Pharmacology And the Nursing Process  8e by Linda Lane Collins -Julie S. Snyder  – Test Bank  

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INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS

 

Pharmacology And the Nursing Process  8e by Linda Lane Collins -Julie S. Snyder  – Test Bank

 

Sample  Questions

 

Chapter 07: Over-the-Counter Drugs and Herbal and Dietary Supplements

Lilley: Pharmacology and the Nursing Process, 8th Edition

 

MULTIPLE CHOICE

 

  1. A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go “natural” with her pregnancy. She shows the nurse a list of herbal remedies that she wants to buy so that she can “avoid taking any drugs.” Which statement by the nurse is correct?
a. “Most herbal remedies are not harmful and are safe for use during pregnancy.”
b. “Please read each label carefully before use to check for cautionary warnings.”
c. “Keep in mind that products from different manufacturers are required to contain consistent amounts of the herbal products.”
d. “It’s important to remember that herbal remedies do not have proven safety ratings for pregnant women.”

 

 

ANS:  D

The fact that a drug is an herbal or a dietary supplement does not mean that it can be safely administered to children, infants, or pregnant or lactating women. Many herbal products have not been tested for safety during pregnancy. Simply reading the labels may not provide enough information for use during pregnancy. Last, manufacturers of herbal products are not required to guarantee the reliability of the contents.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 93

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. The patient is asking the nurse about current U.S. laws and regulations of herbal products. According to the Dietary Supplement and Health Education Act of 1994, which statement is true?
a. Medicinal herbs are viewed as dietary supplements.
b. Herbal remedies are held to the same standards as drugs.
c. Producers of herbal products must prove therapeutic efficacy.
d. Herbal remedies are protected by patent laws.

 

 

ANS:  A

Current U.S. laws view herbal products as dietary supplements and do not hold them to the same efficacy standards as drugs. The other options do not correctly reflect current U.S. laws regarding herbal supplements.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 89

TOP:   NURSING PROCESS: General

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The patient wants to take the herb valerian to help him rest at night. The nurse would be concerned about potential interactions if he is taking a medication from which class of drugs?
a. Digitalis
b. Anticoagulants
c. Sedatives
d. Immunosuppressants

 

 

ANS:  C

Valerian may cause increased central nervous system depression if used with sedatives. Digitalis, anticoagulants, and immunosuppressants do not have interactions with valerian.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 90

TOP:   NURSING PROCESS: Assessment

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. The patient has been taking an over-the-counter (OTC) acid-reducing drug because he has had “stomach problems” for several months. He tells the nurse that the medicine helps as long as he takes it, but once he stops it, the symptoms return. Which statement by the nurse is the best advice for this patient?
a. “The over-the-counter drug has helped you, so you should continue to take it.”
b. “The over-the-counter dosage may not be strong enough. You should be taking prescription-strength for best effects.”
c. “For best results, you need to watch what you eat in addition to taking this drug.”
d. “Using this drug may relieve your symptoms, but it does not address the cause. You should be seen by your health care provider.”

 

 

ANS:  D

The use of OTC drugs may postpone effective management of chronic disease states and may delay treatment of serious or life-threatening disorders because these drugs may relieve symptoms without necessarily addressing the cause of the disorder. The other options do not address the need to investigate the cause of the symptoms and are incorrect.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 87

TOP:   NURSING PROCESS: Planning

MSC:  NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. During an assessment, the patient tells the nurse that he eats large amounts of garlic for its cardiovascular benefits. Which drug or drug class, if taken, would have a potential interaction with the garlic?
a. Acetaminophen (Tylenol)
b. Insulin
c. Antilipemic drugs
d. Sedatives

 

 

ANS:  B

The use of garlic may interfere with hypoglycemic drugs. The other options are incorrect because acetaminophen, antilipemic drugs, and sedatives do not have interactions with garlic.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 90

TOP:   NURSING PROCESS: Planning

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. A patient calls the clinic to ask about taking cranberry dietary supplement capsules because a friend recommended them. The nurse will discuss which possible concern when a patient is taking cranberry supplements?
a. It may increase the risk for bleeding if the patient is taking anticoagulants.
b. It may increase the risk of toxicity of some psychotherapeutic drugs.
c. It may reduce elimination of drugs that are excreted by the kidneys.
d. Cranberry may increase the intensity and duration of effects of caffeine.

 

 

ANS:  C

The use of cranberry decreases the elimination of many drugs that are renally excreted. The other concerns do not occur with cranberry supplements.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 90

TOP:   NURSING PROCESS: Planning

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. A patient wants to take the herb gingko to help his memory. The nurse reviews his current medication list and would be concerned about potential interactions if he is taking a medication from which class of drugs?
a. Digitalis
b. Anticoagulants
c. Sedatives
d. Immunosuppressants

 

 

ANS:  B

The use of gingko increases the risk of bleeding with anticoagulants (warfarin, heparin) and antiplatelets (aspirin, clopidogrel). The other concerns do not occur with gingko supplements.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 90

TOP:   NURSING PROCESS: Planning

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

MULTIPLE RESPONSE

 

  1. The nurse is conducting a class for senior citizens about the use of over-the-counter (OTC) drugs. Which statements are true regarding the use of OTC drugs? (Select all that apply.)
a. Use of OTC drugs may delay treatment of serious ailments.
b. Drug interactions with OTC medications are rare.
c. OTC drugs may relieve symptoms without addressing the cause of the problem.
d. OTC drugs are indicated for long-term treatment of conditions.
e. Patients may misunderstand product labels and use the drugs improperly.

 

 

ANS:  A, C, E

It is true that use of OTC drugs may delay treatment of serious ailments; OTC drugs may relieve symptoms without addressing the cause of the problem, and patients may misunderstand product labels and use the drugs improperly. These statements should be included when teaching patients about their use. In contrast, drug interactions with OTC medications are not rare and may indeed occur with prescription medications and other OTC drugs. Normally, OTC drugs are intended for short-term treatment of minor ailments.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   pp. 86-88

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is reviewing the criteria for over-the-counter drugs. Which criteria for over-the-counter status in the United States are accurate? (Select all that apply.)
a. The drug must be easy to use.
b. The drug must have a low therapeutic index.
c. The consumer must be able to monitor the drug’s effectiveness.
d. The drug must have a low potential for abuse.
e. The drug must not have any interactions with other drugs.

 

 

ANS:  A, C, D

In the United States, criteria for over-the-counter status include the drug being easy to use, the drug having a low potential for abuse, and the consumer must be able to monitor the drug’s effectiveness for the condition. The drug must have a high therapeutic index (not a low one), and the drug must have limited interactions with other drugs.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 87

TOP:   NURSING PROCESS: General

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Chapter 09: Photo Atlas of Drug Administration

Lilley: Pharmacology and the Nursing Process, 8th Edition

 

MULTIPLE CHOICE

 

  1. Before administering any medication, what is the nurse’s priority action regarding patient safety?
a. Verifying orders with another nurse
b. Documenting the medications given
c. Counting medications in the medication cart drawers
d. Checking the patient’s identification using two identifiers

 

 

ANS:  D

Verifying the patient’s identity, using two identifiers, before administering any medication is essential for the patient’s safety and reflects checking one of the “Nine Rights” of medication administration. Documentation is done after the medications are given.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   pp. 104-105

TOP:   NURSING PROCESS: Assessment

MSC:  NCLEX: Safe and Effective Care Environment: Safety and Infection Control

 

  1. The nurse is giving an intradermal (ID) injection and will choose which syringe for this injection?
a.
b.
c.
d.

 

 

ANS:  B

The proper size syringe for ID injection is 1-mL tuberculin. The other syringes pictured are incorrect. Insulin syringes (marked in units) are not used for intradermal injections.

 

DIF:    COGNITIVE LEVEL: Analyzing (Analysis)                   REF:   pp. 116-117

TOP:   NURSING PROCESS: Planning

MSC:  NCLEX: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A patient is to receive a penicillin intramuscular (IM) injection in the ventrogluteal site. The nurse will use which angle for the needle insertion?
a. 15 degrees
b. 45 degrees
c. 60 degrees
d. 90 degrees

 

 

ANS:  D

The proper angle for IM injections is 90 degrees. The other angles are incorrect.

 

DIF:    COGNITIVE LEVEL: Remembering (Knowledge)         REF:   p. 116

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. When administering medication by IV bolus (push), the nurse will occlude the IV line by which method?
a. Not pinching the IV tubing at all
b. Pinching the tubing just above the injection port
c. Pinching the tubing just below the injection port
d. Pinching the tubing just above the drip chamber of the infusion set

 

 

ANS:  B

Before a medication is injected by IV push, the IV line is occluded by pinching the tubing just above the injection port. The other locations are incorrect.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 128

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse has an order to administer an intramuscular (IM) immunization to a 2-month-old child. Which site is considered the best choice for this injection?
a. Deltoid
b. Dorsogluteal
c. Ventrogluteal
d. Vastus lateralis

 

 

ANS:  D

The vastus lateralis is the preferred site of injection of drugs such as immunizations for infants. The other sites are not appropriate for infants. The ventrogluteal site is the preferred site for adults and children. The deltoid site is used only for the administration of immunizations to toddlers, older children, and adults (not infants) and only for small volumes of medication. The dorsogluteal site is no longer recommended because of the possibility of nerve injury.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 122

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse needs to administer insulin subcutaneously to an obese patient. Which is the proper technique for this injection?
a. Using the Z-track method
b. Inserting the needle at a 5- to 15-degree angle until resistance is felt
c. Pinching the skin at the injection site, and then inserting the needle to below the tissue fold at a 90-degree angle
d. Spreading the skin tightly over the injection site, inserting the needle, and then releasing the skin

 

 

ANS:  C

The proper technique for a subcutaneous injection for an obese patient is to pinch the skin at the site and inject the needle to below the skin fold at a 90-degree angle.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 116

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse will plan to use the Z-track method of intramuscular (IM) injections for which situation?
a. The medication is known to be irritating to tissues.
b. The patient is emaciated and has very little muscle mass.
c. The medication must be absorbed quickly into the tissues.
d. The patient is obese and has a deep fat layer below the muscle mass.

 

 

ANS:  A

The Z-track method is used for medications known to irritate tissues or for medications that are painful or cause stains to the tissues. It also prevents the deposit of medication into more sensitive subcutaneous tissues. The other options are not appropriate situations for the Z-track method.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 120

TOP:   NURSING PROCESS: Planning

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. After administering an intradermal (ID) injection for a skin test, the nurse notices a small bleb at the injection site. The best action for the nurse to take at this time is to:
a. apply heat.
b. massage the area.
c. do nothing.
d. report the bleb to the physician.

 

 

ANS:  C

The formation of a small bleb is expected after an ID injection for skin testing. The other actions are not appropriate.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 116

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is administering an IV push medication through an IV lock. After injecting the medication, which action will be taken next?
a. Flushing the lock
b. Regulating the IV flow
c. Clamping the tubing for 10 minutes
d. Holding the patient’s arm up to improve blood flow

 

 

ANS:  A

IV locks are to be flushed before and after each use; either heparin or saline flush is used, depending on the individual institution’s policy. The other actions are not appropriate.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 128

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. When adding medications to a bag of intravenous (IV) fluid, the nurse will use which method to mix the solution?
a. Shaking the bag or bottle vigorously
b. Turning the bag or bottle gently from side to side
c. Inverting the bag or bottle one time after injecting the medication
d. Allowing the IV solution to stand for 10 minutes to enhance even distribution of medication

 

 

ANS:  B

When medications are added to IV fluid containers, the medication and the IV solution are mixed by holding the bag or bottle and turning it end-to-end, mixing it gently. Shaking vigorously is not appropriate; inverting the bag just once or simply allowing the bag to stand for 10 minutes may not be sufficient to mix the medication into the fluid.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 124

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is measuring 4 mL of a liquid cough elixir for a child. Which method is most appropriate?
a. Using a teaspoon to measure and administer
b. Holding the medication cup at eye level and filling it to the desired level
c. Withdrawing the elixir from the container using a syringe without a needle attached
d. Withdrawing the elixir from the container using a calibrated oral syringe

 

 

ANS:  D

Small doses of liquid medications must be withdrawn using a calibrated oral syringe. A hypodermic syringe or a syringe with a needle or syringe cap must not be used. If hypodermic syringes are used, the drug may be inadvertently given parenterally, or the syringe cap or needle, if not removed from the syringe, may become dislodged and accidentally aspirated by the patient when the syringe plunger is pressed. The other methods are not accurate for small volumes.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 109

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. While the nurse is assisting a patient in taking his medications, the medication cup falls to the floor, spilling the tablets. What is the nurse’s best action at this time?
a. Discarding the medications and repeating preparation
b. Asking the patient if he will take the medications
c. Waiting until the next dose time, and then giving the medications
d. Retrieving the medications and administering them to avoid waste

 

 

ANS:  A

Medications that fall to the floor must be discarded, and the procedure must be repeated with new medications. The other actions are not appropriate.

 

DIF:    COGNITIVE LEVEL: Analyzing (Analysis)                   REF:   p. 105

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Safe and Effective Care Environment: Safety and Infection Control

 

  1. When giving a buccal medication to a patient, which action by the nurse is appropriate?
a. Encouraging the patient to swallow, if necessary
b. Administering water after the medication has been given
c. Placing the medication between the upper or lower molar teeth and the cheek
d. Placing the tablet under the patient’s tongue and allowing it to dissolve completely

 

 

ANS:  C

Buccal medications are properly administered between the upper or lower molar teeth and the cheek. Caution the patient against swallowing, and do not administer with water. Medications given under the tongue are sublingually administered.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 106

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is giving medications through a percutaneous endoscopic gastrostomy (PEG) tube. Which technique is correct?
a. Administering the medications using a 3-mL medication syringe
b. Applying firm pressure on the syringe’s piston to infuse the medication
c. Flushing the tubing with 30 mL of saline after the medication has been given
d. Using the barrel of the syringe, allowing the medication to flow via gravity into the tube

 

 

ANS:  D

For PEG tubes (and nasogastric tubes), medications are poured into the barrel of the syringe with the piston removed, and the medication is allowed to flow via gravity into the tube. Fluid must never be forced into the tube. The tubing is to be flushed with 30 mL of tap water (not saline) to ensure that the medication is cleared from the tube after the medication has been given. A 3-mL syringe is too small for this procedure.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 110

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is about to give a rectal suppository to a patient. Which technique would facilitate the administration and absorption of the rectal suppository?
a. Having the patient lie on his or her right side, unless contraindicated
b. Having the patient hold his or her breath during insertion of the medication
c. Lubricating the suppository with a small amount of petroleum-based lubricant before insertion
d. Encouraging the patient to lie on his or her left side for 15 to 20 minutes after insertion

 

 

ANS:  D

Position the patient on his or her left side for rectal suppository insertion. The suppository is then lubricated with a small amount of water-soluble lubricant, not petroleum-based substances. The patient is told to take a deep breath and exhale through the mouth during insertion. Then the patient needs to remain lying on the left side for 15 to 20 minutes to allow absorption of the drug.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 111

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient is receiving eyedrops that contain a beta-blocker medication. The nurse will use what method to reduce systemic effects after administering the eyedrops?
a. Wiping off excess liquid immediately after instilling the drops
b. Having the patient close the eye tightly after the drops are instilled
c. Having the patient try to keep the eye open for 30 seconds after the drops are instilled
d. Applying gentle pressure to the patient’s nasolacrimal duct for 30 to 60 seconds after instilling the drops

 

 

ANS:  D

When administering ophthalmic drugs that may cause systemic effects, one’s finger should be protected by a clean tissue or glove and gentle pressure applied to the patient’s nasolacrimal duct for 30 to 60 seconds. The other actions are not appropriate.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 130

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A 2-year-old child is to receive eardrops. The nurse is teaching the parent about giving the eardrops. Which statement reflects the proper technique for administering eardrops to this child?
a. Administer the drops without pulling on the ear lobe.
b. Straighten the ear canal by pulling the lobe upward and back.
c. Straighten the ear canal by pulling the pinna down and back.
d. Straighten the ear canal by pulling the pinna upward and outward.

 

 

ANS:  C

In an infant or a child younger than 3 years of age, the ear canal is straightened by pulling the pinna down and back. In adults, the pinna is pulled up and outward. Pulling the lobe and administering eardrops without pulling on the ear lobe are not appropriate actions.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 131

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient with asthma is to begin medication therapy using a metered-dose inhaler. What is an important reminder to include during teaching sessions with the patient?
a. Repeat subsequent puffs, if ordered, after 5 minutes.
b. Inhale slowly while pressing down to release the medication.
c. Inhale quickly while pressing down to release the medication.
d. Administer the inhaler while holding it 3 to 4 inches away from the mouth.

 

 

ANS:  B

Position the inhaler to an open mouth, with the inhaler 1 to 2 inches away from the mouth, or attach a spacer to the mouthpiece of the inhaler, or place the mouthpiece in the mouth. To administer, press down on the inhaler to release the medication while inhaling slowly. Wait 1 to 2 minutes between puffs if a second puff of the same medication has been ordered.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 132

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. When giving medications, the nurse will use Standard Precautions, which include what action?
a. Bending the needle to prevent reuse
b. Recapping needles to prevent needle sticks
c. Discarding all syringes and needles in the trash can
d. Discarding all syringes and needles in a puncture-resistant container

 

 

ANS:  D

Standard Precautions include wearing clean gloves when there is potential exposure to a patient’s blood or other body fluids; never recapping needles; never bending needles or syringes; and discarding all disposable syringes and needles in the appropriate puncture-resistant container.

 

DIF:    COGNITIVE LEVEL: Remembering (Knowledge)         REF:   p. 108

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A patient says he prefers to chew rather than swallow his pills. One of the pills has the abbreviation SR behind the name of the medication. The nurse needs to remember which correct instruction regarding how to give this medication?
a. Break the tablet into halves or quarters.
b. Dissolve the tablet in a small amount of water before giving it.
c. Do not crush or break the tablet before administration.
d. Crush the tablet as needed to ease administration.

 

 

ANS:  C

Sustained-release (SR) and enteric-coated tablets or capsules are forms of medications that must not be crushed before administration so as to protect the gastrointestinal lining or the medication itself. Do not break, dissolve, or crush these tablets before administering.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 106

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Safe and Effective Care Environment: Safety and Infection Control

 

  1. When administering nasal spray, which instruction by the nurse is appropriate?
a. “You will need to blow your nose before I give this medication.”
b. “You will need to blow your nose after I give this medication.”
c. “When I give this medication, you will need to hold your breath.”
d. “You need to sit up for 5 minutes after you receive the nasal spray.”

 

 

ANS:  A

Clear the nasal passages before receiving nasal spray. Blowing one’s nose after receiving the medication will remove the medication from the nasal passages. The patient will receive the spray while inhaling through the open nostril and needs to remain in a supine position for 5 minutes afterward.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 136

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. The nurse is preparing to give an aqueous intramuscular (IM) injection to an average-sized adult. Which actions are appropriate? (Select all that apply.)
a. Choose a 26- or 27-gauge, – to -inch needle.
b. Choose a 22- to 27-gauge, 1- to -inch needle.
c. Choose the dorsogluteal site, the preferred site for IM injections for adults.
d. Insert the needle at a 45-degree angle.
e. Insert the needle at a 90-degree angle.
f. Before injecting the medication, withdraw the plunger to check for blood return.

 

 

ANS:  B, E, F

In general, aqueous medications can be given with a 22- to 27-gauge needle, and average needle lengths for adults range from 1 to  inches. Insert the needle at a 90-degree angle. Checking for blood return is also part of the technique for IM injections to prevent inadvertent administration into the bloodstream. The ventrogluteal site is the preferred site for IM injections in adults. The dorsogluteal site is to be avoided because of proximity to nerves and blood vessels.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   pp. 116

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

COMPLETION

 

  1. A patient is to receive hydromorphone (Dilaudid) 1.5 mg IV push now. The medication comes in a prefilled syringe, 2 mg/mL. Identify how many milliliters will the nurse administer for this dose. _______

 

ANS:

0.75 mL

 

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   N/A

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Chapter 11: General and Local Anesthetics

Lilley: Pharmacology and the Nursing Process, 8th Edition

 

MULTIPLE CHOICE

 

  1. During a fishing trip, a patient pierced his finger with a large fishhook. He is now in the emergency department to have it removed. The nurse anticipates that which type of anesthesia will be used for this procedure?
a. No anesthesia
b. Topical benzocaine spray on the area
c. Topical prilocaine (EMLA) cream around the site
d. Infiltration of the puncture wound with lidocaine

 

 

ANS:  D

Infiltration anesthesia is commonly used for minor surgical procedures. It involves injecting the local anesthetic solution intradermally, subcutaneously, or submucosally across the path of nerves supplying the area to be anesthetized. The local anesthetic may be administered in a circular pattern around the operative field. The other types are not appropriate for this injury. This is a painful procedure; therefore, the option of “no anesthesia” is incorrect.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 176

TOP:   NURSING PROCESS: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. While monitoring a patient who had surgery under general anesthesia 2 hours ago, the nurse notes a sudden elevation in body temperature. This finding may be an indication of which problem?
a. Tachyphylaxis
b. Postoperative infection
c. Malignant hypertension
d. Malignant hyperthermia

 

 

ANS:  D

A sudden elevation in body temperature during the postoperative period may indicate the occurrence of malignant hyperthermia, a life-threatening emergency. The elevated temperature does not reflect the other problems listed.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 174

TOP:   NURSING PROCESS: Assessment

MSC:  NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. When assessing patients in the preoperative area, the nurse knows that which patient is at a higher risk for an altered response to anesthesia?
a. The 21-year-old patient who has never had surgery before
b. The 35-year-old patient who stopped smoking 8 years ago
c. The 40-year-old patient who is to have a kidney stone removed
d. The 82-year-old patient who is to have gallbladder removal

 

 

ANS:  D

The elderly patient is more affected by anesthesia than the young or middle-aged adult patient because of the effects of aging on the hepatic, cardiac, respiratory, and renal systems.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 173

TOP:   NURSING PROCESS: Assessment

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. A patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which nursing diagnosis would be appropriate for this patient?
a. Anxiety related to the use of an anesthetic
b. Risk for injury related to increased sensorium from general anesthesia
c. Decreased cardiac output related to systemic effects of local anesthesia
d. Impaired gas exchange related to central nervous system depression produced by general anesthesia

 

 

ANS:  D

The nursing diagnosis of impaired gas exchange is appropriately worded for this patient. Anxiety would not be appropriate while the patient is in surgery. Sensorium would be decreased during surgery, not increased. Cardiac output is affected by general anesthesia, not local anesthesia.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 183

TOP:   NURSING PROCESS: Nursing Diagnosis

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. When administering a neuromuscular blocking drug, the nurse needs to remember which principle?
a. It is used instead of general anesthesia during surgery.
b. Only skeletal muscles are paralyzed; respiratory muscles remain functional.
c. It causes sedation and pain relief while allowing for lower doses of anesthetics.
d. Artificial mechanical ventilation is required because of paralyzed respiratory muscles.

 

 

ANS:  D

Patients receiving neuromuscular blocking drugs require artificial mechanical ventilation because of the resultant paralysis of the respiratory muscles. In addition, they do not cause sedation or pain relief. They are used along with, not instead of, general anesthesia during surgery.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 178

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient is being prepared for an oral endoscopy, and the nurse anesthetist reminds him that he will be awake during the procedure but probably will not remember it. What type of anesthetic technique is used in this situation?
a. Local anesthesia
b. Moderate sedation
c. Topical anesthesia
d. Spinal anesthesia

 

 

ANS:  B

Moderate sedation effectively reduces patient anxiety, sensitivity to pain, and recall of the medical procedure, yet it preserves a patient’s ability to maintain his or her own airway and respond to verbal commands. The other options are incorrect.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 175

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a patient who had hip surgery. The patient is experiencing tachycardia, tachypnea, and muscle rigidity, and his temperature is 103° F (39.4° C). The nurse will prepare for what immediate treatment?
a. Naltrexone hydrochloride (Narcan) injection, an opioid reversal drug
b. Dantrolene (Dantrium) injection, a skeletal muscle relaxant
c. An anticholinesterase drug, such as neostigmine
d. Cardiopulmonary resuscitation (CPR) and intubation

 

 

ANS:  B

Tachycardia, tachypnea, muscle rigidity, and raised temperature are symptoms of malignant hyperthermia, which is treated with cardiorespiratory supportive care as needed to stabilize heart and lung function as well as with immediate treatment with the skeletal muscle relaxant dantrolene. CPR is not immediately needed because the patient still has a pulse and respirations. Naltrexone and anticholinesterase drugs are not appropriate in this situation.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 174

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. The nurse is preparing to administer dexmedetomidine (Precedex) to a patient. Which is an appropriate indication for dexmedetomidine? (Select all that apply.)
a. Procedural sedation
b. Surgeries of short duration
c. Surgeries of long duration
d. Postoperative anxiety
e. Sedation of mechanically ventilated patients

 

 

ANS:  A, B, E

Dexmedetomidine (Precedex) is used for procedural sedation and for surgeries of short duration, and it is also used in the intensive care setting for sedation of mechanically ventilated patients. The other options are incorrect.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 174

TOP:   NURSING PROCESS: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

COMPLETION

 

  1. A patient is to receive midazolam (Versed) 2 mg IV push over 2 minutes just before an endoscopy procedure. The medication is available in a strength of 1 mg/mL. Identify how many milliliters of medication will the nurse draw up into the syringe for this dose. _______

 

ANS:

2 mL

 

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   N/A

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Chapter 15: Antiparkinson Drugs

Lilley: Pharmacology and the Nursing Process, 8th Edition

 

MULTIPLE CHOICE

 

  1. A patient has been taking selegiline (Eldepryl), 20 mg/day for 1 month. Today, during his office visit, he tells the nurse that he forgot and had a beer with dinner last evening, and “felt awful.” What did the patient most likely experience?
a. Hypotension
b. Hypertension
c. Urinary discomfort
d. Gastrointestinal upset

 

 

ANS:  B

At doses that exceed 10 mg/day, selegiline becomes a nonselective monoamine oxidase inhibitor (MAOI), contributing to the development of the cheese effect, so-called because it interacts with tyramine-containing foods (cheese, red wine, beer, and yogurt) and can cause severe hypertension.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 238

TOP:   NURSING PROCESS: Evaluation

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. A patient has been given a prescription for levodopa-carbidopa (Sinemet) for her newly diagnosed Parkinson’s disease. She asks the nurse, “Why are there two drugs in this pill?” The nurse’s best response reflects which fact?
a. Carbidopa allows for larger doses of levodopa to be given.
b. Carbidopa prevents the breakdown of levodopa in the periphery.
c. There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy.
d. Carbidopa is the biologic precursor of dopamine and can penetrate into the central nervous system.

 

 

ANS:  B

When given in combination with levodopa, carbidopa inhibits the breakdown of levodopa in the periphery and thus allows smaller doses of levodopa to be used. Lesser amounts of levodopa result in fewer unwanted adverse effects. Levodopa, not carbidopa, is the biologic precursor of dopamine and can penetrate into the CNS.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 243

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. When a patient is taking an anticholinergic such as benztropine (Cogentin) as part of the treatment for Parkinson’s disease, the nurse should include which information in the teaching plan?
a. Minimize the amount of fluid taken while on this drug.
b. Discontinue the medication if adverse effects occur.
c. Take the medication on an empty stomach to enhance absorption.
d. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.

 

 

ANS:  D

Dry mouth can be managed with artificial saliva through drops or gum, frequent mouth care, forced fluids, and sucking on sugar-free hard candy. Anticholinergics should be taken with or after meals to minimize GI upset and must not be discontinued suddenly. The patient must drink at least 3000 mL/day unless contraindicated. Drinking water is important, even if the patient is not thirsty or in need of hydration, to prevent and manage the adverse effect of constipation.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 246

TOP:   NURSING PROCESS: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient has been treated with antiparkinson medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient?
a. Decreased appetite
b. Gradual development of cogwheel rigidity
c. Newly developed dyskinesias
d. Improved ability to perform activities of daily living

 

 

ANS:  D

Therapeutic responses to antiparkinson agents include an improved sense of well-being, improved mental status, increased appetite, increased ability to perform activities of daily living and to concentrate and think clearly, and less intense parkinsonian manifestations.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 247

TOP:   NURSING PROCESS: Evaluation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Carbidopa-levodopa (Sinemet) is prescribed for a patient with Parkinson’s disease. The nurse informs the patient that which common adverse effects can occur with this medication?
a. Drowsiness, headache, weight loss
b. Dizziness, insomnia, nausea
c. Peripheral edema, fatigue, syncope
d. Heart palpitations, hypotension, urinary retention

 

 

ANS:  D

Common adverse reactions associated with carbidopa-levodopa include palpitations, hypotension, urinary retention, dyskinesia, and depression. The other effects may occur with other antiparkinson drugs.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 239

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is assessing the medication history of a patient with a new diagnosis of Parkinson’s disease. Which condition is a contraindication for the patient, who will be taking tolcapone (Tasmar)?
a. Glaucoma
b. Seizure disorder
c. Liver failure
d. Benign prostatic hyperplasia

 

 

ANS:  C

Tolcapone is contraindicated in patients who have shown a hypersensitivity reaction to it, and it should be used with caution in patients with pre-existing liver disease. The other conditions listed are not contraindications.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 241

TOP:   NURSING PROCESS: Assessment

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which nursing diagnosis would be appropriate for this patient?
a. Diarrhea
b. Urinary retention
c. Risk for infection
d. Disturbed sleep pattern

 

 

ANS:  B

Patients receiving anticholinergic drugs are at risk for urinary retention and constipation, not diarrhea. The other nursing diagnoses are not applicable to anticholinergic drugs.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 245

TOP:   NURSING PROCESS: Nursing Diagnosis

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. A patient has a new order for a catechol ortho-methyltransferase (COMT) inhibitor as part of treatment for Parkinson’s disease. The nurse recognizes that which of these is an advantage of this drug class?
a. It has a shorter duration of action.
b. It causes less gastrointestinal distress.
c. It has a slower onset than traditional Parkinson’s disease drugs.
d. It is associated with fewer wearing-off effects.

 

 

ANS:  D

COMT inhibitors are associated with fewer wearing-off effects and have prolonged therapeutic benefits. They have a quicker onset, and they prolong the duration of action of levodopa.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   pp. 240-241

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient taking entacapone (Comtan) for the first time calls the clinic to report a dark discoloration of his urine. After listening to the patient, the nurse realizes that what is happening in this situation?
a. This is a harmless effect of the drug.
b. The patient has taken this drug along with red wine or cheese.
c. The patient is having an allergic reaction to the drug.
d. The ordered dose is too high for this patient.

 

 

ANS:  A

COMT inhibitors, including entacapone, may darken a patient’s urine and sweat.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 239

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. While a patient is receiving drug therapy for Parkinson’s disease, the nurse monitors for dyskinesia, which is manifested by which finding?
a. Rigid, tense muscles
b. Difficulty in performing voluntary movements
c. Limp extremities with weak muscle tone
d. Confusion and altered mental status

 

 

ANS:  B

Dyskinesia is the difficulty in performing voluntary movements that is experienced by some patients with Parkinson’s disease. The other options are incorrect.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 237

TOP:   NURSING PROCESS: Assessment

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. When treating patients with medications for Parkinson’s disease, the nurse knows that the wearing-off phenomenon occurs for which reason?
a. There are rapid swings in the patient’s response to levodopa.
b. The patient cannot tolerate the medications at times.
c. The medications begin to lose effectiveness against Parkinson’s disease.
d. The patient’s liver is no longer able to metabolize the drug.

 

 

ANS:  C

The wearing-off phenomenon occurs when antiparkinson medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses. The other options are incorrect.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 237

TOP:   NURSING PROCESS: Assessment

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. When assessing the medication history of a patient with a new diagnosis of Parkinson’s disease, which conditions are contraindications for the patient who will be taking carbidopa-levodopa? (Select all that apply.)
a. Angle-closure glaucoma
b. History of malignant melanoma
c. Hypertension
d. Benign prostatic hyperplasia
e. Concurrent use of monoamine oxidase inhibitors (MAOIs)

 

 

ANS:  A, B, E

Angle-closure glaucoma, a history of melanoma or other undiagnosed skin conditions, and concurrent use of MAOIs are contraindications to the use of carbidopa-levodopa. The other options are incorrect.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   pp. 242-243

TOP:   NURSING PROCESS: Assessment

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

COMPLETION

 

  1. The prescriber writes this order, “Give amantadine (Symmetrel) 100 mg per PEG tube twice a day.” The medication is available in a liquid form with a concentration 50 mg/5 mL. Identify how many milliliters will the nurse give with each dose. _______

 

ANS:

10 mL

 

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   N/A

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Chapter 21: Cholinergic-Blocking Drugs

Lilley: Pharmacology and the Nursing Process, 8th Edition

 

MULTIPLE CHOICE

 

  1. The nurse is about to administer a stat dose of intravenous atropine sulfate to a patient who is experiencing a symptomatic cardiac dysrhythmia. During administration of this drug, the nurse will monitor the patient closely for which adverse effect?
a. Tachycardia
b. Bradycardia
c. Ectopic beats
d. Cardiac standstill

 

 

ANS:  A

Cardiovascular effects of cholinergic blockers include increased heart rate and dysrhythmias. One indication for use is the treatment of sinus bradycardia accompanied by hemodynamic compromise. The other options are incorrect.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 333

TOP:   NURSING PROCESS: Evaluation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient has a prescription for oxybutynin (Ditropan), an anticholinergic drug. When reviewing the patient’s medical history, which condition, if present, would be considered a contraindication to therapy with this drug?
a. Diarrhea
b. Hypertension
c. Neurogenic bladder
d. Uncontrolled angle-closure glaucoma

 

 

ANS:  D

Contraindications include drug allergy, urinary or gastric retention, and uncontrolled angle-closure glaucoma. Neurogenic bladder is an indication for oxybutynin. The other options are incorrect.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 334

TOP:   NURSING PROCESS: Assessment

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is reviewing the use of anticholinergic drugs. Anticholinergic drugs block the effects of which nervous system?
a. Central nervous system
b. Somatic nervous system
c. Sympathetic nervous system
d. Parasympathetic nervous system

 

 

ANS:  D

Anticholinergic drugs block or inhibit the actions of acetylcholine in the parasympathetic nervous system. The other options are incorrect.

 

DIF:    COGNITIVE LEVEL: Remembering (Knowledge)         REF:   p. 331

TOP:   NURSING PROCESS: General

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient has received an accidental overdose of intravenous atropine. Which drug will the nurse prepare to administer?
a. Atenolol (Tenormin)
b. Bethanechol (Urecholine)
c. Dicyclomine (Bentyl)
d. Physostigmine (Antilirium)

 

 

ANS:  D

Physostigmine salicylate is the antidote to an atropine overdose in patients who show extreme delirium or agitation and could inflict injury to themselves. Its routine use as an antidote for cholinergic-blocker overdose is controversial, however. The other options are incorrect choices.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 333

TOP:   NURSING PROCESS: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A 72-year-old man has a new prescription for an anticholinergic drug. He is an active man and enjoys outdoor activities, such as golfing and doing his own yard work. What will the nurse emphasize to him during the teaching session about his drug therapy?
a. Drowsiness may interfere with his outdoor activities.
b. Increased salivation may occur during exercise and outside activities.
c. Fluid volume deficits may occur as a result of an increased incidence of diarrhea.
d. He will need to take measures to reduce the occurrence of heat stroke during his activities.

 

 

ANS:  D

Elderly patients who take an anticholinergic drug need to be reminded that they are at a greater risk for suffering heat stroke because of decreased sweating and loss of normal heat-regulating mechanisms.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 337

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. The nurse will monitor for which adverse effect when administering an anticholinergic drug?
a. Excessive urination
b. Diaphoresis
c. Dry mouth
d. Pupillary constriction

 

 

ANS:  C

Anticholinergic drugs commonly cause the adverse effects of dry mouth, blurred vision, constipation, and urinary retention. They also cause mydriasis (pupillary dilation).

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 333

TOP:   NURSING PROCESS: Assessment

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is reviewing a patient’s medication history and notes that the patient is taking the cholinergic blocker tolterodine (Detrol). Which is an indication for this medication?
a. Irritable bowel disease
b. Induction of mydriasis
c. Urge incontinence
d. Reduction of secretions preoperatively

 

 

ANS:  C

Tolterodine (Detrol) is used for urinary frequency, urgency, and urge incontinence caused by bladder (detrusor) overactivity. The conditions in the other options are not indications.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 335

TOP:   NURSING PROCESS: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient has been taking tolterodine (Detrol), but today her prescriber changed her to a newer drug, darifenacin (Enablex). What advantage does darifenacin have over the tolterodine?
a. The newer cholinergic-blocker drugs are more effective.
b. It helps reduce urinary retention.
c. It can be used in patients with narrow-angle glaucoma.
d. The incidence of dry mouth is much lower with darifenacin.

 

 

ANS:  D

The incidence of dry mouth is much lower with use of the newer cholinergic-blocker drugs, such as darifenacin, because the actions of these drugs are more specific for the bladder as opposed to the salivary glands. These drugs are contraindicated if narrow-angle glaucoma or urinary retention is present. The newer cholinergic-blocker drugs are not necessarily more effective.

 

DIF:    COGNITIVE LEVEL: Understanding (Comprehension) REF:   p. 335

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse working in a preoperative admitting unit administers an anticholinergic medication to a patient before surgery. What is the purpose of this drug in the preoperative setting?
a. Control the heart rate
b. Relax the patient
c. Reduce urinary frequency
d. Reduce oral and gastrointestinal secretions

 

 

ANS:  D

Anticholinergic drugs are given preoperatively to control oral and gastrointestinal secretions during surgery. The other options are incorrect.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 333

TOP:   NURSING PROCESS: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. In preparation for eye surgery, the nurse monitors for which desired drug effect in a patient who is receiving a cholinergic-blocking eyedrop medication?
a. Miosis
b. Mydriasis
c. Increased intraocular fluid production
d. Enhanced tear production

 

 

ANS:  B

Cholinergic-blocking eyedrops cause dilation of the pupil (mydriasis) and paralysis of the ocular lens (cycloplegia), both of which are important for eye surgery. The other options are incorrect.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 332

TOP:   NURSING PROCESS: Evaluation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient has a new prescription for the transdermal form of scopolamine. The nurse knows that this form of scopolamine is used for which condition?
a. Angina
b. Chronic pain
c. Hypertension
d. Motion sickness

 

 

ANS:  D

Transdermal scopolamine (Transderm-Scop) is a patch that can be applied just behind the ear 4 to 5 hours before travel for the prevention of motion sickness. The other options are incorrect.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   p. 335

TOP:   NURSING PROCESS: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. The nurse is reviewing the indications for atropine sulfate. Atropine is appropriate for which of these patients? (Select all that apply.)
a. A patient who has suddenly developed symptomatic bradycardia with a heart rate of 32 beats/min
b. A patient who has suddenly developed symptomatic tachycardia with a heart rate of 180 beats/min
c. A patient with severe narrow-angle glaucoma
d. A patient who is about to have surgery
e. A patient newly diagnosed with myasthenia gravis
f. A patient with anticholinesterase inhibitor poisoning

 

 

ANS:  A, D, F

Anticholinergic drugs are used for symptomatic bradycardia and certain other cardiac conditions. It is given preoperatively to control secretions during surgery and is used as an antidote for anticholinesterase inhibitor poisoning. The other options are contraindications to the use of atropine.

 

DIF:    COGNITIVE LEVEL: Analyzing (Analysis)                   REF:   p. 334

TOP:   NURSING PROCESS: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

COMPLETION

 

  1. A patient is to receive glycopyrrolate (Robinul) 4 mcg/kg IM 30 minutes before a procedure. The patient weighs 110 pounds; the medication is available in a strength of 0.2 mg/mL. Identify how many milliliters of medication will the nurse draw up into the syringe. _______

 

ANS:

1 mL

 

To calculate mcg/kg, multiply

The patient will receive 200 mcg, or 0.2 mg.

The medication is available in a strength of 0.2 mg/mL; therefore, the patient will receive 1 mL.

 

DIF:    COGNITIVE LEVEL: Applying (Application)                REF:   N/A

TOP:   NURSING PROCESS: Implementation

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies