Pharmacology For Nurses  A Pathophysiologic Approach 5th Edition by Michael Patrick Adams -Holland-Urban – Test Bank

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Pharmacology For Nurses  A Pathophysiologic Approach 5th Edition by Michael Patrick Adams-  Holland-Urban- Test Bank

 

Sample  Questions

 

Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E
Chapter 6

Question 1

Type: MCSA

The nurse follows the nursing process when conducting medication education about insulin. The step of evaluation is best demonstrated by which question?

  1. “Is your abdomen the best place to inject insulin?”
  2. “What questions do you have about insulin?”
  3. “Can you recognize when you are experiencing hypoglycemia?”
  4. “Can you tell me four points you remember about how to take your insulin?”

Correct Answer: 4

Rationale 1: Asking the patient what questions she has about insulin is an assessment question.

Rationale 2: Asking the patient what questions she has about insulin is an assessment question.

Rationale 3: Asking the patient if she can recognize when she is experiencing hypoglycemia is an assessment question.

Rationale 4: The nurse is evaluating the effectiveness of medication education by asking the patient for feedback from the education provided.

Global Rationale: The nurse is evaluating the effectiveness of medication education by asking the patient for feedback from the education provided. Asking the patient what questions she has about insulin is an assessment question. Asking the patient if her abdomen is the best place to inject insulin is an assessment question. Asking the patient if she can recognize when she is experiencing hypoglycemia is an assessment question.

 

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 continuity.

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: 6-1 Compare and contrast the different steps of the nursing process.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 67

 

Question 2

Type: MCMA

The nurse assesses the patient with diabetes mellitus prior to administering medications. Which questions are important to ask 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. “Are you allergic to any medications?”
  2. “Are you taking any herbal or over-the-counter medications?”
  3. “How difficult is it for you to maintain your ideal body weight?”
  4. “Will you please tell me about the kind of diet you follow?”
  5. “What other medications are you currently taking?”

Correct Answer: 1,2,4,5

Rationale 1: Questions about allergies are important during assessment.

Rationale 2: Questions about herbal and OTC medications are an important part of assessment.

Rationale 3: Ideal body is an important question, but does not refer specifically to medication administration.

Rationale 4: Questions about normal diet help to assess health management and are pertinent to drug administration.

Rationale 5: Questions about current medication are important during assessment.

Global Rationale: Questions about allergies and which medications are being taken are assessment questions. Questions about normal diet help to assess health management and are pertinent to drug administration. Ideal body weight is an important question but does not refer specifically to medication administration.

 

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 continuity.

AACN Essentials Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches.

NLN Competencies: Relationship Centered Care: Factors that contribute to or threaten health.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase that are pertinent to medication administration.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 63

 

Question 3

Type: MCSA

The physician has prescribed a nitroglycerine (Nitrodur) patch for the patient. What is the best outcome for this patient as it relates to use of the medication?

  1. Patient will be able to identify the expiration date of the medication prior to discharge.
  2. Patient will verbalize three side effects of the medication prior to discharge.
  3. Patient will state the reason for receiving the medication prior to discharge.
  4. Patient will demonstrate correct application of the patch prior to discharge.

Correct Answer: 4

Rationale 1: The patient does not need to identify the expiration date of the medication in order to correctly apply the patch.

Rationale 2: The patient does not need to identify side effects of the medication in order to correctly apply the patch. The patient does not need to state the reason for the medication in order to correctly apply the patch. The patient does not need to identify the expiration date of the medication in order to correctly apply the patch.

Rationale 3: The patient does not need to state the reason for the medication in order to correctly apply the patch.

Rationale 4: The overall goal of nursing care related to pharmacotherapy is the safe and effective administration of medication. In this instance, the most important aspect of patient teaching is that the patient be able to correctly apply the patch. If the patch is not correctly applied, the other issues are irrelevant. The patient does not need to identify side effects of the medication in order to correctly apply the patch. The patient does not need to state the reason for the medication in order to correctly apply the patch. The patient does not need to identify the expiration date of the medication in order to correctly apply the patch.

Global Rationale: The overall goal of nursing care related to pharmacotherapy is the safe and effective administration of medication. In this instance, the most important aspect of patient teaching is that the patient be able to correctly apply the patch. If the patch is not correctly applied, the other issues are irrelevant. The patient does not need to identify side effects of the medication in order to correctly apply the patch. The patient does not need to state the reason for the medication in order to correctly apply the patch. The patient does not need to identify the expiration date of the medication in order to correctly apply the patch.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6-4 Identify the main components of the planning phase of the nursing process.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 65

 

 

 

Question 4

Type: MCSA

The patient is receiving albuterol (Proventil) for treatment of bronchospasm related to asthma. What is the primary nursing intervention as it relates to this medication?

  1. Monitor the patient for relief of bronchospasms.
  2. Monitor the patient for nausea and headache.
  3. Monitor the patient’s serum drug levels.
  4. Provide the patient with age-appropriate education about albuterol (Proventil).

Correct Answer: 1

Rationale 1: Monitoring drug effects, in this case, the relief of bronchospasms, is a primary intervention that nurses perform.

Rationale 2: Nausea and headache are expected side effects, but monitoring for these side effects is not part of the primary intervention.

Rationale 3: Monitoring of serum drug levels for albuterol (Proventil) is not indicated.

Rationale 4: Education about medication is important but is not part of the primary intervention.

Global Rationale: Monitoring drug effects, in this case, the relief of bronchospasms, is a primary intervention that nurses perform. Nausea and headache are expected side effects, but monitoring for these side effects is not part of the primary intervention. Education about medication is important but is not part of the primary intervention. Monitoring of serum drug levels for albuterol (Proventil) is not indicated.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase of the nursing process for patients receiving medications.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 66

 

Question 5

Type: MCSA

The patient is receiving an oral antibiotic as treatment for cellulitis of the lower extremity. The patient’s outcome is “Patient will state a key point about antibiotic treatment for cellulitis.” Which statement would the nurse evaluate as best indicating this outcome has been met?

  1. “If the pain gets too bad, I can take my prescribed pain medication.”
  2. “If the swelling continues, I can apply an ice pack.”
  3. “I need to take all the pills even if my leg looks better.”
  4. “I must keep my leg elevated until the swelling goes down.”

Correct Answer: 3

Rationale 1: Taking pain medication does not address the outcome for antibiotic treatment.

Rationale 2: Applying an ice pack does not address the outcome for antibiotic treatment.

Rationale 3: Taking all the medication even if the leg looks better is a key point about antibiotic therapy and meets the patient’s outcome.

Rationale 4: Keeping the leg elevated does not address the outcome for antibiotic treatment.

Global Rationale: Taking all the medication even if the leg looks better is a key point about antibiotic therapy and meets the patient’s outcome. Keeping the leg elevated does not address the outcome for antibiotic treatment. Applying an ice pack does not address the outcome for antibiotic treatment. Taking pain medication does not address the outcome for antibiotic treatment.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Quality and Safety: Contribute to assessment of outcome achievement.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-6 Explain the importance of the evaluation phase of the nursing process as applied to pharmacotherapy.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 67

 

 

 

Question 6

Type: MCSA

The physician has prescribed quetiapine (Seroquel) for the patient with chronic auditory hallucinations. The patient has stopped taking the medication. The nurse incorrectly uses the diagnosis of “noncompliance.” In which situation would this diagnosis be appropriate?

 

  1. The patient reported a physical change as the reason for stopping the medication.
  2. The patient made an informed decision not to take the medication.
  3. The patient was unsure about how to order a refill for the prescription.
  4. The patient did not understand why the medication was prescribed.

Correct Answer: 2

Rationale 1: If the patient reports a physical change as the reason for stopping the medication, the nursing diagnosis should be related to that change. For example, if the patient reports being fatigued, the nursing diagnosis would relate to that finding.

Rationale 2: Noncompliance assumes that the patient has been properly educated about the medication and has made an informed decision not to take it.

Rationale 3: Being unsure of the way to obtain a refill on the medication is related to a knowledge deficit, not noncompliance.

Rationale 4: Not knowing why the medication was prescribed related to a knowledge deficit, not noncompliance.

Global Rationale: Noncompliance assumes that the patient has been properly educated about the medication and has made an informed decision not to take it. A lack of understanding of the reason the medication was prescribed or being unsure of how to obtain an prescription refill are related to a knowledge deficit, not noncompliance. Reports of a physical change since taking the medication would be diagnosed as pertaining to the change.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Relationship Centered Care: Factors that contribute to or threaten health.

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 6-3 Describe the areas of concern relating to pharmacotherapy that should be addressed during the diagnosis phase of the nursing process.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 64

 

 

Question 7

Type: MCSA

The nurse is preparing for medication administration to a group of patients. What is the best overall outcome for the patients?

  1. Patients will take the medications after receiving medication instruction.
  2. Patients will receive the best therapeutic outcome from the medications.
  3. Patients will state the reason they are receiving the medications.
  4. Patients will experience minimal side effects after taking the medications.

Correct Answer: 2

Rationale 1: The fact that the patient takes the medication is not the best overall outcome for the patients.

Rationale 2: Outcomes should focus first on the therapeutic outcome of the medications.

Rationale 3: Having the patients state the reason they are receiving the medications is the best overall outcome for the patients.

Rationale 4: The treatment of side effects is not the best overall outcome for the patients.

Global Rationale: Outcomes should focus first on the therapeutic outcome of the medications. The fact that the patient takes the medication is not the best overall outcome for the patients. The treatment of side effects is not the best overall outcome for the patients. Having the patients state the reason they are receiving the medications is the best overall outcome for the patients.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6-4 Identify the main components of the planning phase of the nursing process.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 65

 

 

Question 8

Type: MCSA

The nurse is managing care for several patients at a diabetic treatment center. What is the primary intervention for the nurse?

  1. To administer the correct medicine to the correct patient at the correct dose and the correct time via the correct route
  2. To return the patient to an optimum level of wellness while limiting adverse effects related to the patient’s medical diagnosis
  3. To include any cultural or ethnic preferences in the administration of the medication
  4. To answer any questions the patient may have about the medicine, or any possible side effect of the medication

Correct Answer: 2

Rationale 1: The correct patient, dose, and time refer to the five “rights” of medication administration and, while important, is not the best, overall nursing intervention.

Rationale 2: Interventions are aimed at returning the patient to an optimum level of wellness and limiting adverse effects related to the patient’s medical diagnosis or condition.

Rationale 3: Answering questions the patient may have is an appropriate intervention but is not the best overall intervention. While important to include cultural and ethnic preferences, this is not the best overall intervention.

Rationale 4: Answering questions the patient may have is an appropriate intervention but is not the best overall intervention.

Global Rationale: Interventions are aimed at returning the patient to an optimum level of wellness and limiting adverse effects related to the patient’s medical diagnosis or condition. The correct patient, dose, and time refer to the five “rights” of medication administration and, while important, is not the best, overall nursing intervention. Answering questions the patient may have is an appropriate intervention but is not the best overall intervention. While important to include cultural and ethnic preferences, this is not the best overall intervention.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase of the nursing process for patients receiving medications.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 66

 

 

Question 9

Type: MCSA

What is the most significant role for nurses as defined by state nurse practice acts and by regulating bodies such as The Joint Commission?

  1. Planning care
  2. Teaching
  3. Assessment
  4. Evaluating care

Correct Answer: 2

Rationale 1: Planning is important but not the most significant role of the nurse according to state nurse practice acts and Joint Commission.

Rationale 2: State nurse practice acts and regulating bodies such as the Joint Commission consider teaching to be a primary role for nurses, giving it the weight of law and key important accreditation standards.

Rationale 3: State nurse practice acts and regulating bodies such as the Joint Commission consider teaching to be a primary role for nurses. Assessment is important but not the most significant role of the nurse according to state nurse practice acts and Joint Commission.

Rationale 4: Evaluation is important but not the most significant role of the nurse according to state nurse practice acts and Joint Commission.

Global Rationale: State nurse practice acts and regulating bodies such as the Joint Commission consider teaching to be a primary role for nurses, giving it the weight of law and key important accreditation standards. Assessment, planning, and evaluation are important but not the most significant roles of the nurse according to state nurse practice acts and Joint Commission.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase of the nursing process for patients receiving medications.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 66

 

 

Question 10

Type: MCSA

The Joint Commission documented that patient education was deficient on several medical-surgical units of a local hospital. A nursing committee was formed to address this problem and focused on what likely nursing intervention?

  1. Providing educational pamphlets about medications to the patients.
  2. Asking the physicians to provide medication education to the patients.
  3. Discussing medications each time they are administered to patients.
  4. Requesting more frequent pharmacy consults for the patients.

Correct Answer: 3

Rationale 1: Educational pamphlets can be effective but are not as effective as the nurse providing education to the patient.

Rationale 2: Medication education is considered to be a responsibility of the nurse, not the physician.

Rationale 3: Discussing medications each time they are administered is an effective way to increase the amount of education provided.

Rationale 4: Medication education is considered to be a responsibility of the nurse, not the pharmacist.

Global Rationale: Discussing medications each time they are administered is an effective way to increase the amount of education provided. Medication education is considered to be a responsibility of the nurse, not the physician or pharmacist. Educational pamphlets can be effective but are not as effective as the nurse providing education to the patient.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase of the nursing process for patients receiving medications.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 66

 

 

Question 11

Type: MCSA

The nurse has several educational pamphlets for the patient about medications the patient is receiving. Prior to giving the patient these pamphlets, what is a primary assessment for the nurse?

  1. Assess the patient’s readiness to learn new information.
  2. Assess the patient’s religious attitudes toward medicine.
  3. Assess the patient’s reading level.
  4. Assess the patient’s cultural bias toward taking medicine.

Correct Answer: 3

Rationale 1: Assessing the patient’s readiness to learn is important but not the primary assessment.

Rationale 2: Educational pamphlets are ineffective if the reading level is above what the patient can understand. Assessing the patient’s religious attitudes is important but not the primary assessment.

Rationale 3: Educational pamphlets are ineffective if the reading level is above what the patient can understand.

Rationale 4: Assessing the patient’s cultural bias is important but not the primary assessment.

Global Rationale: Educational pamphlets are ineffective if the reading level is above what the patient can understand. Assessing the patient’s readiness to learn, cultural bias, and religious attitudes are important but not as important as the patient’s reading level.

 

Cognitive Level: Analyzing

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 continuity.

AACN Essentials Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches.

NLN Competencies: Relationship Centered Care: Factors that contribute to or threaten health.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase that are pertinent to medication administration.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 67

 

 

Question 12

Type: MCSA

The nurse is aware that it is most important to be accurate in which portion of the nursing process?

  1. Evaluation
  2. Assessment
  3. Diagnosis
  4. Planning

Correct Answer: 2

Rationale 1: While accuracy in evaluation is important, it is more important to be accurate in a different step of the nursing process.

Rationale 2: Assessment is the basis for the development of the rest of the steps of the nursing process. While the nurse always strives to be accurate, inaccuracies in assessment will translate as inaccuracies in the remaining steps.

Rationale 3: While accuracy in diagnosis is important, it is more important to be accurate in a different step of the nursing process.

Rationale 4: While accuracy in planning is important, it is more important to be accurate in a different step of the nursing process.

Global Rationale: Assessment is the basis for the development of the rest of the steps of the nursing process. While the nurse always strives to be accurate, inaccuracies in assessment will translate as inaccuracies in the remaining steps. While accuracy in evaluation, diagnosis, and planning is important, it is more important to be accurate in assessment.

 

Cognitive Level: Understanding

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 continuity.

AACN Essentials Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches.

NLN Competencies: Relationship Centered Care: Factors that contribute to or threaten health.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase that are pertinent to medication administration.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 61

 

Question 13

Type: MCSA

The nurse is assessing a newly admitted patient’s current medications. What does the best objective data include?

  1. The patient’s wife tells the nurse what medications the patient has been receiving.
  2. The nurse checks the prescription bottles the patient has brought to the hospital.
  3. The nurse asks the physician what medications the patient was currently taking.
  4. The patient lists the medications that have been prescribed.

Correct Answer: 2

Rationale 1: A list of medications provided by the patient’s wife is subjective, not objective, data.

Rationale 2: Objective data includes information gathered through assessment, and not necessarily what the patient says or perceives. The most reliable and objective assessment by the nurse is to check the patient’s prescription medication bottles.

Rationale 3: Asking the physician what medication the patient was receiving is subjective data, and the physician may not remember all the medication the patient was receiving.

Rationale 4: A list of medications provided by the patient is subjective, not objective, data. Asking the physician what medication the patient was receiving is subjective data, and the physician may not remember all the medication the patient was receiving.

Global Rationale: Objective data includes information gathered through assessment, and not necessarily what the patient says or perceives. The most reliable and objective assessment by the nurse is to check the patient’s prescription medication bottles. A list of medications provided by the patient and the patient’s wife is subjective, not objective data. Asking the physician what medication the patient was receiving is subjective data, and the physician may not remember all the medication the patient was receiving.

 

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 continuity.

AACN Essentials Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches.

NLN Competencies: Relationship Centered Care: Factors that contribute to or threaten health.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase that are pertinent to medication administration.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 61

 

 

Question 14

Type: MCSA

The nurse is administering medications to an older adult. Which laboratory tests are most important for the nurse to assess prior to the administration of medication?

  1. Complete blood count (CBC) and electrolytes
  2. Kidney and liver function tests
  3. Arterial blood gases (ABGs) and basic metabolic panel
  4. Lipid panel and thyroid function tests

Correct Answer: 2

Rationale 1: Complete blood count (CBC) and electrolytes are not likely to help in determining the proper drug dosage.

Rationale 2: Renal and hepatic function tests are essential for many patients, particularly older patients and those who are critically ill, as these will be used to determine the proper drug dosage.

Rationale 3: Arterial blood gases (ABGs) and a basic metabolic panel are not likely to help in determining the proper drug dosage.

Rationale 4: Lipid panel and thyroid function tests are not likely to help in determining the proper drug dosage.

Global Rationale: Renal and hepatic function tests are essential for many patients, particularly older patients and those who are critically ill, as these will be used to determine the proper drug dosage. Complete blood count (CBC) and electrolytes, lipid panel and thyroid function tests; and ABGs and a basic metabolic panel are not likely to help in determining the proper drug dosage.

 

Cognitive Level: Analyzing

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 continuity.

AACN Essentials Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches.

NLN Competencies: Relationship Centered Care: Factors that contribute to or threaten health.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase that are pertinent to medication administration.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 62

 

Question 15

Type: MCSA

Which list correctly identifies and orders the primary steps of the nursing process?

  1. Establish nursing diagnosis, assessment, intervene, collaborate, evaluation
  2. Establish goals, assessment, intervention, planning, communication
  3. Assessment, establish nursing diagnosis, planning, interventions, evaluation
  4. Assessment, planning, establish objectives, communication, evaluation

Correct Answer: 3

 

Rationale 1: Nursing diagnoses cannot be established until assessment is done.

Rationale 2: Goals cannot be established until assessment is done.

Rationale 3: The primary steps (in order) include assessment, establish nursing diagnosis, planning, interventions, evaluation.

