Pharmacology for Nursing Care 7th Edition by Richard A. Lehne  – Test Bank  

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INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS

 

Pharmacology for Nursing Care 7th Edition by Richard A. Lehne  – Test Bank

 

Sample  Questions

 

Lehne: Pharmacology for Nursing Care, 7th Edition

 

Chapter 7: Adverse Drug Reactions and Medication Errors

 

Test Bank

 

  1. An hour after taking a medication, a nurse notes that the patient displays urticaria and pruritus. The nurse’s priority action for this patient would be to
a. leave the patient to call the prescriber.
b. assess for changes in respiratory pattern and wheezing.
c. document the findings.
d. administer epinephrine to the patient STAT.

 

 

ANS:   B

Patients who develop urticaria (hives) and pruritus are at risk for anaphylaxis, which would be indicated by bronchoconstriction and wheezing. Note: As a test strategy, when answering a priority question, make sure you go through the ABCs, then other physiological priorities, then safety and security priorities, then love and belonging priorities. This is clearly an ABC priority.

Never leave the patient, because the allergic reaction may precipitate anaphylaxis, and you would need to assess for changes in respiratory status.

Simply documenting the findings ignores the patient risk for anaphylaxis.

Epinephrine should be administered only in the event of anaphylaxis.

 

DIF:    Cognitive Level: Application             REF:    p. 64

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A nurse administered morning medications an hour ago. While assessing a patient who has just been started on a new medication, the nurse notes that the patient is exhibiting an uncommon drug response resulting from a genetic predisposition. The nurse recognizes this as (a)n _____ effect.
a. idiosyncratic
b. iatrogenic
c. teratogenic
d. carcinogenic

 

 

ANS:   A

An idiosyncratic drug response is due to a genetic predisposition.

An iatrogenic drug response is one that causes a disease secondary to the drug.

A teratogenic drug response is one that causes fetal harm.

A carcinogenic drug response is one in which a drug is able to cause cancer.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 65

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse is reviewing the medication administration record (MAR) prior to administration of medications. Which order should the nurse implement?
a. Furosemide (Lasix) 20 mg QD PO
b. Furosemide (Lasix) 20.0 mg qd PO
c. Furosemide (Lasix) 20.0 mg daily
d. Furosemide (Lasix) 20 mg PO daily

 

 

ANS:   D

This is a complete order; it contains the medication, dose, route, and time.

QD is no longer an accepted abbreviation; it should be written out as “daily” or “every day.”

qd is no longer an accepted abbreviation; it should be written out as “daily” or “every day.”

This order does not specify the route to be used.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 72

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A nurse has a busy morning and is rushed. While administering medications, the nurse realizes that he has made a medication error. Which action should the nurse take first?
a. Report the medication error to the charge nurse and fill out an incident report.
b. Assess the patient for any adverse reactions to the medications and notify the prescriber.
c. Document in the patient’s notes the medication given and that an error was made.
d. Explain to the patient that a medication error has occurred and notify the nurse manager.

 

 

ANS:   B

Assessment of the patient is always the priority. Once all assessment data have been collected, the prescriber should be notified.

Ensuring the patient’s safety is the priority, not reporting the medication error.

Medication errors are reported on incident reports, not in the patient’s notes, and this is not the highest priority.

Assessment of the patient is the priority and should be done first.

 

DIF:    Cognitive Level: Application             REF:    pp. 69-70

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A patient is admitted to your unit with hepatomegaly secondary to hepatitis. When conducting patient education, the nurse should counsel the patient to
a. avoid alcohol and acetaminophen.
b. have monthly liver enzymes drawn.
c. measure the abdominal girth to monitor liver enlargement and report findings to the prescriber.
d. discontinue use of all drugs metabolized in the liver.

 

 

ANS:   A

Acetaminophen (Tylenol) and alcohol are contraindicated in a patient with liver problems, because both increase the risk for hepatotoxicity.

Having liver enzymes drawn monthly is too frequent; they usually are drawn every 3 months. Although important, they are not the most important piece of information to teach related to the daily activities of the patient.

Measurement of the abdominal girth to monitor for liver enlargement is a nursing intervention, not a patient intervention.

Discontinuation of all drugs metabolized in the liver is not feasible, because most are metabolized by the liver.

 

DIF:    Cognitive Level: Application             REF:    p. 66

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. Two hours after taking a dose of penicillin, a patient arrives in the emergency department with complaints of slight shortness of breath, respirations 28/minute. Upon further assessment, a nurse observes pruritus and urticaria, BP 92/48, respirations 36/min. Select the most likely analysis of the situation.
a. The patient is experiencing a moderate allergic reaction that will improve as the nurse applies oxygen.
b. The patient is having a mild reaction that can be treated efficiently with administration of an antihistamine.
c. These symptoms are most likely the result of another cause, because fewer than 10% of patients have true allergic responses.
d. The patient is experiencing an anaphylactic response, and emergency interventions should be employed.

 

 

ANS:   D

The signs and symptoms the patient is experiencing reveal an anaphylactic response to the antibiotic, a possibly life-threatening development.

Providing oxygen will not reduce the risk of the potentially life-threatening anaphylaxis.

Anaphylaxis is a potentially life-threatening condition that needs to be treated immediately. It is not mild and cannot be managed by an antihistamine alone.

The assumption cannot be made that the reaction is due to another cause.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 64-65

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A patient has been treated with opioids for a year to manage back pain. After successful surgery, the patient’s pain is greatly improved. The patient reports, “I stopped taking my pain medication when I got home from the hospital, but I got very sick with diarrhea and generalized pain.” Select the nurse’s best response.
a. “This is a common idiosyncratic effect. Over-the-counter antidiarrheals and nonsteroidal agents will help you ride it out.”
b. “Restart the pain medication. It is now required for life because you have tolerance toward opioids.”
c. “You are experiencing toxicity from the drugs used during the hospitalization and will need to be rehospitalized.”
d. “Your reaction is associated with physical dependence on opioids. We will design a tapering dose schedule to avoid the withdrawal symptoms.”

