Test Bank for Pharmacology A Patient Centered Nursing Process Approach 9th Edition By Linda E

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Pharmacology A Patient Centered Nursing Process Approach 9th Edition By Linda E

Chapter 06: Geriatric Considerations

McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition

 

MULTIPLE CHOICE

 

  1. The nurse is caring for an older adult patient who is receiving multiple medications. When monitoring this patient for potential drug toxicity, the nurse should review which lab values closely?
a. Complete blood count and serum glucose levels
b. Pancreatic enzymes and urinalysis
c. Serum creatinine and liver function tests (LFTs)
d. Serum lipids and electrolytes

 

 

ANS:   C

With liver and kidney dysfunction, the efficacy of drugs is generally increased and may cause toxicity. The nurse should review serum creatinine levels to monitor renal function and LFTs to monitor hepatic function. The other lab tests may be ordered for specific drugs if they affect those body systems.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 53

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. An older patient who reports a 2- to 3-year history of upper gastrointestinal (GI) symptoms will begin taking ranitidine (Zantac) to treat this disorder. The patient has completed a health history form. The nurse notes that the patient answered “no” when asked if any medications were being taken. Which action will the nurse take next?
a. Ask whether the patient uses over-the-counter (OTC) medications.
b. Obtain a careful dietary history for the past two weeks.
c. Recommend that the patient take antacid tablets.
d. Suggest that the patient add high-potassium foods to the diet.

 

 

ANS:   A

Many patients do not think of OTC products as medications and often do not list them when asked about medication use. A patient who takes ranitidine along with an OTC antacid could be duplicating medications. A dietary history is important as well but would not be the most important action in this case. The nurse should not recommend antacid tablets or high-potassium foods.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 52

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. To assist an older, confused patient to adhere to a multidrug regimen, the nurse will provide which recommendation?
a. Avoid the use of OTC medications.
b. Bring all medications to each clinic visit.
c. Review the manufacturer’s information insert about each medication.
d. Save money by getting each drug at the pharmacy with the lowest price.

 

 

ANS:   B

Patients who take multiple medications should be advised to bring medications to each clinic visit. Patients may take OTC medications as long as those are included in the list of medications reviewed by the provider. Manufacturers’ inserts provide an overwhelming amount of information. Patients should be advised to use only one pharmacy.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 56

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for an older patient who is taking 25 mg per day of hydrochlorothiazide. The nurse will closely monitor which lab value in this patient?
a. Coagulation studies
b. White blood count
c. LFTs
d. Serum potassium

 

 

ANS:   D

Older patients who take doses of hydrochlorothiazide between 25 and 50 mg/day have increased risk of electrolyte imbalances, so potassium should be monitored closely.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 53

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for an 82-year-old patient who takes digoxin to treat chronic atrial fibrillation. When caring for this patient, to monitor for drug side effects, what will the nurse carefully assess?
a. Blood pressure
b. Heart rate
c. Oxygen saturation
d. Respiratory rate

 

 

ANS:   B

Most of the digoxin is eliminated by the kidneys, so a decline in kidney function can cause digoxin accumulation, which can cause bradycardia. Digoxin should not be given to any patient with a pulse less than 60 beats per minute.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 53

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for an 80-year-old patient who is taking warfarin (Coumadin). Which action does the nurse understand is important when caring for this patient?
a. Encouraging the patient to rise slowly from a sitting position
b. Initiating a fall-risk protocol
c. Maintaining strict intake and output measures
d. Monitoring blood pressure frequently

 

 

ANS:   B

Patients who take anticoagulants have an increased risk of hemorrhage. Older patients have an increased risk of falls that can lead to bleeding complications. Initiating a fall-risk protocol is important. Warfarin does not affect blood pressure and would not cause orthostatic hypotension. Warfarin does not alter urine output.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 53

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. An 80-year-old patient is being treated for an infection. An order for which type of antibiotic would cause concern for the nurse caring for this patient?
a. Aminoglycoside
b. Cephalosporin
c. Penicillin
d. Sulfonamide

 

 

ANS:   A

Penicillins, cephalosporins, tetracyclines, and sulfonamides are normally considered safe for the older adult. Aminoglycosides are excreted in the urine and are not usually prescribed for patients older than 75 years.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 2

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A 75-year-old patient will be discharged home with a prescription for an opioid analgesic. To help the patient minimize adverse effects, what will the nurse recommend for this patient?
a. Sucking on lozenges to moisten oral mucosa
b. Taking an antacid with each dose
c. Taking the medication on an empty stomach
d. Using a stool softener

 

 

ANS:   D

Opioid analgesics can cause constipation. Stool softeners can help minimize this effect. Opioids do not cause dry mouth. Drug absorption may be decreased with an antacid. Opioid analgesics should be taken with food or milk to decrease GI irritation.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 56

TOP:    Nursing Process: Planning

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A 75-year-old patient is readmitted to the hospital to treat recurrent pneumonia. The patient had been discharged home with a prescription for antibiotics 5 days prior. The nurse admitting this patient will take which initial action?
a. Ask the patient about OTC drug use.
b. Ask the patient how many doses of the antibiotic have been taken.
c. Discuss increasing the antibiotic dose with the provider.
d. Obtain an order for a creatinine clearance test.

 

 

ANS:   B

There are many reasons for non-adherence to a drug regimen in an older patient, so if a patient is readmitted, the nurse should first ascertain whether or not the medications have been used. Asking the patient how many doses have been taken will help to assess this. If it is determined that the patient is taking the drug as ordered, the other steps may be taken.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 55

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is performing an admission assessment on an 80-year-old patient who has frequent hospital admissions. The patient appears more disoriented and confused than usual. Which action by the nurse is correct?
a. Asking about medication doses
b. Asking for a neurologist consult
c. Requesting orders for LFTs
d. Suspecting impaired renal function

 

 

ANS:   A

An initial sign of drug toxicity in elderly patients may be confusion or changes in behavior. The nurse should ask about drug doses and notify the provider of the behaviors. The provider may order further evaluation based on the examination of the patient.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 56

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. An older patient takes ibuprofen for arthritis pain. The patient tells the nurse that the ibuprofen causes GI upset. Which action will the nurse take with this patient?
a. Ask the provider about having the patient take a different medication.
b. Instruct the patient to cut the ibuprofen dose in half to avoid GI upset.
c. Explain that all drugs have adverse effects.
d. Explore options to help decrease the drug side effects.

 

 

ANS:   D

Older adults are more likely to experience drug side effects, and nurses should be aware of the measures that may decrease these side effects and thus improve adherence.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 56

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for a 78-year-old patient who lives independently. The patient will begin a new drug regimen that requires taking multiple drugs at various times per day. Which intervention is appropriate for the nurse to implement with this patient?
a. Ask the patient’s family members to monitor the patient’s drug regimen.
b. Develop a log to record the times each drug will be taken.
c. Reinforce the need to take the drugs as scheduled.
d. Write the medication administration times on each prescription label.

 

 

ANS:   B

The patient should be advised to keep a medication record of drugs and when they will be taken. The patient is independent, and this helps maintain independence. Family member support is essential when older patients are confused. Reinforcing information without providing a means to keep track of the medications does not necessarily improve compliance. Writing medication times on prescription labels does not help to organize the medication schedule.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 56

TOP:    Nursing Process: Planning/Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. The nurse is preparing an 80-year-old patient for discharge home from the hospital. The patient will receive several new medications. The patient lives alone but has several family members who stop by every day. Which suggestions will the nurse make for this family? (Select all that apply.)
a. Ask the pharmacy for non-childproof medication bottles.
b. Ask the patient to record all medications and the times they are taken.
c. Place the pills in an organizer container.
d. Provide the patient with the drug manufacturer information sheets.
e. Put water bottles near pills for convenience.

 

 

ANS:   A, B, C, E

To help older patients with compliance, medications should be convenient and easy to open. Asking the pharmacist for non-childproof containers will help make medications easier to get. Using an organizer container helps patients remember which drugs should be taken at what time. Keeping a record of the drugs and when they are to be taken can also increase adherence. Placing water bottles nearby eliminates a step in the process and increases the likelihood that a medication will be taken on time. Providing the patient with the drug manufacturer’s information sheets is not needed for adherence; this level of information is not intended for the older consumer.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    pp. 55-56

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Which drug properties are problematic for older patients? (Select all that apply.)
a. Drugs with anticholinergic effects
b. Drugs that are highly protein-bound
c. Drugs with a short half-life
d. Drugs that undergo hepatic conjugation
e. Drugs with a narrow therapeutic range

 

 

ANS:   A, B, E

Older patients are more susceptible to drug side effects, especially those that cause anticholinergic effects. Older patients have a loss of protein-binder sites for drugs, so those that are highly protein-bound will have higher than usual serum levels and can cause toxicity. Drugs with a narrow therapeutic range require closer monitoring in all patients, but especially in older patients. Drugs with a short half-life are preferred because older patients have a decreased ability to metabolize and excrete drugs. Hepatic conjugation is usually not influenced by older age, liver diseases, or drug interaction.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 53

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

Chapter 07: Drugs of Abuse

McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition

 

MULTIPLE CHOICE

 

  1. The nurse is teaching a group in the community about drug abuse. Which statement by the nurse is correct?
a. “Cue-induced cravings eventually disappear after long periods of abstinence by the person addicted to drugs.”
b. “Substance abuse and addiction are synonymous terms, describing dependence on drugs.”
c. “Substance use disorder occurs when recurrent use causes clinically and functionally significant impairment.”
d. “Substance use disorder occurs when physical dependence is present.”

 

 

ANS:   C

Drug addiction occurs when emotional and mental dependence on a drug is present. Although physical dependence may often occur, it is not always present. Cue-induced cravings may diminish after long abstinence but do not disappear completely. Drug abuse may occur without addiction.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 60

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. The nurse is caring for a patient who is being treated for chronic alcohol intoxication. The nurse notes that the patient’s serum alcohol level is 0.40 mg%. The patient is awake and talkative even though this is a potentially lethal dose. The nurse recognizes this as alcohol
a. substance use disorder.
b. dependence.
c. misuse.
d. tolerance.

 

 

ANS:   D

Intoxication is a state of being influenced by a drug or other substance and may be a very small amount in the drug-naïve person or a potentially lethal amount in the chronic user. This person has developed tolerance to alcohol and is able to have a potentially lethal amount without severe effects. Addiction describes continued involvement in an activity despite the substantial harm it causes. Dependence describes physical need for the drug such that when the drug is stopped, withdrawal symptoms occur. Misuse refers to using a drug or substance to excess.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 60

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. What does the nurse understand must occur in order to produce withdrawal syndrome?
a. Intoxication
b. Craving
c. Drug tolerance
d. Physical dependence

 

 

ANS:   D

Patients who develop a physical dependence on a drug will experience withdrawal syndrome when the drug is stopped. Intoxication is a condition that results in disturbances in the level of consciousness, cognition, perception, judgment, behavior, and other psycho-physiologic functions. Cravings can occur without physical dependence. Tolerance refers to a decrease in drug effects with repeated use.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 60

TOP:    Nursing Process: N/A

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. The nurse is counseling a patient who wants to stop smoking. Which statement by the nurse is correct?
a. “Bupropion (Zyban) is effective and does not have serious adverse effects.”
b. “Nicotine replacement therapies are effective and eliminate the need for behavioral therapy.”
c. “Varenicline (Chantix) may be used short-term for 1 to 2 months.”
d. “You may experience headaches, irritability, and increased appetite for several months after stopping smoking.

 

 

ANS:   D

Headaches and increased appetite are common during nicotine withdrawal and may last for several months. Bupropion is effective but has many serious effects. Nicotine replacement therapy does not eliminate the need for behavioral therapy. Varenicline is used for at least 4 months.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 71

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. A patient with asthma has been using a nicotine transdermal 24-hour patch for 3 weeks to quit smoking. The patient reports having difficulty sleeping. What action will the nurse take?
a. Ask the provider for a prescription for Nicotrol NS.
b. Recommend removing the patch at bedtime.
c. Suggest using an 18-hour patch instead.
d. Tell the patient to stop the patch and join a support group.

 

 

ANS:   C

The patient should try an 18-hour patch to help with sleep. Nicotrol is not a good option for patients with asthma.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 70

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. The nurse is discussing smoking cessation with a nurse colleague who smokes. Which statement indicates a readiness to quit smoking?
a. “I don’t smoke around my children or inside the house.”
b. “I want to stop smoking, but I will need help to do it.”
c. “I will quit so my coworkers will stop harassing me about it.”
d. “If I cut down gradually, I should be able to quit.”

 

 

ANS:   B

Patients exhibit readiness when they state a desire to quit along with a request for professional assistance. Other factors, such as children or coworkers, do not indicate a desire to quit.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 70

TOP:    Nursing Process: Nursing Intervention/Planning

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. A patient is using Commit lozenge 2 mg to help quit smoking and reports nausea and indigestion. The nurse will instruct the patient to perform which action?
a. Allow the lozenge to dissolve slowly over 20 to 30 minutes.
b. Chew the lozenge thoroughly before swallowing it.
c. Increase to 4 mg and use less often.
d. Take the lozenge with food and a full glass of water.

 

 

ANS:   A

The patient should allow the lozenge to dissolve slowly. Chewing or swallowing the lozenge increases gastrointestinal side effects. Increasing the dose and decreasing the frequency is not recommended.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 70

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. A patient is brought to the emergency department by a family member. The patient reports seeing colored lights and describes feeling bugs crawling under the skin. The nurse suspects that this patient is abusing which drug?
a. Alcohol
b. Cocaine
c. Lysergic acid diethylamide (LSD)
d. Oxycodone

 

 

ANS:   B

A stimulant psychosis can occur with chronic use of any stimulant and, with cocaine, progresses to visual hallucinations of colored lights and tactile hallucinations of bugs crawling under the skin. These are not signs of abuse with alcohol or oxycodone. LSD is classified as a hallucinogen.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 63

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. The nurse is caring for a patient who is chronically irritable and anxious and prone to violent behaviors. The patient has several teeth missing and has dental caries in the remaining teeth. The nurse suspects previous chronic use of which drug?
a. Alcohol
b. Cocaine
c. LSD
d. Methamphetamine

 

 

ANS:   D

Patients previously exposed to methamphetamine use will exhibit these symptoms, and the physical effects of extended methamphetamine use are notable tooth decay and dermatologic deterioration.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 64

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. The nurse is teaching a patient who has completed detoxification for alcohol abuse who will be discharged home with a prescription for disulfiram (Antabuse). Which statement by the patient indicates understanding of the teaching?
a. “Even topical products containing alcohol can have serious adverse effects while I am taking this drug.”
b. “If I experience drowsiness or skin rash, I should discontinue this drug immediately.”
c. “It is safe to take a product containing alcohol one week after the last dose of disulfiram.”
d. “This drug acts by blocking the pleasurable effects of alcohol.”

 

 

ANS:   A

Disulfiram causes an unpleasant and potentially fatal reaction if alcohol is consumed while taking the drug and can even occur with topical products containing alcohol. Drowsiness and skin rash are not common adverse effects. The effects of disulfiram do not wear off for up to 2 weeks after the last dose. It does not block the pleasurable effects of alcohol.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 61

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. A patient who has a long history of alcohol abuse is admitted to the hospital for detoxification. In addition to medications needed to treat withdrawal symptoms, the nurse will anticipate giving intravenous
a. dopamine to restore blood pressure.
b. fluid boluses to treat dehydration.
c. glucose to prevent hypoglycemia.
d. thiamine to treat nutritional deficiency.

 

 

ANS:   D

Thiamine should be given to prevent Wernicke encephalopathy in patients treated for alcoholism. If glucose is indicated, the thiamine should be given first. Other treatments are given as indicated.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 67

TOP:    Nursing Process: Nursing Intervention/Planning

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. A patient arrives in the emergency department in an acute state of alcohol intoxication and reports chronic consumption of “several six packs” of beer every day for the past year. The nurse anticipates administering which medication or treatment?
a. Chlordiazepoxide (Librium)
b. Disulfiram (Antabuse)
c. Gastric lavage
d. Vasoconstrictors

 

 

ANS:   A

To prevent acute withdrawal and delirium tremens, a long-acting benzodiazepine, such as chlordiazepoxide, is given. Disulfiram would cause an acute drug interaction. Gastric lavage should no longer be performed, and vasoconstrictors are not indicated.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 72

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. A patient who is unconscious arrives in the emergency department with clammy skin and constricted pupils. The nurse assesses a respiratory rate of 8 to 10 breaths per minute. The paramedics report obvious signs of drug abuse in the patient’s home. The nurse suspects that this patient has had an overdose of which substance?
a. Alcohol
b. LSD
c. An opioid
d. Methamphetamine

 

 

ANS:   C

Opioid overdose is characterized by constricted pupils and respiratory depression.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 69

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. A patient is brought to the emergency department after ingesting an overdose of an opioid several hours prior. The patient has a respiratory rate of 6 to 10 breaths per minute and is unconscious. The nurse will prepare to perform which action?
a. Administer activated charcoal.
b. Give flumazenil (Romazicon).
c. Give naloxone (Narcan).
d. Perform gastric lavage.

 

 

ANS:   C

Naloxone is the drug of choice in the treatment of respiratory depression associated with opioid overdose. Flumazenil is the antidote for benzodiazepine overdose. Activated charcoal is used for asymptomatic patients who have recently consumed the drug. Gastric lavage should no longer be performed for treatment.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 69

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. A patient with a history of opioid abuse will be discharged home with buprenorphine to help prevent relapse. Which product will the nurse anticipate the provider to order?
a. Buprenex
b. Suboxone
c. Subutex
d. Vivitrol

 

 

ANS:   A

Buprenex is an agonist–antagonist opioid that can be used for detoxification and maintenance therapy because it has a low potential for abuse. Suboxone and Subutex have abuse potential. Vivitrol does not contain buprenorphine and does not prevent cravings.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 69

TOP:    Nursing Process: Nursing Intervention/Planning

MSC:   NCLEX: Psychosocial Integrity: Dependency

 

  1. The nurse is teaching a patient who will be discharged home with naltrexone (ReVia) after treatment for opioid addiction. What information will the nurse include in the teaching for this patient?
a. “This drug will help control cravings.”
b. “You may take this drug once weekly.”
c. “ReVia blocks the pleasurable effects of opioids.”
d. “If you discontinue this drug abruptly, you will have withdrawal symptoms.”

 

 

ANS:   C

ReVia acts by blocking the pleasurable effects of opioids. It can precipitate withdrawal when given to opioid-dependent patients. This drug does not control cravings, and it is taken once daily or every other day.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 69

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Psychosocial Integrity: Dependency