Rationale 4: Communication is important but is not a primary step of the nursing process.

Global Rationale: The primary steps (in order) include assessment, establish nursing diagnosis, planning, interventions, evaluation. Although some steps might not be in this precise order, assessment is done first. Communication is important but is not a primary step of the nursing process.

 

Cognitive Level: Remembering

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 continuity.

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: 6-1 Compare and contrast the different steps of the nursing process.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 62

 

 

 

Question 16

Type: Seq

Place these nursing activities in the correct order of the nursing process.

  1. The nurse analyzes the data collected.
  2. The nurse documents the time and route of an administered medication.
  3. The nurse weighs the patient.
  4. The nurse writes an individualized nursing intervention.
  5. The nurse changes a nursing intervention that is not working.

Correct Answer: 3,1,4,2,5

 

Global Rationale: The order of the steps of the nursing process is assessment, diagnosis, planning, implementing, and evaluating. Weighing the patient is assessment, analyzing data occurs in the diagnosis step, writing interventions occurs in the planning step, documentation occurs in the implementation step, and revising interventions occurs in the evaluation step.

 

Cognitive Level: Analyzing

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 continuity.

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: 6-1 Compare and contrast the different steps of the nursing process.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 62

 

 

Question 17

Type: FIB

The nurse uses a newly admitted patient’s armband barcode to identify the patient prior to administering medications. The nurse should use ______ other means of identifying this patient.

Standard Text: Record your answer rounding to the nearest whole number.

 

Correct Answer: 2

Rationale: Even though the barcode identification system has improved safety, it is not foolproof. The nurse should use two other means of identifying the patient such as verifying name and birth date.

Global Rationale: Even though the barcode identification system has improved safety, it is not foolproof. The nurse should use two other means of identifying the patient such as verifying name and birth date.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase of the nursing process for patients receiving medications.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 61

 

 

Question 18

Type: MCSA

Which statement about the nursing process is accurate?

  1. Generally, goals are more measurable than outcomes.
  2. Goals involve very specific criteria that evaluate interventions.
  3. Obtaining the outcomes is essential for goal attainment.
  4. After selecting the nursing diagnosis, interventions are completed.

Correct Answer: 3

Rationale 1: Outcomes are generally more measurable than goals as they are more specific.

Rationale 2: Goals are more general than specific.

Rationale 3: Outcomes are specific, measurable criteria that are used to measure goal attainment.

Rationale 4: The planning phase (including outcomes and goals) follows nursing diagnosis.

Global Rationale: Outcomes are specific, measurable criteria that are used to measure goal attainment. The planning phase (including outcomes and goals) follows nursing diagnosis. Outcomes are generally more measurable than goals as they are more specific. Goals are more general than specific.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6-4 Identify the main components of the planning phase of the nursing process.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 65

 

 

Question 19

Type: MCSA

Which nursing intervention would take priority following administration of a new medication?

  1. Monitoring lab values
  2. Monitoring the patient’s respiratory status
  3. Prescribing additional medications if side effects occur
  4. Measuring patient weight

Correct Answer: 2

Rationale 1: Monitoring lab values might be appropriate nursing interventions with some medications but would not be the priority.

Rationale 2: Any time a new medication is provided to the patient, it is important to monitor for an allergic reaction. Anaphylaxis, a life-threatening allergic reaction, can impair breathing.

Rationale 3: Nurses do not prescribe medications.

Rationale 4: Measuring weight might be appropriate nursing interventions with some medications but would not be the priority.

Global Rationale: Any time a new medication is provided to the patient, it is important to monitor for an allergic reaction. Anaphylaxis, a life-threatening allergic reaction, can impair breathing. Monitoring lab values and measuring weight might be appropriate nursing interventions with some medications but would not be the priority. Nurses do not prescribe medications.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase of the nursing process for patients receiving medications.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 66

 

Question 20

Type: MCSA

A patient with hypertension is receiving medication to lower his blood pressure. Which nursing action demonstrates the evaluation process related to medication administration?

  1. Asking the patient whether he is compliant in taking his medications
  2. Determining that goals were not met 3 days following medication administration
  3. Administration of IV antihypertensive agents
  4. Determination of the patient’s baseline blood pressure

Correct Answer: 2

Rationale 1: Asking about compliance would be the assessment step.

Rationale 2: Evaluation is the final step in the nursing process where goal attainment is determined.

Rationale 3: Administering medications is the intervention step.

Rationale 4: Determining the patient’s baseline blood pressure would be the assessment step.

Global Rationale: Evaluation is the final step in the nursing process where goal attainment is determined. Administering medications is the intervention step. Determining the patient’s baseline blood pressure and asking him about compliance would be the assessment step.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Quality and Safety: Contribute to assessment of outcome achievement.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-6 Explain the importance of the evaluation phase of the nursing process as applied to pharmacotherapy.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 67

 

 

Question 21

Type: MCSA

Which assessment identifies the collection of objective data?

  1. The patient rates her pain a 5 on a 0–10 pain scale.
  2. The patient states she is anxious.
  3. The patient has a wound measured at 5 centimeters in length.
  4. The patient informs the nurse that she weighs 150 pounds.

Correct Answer: 3

Rationale 1: Subjective data consist of what the patient says or perceives.

Rationale 2: Subjective data consist of what the patient says or perceives.

Rationale 3: Objective data are gathered through physical assessment, laboratory tests, and other diagnostic sources.

Rationale 4: Subjective data consist of what the patient says or perceives.

Global Rationale: Objective data are gathered through physical assessment, laboratory tests, and other diagnostic sources. Subjective data consist of what the patient says or perceives.

 

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 continuity.

AACN Essentials Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches.

NLN Competencies: Relationship Centered Care: Factors that contribute to or threaten health.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase that are pertinent to medication administration.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 63

 

 

Question 22

Type: MCMA

When teaching the patient about a new medication, the nurse should include which information?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Adverse effects that can be expected
  2. Which adverse effect to report to the health care provider
  3. The drug’s therapeutic action
  4. Chemical composition of the drug
  5. Name of the drug manufacturer

Correct Answer: 1,2,3

Rationale 1: In order to help the patient identify and prevent adverse effects, the patient should be taught the adverse effects.

Rationale 2: The patient should be taught when to notify the health care provider of adverse effects.

Rationale 3: In order to help the patient identify and prevent adverse effects, the patient should be taught the therapeutic action of the drug.

Rationale 4: It is not necessary to teach the patient the chemical makeup of the drug.

Rationale 5: It is not necessary to teach the patient the name of the drug manufacturer.

Global Rationale: In order to help the patient identify and prevent adverse effects, the patient should be taught the therapeutic action, adverse effects, and when to notify the health care provider of adverse effects. It is not necessary to teach the patient the chemical makeup of the drug or the name of the drug manufacturer.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase of the nursing process for patients receiving medications.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 67

 

 

Question 23

Type: MCMA

A nurse is preparing care for a newly admitted patient with diabetes. Which information would be critical for the nurse to assess?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Medical history
  2. Current lab results
  3. Medication allergies
  4. Use of dietary supplements
  5. Number of previous hospitalizations

Correct Answer: 1,2,3,4

Rationale 1: Medical history may reveal conditions that contraindicate the use of certain drugs.

Rationale 2: Current lab results may reveal important information about the health of organs, such as the kidneys and liver, which would be important to metabolism and excretion of drugs.

Rationale 3: Allergies to one drug may cross over to another drug and would need to be avoided.

Rationale 4: Some dietary supplements can interact with drugs.

Rationale 5: While this is good information, it is not critical to this admission.

Global Rationale: Medical history may reveal conditions that contraindicate the use of certain drugs. Current lab results may reveal important information about the health of organs, such as the kidneys and liver, which would be important to metabolism and excretion of drugs. Allergies to one drug may cross over to another drug and would need to be avoided. Some dietary supplements can interact with drugs. While knowledge about number of previous hospitalization is good to know it is not critical to this admission.

 

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 continuity.

AACN Essentials Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches.

NLN Competencies: Relationship Centered Care: Factors that contribute to or threaten health.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase that are pertinent to medication administration.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 61

 

 

Question 24

Type: MCMA

Which concepts should the nurse use when formulating a nursing diagnosis?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Base the nursing diagnosis on the medical diagnosis
  2. Focus on what the nurse needs to help the patient return to health
  3. Include the patient in the identification of needs
  4. Consider the patient’s response to the current health problem
  5. Be certain the diagnosis is measureable

Correct Answer: 3,4

Rationale 1: The nursing diagnosis is not dependent on the medical diagnosis.

Rationale 2: The focus should be on the patient’s needs.

Rationale 3: Including the patient in the formulation of nursing diagnoses encourages more active involvement in working toward meeting identified goals.

Rationale 4: A nursing diagnosis is a clinical judgment concerning human response to health conditions.

Rationale 5: Goals and outcomes need to be measureable, not nursing diagnosis.

Global Rationale: A nursing diagnosis is a clinical judgment concerning human response to health conditions and should be patient focused. Including the patient in the formulation of nursing diagnoses encourages more active involvement in working toward meeting identified goals. It is not dependent on the medical diagnosis. Goals and outcomes need to be measureable, not nursing diagnosis.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Relationship Centered Care: Factors that contribute to or threaten health.

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 6-3 Describe the areas of concern relating to pharmacotherapy that should be addressed during the diagnosis phase of the nursing process.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 64

 

Question 25

Type: FIB

The nurse who is writing a risk nursing diagnosis will write a ______ part statement.

Standard Text: Record your answer rounding to the nearest whole number.

 

Correct Answer: 2

Rationale: Since risk diagnoses do not have evidence to support the chosen statement, they are written in two parts.

Global Rationale: Since risk diagnoses do not have evidence to support the chosen statement, they are written in two parts.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Relationship Centered Care: Factors that contribute to or threaten health.

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 6-3 Describe the areas of concern relating to pharmacotherapy that should be addressed during the diagnosis phase of the nursing process.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 64

 

 

Question 26

Type: MCMA

A patient returns to the clinic for follow-up after taking a newly prescribed medication for a month. The nurse recognizes medication teaching was successful when the patient makes which statement?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “I’ve been taking my medication on an empty stomach like the prescription label said to.”
  2. “I take my medication first thing in the morning, just like you said.”
  3. “I have been able to decrease my medication to every other day and that saves me some money.”
  4. “I switched all my medications to one pharmacy like you suggested.”
  5. “Did you say I need to take this medication with water or milk?”

Correct Answer: 1,2,4

Rationale 1: Some medications must be taken on an empty stomach. This statement indicates the patient is following instruction.

Rationale 2: This statement indicates the patient is following instruction.

Rationale 3: Changing dosage schedule without direction indicates failure to follow instruction.

Rationale 4: Filling all prescriptions at the same pharmacy will assist the pharmacist in comparing current and new medications for interactions. This statement indicates the patient is following the nurse’s suggestion.

Rationale 5: The patient is unsure of instructions.

Global Rationale: Statements about taking medication as directed indicate the patient is adhering to instructions. Changing dosage schedule without direction indicates failure to follow instruction. If the patient is unsure of instructions, it is less likely that the correct administration technique is being followed.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Quality and Safety: Contribute to assessment of outcome achievement.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-6 Explain the importance of the evaluation phase of the nursing process as applied to pharmacotherapy.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 67

 

 

 

Question 27

Type: MCMA

Which patient outcome statements are correctly formatted?

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 will understand the effects of the medication administered prior to discharge.
  2. The nurse will administer all medications with ten minutes of their scheduled time.
  3. The patient will identify two adverse effects of enoxaprarin (Lovenox) prior to self-administering the drug.
  4. The patient will verbalize the storage requirements for NPH insulin prior to discharge.
  5. The physician will discuss the desired effects of discharge medications with the patient the evening before discharge.

Correct Answer: 3,4

Rationale 1: “Understand” is not a measureable verb.

Rationale 2: Patient outcome statements are focused on what the patient will do, not on what the nurse will do.

Rationale 3: “Identify” is a measurable verb, there is a specific measure to be evaluated and a time line is present.

Rationale 4: “Verbalize” is a measurable verb, there is a specific measure to be evaluated, and a time line is present.

Rationale 5: Patient outcome statements are focused on what the patient will do, not on what the physician will do.

Global Rationale: In order to be complete, the patient outcome measure must be patient (not nurse or physician) focused, must contain a measurable verb, must have the specific circumstances to be evaluated, and must have a time line.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6-4 Identify the main components of the planning phase of the nursing process.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 65

 

Question 28

 

Type: Seq

Place these methods of communicating with a non-English speaking patient in order of their desirability and usefulness.

  1. Adult family member interprets
  2. Health care agency interpreter is present
  3. The nurse uses drawings and body language to communicate
  4. Child relative interprets
  5. No interpretation is attempted

Correct Answer: 2,1,4,3,5

 

Global Rationale: In the ideal situation the nurse will contact an interpreter employed or provided by the health care agency. The next best solution is for an adult family member to interpret with the third best being a child in the family who has been assessed to be able to handle the translation. In the absence of these options, the fourth best plan is for the nurse to use drawings, body language, pictures, and nonverbal clues to communicate. Not using any kind of interpretation is not desirable and leaves the nurse in the situation of doing something “to” a patient with no explanation.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Knowledge and Science: Relationships between knowledge and science and quality and safe patient care.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6-5 Discuss key nursing interventions required in the implementation phase of the nursing process for patients receiving medications.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 66

 

Question 29

Type: MCMA

During evaluation, the nurse, patient, and physician determine that the goals of antibiotic therapy have not been met. What 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. Review the dosage of the medication
  2. Consider checking serum drug levels
  3. Discard the idea that the infection is treatable
  4. Consider prolonging therapy
  5. Consider using a different antibiotic

Correct Answer: 1,2,4,5

Rationale 1: The dosage may not be correct for the individual patient.

Rationale 2: In some instances, checking serum drug levels will help identify if the dosing schedule is adequate.

Rationale 3: Just because the first evaluation is that the goal is not met does not indicate that the goal is not a good one or that the therapy is not going to work.

Rationale 4: The drug may work if given more time.

Rationale 5: The infection may require use of a second antibiotic.

Global Rationale: Just because the first evaluation is that the goal is not met does not indicate that the goal is not a good one or that the therapy is not going to work. The drug may work if the dosage is altered (which may be indicated by serum drug level) or if therapy is continued for a longer time. The antibiotic may need to be changed.

 

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: III.6 Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.

NLN Competencies: Quality and Safety: Contribute to assessment of outcome achievement.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6-6 Explain the importance of the evaluation phase of the nursing process as applied to pharmacotherapy.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 67

 

Question 30

Type: MCMA

Which information is essential for the nurse to collect when reviewing a patient’s medication list?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Drug names
  2. Drug manufacturer
  3. Dosage being taken
  4. Frequency of administration
  5. When last refill was obtained

Correct Answer: 1,3,4

Rationale 1: Drug name is essential information for this assessment.

Rationale 2: It is not necessary to record the name of the drug manufacturer.

Rationale 3: Dosage being taken is essential information for this assessment.

Rationale 4: Frequency of administration is essential information for this assessment.

Rationale 5: It is not necessary to determine when the last prescription refill was obtained.

Global Rationale: Drug name, amount being taken, and frequency of administration are all essential parts of a medication history. It is not important to record the name of the drug manufacturer or when the last prescription refill was obtained.

 

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 continuity.

AACN Essentials Competencies: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches.

NLN Competencies: Relationship Centered Care: Factors that contribute to or threaten health.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6-2 Identify health history questions to ask during the assessment phase that are pertinent to medication administration.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number: 63

 

 

Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E
Chapter 9

Question 1

Type: MCMA

The nurse is doing a holistic assessment on a patient prior to the initiation of antihypertensive medication. What will the best assessment include?

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. The biologic cause of the hypertension
  3. Mood
  4. Level of education
  5. Belief in a higher power

Correct Answer: 1,3,4,5

Rationale 1: Holistic health care incorporates the whole patient to include the biological (blood pressure) dimension.

Rationale 2: The biologic cause of the hypertension focuses on a specific disease, its cause, and treatment; this is a medical model, not a holistic model.

Rationale 3: Holistic health care incorporates the whole patient to include the psychological (mood) dimension.

Rationale 4: Holistic health care incorporates the whole patient to include the sociocultural (level of education) dimension.

Rationale 5: Holistic health care incorporates the whole patient to include the spiritual (belief in a higher power) dimension.

Global Rationale: Holistic health care incorporates the whole patient to include the biological (blood pressure), psychological (mood), sociocultural (level of education), and spiritual (belief in a higher power) dimensions. The biologic cause of the hypertension focuses on a specific disease, its cause, and treatment; this is a medical model, not a holistic model.

 

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: 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: 9-1 Describe fundamental concepts underlying a holistic approach to patient care and their importance to pharmacotherapy.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 95

 

 

Question 2

Type: MCSA

The adolescent Hispanic male has been diagnosed with attention-deficit hyperactivity disorder (ADHD), and is taking methylphenidate (Ritalin). Even though the drug helps with focus and grades, the adolescent will not go to the school office at noon for his medication. Which statement best describes the result of the nurse’s evaluation?

  1. The adolescent has developed alternative coping mechanisms to increase his focus during classes.
  2. The adolescent is fearful that this drug may be a “gateway drug” and he will abuse other substances.
  3. The adolescent really does not need an additional dose of methylphenidate (Ritalin) at school.
  4. The adolescent is embarrassed about having to take medicine at school; it is a social stigma.

Correct Answer: 4

Rationale 1: Attention-deficit hyperactivity disorder is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes.

Rationale 2: Appropriate treatment of attention-deficit hyperactivity disorder will result in less addiction to mood-altering substances, not more addiction.

Rationale 3: Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the patient must receive a dose during school hours.

Rationale 4: Some patients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Patients can also perceive this as a social stigma.

Global Rationale: Some patients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Patients can also perceive this as a social stigma. Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the patient must receive a dose during school hours. Attention-deficit hyperactivity disorder is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes. Appropriate treatment of attention-deficit hyperactivity disorder will result in less addiction to mood-altering substances, not more addiction.

 

Cognitive Level: Analyzing

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; transitions and continuity.

AACN Essentials Competencies: IX.18 Develop an awareness of patients as well as healthcare professionals’ spiritual beliefs and values and how those beliefs and values impact health care.

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: 9-2 Identify psychosocial factors that can affect pharmacotherapeutics.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 96

 

 

Question 3

Type: MCSA

The patient is from an Arab culture and is in labor and delivery. Her husband insists he must stay with her and will not allow her to receive any analgesia during the experience. What is the best action by the nurse?

  1. Inform the husband that it is his wife’s choice whether or not to receive analgesia.
  2. Inform the husband that he must sign a release of responsibility to avoid future litigation against the hospital.
  3. Allow the request but inform the husband that the physician will make the final decision about analgesia.
  4. Allow this request and be available in the event the request changes.

Correct Answer: 4

Rationale 1: With some cultures, the husband makes the choices, not the wife.

Rationale 2: When cultural differences are allowed and supported, patients are not as likely to become involved in litigation.

Rationale 3: With some cultures, the husband makes the choices, not the physician.

Rationale 4: Nurses must allow and support cultural differences. The husband’s decisions must be respected as long as patient safety is not involved, and it is not involved in this situation.

Global Rationale: Nurses must allow and support cultural differences. The husband’s decisions must be respected as long as patient safety is not involved, and it is not involved in this situation. With some cultures, the husband makes the choices, not the wife or the physician. When cultural differences are allowed and supported, patients are not as likely to become involved in litigation.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.

AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations.

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: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic outcomes.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 97

 

 

Question 4

Type: MCSA

A patient is diagnosed with cancer. The physician has recommended chemotherapy, which would likely save the patient’s life. The patient tells the nurse, “This is punishment from God for sins I have committed; some women at my church say so.” What will the best plan of the nurse include?

  1. With the patient’s permission, plan to involve a hospital minister to discuss the patient’s perspective about cancer.
  2. With the patient’s permission, plan to bring the case before the hospital’s board of ethics.
  3. With the patient’s permission, plan to contact the patient’s minister to discuss the patient’s perspective about cancer.
  4. With the patient’s permission, plan to meet with family members to discuss the patient’s perspective about cancer.

Correct Answer: 3

Rationale 1: Involving a hospital minister may be an option, but it is best to work through the patient’s minister initially.

Rationale 2: Bringing the case before the hospital’s board of ethics is premature at this point.

Rationale 3: When patients have strong religious beliefs, these can affect the outcome of the illness. The nurse should involve the patient’s religious leader when possible.

Rationale 4: Meeting with family might help; however, they may have the same perspective as the patient.

Global Rationale: When patients have strong religious beliefs, these can affect the outcome of the illness. The nurse should involve the patient’s religious leader when possible. Meeting with family might help; however, they may have the same perspective as the patient. Bringing the case before the hospital’s board of ethics is premature at this point. Involving a hospital minister may be an option, but it is best to work through the patient’s minister initially.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.

AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations.

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: Planning

Learning Outcome: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic outcomes.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 96

 

Question 5

Type: MCSA

The African American patient has panic attacks, is suicidal, and is on an inpatient psychiatric unit. The psychiatrist orders sertraline (Zoloft) and clonazepam (Klonopin). The patient refuses the drugs; he requests to have herbs and African objects in his room to “remove the curse.” What is the priority action by the nurse?

  1. Allow the request without seeking further information from the patient.
  2. Allow the request as long as the herbs and objects do not pose a safety risk for the patient or other patients.
  3. Allow the request after the patient signs a release of responsibility to avoid litigation.
  4. Allow the request after all members of the treatment team agree to it.

Correct Answer: 2

Rationale 1: To allow an ethnic request without seeking further information about safety could jeopardize patient safety.

Rationale 2: Nurses must grant ethnic requests as long as the request does not pose a safety risk to the patient or others.

Rationale 3: There is no need for the patient to sign a release of responsibility to avoid litigation; if items pose a safety risk, they cannot be allowed on the unit.

Rationale 4: The treatment team does not need to agree to this request; the nurse can approve it as long as the items do not pose a safety risk.

Global Rationale: Nurses must grant ethnic requests as long as the request does not pose a safety risk to the patient or others. To allow an ethnic request without seeking further information about safety could jeopardize patient safety. There is no need for the patient to sign a release of responsibility to avoid litigation; if items pose a safety risk, they cannot be allowed on the unit. The treatment team does not need to agree to this request; the nurse can approve it as long as the items do not pose a safety risk.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.

AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations.

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: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic outcomes.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 97

 

 

Question 6

Type: MCSA

The public health nurse notices that several patients in the hypertension clinic have poorly controlled hypertension, even though they have been prescribed appropriate antihypertensive drugs. Which question will best enable the nurse to assess these patients?

  1. “Does your religion allow the use of high blood pressure medication?”
  2. “Do you think your high blood pressure is a problem?”
  3. “Can you afford the high blood pressure medication?”
  4. “Does your culture use herbs to treat high blood pressure?”

Correct Answer: 3

Rationale 1: Religious beliefs could result in the patient not taking the medication, but the cost of the medication is more likely the problem.

Rationale 2: To ask a patient if they think hypertension is a problem should not be necessary; the nurse could eliminate this by appropriate medication education when the medication is prescribed for the patient.

Rationale 3: Once treatment is rendered, the cost of prescription drugs may be far too high for patients on limited incomes.

Rationale 4: The use of herbs may be important in the patient’s culture, but the cost of the medication is more likely the problem.

Global Rationale: Once treatment is rendered, the cost of prescription drugs may be far too high for patients on limited incomes. The use of herbs may be important in the patient’s culture, but the cost of the medication is more likely the problem. To ask a patient if they think hypertension is a problem should not be necessary; the nurse could eliminate this by appropriate medication education when the medication is prescribed for the patient. Religious beliefs could result in the patient not taking the medication, but the cost of the medication is more likely the problem.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.

AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations.

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: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic outcomes.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 97

 

Question 7

Type: MCSA

The nurse is providing education about warfarin (Coumadin) to a patient of Asian ancestry. The nurse determines that learning has occurred when the patient makes which statement?

  1. “I may need to have more frequent blood tests.”
  2. “I may need to have less frequent blood tests.”
  3. “I may need more medication than someone from a different ethnic group.”
  4. “I may need less medication than someone from a different ethnic group.”

Correct Answer: 4

Rationale 1: There is no need for patients of Asian ancestry to have more frequent blood tests than other patients..

Rationale 2: There is no need for patients of Asian ancestry to have less frequent blood tests.

Rationale 3: A patient of Asian ancestry may be a poor metabolizer of warfarin (Coumadin), so they will not require a higher dose.

Rationale 4: A patient of Asian ancestry may be a poor metabolizer of warfarin (Coumadin), so they will often require lower dosages.

Global Rationale: A patient of Asian ancestry may be a poor metabolizer of warfarin (Coumadin), so they will often require lower dosages. There is no need for patients of Asian ancestry to have more or less frequent blood tests than other patients.

 

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; transitions and continuity.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

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: 9-5 Convey how genetic polymorphisms can influence pharmacotherapy.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 100

 

 

Question 8

Type: MCMA

The nurse is conducting a holistic assessment of a patient with alcoholism. What are the important questions to ask?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “How is drinking alcohol viewed by your culture?”
  2. “Have you ever attended Alcoholics Anonymous meetings?”
  3. “Did you see your parents drinking alcohol when you were growing up?”
  4. “Have you been in alcohol rehabilitation before now?”
  5. “What blood relatives of yours are addicted to alcohol?”

Correct Answer: 1,3,5

Rationale 1: Cultural questions are valid questions to ask during a holistic assessment.

Rationale 2: Participation in Alcoholics Anonymous refers to treatment and does not have relevance to a holistic assessment.

Rationale 3: Environmental questions are valid questions to ask during a holistic assessment.

Rationale 4: Participation in a rehabilitation program refers to treatment and does not have relevance to a holistic assessment.

Rationale 5: Biological questions are valid questions to ask during a holistic assessment.

Global Rationale: Biological, environmental, and cultural questions are valid questions to ask during a holistic assessment. Participation in a rehabilitation program refers to treatment and does not have relevance to a holistic assessment. Participation in Alcoholics Anonymous refers to treatment and does not have relevance to a holistic 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: III.1 Explain the interrelationships among theory, practice, and research.

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: 9-1 Describe fundamental concepts underlying a holistic approach to patient care and their importance to pharmacotherapy.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 95

 

Question 9

Type: MCSA

The patient, who is an American Indian, has been admitted to the hospital for chemotherapy. At any given time, five family members are in the patient’s room, which is private. The nurse tells the patient that according to hospital policy, only two visitors at a time are allowed. What does the best analysis by the nurse manager reveal about the nurse’s action?

  1. The nurse should have assessed the patient’s preferences about how many family members she wanted to be present.
  2. The nurse should have called the physician and obtained an order for additional family members to be present.
  3. This was the correct action; the nurse was following protocol by informing the patient about hospital policy.
  4. The nurse should have allowed the patient to have as many family members as she wanted to be present.

Correct Answer: 1

Rationale 1: The nurse should have assessed the patient’s preference about how many visitors she wanted in her room before so strictly interpreting the hospital rules.

Rationale 2: This situation could be resolved by the nurse; there is no need for a physician’s order at this point.

Rationale 3: Many hospital rules, such as how many visitors are allowed, are flexible and do not have to be strictly interpreted; this patient is in a private room.

Rationale 4: The nurse must be realistic with regard to the number of family visitors the patient wants present; five family members is acceptable; twenty would be too many.

Global Rationale: The nurse should have assessed the patient’s preference about how many visitors she wanted in her room before so strictly interpreting the hospital rules. Many hospital rules, such as how many visitors are allowed, are flexible and do not have to be strictly interpreted; this patient is in a private room. The nurse must be realistic with regard to the number of family visitors the patient wants present; five family members is acceptable; twenty would be too many. This situation could be resolved by the nurse; there is no need for a physician’s order at this point.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.

AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations.

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: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic outcomes.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 97

 

 

Question 10

Type: MCSA

The physician has prescribed a chemotherapeutic drug for the patient with cancer. This drug commonly causes loss of hair. The patient asks the nurse, “Will all of my hair fall out?” What is the most therapeutic response by the nurse?

  1. “We are not really sure; applying an ice bag to your head may help.”
  2. “Don’t worry, we can recommend an excellent wig company if need be.”
  3. “Yes, that is one of the expected side effects of this medication.”
  4. “It might. Have you discussed this with your physician?”

Correct Answer: 3

Rationale 1: Ice bags can minimize hair loss with some patients, but the nurse is not honestly answering the patient’s question.

Rationale 2: Telling a patient not to worry is one of the most non-therapeutic responses a nurse can make.

Rationale 3: The nurse must always be forthright in explaining drug actions and potential side effects; minimizing potential adverse effects can result in a distrust of the nurse.

Rationale 4: In this case, the nurse, not the physician, is responsible for answering the patient’s questions.

Global Rationale: The nurse must always be forthright in explaining drug actions and potential side effects; minimizing potential adverse effects can result in a distrust of the nurse. Ice bags can minimize hair loss with some patients, but the nurse is not honestly answering the patient’s question. Telling a patient not to worry is one of the most non-therapeutic responses a nurse can make. In this case, the nurse, not the physician, is responsible for answering the patient’s questions.

 

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; transitions and continuity.

AACN Essentials Competencies: IX.18 Develop an awareness of patients as well as healthcare professionals’ spiritual beliefs and values and how those beliefs and values impact health care.

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: 9-2 Identify psychosocial factors that can affect pharmacotherapeutics.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 96

 

 

Question 11

Type: MCSA

The patient is admitted to the hospital following an abortion, and she is septic. The physician orders antibiotics that the patient refuses stating, “I don’t deserve them.” The nurse providing care has anti-abortion beliefs. What is the best response by the nurse?

  1. “I think you need to do what is best for you.”
  2. “You have a serious infection and really need the drug.”
  3. “It seems you think you should be punished because you had an abortion”
  4. “I’ll call your physician and let him know about your decision.”

Correct Answer: 2

Rationale 1: Telling the patient she needs to do what is best is inappropriate; the nurse knows she needs the drug.

Rationale 2: Telling the patient she needs the drug is providing the best care possible; this must be done even though the nurse’s beliefs are different from the patient’s beliefs.

Rationale 3: Telling the patient what she thinks is not appropriate.

Rationale 4: Calling the physician is inappropriate; the nurse knows the patient needs the drug.

Global Rationale: Telling the patient she needs the drug is providing the best care possible; this must be done even though the nurse’s beliefs are different from the patient’s beliefs. Telling the patient she needs to do what is best is inappropriate; the nurse knows she needs the drug. Calling the physician is inappropriate; the nurse knows the patient needs the drug. Telling the patient what she thinks is not appropriate.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.

AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations.

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: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic outcomes.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 97

 

Question 12

Type: MCSA

The African American patient had a myocardial infarction and is receiving atorvastatin (Lipitor). The nurse caring for the patient is Caucasian. The nurse assesses the patient’s diet to be very high in fat. What is the best plan by the nurse to improve the patient’s diet and reduce the risk for additional medications?

  1. With the patient’s permission, plan to ask an African American nurse to speak to him about a low-fat diet.
  2. With the patient’s permission, plan to discuss his diet with whomever prepares meals for his family.
  3. Plan to give the patient information specific to African Americans about low-fat diets.
  4. Plan to ask the physician for a consult by dietary services so a dietician can teach the patient about low-fat diets.

Correct Answer: 2

Rationale 1: Asking the patient about having an African American nurse speak to him is racist and implies that a Caucasian nurse cannot understand the dietary needs of an African American patient.

Rationale 2: Every culture has culture-specific diets; the nurse must include the person in the family who does the meal preparation if a different diet is to be successful.

Rationale 3: Providing information is a good idea, but the nurse must also teach the patient.

Rationale 4: At this point, a consult by dietary services is premature.

Global Rationale: Every culture has culture-specific diets; the nurse must include the person in the family who does the meal preparation if a different diet is to be successful. Asking the patient about having an African American nurse speak to him is racist and implies that a Caucasian nurse cannot understand the dietary needs of an African American patient. At this point, a consult by dietary services is premature. Providing information is a good idea, but the nurse must also teach the patient.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.

AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations.

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: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic outcomes.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 97

 

Question 13

Type: MCSA

The patient is receiving a beta-blocker medication. The nurse has done medication education and provided the patient with printed information to take home. During the next appointment, the nurse notes that the patient is not taking the medication properly. What is a therapeutic assessment question to ask this patient?

  1. “Do I have to inform your physician about your noncompliance?”
  2. “Why didn’t you take your medicine as we talked about?”
  3. “Are you able to read and comprehend the printed information?”
  4. “Don’t you understand how important it is to take the medicine?”

Correct Answer: 3

Rationale 1: It is inappropriate to involve the physician before the nurse assesses the reason for noncompliance, and this question is threatening.

Rationale 2: Asking “why” questions put the patient on the defensive, and the nurse might not receive the most accurate answer.

Rationale 3: Many English-speaking patients do not have functional literacy, a basic ability to read, understand, and act on health information. The nurse should ask the patient about the ability to read and understand printed information.

Rationale 4: Being confrontational with a “don’t you understand” question is as demeaning as asking a “why” question.

Global Rationale: Many English-speaking patients do not have functional literacy, a basic ability to read, understand, and act on health information. The nurse should ask the patient about the ability to read and understand printed information. Asking “why” questions put the patient on the defensive, and the nurse might not receive the most accurate answer. Being confrontational with a “don’t you understand” question is as demeaning as asking a “why” question. It is inappropriate to involve the physician before the nurse assesses the reason for noncompliance, and this question is threatening.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.

AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations.

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: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic outcomes.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 97

 

Question 14

Type: MCSA

All of the patients listed have cancer and are receiving chemotherapy. Which patient does the nurse evaluate as having the highest probability for a remission?

  1. The patient with a support group of cancer survivors
  2. The patient who is also seeing a psychiatrist for treatment of depression
  3. The wealthy patient who can afford the best medical care available
  4. The patient who is a former physician

Correct Answer: 1

Rationale 1: Positive attitudes and high expectations toward therapeutic outcomes in the patient may influence the success of pharmacotherapy. The support group of cancer survivors would provide the best support and the highest probability for a positive outcome.

Rationale 2: Treatment for depression might help the outcome, but this patient would not have as high a probability for remission as the patient with another resource.

Rationale 3: A wealthy patient can afford the best medical care, but this patient may not have good psychosocial support.

Rationale 4: A former physician may have a sound knowledge base about cancer, but this patient might not have good psychosocial support.

Global Rationale: Positive attitudes and high expectations toward therapeutic outcomes in the patient may influence the success of pharmacotherapy. The support group of cancer survivors would provide the best support and the highest probability for a positive outcome. A wealthy patient can afford the best medical care, but this patient may not have good psychosocial support. Treatment for depression might help the outcome, but this patient would not have as high a probability for remission as the patient with another resource. A former physician may have a sound knowledge base about cancer, but this patient might not have good psychosocial support.

 

Cognitive Level: Analyzing

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; transitions and continuity.

AACN Essentials Competencies: IX.18 Develop an awareness of patients as well as healthcare professionals’ spiritual beliefs and values and how those beliefs and values impact health care.

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: 9-2 Identify psychosocial factors that can affect pharmacotherapeutics.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 96

 

 

Question 15

Type: MCMA

A nurse is teaching a community group about holistic medicine. Which information should the nurse include about Western medicine?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Western medicine focuses on the cause of disease.
  2. Western medicine is not compatible with holistic medicine.
  3. The patient is at the center of concern in Western medicine.
  4. Disease is often viewed as a malfunction in a specific body system.
  5. Western medicine may focus on disease treatment.

Correct Answer: 1,4,5

Rationale 1: Western medicine often focuses on determining which disease is present and what caused it.

Rationale 2: Western medicine is compatible with holistic medicine, but this requires that those providing care remain mindful of the individuality of the patient.

Rationale 3: Disease and treatment are typically at the center of Western medicine.

Rationale 4: In Western medicine disease is often viewed as a specific malfunction of a body part.

Rationale 5: Western medicine often focuses on the treatment of a disease, not the care of the patient with the disease.

Global Rationale: Western medicine often focuses on determining which disease is present and what caused it. In Western medicine disease is often viewed as a specific malfunction of a body part. Western medicine often focuses on the treatment of a disease, not the care of the patient with the disease. Western medicine is compatible with holistic medicine, but this requires that those providing care remain mindful of the individuality of the patient. Disease and treatment are typically at the center of Western medicine.

 

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: 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: 9-1 Describe fundamental concepts underlying a holistic approach to patient care and their importance to pharmacotherapy.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 95

 

Question 16

Type: MCSA

Which of the following best indicates an ethnic characteristic that can affect pharmacotherapy?

  1. Genetic differences
  2. Diet
  3. Health beliefs
  4. Alternative therapies

Correct Answer: 1

Rationale 1: Ethnicity relates to biology and genetics.

Rationale 2: Diet is a cultural characteristic.

Rationale 3: Health belief is a cultural characteristic.

Rationale 4: Alternative therapies are cultural characteristics.

Global Rationale: Ethnicity relates to biology and genetics. Diet, alternative therapies, and health beliefs are cultural characteristics.

 

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: 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: 9-5 Convey how genetic polymorphisms can influence pharmacotherapy.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 100

 

 

 

Question 17

Type: MCMA

The nurse manager would determine that a nurse understands culturally sensitive care if which 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. “Since all of our patients have the same illnesses, I sometimes get bored.”
  2. “I have been helping my patient understand how to choose foods from our diet menu.”
  3. “I am concerned because my patient needs sterile dressing changes but has no running water at home.”
  4. “My patient and I worked out a way to get her medications delivered to her at home.”
  5. “I invited a group from my church to come and sing hymns for our patients.”

Correct Answer: 2,3,4

Rationale 1: A nurse who believes that patients who have the same illness are alike is not seeing their psychosocial needs.

Rationale 2: Helping the patient cope and navigate through the hospital “culture” is a culturally sensitive action.

Rationale 3: Cultural sensitivity takes environment into consideration.

Rationale 4: Helping the patient cope and navigate through potential blockers to medication adherence is a culturally sensitive action.

Rationale 5: Imposing one’s own religious beliefs on others is not culturally sensitive.

Global Rationale: Helping the patient cope and navigate through the hospital “culture” is a culturally sensitive action. Cultural sensitivity takes environment into consideration. Helping the patient cope and navigate through potential blockers to medication adherence is a culturally sensitive action. A nurse who believes that patients who have the same illness are alike is not seeing their psychosocial needs. Imposing one’s own religious beliefs on others is not culturally sensitive.

 

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: 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: 9-1 Describe fundamental concepts underlying a holistic approach to patient care and their importance to pharmacotherapy.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 95

 

 

Question 18

Type: MCSA

Which statement regarding human DNA sequences is accurate?

  1. Only 2% of human DNA is different among the different ethnicities.
  2. Due to enzyme polymorphism, Hispanics are less likely to metabolize codeine to morphine.
  3. Even though human genetic differences are small, significant differences can be seen with drug metabolism.
  4. Asian Americans are the ethnic group known to be slow acetylators.

Correct Answer: 3

Rationale 1: Human DNA differences of only 0.2% can produce significant differences in the way drugs are handled within the body.

Rationale 2: Asian Americans are less likely to metabolize codeine to morphine.

Rationale 3: Human DNA differences of only 0.2% can produce significant differences in the way drugs are handled within the body.

Rationale 4: Caucasians are known to be slow acetylators.

Global Rationale: Human DNA differences of only 0.2% can produce significant differences in the way drugs are handled within the body. Asian Americans are less likely to metabolize codeine to morphine, and Caucasians are known to be slow acetylators.

 

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: 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: 9-5 Convey how genetic polymorphisms can influence pharmacotherapy.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 99

 

Question 19

Type: MCSA

Which statement is accurate regarding gender and pharmacology?

  1. Women tend to seek medical care earlier than men do.
  2. Heart disease has traditionally been thought of as a woman’s disease.
  3. Since the 1980s, the FDA has mandated that research studies include both male and female subjects.
  4. Studies indicate that men and women suffer from Alzheimer’s disease in equal numbers.

Correct Answer: 1

Rationale 1: Women are quicker to seek medical care than are men.

Rationale 2: Cardiac disease has traditionally been thought of as a men’s issue.

Rationale 3: In 1993, the FDA mandated that research studies include both male and female subjects.

Rationale 4: Studies indicate that more women than men suffer from Alzheimer’s disease.

Global Rationale: Women are quicker to seek medical care than are men. Studies indicate that more women than men suffer from Alzheimer’s disease. In 1993, the FDA mandated that research studies include both male and female subjects. Cardiac disease has traditionally been thought of as a men’s issue.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.

AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations.

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: 9-6 Relate the implications of gender to the actions of certain drugs.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 100

 

 

Question 20

Type: MCMA

The nurse is assessing several patients. For which patient does assessment reveal a psychosocial history that may affect the patient’s outcome?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Older adult who recently suffered a stroke, has an unsteady gait, and lives in a two-story home
  2. Middle-aged patient with Down syndrome living in a group home
  3. Recently divorced mother of three children with breast cancer
  4. Sixteen-year-old requesting birth control without parental consent
  5. Seven-year-old with asthma in a foster care home

Correct Answer: 1,2,3

Rationale 1: This patient may not be able to return to a home that requires climbing stairs.

Rationale 2: A patient with Down syndrome needs additional care to ensure that treatment outcome is successful.

Rationale 3: This patient may be the family’s sole provider and may have financial concerns.

Rationale 4: Many teens seek contraception without their parents’ consent. This should not have a negative impact on outcome.

Rationale 5: Residing in foster care should not have a negative impact on outcome.

Global Rationale: A patient who had a stroke may not be able to return to a home that requires climbing stairs. A patient with Down syndrome needs additional care to ensure that treatment outcome is successful. The patient with breast cancer may be the family’s sole provider and may have financial concerns. Many teens seek contraception without their parents’ consent. This should not have a negative impact on outcome. Residing in foster care should not have a negative impact on outcome.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.

AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations.

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: 9-4 Explain how community and environmental factors can affect health care outcomes.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 98

 

 

Question 21

Type: MCMA

The nurse in charge of a clinical study welcomes the participants in an open forum. One patient is surprised that there are men and women from several ethnic groups. The nurse tells the group that in the past, ethnic variables were largely unknown or ignored for what reasons?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Clinical trials failed to include ethnically diverse subjects.
  2. Clinical trials comprised mostly Caucasian males.
  3. Little attention was focused on identifying the different effects drugs had on various ethnic groups.
  4. Research proved there were no differences among ethnic groups.
  5. The large majority of clinical trials included Caucasian females.

Correct Answer: 1,2,3

Rationale 1: There was a lack of ethnic diversity in early clinical trials.

Rationale 2: Until recently, clinical trials comprised mostly Caucasian males.

Rationale 3: Little attention was focused on identifying the differences in pharmacologic effects in diverse ethnic groups.

Rationale 4: There was insufficient research to show differences because little attention was focused on these differences.

Rationale 5: The large majority of clinical trials excluded females.

Global Rationale: There was a lack of ethnic diversity in early clinical trials. Little attention was focused on identifying the differences in pharmacologic effects in diverse ethnic groups. Until recently, clinical trials comprised mostly Caucasian males.

 

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.

AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations.

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: 9-3 Explain how culture and ethnicity can affect pharmacotherapeutic outcomes.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 96

 

Question 22

Type: MCMA

The nurse in the emergency department is caring for several patients from diverse cultures. Which statement shows the nurse’s ability to provide culturally competent care?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “I understand your religion prohibits blood transfusions. Would you consider nonblood alternatives?”
  2. “I just want to make sure you and your spouse understand the risks as you consider the options.”
  3. “I don’t really understand why you are afraid to take the medication. Do you have any questions I can answer to alleviate your fear?”
  4. “I really don’t understand why you won’t consider an abortion. Your admission papers say you are an atheist.”
  5. “I’m not quite sure why the health care provider is giving you these prescriptions. You didn’t get them filled the last time you were here.”

Correct Answer: 1,2,3

Rationale 1: This statement shows the nurse is respectful of religious beliefs and open to offering alternative treatment.

Rationale 2: This statement shows the nurse is accepting of patients’ beliefs.

Rationale 3: This statement may encourage the patient to open up to the nurse about fears.

Rationale 4: This is a judgmental and insensitive comment. A culturally competent nurse is sensitive to the patient’s spiritual beliefs or lack thereof.

Rationale 5: This statement does not consider social factors that may contribute to nonadherence.

Global Rationale: The nurse providing culturally competent care is respectful of and sensitive to religious beliefs and open to alternate treatment. The nurse encourages patient to open up about fears. There are social factors that may contribute to nonadherence to therapy.

 

Cognitive Level: Analyzing

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; transitions and continuity.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

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: 9-5 Convey how genetic polymorphisms can influence pharmacotherapy.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 96

 

 

Question 23

Type: MCMA

A home health nurse’s patient caseload is ethnically diverse. Which interventions show understanding of cultural variables?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Discussing cultural preferences for herbs and spices and possible alternatives when drug interactions are possible
  2. Assessing the patient’s response to acupuncture for pain
  3. Discussing the patient’s beliefs regarding treatment
  4. Notifying the health care provider of the patient’s intentions to consult with a medicine man for spiritual guidance
  5. Removing the patient’s collection of herbs to decrease the risk of an adverse effect when taken with Western medicine

Correct Answer: 1,2,3

Rationale 1: It is important to assess the cultural use of herbs and spices and determine if there may be any interactions with prescribed medications.

Rationale 2: The nurse can assess the patient’s response to acupuncture and interpret the effects on prescribed treatment with respect for the patient’s culture.

Rationale 3: Cultures view health and wellness in different ways. An understanding of the patient’s cultural beliefs allows the nurse to provide better support and guidance.

Rationale 4: As long as the medicine man does not “prescribe” any herbs, the nurse does not have to discuss this with the provider.

Rationale 5: The nurse need not remove the herbs but rather should discuss possible adverse effects when the herbs are mixed with prescribed medications.

Global Rationale: It is important to assess the cultural use of herbs and spices and determine if there may be any interactions with prescribed medications. The nurse need not remove the herbs but rather should discuss possible adverse effects when the herbs are mixed with prescribed medications. The nurse can assess the patient’s response to acupuncture and interpret the effects on prescribed treatment with respect for the patient’s culture. Cultures view health and wellness in different ways. An understanding of the patient’s cultural beliefs allows the nurse to provide better support and guidance. As long as the medicine man does not “prescribe” any herbs, the nurse does not have to discuss this with the provider.

 

Cognitive Level: Analyzing

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; transitions and continuity.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

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: 9-5 Convey how genetic polymorphisms can influence pharmacotherapy.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 96

 

Question 24

Type: MCMA

A patient asks the nurse why a medication prescribed by the provider “didn’t do anything at all.” Which statement by the nurse accurately describes how genetics influence drug action?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “Genetic differences can result in significant differences in how each patient’s body handles the same medication.”
  2. “Genetic differences can cause mutations in enzymes, changing the way they function. This can alter how the body metabolizes and excretes drugs.”
  3. “Because of genetic differences, medication may accumulate to toxic levels in one patient while in another patient may be inactivated before it can have a therapeutic effect.”
  4. “Genetic differences can be expressed as an alteration in the structure of an enzyme, which can cause a defective receptor and an allergic response to drugs.”
  5. “Genetic differences in patients who are biracial result in an allergic response to medications.”

Correct Answer: 1,2,3

Rationale 1: 99.8% of human DNA sequences are identical. The remaining 0.2% can account for significant differences in people’s ability to handle medications.

Rationale 2: The structure of an enzyme is closely related to its function. A mutation can cause a change in the structure of the enzyme, resulting in a change in its function.

Rationale 3: When enzymes are functionally changed by genetics, metabolism and excretion can be altered, resulting in the drug either accumulating or being inactivated.

Rationale 4: Small changes in the structure of a protein may result in a defective receptor that will not accept the drug and the drug not having any therapeutic effect. This is not an allergic response.

Rationale 5: Genetic differences can result in mutations of enzymes or proteins, which may result in changes in function. Being of a certain race may predispose a patient to mutations and, therefore, uncommon responses to medication, but this does not mean the patient will have an allergic response to medications.

Global Rationale: 99.8% of human DNA sequences are identical. The remaining 0.2% can account for significant differences in people’s ability to handle medications. The structure of an enzyme is closely related to its function. A mutation can cause a change in the structure of the enzyme, resulting in a change in its function. When enzymes are functionally changed by genetics, metabolism and excretion can be altered, resulting in the drug either accumulating or being inactivated. Small changes in the structure of a protein may result in a defective receptor that will not accept the drug and the drug not having any therapeutic effect. This is not an allergic response. Genetic differences can result in mutations of enzymes or proteins, which may result in changes in function. Being of a certain race may predispose a patient to mutations and, therefore, uncommon responses to medication, but this does not mean the patient will have an allergic response to medications.

 

Cognitive Level: Analyzing

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; transitions and continuity.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

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: 9-5 Convey how genetic polymorphisms can influence pharmacotherapy.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 99

 

Question 25

Type: MCMA

A nurse administering medications to a variety of patients on a medical-surgical floor recognizes that which patients may need additional education about medication adherence?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Fifty-year-old recently remarried male taking antihypertensive medication
  2. Thirty-four-year-old female with family history of blood clots taking an estrogen oral contraceptive
  3. Thirty-eight-year-old male recently started on an antidepressant
  4. Twenty-eight-year-old female started on acne medication known to cause male-patterned hair growth
  5. Seventy-eight-year-old female being treated for shingles

Correct Answer: 1,2,3,4

Rationale 1: Antihypertensive medications can cause impotence. This patient will need additional education about this possible side effect.

Rationale 2: Estrogen can cause an increased risk for thrombolytic events, especially in patients who have a positive family history.

Rationale 3: Taking an antidepressant may result in the man feeling weak, unhealthy, or dependent.

Rationale 4: Some acne medications cause increased hair growth in a male pattern, such as on the face. While controlling acne is a goal, the patient may not want the extra hair growth.

Rationale 5: There is no indication that treatment for shingles requires education in excess of that which is generally provided.

Global Rationale: Antihypertensive medications can cause impotence. This patient will need additional education about this possible side effect. Estrogen can cause an increased risk for thrombolytic events, especially in patients who have a positive family history. Taking an antidepressant may result in the man feeling weak, unhealthy, or dependent. Some acne medications cause increased hair growth in a male pattern, such as on the face. While controlling acne is a goal, the patient may not want the extra hair growth. There is no indication that treatment for shingles requires education in excess of that which is generally provided.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.

AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations.

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: 9-6 Relate the implications of gender to the actions of certain drugs.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 100

 

 

Question 26                                                                                                                                            

Type: MCMA

 

A patient who is strictly vegetarian due to religious beliefs has been prescribed a medication contained in a gelatin capsule. Which 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. Do not tell the patient the capsule contains gelatin.
  2. Collaborate with the prescriber to find an alternative medication.
  3. Check to see if the capsule can be opened for administration.
  4. Work to convince the patient that this application does not violate vegetarian beliefs.
  5. Tell the patient that the gelatin is an inactive ingredient in the medication.

Correct Answer: 2,3

 

Rationale 1: Withholding information regarding the medication is not ethical.

Rationale 2: An alternative dosage form that does not require use of a gelatin capsule may be available.

Rationale 3: Many capsules can be opened and the contents placed in fluid or on soft food for administration.

Rationale 4: If the patient is strictly vegetarian the use of a gelatin capsule is a violation of belief. The nurse should not try to influence the patient otherwise.

Rationale 5: Whether the gelatin is an active ingredient or an inactive ingredient is not relevant.

Global Rationale: An alternative dosage form that does not require use of a gelatin capsule may be available. Many capsules can be opened and the contents placed in fluid or on soft food for administration. Withholding information regarding the medication is not ethical. If the patient is strictly vegetarian the use of a gelatin capsule is a violation of belief. The nurse should not try to influence the patient otherwise. Whether the gelatin is an active ingredient or an inactive ingredient is not relevant.

 

Cognitive Level: Analyzing

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; transitions and continuity.

AACN Essentials Competencies: IX.18 Develop an awareness of patients as well as healthcare professionals’ spiritual beliefs and values and how those beliefs and values impact health care.

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: 9-2 Identify psychosocial factors that can affect pharmacotherapeutics.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 96

 

 

Question 27

Type: MCMA

 

Which patient statements would the nurse evaluate as negatively affecting access to health care?

 

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. An older adult says, “If I tell my doctor that I fall frequently, I might have to go to a nursing home.”
  2. A young adult says, “A benefit of my new job is that it pays for my health, dental, and vision insurance.”
  3. A patient being discharged says, “Can you call my prescriptions in to the pharmacy?”
  4. The patient’s new insurance plan requires a $10 copay for office visits.
  5. A patient asks to be discharged before noon as he has a 3-hour drive home.

Correct Answer: 1,4,5

Rationale 1: The older adult may not reveal a fall history out of concern for loss of independence and a change in living conditions.

Rationale 2: Having a job that pays insurance helps ensure access.

Rationale 3: Being able to call prescriptions in to the pharmacy helps ensure access.

Rationale 4: Even a low cost copay may be difficult for some patients to afford.

Rationale 5: Living long distances from health care sources decreases access.

 

Global Rationale: The older adult may not reveal a fall history out of concern for loss of independence and a change in living conditions. Even a low cost copay may be difficult for some patients to afford. Living long distances from health care sources decreases access. Having a job that pays insurance helps ensure access. Being able to call prescriptions in to the pharmacy helps ensure access.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.

AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations.

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: 9-4 Explain how community and environmental factors can affect health care outcomes.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 98

 

Question 28

Type: MCMA

A nurse has been asked to present health promotion information at a community clinic whose clients are primary non-Hispanic Black women. After review of health disparity and inequality statistics the nurse chooses to include information about which disorders?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Stroke
  2. Coronary artery disease
  3. Diabetes
  4. Illicit drug use
  5. Prenatal care

Correct Answer: 1,2,3,5

Rationale 1: The rate of premature death due to stroke is higher among non-Hispanic Blacks than among non-Hispanic Whites.

Rationale 2: The rate of premature death due to coronary artery disease is higher among non-Hispanic Blacks than among non-Hispanic Whites.

Rationale 3: Diabetes is highest among non-Hispanic Blacks and Hispanics.

Rationale 4: Rates for drug-induced death (from both legal and illegal drugs) is highest among American Indians, Alaskan Natives, and non-Hispanic Whites.

Rationale 5: The infant mortality rate for non-Hispanic Black women is more than double that for non-Hispanic White women.

Global Rationale: The rate of premature death due to stroke and coronary artery disease is higher among non-Hispanic Blacks than among non-Hispanic Whites. Diabetes is highest among non-Hispanic Blacks and Hispanics. The infant mortality rate for non-Hispanic Black women is more than double that for non-Hispanic White women. Rates for drug-induced death (from both legal and illegal drugs) is highest among American Indians, Alaskan Natives, and non-Hispanic Whites.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.

AACN Essentials Competencies: II.8 Promote achievement of safe and quality outcomes of care for diverse populations.

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: 9-4 Explain how community and environmental factors can affect health care outcomes.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 98

 

Question 29

Type: MCMA

 

A patient’s genetic testing indicates presence of a genetic polymorphism of the CYP 450 enzyme. The nurse expects this difference to be one of which classifications?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Extensive
  2. Poor
  3. Normal
  4. Ultrarapid
  5. Inefficient

Correct Answer: 1,2,4

Rationale 1: “Extensive” is one of the classifications used to describe this change in drug metabolism.

Rationale 2: “Poor” is one of the classifications used to describe this change in drug metabolism

Rationale 3: Since this patient has a change, the metabolism would not be classified as “normal.”

Rationale 4: “Ultrarapid” is one of the classifications used to describe this change in drug metabolism.

Rationale 5: “Inefficient” is not used to describe this change.

Global Rationale: “Extensive,” “poor,” and “ultrarapid” are all classifications used to describe this change in drug metabolism. Since this patient has a change, the metabolism would not be classified as “normal.” “Inefficient” is not used to describe this change.

 

Cognitive Level: Analyzing

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; transitions and continuity.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

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: 9-5 Convey how genetic polymorphisms can influence pharmacotherapy.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 99

 

Question 30

Type: MCMA

 

A patient’s genetic testing reveals a change in CYP2A6. The nurse would plan which interventions based on this discovery?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Teaching the patient to avoid caffeine-containing drugs.
  2. Planning additional time and interventions to help the patient stop smoking.
  3. Use of an alternative to the drug warfarin.
  4. Increased surveillance for the development of lung cancer.
  5. Frequent monitoring of blood pressure.

Correct Answer: 2,4

Rationale 1: CYP2A6 is not associated with caffeine.

Rationale 2: CYP2A6 reduction may make smoking cessation more difficult.

Rationale 3:.CYP2C9 is associated with reduced metabolism of warfarin.

Rationale 4: CYP2A6 reduction may increase risk of lung cancer.

Rationale 5: CYP2A6 is not associated with blood pressure level.

Global Rationale: CYP2A6 reduction may make smoking cessation more difficult and increases risk of lung cancer. It is not associated with caffeine or blood pressure level. CYP2C9 is associated with reduced metabolism of warfarin.

 

Cognitive Level: Analyzing

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; transitions and continuity.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

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: 9-5 Convey how genetic polymorphisms can influence pharmacotherapy.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the lifespan and various community settings.

Page Number: 100

Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E
Chapter 11

Question 1

Type: MCMA

The nurse is teaching the importance of drugs for emergency preparedness to local firemen. The nurse determines that learning has occurred when the firemen make 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. “The vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours.”
  2. “Our local hospital is supposed to be stockpiling antibiotics.”
  3. “The push package can reach any community within 12 hours of an attack.”
  4. “The Strategic National Stockpile is located at the Centers for Disease Control and Prevention (CDC) in Atlanta.”
  5. “Our country’s drug stockpile is managed by the Centers for Disease Control and Prevention (CDC).”

Correct Answer: 1,3,5

Rationale 1: The vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours.

Rationale 2: Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics.

Rationale 3: The push package can reach any community within 12 hours of an attack.

Rationale 4: The Strategic National Stockpile is located at various sites throughout the country.

Rationale 5: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC).

Global Rationale: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11-3 Identify the purpose and components of the Strategic National Stockpile (SNS).

MNL Learning Outcome:

Page Number: 116

 

Question 2

Type: MCMA

The nurse works for the Centers for Disease Control and Prevention (CDC). In planning for a bioterrorist attack, 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. Learn the signs and symptoms of chemical and biological agents.
  2. Obtain a listing of health and law enforcement contacts.
  3. Assist in the stockpiling of medications.
  4. Obtain current knowledge of emergency management.
  5. Assist in triage at local hospitals.

Correct Answer: 1,2,4

Rationale 1: The key roles of nurses in meeting the challenge of a potential bioterrorist event include diagnosis and treatment (signs and symptoms of chemical and biological agents).

Rationale 2: The key roles of nurses in meeting the challenge of a potential bioterrorist event include resources (health and law enforcement contacts).

Rationale 3: Stockpiling of medications is discouraged.

Rationale 4: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge).

Rationale 5: In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage.

Global Rationale: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-2 Discuss the role of the nurse in preparing for and responding to worldwide epidemics and bioterrorist activity.

MNL Learning Outcome:

Page Number: 116

 

Question 3

Type: MCSA

The patient comes to the emergency department with an anxiety attack. He tells the nurse he heard that there was another anthrax attack in the capitol and is concerned about running out of medications. What is the best response by the nurse?

  1. “You don’t need to worry about another attack at all; I think our government can take care of us.”
  2. “Your health is in danger due to the anxiety; we really need to focus on reducing your anxiety now.”
  3. “The Centers for Disease Control and Prevention (CDC) maintains a large stockpile of medications for us in case that occurs.”
  4. “I’m sure the Centers for Disease Control and Prevention (CDC) has contingency plans in the event of an anthrax attack.”

Correct Answer: 3

Rationale 1: Telling the patient not to worry is a nonspecific and patronizing response.

Rationale 2: Reducing anxiety is important, but this response does not answer the patient’s concern.

Rationale 3: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack.

Rationale 4: Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific.

Global Rationale: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack. Telling the patient not to worry is a nonspecific and patronizing response. Reducing anxiety is important, but this response does not answer the patient’s concern. Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-2 Discuss the role of the nurse in preparing for and responding to worldwide epidemics and bioterrorist activity.

MNL Learning Outcome:

Page Number: 115

 

Question 4

Type: MCSA

The nurse is teaching a class on anthrax to a group of emergency response workers. What is the best instruction to include?

  1. Anthrax is a deadly bacterium; the most common and deadly form is gastrointestinal anthrax.
  2. Cutaneous anthrax is the most common form, but inhaled anthrax is the most lethal form.
  3. Anthrax most commonly affects wild rodents such as mice, rats, squirrels, and chipmunks.
  4. Cutaneous anthrax is serious because it quickly spreads by person-to-person contact.

Correct Answer: 2

Rationale 1: Gastrointestinal anthrax is a rare form of anthrax.

Rationale 2: Cutaneous anthrax is the most common, but inhalation anthrax is the most dangerous form of anthrax.

Rationale 3: Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses.

Rationale 4: Cutaneous anthrax cannot be spread by person-to-person contact.

Global Rationale: Cutaneous anthrax is the most common, but least complicated, form of anthrax. Inhalation anthrax is the least common, but most dangerous, form of anthrax. Gastrointestinal anthrax is a rare form of anthrax. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses. Cutaneous anthrax cannot be spread by person-to-person contact.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-4 Identify specific agents that would likely be used in a bioterrorist attack.

MNL Learning Outcome:

Page Number: 117

 

 

Question 5

Type: MCSA

The patient has been exposed to anthrax. What treatment will the nurse plan to administer?

  1. Penicillin (Bicillin LA) and vancomycin (Vancocin).
  2. Tetracycline (Sumycin) and erythromycin (Erythrocin).
  3. Ampicillin (Principen) and cefepime (Maxipime).
  4. Ciprofloxacin (Cipro) and doxycycline (Vibramycin).

Correct Answer: 4

Rationale 1: Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax.

Rationale 2: Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax.

Rationale 3: Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax.

Rationale 4: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax.

Global Rationale: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-6 Discuss the clinical manifestations and treatment of anthrax exposure.

MNL Learning Outcome:

Page Number: 118

 

Question 6

Type: MCSA

The patient was exposed to cutaneous anthrax 2 weeks ago. What will the nurse see when assessing the patient’s skin?

  1. Large pustules, and later, reddish scabs
  2. Small, fluid-filled vesicles, and later, small skin erosions
  3. Ulcerated areas, and later, keloids
  4. Small skin lesions, and later, black scabs

Correct Answer: 4

Rationale 1: Large pustules, and later, reddish scabs are not seen with cutaneous anthrax.

Rationale 2: Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax.

Rationale 3: Ulcerated areas, and later, keloids are not seen with cutaneous anthrax.

Rationale 4: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs.

Global Rationale: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs. Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax. Large pustules, and later, reddish scabs are not seen with cutaneous anthrax. Ulcerated areas, and later, keloids are not seen with cutaneous anthrax.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-6 Discuss the clinical manifestations and treatment of anthrax exposure.

MNL Learning Outcome:

Page Number: 117

 

Question 7

Type: MCSA

The nursing instructor is teaching student nurses about the use of viruses in a bioterrorism attack. The nurse determines that learning has occurred when the students make which statement?

  1. “The Centers for Disease Control and Prevention (CDC) has a plan to vaccinate Americans against most viruses.”
  2. “Actually, a bigger concern is a nuclear weapon exploding in a city.”
  3. “Most Americans have already been vaccinated against the lethal viruses.”
  4. “A bioterrorist attack with viruses is a real threat to Americans.”

Correct Answer: 4

Rationale 1: The CDC does not have a plan to vaccinate Americans against most viruses.

Rationale 2: At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack.

Rationale 3: Most Americans have not been vaccinated against viruses.

Rationale 4: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack.

Global Rationale: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack. Mass vaccination is not appropriate until safer vaccines can be produced. The CDC does not have a plan to vaccinate Americans against most viruses. Most Americans have not been vaccinated against viruses. At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11-4 Identify specific agents that would likely be used in a bioterrorist attack.

MNL Learning Outcome:

Page Number: 119

 

Question 8

Type: MCSA

The patient tells the nurse that she is concerned about terrorist activity and questions if everyone should be immunized against smallpox. What is the best response by the nurse?

  1. “The vaccine has side effects, which are serious and could kill many people.”
  2. “I really do not think our country has enough vaccine to do this.”
  3. “Don’t be so concerned; if an attack comes, we will immunize people then.”
  4. “The vaccine has some serious side effects, but this is probably a good idea.”

Correct Answer: 1

Rationale 1: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox.

Rationale 2: There is enough vaccine for all Americans to be vaccinated against smallpox.

Rationale 3: Telling a patient not to be concerned is a condescending and non-therapeutic response.

Rationale 4: Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox.

Global Rationale: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox. There is enough vaccine for all Americans to be vaccinated against smallpox. Telling a patient not to be concerned is a condescending and non-therapeutic response. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-8 Explain the advantages and disadvantages of vaccination as a means of preventing illness due to bioterrorist threats.

MNL Learning Outcome:

Page Number: 119

 

Question 9

Type: MCMA

 

A nurse who is presenting community education states, “Drugs are among our most powerful weapons for emergency preparedness.” What additional statements, made by the nurse, would support this statement?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “Drugs help us treat the diseases that could be caused by bioterrorism.”
  2. “We can use drugs to neutralize our enemies.”
  3. “If we control the manufacture and distribution of drugs, we will control global politics.”
  4. “Without drugs, we might be quickly overwhelmed by a bioterrorist attack.”
  5. “Drugs can be used in chemical or nuclear attacks.”

Correct Answer: 1,4,5

Rationale 1: Drugs are a major treatment option for the types of diseases used in bioterrorism.

Rationale 2: The nurse would not have knowledge of this level of emergency planning.

Rationale 3: The nurse has no part in manufacture and distribution.

Rationale 4: If there were no drugs to treat a bioterrorist-released organism, the medical systems would soon become overwhelmed.

Rationale 5: Drugs can be used to treat the results of chemical or nuclear warfare as well as bioterrorism.

 

Global Rationale: Drugs are a major treatment option for the types of diseases used in bioterrorism. If there were no drugs to treat a bioterrorist-released organism, the medical systems would soon become overwhelmed. Drugs can be used to treat the results of chemical or nuclear warfare as well as bioterrorism. The nurse would have no input into how to neutralize enemies or control drug manufacture and distribution.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-1 Explain why drugs are important in the context of emergency preparedness.

MNL Learning Outcome:

Page Number: 114

 

 

Question 10

Type: MCSA

The patient has been exposed to a nerve agent. For which symptoms will the nurse most likely assess?

  1. Salivation, involuntary urination, and convulsions
  2. Dilated pupils and increased blood pressure and heart rate
  3. Pinpoint pupils, decreased blood pressure, and increased heart rate
  4. Rapid breathing and cold, clammy skin

Correct Answer: 1

Rationale 1: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase.

Rationale 2: Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation.

Rationale 3: Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine.

Rationale 4: Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine.

Global Rationale: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase. Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-10 List top substances that represent human poison exposures.

MNL Learning Outcome:

Page Number: 119

 

Question 11

Type: MCSA

The patient has been exposed to a nerve agent. Which antidote will the nurse plan to administer?

  1. Apomorphine
  2. Atropine
  3. Acetate of ammonia
  4. Hydroxyzine (Vistaril)

Correct Answer: 2

Rationale 1: Apomorphine will not reverse the symptoms of acetylcholine overstimulation.

Rationale 2: Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine overstimulation.

Rationale 3: Acetate of ammonia will not reverse the symptoms of acetylcholine overstimulation.

Rationale 4: Hydroxyzine (Vistaril) will not reverse the symptoms of acetylcholine overstimulation.

Global Rationale: Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine overstimulation. Hydroxyzine (Vistaril), acetate of ammonia, and apomorphine will not reverse the symptoms of acetylcholine overstimulation.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-12 Describe specific antidotes used to treat common overdosed substances and toxins.

MNL Learning Outcome:

Page Number: 120

 

 

Question 12

Type: MCSA

A small nuclear weapon has been detonated in a nearby city. For which immediate symptoms of radiation sickness will the nurse assess in patients who have been exposed?

  1. Dilated pupils and aggression
  2. Nausea, vomiting, and diarrhea
  3. Weight loss and fatigue
  4. Anorexia and fatigue

Correct Answer: 2

Rationale 1: Dilated pupils and aggression are not signs of radiation sickness.

Rationale 2: The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea.

Rationale 3: Weight loss and fatigue are late symptoms of radiation sickness.

Rationale 4: Anorexia and fatigue are not signs of radiation sickness.

Global Rationale: The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea. Weight loss and fatigue are late symptoms of radiation sickness. Anorexia and fatigue are not signs of radiation sickness. Dilated pupils and aggression are not signs of radiation sickness.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-9 Describe the symptoms of acute radiation exposure and the role of potassium iodide (KI) in preventing thyroid cancer.

MNL Learning Outcome:

Page Number: 120

 

 

Question 13

Type: MCSA

The nurse administers potassium iodide (KI) tablets to a patient who has been exposed to radiation from a nuclear weapon. What is the rationale for administering potassium iodide (KI) to this patient?

  1. It was administered to prevent thyroid cancer.
  2. It was administered to prevent brain cancer.
  3. It was administered to prevent liver cancer.
  4. It was administered to prevent renal cancer.

Correct Answer: 1

Rationale 1: Potassium iodide (KI) can prevent up to 100% of the radioactive iodine from entering the thyroid gland.

Rationale 2: Potassium iodide (KI) will not protect the brain from the effects of radioactive iodine.

Rationale 3: Potassium iodide (KI) will not protect the liver from the effects of radioactive iodine.

Rationale 4: Potassium iodide (KI) will not protect the kidneys from the effects of radioactive iodine.

Global Rationale: Potassium iodide (KI) can prevent up to 100% of the radioactive iodine from entering the thyroid gland. Potassium iodide (KI) will not protect the liver, the kidneys, or the brain from the effects of radioactive iodine.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11-12 Describe specific antidotes used to treat common overdosed substances and toxins.

MNL Learning Outcome:

Page Number: 121

 

Question 14

Type: MCSA

The nurse conducts a seminar in a local community center on how Americans can be affected by radiation from a nuclear attack. The nurse determines that the education is effective when the patients make which statement?

  1. “I can protect myself from cancers by taking potassium iodide (KI).”
  2. “I need to stay inside my house for at least 2 days after the attack to be safe.”
  3. “I need to take at least four showers every day or I will develop skin ulcers.”
  4. “I am at risk to develop leukemia as a result of radiation exposure.”

Correct Answer: 4

Rationale 1: Potassium iodide (KI) will only protect against thyroid cancer.

Rationale 2: Radiation will not dissipate in 2 days.

Rationale 3: Showers will not always protect the skin.

Rationale 4: Leukemia is one of the long-term effects of radiation.

Global Rationale: Leukemia is one of the long-term effects of radiation. Radiation will not dissipate in 2 days. Showers will not always protect the skin. Potassium iodide (KI) will only protect against thyroid cancer.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11-9 Describe the symptoms of acute radiation exposure and the role of potassium iodide (KI) in preventing thyroid cancer.

MNL Learning Outcome:

Page Number: 120

 

Question 15

Type: MCSA

The nurse is preparing an educational plan for parents about how to protect their children if a bioterrorist attack occurs. What is the best information to include?

  1. “Don’t worry, the Centers for Disease Control and Prevention (CDC) has everything under control.”
  2. “Plan to call the Centers for Disease Control and Prevention (CDC) if an attack occurs.”
  3. “Follow the Centers for Disease Control and Prevention (CDC) guidelines for immunizations.”
  4. “Realistically, there is nothing that can be done.”

Correct Answer: 3

Rationale 1: Telling parents not to worry and that the CDC has everything under control is non-therapeutic and condescending information.

Rationale 2: Phone lines to the CDC would be overwhelmed during an attack, so calling them would elicit no information.

Rationale 3: One of the roles of the Centers for Disease Control and Prevention (CDC) is to publicize recommendations for immunizations.

Rationale 4: Telling the parents that nothing can be done is not true and would leave the parents feeling very powerless.

Global Rationale: One of the roles of the Centers for Disease Control and Prevention (CDC) is to publicize recommendations for immunizations. Telling parents not to worry and that the CDC has everything under control is non-therapeutic and condescending information. Telling the parents that nothing can be done is not true and would leave the parents feeling very powerless. Phone lines to the CDC would be overwhelmed during an attack, so calling them would elicit no information.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-2 Discuss the role of the nurse in preparing for and responding to worldwide epidemics and bioterrorist activity.

MNL Learning Outcome:

Page Number: 116

 

 

Question 16

Type: MCSA

Which of the following correctly and completely identifies the items found within the Strategic National Stockpile (SNS)?

  1. Bandages, airway devices, and IV supplies
  2. Antibiotics and IV fluids
  3. Emergency equipment
  4. Antibiotics, vaccines, and support supplies

Correct Answer: 4

Rationale 1: The SNS consists of more than these materials.

Rationale 2: The SNS consists of more than these materials.

Rationale 3: The SNS consists of more than these materials.

Rationale 4: The SNS consists of antibiotics, vaccines, and support supplies.

Global Rationale: The Strategic National Stockpile consists of antibiotics, vaccines, and support supplies.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-3 Identify the purpose and components of the Strategic National Stockpile (SNS).

MNL Learning Outcome:

Page Number: 116

 

Question 17

Type: MCMA

A nurse presenting information regarding anthrax should include which information?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Anthrax can spread easily.
  2. There are three basic types of anthrax.
  3. Anthrax is killed by heat.
  4. The main area affected by inhalation anthrax is the lung periphery.
  5. Anthrax causes disease by the emission of multiple toxins, each affecting a different part of the body.

Correct Answer: 1,2

Rationale 1: Anthrax spreads easily.

Rationale 2: The types of anthrax are cutaneous, gastrointestinal, and inhalation.

Rationale 3: Anthrax is spore forming and is not killed by drying, heat, or many harsh chemicals. It can live in soil for hundreds or thousands of years.

Rationale 4: The main area affected by inhalation anthrax is the mediastinum.

Rationale 5: There are two toxins emitted by the bacterium.

Global Rationale: Anthrax spreads easily. The types of anthrax are cutaneous, gastrointestinal, and inhalation. Anthrax is spore forming and is not killed by drying, heat, or many harsh chemicals. It can live in soil for hundreds or thousands of years. The main area affected by inhalation anthrax is the mediastinum. There are two toxins emitted by the bacterium.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-5 Explain the threat of anthrax contamination and how anthrax is transmitted.

MNL Learning Outcome:

Page Number: 117

 

Question 18

Type: MCSA

Following a bioterrorism attack, the nurse finds that the victims are suffering from small, black lesions on their forearms. The nurse collaborates with the physician to treat exposure to which agent?

  1. Cutaneous anthrax
  2. Phosgene gas
  3. Gastrointestinal anthrax
  4. Hydrogen cyanide

Correct Answer: 1

Rationale 1: Cutaneous anthrax produces small, black lesions on the skin.

Rationale 2: Phosgene gas causes frostbite-type lesions.

Rationale 3: Gastrointestinal anthrax causes sore throat, difficulty swallowing, cramping, diarrhea, and abdominal swelling.

Rationale 4: Hydrogen cyanide causes flushing of the skin.

Global Rationale: Cutaneous anthrax produces small, black lesions on the skin. Phosgene gas causes frostbite-type lesions. Gastrointestinal anthrax causes sore throat, difficulty swallowing, cramping, diarrhea, and abdominal swelling.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-6 Discuss the clinical manifestations and treatment of anthrax exposure.

MNL Learning Outcome:

Page Number: 117

 

 

Question 19

Type: MCMA

 

A nurse is planning a discussion of emergency preparedness with newly hired nurses. Which events would this nurse use as historical examples of terrorism?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The death of a patient in a Dallas, Texas, hospital was confirmed to be due to the Ebola virus.
  2. Many people died as a result of sarin gas exposure in a Tokyo subway.
  3. Twenty-two confirmed or suspected cases of anthrax infection occurred as a result of the bacillus being sent through U.S. mail.
  4. There is typically a marked increase in overdoses during winter holidays.
  5. More people are contracting H1N1 avian influenza.

Correct Answer: 2,3

Rationale 1: The patient had been exposed to Ebola while traveling overseas. No bioterrorism was suspected.

Rationale 2: The release of sarin gas was determined to be intentional and was called an act of terrorism.

Rationale 3: The exposure of persons to anthrax via contaminated mail was determined to be an act of domestic terrorism.

Rationale 4: The increase in overdoses is typically due to holiday strain put on persons with fragile mental health.

Rationale 5: As far as is known, H1N1 avian influenza’s crossover to humans is related to natural mutations.

 

Global Rationale: The release of sarin gas was determined to be intentional and was called an act of terrorism. The exposure of persons to anthrax via contaminated mail was determined to be an act of domestic terrorism. The patient had been exposed to Ebola while traveling overseas. No bioterrorism was suspected. The increase in overdoses is typically due to holiday strain put on persons with fragile mental health. As far as is known, H1N1 avian influenza’s crossover to humans is related to natural mutations.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-4 Identify specific agents that would likely be used in a bioterrorist attack.

MNL Learning Outcome:

Page Number: 11

 

Question 20

Type: MCSA

What would be most effective for the treatment of a person infected with anthrax?

  1. Anthrax vaccination
  2. Atropine
  3. Ciprofloxacin
  4. Antiviral agents

Correct Answer: 3

Rationale 1: Anthrax vaccine is available to a limited population but would not be used for treatment after exposure.

Rationale 2: Atropine is not indicated for bacterial infections.

Rationale 3: Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax.

Rationale 4: Antiviral agents are not indicated for bacterial infections.

Global Rationale: Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax. Anthrax vaccine is available to a limited population but would not be used for treatment after exposure. Atropine and antiviral agents are not indicated for bacterial infections.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-7 Provide examples of treatments that might be applied during a bioterrorism incident.

MNL Learning Outcome:

Page Number: 118

 

Question 21

Type: MCSA

Atropine would be most useful for a victim of bioterrorism who experienced exposure to

  1. ionizing radiation.
  2. nerve gas.
  3. bacterial agents.
  4. viral agents.

Correct Answer: 2

Rationale 1: Atropine is not useful as treatment for exposure to ionizing radiation.

Rationale 2: Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine. Atropine blocks the attachment of this neurotransmitter to receptor sites.

Rationale 3: Atropine is not useful as treatment for exposure to bacterial agents.

Rationale 4: Atropine is not useful as treatment for exposure to viral agents.

Global Rationale: Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine. Atropine blocks the attachment of this neurotransmitter to receptor sites. Atropine is not useful as treatment for exposure to ionizing radiation, bacterial agents, or viral agents.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-12 Describe specific antidotes used to treat common overdosed substances and toxins.

MNL Learning Outcome:

Page Number: 120

 

Question 22

Type: MCSA

Victims of a bioterrorism attack experienced initial nausea and vomiting followed by weight loss and eventual thyroid cancer. What was the most likely causative agent?

  1. Chemical agent
  2. Viral agent
  3. Bacterial agent
  4. Ionizing radiation

Correct Answer: 4

Rationale 1: Exposure to chemical agents is likely to cause convulsions and loss of consciousness.

Rationale 2: Exposure to viral agents may cause nausea, vomiting, and weight loss, but cancer development is not expected.

Rationale 3: Exposure to bacterial agents may cause nausea, vomiting, and weight loss, but cancer development is not expected.

Rationale 4: Exposure to radiation causes weight loss and eventual thyroid cancer.

Global Rationale: Exposure to radiation causes weight loss and eventual thyroid cancer. Exposure to chemical agents is likely to cause convulsions and loss of consciousness. Exposure to viral or bacterial agents may cause nausea, vomiting, and weight loss, but cancer development is not expected.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-9 Describe the symptoms of acute radiation exposure and the role of potassium iodide (KI) in preventing thyroid cancer.

MNL Learning Outcome:

Page Number: 120

 

Question 23

Type: MCSA

What is the best choice for preventing thyroid cancer in persons exposed to ionizing radiation?

  1. Potassium-iodine tablets
  2. Calcium tablets
  3. Antibiotics
  4. Salt tablets

Correct Answer: 1

Rationale 1: Potassium-iodine tablets are the only recognized therapy for radiation exposure.

Rationale 2: Calcium tablets are not recognized therapy for radiation exposure.

Rationale 3: Antibiotics are not recognized therapy for radiation exposure.

Rationale 4: Salt tablets are not recognized therapy for radiation exposure.

Global Rationale: Potassium-iodine tablets are the only recognized therapy for radiation exposure. Calcium tablets, antibiotics, and salt tablets are not recognized therapy for radiation exposure.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-9 Describe the symptoms of acute radiation exposure and the role of potassium iodide (KI) in preventing thyroid cancer.

MNL Learning Outcome:

Page Number: 121

 

Question 24

Type: MCSA

Which of the following antidotes would be indicated for a patient who overdosed on a benzodiazepine?

  1. Acetylcysteine (Acetadote)
  2. Digibind
  3. Romazicon
  4. Acetaminophen

Correct Answer: 3

Rationale 1: Acetylcysteine (Acetadote) is the antidote for acetaminophen overdose.

Rationale 2: Digibind is the antidote for digoxin overdose.

Rationale 3: Flumazenil (Romazicon) is the antidote for benzodiazepine overdose.

Rationale 4: Acetaminophen is not an antidote for poisoning.

Global Rationale: Flumazenil (Romazicon) is the antidote for benzodiazepine overdose. Acetylcysteine (Acetadote) is the antidote for acetaminophen overdose. Digibind is the antidote for digoxin overdose. Acetaminophen is not an antidote for poisoning.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-12 Describe specific antidotes used to treat common overdosed substances and toxins.

MNL Learning Outcome:

Page Number: 123

 

Question 25

Type: FIB

 

Notice has been received that smallpox virus was aerosolized at a parade attended by thousands of people. The nurse working in the emergency department explains that the vaccine for this virus provides a high level of protection if given within _____ days of exposure.

 

Standard Text: Record your answer rounding to the nearest whole number.

 

Correct Answer: 3

Rationale: The variola vaccine provides a high level of protection if given prior to exposure or up to 3 days after exposure.

Global Rationale: The variola vaccine provides a high level of protection if given prior to exposure or up to 3 days after exposure.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-8 Explain the advantages and disadvantages of vaccination as a means of preventing illness due to bioterrorist threats.

MNL Learning Outcome:

Page Number: 119

 

Question 26

Type: MCMA

The nurse is reviewing the components of the Strategic National Stockpile (SNS), which include

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. intravenous administration equipment.
  2. antibiotics.
  3. life-support medications.
  4. chemical antidotes.
  5. hospital beds.

Correct Answer: 1,2,3,4

Rationale 1: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes intravenous (IV) administration equipment.

Rationale 2: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes antibiotics.

Rationale 3: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes life-support medications.

Rationale 4: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes chemical antidotes.

Rationale 5: The Strategic National Stockpile (SNS), a national repository of medical equipment, does not include hospital beds.

Global Rationale: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes intravenous (IV) administration equipment, antibiotics, life-support medications, and chemical antidotes. The Strategic National Stockpile (SNS), a national repository of medical equipment, does not include hospital beds.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-3 Identify the purpose and components of the Strategic National Stockpile (SNS).

MNL Learning Outcome:

Page Number: 116

 

Question 27

Type: MCMA

The danger from radiation exposure arises primarily from

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 exposure.
  2. the long-lasting effects.
  3. the amount of cellular death.
  4. the gender of the patient exposed.
  5. the amount of naloxone (Narcan) ingested after exposure.

Correct Answer: 1,2,3

Rationale 1: Radiation exposure can cause mass casualty deaths at the point of impact and create residual ionizing radiation for miles around the site. Some radioisotopes emit radiation for decades and even centuries.

Rationale 2: Death may not be immediate but may result from long-lasting effects.

Rationale 3: When exposed to large amounts of radiation, or to small amounts over many decades, patients tend to develop certain malignancies (cellular death) such as leukemia or thyroid cancer.

Rationale 4: Gender is not a determinant of radiation exposure danger.

Rationale 5: Naloxone (Narcan) is not used to treat radiation exposure.

Global Rationale: Radiation exposure can cause mass casualty deaths at the point of impact and create residual ionizing radiation for miles around the site. Some radioisotopes emit radiation for decades and even centuries. Death may not be immediate but may result from long-lasting effects. When exposed to large amounts of radiation, or to small amounts over many decades, patients tend to develop certain malignancies (cellular death) such as leukemia or thyroid cancer. Gender is not a determinant of radiation exposure danger. Naloxone (Narcan) is not used to treat radiation exposure.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-9 Describe the symptoms of acute radiation exposure and the role of potassium iodide (KI) in preventing thyroid cancer.

MNL Learning Outcome:

Page Number: 120

 

 

Question 28

Type: MCMA

 

A patient has been received in the emergency department for treatment of poison ingestion. Gastric lavage and placement of activated charcoal has been prescribed. The nurse would withhold this treatment and collaborate with the prescriber if which instances occur?

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 vomits.
  2. The patient becomes unconscious.
  3. The patient discloses that lithium was the drug taken.
  4. Paramedics report that it has been 2 hours since the drug was taken.
  5. The patient begins to pass copious amounts of watery diarrhea.

Correct Answer: 2,3,4

Rationale 1: It is not possible to determine if all the drug has been vomited or how much has already passed into the intestine.

Rationale 2: If protective airway reflexes are lost, gastric lavage is contraindicated.

Rationale 3: Activated charcoal does not bind well to lithium.

Rationale 4: Both of these interventions are more effective if performed within 1 hour of ingestion.

Rationale 5: It is unknown if the drug is passing in the diarrhea.

 

Global Rationale: If protective airway reflexes are lost, gastric lavage is contraindicated. Activated charcoal does not bind well to lithium. Both of these interventions are more effective if performed within 1 hour of ingestion. It is not possible to determine if all the drug has been vomited or how much has already passed into the intestine. It is unknown if the drug is passing in the diarrhea.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-11 Explain fundamental elements of toxicity treatment provided by the nurse.

MNL Learning Outcome:

Page Number: 122

 

 

Question 29

Type: MCMA

Which interventions will the nurse include when planning care to enhance the removal of poison from a patient who has overdosed on drugs?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Administering activated charcoal
  2. Changing pH of urine
  3. Preparing the patient for enemas
  4. Inserting a nasogastric tube
  5. Preparing corticosteroids for administration

Correct Answer: 1,2,3,4

Rationale 1: Charcoal works by binding with the poison agent.

Rationale 2: Changing the pH of the urine may help to increase excretion.

Rationale 3: Whole bowel irritation may be considered.

Rationale 4: A nasogastric tube might be needed for lavage of stomach contents.

Rationale 5: Corticosteroids are not used to enhance the removal of poison from the body.

Global Rationale: Charcoal works by binding with the poison agent. Changing the pH of the urine may help to increase excretion. Whole bowel irritation may be considered. A nasogastric tube might be needed for lavage of stomach contents. Corticosteroids are not used to enhance the removal of poison from the body.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-11 Explain fundamental elements of toxicity treatment provided by the nurse.

MNL Learning Outcome:

Page Number: 122

 

 

Question 30

Type: FIB

 

A patient who has traveled to an area when Ebola is present is hospitalized with fever and malaise. The nurse anticipates this patient will be considered potentially infected for the length of the ______ day incubation period.

 

Standard Text: Record your answer rounding to the nearest whole number.

 

Correct Answer: 21

Rationale: The incubation period for Ebola is 21 days.

Global Rationale: The incubation period for Ebola is 21 days.

 

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacologic and Parenteral Therapies

QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.

AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.

NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 11-7 Provide examples of treatments that might be applied during a bioterrorism incident.

MNL Learning Outcome:

Page Number: 118

Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E
Chapter 15

Question 1

Type: MCSA

The patient says to the nurse, “My doctor said I have epilepsy and need to take medicine for those seizures I had. Do I really need medicine?” What is the best response by the nurse?

  1. “Having epilepsy is the same as having a mental illness; the medications are very similar.”
  2. “You will need medicine for a little while to cure the seizures.”
  3. “You might not need medicine; you may be controlled by a ketogenic diet.”
  4. “Yes, you need to take medication on a continual basis to control the seizures.”

Correct Answer: 4

Rationale 1: Epilepsy is not a mental illness, although some of the same medications are used to control symptoms of both disorders.

Rationale 2: Epilepsy and associated seizures are not curable with medications.

Rationale 3: The ketogenic diet is used when seizures cannot be controlled through pharmacotherapy or when there are unacceptable side effects to the medications.

Rationale 4: Epilepsy is a disease where seizures occur on a chronic basis. Once seizures are controlled, patients are continued indefinitely on the antiseizure drug.

Global Rationale: Epilepsy is a disease where seizures occur on a chronic basis. Once seizures are controlled, patients are continued indefinitely on the antiseizure drug. Epilepsy and associated seizures are not curable with medications. The ketogenic diet is used when seizures cannot be controlled through pharmacotherapy or when there are unacceptable side effects to the medications. Epilepsy is not a mental illness, although some of the same medications are used to control symptoms of both disorders.

 

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: 15-2 Recognize possible causes of seizures.

MNL Learning Outcome: 3.5.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 181

 

Question 2

Type: MCMA

The nurse is teaching a class for patients who have been recently diagnosed with epilepsy. The nurse determines that learning has occurred when the patients make 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. “Excessive stress levels cause disruptions in how the brain receives oxygen, leading to epilepsy.”
  2. “Epilepsy may be caused by a head injury.”
  3. “Eating disorders, like anorexia nervosa, increase the risk for developing epilepsy.”
  4. “A stroke, or brain attack, could increase the risk for developing epilepsy.”
  5. “With some cases of epilepsy, the cause is never determined.”

Correct Answer: 2,4,5

Rationale 1: Excessive levels of stress cannot disrupt cerebral oxygen to the extent that epilepsy would occur.

Rationale 2: Head trauma is a known cause of seizures.

Rationale 3: There is no known correlation with anorexia nervosa and the development of epilepsy.

Rationale 4: Changes in cerebral perfusion such as hypotension; strokes, or brain attacks; and shock may be causes of seizures.

Rationale 5: In some cases, the exact etiology may not be identified.

Global Rationale: Epilepsy is a disorder where seizures occur on a chronic basis. Head trauma is a known cause of seizures. In some cases, the exact etiology may not be identified. Changes in cerebral perfusion such as hypotension; strokes, or brain attacks; and shock may be causes of seizures. There is no known correlation with anorexia nervosa and the development of epilepsy. Excessive levels of stress cannot disrupt cerebral oxygen to the extent that epilepsy would occur.

 

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: Evaluation

Learning Outcome: 15-2 Recognize possible causes of seizures.

MNL Learning Outcome: 3.5.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 181

 

Question 3

Type: MCSA

A parent says to the nurse, “The doctor prescribed ethosuximide (Zarontin) for my child, who has absence seizures. What does this mean?” What is the best response by the nurse?

  1. “Absence seizures are basically the same kind of seizures as grand mal, but they are less frequent.”
  2. “Your daughter’s seizures manifest as a staring into space for a few seconds. Ethosuximide (Zarontin) is a good medication for this type of seizure.”
  3. “Explaining the types of seizure activity is complicated. Have you spoken to your doctor about it?”
  4. “Are you sure your doctor prescribed ethosuximide (Zarontin)? Phenobarbital (Luminal) is used much more frequently with children.”

Correct Answer: 2

Rationale 1: Grand mal, or tonic-clonic, seizures are different from absence or petit mal seizures; they are different forms of epilepsy.

Rationale 2: It is the responsibility of the RN to educate the patient, not just refer questions to the physician.

Rationale 3: Ethosuximide (Zarontin), not phenobarbital (Luminal), is the drug of choice for absence seizures.

Rationale 4: Absence seizures, formerly known as petit mal, last a few seconds and are seen most often in children. Ethosuximide (Zarontin) is a drug of choice for this type of seizure disorder.

Global Rationale: Absence seizures, formerly known as petit mal, last a few seconds and are seen most often in children. Ethosuximide (Zarontin) is a drug of choice for this type of seizure disorder. Grand mal, or tonic-clonic, seizures are different from absence or petit mal seizures; they are different forms of epilepsy. Ethosuximide (Zarontin), not phenobarbital (Luminal), is the drug of choice for absence seizures. It is the responsibility of the RN to educate the patient, not just refer questions to the physician.

 

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.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-3 Relate signs and symptoms to specific types of seizures.

MNL Learning Outcome: 3.5.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 183

 

Question 4

Type: MCSA

The patient has epilepsy and receives phenytoin (Dilantin). The patient has been seizure-free, and asks the nurse why he still needs blood tests when he is not having seizures. What is the best response by the nurse?

  1. “Because phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose.”
  2. “Because phenytoin (Dilantin) can cause blood-thinning in some patients.”
  3. “Because phenytoin (Dilantin) can cause Stevens-Johnson syndrome, which will show up in the blood tests.”
  4. “Because phenytoin (Dilantin) can deplete your system of potassium.”

Correct Answer: 1

Rationale 1: Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose; blood levels must be monitored to ensure a therapeutic level and to prevent toxicity.

Rationale 2: Phenytoin (Dilantin) is not an anticoagulant and does not cause thinning of the blood.

Rationale 3: Stevens-Johnson syndrome is a severe skin reaction that can be an adverse outcome with phenytoin (Dilantin), but it is monitored by skin assessment, not blood tests.

Rationale 4: There isn’t any evidence to support that phenytoin (Dilantin) causes potassium depletion.

Global Rationale: Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose; blood levels must be monitored to ensure a therapeutic level and to prevent toxicity. There isn’t any evidence to support that phenytoin (Dilantin) causes potassium depletion. Stevens-Johnson syndrome is a severe skin reaction that can be an adverse outcome with phenytoin (Dilantin), but it is monitored by skin assessment, not blood tests. Phenytoin (Dilantin) is not an anticoagulant and does not cause thinning of the blood.

 

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: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan.

NLN Competencies: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-5 Explain the importance of patient drug compliance in the pharmacotherapy of epilepsy and seizures.

MNL Learning Outcome: 3.5.2 Compare the classes of medications used in pharmacologic management.

Page Number: 183

 

Question 5

Type: MCSA

The nurse has been conducting medication education for a patient with epilepsy. What is the best outcome for this patient?

  1. The patient will recognize that the antiseizure medication must be continued indefinitely.
  2. The patient will recognize the need to be on a tyramine-free diet while on antiseizure medications.
  3. The patient will recognize the need to be on a ketogenic diet in combination with antiseizure medications.
  4. The patient will recognize the need to be on antiseizure medication for 1 year after the last seizure.

Correct Answer: 1

Rationale 1: Once seizures have been controlled, patients are continued indefinitely on the antiseizure drug.

Rationale 2: A tyramine-free diet is indicated for patients receiving monoamine oxidase inhibitor medications.

Rationale 3: A ketogenic diet is indicated when seizures cannot be controlled through pharmacotherapy or when there are unacceptable side effects to the medications.

Rationale 4: It is unknown how long antiseizure drugs will be necessary, but many patients require a life-time regimen.

Global Rationale: Once seizures have been controlled, patients are continued indefinitely on the antiseizure drug. A ketogenic diet is indicated when seizures cannot be controlled through pharmacotherapy or when there are unacceptable side effects to the medications. A tyramine-free diet is indicated for patients receiving monoamine oxidase inhibitor medications. It is unknown how long antiseizure drugs will be necessary, but many patients require a life-time regimen.

 

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: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan.

NLN Competencies: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 15-5 Explain the importance of patient drug compliance in the pharmacotherapy of epilepsy and seizures.

MNL Learning Outcome: 3.5.2 Compare the classes of medications used in pharmacologic management.

Page Number: 184

 

Question 6

Type: MCSA

The physician has ordered intravenous (IV) diazepam (Valium) for the patient in status epilepticus. During administration, which assessment by the nurse is most important?

  1. Assessing respirations
  2. Assessing level of consciousness
  3. Assessing pulse for bradycardia
  4. Assessing blood pressure for hypertension

Correct Answer: 1

Rationale 1: Respiratory depression is common when diazepam is given intravenously (IV). Respiratory assessment is the priority.

Rationale 2: A different assessment has higher priority than assessing the level of consciousness.

Rationale 3: Although tachycardia is an effect of intravenous diazepam (Valium), it is not the top priority.

Rationale 4: Although hypotension is an effect of intravenous diazepam (Valium), it is not the top priority.

Global Rationale: Respiratory depression is common when diazepam is given intravenously (IV). Respiratory assessment is the priority. Although hypotension is an effect of intravenous diazepam (Valium), it is not the top priority. Although tachycardia is an effect of intravenous diazepam (Valium), it is not the top priority. Assessing respirations is a higher priority than assessing the level of consciousness.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples and explain their mechanism of drug action, primary actions, and important adverse effects.

MNL Learning Outcome: 3.5.2 Compare the classes of medications used in pharmacologic management.

Page Number: 190

 

Question 7

Type: MCSA

The physician has ordered intravenous (IV) phenytoin (Dilantin). The nurse does not read the drug label and administers the medication intramuscularly (IM). What is the most likely response in the patient?

 

  1. Local tissue damage following extravasation will most likely occur.
  2. A phenomenon known as purple gluteus syndrome will most likely occur.
  3. A marked decrease in serum glucose levels will most likely occur.
  4. Nothing adverse, the medication may be administered intravenously (IV) or intramuscularly (IM).

Correct Answer: 1

Rationale 1: Phenytoin (Dilantin) injectable is a soft-tissue irritant that causes local tissue damage following extravasation.

Rationale 2: There isn’t any such thing as purple gluteus syndrome; purple glove syndrome occurs when phenytoin (Dilantin) is administered in a hand vein and causes a serious local vasoconstrictive response.

Rationale 3: Phenytoin (Dilantin) causes an increase in serum glucose.

Rationale 4: It should not be administered intramuscularly but should be given intravenously into a large vein or via a central catheter.

Global Rationale: Phenytoin (Dilantin) injectable is a soft-tissue irritant that causes local tissue damage following extravasation. It should not be administered intramuscularly but should be given intravenously into a large vein or via a central catheter. There isn’t any such thing as purple gluteus syndrome; purple glove syndrome occurs when phenytoin (Dilantin) is administered in a hand vein and causes a serious local vasoconstrictive response. Phenytoin (Dilantin) causes an increase in serum glucose.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 15-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples and explain their mechanism of drug action, primary actions, and important adverse effects.

MNL Learning Outcome: 3.5.2 Compare the classes of medications used in pharmacologic management.

Page Number: 191

 

Question 8

Type: MCMA

The physician has ordered intravenous phenytoin (Dilantin). The patient is also receiving 5% dextrose in water (D5W) intravenously (IV). What will the nurse plan to do before administering this medication?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Use a large vein for the infusion.
  2. Use an intravenous (IV) line with a filter.
  3. Flush the intravenous (IV) line with saline.
  4. Monitor the patient for hypertension.
  5. Monitor the patient for Stevens-Johnson syndrome.

Correct Answer: 1,2,3

Rationale 1: Phenytoin (Dilantin) is a soft-tissue irritant that will cause local tissue damage if extravasation occurs, so a large vein must be used for infusion.

Rationale 2: An intravenous filter will trap any precipitate that occurs.

Rationale 3: Intravenous lines of 5% dextrose in water (D5W) must be flushed with saline, as traces of dextrose can cause microscopic precipitate formations that become emboli, if infused.

Rationale 4: Patients receiving phenytoin (Dilantin) are at risk for hypotension, not hypertension.

Rationale 5: Stevens-Johnson syndrome is a side effect of phenytoin (Dilantin), but it takes days to occur.

Global Rationale: Intravenous lines of 5% dextrose in water (D5W) must be flushed with saline, as traces of dextrose can cause microscopic precipitate formations that become emboli, if infused. An intravenous filter will trap any precipitate that occurs. Phenytoin (Dilantin) is a soft-tissue irritant that will cause local tissue damage if extravasation occurs, so a large vein must be used for infusion. Patients receiving phenytoin (Dilantin) are at risk for hypotension, not hypertension. Stevens-Johnson syndrome is a side effect of phenytoin (Dilantin), but it takes days to occur.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 15-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples and explain their mechanism of drug action, primary actions, and important adverse effects.

MNL Learning Outcome: 3.5.2 Compare the classes of medications used in pharmacologic management.

Page Number: 191

 

Question 9

Type: MCSA

The patient is receiving valproic acid (Depakene) for treatment of seizures. The patient has also been taking a daily 81 mg aspirin tablet prophylactically for a cardiac condition. What would the nurse be most likely to observe?

  1. An increase in seizure activity
  2. Stevens-Johnson syndrome
  3. Migraine headaches and generalized irritability
  4. Bleeding from the gums and bruising of the skin

Correct Answer: 4

Rationale 1: Increased seizure activity is not associated with valproic acid (Depakene) and aspirin use.

Rationale 2: Stevens-Johnson syndrome is a side effect of valproic acid (Depakene); its occurrence is not increased with concomitant aspirin use.

Rationale 3: Migraine headaches and generalized irritability do not result from valproic acid (Depakene) and aspirin use.

Rationale 4: Valproic acid (Depakene) can prolong bleeding time; concomitant aspirin use can cause severe bleeding.

Global Rationale: Valproic acid (Depakene) can prolong bleeding time; concomitant aspirin use can cause severe bleeding. Increased seizure activity is not associated with valproic acid (Depakene) and aspirin use. Stevens-Johnson syndrome is a side effect of valproic acid (Depakene); its occurrence is not increased with concomitant aspirin use. Migraine headaches and generalized irritability do not result from valproic acid (Depakene) and aspirin use.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples and explain their mechanism of drug action, primary actions, and important adverse effects.

MNL Learning Outcome: 3.5.2 Compare the classes of medications used in pharmacologic management.

Page Number: 192

 

 

Question 10

Type: MCSA

The patient is receiving Phenobarbital (Luminal) for control of seizures. The patient tells the nurse she plans to become pregnant. What is the best response of the nurse?

  1. “Your medication dose will need to be decreased during your pregnancy.”
  2. “Please talk to your doctor; this drug is contraindicated in pregnancy.”
  3. “Your medication dose will need to be increased during your pregnancy.”
  4. “Please talk to your doctor; you will need a safer drug like valproic acid (Depakene).”

Correct Answer: 2

Rationale 1: The medication does not need to be decreased; it might need to be stopped.

Rationale 2: Phenobarbital (Luminal) falls under Pregnancy Category D and is contraindicated in pregnancy.

Rationale 3: The medication does not need to be increased; it might need to be stopped.

Rationale 4: Valproic acid (Depakene) is also a Pregnancy Category D drug and is contraindicated during pregnancy.

Global Rationale: Phenobarbital (Luminal) falls under Pregnancy Category D and is contraindicated in pregnancy. The medication does not need to be increased; it might need to be stopped. The medication does not need to be decreased; it might need to be stopped. Valproic acid (Depakene) is also a Pregnancy Category D drug and is contraindicated during pregnancy.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples and explain their mechanism of drug action, primary actions, and important adverse effects.

MNL Learning Outcome: 3.5.2 Compare the classes of medications used in pharmacologic management.

Page Number: 189

 

Question 11

Type: MCSA

The patient tells the nurse that she has been taking phenytoin (Dilantin) for 2 years now and is still having too many side effects. She wants to stop taking it. What is the best response by the nurse?

  1. “Please do not stop the medication abruptly, as you will have withdrawal seizures.”
  2. “Side effects are a problem, but they are not as bad as the seizures you were having.”
  3. “This is the best medication for you; we can add another medication to decrease side effects.”
  4. “You have probably been on the medication long enough; I’ll let your doctor know you are stopping it.”

Correct Answer: 1

Rationale 1: Seizures are likely to occur with abrupt withdrawal of antiseizure medication. The medication must be withdrawn over a period of 6 to 12 weeks.

Rationale 2: Telling a patient that medication side effects are not as bad as seizures is an inappropriate and non-therapeutic response that does not address the patient’s concerns.

Rationale 3: There is no other medication that can be added to decrease the side effects associated with phenytoin (Dilantin).

Rationale 4: The nurse does not know if the patient has been on the medication long enough, and the patient must be informed of the consequences of abruptly stopping the medication.

Global Rationale: Seizures are likely to occur with abrupt withdrawal of antiseizure medication. The medication must be withdrawn over a period of 6 to 12 weeks. There is no other medication that can be added to decrease the side effects associated with phenytoin (Dilantin). The nurse does not know if the patient has been on the medication long enough, and the patient must be informed of the consequences of abruptly stopping the medication. Telling a patient that medication side effects are not as bad as seizures is an inappropriate and non-therapeutic response that does not address the patient’s concerns.

 

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: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan.

NLN Competencies: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-5 Explain the importance of patient drug compliance in the pharmacotherapy of epilepsy and seizures.

MNL Learning Outcome: 3.5.2 Compare the classes of medications used in pharmacologic management.

Page Number: 184

 

 

Question 12

Type: MCSA

The physician has prescribed phenytoin (Dilantin) for a patient with type 1 diabetes mellitus. What does the nurse include in the plan of care for this patient?

  1. Plan to discuss with the physician the need to decrease the patient’s insulin based on serum glucose levels.
  2. Plan to discuss with the physician the need to increase the patient’s insulin based on serum glucose levels.
  3. Plan to assess the patient for petechiae, epistaxis, and hematuria.
  4. Plan to institute safety precautions, as the patient is at risk for dizziness and ataxia.

Correct Answer: 2

Rationale 1: Phenytoin (Dilantin) can increase serum glucose levels, not decrease them.

Rationale 2: Phenytoin (Dilantin) can increase serum glucose levels, and the patient may need additional insulin.

Rationale 3: All patients receiving phenytoin (Dilantin) are at risk for petechiae, epistaxis, and hematuria; this is not specific to the patient with type 1 diabetes mellitus.

Rationale 4: All patients receiving phenytoin (Dilantin) are at risk for dizziness and ataxia; this is not specific to the patient with type 1 diabetes mellitus.

Global Rationale: Phenytoin (Dilantin) can increase serum glucose levels, and the patient may need additional insulin. All patients receiving phenytoin (Dilantin) are at risk for dizziness and ataxia; this is not specific to the patient with type 1 diabetes mellitus. All patients receiving phenytoin (Dilantin) are at risk for petechiae, epistaxis, and hematuria; this is not specific to the patient with type 1 diabetes mellitus. Phenytoin (Dilantin) can increase serum glucose levels, not decrease them.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 15-4 Describe the nurse’s role in the pharmacologic management of seizures of an acute nature and epilepsy.

MNL Learning Outcome: 3.5.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 191

 

Question 13

Type: MCSA

The young child has absence seizures. The physician has prescribed valproic acid (Depakene) syrup. The nurse has completed medication education with the child’s mother and determines that learning has occurred when the mother makes which statement?

  1. “I should not mix this with carbonated beverages.”
  2. “If my child gets a headache from this, I can administer a baby aspirin.”
  3. “I can still give the clonazepam (Klonopin) prescribed by the psychiatrist for sleep.”
  4. “I can give this on a full stomach or an empty stomach.”

Correct Answer: 1

Rationale 1: Mixing valproic acid (Depakene) syrup with carbonated beverages will trigger immediate release of the drug, which causes severe mouth and throat irritation.

Rationale 2: Aspirin can increase valproic acid (Depakene) toxicity, and aspirin should not be given to children because of Reye syndrome.

Rationale 3: Clonazepam (Klonopin) given with valproic acid (Depakene) can induce absence seizures.

Rationale 4: Valproic acid (Depakene) is a gastrointestinal (GI) irritant and should be given with food.

Global Rationale: Mixing valproic acid (Depakene) syrup with carbonated beverages will trigger immediate release of the drug, which causes severe mouth and throat irritation. Valproic acid (Depakene) is a gastrointestinal (GI) irritant and should be given with food. Aspirin can increase valproic acid (Depakene) toxicity, and aspirin should not be given to children because of Reye syndrome. Clonazepam (Klonopin) given with valproic acid (Depakene) can induce absence seizures.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 15-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples and explain their mechanism of drug action, primary actions, and important adverse effects.

MNL Learning Outcome: 3.5.2 Compare the classes of medications used in pharmacologic management.

Page Number: 192

 

Question 14

Type: MCSA

The patient is receiving phenobarbital (Luminal) for seizure control. The patient asks the nurse how this little pill can stop his seizures. What is the best response by the nurse?

  1. “Phenobarbital (Luminal) stops your seizures by decreasing the calcium in your brain, which is responsible for the seizures.”
  2. “Phenobarbital (Luminal) stops your seizures by increasing a chemical called glutamate that calms down the excitability in your brain.”
  3. “Phenobarbital (Luminal) stops your seizures by decreasing the sodium in your brain, which is responsible for the seizures.”
  4. “Phenobarbital (Luminal) stops your seizures by increasing a chemical called GABA that calms down the excitability in your brain.”

Correct Answer: 4

Rationale 1: Succinimides, not phenobarbital (Luminal), suppress calcium influx.

Rationale 2: Glutamate is the primary excitatory neurotransmitter in the brain; enhancing this neurotransmitter will increase the likelihood of seizures.

Rationale 3: Hydantoins and phenytoin-like drugs, not phenobarbital (Luminal), suppress sodium influx.

Rationale 4: Phenobarbital (Luminal) acts biochemically in the brain by enhancing the action of the neurotransmitter GABA, which is responsible for suppressing abnormal neuronal discharges that can cause epilepsy.

Global Rationale: Phenobarbital (Luminal) acts biochemically in the brain by enhancing the action of the neurotransmitter GABA, which is responsible for suppressing abnormal neuronal discharges that can cause epilepsy. Glutamate is the primary excitatory neurotransmitter in the brain; enhancing this neurotransmitter will increase the likelihood of seizures. Hydantoins and phenytoin-like drugs, not phenobarbital (Luminal), suppress sodium influx. Succinimides, not phenobarbital (Luminal), suppress calcium influx.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-7 Categorize drugs used in the treatment of seizures based on their classification and mechanism of action.

MNL Learning Outcome: 3.5.2 Compare the classes of medications used in pharmacologic management.

Page Number: 181

 

Question 15

Type: MCSA

An older adult patient is taking phenobarbital (Luminal) for seizure control. What is most important for the nurse to assess in the patient?

  1. Fluid intake
  2. Electrolyte balance
  3. Respiratory function
  4. Nutritional status

Correct Answer: 3

Rationale 1: Fluid intake is often decreased in older adults but is not a side effect of barbiturates.

Rationale 2: Barbiturates do not affect electrolyte balance.

Rationale 3: Older adults are at risk for cumulative effects of barbiturates due to diminished hepatic and renal function. Central nervous system (CNS) depression can lead to suppression of respiratory function.

Rationale 4: Nutritional status is important with older adult patients but is not the primary concern.

Global Rationale: Older adults are at risk for cumulative effects of barbiturates due to diminished hepatic and renal function. Central nervous system (CNS) depression can lead to suppression of respiratory function. Nutritional status is important with older adults but is not the primary concern. Fluid intake is often decreased in older adults but is not a side effect of barbiturates. Barbiturates do not affect electrolyte balance.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-4 Describe the nurse’s role in the pharmacologic management of seizures of an acute nature and epilepsy.

MNL Learning Outcome: 3.5.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 189

 

Question 16

Type: MCSA

Identify the correct statement regarding seizures.

  1. Convulsions are a symptom of the underlying seizure disorder.
  2. Seizures can be caused by bacterial infections of the nervous system.
  3. Epilepsy is an acute disorder characterized by non-convulsive seizures.
  4. All seizures are convulsions, but not all convulsions are seizures.

Correct Answer: 2

Rationale 1: Convulsions are a type of seizure, and seizures are a symptom of an underlying disorder.

Rationale 2: Several things, including bacterial infections, can cause seizures.

Rationale 3: Epilepsy is generally chronic and can present with convulsive seizures.

Rationale 4: All convulsions are seizures, but not all seizures are convulsions.

Global Rationale: Several things, including bacterial infections, can cause seizures. All convulsions are seizures, but not all seizures are convulsions. Convulsions are a type of seizure, and seizures are a symptom of an underlying disorder. Epilepsy is generally chronic and can present with convulsive seizures.

 

Cognitive Level: Understanding

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: Evaluation

Learning Outcome: 15-1 Compare and contrast the terms seizures, convulsion, and epilepsy.

MNL Learning Outcome: 3.5.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 181

 

Question 17

Type: MCSA

A person who stops talking mid-sentence and has a blank stare for 5 seconds would most likely be experiencing

  1. a simple partial seizure.
  2. status epilepticus.
  3. a petit mal seizure.
  4. a drop attack.

Correct Answer: 3

Rationale 1: Simple partial seizures manifest in olfactory, auditory, or visual hallucinations; intense emotions; or twitching of arms, legs, and face.

Rationale 2: Status epilepticus is continuous seizure activity, which can lead to coma or death.

Rationale 3: The symptoms presented indicate a general (absence) or petit mal seizure.

Rationale 4: Drop attacks are manifested by falling or stumbling for no reason. These attacks typically last a few seconds.

Global Rationale: The symptoms presented indicate a general (absence) or petit mal seizure. Simple partial seizures manifest in olfactory, auditory, or visual hallucinations; intense emotions; or twitching of arms, legs, and face. Status epilepticus is continuous seizure activity, which can lead to coma or death. Drop attacks are manifested by falling or stumbling for no reason. These attacks typically last a few seconds.

 

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.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-3 Relate signs and symptoms to specific types of seizures.

MNL Learning Outcome: 3.5.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 183

 

Question 18

Type: MCMA

A parent states, “The doctors all say that my son’s problem is epilepsy, but I don’t think that is correct. I have never seen him jerk or thrash.” What nursing response is 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 episodes of jerking and thrashing are called convulsions.”
  2. “Seizures take many forms.”
  3. “Your son may have seizures, but not epilepsy.”
  4. “Seizures can be a sign that epilepsy is present.”
  5. “If there is no physical movement, epilepsy is ruled out.”

Correct Answer: 1,2,4

Rationale 1: Convulsions are the involuntary, violent spasms of the large skeletal muscles of the face, neck, arms, and legs. It is important to provide this parent with correct terminology.

Rationale 2: There are many types of seizures.

Rationale 3: It is inappropriate to lead the parent to believe that the diagnosis is incorrect. The nurse does not have all the necessary information.

Rationale 4: Epilepsy is any disorder that is characterized by recurrent seizures.

Rationale 5: Many seizures do not include physical movement, yet the patient still is diagnosed with epilepsy.

 

Global Rationale: Convulsions are the involuntary, violent spasms of the large skeletal muscles of the face, neck, arms, and legs. It is important to provide this parent with correct terminology. There are many types of seizures. Epilepsy is any disorder that is characterized by recurrent seizures. It is inappropriate to lead the parent to believe that the diagnosis is incorrect. The nurse does not have all the necessary information. Many seizures do not include physical movement, yet the patient still is diagnosed with epilepsy.

 

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: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 15-1 Compare and contrast the terms seizures, convulsion, and epilepsy.

MNL Learning Outcome: 3.5.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 181

 

Question 19

Type: MCSA

A low-income patient without insurance has been prescribed several different medications over several months for seizure control without any improvement. The patient indicates she has not experienced any adverse effects. At this point the nurse should

  1. recommend nontypical drug use.
  2. inform the patient that it might take years for the medications to work.
  3. assess for medication compliance.
  4. advise the patient to double the current dose.

Correct Answer: 3

Rationale 1: Another drug might be indicated, but compliance should be assessed first.

Rationale 2: It generally doesn’t take years for seizure medications to work.

Rationale 3: Due to the financial situation presented and absence of any side effects, it is possible the patient is not in compliance. The nurse should assess for this possibility at this point.

Rationale 4: Changing the prescribed dose of a medication is not within the scope of practice of the nurse.

Global Rationale: Due to the financial situation presented and absence of any side effects, it is possible the patient is not in compliance. The nurse should assess for this possibility at this point. Another drug might be indicated, but compliance should be assessed first. It generally doesn’t take years for seizure medications to work. Changing the prescribed dose of a medication is not within the scope of practice of the nurse.

 

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: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan.

NLN Competencies: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-5 Explain the importance of patient drug compliance in the pharmacotherapy of epilepsy and seizures.

MNL Learning Outcome: 3.5.2 Compare the classes of medications used in pharmacologic management.

Page Number: 195

 

Question 20

Type: MCSA

Which of the following adverse effects would most likely be associated with the use of phenytoin (Dilantin)?

  1. Vitamin B deficiency
  2. Leg edema
  3. Bleeding
  4. Hypoglycemia

Correct Answer: 3

Rationale 1: Dilantin affects the metabolism of vitamin K, which can lead to blood dyscrasias. Hyperglycemia is more common than hypoglycemia, and leg edema is not generally experienced as an adverse effect. Vitamin B deficiency is not the most common complication.

Rationale 2: Leg edema is not generally experienced as an adverse effect.

Rationale 3: Dilantin affects the metabolism of vitamin K, which can lead to blood dyscrasias.

Rationale 4: Hyperglycemia is more common than hypoglycemia.

Global Rationale: Dilantin affects the metabolism of vitamin K, which can lead to blood dyscrasias. Hyperglycemia is more common than hypoglycemia, and leg edema is not generally experienced as an adverse effect. Vitamin B deficiency is not the most common complication.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-6 For each of the drug classes listed in Drugs at a Glance, know representative drug examples and explain their mechanism of drug action, primary actions, and important adverse effects.

MNL Learning Outcome: 3.5.2 Compare the classes of medications used in pharmacologic management.

Page Number: 191

 

Question 21

Type: MCSA

A drug that is used to treat petit mal seizures but not tonic-clonic seizures and works by decreasing neuronal activity in the motor cortex is

  1. diazepam (Valium).
  2. valproic acid (Depakote).
  3. phenytoin (Dilantin).
  4. ethosuximide (Zarontin).

Correct Answer: 4

Rationale 1: Valium can be effective for tonic-clonic seizures.

Rationale 2: Succinimides like Zarontin are indicated for petit mal seizures but not for tonic-clonic seizures. Depakote can be effective for tonic-clonic seizures.

Rationale 3: Dilantin can be effective for tonic-clonic seizures.

Rationale 4: Succinimides like Zarontin are indicated for petit mal seizures but not for tonic-clonic seizures.

Global Rationale: Succinimides like Zarontin are indicated for petit mal seizures but not for tonic-clonic seizures. Depakote, Valium, and Dilantin can be effective for tonic-clonic seizures.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-7 Categorize drugs used in the treatment of seizures based on their classification and mechanism of action.

MNL Learning Outcome: 3.5.2 Compare the classes of medications used in pharmacologic management.

Page Number: 193

 

Question 22

Type: MCSA

The nurse would be especially cautious to avoid extravasation of which drug that is commonly administered intravenously?

  1. Phenobarbital (Luminal)
  2. Phenytoin (Dilantin)
  3. Ethosuximide (Zarontin)
  4. Clonazepam (Klonopin)

Correct Answer: 2

Rationale 1: Phenobarbital would be more likely to be administered orally and is infrequently given intravenously.

Rationale 2: Dilantin is frequently administered IV due to slow and variable absorption rates when given orally. If Dilantin extravasates, serious soft tissue damage can result.

Rationale 3: Zarontin is an oral medication.

Rationale 4: Klonopin is an oral medication.

Global Rationale: Dilantin is frequently administered IV due to slow and variable absorption rates when given orally. If Dilantin extravasates, serious soft tissue damage can result. Phenobarbital would be more likely to be administered orally and is infrequently given intravenously. Zarontin and Klonopin are oral medications.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 15-4 Describe the nurse’s role in the pharmacologic management of seizures of an acute nature and epilepsy.

MNL Learning Outcome: 3.5.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 191

 

 

Question 23

Type: MCMA

A patient had a tonic-clonic seizure. Which findings does the nurse evaluate as indicating the patient is in a postictal state?

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 is incontinent of urine.
  2. The patient is in a deep sleep.
  3. The patient is confused as to place and time.
  4. The patient reports an odd taste in his mouth.
  5. The patient is attempting to remove his hospital gown.

Correct Answer: 2,3

Rationale 1: Incontinence of bowel or bladder is common during a tonic-clonic seizure but is not indicative of a postictal state.

Rationale 2: Deep sleep after the seizure is a finding associated with the postictal state.

Rationale 3: Patients who are in the postictal state may be confused and disoriented.

Rationale 4: An odd taste, specific odor or noise, or other sensory change often heralds a seizure. This is called an aura.

Rationale 5: During complex partial seizures, patients sometimes fumble with or attempt to remove clothing.

 

Global Rationale: Deep sleep after the seizure is a finding associated with the postictal state. Patients who are in the postictal state may be confused and disoriented. Incontinence of bowel or bladder is common during a tonic-clonic seizure but is not indicative of a postictal state. An odd taste, specific odor or noise, or other sensory change often heralds a seizure. This is called an aura. During complex partial seizures, patients sometimes fumble with or attempt to remove clothing.

 

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.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-3 Relate signs and symptoms to specific types of seizures.

MNL Learning Outcome: 3.5.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 183

 

Question 24

Type: MCMA

The nurse has completed education to the parents of a child newly diagnosed with tonic-clonic seizures. Which comments made by the parents would the nurse evaluate as indicating need for further education?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “Some of the times when I thought he was ignoring me may have actually been seizure activity.”
  2. “He just needs to focus more to prevent these attacks.”
  3. “I know he will outgrow these seizures with time.”
  4. “I hope we can help our son identify his seizure aura.”
  5. “We will watch for the development of status epilepticus.”

Correct Answer: 1,2,3

Rationale 1: Behavior that manifests as the child ignoring outside stimuli is most likely absence seizure, which is different from tonic-clonic seizure.

Rationale 2: The patient who suffers seizure disorder cannot prevent seizure occurrence by focusing harder.

Rationale 3: The patient with tonic-clonic seizure disorder is less likely to outgrow them than the patient with absence seizure disorder.

Rationale 4: Many patients experience an aura prior to the tonic-clonic phase. Identifying the aura can provide time for the patient to move to a safe area, notify another person of the impending seizure, and to prepare.

Rationale 5: Status epilepticus is a medical emergency that may occur in the patient who suffers with tonic-clonic seizure disorder.

Global Rationale: Behavior that manifests as the child ignoring outside stimuli is most likely absence seizure, which is different from tonic-clonic seizure. The patient who suffers seizure disorder cannot prevent seizure occurrence by focusing harder. The patient with tonic-clonic seizure disorder is less likely to outgrow them than the patient with absence seizure disorder. Many patients experience an aura prior to the tonic-clonic phase. Identifying the aura can provide time for the patient to move to a safe area, notify another person of the impending seizure, and to prepare. Status epilepticus is a medical emergency that may occur in the patient who suffers with tonic-clonic seizure disorder.

 

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: IX.1 Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 15-3 Relate signs and symptoms to specific types of seizures.

MNL Learning Outcome: 3.5.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 183

 

Question 25

Type: MCMA

The patient who is prescribed valproic acid (Depakene) for seizure control would like to have a baby. Which statements should the nurse include in a discussion with 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. “Since your epilepsy may flare up during pregnancy, your doctor will likely have you take a second antiepileptic medication.”
  2. “Thankfully, most modern antiepileptic medications will not interfere with you getting pregnant.”
  3. “Your current antiepileptic medication should not be used when you are pregnant.”
  4. “Folic acid supplementation is important for you.”
  5. “You should consider adopting a baby instead since there are so many problems associated with epilepsy and pregnancy.”

Correct Answer: 3,4

Rationale 1: Since there are many side effects to antiepileptic medications, single drug therapy is the goal for pregnant patients.

Rationale 2: Women who have epilepsy have a reduced fertility rate, and some do not ovulate.

Rationale 3: Valproic acid (Depakene) is Pregnancy Category D.

Rationale 4: Folic acid supplementation is important for all women who are, or wish to become, pregnant. This is especially true of women who are epileptic because many antiepileptic medications cause folic acid deficiency.

Rationale 5: Women who are epileptic can and do conceive and deliver healthy babies. The nurse should not discourage this patient but should provide information to the patient and then support the patient’s choice.

Global Rationale: Valproic acid (Depakene) is Pregnancy Category D. Folic acid supplementation is important for all women who are, or wish to become, pregnant. This is especially true of women who are epileptic because many antiepileptic medications cause folic acid deficiency. Since there are many side effects to antiepileptic medications, single drug therapy is the goal for pregnant patients. Women who have epilepsy have a reduced fertility rate, and some do not ovulate. Women who are epileptic can and do conceive and deliver healthy babies. The nurse should not discourage this patient but should provide information to the patient and then support the patient’s choice.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-8 Use the nursing process to care for patients receiving pharmacotherapy for epilepsy and seizures.

MNL Learning Outcome: 3.5.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 196

 

Question 26

Type: MCMA

The nurse is planning education sessions for a patient regarding use of a newly prescribed antiepileptic drug (AED). Which topics should be included in this session?

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 should take the medication at the same time every day.
  2. If the patient forgets a dose of medication, wait until the next dose is due and take both doses together.
  3. The patient should take an additional dose of medication upon experiencing a seizure aura.
  4. If the patient experiences side effects of the medication, the patient should skip the next dose to see if the side effects lessen.
  5. The patient should avoid using dietary supplements containing kava when on this medication.

Correct Answer: 1,5

Rationale 1: Stable blood levels of medication are important in the control of seizure activity. In order to achieve this stability, the medication should be taken at the same time every day.

Rationale 2: The patient should take the dose as soon as it is remembered but should not take two doses at the same time or close together.

Rationale 3: Oral medications are not delivered rapidly to the system, so taking an additional dose of medication when an aura occurs is not effective in controlling the impending seizure.

Rationale 4: The patient should never abruptly discontinue taking these medications and should not skip doses.

Rationale 5: Kava interferes with many AEDs, often adding to their sedative effects.

Global Rationale: Stable blood levels of medication are important in the control of seizure activity. In order to achieve this stability, the medication should be taken at the same time every day. Kava interferes with many AEDs, often adding to their sedative effects. The patient should take the dose as soon as it is remembered but should not take two doses at the same time or close together. Oral medications are not delivered rapidly to the system, so taking an additional dose of medication when an aura occurs is not effective in controlling the impending seizure. The patient should never abruptly discontinue taking these medications and should not skip doses.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-8 Use the nursing process to care for patients receiving pharmacotherapy for epilepsy and seizures.

MNL Learning Outcome: 3.5.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 196

 

Question 27

Type: MCMA

A mother phones the clinic and tells the nurse, “My 5-year-old son had a febrile seizure this morning.” She adds that this is the child’s first seizure experience. The nurse responds by asking the mother to bring the child in to be seen today. What other information should the nurse offer?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “Febrile seizures are uncommon in boys.”
  2. “High temperatures generally induce seizures.”
  3. “Five-year-olds are too old for febrile seizures.”
  4. “Febrile seizures occur in up to 2% of children.”
  5. “Seizure medications are usually not necessary for febrile seizures.”

Correct Answer: 4,5

Rationale 1: Febrile seizures occur in both genders.

Rationale 2: Many children experience high temperatures without experiencing seizures.

Rationale 3: Febrile seizures are most common in childhood.

Rationale 4: Up to 2% of children experience seizure activity related to temperature elevation.

Rationale 5: The best course of action for febrile seizures is prevention by using acetaminophen to prevent onset of fever.

Global Rationale: Up to 2% of children experience seizure activity related to temperature elevation. The best course of action for febrile seizures is prevention by using acetaminophen to prevent onset of fever. Febrile seizures occur in both genders. Many children experience high temperatures without experiencing seizures. Febrile seizures are most common in childhood.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

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: 15-2 Recognize possible causes of seizures.

MNL Learning Outcome: 3.5.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 181

 

Question 28

Type: MCMA

The nurse is talking with a patient who was just prescribed ethosuximide (Zarontin). Which patient statement should the nurse immediately discuss 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. “Did I mention that I used to take phenobarbital for my seizures?”
  2. “I forgot to tell the doctor that I am allergic to penicillin.”
  3. “I take ginkgo to help improve my memory.”
  4. “My husband and I plan to have a baby in a couple of years.”
  5. “My husband and I are leading a 20-mile bicycle tour next weekend for the company we have just started.”

Correct Answer: 3,5

Rationale 1: There is no indication that previous phenobarbital use is problematic with the use of ethosuximide (Zarontin).

Rationale 2: There is no indication of cross sensitivity with penicillin.

Rationale 3: Ginkgo may reduce the therapeutic effects of ethosuximide (Zarontin).

Rationale 4: Ethosuximide (Zarontin) is Pregnancy Category C.

Rationale 5: The most common adverse effects of ethosuximide (Zarontin) include dizziness, ataxia, and fatigue. These effects may be problematic for the owner of a company that promotes bicycle touring.

Global Rationale: Ginkgo may reduce the therapeutic effects of ethosuximide (Zarontin). The most common adverse effects of ethosuximide (Zarontin) include dizziness, ataxia, and fatigue. These effects may be problematic for the owner of a company that promotes bicycle touring. There is no indication that previous phenobarbital use is problematic with the use of ethosuximide (Zarontin). There is no indication of cross sensitivity with penicillin. Ethosuximide (Zarontin) is Pregnancy Category C.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-8 Use the nursing process to care for patients receiving pharmacotherapy for epilepsy and seizures.

MNL Learning Outcome: 3.5.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 193

 

Question 29

Type: MCMA

A patient has been prescribed to follow a ketogenic diet to supplement pharmacotherapy for a seizure disorder. The nurse would support the inclusion of which types of food in menu selection?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Foods high in fat
  2. Salty foods
  3. Foods high in vitamin K
  4. Low protein foods
  5. Low carbohydrate foods

Correct Answer: 1,4,5

Rationale 1: The ketogenic diet is high in fat.

Rationale 2: The presence of salt is not a determining factor in inclusion of foods in a ketogenic diet.

Rationale 3: The presence of high amounts of vitamin K is not a determining factor in inclusion of foods in a ketogenic diet.

Rationale 4: The ketogenic diet is low in protein.

Rationale 5: The ketogenic diet is low in carbohydrates.

 

Global Rationale: The ketogenic diet is high in fat and low in protein and carbohydrates. The presence of salt or vitamin K is not a determining factor in inclusion of foods in a ketogenic diet.

 

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: VII.5 Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan.

NLN Competencies: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-5 Explain the importance of patient drug compliance in the pharmacotherapy of epilepsy and seizures.

MNL Learning Outcome: 3.5.2 Compare the classes of medications used in pharmacologic management.

Page Number: 185

 

Question 30

Type: MCMA

The parents of an infant with recurrent seizures are interested in starting amino acid therapy for their child. The father says, “After all, amino acids are natural; it couldn’t hurt to give this a try.” The nurse should consider which complications of this therapy 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. Allergic reactions to the product
  2. Cardiac changes such as palpitations
  3. Neurological effects such as dizziness and lack of coordination
  4. Gastrointestinal effects such as decreased weight gain
  5. Failure to thrive.

Correct Answer: 1,2,3

Rationale 1: Allergic reactions to amino acids are not uncommon.

Rationale 2: Irregular heartbeat may occur in response to this therapy.

Rationale 3: Neurological effects of amino acid therapy include drowsiness, dizziness, and problems with coordination.

Rationale 4: Decreased weight gain may occur but is not likely to be a direct result of amino acid therapy.

Rationale 5: There is no evidence that amino acid therapy results in failure to thrive.

 

Global Rationale: Allergic reactions to amino acids are not uncommon. Irregular heartbeat may occur in response to this therapy. Neurological effects of amino acid therapy include drowsiness, dizziness, and problems with coordination. Decreased weight gain may occur but is not likely to be a direct result of amino acid therapy. There is no evidence that amino acid therapy results in failure to thrive.

 

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: Context and Environment: Chronic disease management.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-8 Use the nursing process to care for patients receiving pharmacotherapy for epilepsy and seizures.

MNL Learning Outcome: 3.5.3 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 194