic nervous system causes bronchial constriction. Rationale 5: The sympathetic nervous system is activated under stress. Global Rationale: The parasympathetic nervous system causes bronchial constriction. The sympathetic and parasympathetic systems are not always opposite in their effects. The sympathetic nervous system is activated under stress. The parasympathetic nervous system is the rest-and-digest response. Sympathetic stimulation causes constriction of arterioles. Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 12-3 Compare and contrast the actions of the parasympathetic and sympathetic divisions of the autonomic nervous system. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 130 Question 14 Type: MCSA The student nurse asks the nursing instructor, "Do the medications we are studying actually make more neurotransmitters?" What is the best response by the nursing instructor? 1. "No, but medications can heal diseases of the autonomic nervous system." 2. "Yes, some of the newer medications are very good at doing this." 3. "Yes, but the newer drugs that do this have some serious side effects." 4. "No, medications can only increase or decrease the action of neurotransmitters." Correct Answer: 4 Rationale 1: There are virtually no diseases of the autonomic nervous system to heal. Rationale 2: Even the newest medications cannot manufacture new neurotransmitters. Rationale 3: Medications cannot manufacture new neurotransmitters, even if they have serious side effects. Rationale 4: Medications cannot manufacture new neurotransmitters; they can only increase or decrease their action. Global Rationale: Medications cannot manufacture new neurotransmitters; they can only increase or decrease their action. There are virtually no diseases of the autonomic nervous system to heal. Even the newest medications cannot manufacture new neurotransmitters. Medications cannot manufacture new neurotransmitters, even if they have serious side effects. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-4 Explain how information is transmitted throughout the nervous system and the neurotransmitters important to the parasympathetic nervous system. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 131 Question 15 Type: MCSA The ability of a person to use his arm muscles to lift a weight is primarily regulated by 1. the somatic nervous system. 2. the sympathetic nervous system. 3. the autonomic nervous system. 4. the parasympathetic nervous system. Correct Answer: 1 Rationale 1: The somatic nervous system (a division of the peripheral nervous system) controls voluntary movement such as lifting a weight. Rationale 2: The sympathetic nervous system is a division of the autonomic nervous system. Rationale 3: The autonomic nervous system involves involuntary responses. Rationale 4: The parasympathetic nervous system is a division of the autonomic nervous system. Global Rationale: The somatic nervous system (a division of the peripheral nervous system) controls voluntary movement such as lifting a weight. The autonomic nervous system involves involuntary responses, and is divided into the sympathetic and parasympathetic divisions. Cognitive Level: Remembering Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-3 Compare and contrast the actions of the parasympathetic and sympathetic divisions of the autonomic nervous system. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 129 Question 16 Type: MCSA Which of the following responses are regulated by the sympathetic nervous system? 1. Increased heart rate, bronchial constriction 2. Peripheral artery dilation, reduced peristalsis 3. Increased secretions, sex organ stimulation 4. Relaxation of bladder, pupil dilation Correct Answer: 4 Rationale 1: The sympathetic nervous system increases heart rate, but the parasympathetic system constricts bronchioles. Rationale 2: Parasympathetic innervation dilates peripheral arteries and stimulates digestion. Rationale 3: The sympathetic system inhibits salivation and stimulates sex organs. Rationale 4: Relaxation of the bladder and pupil dilation is regulated by the sympathetic nervous system. Global Rationale: Relaxation of the bladder and pupil dilation are regulated by the sympathetic nervous system.Parasympathetic innervation dilates peripheral arteries and stimulates digestion. The sympathetic nervous system increases heart rate, but the parasympathetic system constricts bronchioles.The sympathetic system inhibits salivation and stimulates sex organs. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 12-3 Compare and contrast the actions of the parasympathetic and sympathetic divisions of the autonomic nervous system. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 130 Question 17 Type: MCSA A person who had her adrenergic receptors activated would experience 1. fight-or-flight effects. 2. rest-and-digest effects. 3. increased blood volume. 4. bronchial constriction. Correct Answer: 1 Rationale 1: Adrenergic receptors are found within the sympathetic nervous system. Sympathetic nervous system activation produces the fight-or-flight response. Rationale 2: Adrenergic receptors are found within the sympathetic nervous system. Parasympathetic nervous system activation produces the rest-and-digest response. Rationale 3: Blood volume increases are not specifically controlled by the nervous system, but distribution of blood is under nervous control. Rationale 4: Adrenergic receptors are found within the sympathetic nervous system. Parasympathetic nervous system activation initiates bronchial constriction. Global Rationale: Adrenergic receptors are found within the sympathetic nervous system. Sympathetic nervous system activation produces the fight-or-flight response.Parasympathetic nervous system activation produces the rest-and-digest response.Blood volume increases are not specifically controlled by the nervous system, but distribution of blood is under nervous control.Parasympathetic nervous system activation initiates bronchial constriction. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-3 Compare and contrast the actions of the parasympathetic and sympathetic divisions of the autonomic nervous system. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 129 Question 18 Type: MCSA Which substance would inhibit the function of the autonomic nervous system? 1. Drugs that bind and then stimulate the postsynaptic neuron 2. Drugs that prohibit neurotransmitter reuptake 3. Drugs that increase neurotransmitter synthesis 4. Drugs that prevent the storage of neurotransmitter in vesicles Correct Answer: 4 Rationale 1: Stimulation of the postsynaptic neuron would enhance function. Rationale 2: Prohibiting neurotransmitter intake would lower the amount available. Rationale 3: Increasing neurotransmitter synthesis would decrease the amount available. Rationale 4: The more neurotransmitter available, the greater the function/stimulation of the autonomic nervous system. Global Rationale: The more neurotransmitter available, the greater the function/stimulation of the autonomic nervous system. Stimulation of the postsynaptic neuron would enhance function. Prohibiting neurotransmitter intake would lower the amount available. Increasing neurotransmitter synthesis would decrease the amount available. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-5 Compare and contrast the types of responses that occur when drugs activate nicotinic or muscarinic receptors. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 133 Question 19 Type: MCSA Which cholinergic receptor type is found at the ganglionic synapse of both the sympathetic and parasympathetic nervous systems? 1. Alpha receptors 2. Muscarinic 3. Nicotinic 4. Beta receptors Correct Answer: 3 Rationale 1: The term alpha is not used for these receptors. Rationale 2: Muscarinic receptors are found at the ganglionic synapse of the parasympathetic nervous system. Rationale 3: Nicotinic receptors are found at the ganglionic synapse of both sympathetic and parasympathetic nervous systems. Rationale 4: The term beta is not used for these receptors. Global Rationale: Nicotinic receptors are found at the ganglionic synapse of both sympathetic and parasympathetic nervous systems.Muscarinic receptors are found at the ganglionic synapse of the parasympathetic nervous system.The terms alpha and beta are not used for these receptors. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-5 Compare and contrast the types of responses that occur when drugs activate nicotinic or muscarinic receptors. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 131 Question 20 Type: MCMA A patient is prescribed an anticholinergic drug. What discharge instructions should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Wear sunglasses in bright light. 2. Limit fluid intake. 3. Increase fiber intake. 4. Avoid hot showers. 5. Avoid milk and dairy products. Correct Answer: 1,3,4 Rationale 1: Anticholinergic drugs may cause photosensitivity. Rationale 2: Fluids should be increased. Rationale 3: Use of anticholinergics increases risk for constipation. Fiber intake should be increased. Rationale 4: Use of anticholinergics reduces ability of patients to sweat and self-regulate temperature. Hot environments, including hot showers and baths, should be avoided. Rationale 5: There is no reason to avoid dairy products. Global Rationale: Anticholinergic drugs may cause photosensitivity.Use of anticholinergics reduces ability of patients to sweat and self-regulate temperature. Hot environments, including hot showers and baths, should be avoided.Use of anticholinergics increases risk for constipation. Fiber and fluid intake should be increased.There is no reason to avoid dairy products. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-9 Apply the nursing process to care for patients receiving pharmacotherapy with cholinergic drugs and cholinergic-blocking drugs. MNL Learning Outcome: 2.2.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 142 Question 21 Type: MCSA Which statement is accurate regarding exogenous acetylcholine? 1. Acetylcholine has almost no therapeutic effects because it is rapidly destroyed once given. 2. Acetylcholine is broken down rapidly within the body, preventing it from producing adverse effects. 3. Acetylcholine will cause the heart rate to increase and blood pressure to drop. 4. When given in small amounts, acetylcholine will produce profound parasympathetic effects. Correct Answer: 1 Rationale 1: Exogenous acetylcholine is not generally administered, because it is rapidly destroyed by the body. Rationale 2: It does produce many adverse effects. Rationale 3: Acetylcholine can lower blood pressure, but it also lowers heart rate. Rationale 4: Exogenous acetylcholine is not generally administered. Global Rationale: Exogenous acetylcholine is not generally administered, because it is rapidly destroyed by the body. It does produce many adverse effects. Acetylcholine can lower blood pressure, but it also lowers heart rate. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-4 Explain how information is transmitted throughout the nervous system and the neurotransmitters important to the parasympathetic nervous system. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 134 Question 22 Type: MCSA The nurse explains that atropine (Atropair) increases heart rate in which manner? 1. Blocking the beta receptors of the parasympathetic nervous system. 2. Directly stimulating the sympathetic nervous system. 3. Potentiating the effects of acetylcholine on nicotinic receptors. 4. Blocking the effects of acetylcholine by occupying muscarinic receptors. Correct Answer: 4 Rationale 1: Atropine occupies muscarinic receptors. Rationale 2: Atropine blocks parasympathetic actions of acetylcholine. Rationale 3: Atropine does not potentiate acetylcholine effects on nicotinic receptors. Rationale 4: Atropine is a cholinergic-blocking agent that occupies muscarinic receptors. Global Rationale: Atropine is a cholinergic-blocking agent that occupies muscarinic receptors. It is classified as an anticholinergic agent because it inhibits the effects of the parasympathetic nervous system, which induces the fight-or-flight responses of the sympathetic nervous system. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A. 4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process:Assessment Learning Outcome: 12-8 For each of the drug classes listed in Drugs at a Glance, discuss representative drugs and explain their mechanism of action, primary actions, and important adverse effects. MNL Learning Outcome: 2.2.2 Compare the classes of cholinergic agonist drugs. Page Number: 140 Question 23 Type: MCMA Which patient situations are considered involuntary responses to autonomic nervous system control? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Sweating when hot 2. Stepping over a chair to prevent falling 3. Complaining of nausea 4. Salivating at the smell of food 5. Breathing deeper when running Correct Answer: 1,4,5 Rationale 1: Sweating is an involuntary response that is controlled by the sympathetic nervous system. Rationale 2: Muscle movement is controlled by the somatic nervous system. Rationale 3: Complaining of nausea is a result of sensory neuron input and is not part of the autonomic system. Rationale 4: Salivation is involuntary and is controlled by the autonomic nervous system. Rationale 5: Breathing deeper when running is controlled by the autonomic nervous system. The act of running is controlled by the somatic nervous system. Global Rationale: Sweating is an involuntary response that is controlled by the sympathetic nervous system.Salivation is involuntary and is controlled by the autonomic nervous system.Breathing deeper when running is controlled by the autonomic nervous system. The act of running is controlled by the somatic nervous system.Muscle movement is controlled by the somatic nervous system.Complaining of nausea is a result of sensory neuron input and is not part of the autonomic system. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-3 Compare and contrast the actions of the parasympathetic and sympathetic divisions of the autonomic nervous system. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 130 Question 24 Type: MCMA A patient has sustained a large blood loss. During the assessment, the nurse realizes that which findings are under the control of the nervous system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Heart rate 2. Blood pressure 3. Pupil size 4. Bowel sounds 5. Fluid volume Correct Answer: 1,2,3,4 Rationale 1: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as heart rate. Rationale 2: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as blood pressure. Rationale 3: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as pupil size. Rationale 4: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as intestinal motility. Rationale 5: Although the brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions, fluid volume is not under the control of the nervous system. Global Rationale: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as heart rate, blood pressure, pupil size, and intestinal motility. Fluid volume is not under the control of the nervous system. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-1 Identify the basic functions of the nervous system. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 130 Question 25 Type: MCMA The nurse is caring for a patient with multisystem organ failure. Which patient assessment findings are under the control of the sympathetic nervous system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Blood glucose level 210 mg/dL 2. Blood pressure 180/90 mmHg 3. Extremities are cool 4. Respiratory rate 14 and regular 5. Hyperactive bowel sounds Correct Answer: 1,2,3 Rationale 1: Metabolic effects such as an increase in blood glucose are a sympathetic nervous system function. Rationale 2: The constriction and relaxation of arterioles are controlled entirely by the sympathetic nervous system. Rationale 3: The sympathetic nervous system controls release of epinephrine and norepinephrine, which result in peripheral vasoconstriction. Rationale 4: The respiratory rate would be faster and deeper when under sympathetic nervous system control. Rationale 5: When under sympathetic nervous system control, peristalsis is temporarily suspended. Global Rationale: Metabolic effects such as an increase in blood glucose are a sympathetic nervous system function.The constriction and relaxation of arterioles is controlled entirely by the sympathetic nervous system. The sympathetic nervous system controls release of epinephrine and norepinephrine, which result in peripheral vasoconstriction.The respiratory rate would be faster and deeper when under sympathetic nervous system control.When under sympathetic nervous system control, peristalsis is temporarily suspended. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-3 Compare and contrast the actions of the parasympathetic and sympathetic divisions of the autonomic nervous system. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 130 Question 26 Type: MCMA A student nurse is learning about a medication that affects the autonomic nervous system. When instructing the student about the effects of this medication, the nurse will begin by explaining the basic unit of this system. What does this include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The preganglionic neuron 2. The postganglionic neuron 3. The synaptic cleft 4. Norepinephrine 5. Dopamine Correct Answer: 1,2,3 Rationale 1: The basic unit of the autonomic nervous system is a two-neuron chain. The first neuron, called the preganglionic neuron, originates in the central nervous system. Rationale 2: The preganglionic neuron connects with the second nerve in the autonomic nervous system two-neuron chain through the ganglia, which contains the postganglionic neuron. Rationale 3: Autonomic messages must cross the synaptic cleft. Rationale 4: Acetylcholine is the neurotransmitter released at cholinergic receptors. Rationale 5: Dopamine is a neurotransmitter within the limbic system and hypothalamus and not the autonomic nervous system. Global Rationale: The basic unit of the autonomic nervous system is a two-neuron chain. The first neuron, called the preganglionic neuron, originates in the central nervous system.The preganglionic neuron connects with the second nerve in the autonomic nervous system two-neuron chain through the ganglia, which contains the postganglionic neuron.Autonomic messages must cross the synaptic cleft.Acetylcholine is the neurotransmitter released at cholinergic receptors.Dopamine is a neurotransmitter within the limbic system and hypothalamus and not the autonomic nervous system. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-4 Explain how information is transmitted throughout the nervous system and the neurotransmitters important to the parasympathetic nervous system. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 131 Question 27 Type: SEQ The nurse educator is reviewing the process of synaptic transmission following the sympathetic pathway. In which order will the nurse explain the steps of synaptic transmission? 1. Action potential encounters adrenergic receptors 2. Action potential encounters cholinergic receptors 3. Action potential travels across the preganglionic neuron 4. Action potential travels across the postganglionic neuron 5. Target tissue is reached. Standard Text: Click and drag the options below to move them up or down. Correct Answer: 3,2,4,1,5 Global Rationale: In the sympathetic pathway, the action potential travels down the preganglionic neuron, encounters cholinergic receptors where is crosses the first ganglionic synapse, travels down the postganglionic neuron, encounters adrenergic receptors, and the reaches target tissues. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-4 Explain how information is transmitted throughout the nervous system and the neurotransmitters important to the parasympathetic nervous system. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 132 Question 28 Type: MCMA A patient is prescribed a medication that will block muscarinic receptors. The nurse realizes that this medication has implications for which body systems? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Eyes 2. Respiratory 3. Cardiac 4. Endocrine 5. Metabolic Correct Answer: 1,2,3 Rationale 1: Medications that block muscarinic receptors are used during ophthalmic procedures. Rationale 2: Medications that block muscarinic receptors are used in the pharmacologic treatment of asthma. Rationale 3: Medications that block muscarinic receptors are used in the pharmacologic treatment of bradycardia. Rationale 4: Medications that block muscarinic receptors are not used in the treatment of endocrine disorders. Rationale 5: Medications that block muscarinic receptors are not used in the treatment of metabolic disorders. Global Rationale: Medications that block muscarinic receptors are used during ophthalmic procedures, treatment of asthma, and to increase heart rate. They are not used in endocrine or metabolic disorders. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-5 Compare and contrast the types of responses that occur when drugs activate nicotinic or muscarinic receptors. MNL Learning Outcome: 2.2.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 136 Question 29 Type: MCMA A patient has been prescribed scopolamine (Transderm-Scop) for the prevention of motion sickness. The nurse should teach the patient to immediately report which adverse effects? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Slow heart rate 2. Cardiac palpitations 3. Decreased urinary output 4. Development of tremors 5. Diarrhea Correct Answer: 2,3,4 Rationale 1: Tachycardia is the adverse effect associated with scopolamine (Transderm-Scop). Rationale 2: Dysrhythmia is an adverse effect of this drug. Rationale 3: Decreased urinary output is an adverse effect of this drug. Rationale 4: Tremors are an adverse effect of this drug. Rationale 5: Diarrhea is not an expected adverse effect of this drug. Global Rationale: Dysrhythmia, decreased urinary output, and tremors are adverse effects of scopolamine (Transderm-Scop).Tachycardia is the adverse effect associated with scopolamine (Transderm-Scop).Diarrhea is not an expected adverse effect of this drug. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-9 Apply the nursing process to care for patients receiving pharmacotherapy with cholinergic drugs and cholinergic-blocking drugs. MNL Learning Outcome: 2.2.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 141 Question 30 Type: MCMA A patient who has myasthenia gravis (MG) presents to the emergency department with abrupt onset of increased muscle weakness and difficulty swallowing. An attempt to distinguish worsening of the MG symptoms from overdose of the patient’s prescribed anticholinergic is planned. What medications should the nurse obtain for use in this procedure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Donepezil (Aricept) 2. Pyridostigmine (Mestinon) 3. Neostigmine (Prostigmin) 4. Edrophonium (Edrophonium Injectable) 5. Atropine (Atropine Injectable) Correct Answer: 4,5 Rationale 1: Donepezil (Aricept) is prescribed for the treatment of Alzheimer’s disease and would not be used in this situation. Rationale 2: Pyridostigmine (Mestinon) is prescribed for the treatment of MG but would not be used to determine if this patient is having increased symptoms or excessive medication. Rationale 3: Neostigmine (Prostigmin) is prescribed for the treatment of MG but would not be used to determine if this patient is having increased symptoms or excessive medication. Rationale 4: Edrophonium (Edrophonium Injectable) is given as a test dose. If muscular symptoms improve, the patient is having a myasthenic crisis. Rationale 5:Atropine (Atropine Injectable) is given if the test results in a cholinergic crisis. Global Rationale: Edrophonium (Edrophonium Injectable) is given as a test dose. If muscular symptoms improve, the patient is having a myasthenic crisis.Atropine (Atropine Injectable) is given if the test results in a cholinergic crisis.Donepezil (Aricept) is prescribed for the treatment of Alzheimer’s disease and would not be used in this situation.Pyridostigmine (Mestinon) is prescribed for the treatment of MG but would not be used to determine if this patient is having increased symptoms or excessive medication.Neostigmine (Prostigmin) is prescribed for the treatment of MG but would not be used to determine if this patient is having increased symptoms or excessive medication. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-7 Describe the nurse’s role in the pharmacologic management of patients receiving drugs affecting the parasympathetic nervous system. MNL Learning Outcome: 2.2.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 135 Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E Chapter 13 Question 1 Type: MCSA The patient receives methyldopa (Aldomet), an adrenergic drug. The nurse determines that the patient is having side effects when the patient makes which statement? 1. "Will you check my pupils? I can't see very well at all." 2. "I am so thirsty; will you please bring me another pitcher of water?" 3. "I am so anxious; I really need to walk around the room." 4. "I feel so sleepy that I don't think I can eat my dinner." Correct Answer: 3 Rationale 1: Adrenergic drugs dilate the pupils, so vision should not be affected. Rationale 2: Anticholinergic, not adrenergic, drugs dry secretions, therefore the patient would not be thirsty. Rationale 3: Adrenergic drugs mimic the effect of the sympathetic nervous system (SNS). This can result in anxiety and restlessness. Rationale 4: Adrenergic drugs increase alertness, so the patient would not be sleepy. Global Rationale: Adrenergic drugs mimic the effect of the sympathetic nervous system (SNS). This can result in anxiety and restlessness. Adrenergic drugs increase alertness, so the patient would not be sleepy. Anticholinergic, not adrenergic, drugs dry secretions, therefore the patient would not be thirsty. Adrenergic drugs dilate the pupils, so vision should not be affected. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs and adrenergic-blocking drugs. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 153 Question 2 Type: MCSA The patient receives metaproterenol (Alupent), an adrenergic drug. A consulting physician orders carteolol (Cartrol), a beta blocker. What best describes the nurse's assessment? 1. The patient is at risk for a hypertensive crisis. 2. The effects of metaproterenol (Alupent) will be decreased. 3. The drugs are compatible; there will not be any adverse effects. 4. The effects of metaproterenol (Alupent) will be increased. Correct Answer: 2 Rationale 1: A hypertensive crisis is unlikely. Rationale 2: Beta-adrenergic blockers block the receptors that are stimulated by adrenergic drugs; the effects of metaproterenol (Alupent) would be decreased. Rationale 3: The drugs are not compatible. Rationale 4: The effects of metaproterenol (Alupent) would not be increased. Global Rationale: Beta-adrenergic blockers block the receptors that are stimulated by adrenergic drugs; the effects of metaproterenol (Alupent) would be decreased, not increased. The drugs are not compatible; the effects of metaproterenol (Alupent) would be decreased. A hypertensive crisis is unlikely. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-1 Compare and contrast the types of responses that occur when drugs activate alpha1-, alpha2-, beta1-, beta2-, or beta3- adrenergic receptors. MNL Learning Outcome: 2.1.2 Compare the classes of adrenergic agonist drugs. Page Number: 153 Question 3 Type: MCSA The nurse has been doing medication education for the patient receiving atenolol (Tenormin), a beta blocker. The nurse determines that learning has occurred when the patient makes which statement? 1. "I need to take my pulse every day." 2. "If I have any side effects, I will stop the medication." 3. "I cannot take this drug if I develop glaucoma." 4. "I cannot continue to have my morning cup of coffee." Correct Answer: 1 Rationale 1: Beta blockers slow the heart rate; therefore, the patient must monitor his pulse every day. Rationale 2: Beta blockers should not be stopped suddenly. Rationale 3: Adrenergic blockers, not beta blockers, are used to treat glaucoma. Rationale 4: Caffeine is not prohibited with beta blockers. Global Rationale: Beta blockers slow the heart rate; therefore, the patient must monitor his pulse every day. Beta blockers should not be stopped suddenly. Caffeine is not prohibited with beta blockers. Adrenergic blockers, not beta blockers, are used to treat glaucoma. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs and adrenergic-blocking drugs. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 157 Question 4 Type: MCSA The physician ordered prazosin (Minipress), an alpha-adrenergic blocker, for the patient. The nurse plans to do medication education. What will the best plan of the nurse include? 1. Instruct the patient to not take OTC herbal preparations containing saw palmetto. 2. Instruct the patient to not take tub baths. 3. Instruct the patient to decrease his intake of sodium. 4. Instruct the patient to wear sunglasses when outdoors. Correct Answer: 1 Rationale 1: A hypotensive response may occur when saw palmetto is taken concurrently. Rationale 2: Patients should be careful when taking tub baths, especially if the drug causes dizziness, but such baths are not prohibited. Rationale 3: There is no relationship between alpha blockers and sodium intake. Rationale 4: Alpha blockers do not cause photophobia; sunglasses are not required with this drug. Global Rationale: A hypotensive response may occur when saw palmetto is taken concurrently. Patients should be careful when taking tub baths, especially if the drug causes dizziness, but such baths are not prohibited. Alpha blockers do not cause photophobia; sunglasses are not required with this drug. There is no relationship between alpha blockers and sodium intake. It is a good idea to avoid herbal preparations, but this is not the primary plan. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs and adrenergic-blocking drugs. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 156 Question 5 Type: MCMA A patient has been prescribed an alpha1 adrenergic agonist drug. The nurse would plan to monitor for effects from which organs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Kidneys 2. Eyes 3. Heart 4. Bowels 5. Lungs Correct Answer: 1,2,4,5 Rationale 1: Alpha1 receptors have potential to affect the renal system. Rationale 2: Alpha1 receptors result in dilation of the pupils. Rationale 3: Alpha1 receptors do not affect receptors in the heart. Rationale 4: Alpha1 receptors have potential to affect receptors in the gastrointestinal tract. Rationale 5:Alpha1 receptors have potential to affect receptors in the respiratory system. Global Rationale:Alpha1 receptors do not affect receptors in the heart. Alpha1 receptors have potential to affect the renal, gastrointestinal, and respiratory systems. Alpha1 receptors result in dilation of the pupils. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 13-1 Compare and contrast the types of responses that occur when drugs activate alpha1-, alpha2-, beta1-, beta2-, or beta3- adrenergic receptors. MNL Learning Outcome: 2.1.2 Compare the classes of adrenergic agonist drugs. Page Number: 147 Question 6 Type: MCSA A patient is prescribed a drug that activates alpha2 receptors. The nurse would plan care based on which physiological response? 1. Inhibition of norepinephrine release 2. Absence of monoamine oxidase 3. Increased lipolysis 4. Destruction of presynaptic nerve terminals Correct Answer: 1 Rationale 1: The action of alpha2 receptors is to inhibit release of norepinephrine. Rationale 2: Alpha2 receptors do not destroy monoamine oxidase. Rationale 3: Alpha2 receptors do not increase lipolysis. Rationale 4: Alpha2 receptors do not destroy presynaptic nerve terminals. Global Rationale:The action of alpha2 receptors is to inhibit release of norepinephrine.Alpha2 receptors do not increase lipolysis or destroy monoamine oxidase or presynaptic nerve terminals. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 13-1 Compare and contrast the types of responses that occur when drugs activate alpha1-, alpha2-, beta1-, beta2-, or beta3- adrenergic receptors. MNL Learning Outcome: 2.2.2 Compare the classes of cholinergic agonist drugs. Page Number: 147 Question 7 Type: MCMA A nurse is reviewing medical records for usage of drugs that are beta2 agonists. The nurse should start with the medical records of patients with which conditions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Heart failure 2. Asthma 3. COPD 4. Overactive bladder 5. Nasal congestion Correct Answer: 2,3 Rationale 1: Beta1 agonists are most likely to be given to patients with heart failure. Rationale 2: Beta2 agonists are useful in the treatment of asthma. Rationale 3: Beta2 agonists are useful in the treatment of COPD. Rationale 4: Beta3 agonists are most likely to be given to patients with overactive bladder. Rationale 5:Alpha1 agonists are most likely to be given to patients with nasal congestion. Global Rationale:Beta2 agonists are useful in the treatment of asthma and COPD. Beta1 agonists are most likely to be given to patients with heart failure.Beta2 agonists are useful in the treatment of asthma.Alpha1 agonists are most likely to be given to patients with nasal congestion. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 13-1 Compare and contrast the types of responses that occur when drugs activate alpha1-, alpha2-, beta1-, beta2-, or beta3- adrenergic receptors. MNL Learning Outcome: 2.1.2 Compare the classes of adrenergic agonist drugs. Page Number: 148 Question 8 Type: SEQ Place these substances in the correct order of synthesis of catecholamines. 1. Norepinephrine 2. Tyrosine 3. Dopamine 4. Epinephrine 5. L-dopa Standard Text: Click and drag the options below to move them up or down. Correct Answer: 2,5,3,1,4 Global Rationale: The synthesis begins with tyrosine then moves to L-dopa, dopamine, norepinephrine, and ends with the synthesis of epinephrine. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-2 Discuss the classification and naming of adrenergic drugs. MNL Learning Outcome: 2.1.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 148 Question 9 Type: MCMA A patient who is in heart failure is administered a beta1 agonist. The nurse would evaluate that the drug is effective if which changes occur? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Heart rate increases 2. Pulse becomes stronger 3. Pupils dilate 4. Dysrhythmias dissipate 5. Blood pressure drops Correct Answer: 1,2 Rationale 1: One of the effects of beta1 agonists is to increase the heart rate. Rationale 2: One of the effects of beta1 agonists is to increase force of cardiac contraction, which would be felt as a stronger pulse. Rationale 3: Pupil dilation is an effect of alpha1 drugs. Rationale 4: Beta1 antagonists are given to control dysrhythmias. Rationale 5:Beta1 antagonists are given to control hypertension. Global Rationale:The effects of beta1 agonists are to increase the heart rate and the force of cardiac contraction.Pupil dilation is an effect of alpha1 drugs.Beta1 antagonists are given to control dysrhythmias and hypertension. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluate Learning Outcome: 13-1 Compare and contrast the types of responses that occur when drugs activate alpha1-, alpha2-, beta1-, beta2-, or beta3- adrenergic receptors. MNL Learning Outcome: 2.1.2 Compare the classes of adrenergic agonist drugs. Page Number: 148 Question 10 Type: MCMA A patient has been prescribed isoproterenol (Isuprel). The nurse plans care based on the drug’s stimulation of which receptors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Alpha1 2. Alpha2 3. Beta1 4. Beta2 5. Beta3 Correct Answer: 3,4 Rationale 1: This drug does not affect alpha1 receptors. Rationale 2: This drug does not affect alpha2 receptors. Rationale 3: Isoproterenol (Isuprel) is a nonselective drug that stimulates beta1 receptors. Rationale 4: Isoproterenol (Isuprel) is a nonselective drug that stimulates beta2 receptors. Rationale 5:This drug does not affect beta3 receptors. Global Rationale:Isoproterenol (Isuprel) is a nonselective drug that stimulates beta1 and beta2 receptors.This drug does not affect alpha1, alpha2, or beta3receptors. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 13-1 Compare and contrast the types of responses that occur when drugs activate alpha1-, alpha2-, beta1-, beta2-, or beta3- adrenergic receptors. MNL Learning Outcome: 2.1.2 Compare the classes of adrenergic agonist drugs. Page Number: 150 Question 11 Type: Hot Spot The nurse is providing discharge medication instruction to the family of a child who is severely allergic to peanuts. Mark the spot where the family or patient should inject epinephrine from an EpiPen should an allergic response occur. 1. A 2. B 3. C 4. D Answer: 4 Rationale: This drug should be injected into the thigh only. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-3 Describe the nurse’s role in the pharmacologic management of patients receiving drugs affecting the sympathetic nervous system. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 151 Question 12 Type: MCMA A nurse is providing discharge medication instruction regarding use of injectable epinephrine (EpiPen). What information should the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. If you need to use this pen, seek medical advice as follow-up. 2. You can dispose of a used EpiPen in your regular trash. 3. Keep an extra EpiPen on hand. 4. Store this device in your refrigerator. 5. Carry an EpiPen in your car’s glovebox. Correct Answer: 1,3 Rationale 1:If it is necessary to use the EpiPen, it is important to seek immediate follow-up by calling 911 or the provider. Rationale 2: The used EpiPen should be taken to an emergency department or the provider’s office for disposal. Rationale 3: It is recommended that the patient have an extra EpiPen on hand in case of emergency or failure of the original unit. Rationale 4: It is not necessary to refrigerate the EpiPen. Rationale 5: The EpiPen should be kept in a cool, dark place. The glovebox of a car becomes too hot. Global Rationale:If it is necessary to use the EpiPen, it is important to seek immediate follow-up by calling 911 or the provider.It is recommended that the patient have an extra EpiPen on hand in case of emergency or failure of the original unit.The used EpiPen should be taken to an emergency department or the provider’s office for disposal.The EpiPen should be kept in a cool, dark place. The glovebox of a car becomes too hot. It is not necessary to refrigerate the EpiPen. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-3 Describe the nurse’s role in the pharmacologic management of patients receiving drugs affecting the sympathetic nervous system. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 151 Question 13 Type: MCMA A patient has been prescribed phenylephrine (Neo-Synephrine) spray for nasal congestion. What information about adverse effects should the nurse provide in discharge teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “This drug may cause some stinging or burning in your nose.” 2. “You may notice that your nasal secretions take on a slightly orange tint.” 3. “You may feel like your blood pressure is low for the first few times you use this spray.” 4. “One of the major adverse effects of this drug is rebound congestion if it is used more than a few days.” 5. “Do not drink herbal teas while taking this medication.” Correct Answer: 1,4 Rationale 1: Intranasal use of this drug can cause burning of the mucosa. Rationale 2: There is no indication that orange-tinted nasal secretions should be expected. Rationale 3: Intranasal medications, if used properly, should have little or no effect on blood pressure. Rationale 4: Rebound congestion is likely to occur if the drug is used for over 3–5 days. Rationale 5: There are no known drug–herbal interactions with this drug. Global Rationale:Intranasal use of this drug can cause burning of the mucosa.Rebound congestion is likely to occur if the drug is used for over 3–5 days.There is no indication that orange-tinted nasal secretions should be expected.Intranasal medications, if used properly, should have little or no effect on blood pressure.There are no known drug–herbal interactions with this drug. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-4 For each of the drug classes listed in Drugs at a Glance, know representative drugs and explain their mechanism of action, primary actions, and important adverse effects. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 152 Question 14 Type: MCMA The nurse is preparing to administer an adrenergic drug intravenously. What nursing actions should be planned? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Give the drug as rapidly as possible by intravenous push. 2. Dilute the drug before administration. 3. Use an infusion pump to control rate of administration. 4. Monitor for blanching at the infusion site. 5. Advise the patient that a sweet taste may occur as the drug is being given. Correct Answer: 2,3,4 Rationale 1: These drugs should be administered slowly. Rationale 2: These drugs should be diluted prior to administration. Rationale 3: Infusion of these drugs should be controlled via an infusion pump. Rationale 4: Blanching at the infusion site indicates probable extravasation. The drip should be stopped. Rationale 5: There is no evidence that a sweet taste will occur. Global Rationale:These drugs should be diluted prior to administration.Infusion of these drugs should be controlled via an infusion pump.Blanching at the infusion site indicates probable extravasation. The drip should be stopped.These drugs should be administered slowly.There is no evidence that a sweet taste will occur. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-3 Describe the nurse’s role in the pharmacologic management of patients receiving drugs affecting the sympathetic nervous system. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 153 Question 15 Type: MCMA A patient has been prescribed phenylephrine (Neo-Synephrine). Prior to administering this drug the nurse would review the patient’s medication history for presence of which drugs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. MAO inhibitors 2. Tricyclic antidepressants 3. Iron supplements 4. Digoxin 5. Aspirin Correct Answer: 1,2,3,4 Rationale 1: Concurrent use with MAO inhibitors may result in hypertensive crisis. Rationale 2: Tricyclic antidepressants can potentiate the effects ofphenylephrine (Neo-Synephrine). Rationale 3: Iron supplements are incompatible withphenylephrine (Neo-Synephrine). Rationale 4: Dysrhythmias may occur when phenylephrine (Neo-Synephrine) and digoxin are used concurrently. Rationale 5: There is no incompatibility with aspirin. Global Rationale:Concurrent use with MAO inhibitors may result in hypertensive crisis.Tricyclic antidepressants can potentiate the effects ofphenylephrine (Neo-Synephrine).Iron supplements are incompatible withphenylephrine (Neo-Synephrine).Dysrhythmias may occur when phenylephrine (Neo-Synephrine) and digoxin are used concurrently.There is no incompatibility with aspirin. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-4 For each of the drug classes listed in Drugs at a Glance, know representative drugs and explain their mechanism of action, primary actions, and important adverse effects. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 152 Question 16 Type: MCMA A patient who was recently prescribed an adrenergic drug says, “I am so nervous and I cannot sleep.” The nurse would ask which questions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “How much coffee do you drink?” 2. “Have you recently increased your intake of dairy products?” 3. “Do you eat chocolate?” 4. “When was the last time you ate pickled foods or aged cheese?” 5. “How much wine or other alcoholic beverages do you drink?” Correct Answer: 1,3 Rationale 1: The caffeine in coffee may cause excessive nervousness, insomnia, and tremors. Rationale 2: There should be no drug-food interaction with dairy products. Rationale 3: The caffeine in chocolate may cause excessive nervousness, insomnia, and tremors. Rationale 4: There should be no drug-food interaction with pickled foods or aged cheese. Rationale 5: There should be no drug-food interaction with beverages that contain alcohol. Global Rationale:The caffeine in coffee or chocolate may cause excessive nervousness, insomnia, and tremors.There should be no drug-food interaction with dairy products, pickled foods, aged cheese, or beverages containing alcohol. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs and adrenergic-blocking drugs. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 153 Question 17 Type: MCMA A patient who has used an adrenergic nasal spray for 2 weeks complains that, “I am more stuffed up now than I was when I was sick.” What advise should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “You are having an allergic reaction to the nasal spray. Stop using it immediately.” 2. “You probably have developed a secondary infection.” 3. “Try increasing the amount of fluids you are drinking.” 4. “Switch to a saline-based nasal spray.” 5. “Continue to use your current nasal spray until the congestion goes away.” Correct Answer: 3,4 Rationale 1: There is no evidence that an allergic reaction has occurred. Rationale 2: There is no evidence that a secondary infection has occurred. Rationale 3: Increased oral fluids may help to thin secretions, making them easier to remove. Rationale 4: The patient is probably experiencing rebound congestion. Switching from the adrenergic spray to a saline spray will keep the mucosa moist and more comfortable until the effects of the adrenergic spray abate. Rationale 5: The patient is probably experience rebound congestion. Continuing to use this spray is contraindicated. Global Rationale:The patient is probably experiencing rebound congestion. Switching from the adrenergic spray to a saline spray will keep the mucosa moist and more comfortable until the effects of the adrenergic spray abate.Increased oral fluids may help to thin secretions, making them easier to remove.There is no evidence that an allergic reaction or secondary infection has occurred.Continuing to use this spray is contraindicated. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs and adrenergic-blocking drugs. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 154 Question 18 Type: MCMA An older adult patient received an adrenergic eye drop to dilate the pupils for a retinal exam. What information should the nurse provide when discharging this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Do not drive until the effects of the eye drops have worn off.” 2. “Wear sunglasses when in bright light.” 3. “You may be more comfortable in a darkened room.” 4. “You may experience burning in your eyes for a couple of days.” 5. “Do not eat or drink anything for at least an hour after discharge.” Correct Answer: 1,2,3 Rationale 1: Older adults may notice blurring of vision after receiving drops to dilate the eyes. The patient should not drive until vision is clear. Rationale 2: Photosensitivity is a common effect, and protective eyewear should be worn. Rationale 3: Photosensitivity is a common effect, and the patient may be more comfortable in a darkened room or with a soft cloth covering the eyes. Rationale 4: The burning associated with these drops should be transient. It should not last for “a couple of days.” Rationale 5: There is no reason for the patient to be NPO. Global Rationale:Older adults may notice blurring of vision after receiving drops to dilate the eyes. The patient should not drive until vision is clear.Photosensitivity is a common effect, and the patient may be more comfortable in a darkened room or with a soft cloth covering the eyes. Protective eyewear should be worn in bright light. The burning associated with these drops should be transient. It should not last for “a couple of days.”There is no reason for the patient to be NPO. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs and adrenergic-blocking drugs. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 154 Question 19 Type: MCMA A patient has been prescribed an adrenergic nasal spray. What medication instruction should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Do not share this spray with anyone.” 2. “Sit upright while using this spray.” 3. “Only use this spray for 3–5 days.” 4. “Do not shake the bottle before using this spray.” 5. “Keep this spray refrigerated.” Correct Answer: 1,2,3 Rationale 1: Sharing nasal sprays may spread infection. Rationale 2: The patient should sit upright to use this medication so that it is delivered appropriately, avoiding overdosage. Rationale 3: Adrenergic nasal sprays may cause rebound congestion if used more that 3–5 days. Rationale 4: There is no indication that the bottle should not be shaken. Rationale 5: There is no indication that the medication should be refrigerated. Global Rationale:Sharing nasal sprays may spread infection.The patient should sit upright to use this medication so that it is delivered appropriately, avoiding overdosage.Adrenergic nasal sprays may cause rebound congestion if used more that 3–5 days.There is no indication that the bottle should not be shaken.There is no indication that the medication should be refrigerated. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs and adrenergic-blocking drugs. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 154 Question 20 Type: MCSA Which statement is accurate concerning drugs classified as adrenergic antagonists? 1. They are also known as anticholinergics. 2. Their actions will block the neurotransmitter acetylcholine. 3. Their actions are the opposite of those of sympathomimetics. 4. They will stimulate the sympathetic nervous system. Correct Answer: 3 Rationale 1: They are also known as sympatholytics. Rationale 2: They block adrenergic receptors, not cholinergic receptors. Rationale 3: Adrenergic antagonists inhibit the actions of the sympathetic nervous system. Rationale 4: Adrenergic antagonists inhibit the actions of the sympathetic nervous system. Global Rationale: Adrenergic antagonists inhibit the actions of the sympathetic nervous system. They are also known as sympatholytics. They block adrenergic receptors, not cholinergic receptors. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 13-2 Discuss the classification and naming of adrenergic drugs. MNL Learning Outcome: 2.1.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 147 Question 21 Type: MCMA During assessment a patient says, “I took my blood pressure at home and it was high. I have been taking my husband’s propranolol (Inderal) for the last week.” The nurse is especially concerned about this action when it is noted that the patient has which preexisting conditions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Obesity 2. Diabetes mellitus 3. COPD 4. Asthma 5. Rheumatoid arthritis Correct Answer: 2,3,4 Rationale 1: While obesity may be contributing to the patient’s hypertension, use of propranolol (Inderal) is not contraindicated. Rationale 2: Beta blockers may cause hyperglycemia or hypoglycemia and may mask the symptoms of hypoglycemia in patients with diabetes. Rationale 3: Beta blockers may cause significant bronchial constriction. Rationale 4: Beta blockers may cause significant bronchial constriction. Rationale 5: Beta blockers are not contraindicated for use in patients with rheumatoid arthritis. Global Rationale:Beta blockers may cause hyperglycemia or hypoglycemia and may mask the symptoms of hypoglycemia in patients with diabetes.Beta blockers may cause significant bronchial constriction.While obesity may be contributing to the patient’s hypertension, use of propranolol (Inderal) is not contraindicated. Beta blockers are not contraindicated for use in patients with rheumatoid arthritis. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-3 Describe the nurse’s role in the pharmacologic management of patients receiving drugs affecting the sympathetic nervous system. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 155 Question 22 Type: MCMA A patient states, “I stopped taking that beta blocker last week. It made me so tired, I just couldn’t go on taking it.” What are the priority nursing assessments? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Blood pressure 2. Heart rhythm 3. Urinary output 4. Presence of chest pain 5. Presence of respiratory crackles Correct Answer: 1,2,4 Rationale 1: Abruptly discontinuing beta blockers may result in acute resurgence of symptoms such as hypertension. Rationale 2: Abruptly discontinuing beta blockers may result in acute resurgence of symptoms such as dysrhythmia. Rationale 3: Abruptly discontinuing beta blockers should not have an immediate effect on urinary output. Rationale 4: Abruptly discontinuing beta blockers may result in chest pain. Rationale 5:Abruptly discontinuing beta blockers should not result in pulmonary complications. Global Rationale:Abruptly discontinuing beta blockers may result in acute resurgence of symptoms such as hypertension, dysrhythmia, and the development of chest pain. Abruptly discontinuing beta blockers should not have an immediate effect on urinary output and should not result in pulmonary complications. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-3 Describe the nurse’s role in the pharmacologic management of patients receiving drugs affecting the sympathetic nervous system. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 155 Question 23 Type: MCMA A patient has been prescribed prazosin (Minipress). What information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Stay out of the sun until you determine if you become sun-sensitive.” 2. “Take this medication just before you go to bed.” 3. “This medication may make you dizzy.” 4. “This medication may slow your heart rate noticeably.” 5. “Do not take this medication with milk.” Correct Answer: 2,3 Rationale 1: There is no indication that this medication will make the patient sensitive to the sun. Rationale 2: This medication should be taken just before bedtime as it may cause drowsiness or light-headedness. Rationale 3: Dizziness is a common adverse effect of this drug. Rationale 4: Tachycardia is the expected adverse effect. Rationale 5: There is no reason to avoid milk when taking this drug. Global Rationale:This medication should be taken just before bedtime as it may cause drowsiness or light-headedness.Dizziness is a common adverse effect of this drug.There is no indication that this medication will make the patient sensitive to the sun.Tachycardia is the expected adverse effect.There is no reason to avoid milk when taking this drug. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-4 For each of the drug classes listed in Drugs at a Glance, know representative drugs and explain their mechanism of action, primary actions, and important adverse effects. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 156 Question 24 Type: MCMA A patient who was administered prazosin (Minipress) became unconscious 30 minutes after the first dose. What medications should the nurse prepare for resuscitation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Normal saline 2. Dobutamine 3. Atenolol (Tenormin) 4. Carvedilol (Coreg) 5. Propranolol (Inderal) Correct Answer: 1,2 Rationale 1: Unconsciousness after the first dose of prazosin (Minipress) is typically due to severe hypotension. Normal saline can be used as a volume expander. Rationale 2: Unconsciousness after the first dose of prazosin (Minipress) is typically due to severe hypotension. Treatment with a vasopressor such as dobutamine may be indicated. Rationale 3: Atenolol (Tenormin) is an adrenergic blocker and would exacerbate the problem. Rationale 4: Carvedilol (Coreg) is an adrenergic blocker and would exacerbate the problem. Rationale 5:Propranolol (Inderal) is an adrenergic blocker and would exacerbate the problem. Global Rationale:Unconsciousness after the first dose of prazosin (Minipress) is typically due to severe hypotension. Normal saline can be used as a volume expander. Treatment with a vasopressor such as dobutamine may be indicated. Atenolol (Tenormin), carvedilol (Coreg), and propranolol (Inderal) are adrenergic blockers and would exacerbate the problem. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 13-3 Describe the nurse’s role in the pharmacologic management of patients receiving drugs affecting the sympathetic nervous system. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 155 Question 25 Type: MCMA A patient has been prescribed an adrenergic-blocker for treatment of hypertension. What information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Rise from a sitting position slowly.” 2. “Sit on the side of the bed a few moments before you stand.” 3. “If you feel dizzy, add more salt to your diet.” 4. “If you feel dizzy, sit or lie down until the dizziness passes.” 5. “Try to continue daily activities even if dizziness occurs.” Correct Answer: 1,2,4 Rationale 1: Patients who are starting on adrenergic-blocking drugs should move slowly from the sitting position. Rationale 2: Sitting on the side of the bed will help blood pressure normalize before standing. Rationale 3: Additional salt is not indicated for people who have hypertension. Rationale 4: If the patient feels dizzy, sitting down or lying down will help to prevent falls. Rationale 5: The patient should monitor dizziness and should take safety precautions until acclimated to the medication. Global Rationale:Patients who are starting on adrenergic-blocking drugs should move slowly from the sitting position.Sitting on the side of the bed will help blood pressure normalize before standing.If the patient feels dizzy, sitting down or lying down will help to prevent falls.Additional salt is not indicated for people who have hypertension.The patient should monitor dizziness and should take safety precautions until acclimated to the medication. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs and adrenergic-blocking drugs. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 157 Question 26 Type: MCMA A patient returns to the clinic for follow-up after taking an adrenergic blocking medication for benign prostatic hypertrophy (BPH.) What assessment questions should the nurse ask? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “What color is your urine?” 2. “Do you have any difficulty starting to urinate?” 3. “Do you have the feeling that your bladder is full?” 4. “When was your last bowel movement?” 5. “Have you noticed being more hungry than usual?” Correct Answer: 2,3 Rationale 1: Adrenergic blockers do not change the color of the urine. Rationale 2: Adrenergic blockers may result in hesitancy. Rationale 3: Adrenergic blockers may result in retention of urine. Rationale 4: Questions about time of last BM are not indicated. Rationale 5: Adrenergic blockers do not affect appetite. Global Rationale:Adrenergic blockers may result in hesitancy or urinary retention.Adrenergic blockers do not change the color of the urine.Questions about time of last BM are not indicated.Adrenergic blockers do not affect appetite. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-5 Use the nursing process to care for patients receiving adrenergic drugs and adrenergic-blocking drugs. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 157 Question 27 Type: MCMA The nurse would classify which sympathomimetics as binding to and activating adrenergic receptors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Epinephrine 2. Dopamine 3. Amphetamine 4. Cocaine 5. Ephedrine Correct Answer: 1,2,5 Rationale 1: Epinephrine is an endogenous catecholamine that acts directly by binding to and activating adrenergic receptors. Rationale 2: Dopamine is an endogenous catecholamine that acts directly by binding to and activating adrenergic receptors. Rationale 3: Amphetamine acts indirectly by affecting norepinephrine release. Rationale 4: Cocaine acts indirectly by affecting norepinephrine release. Rationale 5: Ephedrine acts both directly and indirectly. Global Rationale:Epinephrine and dopamine are endogenous catecholamines that act directly by binding to and activating adrenergic receptors.Amphetamine and cocaine act indirectly by affecting norepinephrine release.Ephedrine acts both directly and indirectly. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-2 Discuss the classification and naming of adrenergic drugs. MNL Learning Outcome: 2.1.1 Examine the neuropharmacology of the autonomic nervous system. Page Number: 150 Question 28 Type: MCMA A patient is being assessed for the presence of pheochromocytoma. The nurse would prepare for which interventions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Monitoring blood pressure 2. Monitoring bowel sounds 3. Administration of phentolamine (Regitine) 4. Rapid administration of normal saline 5. Urinary catheterization to bypass prostatic enlargement Correct Answer: 1,3 Rationale 1: Pheochromocytoma affects blood pressure, so continuous monitoring is necessary. Rationale 2: While monitoring bowel sounds is part of all ongoing assessment, it is not particular to pheochromocytoma. Rationale 3: Sudden and marked reduction of blood pressure results when a patient with pheochromocytoma is administered phentolamine (Regitine) parenterally. Rationale 4: Rapid administration of normal saline is treatment for hypotension. This patient will be hypertensive. Rationale 5: A urinary catheter may be inserted, but this is not because of prostatic enlargement. Global Rationale:Pheochromocytoma affects blood pressure, so continuous monitoring is necessary.Sudden and marked reduction of blood pressure results when a patient with pheochromocytoma is administered phentolamine (Regitine) parenterally.While monitoring bowel sounds is part of all ongoing assessment, it is not particular to pheochromocytoma.Rapid administration of normal saline is treatment for hypotension. This patient will be hypertensive. A urinary catheter may be inserted, but this is not because of prostatic enlargement. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13-3 Describe the nurse’s role in the pharmacologic management of patients receiving drugs affecting the sympathetic nervous system. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 149 Question 29 Type: MCMA Due to an administration error, a patient may have received too much phenylephrine (Neo-Synephrine). Which findings would support the nurse’s concerns about overdosage? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The patient’s heart rate has increased from 72 bpm to 114 bpm. 2. The patient reports feeling anxious. 3. The patient’s blood pressure has increased from 140/86 mmHg to 180/98 mmHg. 4. The patient’s stools are dark and tarry. 5. The patient reports burning at the injection site. Correct Answer: 1,3 Rationale 1: An overdose of phenylephrine (Neo-Synephrine) will result in tachycardia. Rationale 2: Feelings of anxiety and restlessness are expected adverse effectsof phenylephrine (Neo-Synephrine). Rationale 3: Overdosage of phenylephrine (Neo-Synephrine) will result in hypertension. Rationale 4: Dark and tarry stools are not related to phenylephrine (Neo-Synephrine). Rationale 5: Burning at the injection site would indicate possible extravasation, not overdose. Global Rationale:An overdose of phenylephrine (Neo-Synephrine) will result in tachycardia and hypertension.Feelings of anxiety and restlessness are expected adverse effectsof phenylephrine (Neo-Synephrine).Dark and tarry stools are not related to phenylephrine (Neo-Synephrine).Burning at the injection site would indicate possible extravasation, not overdose. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 13-4 For each of the drug classes listed in Drugs at a Glance, know representative drugs and explain their mechanism of action, primary actions, and important adverse effects. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 152 Question 30 Type: MCMA A 48-year-old male patient tells the nurse, “I have stopped taking my prazosin (Minipress). I don’t like its effect on me.” The nurse should ask further assessment questions about which possible effects? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Impotence 2. Nasal congestion 3. Somnolence 4. Nervousness 5. Slow heart rate Correct Answer: 1,2,3 Rationale 1: Some alpha blockers result in impotence or inhibition of ejaculation. Rationale 2: Nasal congestion is a common adverse effect of alpha blockade. Rationale 3: Drowsiness may occur with alpha blockers. Rationale 4: Anxiety is not a common adverse effect of this drug. Rationale 5: Reflex tachycardia may occur, but bradycardia is not expected. Global Rationale:Some alpha blockers result in impotence or inhibition of ejaculation.Nasal congestion is a common adverse effect of alpha blockade.Drowsiness may occur with alpha blockers.Anxiety is not a common adverse effect of this drug.Reflex tachycardia may occur, but bradycardia is not expected. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: I.X.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13-4 For each of the drug classes listed in Drugs at a Glance, know representative drugs and explain their mechanism of action, primary actions, and important adverse effects. MNL Learning Outcome: 2.1.4 Explore the nurse’s role in administering adrenergic agonists and antagonists. Page Number: 156 Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E Chapter 20 Question 1 Type: MCMA Several senior citizens have asked the nurse to do a presentation on degenerative diseases. What does the nurse plan to teach as the most common degenerative diseases? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Amyotrophic lateral sclerosis 2. Multiple sclerosis 3. Alzheimer's disease 4. Huntington's chorea 5. Parkinson's disease Correct Answer: 3,5 Rationale 1: Amyotrophic lateral sclerosis is not as common as other diseases. Rationale 2: Multiple sclerosis is not as common as other diseases. Rationale 3: Alzheimer's disease is one of the most common diseases of the central nervous system. Rationale 4: Huntington's chorea is not as common as other diseases. Rationale 5: Parkinson's disease is one of the most common diseases of the central nervous system. Global Rationale: Alzheimer's disease and Parkinson's disease are the two most common diseases of the central nervous system. Multiple sclerosis is not as common as Alzheimer's disease and Parkinson's disease. Huntington's chorea is not as common as Alzheimer's disease and Parkinson's disease. Amyotrophic lateral sclerosis is not as common as Alzheimer's disease and Parkinson's disease. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-1 Identify the most common degenerative diseases of the central nervous system. MNL Learning Outcome: 3.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 282 Question 2 Type: MCSA The patient is diagnosed with Parkinson's disease. The patient's wife asks the nurse how taking medicine will help her husband. What is the best response by the nurse? 1. "The medications will help prevent muscle wasting in your husband." 2. "The medications will boost your husband's appetite and energy." 3. "The medications will balance serotonin and acetylcholine in your husband's brain." 4. "The medications will help your husband to eat and walk." Correct Answer: 4 Rationale 1: Medications do not prevent muscle wasting. Rationale 2: Medications do not boost appetite or energy. Rationale 3: The medications help restore balance between dopamine, not serotonin, and acetylcholine. Rationale 4: The goal of pharmacotherapy for Parkinson's disease is to increase the ability of the patient to perform activities of daily living (ADLs) such as walking, eating, dressing, and bathing. Global Rationale: The goal of pharmacotherapy for Parkinson's disease is to increase the ability of the patient to perform activities of daily living (ADLs) such as walking, eating, dressing, and bathing. Medications do not prevent muscle wasting. Medications do not boost appetite or energy. The medications help restore balance between dopamine, not serotonin, and acetylcholine. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-3 Explain the neurochemical basis for Parkinson’s disease, focusing on the roles of dopamine and acetylcholine in the brain. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 283 Question 3 Type: MCMA The nurse plans to teach a class about Alzheimer's disease to a caregiver's support group. What will the best plan by the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Depression and aggressive behavior are common with the disease. 2. Alzheimer's disease accounts for about 50% of all dementias. 3. Glutamergic inhibitors are the most common class of drugs for treating Alzheimer's disease. 4. Chronic inflammation of the brain may be a cause of the disease. 5. Memory difficulties are an early symptom of the disease. Correct Answer: 1,4,5 Rationale 1: Depression and aggressive behavior are common symptoms of the disease. Rationale 2: Alzheimer's disease accounts for about 70% of all dementias. Rationale 3: The acetylcholinesterase inhibitors, not the glutamergic inhibitors, are the most widely used class of drugs for treating the disease. Rationale 4: It is suspected that chronic inflammation and excess free radicals may cause neuron damage and contribute to the disease. Rationale 5: Memory difficulties are an early symptom of Alzheimer's disease. Global Rationale: Memory difficulties are an early symptom of Alzheimer's disease. It is suspected that chronic inflammation and excess free radicals may cause neuron damage and contribute to the disease. Depression and aggressive behavior are common symptoms of the disease. Alzheimer's disease accounts for about 70% of all dementias. The acetylcholinesterase inhibitors, not the glutamergic inhibitors, are the most widely used class of drugs for treating the disease. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-5 Describe symptoms of Alzheimer’s disease and explain theories about why these symptoms develop. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 287 Question 4 Type: MCSA The nurse plans care for a patient with Parkinson's disease. What will the best plan by the nurse include? 1. Monitor the patient for the ability to chew and swallow. 2. Check peripheral circulation for thrombophlebitis. 3. Monitor the patient for psychotic symptoms. 4. Limit exercise to decrease the possibility of fractures. Correct Answer: 1 Rationale 1: In Parkinson's disease, muscle function is lost, and the patient's ability to chew and swallow to prevent aspiration becomes a safety issue. Rationale 2: Thrombophlebitis is not related to Parkinson's disease. Rationale 3: Psychosis is possible; however, this is not the primary concern. Rationale 4: Activity is important to maintain as much muscle tone as possible and should not be limited. Global Rationale: In Parkinson's disease, muscle function is lost, and the patient's ability to chew and swallow to prevent aspiration becomes a safety issue. Psychosis is possible; however, this is not the primary concern. Activity is important to maintain as much muscle tone as possible and should not be limited. Thrombophlebitis is not related to Parkinson's disease. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-2 Describe symptoms of Parkinson’s disease. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 282 Question 5 Type: MCSA The patient receives levodopa-carbidopa (Sinemet). The nurse has completed medication education and determines that learning has occurred when the patient makes which statement? 1. "I need to increase my daily intake of protein." 2. "I must increase the fiber in my diet." 3. "I need to check my pulse before taking the medication." 4. "I must avoid carbohydrates in my diet." Correct Answer: 2 Rationale 1: There isn't any need to increase the daily intake of protein, and a high protein diet may interfere with absorption. Rationale 2: Fiber will help prevent constipation, which is a side effect of levodopa-carbidopa (Sinemet). Rationale 3 There isn't any need to check the pulse prior to the medication. Rationale 4: There isn't any need to avoid carbohydrates. Global Rationale: Fiber will help prevent constipation, which is a side effect of levodopa-carbidopa (Sinemet). There isn't any need to check the pulse prior to the medication. There isn't any need to avoid carbohydrates. There isn't any need to increase the daily intake of protein. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 20-4 Describe the nurse’s role in the pharmacologic management of Parkinson’s disease and Alzheimer’s disease. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 284 Question 6 Type: MCSA The nurse prepares to administer benztropine (Cogentin) to the patient. The nurse holds the dose and notifies the physician based on which assessment finding? 1. A respiratory rate of 14 2. A pulse of 112 3. Blood pressure of 88/60 mmHg 4. A temperature of 100.2°F Correct Answer: 2 Rationale 1: A respiratory rate of 14 is a normal finding. Rationale 2: Benztropine (Cogentin) can cause tachycardia. Rationale 3: Initial hypotension may occur, but this is uncommon. Rationale 4: An elevated temperature is not related to benztropine (Cogentin). Global Rationale: Benztropine (Cogentin) can cause tachycardia. Initial hypotension may occur, but this is uncommon. An elevated temperature is not related to benztropine (Cogentin). A respiratory rate of 14 is a normal finding. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-9 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 288 Question 7 Type: MCSA The patient receives aspirin, a multivitamin, and an antihistamine every day. What is the best instruction by the nurse prior to administering levodopa, carbidopa, and entacapone (Stalevo)? 1. "You should not take the aspirin with your levodopa, carbidopa, and entacapone (Stalevo)." 2. "You should not take the antihistamine with your levodopa, carbidopa, and entacapone (Stalevo)." 3. "You should not take the multivitamin with your levodopa, carbidopa, and entacapone (Stalevo)." 4. "These medications are safe to take with levodopa, carbidopa, and entacapone (Stalevo)." Correct Answer: 3 Rationale 1: There isn't any contraindication to the use of aspirin and levodopa, carbidopa, and entacapone (Stalevo). Rationale 2: There isn't any contraindication to the use of an antihistamine and levodopa, carbidopa. and entacapone (Stalevo). Rationale 3: Vitamin B6 will decrease the effects of levodopa, carbidopa, and entacapone (Stalevo), so the patient should not take a multivitamin while receiving levodopa, carbidopa, and entacapone (Stalevo). Rationale 4: One of these medications will decrease the effects of levodopa, carbidopa, and entacapone (Stalevo). Global Rationale: Vitamin B6 will decrease the effects of levodopa, carbidopa, and entacapone (Stalevo), so the patient should not take a multivitamin while receiving levodopa, carbidopa, and entacapone (Stalevo). There isn't any contraindication to the use of aspirin and levodopa, carbidopa, and entacapone (Stalevo). There isn't any contraindication to the use of an antihistamine and levodopa, carbidopa, and entacapone (Stalevo). Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-9 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 286 Question 8 Type: MCSA An older adult receives levodopa, carbidopa, and entacapone (Stalevo). The nurse is primarily concerned about which problem with this patient? 1. Hypertension 2. Diarrhea 3. Muscle twitching 4. Dark urine Correct Answer: 3 Rationale 1: Hypotension, not hypertension, is possible with levodopa, carbidopa, and entacapone (Stalevo). Rationale 2: Constipation, not diarrhea, is a side effect of levodopa, carbidopa, and entacapone (Stalevo). Rationale 3: Muscle twitching may indicate toxicity. Rationale 4: Dark urine is a normal finding associated with this medication. Global Rationale: Muscle twitching may indicate toxicity. Constipation, not diarrhea, is a side effect of levodopa, carbidopa, and entacapone (Stalevo). Dark urine is a normal finding associated with this medication. Hypotension, not hypertension, is possible with levodopa, carbidopa, and entacapone (Stalevo). Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-9 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 286 Question 9 Type: MCSA The patient receives levodopa and carbidopa (Sinemet). What will the best teaching by the nurse include as relates to this medication? 1. Avoid drinking caffeinated beverages. 2. Take the medication with meals. 3. Take the medication on an empty stomach. 4. Take the medication with a protein food. Correct Answer: 3 Rationale 1: There isn't any significant relationship between caffeine and Levodopa and carbidopa (Sinemet). Rationale 2: Levodopa and carbidopa (Sinemet) should not be taken with meals; this will decrease absorption. Rationale 3: Levodopa and carbidopa (Sinemet) should be taken on an empty stomach for better absorption. Rationale 4: Levodopa and carbidopa (Sinemet) should not be taken with a protein food; this will decrease absorption. Global Rationale: Levodopa and carbidopa (Sinemet) should be taken on an empty stomach for better absorption. Levodopa and carbidopa (Sinemet) should not be taken with meals; this will decrease absorption. Levodopa and carbidopa (Sinemet) should not be taken with a protein food; this will decrease absorption. There isn't any significant relationship between caffeine and Levodopa and carbidopa (Sinemet). Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-10 Use the nursing process to care for patients receiving pharmacotherapy for degenerative diseases of the central nervous system. MNL Learning Outcome: 3.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 295 Question 10 Type: MCSA The patient has been diagnosed with Alzheimer's disease. What is the best medication education the nurse gives to the patient's husband? 1. "The medication may help her symptoms for a little while." 2. "The medication has serious side effects if used for a long time." 3. "Her symptoms will improve as long as she takes the medication." 4. "Her symptoms should begin improving in a few days." Correct Answer: 1 Rationale 1: Medications will only slow the progression of the disease. Rationale 2: The medications are usually not used over a long period of time. Rationale 3: Improvement with medication usually only lasts a matter of months. Rationale 4: It takes a minimum of 1 to 4 weeks to begin to see improvement. Global Rationale: Medications will only slow the progression of the disease. Improvement with medication usually lasts only a matter of months. It takes a minimum of 1 to 4 weeks to begin to see improvement. The medications do not have serious side effects and are usually not used over a long period of time. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-5 Describe symptoms of Alzheimer’s disease and explain theories about why these symptoms develop. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 289 Question 11 Type: MCSA The nurse is teaching a class for caregivers of patients with Alzheimer's disease. The nurse determines that learning has occurred when the caregivers make which statement? 1. “Antianxiety drugs are not effective when the patient’s anxiety is due to Alzheimer’s disease." 2. "No new drugs are being developed for Alzheimer’s disease.” 3. "Some health care providers think vitamin E and nonsteroidal anti-inflammatory medications may help control Alzheimer’s symptoms." 4. "All of the drugs used for Alzheimer’s disease are from the same drug class.." Correct Answer: 3 Rationale 1: There are antianxiety drugs that will treat anxiety associated with Alzheimer’s disease. Rationale 2: New drugs are being used and are in development. Rationale 3: Vitamin E and NSAIDS may be effective in slowing progression of Alzheimer’s disease. Rationale 4: Drugs to treat Alzheimer’s disease come from different classes. Global Rationale: Vitamin E and NSAIDS may be effective in slowing progression of Alzheimer’s disease.There are antianxiety drugs that will treat anxiety associated with Alzheimer’s disease.New drugs are being used and are in development.Drugs to treat Alzheimer’s disease come from different classes. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 20-6 Explain the goals of pharmacotherapy for Alzheimer’s disease and the efficacy of existing medication. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 288 Question 12 Type: MCSA The patient has multiple sclerosis and develops depression. What is the best education the nurse can give the patient's family? 1. "Anytime someone has a brain disease, depression will result." 2. "Depression is very easy to treat with medications we have available." 3. "This is a common problem with chronic debilitating diseases but requires close monitoring." 4. "This is a result of the medications taken for control of symptoms." Correct Answer: 3 Rationale 1: Patients with a neurological illness do not always develop depression. Rationale 2: Depression is treatable with medications, but this does not help the family to understand what is happening with the patient. Rationale 3: Depression is common with any chronic, debilitating disease, but may also be associated with medications. Close monitoring is required. Rationale 4: The medications are not the cause of the depression. Global Rationale: Depression is common with any chronic, debilitating disease, but may also be associated with medications. Close monitoring is required.. The medications are not the cause of the depression. Patients with a neurological illness do not always develop depression. Depression is treatable with medications, but this does not help the family to understand what is happening with the patient. Cognitive Level: Applying Client Need: Psychological Integrity Client Need Sub: QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-10 Use the nursing process to care for patients receiving pharmacotherapy for degenerative diseases of the central nervous system. MNL Learning Outcome: 3.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 295 Question 13 Type: MCSA The patient receives trihexyphenidyl (Artane) for Parkinson's disease. Which assessment data will the nurse report to the physician? 1. Dry mouth 2. Anorexia 3. Hypertension 4. Urinary retention Correct Answer: 4 Rationale 1: Dry mouth is a common side effect of trihexyphenidyl (Artane) that does not need reporting. Rationale 2: Anorexia is not a side effect of trihexyphenidyl (Artane). Rationale 3: Hypertension is not a side effect of trihexyphenidyl (Artane). Rationale 4: Urinary retention is a serious side effect that must be reported to the physician. Global Rationale: Urinary retention is a serious side effect that must be reported to the physician. Dry mouth is a common side effect of trihexyphenidyl (Artane) that does not need reporting. Hypertension is not a side effect of trihexyphenidyl (Artane). Anorexia is not a side effect of trihexyphenidyl (Artane). Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-4 Describe the nurse’s role in the pharmacologic management of Parkinson’s disease and Alzheimer’s disease. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 287 Question 14 Type: MCSA The patient receives donepezil (Aricept) as treatment for Alzheimer's disease. Which laboratory test(s) will the nurse primarily assess? 1. Serum amylase levels 2. Complete blood count 3. Pulmonary function tests 4. Liver function tests Correct Answer: 4 Rationale 1: Donepezil (Aricept) does not affect pancreatic function; so monitoring of serum amylase levels is not required. Rationale 2: Donepezil (Aricept) does not affect blood counts; so monitoring of complete blood counts (CBC) is not required. Rationale 3: Donepezil (Aricept) does not affect pulmonary function; so monitoring of pulmonary function tests is not required. Rationale 4: Donepezil (Aricept) is hepatotoxic and requires monitoring of liver function tests (LFTs) in any patient who is receiving this drug. Global Rationale: Donepezil (Aricept) is hepatotoxic and requires monitoring of liver function tests (LFTs) in any patient who is receiving this drug. Donepezil (Aricept) does not affect pulmonary function; so monitoring of pulmonary function tests is not required. Donepezil (Aricept) does not affect pancreatic function; so monitoring of serum amylase levels is not required. Donepezil (Aricept) does not affect blood counts; so monitoring of complete blood counts (CBC) is not required. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-9 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 289 Question 15 Type: MCSA Which degenerative disease of the central nervous system is the most common? 1. Amyotrophic lateral sclerosis (ALS) 2. Alzheimer’s 3. Multiple sclerosis (MS) 4. Huntington’s chorea Correct Answer: 2 Rationale 1: ALS is not the most common disease. Rationale 2: Parkinson’s and Alzheimer’s diseases are the most common degenerative diseases of the central nervous system. Rationale 3: MS is not the most common disease. Rationale 4: Huntington’s chorea is not the most common disease. Global Rationale: Parkinson’s and Alzheimer’s diseases are the most common degenerative diseases of the central nervous system. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: IX.7 Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-1 Identify the most common degenerative diseases of the central nervous system. MNL Learning Outcome: 3.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 282 Question 16 Type: MCSA Heat sensitivity, spascity, and visual impairment are symptoms most likely associated with which disorder? 1. Parkinson’s disease 2. Multiple sclerosis (MS) 3. Alzheimer’s disease (AD) 4. Amyotrophic lateral sclerosis (ALS) Correct Answer: 2 Rationale 1: Parkinson’s disease has several symptoms, including muscle stiffness, pill-rolling activity, and bradykinesia. Rationale 2: Patients with multiple sclerosis often have fatigue, heat-sensitivity, spasticity, and visual impairment. Rationale 3: Patients with AD have memory issues. Rationale 4: Patient with ALS have progressive muscle weakness which eventually involves the respiratory muscles. Global Rationale: Patients with multiple sclerosis often have fatigue, heat-sensitivity, spasticity, and visual impairment. Parkinson’s disease has several symptoms, including muscle stiffness, pill-rolling activity, and bradykinesia.Patients with AD have memory issues.Patient with ALS have progressive muscle weakness which eventually involves the respiratory muscles. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-7 Describe the signs and basis for development of multiple sclerosis symptoms. MNL Learning Outcome: 3.3.3 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of multiple sclerosis. Page Number: 282 Question 17 Type: MCSA Pharmacotherapy for Parkinson’s disease is intended to 1. increase the amount of dopamine and reduce the amount of acetylcholine. 2. increase the amount of dopamine and acetylcholine. 3. reduce the amount of dopamine and increase the amount of acetylcholine. 4. reduce the amount of dopamine and acetylcholine. Correct Answer: 1 Rationale 1: Parkinson’s disease results in the death of neurons that produce dopamine. The balance is restored by increasing the levels of dopamine or by inhibiting the excitatory actions of acetylcholine. Rationale 2: Parkinson’s disease results in the death of neurons that produce dopamine. Due to the imbalance, dopamine is provided (levodopa), and anticholinergics can be administered as well. Acetylcholine is not increased. Rationale 3: Dopamine is not reduced. Rationale 4: Dopamine is not reduced. Global Rationale: Parkinson’s disease results in the death of neurons that produce dopamine. The balance is restored by increasing the levels of dopamine or by inhibiting the excitatory actions of acetylcholine. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-3 Explain the neurochemical basis for Parkinson’s disease, focusing on the roles of dopamine and acetylcholine in the brain. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 284 Question 18 Type: MCSA From a pharmacology standpoint, which statement best explains why levodopa is superior to dopamine? 1. It crosses the blood–brain barrier. 2. It has fewer adverse effects. 3. It has less risk for addiction. 4. It can be administered orally. Correct Answer: 1 Rationale 1: Levodopa can cross the blood–brain barrier, but dopamine cannot. Levodopa administration leads directly to dopamine synthesis. Rationale 2: Levodopa does not have fewer side effects. Rationale 3: There is no risk for addiction from either substance. Rationale 4: Route of administration is not a factor. Global Rationale: Levodopa can cross the blood–brain barrier, but dopamine cannot. Levodopa administration leads directly to dopamine synthesis.Levodopa does not have fewer side effects.There is no risk for addiction from either substance.Route of administration is not a factor. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-3 Explain the neurochemical basis for Parkinson’s disease, focusing on the roles of dopamine and acetylcholine in the brain. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 284 Question 19 Type: MCSA Which statement best explains why structural changes occur within the brains of people with Alzheimer’s disease? 1. Increased acetylcholine levels 2. Increases in blood pressure and cholesterol levels 3. Chronic inflammation and oxidative cellular damage 4. Cerebral bleeding and associated hypoxia Correct Answer: 3 Rationale 1: There is no increase of acetylcholine levels. Rationale 2: Blood pressure and cholesterol levels are not implicated. Rationale 3: Alzheimer’s disease is characterized by amyloid plaques and neurofibrillary tangles that most likely occur from chronic inflammation or oxidative cellular damage. Rationale 4: Cerebral bleeding and associated hypoxia are not implicated. Global Rationale: Alzheimer’s disease is characterized by amyloid plaques and neurofibrillary tangles that most likely occur from chronic inflammation or oxidative cellular damage.There is no increase of acetylcholine levels. Blood pressure and cholesterol levels are not implicated.Cerebral bleeding and associated hypoxia are not implicated. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-10 Use the nursing process to care for patients receiving pharmacotherapy for degenerative diseases of the central nervous system. MNL Learning Outcome: 3.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 287 Question 20 Type: MCSA Which drug would most likely be an initial treatment for a patient with Alzheimer’s disease? 1. Levodopa (Larodopa) 2. Haloperidol (Haldol) 3. Benztropine mesylate (Cogentin) 4. Donepezil hydrochloride (Aricept) Correct Answer: 4 Rationale 1: Levodopa (Larodopa) is used for Parkinson’s disease. Rationale 2: Haloperidol (Haldol) can be used in some cases of Alzheimer’s disease, but due to its adverse effects it is not frequently used. Rationale 3: Benztropine mesylate (Cogentin) is used for Parkinson’s disease. Rationale 4: Donepezil hydrochloride (Aricept) is an acetylcholinesterase inhibitor and the most frequently used drug for Alzheimer’s disease. Global Rationale: Donepezil hydrochloride (Aricept) is an acetylcholinesterase inhibitor and the most frequently used drug for Alzheimer’s disease. Levodopa (Larodopa) and benztropine mesylate (Cogentin) are used for Parkinson’s disease. Haloperidol (Haldol) can be used in some cases of Alzheimer’s disease, but due to its adverse effects it is not frequently used. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-6 Explain the goals of pharmacotherapy for Alzheimer’s disease and the efficacy of existing medication. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 289 Question 21 Type: MCSA Which statement is the most accurate regarding acetylcholinesterase inhibitors when used for Alzheimer's disease? 1. They reverse the structural damage within the brain. 2. They increase synthesis of acetylcholine. 3. They increase enzymatic breakdown, leading to increased neuronal production. 4. They intensify the effect of acetylcholine at the receptor. Correct Answer: 4 Rationale 1: Currently no drugs can reverse the structural damages associated with Alzheimer’s disease. Rationale 2: They do not increase acetylcholine synthesis or enzymatic breakdown. Rationale 3: They do not increase enzymatic breakdown. Rationale 4: Acetylcholinesterase inhibitors intensify the effect of acetylcholine at the receptor. Global Rationale: Acetylcholinesterase inhibitors intensify the effect of acetylcholine at the receptor. They do not increase acetylcholine synthesis or enzymatic breakdown. Currently no drugs can reverse the structural damages associated with Alzheimer’s disease. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-Explain the goals of pharmacotherapy for Alzheimer’s disease and the efficacy of existing medication. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 287 Question 22 Type: MCMA What will the nurse include when teaching a caregivers' support group about Alzheimer's disease? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Glutamergic inhibitors are the most common class of drugs for treating Alzheimer's disease. 2. Depression and aggressive behavior are common with the disease. 3. Memory difficulties are an early symptom of the disease. 4. Chronic inflammation of the brain can be a cause of the disease. 5. Pharmacologic therapies are given to help improve memory in Alzheimer's disease. Correct Answer: 2,3,4,5 Rationale 1: Glutamergic inhibitors are not the most common class of drugs for treating Alzheimer's disease. Rationale 2: Depression and aggressive behavior are common symptoms of the disease. Rationale 3: Memory difficulties are an early symptom of Alzheimer's disease. Rationale 4: It is suspected that chronic inflammation and excess free radicals can cause neuron damage and contribute to the disease. Rationale 5: The acetylcholinesterase inhibitors are the most widely used class of drugs for treating the disease. These drugs work by increasing the availability of acetylcholine. Acetylcholine is involved in cognition, memory, and learning. Global Rationale: Depression and aggressive behavior are common symptoms of the disease.Memory difficulties are an early symptom of Alzheimer's disease.It is suspected that chronic inflammation and excess free radicals can cause neuron damage and contribute to the disease.The acetylcholinesterase inhibitors are the most widely used class of drugs for treating the disease. These drugs work by increasing the availability of acetylcholine. Acetylcholine is involved in cognition, memory, and learning.Glutamergic inhibitors are not the most common class of drugs for treating Alzheimer's disease. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-Explain the goals of pharmacotherapy for Alzheimer’s disease and the efficacy of existing medication. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 287–288 Question 23 Type: MCMA A patient is diagnosed with multiple sclerosis. What symptoms will the nurse most likely assess in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Muscle weakness 2. Difficulty maintaining balance 3. Atrophy of the hands and legs 4. Slow shuffling gait 5. Progressive chorea Correct Answer: 1,2 Rationale 1: Muscle weakness is a manifestation of multiple sclerosis. Rationale 2: Difficulty maintaining balance is a manifestation of multiple sclerosis. Rationale 3: Atrophy of the hands and legs is not a manifestation of multiple sclerosis. Rationale 4: A slow shuffling gait is not a manifestation of multiple sclerosis. Rationale 5: Progressive chorea is not a manifestation of multiple sclerosis. Global Rationale: Muscle weakness and difficulty maintaining balance are manifestations of multiple sclerosis.Atrophy of the hands and legs is not a manifestation of multiple sclerosis.A slow shuffling gait is not a manifestation of multiple sclerosis.Progressive chorea is not a manifestation of multiple sclerosis. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-7 Describe the signs and basis for development of multiple sclerosis symptoms. MNL Learning Outcome: 3.3.3 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of multiple sclerosis. Page Number: 291 Question 24 Type: MCMA The nurse observes a patient with Parkinson's disease having difficulty controlling hand movements. What did the nurse observe in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Pill rolling 2. Tremor 3. Stooped posture 4. Lack of arm swing 5. Difficulty bending the arms Correct Answer: 1,2 Rationale 1: Pill rolling is a common behavior in progressive Parkinson's disease in which the patient rubs the thumb and forefinger together in a circular motion resembling the motion of rolling a tablet between two fingers. Rationale 2: The hands develop a palsy-like continuous motion or shaking when at rest. Rationale 3: A stooped posture would not influence the patient's ability to control hand movements. Rationale 4: A lack of arm swing does not influence the patient's ability to control hand movements. Rationale 5: Difficulty bending the arms does not influence the patient's ability to control hand movements. Global Rationale: Pill rolling is a common behavior in progressive Parkinson's disease in which the patient rubs the thumb and forefinger together in a circular motion resembling the motion of rolling a tablet between two fingers.The hands develop a palsy-like continuous motion or shaking when at rest.A stooped posture, lack of arm swing, and difficulty bending the arms would not influence the patient's ability to control hand movements. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-2 Describe symptoms of Parkinson’s disease. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 282 Question 25 Type: MCMA A patient with Parkinson's disease is experiencing an increase in bradykinesia. What will the patient demonstrate with this manifestation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Slow speech 2. Difficulty chewing 3. Shuffling the feet when walking 4. Stooped posture 5. Lack of facial expression Correct Answer: 1,2,3 Rationale 1: Slow speech is a manifestation of bradykinesia. Rationale 2: Difficulty chewing is a manifestation of bradykinesia. Rationale 3: Shuffling the feet when walking is a manifestation of bradykinesia. Rationale 4: Stooped posture is not a manifestation of bradykinesia. Rationale 5: Lack of facial expression is not a manifestation of bradykinesia. Global Rationale: Slow speech, difficulty chewing, and a shuffling gait are manifestations of bradykinesia.Stooped posture and lack of facial expression are not manifestations of bradykinesia. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20-2 Describe symptoms of Parkinson’s disease. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 282 Question 26 Type: MCMA A patient with progressive multiple sclerosis will be started on alemtuzumab (Lemtrada). The nurse should ensure which interventions are completed prior to initiating this therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A varicella zoster vaccination is scheduled. 2. A complete blood count (CBC) has been drawn. 3. A serum creatinine has been drawn. 4. A skin exam has been completed. 5. An indwelling urinary catheter is placed. Correct Answer: 1,2,3,4 Rationale 1:The patient should have a varicella zoster vaccination at least 6 weeks prior to beginning this therapy. Rationale 2: A CBC should be obtained prior to treatment. Rationale 3: A serum creatinine should be obtained prior to treatment. Rationale 4: A skin examination is necessary prior to treatment to monitor for melanoma. Rationale 5: There is no reason to place an indwelling urinary catheter. Global Rationale:The patient should have a varicella zoster vaccination at least 6 weeks prior to beginning this therapy.A CBC and a serum creatinine should be obtained prior to treatment.A skin examination is necessary prior to treatment to monitor for melanoma.There is no reason to place an indwelling urinary catheter. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-8 Categorize drugs used in the treatment of Alzheimer’s disease, Parkinson’s disease, ad multiple sclerosis based on their classification and mechanism of action. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 293 Question 27 Type: MCMA The nurse providing medications to a patient with multiple sclerosis realizes that the goals of medication therapy for this patient include Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. modifying the progression of the disease. 2. treating acute exacerbations. 3. managing symptoms. 4. curing the disease. 5. remyelinating nerve fibers. Correct Answer: 1,2,3 Rationale 1: This is a goal of pharmacologic therapy for multiple sclerosis. Rationale 2: This is a goal of pharmacologic therapy for multiple sclerosis. Rationale 3: This is a goal of pharmacologic therapy for multiple sclerosis. Rationale 4: This is not a goal of pharmacologic therapy for multiple sclerosis. Rationale 5: This is not a goal of pharmacologic therapy for multiple sclerosis. Global Rationale: Drugs can modify the progression of the disease, treat acute exacerbations, and manage symptoms. They cannot cure the disease or remyelinate nerve fibers. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20-8 Categorize drugs used in the treatment of Alzheimer’s disease, Parkinson’s disease, ad multiple sclerosis based on their classification and mechanism of action. MNL Learning Outcome: 3.3.2 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Alzheimer’s disease. Page Number: 287 Question 28 Type: MCMA The nurse notes that a patient who has Parkinson’s disease often has twitching of the eye and increased tremors when medications are being administered. The nurse discusses which changes in therapy with the provider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Increasing the dose of medications 2. Changing the interval between doses of medication 3. Using a liquid form of the medication 4. Scheduling a drug holiday 5. Adding an adjunctive drug Correct Answer: 1,2,5 Rationale 1:These findings may indicate a wearing-off time has occurred. The dose of medication may need to be increased. Rationale 2: These findings may indicate a wearing-off time has occurred. The timing of drug administration may need to be changed. Rationale 3: There is no indication that a liquid form of the medication is indicated. Rationale 4: The patient needs to remain on the medication. Rationale 5:These findings may indicate a wearing-off time has occurred. There may be a need to add an adjunctive medication. Global Rationale:These findings may indicate a wearing-off time has occurred. The dose of medication may need to be increased, the timing of drug administration may need to be changed, or an adjunctive drug may need to be added.There is no indication that a liquid form of the medication is indicated.The patient needs to remain on the medication. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-10 Use the nursing process to care for patients receiving pharmacotherapy for degenerative diseases of the central nervous system. MNL Learning Outcome: 3.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 295 Question 29 Type: MCMA A nurse has provided medication education for a patient just diagnosed with Parkinson’s disease. The nurse would evaluate that this instruction is successful when the patient makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “I guess I will have to give up eating my wife’s banana pudding.” 2. “I should add some wheat germ to my breakfast cereal.” 3. “I should add olive oil to the salads I eat at noon each day.” 4. “I have to become a vegetarian.” 5. “I will take my medication on an empty stomach.” Correct Answer: 1,5 Rationale 1:Bananas are high in vitamin B6 and should be avoided when taking these medications. Rationale 2: Wheat germ and fortified cereals should be avoided when taking these medications. Rationale 3: Olive oil is not prohibited, but green vegetables should be limited. Rationale 4: The patient does not need to follow a vegetarian diet but should reduce meat intake. Rationale 5: These medications should be taken on an empty stomach. Global Rationale:Bananas are high in vitamin B6 and should be avoided when taking these medications.These medications should be taken on an empty stomach.Wheat germ and fortified cereals should be avoided when taking these medications.Olive oil is not prohibited, but green vegetables should be limited.The patient does not need to follow a vegetarian diet but should reduce meat intake. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 20-10 Use the nursing process to care for patients receiving pharmacotherapy for degenerative diseases of the central nervous system. MNL Learning Outcome: 3.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 295 Question 30 Type: MCMA A patient who takes benztropine (Cogentin) has developed constipation. What treatment should the nurse recommend? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Try drinking a glass of wine each evening.” 2. “Take docusate (Colace) every evening.” 3. “Increase your fluid intake.” 4. “Taking a walk each day may help.” 5. “Stop taking your medication until your bowel function normalizes.” Correct Answer: 3,4 Rationale 1:Benztropine (Cogentin) should not be taken with alcohol. Rationale 2: Docusate (Colace) is contraindicated when benztropine (Cogentin) is taken. Rationale 3: Increasing fluid intake is recommended to treat constipation. Rationale 4: Exercising is recommended to treat constipation. Rationale 5: The patient should not stop medications. Global Rationale:Increasing fluid intake is recommended to treat constipation.Exercising is recommended to treat constipation.Benztropine (Cogentin) should not be taken with alcohol.Docusate (Colace) is contraindicated when benztropine (Cogentin) is taken.The patient should not stop medications. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20-9 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.3.1 Examine etiology, pathophysiology, clinical manifestations, and pharmacotherapy of Parkinson’s disease. Page Number: 288 Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E Chapter 21 Question 1 Type: MCMA The nurse teaches a class about muscle movement to a group of patients who have neuromuscular disorders. What will the best plan of the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Body movement depends on an intact spinal cord. 2. Body movement depends on proper functioning of muscles. 3. Body movement depends on intact nerves. 4. Body movement depends on proper endocrine functioning. 5. Body movement depends on the level of consciousness. Correct Answer: 2,3 Rationale 1: Body movement does not depend on an intact spinal cord as portions of the body move even if the spinal cord is damaged. Rationale 2: Body movement depends on proper functioning of muscles. Rationale 3: Body movement depends on intact nerves. Rationale 4: Body movement does not depend on proper endocrine functioning. Rationale 5: Body movement does not depend on the level of consciousness. Global Rationale: Body movement depends on proper functioning of muscles. Body movement does not depend on the level of consciousness. Body movement does not depend on an intact spinal cord as portions of the body move even if the spinal cord is damaged. Body movement does not depend on proper endocrine functioning. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 21-1 Identify the different body systems contributing to muscle movement. MNL Learning Outcome: 3.6.1 Examine etiology, pathophysiology, clinical manifestations. Page Number: 300 Question 2 Type: MCMA The nurse teaches the patient with a neuromuscular disorder about nonpharmacological treatment of muscle spasms. What will the best information include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Application of heat or cold 2. Ultrasound 3. Massage 4. Relaxation techniques 5. Guided imagery Correct Answer: 1,2,3 Rationale 1: Nonpharmacological treatment of muscle spasms includes application of heat or cold. Rationale 2: Nonpharmacological treatment of muscle spasms includes ultrasound. Rationale 3: Nonpharmacological treatment of muscle spasms includes massage. Rationale 4: Relaxation techniques are not a type of nonpharmacological treatment for muscle spasms. Rationale 5: Guided imagery is not a nonpharmacological treatment for muscle spasms. Global Rationale: Nonpharmacological treatment of muscle spasms includes application of heat or cold, ultrasound, and massage. Guided imagery is not a nonpharmacological treatment for muscle spasms. Relaxation techniques are not a type of nonpharmacological treatment for muscle spasms. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in health care. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-2 Discuss pharmacologic and nonpharmacologic therapies used to treat muscle spasms and spasticity. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 300 Question 3 Type: MCSA The patient is started on a medication to treat a neuromuscular disorder. What does the nurse teach as the primary therapeutic goal of the medication? 1. To stop the patient's muscle spasms 2. To improve the patient's appearance 3. To promote exercise in the patient 4. To allow the patient increased independence Correct Answer: 4 Rationale 1: Stopping muscle spasms can be achieved, but this is not the primary goal. Rationale 2: Improving the patient's appearance is not a goal. Rationale 3: Promoting exercise is not a goal. Rationale 4: The therapeutic goals of pharmacotherapy include minimizing pain and discomfort, increasing range of motion, and improving the patient's ability to function independently. Global Rationale: The therapeutic goals of pharmacotherapy include minimizing pain and discomfort, increasing range of motion, and improving the patient's ability to function independently. Stopping muscle spasms can be achieved, but this is not the primary goal. Promoting exercise is not a goal. Improving the patient's appearance is not a goal. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-3 Explain the goals of pharmacotherapy with skeletal muscle relaxants. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 300 Question 4 Type: MCSA The patient receives dantrolene (Dantrium) for muscle spasticity. Which lab result is a priority for the nurse to assess? 1. Creatinine clearance 2. Serum amylase 3. Hemoglobin and hematocrit 4. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) Correct Answer: 4 Rationale 1: Dantrolene (Dantrium) does not significantly affect renal function; the creatinine clearance test isn't a priority laboratory test to assess. Rationale 2: Dantrolene (Dantrium) does not affect pancreatic function; the serum amylase isn't a priority laboratory test to assess. Rationale 3: Dantrolene (Dantrium) does not affect hemoglobin or hematocrit; these laboratory tests are not a priority to assess. Rationale 4: Dantrolene (Dantrium) can cause hepatitis; the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are the priority laboratory tests for the nurse to assess. Global Rationale: Dantrolene (Dantrium) can cause hepatitis; the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are the priority laboratory tests for the nurse to assess. Dantrolene (Dantrium) does not affect hemoglobin or hematocrit; these laboratory tests are not a priority to assess. Dantrolene (Dantrium) does not significantly affect renal function; the creatinine clearance test isn't a priority laboratory test to assess. Dantrolene (Dantrium) does not affect pancreatic function; the serum amylase isn't a priority laboratory test to assess. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 305 Question 5 Type: MCSA The patient takes a skeletal muscle relaxer for back pain. A consulting physician orders hydroxyzine (Vistaril) for the patient and he begins taking it. What will the best assessment by the nurse reveal? 1. Confusion 2. Hypertension 3. Respiratory depression 4. Delirium Correct Answer: 3 Rationale 1: Confusion would not result from the use of these two medications. Rationale 2: Hypertension would not result from the use of these two medications. Rationale 3: Skeletal muscle relaxers and hydroxyzine (Vistaril) are both central nervous system (CNS) depressants, and the patient needs to be assessed for respiratory depression. Rationale 4: Delirium would not result from the use of these two medications. Global Rationale: Skeletal muscle relaxers and hydroxyzine (Vistaril) are both central nervous system (CNS) depressants, and the patient needs to be assessed for respiratory depression. Hypertension would not result from the use of these two medications. Confusion would not result from the use of these two medications. Delirium would not result from the use of these two medications. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 308 Question 6 Type: MCSA The physician has ordered dantrolene (Dantrium) for a patient. What is a priority assessment by the nurse prior to administering this medication? 1. Does the patient have gastric ulcer disease? 2. Does the patient have psoriasis? 3. Does the patient have gallbladder disease? 4. Is the patient pregnant or lactating? Correct Answer: 4 Rationale 1: Gastric ulcer disease is not a contraindication to receiving dantrolene (Dantrium). Rationale 2: Psoriasis is not a contraindication to receiving dantrolene (Dantrium). Rationale 3: Gallbladder disease is not a contraindication to receiving dantrolene (Dantrium). Rationale 4: Dantrolene (Dantrium) is a Pregnancy Category C drug, so pregnancy should be assessed prior to administration. Global Rationale: Dantrolene (Dantrium) is a Pregnancy Category C drug, so pregnancy should be assessed prior to administration. Gastric ulcer disease is not a contraindication to receiving dantrolene (Dantrium). Gallbladder disease is not a contraindication to receiving dantrolene (Dantrium). Psoriasis is not a contraindication to receiving dantrolene (Dantrium). Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 305 Question 7 Type: MCSA The physician prescribes cyclobenzaprine (Flexeril) for the patient. When doing medication education, what will the best information of the nurse include? 1. Increase the intake of fiber while taking this medication. 2. Restrict the intake of sodium while taking this medication. 3. Increase the intake of protein while taking this medication. 4. Do not drink any caffeine while taking this medication. Correct Answer: 1 Rationale 1: Cyclobenzaprine (Flexeril) has anticholinergic properties and can cause constipation, so the patient should increase the intake of fiber while taking this medication. Rationale 2: There is no need to limit sodium. Rationale 3: There is no need to increase protein. Rationale 4: There is no need to limit caffeine. Global Rationale: Cyclobenzaprine (Flexeril) has anticholinergic properties and can cause constipation, so the patient should increase the intake of fiber while taking this medication. There is no need to limit sodium. There is no need to limit caffeine. There is no need to increase protein. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-7 Use the nursing process to care for patients receiving pharmacotherapy for muscle spasms. MNL Learning Outcome: 3.6.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 308 Question 8 Type: MCSA The patient is treated for muscle spasms following a spinal cord injury. What is the best outcome for this patient? 1. Patient will have stabilized vital signs. 2. Patient will have an improved self-concept. 3. Patient will sleep without pain. 4. Patient will have increased bladder tone. Correct Answer: 3 Rationale 1: Stabilization of vital signs is not an expected effect of this medication. Rationale 2: Relief of muscle spasms may help with self-concept, but this is not a direct effect of the drug. Rationale 3: Decreasing muscle spasms will help prevent pain that can interfere with sleep. Rationale 4: This medication relaxes muscles, but it will not increase bladder tone. Global Rationale: Decreasing muscle spasms will help prevent pain that can interfere with sleep. This medication relaxes muscles, but it will not increase bladder tone. Stabilization of vital signs is not an expected effect of this medication. Relief of muscle spasms may help with self-concept, but this is not a direct effect of the drug. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 21-4 Describe the nurse’s role in the pharmacologic management of muscle spasms. MNL Learning Outcome: 3.6.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 303 Question 9 Type: MCSA The patient tells the nurse that she awakens frequently during the night because of leg and foot cramps. What is the best response by the nurse? 1. "Ask your physician for a muscle relaxant." 2. "Increase your intake of vitamin B6." 3. "Take a warm bath before going to bed." 4. "Apply heat to relieve the cramping." Correct Answer: 2 Rationale 1: It is premature to ask the physician for a muscle relaxant. Rationale 2: Oral therapy with vitamin B6 may reduce the intensity and duration of leg muscle cramping. Rationale 3: Taking a warm bath will relax the muscles but will not prevent cramping. Rationale 4: Applying heat will relax the muscles but will not prevent cramping. Global Rationale: Oral therapy with vitamin B6 may reduce the intensity and duration of leg muscle cramping. It is premature to ask the physician for a muscle relaxant. Applying heat will relax the muscles but will not prevent cramping. Taking a warm bath will relax the muscles but will not prevent cramping. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-4 Describe the nurse’s role in the pharmacologic management of muscle spasms. MNL Learning Outcome: 3.6.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 303 Question 10 Type: MCSA The patient receives dantrolene (Dantrium). Which medication would the nurse evaluate as being contraindicated with dantrolene (Dantrium)? 1. Verapamil (Calan) 2. Insulin 3. Clarithromycin (Biaxin) 4. Methylphenidate (Concerta) Correct Answer: 1 Rationale 1: Verapamil (Calan) is a calcium channel blocker; combining this with dantrolene (Dantrium) could lead to cardiovascular collapse. Rationale 2: There isn't any contraindication to the use of dantrolene (Dantrium) and insulin. Rationale 3: There isn't any contraindication to the use of dantrolene (Dantrium) and clarithromycin (Biaxin). Rationale 4: There isn't any contraindication to the use of dantrolene (Dantrium) and methylphenidate (Concerta). Global Rationale: Verapamil (Calan) is a calcium channel blocker; combining this with dantrolene (Dantrium) could lead to cardiovascular collapse. There isn't any contraindication to the use of dantrolene (Dantrium) and insulin. There isn't any contraindication to the use of dantrolene (Dantrium) and methylphenidate (Concerta). There isn't any contraindication to the use of dantrolene (Dantrium) and clarithromycin (Biaxin). Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 305 Question 11 Type: MCSA The patient receives dantrolene (Dantrium) intravenously (IV). What will a priority assessment by the nurse include? 1. Assessing the patient's urinary output 2. Assessing the patient's blood glucose 3. Assessing the patient's breath sounds 4. Assessing the patient's intravenous (IV) site Correct Answer: 4 Rationale 1: Dantrolene (Dantrium) does not affect the patient's urinary output. Rationale 2: Dantrolene (Dantrium) does not affect the patient's blood glucose. Rationale 3: Dantrolene (Dantrium) does not affect the patient's breath sounds. Rationale 4: Dantrolene (Dantrium) intravenous (IV) solution has a high pH and is very irritating to tissue. The nurse should assess for infiltration of the intravenous (IV) site. Global Rationale: Dantrolene (Dantrium) intravenous (IV) solution has a high pH and is very irritating to tissue. The nurse should assess for infiltration of the intravenous (IV) site. Dantrolene (Dantrium) does not affect the patient's blood glucose. Dantrolene (Dantrium) does not affect the patient's breath sounds. Dantrolene (Dantrium) does not affect the patient's urinary output. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-7 Use the nursing process to care for patients receiving pharmacotherapy for muscle spasms. MNL Learning Outcome: 3.6.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 305 Question 12 Type: MCSA Which list of treatment options would be considered optimal for treating a muscle spasm with an unknown cause? 1. Anti-inflammatory agents, casting, and ultrasound 2. Analgesics, antibiotics, and heat application 3. Analgesics, muscle relaxants, and massage 4. Anti-inflammatory agents, immobilization, and fluid and electrolyte replacement Correct Answer: 3 Rationale 1: Casting is not indicated for muscle spasms. Rationale 2: Antibiotics are not indicated for muscle spasms. Rationale 3: Muscle spasms can be treated with a variety of pharmacologic and nonpharmacologic methods. When the cause is unknown, a more general approach is indicated, such as analgesics, muscle relaxants, and massage. Rationale 4: Fluid and electrolyte replacement can be indicated, if determined to be the cause; immobilization is not indicated. Global Rationale: Muscle spasms can be treated with a variety of pharmacologic and nonpharmacologic methods. When the cause is unknown, a more general approach is indicated, such as analgesics, muscle relaxants, and massage. Antibiotics and casting are not indicated for muscle spasms. Fluid and electrolyte replacement can be indicated, if determined to be the cause; immobilization is not indicated. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in health care. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 21-2 Discuss pharmacologic and nonpharmacologic therapies used to treat muscle spasms and spasticity. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 300 Question 13 Type: MCSA Which statement about skeletal muscle relaxants is correct? 1. They inhibit upper motor neuron activity within the central nervous system. 2. They work primarily by stimulating the peripheral nervous system. 3. They increase the amount of neurotransmitter within the muscles. 4. They stimulate motor activity within the brainstem. Correct Answer: 1 Rationale 1: The exact mechanism by which skeletal muscle relaxants work is not fully understood. It is believed that they inhibit upper motor neuron activity, causing CNS depression. Rationale 2: Stimulation of the peripheral nervous system is not the mechanism of action of muscle relaxants. Rationale 3: Muscle relaxants do not increase the amount of neurotransmitter. Rationale 4: Muscle relaxants do not stimulate motor activity in the brainstem. Global Rationale: The exact mechanism by which skeletal muscle relaxants work is not fully understood. It is believed that they inhibit upper motor neuron activity, causing CNS depression.Stimulation of the peripheral nervous system is not the mechanism of action of muscle relaxants.Muscle relaxants do not increase the amount of neurotransmitter.Muscle relaxants do not stimulate motor activity in the brainstem. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 21-3 Explain the goals of pharmacotherapy with skeletal muscle relaxants. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 300 Question 14 Type: MCSA The nurse identifies a patient with a repeating pattern of muscle contraction of the leg for 5 seconds followed by 2 seconds of relaxation as experiencing 1. a clonic spasm. 2. a tonic spasm. 3. spasticity. 4. dystonia. Correct Answer: 1 Rationale 1: Clonic muscle spasms involve multiple, rapidly repeated contractions. Rationale 2: Tonic spasms involve a single prolonged contraction. Rationale 3: Spasticity involves a continuous state of contraction. Rationale 4: Dystonia is a chronic neurological disorder that can cause spasticity. Global Rationale: Clonic muscle spasms involve multiple, rapidly repeated contractions. Tonic spasms involve a single prolonged contraction. Spasticity involves a continuous state of contraction, and dystonia is a chronic neurological disorder that can cause spasticity. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-7 Use the nursing process to care for patients receiving pharmacotherapy for muscle spasms. MNL Learning Outcome: 3.6.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 300 Question 15 Type: MCSA Which change is a common adverse effect of cyclobenzaprine (Flexeril)? 1. Alopecia 2. Tongue swelling 3. Drowsiness 4. Hypotension Correct Answer: 3 Rationale 1: Alopecia is not an associated adverse effect. Rationale 2: Tongue swelling is serious, but rare. Rationale 3: All centrally acting agents have the potential to cause sedation. Rationale 4: Tachycardia is possible but would likely lead to hypertension, not hypotension. Global Rationale: All centrally acting agents have the potential to cause sedation. Tongue swelling is serious, but rare. Tachycardia is possible but would likely lead to hypertension, not hypotension. Alopecia is not an associated adverse effect. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 21-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 302 Question 16 Type: MCSA Which statement describes the primary difference between centrally acting muscle relaxants and direct-acting antispasmodics? 1. Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents stimulate neurons of the central nervous system. 2. Centrally acting agents stimulate neurons of the central nervous system, while direct-acting agents stimulate neurons of the peripheral nervous system. 3. Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents work at the level of the neuromuscular junction and skeletal muscles. 4. Centrally acting agents stimulate the central nervous system, while direct-acting agents inhibit neuronal conduction of the central nervous system. Correct Answer: 3 Rationale 1: Direct-acting agents do not work at the level of the neuromuscular junction and skeletal muscles. Rationale 2: Centrally acting agents inhibit neurons of the central nervous system. Rationale 3: Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents work at the level of the neuromuscular junction and skeletal muscles. Rationale 4: Centrally acting agents inhibit neurons of the central nervous system. Global Rationale: Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents work at the level of the neuromuscular junction and skeletal muscles. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-5 Compare and contrast the roles of the following drug categories in treating muscle spasms and spasticity: centrally acting skeletal muscle relaxants, direct-acting antispasmodics, and skeletal muscle relaxants for short medical procedures. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 303 Question 17 Type: MCSA Which patient suffering from muscle spasms should not receive the direct-acting antispasmodic medication dantrolene sodium (Dantrium)? 1. 20-year-old suffering from a spinal cord injury 2. 57-year-old suffering from congestive heart failure 3. 40-year-old suffering from multiple sclerosis 4. 65-year-old suffering from a cerebral vascular accident Correct Answer: 2 Rationale 1: Dantrolene sodium (Dantrium) is indicated for spinal cord injury. Rationale 2: Dantrolene sodium (Dantrium) is contraindicated in patients with cardiac, pulmonary, and hepatic problems. Rationale 3: Dantrolene sodium (Dantrium) is indicated for multiple sclerosis. Rationale 4: Dantrolene sodium (Dantrium) is indicated for strokes. Global Rationale: Dantrolene sodium (Dantrium) is contraindicated in patients with cardiac, pulmonary, and hepatic problems. It is indicated for spinal cord injury, strokes, and multiple sclerosis. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 21-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 305 Question 18 Type: MCSA Spasticity is most commonly caused by damage to what area of the body? 1. Cerebral cortex 2. Peripheral nerves 3. Brainstem 4. Spinal cord Correct Answer: 1 Rationale 1: Spasticity usually results from damage to the motor area of the cerebral cortex. Rationale 2: Spasticity is not likely to occur with damage to peripheral nerves. Rationale 3: Spasticity usually results from damage to the motor area of the cerebral cortex. Spasticity is not likely to occur with damage to the brainstem. Rationale 4: Spasticity is not likely to occur with damage to the spinal cord. Global Rationale: Spasticity usually results from damage to the motor area of the cerebral cortex.Spasticity is not likely to occur with damage to peripheral nerves, the brainstem, or the spinal cord. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-1 Identify the different body systems contributing to muscle movement. MNL Learning Outcome: 3.6.1 Examine etiology, pathophysiology, clinical manifestations. Page Number: 302 Question 19 Type: MCSA Which statement is correct in regard to the muscle relaxant botulinum toxin type B (Myobloc)? 1. It can be classified as a cholinergic agonist. 2. Increased muscle strength is often seen within a couple of weeks. 3. It can take 6 months for the effects to be seen. 4. In high doses, it is poisonous, causing the same symptoms food poisoning does. Correct Answer: 4 Rationale 1: The drug works by blocking the release of acetylcholine from cholinergic nerve terminals. Rationale 2: It generally takes 6 weeks to see the effects. Rationale 3: Effects typically only last for 3–6 months. Rationale 4: Botulinum toxin type B (Myobloc) is toxic in high doses. Clostridium botulinum is the bacterium responsible for food poisoning. Global Rationale: Botulinum toxin type B (Myobloc) is toxic in high doses. Clostridium botulinum is the bacterium responsible for food poisoning. The drug works by blocking the release of acetylcholine from cholinergic nerve terminals. It generally takes 6 weeks to see the effects, and they only last for 3–6 months. Patients taking this drug generally experience muscle weakness, not strength. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 21-5 Compare and contrast the roles of the following drug categories in treating muscle spasms and spasticity: centrally acting skeletal muscle relaxants, direct-acting antispasmodics, and skeletal muscle relaxants for short medical procedures. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 303 Question 20 Type: MCMA A patient tells the nurse, "I have been reading about using capsaicin as a treatment for muscle pain. Do you know anything about that?" How should the nurse respond to this question? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Why don't you ask the doctor about whether it works or not?" 2. "I think you take a tablespoon twice a day." 3. "You should use a hot pad on the site prior to applying the capsaicin." 4. "Some patients report that capsaicin stings." 5. "Be certain to wash your hands after applying the capsaicin." Correct Answer: 4,5 Rationale 1: The nurse should be prepared to discuss pharmaceutical and nonpharmaceutical methods of symptom management, including complementary and alternative therapies. There is no reason to defer to the health care provider. Rationale 2: Capsaicin is used as a topical application when it is used for muscle pain. Rationale 3: The patient should apply a cool compress to the application site prior to using capsaicin. Rationale 4: Reddening of the skin and local stinging are the most common side effects. Rationale 5: Capsaicin will cause burning of eyes or mucous membranes so the patient should carefully wash hands after applying this ointment. Global Rationale: Reddening of the skin and local stinging are the most common side effects.Capsaicin will cause burning of eyes or mucous membranes so the patient should carefully wash hands after applying this ointment.The nurse should be prepared to discuss pharmaceutical and nonpharmaceutical methods of symptom management, including complementary and alternative therapies. There is no reason to defer to the health care provider.Capsaicin is used as a topical application when it is used for muscle pain.Reddening of the skin and local stinging are the most common side effects. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in health care. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-2 Discuss pharmacologic and nonpharmacologic therapies used to treat muscle spasms and spasticity. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 303 Question 21 Type: MCMA A nurse is providing discharge instruction for a patient who had onabotulinumtoxinA (Botox) injected to smooth the wrinkles across his forehead. The nurse would advise this patient to monitor for which changes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Chest pain 2. Urinary retention 3. Heart palpitations 4. Difficulty swallowing 5. Eye spasm Correct Answer: 1,3,4 Rationale 1:Angina is an adverse effect of this medication. Rationale 2: Loss of bladder control is the adverse effect associated with onabotulinumtoxinA (Botox). Rationale 3: Dysrhythmias may occur. Rationale 4: Difficulty swallowing may occur. Rationale 5:OnabotulinumtoxinA (Botox) is used to treat eye spasm. Global Rationale:Angina is an adverse effect of this medication.Dysrhythmias may occur, as may difficulty swallowing. Loss of bladder control is the adverse effect associated with onabotulinumtoxinA (Botox).OnabotulinumtoxinA (Botox) is used to treat eye spasm. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-5 Compare and contrast the roles of the following drug categories in treating muscle spasms and spasticity: centrally acting skeletal muscle relaxants, direct-acting antispasmodics, and skeletal muscle relaxants for short medical procedures. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 305 Question 22 Type: MCMA The parents of a 2-year-old who has cerebral palsy are only now beginning to accept that their child will have a permanent disability. The nurse has been instructing the parents about the treatment for the spasticity their child is experiencing. Which statements by the parents indicate that the nurse should plan additional teaching sessions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "At some point, our child may require surgery to correct this spasticity." 2. "As long as we continue our child's medications, the spasticity can be controlled." 3. "Our physical therapy sessions should focus on flexing our child's muscles." 4. "We should repeat the exercises several times with each muscle group." 5. "It is best to give our child a rest from physical therapy by skipping 1 week a month." Correct Answer: 2,3,5 Rationale 1: Surgery is sometimes necessary in these cases, so this statement reflects accurate knowledge. Rationale 2: Medication alone is generally not enough to control spasticity in these children. The parents need additional teaching. Rationale 3: The physical therapy sessions for spasticity focus on muscle stretching, not flexion. The parents need additional teaching. Rationale 4: Repetitive motion exercises are beneficial in reducing and controlling spasticity. The parents have expressed accurate knowledge. Rationale 5: Physical therapy should be routine and consistent in order to reduce or control spasticity. These parents need additional teaching. Global Rationale: Medication alone is generally not enough to control spasticity in these children. The parents need additional teaching.The physical therapy sessions for spasticity focus on muscle stretching, not flexion. The parents need additional teaching.Physical therapy should be routine and consistent in order to reduce or control spasticity. These parents need additional teaching.Surgery is sometimes necessary in these cases, so this statement reflects accurate knowledge.Repetitive motion exercises are beneficial in reducing and controlling spasticity. The parents have expressed accurate knowledge. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.17 Develop a beginning understanding of complementary and alternative modalities and their role in health care. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 21-2 Discuss pharmacologic and nonpharmacologic therapies used to treat muscle spasms and spasticity. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 303 Question 23 Type: MCSA The patient's health care provider prescribed cyclobenzaprine (Flexeril) for the treatment of neck spasms. The patient reports that the medication is "not working," even though it has been a week since the medication was started. What changes in this patient's plan of care would the nurse anticipate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Increase in the dosage frequency 2. Discontinuation of the medication 3. Waiting a few more days for full medication effect 4. Change to a different medication Correct Answer: 2,4 Rationale 1: Increasing the dosage frequency is not indicated. Rationale 2: It is not yet time to discontinue the medication. Rationale 3: Full effects of this medication may take two weeks. Rationale 4: It is not yet time to change medications. Global Rationale: Full effects of this medication may take two weeks.Increasing the dosage frequency is not indicated.It is not yet time to discontinue the medication or to change the medication. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 21-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 302 Question 24 Type: MCMA The patient tells the nurse, "The doctor is going to start me on Botox for the muscle spasms in my neck. I've always wanted to try that. It will make my face look younger." What information should the nurse provide to this patient regarding onabotulinumtoxinA (Botox)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Once you start on the medication, it may take a week or so before you notice a change in your skin." 2. "Be certain you take the medication with a full glass of water because it can be hard on your kidneys." 3. "There are many different uses for that drug, depending on how it is administered." 4. "You may need additional treatments with the medication in a few months." 5. "You should be aware that side effects of the medication can occur hours or weeks after your treatment." Correct Answer: 3,4,5 Rationale 1: OnabotulinumtoxinA (Botox) in this patient's case will not change the skin. Rationale 2: OnabotulinumtoxinA (Botox) is administered by injection into the muscle. Rationale 3: OnabotulinumtoxinA (Botox) has many clinical indications. Action depends on the area where the medication is administered. Rationale 4: Repeated doses of onabotulinumtoxinA (Botox) are often required. Rationale 5: Side effects of onabotulinumtoxinA (Botox) may not occur immediately upon administration, and the patient should watch for their development for several hours to weeks later. Global Rationale: OnabotulinumtoxinA (Botox) has many clinical indications. Repeated doses of onabotulinumtoxinA (Botox) are often required.Side effects of onabotulinumtoxinA (Botox) may not occur immediately upon administration, and the patient should watch for their development for several hours to weeks later. Action depends on the area where the medication is administered. OnabotulinumtoxinA (Botox) in this patient's case will not change the skin.OnabotulinumtoxinA (Botox) is administered by injection into the muscle. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-5 Compare and contrast the roles of the following drug categories in treating muscle spasms and spasticity: centrally acting skeletal muscle relaxants, direct-acting antispasmodics, and skeletal muscle relaxants for short medical procedures. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 303 Question 25 Type: MCMA The nurse is discharging a 72-year-old man who was hospitalized after a muscle strain injury to his back. One of the discharge prescriptions for this patient is cyclobenzaprine (Flexeril) 10 mg three times per day with food. The prescription is written for 90 tablets and there are three refills available. Which information from this situation would alert the nurse for the need to collaborate with the patient's health care provider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The dosage amount is too low for the type of injury this patient sustained. 2. Cyclobenzaprine should be used with great caution in those over 65. 3. If taken as directed, the patient would be able to take the medication for 120 days. 4. Cyclobenzaprine is not effective for back pain. 5. Cyclobenzaprine should not be taken with food. Correct Answer: 2,3,5 Rationale 1: The dosage of 10 mg three times daily is standard. Rationale 2: The adverse reactions from cyclobenzaprine include confusion, hallucinations, and cardiac events, which are more common in patients over 65. Rationale 3: The manufacturer recommends that treatment not extend beyond 3 weeks or 21 days. Rationale 4: Cyclobenzaprine is not effective for muscle spasm due to spinal cord injury but is useful in the treatment of back pain from muscle strain. Rationale 5: The drug may be taken with food or milk if gastric upset occurs. Global Rationale: The adverse reactions from cyclobenzaprine include confusion, hallucinations, and cardiac events, which are more common in patients over 65.The manufacturer recommends that treatment not extend beyond 3 weeks or 21 days.The drug may be taken with food or milk if gastric upset occurs. The dosage of 10 mg three times daily is standard.Cyclobenzaprine is not effective for muscle spasm due to spinal cord injury but is useful in the treatment of back pain from muscle strain. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 302 Question 26 Type: MCMA A nurse is talking with a patient who has just been prescribed cyclobenzaprine (Flexeril). The nurse would provide additional information if the patient made which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “My wife and I are driving our motor home to the beach tomorrow.” 2. “I am going home to mow my lawn.” 3. “I take a nap every afternoon.” 4. “I just checked out a new book from the library.” 5. “I am taking my grandchildren to the zoo tomorrow.” Correct Answer: 1,2,5 Rationale 1:The patient should avoid driving until the effects of the medication are known. Rationale 2: The patient should not operate machinery until the effects of the medication are known. Rationale 3: The medication will probably cause the patient to be drowsy. Rationale 4: Reading is a quiet activity that does not require the use of dangerous equipment. Rationale 5: It is not wise for the patient to be responsible for children until the effects of the medication are known. Global Rationale:The patient should not drive or operate machinery until the effects of the medication are known.It is not wise for the patient to be responsible for children until the effects of the medication are known.The medication will probably cause the patient to be drowsy. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 21-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 307 Question 27 Type: SEQ The nurse suspects that a patient is developing malignant hyperthermia. Arrange these interventions in the correct order of priority. 1. Start dantrolene therapy 2. Identify any signs and symptoms that support this suspicion. 3. Control associated symptoms 4. Discontinue medication that may cause malignant hyperthermia. 5. Maintain intravenous dantrolene Standard Text: Click and drag the options below to move them up or down. Correct Answer: 2,4,1,3,5 Global Rationale: Treatment of malignant hyperthermia requires rapid identification of signs and symptoms, discontinuation of the triggering agent, institution of dantrolene therapy, control of associated symptoms, and maintaining intravenous dantrolene. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-7 Use the nursing process to care for patients receiving pharmacotherapy for muscle spasms. MNL Learning Outcome: 3.6.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 307 Question 28 Type: MCMA The nurse would plan to most closely observe which patients for the development of liver toxicity after dantrolene (Dantrium) is initiated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A 49-year-old woman who has a history of esophagitis. 2. A 60-year-old man with pneumonia. 3. A 38-year-old woman who has type 2 diabetes. 4. An 18-year-old who injured his leg playing soccer. 5. A 26-year-old woman who has an ostomy. Correct Answer: 1,3 Rationale 1:A 49-year-old woman is in the high risk group. Rationale 2: Risk is present for all patients, but there is nothing about this scenario that indicates risk is particularly high. Rationale 3: A 38-year-old woman is in the high risk group. Rationale 4: Risk is present for all patients, but there is nothing about this scenario that indicates risk is particularly high. Rationale 5:Risk is present for all patients, but there is nothing about this scenario that indicates risk is particularly high. Global Rationale: Women over age 35 are at high risk for development of hepatotoxicity. While risk is present for all patients, there is nothing in the other scenarios that indicates risk is particularly high. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 21-7 Use the nursing process to care for patients receiving pharmacotherapy for muscle spasms. MNL Learning Outcome: 3.6.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 308 Question 29 Type: MCMA A patient experienced malignant hyperthermia after receiving anesthesia and is being maintained on dantrolene (Revonto). The nurse would increase assessment for which findings? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Swelling at the IV site 2. Muscle weakness 3. Sore throat 4. Irritability 5. Anorexia Correct Answer: 1,2 Rationale 1:Injection site reactions such as pain, redness, and swelling are adverse reactions. Rationale 2: Muscle weakness is an adverse reaction. Rationale 3: Sore throat is not associated with administration of dantrolene (Revonto). Rationale 4: Irritability is not associated with administration of dantrolene (Revonto). Rationale 5:Anorexia is not associated with administration of dantrolene (Revonto). Global Rationale:Injection site reactions such as pain, redness, and swelling are adverse reactions.Muscle weakness is an adverse reaction.Sore throat, irritability, and anorexia are not associated with administration of dantrolene (Revonto). Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 21-5 Compare and contrast the roles of the following drug categories in treating muscle spasms and spasticity: centrally acting skeletal muscle relaxants, direct-acting antispasmodics, and skeletal muscle relaxants for short medical procedures. MNL Learning Outcome: 3.6.2 Compare the classes of medications used in pharmacologic management. Page Number: 308 Question 30 Type: MCMA A patient calls the clinic and asks for a refill for a prescription for cyclobenzaprine (Flexeril) that was written a year ago. Which information from the medical record would the nurse draw to the prescriber’s attention? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The patient reported drinking wine each day with dinner. 2. The patient has been using nasal saline spray for allergies. 3. The patient was prescribed a MAO inhibitor last month. 4. The patient’s blood glucose was elevated at the last visit. 5. The patient had a ulnar fracture repaired a year ago. Correct Answer: 1,3 Rationale 1:Alcohol should not be consumed while taking cyclobenzaprine (Flexeril). Rationale 2: There is no interaction between nasal saline spray and cyclobenzaprine (Flexeril). Rationale 3: Concurrent use of cyclobenzaprine (Flexeril) and MAOIs is contraindicated. Rationale 4: There is no contraindication for use of cyclobenzaprine (Flexeril) in a patient with elevated blood glucose. Rationale 5: There is no relationship between use of cyclobenzaprine (Flexeril) and a fractured ulna. Global Rationale:Alcohol should not be consumed while taking cyclobenzaprine (Flexeril).Concurrent use of cyclobenzaprine (Flexeril) and MAOIs is contraindicated.There is no interaction between nasal saline spray and cyclobenzaprine (Flexeril).There is no contraindication for use of cyclobenzaprine (Flexeril) in a patient with elevated blood glucose.There is no relationship between use of cyclobenzaprine (Flexeril) and a fractured ulna. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 21-7 Use the nursing process to care for patients receiving pharmacotherapy for muscle spasms. MNL Learning Outcome: 3.6.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 302 [Show More]

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