 

 

ANS:   D

The patient is experiencing withdrawal from a dependence on opioids, and a tapering schedule must be instituted to prevent the symptoms.

The description by the patient is not indicative of an idiosyncratic effect.

Pain medication is not required lifelong; this will enhance the tolerance problem, not manage it.

The patient is not experiencing toxicity, but rather withdrawal symptoms.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 65

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. Most patients who receive succinylcholine (Anectine) as a muscle paralyzer have a brief response that lasts only a few minutes. A patient who experiences a very prolonged effect from the drug at a standard dosage is experiencing a(n)
a. anaphylactic reaction.
b. idiosyncratic effect.
c. iatrogenic response.
d. physical dependence.

 

 

ANS:   B

An idiosyncratic effect occurs as an uncommon drug response resulting from a genetic predisposition.

An anaphylactic reaction occurs when there is an immune response by the body to a medication or allergen that causes the patient to experience bronchoconstriction, hypotension, and urticaria.

An iatrogenic response occurs when a disease or health alteration is caused by a drug.

Physical dependence occurs when the patient experiences a physical need for a drug; this is commonly seen with opioids.

 

DIF:    Cognitive Level: Application             REF:    pp. 64-65

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Two hours after taking a dose of penicillin, a patient arrives in the emergency department complaining of tightness in the throat, pruritus, and red wheals. During the physical assessment, the patient develops difficulty breathing, respirations 36/min, blood pressure 90/42, pulse rate of 120/min. The priority nursing action would be to
a. administer diphenhydramine (Benadryl), because the patient is experiencing a moderate allergic reaction that should improve shortly.
b. sit the patient up in bed, administer oxygen until the symptoms subside, and notify the prescriber.
c. question the patient about any previous allergy to penicillin and report the symptoms to the prescriber.
d. call for assistance, apply oxygen, administer epinephrine as ordered, and notify the prescriber.

 

 

ANS:   D

The patient is experiencing anaphylaxis, and emergency care must be provided.

Diphenhydramine is most effective when used to manage an allergic reaction that does not include anaphylaxis. This is a life-threatening situation, and emergency care must be provided.

Positional changes and oxygen are not the priority care needed in this situation.

Questioning the patient at this time is inappropriate and disregards the emergency nature of the situation.

 

DIF:    Cognitive Level: Application             REF:    pp. 64-65

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A nurse is providing education to the unit on adverse drug reactions to reduce the number of medication errors. After the teaching has been conducted, the nurse asks, “Which factor is a primary determinant of the intensity of an allergic drug reaction?” The participants’ best response would be the
a. dose of drug ingested.
b. body surface area of the patient.
c. patient’s degree of compliance.
d. degree of sensitization.

 

 

ANS:   D

The intensity of an allergic reaction is determined primarily by the degree of sensitization of the immune system, not by drug dosage.

The intensity of an allergic reaction is largely independent of dosage. The dose of the drug is not necessarily related to whether the patient experiences an allergic reaction.

The body surface area is used to determine dose and is not a primary determinant of an allergic reaction.

The patient’s degree of compliance is not relevant to the development of an allergic reaction.

 

DIF:    Cognitive Level: Comprehension       REF:    pp. 64-65

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse is trying to determine whether a patient has experienced an adverse drug reaction. Which question would most likely assist the nurse in this determination?
a. Did the patient notice that the drug caused a bad taste in the mouth?
b. Did the patient’s symptoms appear shortly after the drug was first used?
c. Is the patient complaining about the frequency of drug dosing?
d. Has the drug produced this effect in another patient receiving the same agent at the same dose?

 

 

ANS:   B

Symptoms that appear shortly after a drug is administered are likely related to the medication and indicative of an adverse reaction.

A bad taste in the mouth is usually considered a side effect of certain medications and is not indicative of an adverse reaction in most cases.

Frequency of drug dosing is not typically associated with adverse drug reactions.

All patients do not react the same to medications, even the same medications.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 66-67

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. While preparing a drug for administration, a nurse is asked a question by the nursing assistant, is greeted by visitors coming to see a hospitalized patient, and receives a telephone call. To promote safety, which action should the nurse take in this situation?
a. The nurse should instruct the nursing assistant not to interrupt while he is preparing medications, because that may result in a medication error.
b. The nurse should review the six rights of medication administration, because the events were distracting and therefore increased the likelihood of a medication error.
c. The nurse should refer the visitors to the secretary to reduce interruptions during the process of medication administration.
d. The nurse should not accept telephone calls during the process of medication administration.

 

 

ANS:   B

The most effective way to promote safety and reduce the chance of medication errors is to review the six rights of medication administration for every medication situation; even more vigilance is needed when interruptions have occurred.

Although instructing the nursing assistant not to interrupt during the med pass is important, it should not be an absolute, because an interruption may be necessary in an emergency.

Visitor interruptions are situational and may be unavoidable in some cases. The most effective way to promote safety during medication administration is to review the six rights of medication administration.

Not accepting phone calls during the medication pass would promote safety but is not always feasible; therefore, the nurse should implement the six rights of medication administration to ensure safe medication delivery.

 

DIF:    Cognitive Level: Application             REF:    p. 71 | p. 73

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is reviewing the six rights of medication administration. Which medication order is written correctly?
a. Regular insulin 10 units SubQ q AM
b. Regular insulin 10U subQ q AM
c. Regular insulin 10 units SQ q AM
d. Regular insulin 10.0 units subQ q AM

 

 

ANS:   A

Regular insulin 10 units SubQ q AM is correct, because it uses correct and approved abbreviations.

Units should be written out; the use of “U” is incorrect, because it is an unapproved abbreviation.

SQ is not an approved abbreviation; SubQ should be used instead.

The use of a trailing zero is no longer approved; 10.0 should be written as 10.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 72

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care

Lehne: Pharmacology for Nursing Care, 7th Edition

 

Chapter 9: Drug Therapy During Pregnancy and Breast-Feeding

 

Test Bank

 

  1. Based on physiological changes in the kidney during pregnancy, which adjustment would a nurse anticipate for a patient in her third trimester who has been taking a drug excreted only by the kidneys?
a. Decreased dosage to protect the fetus
b. Increased dosage because of accelerated clearance
c. Rescheduling of drug administration times
d. No changes would be expected

 

 

ANS:   B

By the third trimester, renal blood flow is doubled, causing a large increase in the glomerular filtration rate. As a result, there is accelerated clearance of drugs eliminated by glomerular filtration. To compensate for accelerated excretion, the dosage must be increased.

A decreased dosage is not indicated in this instance.

Rescheduling of the drug is not indicated in this instance.

With an increase in the glomerular filtration rate, the dosage must be increased, not left the same.

 

DIF:    Cognitive Level: Application             REF:    p. 85

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. A pregnant patient is taking a medication that may produce toxicity if it is prolonged in her body. Which physiological change in the pregnant woman would be the most likely cause of an increased risk of toxicity?
a. Increased glomerular filtration rate (GFR)
b. Decreased renal blood flow
c. Prolonged transit through the gut
d. Increased hepatic metabolism

 

 

ANS:   C

Prolonged transit means more time for drugs to be absorbed, and this could increase the levels of drugs for which absorption is normally poor; therefore, prolonged transit increases the possibility of toxicity.

An increased GFR would expedite the passage of drugs through the system and therefore would be least likely to produce toxicity.

Decreased renal blood flow does not occur in the third trimester of pregnancy, therefore it is not relevant to this situation.

Increased hepatic metabolism would not affect toxicity.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 85

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. A nurse is teaching a class to a group of pregnant women. The nurse correctly teaches that the period during which the highest risk of teratogen-induced gross malformations exists is
a. immediately following preconception.
b. during the first trimester.
c. during the second trimester.
d. during the third trimester.

 

 

ANS:   B

Gross malformations are caused by exposure to teratogens during the embryonic period, which is considered the first trimester. This is the time when the basic shape of internal organs and other structures is being established.

No risk exists immediately prior to conception, unless the medication is a category X drug.

Teratogen exposure during the second and third trimesters usually disrupts function rather than gross anatomy.

 

DIF:    Cognitive Level: Application             REF:    p. 86

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. A pregnant woman is admitted to the emergency department. After a toxicology screen, it is determined that the patient is an active heroin addict. The patient is in active labor and gives birth to a girl. A nurse who is caring for the newborn should anticipate which clinical manifestation?
a. Passivity and flat affect
b. Diarrhea and salivation
c. A shrill cry and irritability
d. Continuous restless sleep

 

 

ANS:   C

The newborn of an active heroin addict experiences a withdrawal syndrome that includes shrill crying, vomiting, and extreme irritability.

The newborn will not experience passivity or a flat affect as a result of being born to an active heroin addict.

The newborn will not experience diarrhea or salivation as a result of being born to an active heroin addict.

The newborn will not experience continuous restless sleep as a result of being born to an active heroin addict.

 

DIF:    Cognitive Level: Application             REF:    p. 86

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. A mother has just given birth to a baby boy. A nurse notes that the infant has a cleft palate and low-set, malformed ears. The mother is upset and wants to know what is wrong with her baby. The nurse’s most appropriate answer would be
a. “Do you recall any medications that you took during the second trimester of your pregnancy?”
b. “Please don’t be concerned, a cleft palate is not that uncommon and can be fixed.”
c. “It is important that I take a medication history from you concerning medications that you took, if any, during your first trimester.”
d. “Did you take any medications or herbal products during your last trimester?”

 

 

ANS:   C

A cleft palate, low-set, malformed ears, and deafness typically are the result of teratogens consumed during the first trimester; therefore taking an accurate and complete medication history is important.

Telling the patient not to worry is condescending and does not validate her feelings.

A cleft palate would not develop during the second trimester, because the mouth and gut are formed at 7 to 12 weeks’ gestation.

A cleft palate would not develop during the third trimester, because the mouth and gut are formed at 7 to 12 weeks’ gestation.

 

DIF:    Cognitive Level: Application             REF:    p. 85

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. A nurse is providing patient education to a pregnant woman regarding chronic asthma, because the patient has just been diagnosed with the disease. Which statement made by the nurse best demonstrates the nurse’s understanding of the use of asthma medications during pregnancy?
a. The use of these medications during the first trimester is an indication for termination of pregnancy.
b. Asthma medications pose no potential harm to a developing fetus and may be taken as needed.
c. The use of these medications is contraindicated throughout pregnancy.
d. Untreated asthma may be more detrimental to the developing fetus than the drugs used to treat it.

 

 

ANS:   D

Uncontrolled maternal asthma is far more dangerous to the fetus than the drugs used to treat it.

The use of asthma drugs is not an indication for termination of the pregnancy.

Asthma drugs may pose a risk to the fetus, but the treatment benefits outweigh the risk.

The use of asthma medications is not contraindicated throughout pregnancy.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 85

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A breast-feeding patient has been given a prescription medication. The prescriber assures her that the drug is safe for both her and her baby. The mother is concerned but wants to continue breast-feeding. What clarification should the nurse provide for the patient?
a. Stop breast-feeding and feed the baby formula.
b. Take the medication immediately after breast-feeding.
c. Pump breast milk and feed the baby by bottle.
d. Take the medication 1 hour prior to breast-feeding.

 

 

ANS:   B

The nurse should clarify with the patient that she should take the medication immediately after breast-feeding, because this schedule facilitates a decreased drug concentration in the next breast-feeding.

Discontinuing breast-feeding is not indicated.

Pumping the breast milk will not diminish the drugs or drug concentration in the breast milk.

Taking the medication 1 hour prior to breast-feeding will increase concentrations of the drug in the breast milk.

 

DIF:    Cognitive Level: Application             REF:    pp. 89-90

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A nurse interviews a pregnant woman regarding health maintenance behaviors. Which statement made by the patient best demonstrates the need for further teaching?
a. “I’ve been taking extra doses of vitamin A, because I heard it will make my skin look very nice.”
b. “If I get a headache or my back hurts, I usually take two acetaminophen (Tylenol) tablets and rest for a while.”
c. “I have had diabetes for many years. Since I’ve been pregnant, I’ve noticed that I need a little more insulin every day.”
d. “I should avoid all cigarettes and alcoholic beverages while I’m pregnant.”

 

 

ANS:   A

Taking vitamin A in excess may produce multiple defects (CNS, craniofacial, cardiovascular, and others) and should be discouraged in the pregnant patient; further education is required.

Acetaminophen is generally safe to take per the doctor’s orders; no further education is required.

The diabetic pregnant female may require extra insulin, because her metabolic demands are increased during pregnancy, especially during the third trimester; no further education is required.

The patient should avoid cigarettes and alcoholic beverages during pregnancy; no further education is required.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 88

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

Lehne: Pharmacology for Nursing Care, 7th Edition

 

Chapter 11: Drug Therapy in Geriatric Patients

 

Test Bank

 

  1. An 84-year-old patient is 3 days postoperative from a right hip replacement. The patient is taking more than 14 different scheduled medications and six PRN medications, including analgesics. The nurse is concerned about renal function and should assess the patient’s
a. creatinine clearance.
b. sodium levels.
c. potassium levels.
d. urinalysis.

 

 

ANS:   A

The proper index of renal function in the elderly is creatinine clearance, which indicates renal function in elderly patients whose organs are undergoing age-related deterioration.

Sodium levels are not indicative of renal function.

Potassium levels are not indicative of renal function.

A urinalysis analyzes urine, not renal function.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 96-97

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse is caring for an elderly patient on multiple medications. The nurse suspects that age-related toxicity may have developed. Which laboratory/diagnostic test would provide the best indication of renal function?
a. Creatinine clearance
b. Renal biopsy
c. Urinalysis
d. Blood urea nitrogen

 

 

ANS:   A

The proper index of renal function in the elderly is creatinine clearance.

A renal biopsy would not be indicated as an index of renal function without other initial laboratory/diagnostic testing.

A urinalysis analyzes urine, not renal function.

Blood urea nitrogen can evaluate renal function; however, it also can be altered by other factors, such as hydration status; therefore, it is not the best indicator of renal function.

 

DIF:    Cognitive Level: Comprehension       REF:    pp. 96-97

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse formulates nursing diagnoses for an older adult who takes 12 prescription drugs daily. The nurse designates “Risk for falls” as the priority diagnosis because risk for falls is related to
a. age-related mobility issues, not necessarily the drugs being taken.
b. inappropriate use of prescription drugs.
c. potential drug interactions and toxicity.
d. rapid drug excretion.

 

 

ANS:   C

Adverse drug reactions are seven times more common in the elderly than in younger adults and may contribute to an increased risk for drug interactions, toxicity, and falls.

Mobility may decline in the elderly, increasing the risk for falls; however, this option ignores the link between falls and medication use in the elderly.

Inappropriate use of prescription drugs is a concern, but it is not the best reasoning for an increased risk for falls in the elderly.

Rapid drug excretion should not contribute to an increased risk for falls in the elderly.

 

DIF:    Cognitive Level: Application             REF:    p. 97

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. The nurse is providing education to a group of geriatric nurses regarding drug therapy in the elderly. Which response by a member of the group demonstrates a need for further teaching?
a. Elderly persons take 31% of the nation’s prescribed drugs.
b. Elderly persons experience more adverse drug reactions.
c. Elderly persons are more sensitive to drugs than younger adults.
d. Elderly persons have a greater tolerance to medications than younger adults.

 

 

ANS:   D

Elderly persons do not have a greater tolerance to medication than younger adults; this statement is indicative of a need for further education.

Elderly persons do take 31% of the nation’s prescribed drugs; this statement indicates that no further education is required.

Elderly persons do experience more adverse drug reactions; this statement indicates that no further education is required.

Elderly persons are more sensitive to drugs than younger adults; thus this statement indicates that no further education is required.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 96

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. Based on changes in hepatic function in older adult patients, which adjustment should the nurse expect for oral medications that undergo extensive first-pass metabolism?
a. A higher dose should be used with the same time schedule.
b. The interval between doses should be increased.
c. No change is necessary; metabolism will not be affected.
d. The interval between doses should be decreased.

 

 

ANS:   B

The interval between doses of the medication should be increased in older adult patients, because drugs that undergo the first-pass effect may not be broken down as well as in someone with full liver function.

A higher dose of the medication is not indicated, because toxic effects could occur.

A change in administration may be indicated in the older adult, because metabolism is affected in the elderly.

The interval between doses should not be decreased, but increased.

 

DIF:    Cognitive Level: Application             REF:    p. 96

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. A nurse understands the pharmacokinetics associated with medications in the elderly. Which laboratory finding would the nurse associate with the greatest risk of increased drug effects in the geriatric patient who is taking a drug that is highly protein bound?
a. Low serum albumin level
b. High serum albumin levels
c. Low serum creatinine levels
d. Increased gastric pH

 

 

ANS:   A

Reduced albumin levels in older adults can result in an increase in the levels of free drug in the system, creating more intense drug effects.

A high albumin level would not affect the intensity of a drug.

Low serum creatinine levels would not affect the intensity of a drug.

Increased gastric acid would not affect the intensity of a drug but may destroy it in the gut if it is acid labile.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 96

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. A nurse is working on a geriatric unit and caring for a patient on multiple medications. While reviewing the patient’s laboratory findings, the nurse notes a slightly abnormal serum creatinine level. The nurse is not concerned, because she understands that serum creatinine is not a good reflection of renal function because
a. lean body mass decreases parallel with the decline in renal function.
b. lean body mass is increased as renal function declines.
c. obese body tissue sequesters creatinine.
d. blood urea nitrogen decreases in older adults.

 

 

ANS:   A

In the elderly, the proper index of renal function is creatinine clearance, not serum creatinine levels. Creatinine levels do not reflect kidney function in the elderly because the sources of serum creatinine, lean muscle mass, decline in parallel with the decline in kidney function. As a result, creatinine levels may be normal even though renal function is greatly reduced.

Lean body mass is decreased, not increased as renal function declines.

Obese body tissue does not sequester creatinine.

Blood urea nitrogen does not decrease in older adults.

 

DIF:    Cognitive Level: Application             REF:    pp. 96-97

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

  1. A nurse completes a drug history for an 83-year-old patient newly hospitalized with syncope. Which information would be the most important for the nurse to assess to prevent drug-to-drug interactions?
a. Prescription and nonprescription drugs and substances the patient uses
b. Places the patient stores medications at home
c. Names of persons who assist the patient daily with medication management
d. Name of the pharmacy where the patient routinely has prescriptions filled

 

 

ANS:   A

The most important information the nurse can assess is the potential drug-to-drug interactions that can occur with prescription and nonprescription drugs, as well as herbal substances.

The places the patient stores the medication may be significant if the medications are sensitive to light, but this is not related to drug-to-drug interactions.

The names of persons who assist the patient are not the priority in drug-to-drug interactions unless the individual is administering the drugs improperly, and the question as stated does not indicate such.

The name of the pharmacy is not important either, because there is no indication that the patient has the prescriptions filled at multiple pharmacies.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 97

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

 

  1. A nurse is working with an elderly patient who takes multiple medications for various ailments and illnesses. What interventions could the nurse implement to help promote compliance by this elderly patient? (Select all that apply.)
a. Ensure that the number of drugs and doses per day is as small as possible.
b. Explain the treatment plan in clear, concise instructions.
c. Choose an appropriate dosing form, such as liquid versus pill form.
d. Have the patient administer medication patches every week to cut down on pills.
e. Enlist the assistance of a neighbor or friend to help with administration of medications.
f. Use multiple containers clearly labeled with the medications.

 

 

ANS:   A, B, C, E

Compliance may be promoted by ensuring that the number of drugs and doses per day is as small as possible; explaining the treatment plan in clear, concise language; choosing an appropriate dosing form (ie, if the patient has difficulty swallowing pills, have a liquid ordered); and enlisting the assistance of a neighbor or friend to help with reminders or administration of medications.

Having the patient administer patches may be dangerous, because toxicity may develop if the patient forgets to take one off as prescribed.

Using multiple containers for medications may result in double dosing and confuse the patient.

 

DIF:    Cognitive Level: Application             REF:    p. 97

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

Lehne: Pharmacology for Nursing Care, 7th Edition

 

Chapter 17: Adrenergic Agonists

 

Test Bank

 

  1. A patient presents to the emergency department with edema of the glottis, bronchoconstriction, and a blood pressure of 82/38. Friends state that the reaction was a result of an insect sting. Which drug should the nurse prepare to administer?
a. Ephedrine
b. Diphenhydramine (Benadryl)
c. Dopamine
d. Epinephrine (Adrenaline)

 

 

ANS:   D

Epinephrine is the drug of choice for anaphylaxis.

Ephedrine is not a drug of choice in an anaphylaxis situation.

Diphenhydramine is an antihistamine and is indicated for minor allergic reactions, not evident in this patient, who is symptomatic of anaphylaxis.

Dopamine, which can be used to bring blood pressure up, would not reverse the signs and symptoms of anaphylaxis.

 

DIF:    Cognitive Level: Application             REF:    p. 153

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. After dopamine is administered to a patient who has been experiencing hypotensive episodes, other than an increase in blood pressure, which indicator would the nurse use to evaluate a successful response?
a. Decrease in pulse and blood pressure
b. Increase in urine output
c. Weight gain
d. Improved gastric motility

 

 

ANS:   B

Dopamine would cause an increase in urine output, because cardiac output is increased as a result of the increase in blood pressure.

The effectiveness of dopamine would not be measured by a decrease in pulse and blood pressure, because dopamine’s primary effect is to increase blood pressure.

Dopamine’s effectiveness would not be evaluated by a weight gain.

Dopamine’s effectiveness would not be evaluated by improved gastric motility.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 157-158

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse in the intensive care unit is preparing to administer dobutamine (Dobutrex). For which of the following patients would dobutamine (Dobutrex) most likely be indicated?
a. The patient with hypertension
b. The patient with tachycardia
c. The patient with asthma
d. The patient with heart failure

 

 

ANS:   D

Dobutamine is indicated for heart failure, because it helps alleviate symptoms by activating beta1 receptors on the heart, which increases myocardial contractility and thereby cardiac output.

Dobutamine is indicated for patients with hypotension to increase blood pressure, therefore it would be contraindicated in patients with hypertension.

Tachycardia is a side effect of dobutamine and is not among its therapeutic uses.

Dobutamine is not indicated for asthma, because it is a beta1-adrenergic drug.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 158

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient is brought to the emergency department for a superficial stab wound to the forearm. Sutures are required, and a prescriber orders a local anesthetic with epinephrine. The nurse understands that the rationale for the use of epinephrine with a local anesthetic is to cause which of the following effects?
a. Reduce anesthetic-induced nausea.
b. Prolong anesthetic absorption.
c. Reduce the pain of an injection.
d. Prevent hypertension induced by the anesthetic.

 

 

ANS:   B

Epinephrine prolongs anesthetic absorption, because it is an alpha1 agonist. It is frequently combined with a local anesthetic to delay anesthetic absorption.

Epinephrine does not act as an antiemetic, therefore it would not reduce anesthetic-induced nausea.

Epinephrine is not used to reduce the pain of an injection.

Anesthesia does not induce hypertension, therefore epinephrine is not indicated for use in such cases.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 151-153

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse is preparing to hang intravenous dopamine (Intropin) for a patient with dysrhythmias in the intensive care unit. Which of the following would most concern the nurse?
a. The patient asks why the solution is brown.
b. The patient states that she is experiencing a little more urination than normal.
c. The patient has a triple lumen intrajugular central line.
d. The patient has the potential to become an intravenous drug user.

 

 

ANS:   A

Dopamine should be discarded if the solution is not clear, as would be the case with most intravenous solutions. The potential for serious reactions exists if a tainted solution is administered. A nurse should always be aware of the reason for a change in the color of an intravenous solution, such as when multivitamin is added to the solution.

Dopamine is indicated to increase the patient’s blood pressure, thereby increasing cardiac output, and an expected consequence of that effect would be an increase in urination.

Dopamine is administered intravenously in any of the various types of peripheral and central lines, therefore use of an intrajugular central line would not be a concern.

There is no risk of drug addiction to dopamine.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 157-158

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient is receiving a drug that activates alpha1 receptors. Based on that mechanism of action, a nurse should assess for which of the following expected effects of the medication?
a. Mydriasis
b. Miosis
c. Hypertension
d. Decreased heart rate

 

 

ANS:   A

An alpha1 response would result in mydriasis, or widening of the pupil, and would facilitate an eye exam.

Miosis describes pupillary constriction and is not a result of an alpha1-receptor response.

Hypertension is an adverse effect of alpha1 activation and therefore would not be an expected response.

A decreased heart rate would not be an expected response of an alpha1-receptor medication.

 

DIF:    Cognitive Level: Application             REF:    pp. 152-153

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse is providing education regarding catecholamines. The nurse is evaluating understanding among the staff. Which statement made by one of the nurses would best demonstrate an understanding of why catecholamine medications cannot be administered orally?
a. Catecholamines have a long half-life.
b. The effects of catecholamines would be excessively potent if the drugs were given by this route.
c. The side effect of catecholamines prevents this route of administration.
d. Catecholamines are quickly destroyed by monoamine oxidase and catechol-O-methyltransferase enzymes.

 

 

ANS:   D

The actions of two enzymes, monoamine oxidase and catechol-O-methyltransferase, explain why catecholamines have a short half-life and cannot be used orally.

Catecholamines have a short half-life, not a long one, and therefore cannot be given orally.

The potency of catecholamines would not be affected by the route of oral administration.

The side effects of catecholamines are not related to the route of oral administration.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 150-151

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A charge nurse has just received four admissions to the unit. A nurse admitting one of the patients receives an order for a drug that activates alpha1 receptors. The nurse would anticipate which response as a result of administration of the drug to the patient?
a. Vasodilation
b. Constricted pupils
c. Elevated blood pressure
d. Bleeding

 

 

ANS:   C

Activation of alpha1 receptors causes elevation of blood pressure, mydriasis (dilated pupils), and vasoconstriction.

Activation of alpha1 receptors does not result in vasodilation, pupil constriction, or bleeding.

 

DIF:    Cognitive Level: Application             REF:    pp. 152-153

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A prescriber has ordered a beta1-agonist medication for a patient. A nurse understands that the patient who would most likely benefit from a beta1 agonist would be a patient with which of the following health alterations?
a. Heart failure
b. Hypertension
c. Asthma
d. Glaucoma

 

 

ANS:   A

Therapeutic applications of beta1 activation include cardiac arrest, heart failure, shock, and AV heart block.

Hypertension is not an indication for the use of a beta1-agonist medication.

Asthma would be most effectively managed with a beta2-agonist medication.

Glaucoma is not an indication for use of a beta1-agonist medication.

 

DIF:    Cognitive Level: Application             REF:    p. 153

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient is to receive dopamine 5 mcg/kg/min by continuous intravenous infusion. The patient’s weight is 176 lb. To complete the calculation of this medication problem, a nurse would have to know that 176 lb would convert to how many kilograms (kg)?
a. 80
b. 880
c. 83
d. 352

 

 

ANS:   A

The formula must be shown for the student to understand how the answer was achieved. The first step is to change 176 lb to kg, which is the unit of measure in which the order is written: 176 lb = X kg; 2 lb = 1 kg; X = 80 kg.

 

DIF:    Cognitive Level: Application             REF:    pp. 158-159

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient in preterm labor is concerned about her baby. She asks the nurse which medication she will be given to stop the labor. The nurse should clarify for her that the medication the prescriber will order will be which of the following drugs?
a. Isoproterenol (Isuprel)
b. Dopamine (Intropin)
c. Terbutaline (Brethine)
d. Phenylephrine (Neo-Synephrine)

 

 

ANS:   C

Terbutaline is indicated to delay preterm labor by activating beta2 receptors in the uterus, relaxing the uterine muscles and preventing contractions.

Isoproterenol is not indicated for use in a patient with preterm labor.

Dopamine is not indicated for use in a patient with preterm labor.

Phenylephrine is not indicated for use in a patient with preterm labor.

 

DIF:    Cognitive Level: Application             REF:    p. 158

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse is reviewing a patient’s medications. When given concurrently with epinephrine (Adrenalin), which drugs may precipitate a hypertensive crisis?
a. Beta blockers
b. Diuretics
c. Alpha1-adrenergic blockers
d. Monoamine oxidase inhibitors

 

 

ANS:   D

Monoamine oxidase inhibitors can intensify the vasoconstrictive effects of epinephrine on the heart and blood vessels, therefore their administration together would be contraindicated.

Beta blockers are vasodilators and would not likely precipitate a hypertensive crisis when administered with epinephrine.

Diuretics can complement the beneficial effects of dopamine on the kidney.

Alpha1-adrenergic blockers would cause vasodilation and would not likely precipitate a hypertensive crisis when administered with epinephrine.

 

DIF:    Cognitive Level: Application             REF:    pp. 154 | pp. 156

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A patient is receiving dobutamine (Dobutrex) as a continuous infusion. Monitoring of the effectiveness of this medication is based on which assessment findings? (Select all that apply.)
a. Heart rate
b. Blood pressure
c. Urine output
d. Body temperature
e. Uterine contractions

 

 

ANS:   A, B, C

Indications for beta1 activation include heart failure, cardiac arrest, and shock, all of which would affect the heart rate, blood pressure, and urine output. Dobutamine’s effectiveness would be measured by assessing for and observing positive outcomes in these findings.

Temperature and uterine contractions would not be affected.

 

DIF:    Cognitive Level: Application             REF:    pp. 160-161

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

Lehne: Pharmacology for Nursing Care, 7th Edition

 

Chapter 25: Drugs for Muscle Spasm and Spasticity

 

Test Bank

 

  1. Intravenous diazepam (Valium) 4 mg is prescribed. A solution of 5 mg/mL is available. The  nurse will administer _____ mL.

 

ANS:

0.8

5 mg ´ 4 mg

1 mL      mL

5x = 4

x = 4/5 = 0.8 mL

 

DIF:    Cognitive Level: Application             REF:    p. 242

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is providing patient education for a patient who is to gradually discontinue baclofen (Lioresal). The nurse advises the patient to avoid abrupt discontinuation of the medication to prevent which adverse effect?
a. Weakness
b. Fatigue
c. Seizures
d. Respiratory depression

 

 

ANS:   C

Abrupt discontinuation (or withdrawal) from baclofen has been associated with adverse reactions such as visual hallucinations, paranoid ideation, and seizures.

Central nervous system effects may cause weakness and fatigue but not as a result of abrupt discontinuation.

Respiratory depression is a result of overdose, not abrupt discontinuation of the baclofen.

 

DIF:    Cognitive Level: Application             REF:    pp. 241-242

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Intravenous dantrolene (Dantrium) 2 mg/kg is prescribed for preoperative prophylaxis for a patient with a history of malignant hyperthermia. The patient weighs 132 lb. The nurse administer _____ mg.

 

ANS:

120

132 lb = x kg

2.2 lb ´ 132 lb

1 kg           x

2.2y = 132

x = 60 kg

2 mg ´ x

1 kg    60

x = 120 mg

 

DIF:    Cognitive Level: Application             REF:    p. 242

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient comes to the clinic with severe spastic paralysis. During the health history the patient asks a nurse which drug could be used in an attempt to provide relief from the spasms. The nurse explains that the only benzodiazepine used to treat spasticity is
a. carisoprodol (Soma).
b. tizanidine (Zanaflex).
c. orphenadrine (Norflex).
d. diazepam (Valium).

 

 

ANS:   D

Diazepam is the only benzodiazepine labeled for the treatment of spasticity.

Carisoprodol, tizanidine, and orphenadrine are not benzodiazepines; they are muscle relaxers.

 

DIF:    Cognitive Level: Application             REF:    p. 242

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse suspects that one of the patients she is caring for exhibits symptoms of baclofen (Lioresal) overdose. The patient is unresponsive. What should the nurse’s initial action be?
a. Prepare to support respirations.
b. Administer the antidote to baclofen.
c. Administer diazepam to relax the body.
d. Obtain an electrocardiogram.

 

 

ANS:   A

An overdose of baclofen can produce coma and respiratory depression. Respiratory support should be the nurse’s initial action.

No antidote is available to baclofen poisoning.

Diazepam would not be indicated and may further depress respirations.

An electrocardiogram is not indicated for this patient.

 

DIF:    Cognitive Level: Application             REF:    p. 241

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

  1. A nurse is caring for a patient admitted to the unit and receiving dantrolene (Dantrium) for spasticity. The nurse should particularly monitor the patient’s
a. liver enzymes.
b. renal function tests.
c. complete blood count.
d. serum electrolytes.

 

 

ANS:   A

Hepatotoxicity is a serious potential problem in a patient receiving dantrolene, and baseline liver enzymes should be obtained prior to dosing and periodically thereafter.

There is no indication that renal function tests, a complete blood cell count, or electrolytes should be monitored in a patient receiving dantrolene.

 

DIF:    Cognitive Level: Application             REF:    p. 242

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A prescriber orders a muscle relaxant to be administered intravenously. Which medication should the nurse expect to administer?
a. Diazepam (Valium)
b. Carisoprodol (Soma)
c. Chlorzoxazone (Paraflex)
d. Metaxalone (Skelaxin)

 

 

ANS:   A

Diazepam is the only medication of those listed that is approved for intravenous use.

Carisoprodol, chlorzoxazone, and metaxalone are only administered orally.

 

DIF:    Cognitive Level: Application             REF:    p. 242

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient with multiple sclerosis participates in a rehabilitation program. The patient takes baclofen (Lioresal) to help manage spasticity. How might the baclofen (Lioresal) interfere with the patient’s rehabilitation activities?
a. By producing drowsiness and lethargy
b. By causing gastrointestinal distress
c. By increasing pain associated with activities
d. By exacerbating spasticity with increased movement

 

 

ANS:   A

The central nervous system effects of baclofen include drowsiness and lethargy, which might diminish the effectiveness of rehabilitation activities.

Baclofen does not cause gastrointestinal distress and would not impede rehabilitation activities.

Baclofen does not cause an increase in pain with activity. In fact by reducing spasticity, pain may be reduced, thus enhancing rehabilitation activities.

Baclofen reduces rather than exacerbates spasticity.

 

DIF:    Cognitive Level: Application             REF:    pp. 241-242

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

Lehne: Pharmacology for Nursing Care, 7th Edition

 

Chapter 35: Management of Anxiety Disorders

 

Test Bank

 

  1. A patient is brought to the emergency department in a state of extreme uncontrolled anxiety. The prescriber orders a benzodiazepine. A nurse understands that benzodiazepines are used in this clinical situation based on which of the following principles?
a. Benzodiazepines have a very short half-life.
b. There is no risk of physical dependence when taking benzodiazepines.
c. Benzodiazepines are known to cure generalized anxiety.
d. Benzodiazepines have a rapid onset of action.

 

 

ANS:   D

The patient is clearly in a state of extreme uncontrolled anxiety. Benzodiazepines are the drug of choice for acute episodes of anxiety because of their rapid onset of action.

Benzodiazepines do not have a very short half-life.

Benzodiazepines are associated with physical dependence.

Benzodiazepines do not cure generalized anxiety, nor do any other drugs.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 384

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse compares the actions of benzodiazepines with those of buspirone (BuSpar). Which statement is correct regarding buspirone (BuSpar)?
a. Buspirone is not a central nervous system depressant.
b. The effects of buspirone are more rapid than those of benzodiazepines.
c. Buspirone is suitable for an as-needed medication use.
d. The potential for abuse is higher with buspirone than with the benzodiazepines.

 

 

ANS:   A

Buspirone is not a central nervous system depressant.

The effects of buspirone manifest less rapidly than those of the benzodiazepines.

Buspirone is not suitable for an as-needed medication because of the delay in therapeutic effects.

The potential for abuse is lower with buspirone than with the benzodiazepines.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 384

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse provides education for a patient who has just started taking buspirone (BuSpar). The patient asks the nurse, “When should I expect to see an effect from the medication?” The nurse’s best response would be based on the understanding that the effects of buspirone begin in most patients during which time frame?
a. 3 days
b. 24 to 48 hours
c. 1 day
d. 4 to 6 weeks

 

 

ANS:   D

Although an initial response to buspirone may occur as early as 1 week, it may take up to 4 to 6 weeks for peak results of the medication to occur.

One to 3 days is too short an interval to expect the effects of buspirone to develop.

 

DIF:    Cognitive Level: Application             REF:    pp. 384-385

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient is being discharged from the hospital on buspirone (BuSpar). A nurse is providing education on the effects and side effects of the medication. What statement made by the patient would most concern the nurse?
a. “I will take the medication with grapefruit juice.”
b. “I will limit alcohol-containing products.”
c. “I can take the medication with food.”
d. “This drug is not addicting.”

 

 

ANS:   A

Grapefruit juice can increase levels of buspirone, which can cause drowsiness and dysphoria; this statement indicates a need for further teaching.

The patient is correct in stating that alcohol-related products should be limited.

The patient is correct that the medication may be taken with food.

The patient is correct in stating that buspirone is not addicting.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 385

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who is also a nurse is being treated for anxiety with a selective serotonin reuptake inhibitor. She asks about the rationale for use of this agent rather than a benzodiazepine. Which of the following is the nurse’s best response?
a. “Selective serotonin reuptake inhibitors are better for the control of bodily symptoms than benzodiazepines.”
b. “Selective serotonin reuptake inhibitors provide a more rapid and durable response to the uncomfortable anxiety symptoms.”
c. “Benzodiazepines currently have no role in the treatment of anxiety.”
d. “Selective serotonin reuptake inhibitors are better for reducing the cognitive and psychic symptoms of anxiety than benzodiazepines.”

 

 

ANS:   D

Compared with benzodiazepines, selective serotonin reuptake inhibitors are better for reducing the cognitive and psychic symptoms of anxiety, but not the somatic symptoms.

Selective serotonin reuptake inhibitors are not better than benzodiazepines for reducing somatic symptoms of anxiety.

Selective serotonin reuptake inhibitors have a delayed response to uncomfortable anxiety symptoms.

Benzodiazepines are used in the treatment of anxiety.

 

DIF:    Cognitive Level: Application             REF:    p. 385

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who just returned from a war-torn country is admitted to the hospital with post-traumatic stress disorder. A nurse anticipates that the prescriber will order which of the following medications for the patient?
a. Paroxetine (Paxil)
b. Alprazolam (Xanax)
c. Clomipramine (Anafranil)
d. Venlafaxine (Effexor XR)

 

 

ANS:   A

Paroxetine is approved by the FDA for post-traumatic stress disorder.

Alprazolam is used to treat anxiety.

Clomipramine is used to treat obsessive-compulsive disorder.

Venlafaxine is used to treat anxiety.

 

DIF:    Cognitive Level: Application             REF:    pp. 389-390

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient discloses feelings of helplessness and fear after being stranded on a rooftop for 3 days after a major hurricane. Which nursing diagnosis would be most appropriate for this patient?
a. Ineffective coping related to generalized anxiety disorder
b. Fear related to post-traumatic stress disorder
c. Alteration in activities of daily living related to obsessive-compulsive disorder
d. Fear secondary to panic disorder

 

 

ANS:   B

Post-traumatic stress disorder develops after a traumatic event that elicited an immediate reaction of fear, helplessness, or horror. This patient’s fear is directly related to the traumatic event experienced.

This patient is not experiencing generalized anxiety, therefore this is an inappropriate nursing diagnosis.

This patient is not experiencing obsessive-compulsive disorder, therefore this is an inappropriate nursing diagnosis.

Although the patient is experiencing panic and fear, the symptoms are directly related to post-traumatic stress disorder, therefore panic disorder is not an appropriate nursing diagnosis.

 

DIF:    Cognitive Level: Application             REF:    pp. 389-390

TOP:    Nursing Process: Diagnosis

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies