Abrams’ Clinical Drug Therapy-Rationales for Nursing Practice 13th Ed Geralyn Frandsen TEST BANK

Test Bank ForAbrams’ Clinical Drug Therapy: Rationales for Nursing Practice, 13th Edition Geralyn Frandsen, Sandra Pennington (2024) All Chapters 1-61

TEST BANK

Chapter 1: The Foundation of Pharmacology: Quality and Safety Abrams’ Clinical Drug Therapy: Rationales for Nursing Practice, 13th Edition Test Bank

1. A woman diagnosed with obsessive–compulsive disorder has been prescribed oralparoxetine hydrochloride.

What is the expected effect for this prescription?

A. Curative effect on symptoms B. Systemic effect on symptoms C. Local effect on symptoms D. Parenteral effect on symptoms ANS: B Rationale: Drugs that produce systemic effects are taken into the body, circulated through the bloodstream to their sites of action in various body tissues, and eventuallyeliminated from the body. Curative agents are given to cure a disease process. In this case, paroxetine hydrochloride will control the symptoms but not cure the disorder.

Drugs with local effects, such as sunscreen and local anesthetics, act mainly at the site of application.

Paroxetine hydrochloride is not administered parenterally. Parenteral agents are administered subcutaneously, intramuscularly, or intravenously.

PTS: 1 REF: p. 3, Introduction OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client has been prescribed an antibiotic. This medication is a naturally occurring substance that has been chemically modified. What is another name for this type of medication?

A. Synthetic drug B. Semisynthetic drug C. Biotechnology drug D. Prototype drug ANS: B Rationale: Semisynthetic drugs (e.g., many antibiotics) are naturally occurring substances that have been chemically modified. Synthetic drugs are more standardized intheir chemical characteristics, more consistent in their effects, and less likely to produce allergic reactions. Biotechnology drugs involve manipulating DNA and RNA and recombining genes into hybrid molecules that can be inserted into living organisms.

Prototype drugs are the first drug of a particular group to be developed.

PTS: 1 REF: p. 3, Drug Sources OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. Which classification applies to morphine?

A. Central nervous system depressant B. Central nervous system stimulant C. Anti-inflammatory D. Antihypertensive ANS: A Rationale: Drugs are classified according to their effects on particular body systems, their therapeutic uses, and their chemical characteristics. Morphine is classified as a central nervous system depressant and will produce this effect in the client. A centralnervous system stimulant increases attention and raises mood. An anti-inflammatoryagent decreases inflammation at the site of tissue or joint inflammation. An antihypertensive agent reduces blood pressure.

PTS: 1 REF: p. 3, Drug Classifications and Prototypes OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 4. A client is administered amoxicillin. The generic name of this medication belongs towhich drug group?

A. Selective serotonin reuptake inhibitors B. Diuretics C. Penicillins D. ACE inhibitors ANS: C Rationale: The generic name often indicates the drug group (e.g., drugs with generic names ending in “cillin” are penicillins). Selective serotonin reuptake inhibitors are medications that have antidepressant effects; SSRI is a broad classification, not a genericname. Diuretics are medications that increase urine output; diuretic is a broad classification, not a generic name. ACE inhibitor is the broad classification for the angiotensin receptor blockers, not the generic name.

PTS: 1 REF: p. 3, Drug Names OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. The administration of diphenhydramine is regulated by which U.S. government agency?

A. Public Health Service B. Federal Trade Commission C. Occupational Safety and Health Administration D. Food and Drug Administration ANS: D

Rationale: The Food and Drug Administration approves drugs for over-the-counter availability, including the transfer of drugs from prescription to OTC status, and may require clinical trials to determine the safety and effectiveness of OTC use. The Public Health Service is regulated by the state to maintain the health of individual citizens of the state. The Federal Trade Commission regulates imports and exports throughout the nation. The Occupational Safety and Health Administration regulates safety within the workplace.

PTS: 1 REF: p. 4, Prescription and Nonprescription Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 6. In the U.S., the administration of anabolic steroids is regulated by which law?

A. The Food, Drug, and Cosmetic Act of 1938 B. The Comprehensive Drug Abuse Prevention and Control Act C. The Harrison Narcotic Act D. The Sherley Amendment ANS: B Rationale: The Comprehensive Drug Abuse Prevention and Control Act regulates the manufacture and distribution of narcotics, stimulants, depressants, hallucinogens, and anabolic steroids. The Food, Drug, and Cosmetic Act of 1938 revised and broadened FDA powers and responsibilities, giving the FDA control over drug safety. The Harrison Narcotic Act restricted the importation, manufacture, sale, and use of opium, cocaine, marijuana, and other drugs that the act defined as narcotics. The Sherley Amendment of 1912 prohibited fraudulent claims of drug effectiveness.

PTS: 1 REF: p. 4, Prescription and Nonprescription Drugs OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 7. A nurse is responsible for maintaining an accurate count and record of the controlled substances on the nursing division. This nursing action is regulated by which U.S. law or agency?

A. The Food, Drug, and Cosmetic Act of 1938 B. The Public Health Service C. The Drug Enforcement Administration D. The Sherley Amendment ANS: C

Rationale: The Drug Enforcement Administration enforces the Controlled Substances Act. Under this enforcement, nurses are responsible for storing controlled substances in locked containers, administering them only to the people for whom they are prescribed, recording each dose given, and maintaining an accurate inventory. The Food, Drug, and Cosmetic Act of 1938 revised and broadened FDA powers and responsibilities, giving the FDA control over drug safety. The Public Health Service is regulated by the state to maintain the health of individual citizens of the state. The Sherley Amendment of 1912 prohibited fraudulent claims of drug effectiveness.

PTS: 1 REF: p. 7, Testing Procedure OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 8. In Phase 1 clinical trials, the potential uses and effects of a new drug are determined by which method?

A. Administering doses to healthy volunteers B. Administering doses to people with the disease C. Administering in placebo-controlled design D. Calculating the risk-to-benefit ratio ANS: A Rationale: Phase 1 studies allow for the administration of the medication to healthy volunteers to determine safe dosages, routes of administration, absorption, metabolism, excretion, and toxicity. In Phase 2 studies, a few doses are given to a certain number of subjects with the disease or symptom for which the drug is being studied and responses are compared with those of healthy subjects. Placebo-controlled designs are used in Phase 3 studies, in which half of the subjects receive the new drug and half receive the placebo. Calculating the risk-to-benefit ratio is used in Phase 2 studies to determine whether the potential benefits of the drug outweigh the risks.

PTS: 1 REF: p. 7, Testing Procedure OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. A new medication for the treatment of Alzheimer’s disease is being administered to a group of subjects with the disease. The subjects receiving this medication are unaware of whether they are being administered the medication or a placebo. This testing occurs in which phase?

A. Phase 1 B. Phase 2 C. Phase 3 D. Phase 4 ANS: C

Rationale: In Phase 3, the drug is given to a larger and more representative group of subjects. In double-blind, placebo-controlled designs, half of the subjects receive the new drug and half receive a placebo (an inactive substance similar in appearance to the actual drug), with neither subjects nor researchers knowing which subjects receive which formulation. In Phase 1, a few doses are given to a certain number of healthy volunteers to determine safe dosages, routes of administration, absorption, metabolism, excretion, and toxicity. In Phase 2, a few doses are given to a certain number of subjects with the disease or symptom for which the drug is being studied and responses are compared with those of healthy subjects. In Phase 4, the FDA evaluates the data from the first three phases for drug safety and effectiveness, allows the drug to be marketed for general use, and requires manufacturers to continue monitoring the drug’s effects.

PTS: 1 REF: p. 7, Testing Procedure OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. Which organization is responsible for approving new drugs in the United States?

A. The American Medical Association (AMA) B. The American Pharmaceutical Association (APA) C. The Food and Drug Administration (FDA) D. The U.S. Pharmacopeia ANS: C Rationale: The Food and Drug Administration is responsible for approving new drugs in the United States. The American Medical Association represents the health care providers of the United States. The American Pharmaceutical Association represents the pharmacists of the United States. The U.S. Pharmacopeia was adopted in 1906 and is issued every 5 years under the supervision of a national committee of pharmacists, scientists, and health care providers to provide information concerning drug purity and strength.

PTS: 1 REF: p. 7, Testing Procedure OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 11. A client with a long-standing dermatologic health problem has been advised to use a drug with a local effect. The nurse should recognize what characteristic of this drug?

A. It affects only the organ system in which it is metabolized.

B. The drug requires application at multiple sites.

C. It is effective only as long as it is in contact with skin.

D. The drug acts primarily at the site where it is applied.

ANS: D

Rationale: Drugs with local effects, such as sunscreen lotions and local anesthetics, act mainly at the site of application. Those with systemic effects are taken into the body, circulated through the bloodstream to their sites of action in various body tissues, and eventually eliminated from the body. A drug with local effect does not necessarily have to be applied at multiple sites, and its action may affect tissues long after contact.

PTS: 1 REF: p. 3, Introduction OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 12. What is the primary importance of a black box warning?

A. It will result in the medication being removed from the market.

B. It acknowledges that the medication has been tested on only a selected portion of the population.

C. It suggests that the prescription of the medication be avoided when treating certain populations.

D. It alerts health care professionals of the potential of serious adverse effects associated with the medication.

ANS: D Rationale: Black box warnings identify the fact that a drug can cause serious adverse effects. Subsequent withdrawal of approved and marketed drugs has occurred, usually because of serious adverse effects that become evident only when the drugs are used in a large, diverse population. The warning does not address testing or target populations.

PTS: 1 REF: p. 7, Testing Procedure OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. A health care facility is complying with the mandates of U.S. The Drug Enforcement Administration (DEA) concerning Schedule II medications when implementing which nursing intervention? Select all that apply.

A. Access to narcotics is controlled by key or codes.

B. Narcotics are administered by prescriptions only.

C. Only selected narcotics may be automatically renewed.

D. The administration of individual narcotic doses is recorded in specific unit documentation.

E. Any recognized discrepancy involving a narcotic must be reported to the appropriate facility authority.

ANS: A, B, D, E Rationale: Nurses are responsible for storing controlled substances in locked containers, administering them only to the people for whom they are prescribed, recording each dose given on agency narcotic sheets and on the client’s medication administration record, maintaining an accurate inventory, and reporting discrepancies to the proper authorities.

Prescriptions for Schedule II drugs cannot be refilled; a new prescription is required.

PTS: 1 REF: p. 7, Testing Procedure OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Select 14. Which medication reference is considered to be an authoritative, well-respected source of information? Select all that apply.

A. American Hospital Formulary Service B. Drug Facts and Comparisons C. Physicians’ Desk Reference D. Lippincott’s Nursing Drug Guide E. Package inserts provided with each medication ANS: A, B Rationale: An authoritative source is a work known to be reliable because its authority or authenticity is widely recognized by experts in the field. Both the American Hospital Formulary Service and the Drug Facts and Comparisons are authoritative sources of drug information that have been recognized as reliable sources of medication information. The Physicians’ Desk Reference is published yearly and contains manufacturers’ published inserts for selected drugs. The package inserts are produced by the drug manufacturers and do not necessarily contain the details included in the correct options. Lippincott’s Nursing Drug Guide is an example of a drug handbook, not a compilation of manufacturers’ inserts and intended as a student resource.

PTS: 1 REF: p. 11, Sources of Drug Information OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 15. A nursing student in a pharmacology class should be encouraged to study the medications according to which categorization? Select all that apply.

A. Prototype B. Controlled substance C. Drug use D. Generic names E. Therapeutic classification ANS: A, E Rationale: The nursing student should concentrate on therapeutic classifications and their prototypes. Controlled substances limit the medications studied to one broad classification. Drug use is only one part of the broad classification. Generic names are only one aspect of the medication.

PTS: 1 REF: p. 12, Strategies for Studying Pharmacology OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 16. A client diagnosed with an autoimmune disorder has just been prescribed a synthetic drug. Which characteristic is a noted advantage of synthetic drugs?

A. The client is at a lesser risk for an allergic reaction.

B. The client will require less frequent dosing.

C. The medication will be available on an over-the-counter basis.

D. The medication is available in a wider variety of administration routes.

ANS: A Rationale: Synthetic drugs are more standardized in their chemical characteristics, more consistent in their effects, and less likely to produce allergic reactions. They do not necessarily require less frequent dosing and may or may not be available OTC. They are not noted to be available in a wider variety of administration routes than naturally occurring substances.

PTS: 1 REF: p. 3, Drug Sources OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 17. A client is confused and has stated to the nurse, “I wasn’t sure whether I’m supposed to take Tylenol or acetaminophen.” To best address the client’s concern, the nurse should base the response on what information concerning generic and trade names?

A. Prescribers should refer solely to generic names in their recommendations and written prescriptions.

B. A generic name is independent of any particular drug manufacturer.

C. Generic names change frequently, but trade names are more consistent.

D. Prescribers should refer solely to trade names in their recommendations and written prescriptions.

ANS: B Rationale: A generic name is related to the chemical or official name and is independent of the manufacturer. Drugs may be prescribed and dispensed by generic or trade name.

Generic names do not change, while trade names vary according to time and place.

PTS: 1 REF: p. 3, Drug Names OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 18. What is the primary purpose of American drug laws?

A. To ensure maximum choice for consumers B. To expedite the workload of health care providers C. To protect the safety of the public D. To enhance the efficient delivery of health care

ANS: C Rationale: The main goal of drug laws is to protect the public by ensuring that drugs marketed for therapeutic purposes are safe and effective. Efficiency and choice are valid considerations, but neither is the primary goal of American drug legislation. Workload is expedited when delivery of health care is efficient.

PTS: 1 REF: p. 4, Prescription and Nonprescription Drugs OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 19. A nurse who provides care on a postsurgical unit frequently administers Schedule II drugs to clients. Which aspect of administering these drugs falls under the auspices of the U.S. Drug Enforcement Administration?

A. Performing a thorough client assessment prior to administration B. Recording each dose administration on an agency narcotic sheet C. Informing clients of the potential risks and benefits of such drugs prior to the first dose D. Assessing the client shortly after administration to ensure existence of the expected therapeutic effect ANS: B Rationale: Nurses are responsible for storing controlled substances in locked containers, administering them only to people for whom they are prescribed, recording each dose given on agency narcotic sheets and on the client’s medication administration record, maintaining an accurate inventory, and reporting discrepancies to the proper authorities.

The other given actions are appropriate nursing activities, but they are not within the scope of the DEA authority.

PTS: 1 REF: p. 7, Testing Procedure OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 20. Trials of a new drug are scheduled to begin soon. The testing methodology will integrate the stipulations of the National Institutes of Health (NIH) Revitalization Act. According to this act, the manufacturer must address which requirement?

A. Independently fund the entire testing process.

B. Make the results of the testing process publicly available.

C. Include women and minorities in the testing process.

D. Exclude any potential for financial gain during the testing process.

ANS: C

Rationale: In 1993, the United States Congress passed the National Institutes of Health (NIH) Revitalization Act, which formalized a policy of the NIH that women and minorities be included in human subject research studies funded by the NIH and that women and minorities be included in clinical drug trials. This act does not specifically address the financial structure of testing or the accessibility of information.

PTS: 1 REF: p. 7, Testing Procedure OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 21. A hospital nurse is vigilant in ensuring the safe use of medications and consistently applies the rights of medication administration. What are the rights of medication administration? Select all that apply.

A. Right to refuse prescribed medication B. Right route for effective medication therapy C. Right to effective medication education D. Right evaluation of expected results E. Right to low-cost medication therapy ANS: A, B, C, D Rationale: The traditional rights of medication administration (right drug, right dose, right client, right route, right time, right reason, and right documentation) now include additional rights that should also be considered (right education, right evaluation, and right to refuse the medication). While important, there is not a recognized right to low-cost medication.

PTS: 1 REF: p. 8, Rights of Medication Administration OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Select 22. A client’s current medication administration record includes a drug that the nurse recognizes as an Institute for Safe Medication Practices (ISMP) high-alert medication.

This designation signals the nurse to what characteristic of the drug?

A. It can only be administered by a health care provider or advanced practice nurse.

B. Administration must be cosigned by a second registered nurse or practical/vocational nurse.

C. It is currently undergoing Phase 4 testing and is pending full FDA approval.

D. Administration errors carry a heightened risk of causing significant client harm.

ANS: D Rationale: The Institute for Safe Medication Practices (ISMP) identifies drugs that when used in error have a heightened risk of causing significant client harm. Such drugs are not limited to health care provider or advanced practice nurse administration. The drug would have completed the testing and approval procedure, and administration does not necessarily require a cosignature.

PTS: 1 REF: p. 9, High-Alert Medications OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

Chapter 2, Basic Concepts and Processes 1. Which cellular structure stores hormones and other substances?

A. Golgi apparatus B. Endoplasmic reticulum C. Mitochondria D. Lysosome ANS: A Rationale: The Golgi apparatus stores hormones and other substances. The endoplasmic reticulum contains ribosomes, which synthesize proteins, including enzymes that synthesize glycogen, triglycerides, and steroids and those that metabolize drugs and other chemicals. The mitochondria generate energy for cellular activities and require oxygen. Lysosomes are membrane-enclosed vesicles that contain enzymes capable of digesting nutrients (proteins, carbohydrates, fats), damaged cellular structures, foreign substances (bacteria), and the cell itself.

PTS: 1 REF: p. 17, Cell Structures and Functions OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 2. A client is experiencing a cough associated with an upper respiratory infection. Which oral medication will likely produce the quickest therapeutic effect?

A. A tablet B. A liquid C. A topical spray D. A timed-release tablet ANS: B Rationale: Liquid medications are absorbed faster than tablets or capsules. A tablet is an oral medication that has a slower onset of action than a liquid medication. A topical spray can be sprayed to the back of the throat and provides only a local effect. A timed-release tablet is an oral medication that has a slower onset and longer duration of action.

PTS: 1 REF: p. 19, Absorption OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A client is administered an oral contraceptive. What is the process that occurs between the time the drug enters the body and the time it enters the bloodstream?

A. Absorption B. Distribution C. Metabolism

D. Excretion ANS: A Rationale: Absorption is the process that occurs from the time the drug enters the body to the time it enters the bloodstream to be circulated. Distribution involves the transport of drug molecules within the body. Metabolism is the method by which drugs are inactivated or biotransformed by the body. Excretion refers to elimination of a drug from the body.

PTS: 1 REF: p. 19, Distribution OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. Which site of drug absorption is considered to have the largest surface area?

A. Rectum B. Vagina C. Eye D. Lungs ANS: D Rationale: The lungs have the largest surface area for absorption of anesthetic gases and a few other drugs. The rectum absorbs the medication through the mucous membranes and has a smaller surface area than the lungs. The vagina absorbs the medication through the mucous membranes and has a smaller surface area than the lungs. The eye also has a smaller surface area than the lungs and absorbs the medication through the mucous membranes.

PTS: 1 REF: p. 19, Absorption OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. An older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect?

A. Toxicity B. Increased absorption C. Delayed gastric emptying D. Idiosyncratic effects ANS: A Rationale: An elevated creatinine level is indicative of diminished kidney function, which will result in serum drug toxicity. The creatinine level is unrelated to absorption and gastric emptying. Idiosyncratic effects are reactions that occur rarely and unpredictably among the population.

PTS: 1 REF: p. 20, Excretion OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. What is the primary role of protein binding on drug action?

A. Increasing the medication’s speed of action B. Decreasing the medication’s speed of action C. Increasing the rate of the medication’s excretion D. Averting the risk of adverse effects posed by the medication ANS: B Rationale: Protein binding allows part of a drug to be stored and released as needed.

Drugs that are highly bound to plasma proteins or stored extensively in other tissues have a long duration of action. Protein binding does not increase the speed of action or increase metabolism. Protein binding does decrease the speed of action by storing the drug to be released when needed. Protein binding does not prevent adverse reactions.

PTS: 1 REF: p. 19, Distribution OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. A client is taking a medication that is metabolized by the CYP enzymes. Which medication inhibits several of the CYP enzymes?

A. Cisplatin B. Acebutolol hydrochloride C. Cimetidine D. Dicloxacillin sodium ANS: C Rationale: Cimetidine is a gastric acid suppressor that inhibits several CYP enzymes and can greatly decrease drug metabolism. Cisplatin prevents DNA, RNA, and protein synthesis. Acebutolol hydrochloride is a beta1-selective adrenergic blocking agent.

Dicloxacillin sodium inhibits the final stage of bacterial cell wall synthesis.

PTS: 1 REF: p. 20, Metabolism OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 8. Which phrase accurately describes the concept of a medication’s serum half-life?

A. The time required for IV medications to penetrate the brain tissue B. The time needed for the serum level to fall by 50% C. The safest margin to prevent toxicity D. The dose adjustment that reduces the risk of adverse effects by one half ANS: B

Rationale: Serum half-life is the time required for the serum concentration of a drug to decrease by 50%. Although many IV medications penetrate the brain tissue, this action does not describe the half-life. The safest margin to prevent toxicity depends on the rate of metabolism and excretion. Half-life does not describe a strategy for mitigating adverse effects.

PTS: 1 REF: p. 22, Serum Half-Life OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. A client has increased intracranial pressure and is prescribed a diuretic. Which diuretic would be the most appropriate for this client?

A. Furosemide B. Hydrochlorothiazide C. Spironolactone D. Mannitol ANS: D Rationale: Mannitol is an osmotic diuretic that increases the osmolarity of plasma and pulls water out of the tissues into the bloodstream. It does not act on receptor sites.

Furosemide is a loop diuretic that inhibits the reabsorption of sodium and chloride in the loop of Henle. Hydrochlorothiazide is associated with drug interference with absorption of sodium ions across the distal renal tubule. Spironolactone acts by competing with aldosterone for cellular receptor sites.

PTS: 1 REF: p. 22, Nonreceptor Drug Actions OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. Which factor accounts for the increased risk for drug reactions among clients aged 65 years and older?

A. Drugs more readily crossing the blood–brain barrier in older people B. Physiologic changes affecting all pharmacokinetic processes C. Increased drug-metabolizing enzymes in older people D. Diminished immune response ANS: B Rationale: In older adults, physiologic changes may alter all pharmacokinetic processes, which can increase the risk for drug interactions. Drugs cross the blood–brain barrier easily in infants due to the barrier’s immaturity; the barrier is fully developed in older adults. Older adults experience a decrease, not an increase, in drug-metabolizing enzymes. Older adults exhibit a diminished immune response; however, while this makes them more susceptible to illness, it does not increase the risk for interactions.

PTS: 1 REF: p. 25, Age OBJ: 4 NAT: Client Needs: Health Promotion and Maintenance

TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 11. When considering the dosage requirement for a 6-feet (1.8-m) tall client who weighs 280 pounds (127 kg), which statement is accurate?

A. The dose will be higher than that required of a client who weighs 180 pounds (82 kg).

B. The dose will be lower than that required of a client who weighs 180 pounds (82 kg).

C. The dose will be similar to that required of a client who weighs 180 pounds (82 kg).

D. The dose will be more effective if given parenterally.

ANS: A Rationale: In general, people heavier than average may need larger doses, provided their renal, hepatic, and cardiovascular functions are adequate. In this situation, route is not relevant.

PTS: 1 REF: p. 25, Body Weight OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. Which drug is formulated to be absorbed through the skin? Select all that apply.

A. Lidocaine B. Clonidine C. Propranolol D. Nitroglycerin E. Fentanyl ANS: A, B, D, E Rationale: Some drugs are formulated in adhesive skin patches for absorption through the skin. Clonidine, fentanyl, and nitroglycerin are examples of drugs that are formulated in adhesive skin patch form to be absorbed through the skin. Lidocaine can be administered intravenously, subcutaneously, or topically. Propranolol is administered orally.

PTS: 1 REF: p. 19, Absorption OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 13. What is the mechanism that allows mannitol to produce diuresis?

A. Competes with aldosterone for cellular receptor sites B. Inhibits the reabsorption of sodium and chloride in the loop of Henle C. Interferes with absorption of sodium ions across the distal renal tubule D. Increases the osmolarity of plasma and pulls water out of the tissues into the

bloodstream ANS: D Rationale: Mannitol is an osmotic diuretic that increases the osmolarity of plasma and pulls water out of the tissues into the bloodstream. It does not act on receptor sites.

Furosemide is a loop diuretic that inhibits the reabsorption of sodium and chloride in the loop of Henle. Hydrochlorothiazide is associated with drug interference with absorption of sodium ions across the distal renal tubule. Spironolactone acts by competing with aldosterone for cellular receptor sites.

PTS: 1 REF: p. 22, Nonreceptor Drug Actions OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. What is the characteristic action of an agonist?

A. Agonists alter the normal processes of distribution and metabolism.

B. Agonists counteract the action of specific neurotransmitters.

C. Agonists block the action of specific neurotransmitters.

D. Agonists bind to receptors and cause a physiologic effect.

ANS: D Rationale: Agonists are drugs that produce effects similar to those produced by naturally occurring hormones, neurotransmitters, and other substances by activating (not blocking or counteracting) a receptor. Classification of a drug as an agonist does not denote a change to metabolism and distribution.

PTS: 1 REF: p. 23, Additional Elements of the Receptor Theory of Drug Action OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 15. What is the expected therapeutic outcome of the simultaneous administration of two medications?

A. The adverse effects of one of the drugs are nullified by the other drug.

B. The combined effects are greater than the effects of either one of the drugs alone.

C. One of the drugs enhances metabolism, while the other drug enhances either distribution or absorption.

D. Both drugs are toxic in isolation but therapeutic when administered together.

ANS: B Rationale: Synergism occurs when two drugs with different sites or mechanisms of action produce greater effects when taken together. This does not mean that potential toxicity or adverse effects are “canceled out.” The two drugs would not individually affect different aspects of pharmacokinetics.

PTS: 1 REF: p. 24, Drug–Drug Interactions OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 16. When considering the half-life of naloxone, what are the implications for this medication therapy?

A. Repeated doses of naloxone will likely be necessary.

B. An increase in the dosage of naloxone will most likely be required.

C. A different antidote will be required as the serum level of naloxone decreases.

D. The antidote is unlikely to have a therapeutic effect on the client’s symptoms.

ANS: A Rationale: When an antidote is used, its half-life relative to the toxin’s half-life must be considered. For example, the half-life of naloxone, a narcotic antagonist, is relatively short compared with the half-life of the longer-acting opioids such as methadone, and repeated doses may be needed to prevent recurrence of the toxic state. None of the remaining options present accurate information regarding the significance of naloxone’s half-life.

PTS: 1 REF: p. 30, Enteral Management of Toxicity OBJ: 11 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A client tells the nurse, “I took my sleeping pill yesterday evening, but it didn’t seem to work for me like it usually does.” The nurse should consider which variable that can affect drug absorption? Select all that apply.

A. GI function B. Blood flow to the site of administration C. The presence of other drugs D. Route of administration E. The presence of receptor agonists ANS: A, B, C, D Rationale: Numerous factors affect the rate and extent of drug absorption, including dosage form, route of administration, blood flow to the site of administration, GI function, the presence of food or other drugs, and other variables. Agonist activity is a relevant variable, but this is not an aspect of absorption.

PTS: 1 REF: p. 19, Absorption OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select

18. A client with a diagnosis of bipolar disorder has begun lithium therapy. What is the primary rationale for the nurse’s instructions regarding the need for regular monitoring of the client’s serum drug levels?

A. It is necessary to regularly test for blood–drug incompatibilities that may develop during treatment.

B. It is necessary to ensure that the client’s drug levels are therapeutic but not toxic.

C. It is needed to determine if additional medications will be needed to potentiate the effects of lithium.

D. It is needed in order to confirm the client’s adherence to the drug regimen.

ANS: B Rationale: Measuring serum drug levels is useful when drugs with a narrow margin of safety are given, because their therapeutic doses are close to their toxic doses. This is the case during lithium therapy. Serum levels are not commonly taken to monitor adherence to treatment. Blood–drug incompatibilities are not a relevant consideration.

PTS: 1 REF: p. 21, Serum Drug Levels OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 19. A client in cardiovascular collapse requires pharmacologic interventions. What route of administration is most likely appropriate?

A. Intravenous B. Oral C. Rectal D. Topical ANS: A Rationale: For rapid drug action and response, the IV route is most effective because the drug is injected directly into the bloodstream. None of the other options deliver the medication directly into the bloodstream; thus, all other routes require additional steps to deliver the medication to the vascular system that is already compromised.

PTS: 1 REF: p. 23, Route of Administration OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. A client with cancer is taking the prescribed dose of morphine sulfate, and a family member informs the nurse that the client is extremely sedated. What finding by the nurse would indicate the causative factor for the increased sedation experienced by the client?

A. The client is taking St. John’s wort for depression.

B. The client has a glass of ginger ale by the bedside.

C. A family member has a naloxone pen by the bedside.

D. The client is taking metoprolol for hypertension.

ANS: A

Rationale: Herbs such as St. John’s wort, which is used as an over-the-counter antidepressant, can enhance the sedation effects of the morphine and so should not be used with the drug.. Ginger ale does not have an effect on the CNS and would not enhance the sedation effect. Naloxone would reverse respiratory depression related to the use of opioid analgesia and would not be a factor in the increased sedation. Metoprolol does not increase the sedative effects of morphine.

PTS: 1 REF: p. 24, Drug–Drug Interactions OBJ: 9 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 21. What is the effect of a significant first-pass effect on the metabolism of a medication?

A. The medication must pass through the client’s bloodstream several times in order to generate a therapeutic effect.

B. The medication must pass through the renal tubules and is excreted in large amounts.

C. The medication’s effectiveness increases with each subsequent dose.

D. The medication is biotransformed extensively in the client’s liver.

ANS: D Rationale: Some drugs are extensively metabolized in the liver, with only part of a drug dose reaching the systemic circulation for distribution to sites of action. This is called the first-pass effect or presystemic metabolism. The first-pass effect is not related to renal function or the need to pass through the bloodstream multiple times.

PTS: 1 REF: p. 19, Absorption OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 22. A nurse has administered a dose of a drug that is known to be highly protein bound.

What are the implications of this characteristic?

A. The client must consume adequate protein in order to achieve a therapeutic effect.

B. The molecules of the drug that are bound to protein are inactive and do not affect body cells.

C. Increased levels of serum protein will increase the effect of the drug.

D. Each molecule of the drug must bind to a protein molecule to become effective.

ANS: B Rationale: Drug molecules bound to plasma proteins are pharmacologically inactive because the large size of the complex prevents their leaving the bloodstream through the small openings in capillary walls and reaching their sites of action, metabolism, and excretion. Only the free or unbound portion of a drug acts on body cells. The client’s protein intake or levels of protein are not normally relevant.

PTS: 1 REF: p. 19, Distribution OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 2: Basic Concepts and Processes KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 3, Medication Administration and the Nursing Process of Drug Therapy 1. An infant’s current weight indicates that the maximum safe dose of acetaminophen is 30 mg by mouth. The health care provider orders 65 mg to be given, and the nurse administers acetaminophen 65 mg. Who is legally responsible in the event that the infant has a toxic reaction to the medication?

A. The nurse B. The pharmacist C. The health care provider D. The pharmacy technician ANS: A Rationale: When giving medications, the nurse is legally responsible for safe and accurate administration. This means that the nurse may be held liable for not giving a drug or for giving a wrong drug or dose. The pharmacist is responsible for filling the medication order, but if an error exists in the order and the medication is still administered by the nurse, the nurse is the most responsible. If the health care provider writes the order but does not administer the medication, then the health care provider is not legally responsible. The pharmacy technician is not legally responsible.

PTS: 1 REF: p. 37, Legal Responsibilities OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Caring BLM: Cognitive Level: Understand NOT: Multiple Choice 2. The health care provider orders potassium chloride 40 mEq to be added to the client’s IV solution. The vial reads 10 mEq/5 mL. How many milliliters will be added to the IV solution?

A. 0.25 mL B. 20 mL C. 200 mL D. 40 mL ANS: B Rationale: 40 mEq/x mL = 10 mEq/5 mL. 10x = 200 x = 20 PTS: 1 REF: p. 46, Calculating Drug Dosages OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. The nurse has received an order for a medication to be administered buccally. Where is the medication administered?

A. Eye

B. Vagina C. Cheek D. Nose ANS: C Rationale: A medication that has been ordered to be administered buccally is given in the client’s cheek. The eye, vagina, and nose are not parts of the buccal route.

PTS: 1 REF: p. 44, Drug Preparations and Dosage Forms OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 4. The nurse is repeatedly unsuccessful in starting an IV on a client who requires antibiotic therapy. The client is prescribed an oral antibiotic. What is the major disadvantage of the oral route over the parenteral route?

A. The associated fever will take longer to be resolved.

B. The client will need close monitoring for adverse effects.

C. The client is at risk of developing a future tolerance to the antibiotic.

D. Resolution of the infection will initially require a larger dose of antibiotic.

ANS: A Rationale: The oral route of administration has a slower rate of action, causing a delay in resolution of the symptoms. Oral antibiotics do not produce greater adverse effects. The risk of tolerance is equal in intravenous and oral antibiotics. The dose is not larger in oral versus intravenous antibiotics.

PTS: 1 REF: p. 48, Routes of Administration OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. A client has a gastrostomy tube, and the pharmacy has delivered an extended-release tablet. What is the most appropriate action taken by the nurse to assure effective administration of the medication?

A. Administer the medication orally.

B. Administer the medication through the tube.

C. Crush the medication and administer half of it at a time.

D. Call the pharmacy to obtain the medication in liquid form.

ANS: D Rationale: The most important nursing action is to call the pharmacy to determine whether a liquid or a non–extended-release tablet can be substituted. Extended-release tablets should never be crushed—the client would be placed at risk for overdose or potentially serious adverse effects or death. If the client has a gastrostomy tube, then he or she cannot swallow and cannot take the pill orally. The medication cannot be administered through the tube because it will obstruct the tube.

PTS: 1 REF: p. 48, Routes of Administration OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. The nurse has measured a client’s capillary blood glucose and is preparing to administer NPH insulin. Which action should the nurse perform to effectively administer the medication?

A. Administer intramuscularly.

B. Rotate the medication vial.

C. Vigorously shake the vial.

D. Administer intradermally.

ANS: B Rationale: When administering NPH insulin, particles of active drug are suspended in a liquid; the medication vial must be rotated. NPH insulin is administered subcutaneously, not intramuscularly or intradermally. The vial should be rotated or shaken but not vigorously shaken.

PTS: 1 REF: p. 45, Table 3.3. Drug Dosage Forms OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A nurse begins a client interaction by systematically gathering information on the client’s care and eventually evaluating the outcomes of care. Which represents this continuum of care?

A. Assessment process B. Outcomes analysis C. Nursing interventions D. Nursing process ANS: D Rationale: The nursing process is a systematic way of gathering and using information to plan and provide individualized client care and to evaluate the outcomes of care. The assessment, outcomes, and nursing interventions are individual components of the nursing process.

PTS: 1 REF: p. 53, Nursing Process in Drug Therapy OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 8. Which assessment should be made by the nurse before administering a new medication?

A. Determining the client’s past medication history B. Evaluating the client’s health beliefs C. Instructing the client on the effect of the medication D. Teaching the client about the desired outcomes of drug therapy ANS: A Rationale: Assessment involves collecting data on client characteristics known to affect drug therapy. This process includes observing and interviewing the client, interviewing family members, completing a physical assessment, reviewing medical records for pertinent laboratory and diagnostic reports, and other methods. Initially (before drug therapy is started or on first contact), the client should be assessed for age, weight, vital signs, health status, pathologic conditions, and ability to function in usual activities. It is not necessarily important to evaluate the client’s health beliefs at this point. Education is considered to be an intervention, not an assessment.

PTS: 1 REF: p. 53, Assessment OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A client who has been diagnosed with type 2 diabetes mellitus is being instructed on medication regimen, diet, and exercise. The client is having difficulty grasping information about care. Which nursing diagnosis is most appropriate for this client?

A. Deficient knowledge: drug therapy regimen B. Noncompliance: overuse C. Risk for injury related to adverse effects D. Acute confusion related to insulin regimen ANS: A Rationale: Deficient knowledge: drug therapy regimen is the most accurate nursing diagnosis for this client. The question does not address noncompliance: overuse. The client is not necessarily at risk for injury based on the stem of the question. Acute confusion does not relate to a lack of understanding or knowledge.

PTS: 1 REF: p. 54, Nursing Diagnosis OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A client, diagnosed with pneumonia, has been prescribed an antibiotic to treat the infection. Which nursing action will assist in increasing lung capacity?

A. Promoting hand hygiene B. Increasing rest C. Frequent repositioning D. Promoting deep breathing ANS: D

Rationale: Assisting the client to cough and deep breathe will increase lung capacity and assist in fighting the infection. Promoting hand hygiene is important but will not increase lung capacity. Increasing rest will assist in recovery but will not increase lung capacity.

Frequent repositioning does not increase lung capacity.

PTS: 1 REF: p. 55, Interventions OBJ: 5 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. The nurse is providing care for a client who has been diagnosed with osteoarthritis.

Which herbal supplement should the nurse educate the client on when discussing the interest in supplementing cartilage repair?

A. Gingko B. Glucosamine C. St. John’s wort D. Saw palmetto ANS: B Rationale: Glucosamine is an herbal supplement that is usually combined with chondroitin to repair cartilage. Gingko is used to improve memory and cognitive function in people with Alzheimer’s disease. St. John’s wort is used to treat depression.

Saw palmetto is used to treat urinary symptoms in men with benign prostatic hyperplasia.

PTS: 1 REF: p. 61, Herbal and Dietary Supplements OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. The nurse has learned that a client has begun supplementing the prescribed medication regimen with a series of herbal remedies. Which is the most important nursing intervention regarding the safe use of herbal supplements?

A. Research for potential interactions with medications.

B. Instruct the client to discontinue them if taking prescription medications.

C. Instruct the client to take the supplements 1 hour before prescription medications.

D. Instruct the client to take the supplements 3 hours after prescription medications.

ANS: A Rationale: Two major concerns are that the use of supplements may keep clients from seeking treatment from a health care provider and that products may interact with prescription drugs. Not all herbal supplements should be discontinued in combination with prescription medications. The herbal supplements should be administered in varying quantities and at varying times based on the medication regime. They are not always administered 1 hour before prescription medications or 3 hours after prescription medications.

PTS: 1 REF: p. 61, Herbal and Dietary Supplements OBJ: 8 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A client is being administered warfarin to decrease blood clotting. Which herbal supplement may contribute alteration in blood clotting mechanisms?

A. St. John’s wort B. Glucosamine C. Chondroitin D. Melatonin ANS: A Rationale: Herbal products may interact with prescription drugs to decrease therapeutic effects or increase adverse effects. Dangerous interactions have been identified with St. John’s wort and some herbs that affect blood clotting. Glucosamine, chondroitin, and melatonin are not known to affect blood clotting.

PTS: 1 REF: p. 61, Herbal and Dietary Supplements OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. Which nursing action when administering medication to children is appropriately directed toward medication safety?

A. If a child is resistant, the nurse should tell the child that the medication is candy.

B. Measurement by teaspoons is as accurate as milliliters.

C. If a drug is not supplied in liquid form, the nurse can always crush the pill.

D. Assess the child’s weight prior to initial drug administration.

ANS: D Rationale: It is imperative to determine a child’s weight in order to ensure safe dosage.

Never describe the medication to the child as candy. Liquid medications should always be measured by milliliters, not teaspoons. Some, but not all, medications may be safely crushed.

PTS: 1 REF: p. 36, General Principles of Accurate Drug Administration OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. Which statement best describes drug efficacy and toxicity in pediatric clients?

A. Drug requirements for infants have been studied extensively.

B. Drug dosage is altered by disease state and weight in children.

C. Children should be administered the same dose of aspirin as adults.

D. Infants and children are at lowest risk for drug toxicity.

ANS: B Rationale: All aspects of pediatric drug therapy must be guided by the child’s age, weight, and level of growth and development. Physiologic differences alter drug pharmacokinetics, and drug therapy in children is less predictable than in adults. Drug requirements have not been studied in children. Children should never be administered aspirin. Infants and children are at greater risk for drug toxicity.

PTS: 1 REF: p. 36, General Principles of Accurate Drug Administration OBJ: 7 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 16. An older client has developed syncope since an antihypertensive agent was added to the client’s medication regime. The development of syncope may be related to which physiologic process?

A. Interaction of other medications B. Ingestion of herbal supplements C. Diminished excretion of the medication D. Increased metabolism of the medication ANS: C Rationale: Adverse effects of medications in an older adult client are likely because of physiologic changes associated with aging, pathologic changes due to disease processes, multiple drugs for acute and chronic disorders, impaired memory and cognition, and difficulty in complying with drug orders. The question does not address the interaction of other medications. The question does not identify any herbal supplements. Based on physiologic alterations, the client will not have increased metabolism of the medication.

PTS: 1 REF: p. 57, Box 3.4 OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 17. The nurse makes an effort to provide high-quality care to clients by obtaining and analyzing the best available scientific research. This activity demonstrates which important component of practice?

A. Evidence-based nursing B. Medical justification C. Nursing data synthesis D. Scientific nursing ANS: A

Rationale: Evidence-based nursing practice requires a conscientious and continuing effort to provide high-quality care to clients by obtaining and analyzing the best available scientific evidence from research. Then, the scientific evidence is integrated with the nurse’s clinical expertise and the client’s preferences and values to yield “best practices” for a client with a particular disease process or health problem.

PTS: 1 REF: p. 61, Integrating Evidence-Based Practice with the Nursing Process OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 18. A nurse is preparing to administer an intramuscular injection of an older adult’s seasonal influenza vaccination. What size needle should the nurse use to administer the injection?

A. 16 gauge B. 20 gauge C. 24 gauge D. 28 gauge ANS: B Rationale: Usually, a 25-gauge, 5/8-inch needle is used for sub-Q injections and a 22- or 20-gauge, 1 1/2-inch needle is used for IM injections.

PTS: 1 REF: p. 51, Equipment for Injections OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 3: Medication Administration and the Nursing Process of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 4, Pharmacology and the Care of Infants and Pediatric Patients 1. When considering physiologic variables that influence safe pharmacotherapy in clients younger than 18, which principle should the nurse integrate into care?

A. The physiology of clients older than 15 can be considered to be the same as an adult client.

B. The younger the client, the greater the variation in medication action compared to an adult.

C. The larger the client’s body mass index, the more his or her physiology varies from that of an adult.

D. Pediatric clients have a greater potential to benefit from pharmacotherapy than adult clients.

ANS: B Rationale: Safe pharmacotherapy depends on a variety of factors, age being only one of them. The younger the client, the greater the variation in medication action when compared to an adult. This does not necessarily equate to a greater potential for benefit, however. BMI is not the main or sole basis of variations between adults and children. An adolescent cannot be assumed to be physiologically equivalent to an adult; decisions should take into account physical size, weight, and development rather than strictly age.

PTS: 1 REF: p. 71, Introduction OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 2. An infant born at full gestation 3 weeks ago is seen in the emergency department (ED) with signs and symptoms of failure to thrive. This pediatric client is classified into what pediatric age group?

A. Child B. Young infant C. Neonate D. Early postnatal ANS: C Rationale: Neonates are considered to be infants from full-term newborn 0 to 4 weeks of age. None of the other terms accurately describes the appropriate pediatric age group of this client. A child is between 1 to 12 years of age. An infant is between 4 weeks to 1 year of age, while postnatal refers to period immediately after birth.

PTS: 1 REF: p. 71, Table 4.1. Pediatric Age Groups OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

3. What is the primary failing that contributes to safety issues related to the practice of pediatric pharmacology?

A. A lack of scientific understanding of the anatomy and physiology of children and infants B. The historical lack of pediatric participation in the drug testing process C. The fact that research grants in pharmacology have traditionally specified adult participation D. Assumptions that there are no physiologic differences between adults and children ANS: B Rationale: Historically, researchers used only adults to test medications, and prescribers simply assumed that smaller doses would elicit the same results in pediatric clients. The knowledge base surrounding anatomical and physiological differences between adults and children is substantial, and grant funding is not typically limited to adult participation.

PTS: 1 REF: p. 71, Legislation and Drug Testing OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 4. A 9-year-old boy with severe influenza symptoms will be treated with ribavirin, an antiviral that is usually taken by adults twice daily in doses of 600 mg PO. After learning that the child’s body surface area (BSA) is 1.10, the nurse will anticipate that the child will likely receive how much ribavirin for each dose?

A. 110 mg B. 380 mg C. 545 mg D. 660 mg ANS: B Rationale: The prescriber calculates a dose based on a known adult dose by using the following equation: pediatric dose = BSA/1.73  adult dose. Thus, 1.1 ÷ 1.73  600 = 381.5 mg. This would likely be rounded to 380 mg.

PTS: 1 REF: p. 71, Calculating Drug Dosages OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. Significant pharmacodynamic variations exist between adult clients and pediatric clients.

Which factor is known to contribute to differences in the ways that drugs affect target cells in children and infants? Select all that apply.

A. Inability of children to accurately describe adverse effects B. Immaturity of children’s organ systems C. Differences in the body composition of children D. The lack of active immunity in children

E. Differences in the function of humoral immunity in children ANS: B, C Rationale: Immature organ systems and changing body compositions mean that drugs affect children differently. Causes of pharmacodynamic variability across the life span include differences in body composition, immature systems, and genetic makeup. Total body water, fat stores, and protein amounts change throughout childhood and greatly influence the effectiveness of drugs in the pediatric population. Children are indeed less able to describe adverse effects, but this is not a pharmacodynamics variation.

Differences in the function of the immune system are not noted to significantly influence pharmacodynamics.

PTS: 1 REF: p. 72, Pharmacodynamic OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Select 6. A 2-year-old child with a recent history of idiopathic nausea and vomiting was prescribed promethazine by the health care provider. The immaturity of this child’s gastrointestinal system will primarily influence what aspect of pharmacokinetics?

A. Absorption B. Distribution C. Metabolism D. Elimination ANS: A Rationale: Gastric emptying and intestinal motility greatly affect the child’s drug absorption. The GI tract is less directly involved in distribution, metabolism, and elimination.

PTS: 1 REF: p. 72, Pharmacokinetic OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 7. A neonate has been prescribed a water-soluble drug for the treatment of an acute infection. The nurse recognizes that the percentage of body water in an infant is significantly higher than that of an adult. What implication does this have for pharmacotherapy of an infant and the nurse providing care?

A. The drug will need to be emulsified before administration.

B. The infant’s fluid intake will be reduced before and after administration.

C. The infant will have a fat-soluble drug substituted.

D. The infant may require an increased dose of the drug.

ANS: D

Rationale: In adults, total body water is approximately 60%, whereas in newborns, it is 80%. This difference means that water-soluble drugs are diluted easily and readily moved into intercellular tissue. As a result, serum drug concentrations are lower, and increased dosages of water-soluble drugs may be necessary to maintain therapeutic drug levels. Substitutes may not be available, and fluid restriction does not compensate for this physiologic difference.

PTS: 1 REF: p. 72, Distribution OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. An infant who recently experienced seizures is being treated in the neonatal intensive care unit with phenytoin. The infant’s low plasma protein levels during the first year of life have what consequence?

A. The infant may have an unpredictable drug response.

B. The infant may have an increased risk of toxicity.

C. The infant may experience impaired elimination of the drug.

D. The infant will have an increased rate of drug metabolism.

ANS: B Rationale: In infants, immature liver function leads to very low plasma protein levels, which limit the amount of protein binding by drugs. Consequently, the serum concentrations of highly protein-bound drugs may be higher, and toxicity may occur.

This is not a result of differences in elimination or increased metabolism.

PTS: 1 REF: p. 72, Distribution OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 9. Which laboratory test should the nurse monitor to assess the status of drug elimination that is expected in neonates?

A. C-reactive protein level B. Creatine kinase C. Serum albumin level D. Glomerular filtration rate ANS: D Rationale: Excretion of most drugs occurs via the kidneys, and elimination in the urine follows. Young children have immature kidneys, a reduced glomerular filtration rate, and slower renal clearance. Neonates are especially prone to increased levels of drugs that are eliminated primarily by the kidneys. CK, albumin, and C-reactive protein levels do not directly relate to this physiologic characteristic.

PTS: 1 REF: p. 73, Elimination OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A 3-year-old child is resisting the nurse’s efforts to administer an oral antibiotic. How can the nurse best ensure that this client receives the necessary medication?

A. Convince the child that the medication is actually a treat, especially reserved for the child.

B. Mix the medication with pleasantly flavored syrup or pureed fruit.

C. Withdraw some of the child’s privileges if the child refuses to take the medication.

D. Distract the child with a toy, and then put it in the mouth quickly.

ANS: B Rationale: To make oral medications more palatable, the nurse may mix them with flavored syrups or fruit purees. It would be inappropriate to use negative reinforcement, and medications should not be characterized as candy or treats. Sneaking the medication into the child’s mouth will not ensure that it will be swallowed.

PTS: 1 REF: p. 74, Toddlers and Preschoolers OBJ: 6 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. Oral acetaminophen has been prescribed for a young child who has a fever. A liquid form has been obtained by the nurse to increase the chance of problem-free administration. Prior to administration, the nurse is going through the rights of medication administration. When confirming the right dose, what term is most appropriate?

A. 160 mg B. One teaspoon C. One third of a tablespoon D. 5 mL ANS: A Rationale: To ensure accuracy and safety, the nurse should administer medications based on individual dosages in milligrams, micrograms, or units, not on variables such as tablets, teaspoons, or milliliters, for which the concentration may vary.

PTS: 1 REF: p. 74, QSEN Alert: Safety for Pediatric Patients OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A nurse is preparing to administer a nebulized bronchodilator to a young child with asthma. The nurse will base the dosage primarily on which nursing intervention?

A. Weighing the child B. Confirming the child’s age C. Measuring the child’s wrist circumference

D. Establishing the child’s developmental stage ANS: A Rationale: Medications are dosed, administered, and their effectiveness evaluated differently in pediatric clients because of physiologic differences across developmental levels. However, dosages of pediatric medications are always based on weight.

PTS: 1 REF: p. 71, Calculating Drug Dosages OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 13. An infant’s antiseizure medication has been prescribed after careful consideration of the unique pharmacokinetics among this population. What characteristic of neonates has the greatest bearing on drug metabolism?

A. The undeveloped state of the blood–brain barrier B. Increased gastric motility in infants C. The infant’s undeveloped renal function D. Immaturity of the infant’s liver ANS: D Rationale: The enzyme cytochrome P-450 (CYP450) in the liver metabolizes most drugs. In neonates, the ability to metabolize drugs is very low because of the immaturity of the liver and the resultant inability to break down drugs. Characteristics of the kidneys, the blood–brain barrier, and GI function do not primarily affect metabolism.

PTS: 1 REF: p. 73, Metabolism OBJ: 5 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 14. A public health nurse is preparing to administer an intramuscular injection of a vaccine to an 8-year-old child. The nurse recognizes that the child is uncharacteristically quiet and appears tense. The nurse should recognize the possibility of what nursing diagnosis?

A. Fear related to IM injection B. Acute confusion related to misunderstanding of the necessity of IM injection C. Risk for injury related to IM injection D. Ineffective coping related to reluctance to receive IM injection ANS: A Rationale: IM injections are frightening for older children, and they need praise and encouragement. Fear is a far more likely cause of this child’s behavior than confusion or ineffective coping. There is risk for injury associated with IM injections, but the nurse can mitigate this risk through proper technique.

PTS: 1 REF: p. 72, Absorption OBJ: 5 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 15. A 4-year-old child is postoperative day 1 following surgery for trauma suffered in a motor vehicle accident. The child is in pain, and the nurse is preparing to administer a dose of hydromorphone syrup as prescribed. To administer this drug, the nurse should use a(n): A. teaspoon.

B. transparent, 2-ounce medication cup.

C. parenteral syringe with the needle removed.

D. oral syringe.

ANS: D Rationale: The nurse should administer oral medications only in oral syringes. Other methods have the potential to be inaccurate.

PTS: 1 REF: p. 74, QSEN Alert: Safety for Pediatric Patients OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. An emergency department nurse is confirming that a child’s prescribed dose of IV analgesia is congruent with the body surface area (BSA). In order to calculate the child’s BSA, the nurse must know which variable? Select all that apply.

A. The child’s height B. The child’s percentage of body water C. The child’s weight D. The usual adult dose of the drug E. The child’s age in months ANS: A, C Rationale: BSA is calculated using the child’s weight and height. Then, the prescriber calculates the dose based on a known adult dose by using the following equation: pediatric dose = BSA/1.73  adult dose. Neither the child’s age, percentage of body water, nor the normal adult dose is normally relevant to the calculation of BSA. PTS: 1 REF: p. 71, Calculating Drug Dosages OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 17. An infant’s parent is reluctant for the nurse to administer a suppository to the baby, stating, “It just seems so terribly invasive.” What principle should guide the nurse’s use of suppositories in infant clients?

A. Suppositories are generally avoided unless absolutely necessary because of the risk of injuring the rectal mucosa.

B. Suppositories can be an effective means of administering medications to infants

since oral administration is often challenging.

C. Suppositories should only be administered after the nurse manually clears the infant’s rectum.

D. Suppositories are poorly absorbed in infants due to their immature gastrointestinal tract.

ANS: B Rationale: Suppositories are an effective way of administering medications to infants.

They do not require manual clearing of the rectum prior to administration. Suppositories are well absorbed by the child’s gastrointestinal tract and are not usually a risk to the rectal mucosa when inserted properly.

PTS: 1 REF: p. 74, Infants OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 4: Pharmacology and the Care of Infants and Pediatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

Chapter 5, Pharmacology and the Care of Adults and Geriatric Patients 1. An older adult client has sought care for a dermatologic health problem that most often requires treatment with an oral corticosteroid. When considering whether to prescribe steroids to this client, the health care provider should prioritize which question?

A. “Should this client receive a medication that was likely tested on younger adults?”

B. “Do the potential benefits of this medication outweigh the potential harm?”

C. “Are there plausible herbal or complementary alternatives to this medication?”

D. “Is there a younger adult who can oversee this client’s medication regimen?”

ANS: B Rationale: The nurse and the prescriber must carefully consider the risk of associated adverse effects of those medications as well as possible benefits these medications might have in changing physiologic processes related to disease. This consideration is a priority over the specifics of the drug’s original testing procedure or the presence of herbal alternatives. Not every older adult requires another person to oversee his or her medications.

PTS: 1 REF: p. 79, Beers Criteria OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A nurse is teaching an older adult client about the risk for potential adverse effects before beginning a course of antibiotics for an upper respiratory infection. What characteristic of older adults predisposes them to adverse drug reaction?

A. Increased excretion time due to increased bowel motility B. Impaired distribution due to polypharmacy C. A decrease in overall body surface area D. A decrease in the number of receptors needed for distribution ANS: D Rationale: Older adults are prone to adverse drug reactions because of a decrease in the number of receptors needed for drug distribution. BSA does not change appreciably with age, and bowel motility slows with age. Polypharmacy is a valid concern, but this phenomenon does not primarily involve distribution.

PTS: 1 REF: p. 87, Medication Adherence and Aging OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice 3. A nurse is conducting a medication reconciliation for a client who is newly admitted to a long-term care facility. When appraising the client’s medication regimen in light of the Beers Criteria, the nurse will look for: A. drugs that are known to cause adverse effects in older adults.

B. drugs for which generic equivalents are available at lower cost.

C. drugs that have been found to be ineffective in older adults.

D. drugs that are known to exacerbate the aging process.

ANS: A Rationale: Dr. Mark Beers developed the Beers Criteria list of potentially inappropriate medications used by the older adult population. The list confirms that toxic medication effects and drug-related problems affect the safety of older adults and names drugs that cause problems in this population. None of the remaining options present accurate information regarding the purpose/function of the Beers Criteria.

PTS: 1 REF: p. 79, Beers Criteria OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A nurse has noted that an older adult client on an acute care for elders (ACE) unit has an exceptionally lengthy medication administration record. The nurse has alerted the pharmacist because one of the client’s long-standing medications appears on the Beers list. What medication is the nurse likely addressing?

A. Low-dose enteric-coated ASA B. Metoprolol C. Digoxin D. Vitamin D ANS: C Rationale: Digoxin appears on the list of Beers Criteria because of the risk of adverse effects in older adults. ASA, metoprolol, and vitamin D do not appear on the list.

PTS: 1 REF: p. 79, Beers Criteria OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. A nurse has learned that an older adult client has been taking meperidine hydrochloride for pain control. The nurse should now include which assessment into the client’s plan of care?

A. Confusion B. Blood dyscrasias C. Gastrointestinal bleeding D. Hepatotoxicity ANS: A Rationale: Meperidine hydrochloride is associated with confusion in older adults. It is not noted to cause blood dyscrasias, GI bleeding, or hepatotoxicity.

PTS: 1 OBJ: 3

REF: p. 79, QSEN Alert: Patient-Centered Care

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. When appraising an older adult’s ability to excrete medications, what laboratory or diagnostic finding should the nurse prioritize?

A. Renal ultrasound B. Complete blood count (CBC) C. Serum bilirubin and albumin levels D. Blood urea nitrogen and creatinine levels ANS: D Rationale: The nurse should assess an older adult’s blood urea nitrogen and creatinine clearance (CrCl) levels to determine the client’s ability to excrete the medications since it is the function of the kidneys. Renal ultrasound identifies structural abnormalities in the kidneys but is less useful in diagnosing function. The client’s CBC and bilirubin and albumin levels do not help the nurse assess the client’s ability to excrete medications.

PTS: 1 REF: p. 86, Excretion OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. An older adult client’s most recent blood work includes the following data: alanine aminotransferase (ALT) 1.99 kat/L (high) and aspartate aminotransferase (AST) 3.1 kat/L (high). What implication do these data have for the client’s pharmacokinetics?

A. Distribution of drugs may be erratic.

B. Absorption of drugs may be incomplete.

C. Excretion of drugs may be delayed.

D. Metabolism of drugs may be impaired.

ANS: D Rationale: AST and ALT levels are used to determine the client’s liver function and ability to metabolize drugs. None of the remaining options accurately describe the implications of the identified blood work.

PTS: 1 REF: p. 86, Metabolism OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 8. An older adult client has developed chronic obstructive pulmonary disease (COPD) and has consequently been prescribed albuterol, a beta2-adrenergic agonist. When administering this medication, the nurse should be aware that: A. the drug carries a higher potential for hepatotoxicity in this client than in a younger client.

B. the drug may be less effective than in a younger client due to decreased

beta-receptor function.

C. the client will need to take a beta-adrenergic blocker concurrently to mitigate the likelihood of adverse effects.

D. the client will need to have serial complete blood counts (CBCs) drawn following the initiation of therapy.

ANS: B Rationale: Beta-adrenergic agonists are less effective in older adults as a result of the decreased function of the beta-receptor system. The potential for hepatotoxicity is not increased, and a beta-blocker is not indicated. Serial blood work is not necessary.

PTS: 1 REF: p. 79, Pharmacodynamics in Older Adults OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. The adult child of an older adult client states that the client has been taking alendronate for several years for the treatment of osteoporosis. The child tells the nurse that the client never reported nausea after taking this medication until recently. How should the nurse respond to the child’s statement?

A. “It could be that your parent’s stomach empties more slowly than it used to, which is a normal result of aging.”

B. “As people get older, the medication travels down their esophagus more slowly than it is used to. This can cause nausea.”

C. “Because the client processes drugs more slowly than when younger, there is more time during which they can cause nausea.”

D. “As people age, they have more of the receptors that trigger nausea. This is a normal change that accompanies the aging process.”

ANS: A Rationale: Gastric emptying is diminished in the older adult, causing medications to be in the stomach for a longer period.. This factor increases the risk of developing nausea and vomiting, thus causing elimination of the medication in emesis and promoting fluid volume deficit. This phenomenon is not attributable to receptor changes, sensitivity, or decreased esophageal motility.

PTS: 1 REF: p. 85, Absorption OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 10. An older adult client’s most recent blood work reveals a serum albumin level of 21 g/L (low). This will most influence what aspect of pharmacokinetics?

A. Absorption B. Distribution C. Metabolism D. Excretion

ANS: B Rationale: Many medications require serum albumin to bind, transport, and distribute the medication to the target organ. In the event that the amount of serum albumin is insufficient, the amount of free drug rises, and the effect of the drug is more intense.

None of the other functions are evaluated by the client’s serum albumin level.

PTS: 1 REF: p. 86, Distribution OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 11. Laboratory testing of an older adult client who is well-known to the clinic nurse indicates that liver function has been gradually decreasing over the last several years.

How will this age-related physiologic change influence drug metabolism?

A. The client will metabolize drugs more quickly but derive less of a therapeutic benefit from them.

B. The liver will sequester drug molecules in the hepatocytes, and they will be released at unpredictable times.

C. Many of the client’s medications will remain in the body for a longer time.

D. The client’s kidneys will be forced to metabolize a disproportionate quantity of medications.

ANS: C Rationale: The hepatic enzymes of the liver are decreased in the older adult, altering the ability to remove metabolic by-products. It is important to understand that because older adults have a reduced metabolism, medications with a long half-life will remain in the body for a greater amount of time. The kidneys do not compensate for this loss of function. Drugs are not normally sequestered in the liver tissue.

PTS: 1 REF: p. 86, Metabolism OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 12. A gerontological nurse is aware that age is a salient variable that must be considered during pharmacotherapy in adults. However, the nurse knows that many other important variables must also be considered, including race. Members of which racial group typically require lower doses of many common medications?

A. Native American/First Nation clients B. White clients C. Clients of Asian descent D. Black clients ANS: C

Rationale: White clients and Black clients are poor metabolizers of medication compared with clients of Asian descent; clients of Asian descent have the ability to metabolize and excrete medications more quickly. This often means that clients of Asian descent require lower doses.

PTS: 1 REF: p. 86, Metabolism OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 13. A nurse is reviewing a new client’s admission blood work, which indicates that the client’s glomerular filtration rate is 51 mL/min/1.73 m2 (low). What implication does this have for the client’s subsequent pharmacotherapy?

A. The client may need lower-than-normal doses of some medications.

B. The client may require a fluid challenge prior to medication administration.

C. The client may need IV administration of a hypotonic solution to aid medication excretion.

D. The client may need to receive medications by topical and subcutaneous routes rather than parenteral.

ANS: A Rationale: With a decreased GFR, it is necessary to reduce the dosage of the medication.

IV fluid administration and alternative routes do not adequately compensate for this change in pharmacokinetics.

PTS: 1 REF: p. 86, Excretion OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. An older adult client has been prescribed a nitrate and a calcium channel blocker for the treatment of unstable angina. When performing health education to promote adherence to the client’s medication regimen, the nurse should emphasize which point?

A. The client will likely need medications until he or she no longer experiences signs of angina.

B. The client should take medications as prescribed even if he or she feels well in the short term.

C. Inconsistent medication use will likely cause the onset of hypertension.

D. The client should gauge the day’s dose based on how he or she feels in the morning.

ANS: B Rationale: Being asymptomatic may contribute to nonadherence to a medication regimen. Many clients begin to feel better with the initiation of therapy and then discontinue medications altogether or miss individual doses. Clients and their families should be educated about adherence to medication regimens and taught to not skip doses, even if they feel well. Inconsistent use of nitrates and calcium channel blockers does not normally lead to hypertension.

PTS: 1 REF: p. 87, Medication Adherence and Aging OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 15. An older adult client has been taking a diuretic and a beta-blocker for the treatment of hypertension for the past several months. During the latest clinic visit, the client reports measuring blood pressure regularly at the local drug store and claims that it is usually in the range of 120/78 mm Hg. As a result, the client has cut down on doses of both drugs.

The client’s actions should indicate the initial need for which intervention?

A. Assess the client’s ability to pay for this long-term medication regimen.

B. Assess the client’s cognitive status for signs of confusion that could interfere with medication adherence.

C. Evaluate the client’s ability to accurately monitor blood pressure.

D. Instruct on the need to adhere to the prescribed medication regimen.

ANS: D Rationale: Being asymptomatic may contribute to nonadherence to a medication regimen. Many clients begin to feel better with the initiation of therapy and then discontinue medications altogether or miss individual doses. Clients and their families should be educated about adherence to medication regimens. While the other options may be appropriate, the initial need is for education on the need for medication adherence.

PTS: 1 REF: p. 87, Medication Adherence and Aging OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A nurse at a long-term care facility is surprised to learn that a new resident’s medication administration record runs four pages in length. The nurse knows that polypharmacy carries risks and will include which interventions into the resident’s plan of care? Select all that apply.

A. Assessment focused on possible drug complications B. Evaluation of swallowing ability C. Assessment of cognition and mood D. Evaluation of medication adherence E. Planning for effective cost containment ANS: A, C Rationale: Polypharmacy and the consequent interactions of medications can lead to greater complications and diminished mental status. While the other interventions may be appropriate, they are not necessarily associated with polypharmacy risks.

PTS:

1

REF: p. 87, Medication Adherence and Aging

OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 17. The nurse prepares to administer the following medications to a 62-year-old client with a recent onset of confusion: carbidopa–levodopa, benztropine, cimetidine, benazepril, and atenolol. The nurse would determine which medications are potentially inappropriate?

Select all that apply.

A. Carbidopa–levodopa B. Benztropine C. Diazepam D. Benazepril E. Atenolol ANS: B, C Rationale: The nurse should examine the latest “American Geriatrics Society Beers Criteria” for potentially inappropriate medication use in the older adult. Benztropine and diazepam are both on the list; the other medications are not. Using the list can help the nurse and other health care team members determine medications that may be causing issues with the older adult and make safe and effective decisions about the care provided.

PTS: 1 REF: p. 79, Beers Criteria OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 18. The nurse prepares to administer an antibiotic, gentamicin IV, to the older adult client.

The nurse would predict the pharmacokinetics that influence drug action to include which concepts? Select all that apply.

A. With aging, there is an increased gastric pH and delayed or lack of absorption of drugs.

B. Toxicity risk is increased with water-soluble drugs because drug concentrations are larger.

C. The aging liver decreases in size and function leading to decreased metabolism of drugs and longer half-life for medications.

D. Decrease in muscle mass and changes in the circulation leads to abnormal drug concentrations and altered absorption.

E. The creatinine level is the most accurate method to determine renal function for the older adult.

ANS: B, C

Rationale: The medication is administered intravenously, so the age-related changes to the gastric pH and changes with absorption that affect oral medications do not apply.

Gentamicin is a water-soluble drug, and toxicity is increased because larger drug concentrations occur since the body composition of water decreases with aging. The liver decreases in its ability to metabolize drugs with aging leading to a longer half-life for gentamicin. When administering a medication intramuscularly (IM), the nurse would be concerned about the decrease in muscle mass and circulation affecting absorption and abnormal drug concentrations. The creatinine level in the older adult may be normal because muscle mass decreases and produces less creatinine. Estimating creatinine clearance by using a formula such as the Cockcroft-Gault method provides the most accurate assessment for renal function.

PTS: 1 REF: p. 86, Excretion OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 19. The home visiting nurse observes an older adult prepare to administer a prescribed 8 units of insulin glargine. The client squints and draws up 10 units into the syringe.

Which intervention should the nurse implement to best assure safe medication administration?

A. Provide a magnifying glass.

B. Assess the client’s near vision.

C. Ask the client to redraw again.

D. Review the markings on the syringe.

ANS: B Rationale: The nurse should intervene because the client cannot safely draw up the insulin into the syringe. The client squinted while trying to draw up insulin, signaling a visual issue. The nurse’s best action should be to assess the client’s near vision.

Providing a magnifying glass first does not determine the visual acuity or what magnification is needed. Asking the client to try again or review the markings on the syringe ignores the vision issue and will only frustrate the client.

PTS: 1 REF: p. 87, Medication Adherence and Aging OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 5: Pharmacology and the Care of Adults and Geriatric Patients KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 6, Pharmacology and the Care of Pregnant or Lactating Women 1. A pregnant woman is experiencing nausea and vomiting in her first trimester of pregnancy. Which herbal agent that has traditionally been used as an antiemetic could the nurse discuss with the client?

A. Ginger B. Garlic C. Ginkgo biloba D. Green tea ANS: A Rationale: Ginger has been used to relieve nausea and vomiting during pregnancy.

Garlic, Ginkgo biloba, and green tea are not recommended to relieve nausea and vomiting in pregnancy.

PTS: 1 REF: p. 98, Use of Herbs During Pregnancy OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A pregnant woman asks why she needs to take a folic acid supplement. What is the nurse’s best explanation for the administration of folic acid?

A. “Folic acid prevents the development of contractions.”

B. “Folic acid prevents neural tube birth defects.”

C. “Folic acid builds strong fetal bones.”

D. “Folic acid will decrease nausea and vomiting.”

ANS: B Rationale: Folic acid prevents neural tube birth defects. Folic acid does not prevent contractions. Folic acid will not build fetal bones. Folic acid will not prevent nausea and vomiting.

PTS: 1 REF: p. 97, Maternal Therapeutics OBJ: 5 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A woman is being administered IV magnesium sulfate for treatment of toxemia. What is the most important outcome related to the administration of magnesium sulfate?

A. Decreased contractions B. Respiratory rate below 16 C. Absence of seizure activity D. Diminished reflexes ANS: C

Rationale: The administration of magnesium sulfate to treat toxemia can prevent seizure activity. Magnesium sulfate is administered for preterm labor to prevent contractions, not for toxemia. A respiratory rate below 16 and diminished reflexes are indicative of excess magnesium sulfate.

PTS: 1 REF: p. 99, Hypertensive Disorders in Pregnancy OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A woman in preterm labor is being treated with magnesium sulfate intravenously. Which of the assessment should be implemented during the administration of magnesium sulfate?

A. Assess uterine bleeding.

B. Assess magnesium level.

C. Assess potassium level.

D. Assess for fever.

ANS: B Rationale: When administering magnesium sulfate, it is important to assess the serum magnesium level. The client in preterm labor should not experience uterine bleeding related to magnesium sulfate administration. The client will not need her serum potassium level monitored. The client will not need to be assessed for fever related to magnesium sulfate administration.

PTS: 1 REF: p. 100, Drugs That Alter Uterine Motility: Tocolytics OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A client is being administered magnesium sulfate for preterm labor. The client’s serum magnesium level is 11 mg/dL. What signs and symptoms will the client present?

A. Tachypnea B. Muscle rigidity C. Tachycardia D. Depressed deep tendon reflexes ANS: D Rationale: Hypermagnesemia will cause depressed deep tendon reflexes. The serum magnesium level of 11 would result in depressed respirations. The serum magnesium level of 11 would result in decreased muscle strength. The serum level of 11 would result in bradycardia, not tachycardia.

PTS: 1 REF: p. 99, Table 6.3. Magnesium Levels with Associated Signs and Symptoms of Toxicity OBJ: 7

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A woman in preterm labor has developed depressed deep tendon reflexes. Which medication will be administered?

A. Potassium chloride B. Epinephrine C. Carboprost D. Calcium gluconate ANS: D Rationale: Calcium gluconate is administered for hypermagnesemia. Potassium chloride, epinephrine, and carboprost will not be administered for hypermagnesemia.

PTS: 1 REF: p. 99, QSEN Alert: Safety OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A woman who is 7 months pregnant is experiencing gastroesophageal reflux. Which medication is most highly recommended?

A. Terbutaline B. Diphenoxylate C. Ranitidine D. Chlorothiazide ANS: C Rationale: A histamine2 receptor antagonist, such as ranitidine, is used for gastroesophageal reflux disease. Terbutaline is a tocolytic agent. Diphenoxylate is not administered for GERD. Chlorothiazide is a diuretic agent.

PTS: 1 REF: p. 98, Gastroesophageal Reflux Disease OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. An infant is born to an HIV/AIDS-positive mother. What treatment is provided for the infant?

A. Zidovudine for 2 weeks after delivery B. Zidovudine for 4 weeks after delivery C. Zidovudine for 6 weeks after delivery D. Zidovudine for 2 months after delivery ANS: C

Rationale: The infant born to an HIV-positive mother should be administered zidovudine for 6 weeks after delivery. The infant born to an HIV-positive mother will not be administered zidovudine for 2 weeks, 4 weeks, or 2 months.

PTS: 1 REF: p. 100, Human Immunodeficiency Virus OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. A client is receiving oxytocin. Which is a maternal-focused adverse effect of the medication?

A. Acute confusion B. Hypertension C. Edema D. Inverted T wave ANS: B Rationale: Hypertension is a maternal adverse effect of oxytocin. This adverse reaction is a result of the medication’s ability to constrict involuntary muscles like those lining blood vessels. Other adverse effects include cardiac dysrhythmias, nausea, vomiting, excessive uterine stimulation, and water intoxication. Confusion, edema, and inverted T wave are not adverse effects of oxytocin since none are a result of involuntary muscle contraction.

PTS: 1 REF: p. 103, Oxytocics OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. An 18-week-gestation pregnant woman has been diagnosed with fetal demise. What medication can be administered to initiate the birthing process?

A. Misoprostol B. Calcium gluconate C. Magnesium sulfate D. Folic acid ANS: A Rationale: Misoprostol is administered to initiate the birthing process in the client with fetal demise prior to 20 weeks’ gestation. Calcium gluconate is administered for hypermagnesemia. Magnesium sulfate is administered for preterm labor and toxemia.

Folic acid is administered to prevent fetal neural tube defects.

PTS: 1 REF: p. 102, Prostaglandins OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

11. A client is being treated at home for preterm labor. Which beta-adrenergic medication is administered orally to decrease uterine contractions?

A. Magnesium sulfate B. Oxytocin C. Nifedipine D. Terbutaline ANS: D Rationale: Terbutaline is a beta-adrenergic agent that inhibits uterine contractions by reducing intracellular calcium levels. Magnesium sulfate is administered intravenously and not administered at home. Oxytocin induces labor. Nifedipine is a calcium channel blocker that decreases uterine contractions.

PTS: 1 REF: p. 101, Terbutaline Sulfate OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A woman is being administered IV magnesium sulfate. What is a desired outcome related to the administration of magnesium sulfate?

A. Increased contractions B. Respiratory rate above 18 C. Decreased blood pressure D. Increased uterine tone ANS: C Rationale: The administration of magnesium sulfate can prevent seizure activity and reduce severe hypertension. Magnesium sulfate is administered for preterm labor to prevent contractions and reduce uterine tone, not to increase respiratory rate.

PTS: 1 REF: p. 99, Hypertensive Disorders in Pregnancy OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. A woman who began labor several hours ago is now prescribed oxytocin. What is the goal of oxytocin therapy?

A. Prevent postpartum bleeding.

B. Decrease fetal hyperactivity.

C. Augment weak or irregular contractions.

D. Diminish periods of uterine relaxation.

ANS: C

Rationale: Use of this manufactured hormone induces labor or augments weak or irregular uterine contractions during labor. It is not used in the labor phase to prevent bleeding. It is not administered to decrease fetal hyperactivity. The administration of oxytocin should allow for adequate periods of relaxation between contractions.

PTS: 1 REF: p. 103, Oxytocics OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 14. When administering magnesium sulfate, the nurse should assess the client for what sign?

A. Dry, pale skin B. Respiratory depression C. Agitation D. Tachycardia ANS: B Rationale: Overdoses of magnesium sulfate may lead to hypotension, muscle paralysis, respiratory depression, and cardiac arrest. The nurse would not anticipate dry, pale skin; agitation; or tachycardia.

PTS: 1 REF: p. 103, QSEN Alert: Safety OBJ: 6 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. A woman in preterm labor has been administered terbutaline sulfate. For what potential adverse effects should the nurse assess?

A. Pruritus (itching) and copious diaphoresis B. Joint pain and numbness in the extremities C. Headache and visual disturbances D. Palpitations and shortness of breath ANS: D Rationale: Terbutaline sulfate is a beta-adrenergic agent that inhibits uterine contractions by reducing intracellular calcium levels. Adverse effects may include hyperkalemia, hyperglycemia, cardiac dysrhythmias, hypotension, and pulmonary edema. Women commonly experience hand tremors, palpitations, and shortness of breath with chest tightness.

PTS: 1 REF: p. 101, Terbutaline Sulfate OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A pregnant woman states that she has been constipated since becoming pregnant. Which medication is most appropriate for preventing constipation related to pregnancy?

A. Psyllium B. Mineral oil C. Saline cathartic D. Stimulant cathartic ANS: A Rationale: A bulk-producing agent, such as psyllium, is most physiologic for the mother and safe for the fetus. Mineral oil is not recommended because it interferes with absorption of fat-soluble vitamins. Saline cathartics are not recommended because of hypernatremia. Stimulant cathartics are not recommended for the pregnant woman.

PTS: 1 REF: p. 97, Constipation OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A woman prescribed the highly active antiretroviral therapy (HAART) for HIV/AIDS has become pregnant. What is the effect the woman’s pregnancy is expected to have on her drug regimen?

A. She must discontinue HAART due to risk of teratogenic effects.

B. Her dosages of HAART must be increased to reduce the risk of in utero transmission.

C. She can continue her HAART unchanged as long as recommended doses are prescribed.

D. Some components of her HAART must be replaced or discontinued.

ANS: C Rationale: Antiretroviral drug therapy for the pregnant woman reduces perinatal transmission by about two thirds. In general, highly active antiretroviral therapy, or HAART, is safe, with recommended dosage the same as for nonpregnant women. None of the remaining options accurately describe the effect pregnancy will have on this medication therapy.

PTS: 1 REF: p. 100, Human Immunodeficiency Virus OBJ: 10 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 18. A woman is at 42 weeks of gestation. Which medication will be administered to promote cervical ripening?

A. Calcium gluconate B. Magnesium sulfate C. Terbutaline D. Dinoprostone ANS: D

Rationale: Dinoprostone is administered to ripen the cervix in a woman who is at 42 weeks of gestation. Calcium gluconate, magnesium sulfate, and terbutaline are not administered to ripen the cervix. Calcium gluconate is prescribed to reverse hypermagnesemia. Magnesium sulfate is prescribed in the management of hypertension related to preeclampsia. Terbutaline is used to inhibit uterine contractions in cases such as premature labor.

PTS: 1 REF: p. 102, Prostaglandins OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. A woman was administered misoprostol in an effort to induce labor, but the health care team is unsatisfied with the results. Consequently, oxytocin will be used. Prior to administering oxytocin, what must occur?

A. Four hours must elapse after the last dose of misoprostol.

B. The woman must have a type and cross-match performed.

C. The woman must receive a bolus of 500-mL normal saline.

D. The woman must have her electrolytes measured.

ANS: A Rationale: If the course of treatment changes and oxytocin is to be given after misoprostol, it is essential to wait 4 hours from the last administration of misoprostol before starting oxytocin. Blood work and IV hydration are not necessary.

PTS: 1 REF: p. 102, Prostaglandins OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. A couple have been trying unsuccessfully for nearly a year to become pregnant and have now sought fertility counseling. The nurse should be aware of what potential etiological factors related to infertility? Select all that apply.

A. Absence of sperm B. Endometriosis C. Vaginitis D. Blocked fallopian tubes E. Fibromyalgia ANS: A, B, D Rationale: In women, the most common causes are ovulation disorders, blocked fallopian tubes, endometriosis, and advanced maternal age, which affects egg quality and quantity. In men, causes include absence of sperm, declining sperm counts, testicular abnormalities, and ejaculatory dysfunction. Vaginitis cannot cause infertility, and fibromyalgia is not noted as a common etiological factor.

PTS: 1 REF: p. 92, Drug Therapy for Infertility OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation

TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 21. A woman has been unable to conceive for many months and will soon begin treatment with clomiphene. What health education should the nurse provide to this client?

A. Avoid drinking alcohol while taking clomiphene.

B. Perform daily OTC pregnancy tests beginning the day after taking clomiphene.

C. Take basal temperature between 5 and 10 days after taking clomiphene.

D. Report any numbness or tingling in the hands or lips to the health care provider.

ANS: C Rationale: Ovulation occurs 5 to 10 days after the course of clomiphene treatment has been completed. Prior to beginning the drug regimen, the nurse instructs the woman about taking her basal temperature 5 to 10 days following administration. An incremental rise in temperature is an indication of ovulation. There is no specific contraindication against alcohol, and neurologic adverse effects are not expected.

PTS: 1 REF: p. 92, Clomiphene Citrate OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 22. A nurse is performing health education with a woman who has just learned that she is pregnant. The nurse has explained the concept of teratogenic drugs and emphasized the need to have her health care provider assess any medications she should consider taking.

The nurse should teach the woman that drug-induced teratogenicity is most likely to occur at what point in her pregnancy?

A. During the second half of her third trimester B. In the 7 to 10 days after conception C. In the first trimester during organogenesis D. During 30 to 34 weeks of gestation ANS: C Rationale: Drug-induced teratogenicity is most likely to occur when drugs are taken during the first 3 months of pregnancy, during organogenesis.

PTS: 1 REF: p. 94, Drug Effects on the Fetus OBJ: 4 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 23. A primiparous woman was vigilant in avoiding medications and herbs during her pregnancy and states that she is similarly committed to protecting her baby’s health now that she is breast-feeding. What principle should guide the woman’s use of medications while breast-feeding?

A. Very few herbs are explicitly contraindicated while breast-feeding.

B. It is generally safe to use herbs rather than medications while breast-feeding.

C. Most women can resume their prepregnancy herbal medication regimen after birth.

D. Not all herbs are safe while a woman is breast-feeding.

ANS: D Rationale: A wide variety of medications and herbs are contraindicated during pregnancy and lactation. To be safe, the breast-feeding mother should consult with her primary health care provider before self-medicating with herbs. None of the remaining options accurately describe the safe use of herbs while breast-feeding.

PTS: 1 REF: p. 104, Drug Use During Lactation OBJ: 9 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 6: Pharmacology and the Care of Pregnant or Lactating Women KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 7, Pharmacology and Women’s Health 1. A young client is being seen in the gynecology clinic of the local health department. The client has decided to begin hormonal contraceptives. What action is specific to hormonal contraceptives and should be taught to this client?

A. The cervical mucus is made resistant to penetration by spermatozoa.

B. The follicle-stimulating hormone release is increased to block fertility.

C. The maturation of the endometrial lining is activated by the contraceptive.

D. The pituitary gland increases the release of luteinizing hormone.

ANS: A Rationale: Hormonal contraceptives inhibit the hypothalamic secretion of gonadotropin-releasing hormone, which inhibits FSH and LH. The drugs produce cervical mucus that resists penetration of spermatozoa into the upper reproductive tract.

Hormonal contraceptives inhibit the release of follicle-stimulating hormone and luteinizing hormone.

PTS: 1 REF: p. 109, Estrogens OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 2. During client teaching, a young client asks the nurse, “If I get pregnant on the ‘pill’ should I continue to take it?” What is the nurse’s best response?

A. “The pill has no effect on pregnancy.”

B. “The pill will cause miscarriage.”

C. “The pill is not harmful to the male fetus.”

D. “The pill can be harmful to the female fetus.”

ANS: D Rationale: If pregnancy does occur, estrogens are contraindicated because their use during pregnancy has been associated with the occurrence of vaginal cancer in female offspring. The pill will affect the pregnancy and should be discontinued. The pill will not cause miscarriage. The pill can cause harmful effects on male offspring if it is continued through pregnancy.

PTS: 1 REF: p. 109, Estrogens OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 3. A woman experiencing amenorrhea should be provided with medication information concerning which drug?

A. Testosterone B. Follicle-stimulating hormone C. Estrogen D. Lactate

ANS: C Rationale: Estrogen is prescribed in women of reproductive age to treat amenorrhea.

Testosterone, FSH, and lactate are not used to treat amenorrhea.

PTS: 1 REF: p. 109, Estrogens OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client is diagnosed with dysmenorrhea. Which oral medication will be prescribed?

A. Estrogen B. Progestins C. Naproxen D. Ibuprofen ANS: B Rationale: Progestins are used to suppress ovarian function in dysmenorrhea, endometriosis, endometrial cancer, and uterine bleeding. Estrogen is not administered alone but in combination with progestins. Nonsteroidal anti-inflammatory agents, such as naproxen and ibuprofen, decrease pain and inflammation but do not affect ovarian function.

PTS: 1 REF: p. 116, Progestins OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. A client of childbearing age is diagnosed with breast cancer. The client is currently taking hormonal contraceptives. What information should the client be given regarding the hormonal contraceptives and the cancer diagnosis?

A. The hormonal contraceptives do not affect the course of the disease.

B. The hormonal contraceptives will stimulate uterine bleeding.

C. The hormonal contraceptives will impair uterine bleeding.

D. The hormonal contraceptives will stimulate tumor growth.

ANS: D Rationale: With known or suspected cancers of the breast or genital tissues, hormonal contraceptives may stimulate tumor growth. The hormonal contraceptives should be discontinued due to adverse reactions and stimulated tumor growth. The hormonal contraceptives will not inhibit tumor growth. The hormonal contraceptives can decrease uterine bleeding, but this action is not related to the breast tumor. The hormonal contraceptives will not stimulate or impair uterine bleeding in relation to the breast mass.

PTS: 1 REF: p. 116, Patient Teaching Guidelines for Estrogens, Progestins, and Estrogen–Progestin Combinations OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health

KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A client is taking hormonal contraceptives to prevent pregnancy. The client visits the gynecology clinic and is noted with a blood pressure of 176/102 mm Hg. The client is started on enalapril mesylate 10 mg. In collaboration with the health care provider, what other client teaching should be provided based on the current medical regimen?

A. Instruct on a no-salt diet.

B. Instruct to discontinue the contraceptives.

C. Instruct on the use of relaxation to decrease stress.

D. Instruct on the rationale for increasing contraceptive dose.

ANS: B Rationale: Because of widespread effects on the body tissues and reported adverse reactions, the client should be instructed to discontinue hormonal contraceptives that contribute to hypertension. The client should restrict salt but not eliminate salt. The implementation of relaxation techniques is important but not crucial to the current medical regimen.

PTS: 1 REF: p. 116, Patient Teaching Guidelines for Estrogens, Progestins, and Estrogen–Progestin Combinations OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client taking hormonal contraceptives will soon turn 35 years of age. The client is moderately obese and has smoked for 15 years. Which action should the nurse encourage the client to take to best minimize risk for complications associated with contraception use?

A. Beginning an exercise regime B. Beginning smoking cessation C. Beginning daily aspirin therapy D. Beginning taking a loop diuretic to aid weight loss ANS: B Rationale: Women older than 35 years of age who smoke cigarettes are at greater risk for thromboembolic disorders. The client should be instructed on smoking cessation. The client should not begin an exercise regimen, daily aspirin therapy, or diuretic therapy unless prescribed by the health care provider..

PTS: 1 REF: p. 113, Adverse Effects OBJ: 5 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client is prescribed hormonal contraceptives. What aspect of this treatment places the client at greatest risk for the development of blood clots?

A. Increased serum triglyceride and cholesterol B. Increased platelet levels C. Increased blood levels of clotting factors D. Increased blood vessel lumen size ANS: C Rationale: The administration of estrogen in hormonal contraceptives increases hepatic production of blood clotting factors. Hormonal contraceptives will not increase serum triglyceride and cholesterol or platelet levels. Hormonal contraceptives will cause injury to blood vessels but not necessarily by increasing lumen size.

PTS: 1 REF: p. 113, Adverse Effects OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A postmenopausal woman is administered estradiol for the purpose of preventing which condition?

A. Endometriosis B. Amenorrhea C. Osteoporosis D. Uterine cancer ANS: C Rationale: Conjugated estrogens are used to prevent osteoporosis in postmenopausal women. Conjugated estrogens are not administered in postmenopausal women to treat endometriosis, amenorrhea, or uterine cancer.

PTS: 1 REF: p. 117, Use OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A client has been prescribed a transdermal estradiol patch. Which instruction should the client be given by the nurse regarding the administration?

A. Avoid prolonged sun exposure at the patch site due to increased plasma concentrations.

B. The application of heat at the patch site will decrease effectiveness and result in pregnancy.

C. The medication, when exposed to sunlight, can increase the risk of breast cancer development.

D. Exposure of the medication to cold will increase effectiveness with application once a month.

ANS: A

Rationale: The total amount of drug absorbed and the resulting plasma drug concentrations from transdermal estrogen can increase during exposure to heat, so clients should be advised to avoid prolonged sun exposure in the area of the patch. The application of heat at the patch site will increase effectiveness. The medication’s exposure to sunlight will not increase the risk of breast cancer. The medication’s exposure to cold will not change its effectiveness.

PTS: 1 REF: p. 117, Pharmacokinetics OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A client is suffering from a seizure disorder. The client is being treated with phenytoin.

What effect will phenytoin and an oral contraceptive produce?

A. Increased seizure activity B. Increased blood pressure C. Alteration in clotting factors D. Increased gastric acid ANS: A Rationale: Estrogen and phenytoin will decrease the effectiveness of phenytoin and increase the client’s risk of a seizure. The administration of phenytoin and estrogen will not increase blood pressure, alter clotting factors, or increase gastric acid.

PTS: 1 REF: p. 115, Drugs That Decrease the Effects of Estrogen OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. An insulin-dependent diabetic client has begun taking an oral contraceptive. What effect will this medication regime have on the client physiologically?

A. Increase blood pressure B. Increase heart rate C. Increase blood glucose D. Metabolic alkalosis ANS: C Rationale: A client who has begun oral contraceptives and is insulin dependent will require more insulin due to increased blood glucose as estrogens and progesterones are metabolized in the liver. The combination of oral contraceptives and insulin will not increase blood pressure or heart rate or cause metabolic alkalosis.

PTS: 1 REF: p. 110, Progesterone OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

13. A client with a complex medical history is considering the use of oral contraceptives.

The nurse should be aware that many antibiotics and antiseizure medications cause what effect when combined with oral contraceptives?

A. Increased risk of pregnancy B. Increased blood pressure C. Increased risk of thromboembolism D. Increased gastric acid ANS: A Rationale: Several medications may reduce the effectiveness of oral contraceptives (i.e., increase the likelihood of pregnancy). These include several antibiotics and antiseizure medications. This combination does not increase blood pressure, risk of thromboembolism, or gastric acid secretion.

PTS: 1 REF: p. 115, Preventing Interactions OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. A 34-year-old woman has presented to the clinic for the first time, and the nurse learns that the client has been taking medroxyprogesterone for the past 13 years. This aspect of the client’s medical history should prompt what assessment?

A. Cardiac stress testing B. Renal ultrasound C. Bone density testing D. Evaluation of triglyceride levels ANS: C Rationale: There is a black box warning regarding the use of medroxyprogesterone that relates to its being associated with the loss of stored calcium from bones, which increases the risk of broken bones and osteoporosis, especially after menopause. There is a greater risk of bone loss with long-term use. Consequently, bone density testing may be warranted. There is no particular indication for this client to undergo stress testing, renal ultrasound, or triglyceride testing.

PTS: 1 REF: p. 119, Adverse Effects OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. A 74-year-old woman states that many of her peers underwent hormone replacement therapy (HRT) in years past. The client asks the nurse why the health care provider has not yet proposed this treatment. What fact should underlie the nurse’s response to the client?

A. The risks of stroke and breast cancer are unacceptably high in women taking HRT. B. HRT was found to cause mood disturbances in many of the women who used it long term.

C. HRT was found to be a significant risk factor for bone fractures and osteoporosis.

D. The risks of chronic obstructive pulmonary disease were found to be significantly higher in women taking HRT. ANS: A Rationale: Studies have demonstrated no evidence for HRT in secondary prevention of heart disease and showed increased rates of CHD, thromboembolic stroke, venous thromboembolism, dementia, and breast cancer, which outweigh the benefits of decreased risk of fracture and colon cancer. Mood disturbances and COPD were not significant factors.

PTS: 1 REF: p. 111, Menopause OBJ: 3 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 16. A 37-year-old woman has a 10 pack-year smoking history and has been using oral contraceptives for the past 2 years. The nurse should plan health education interventions in the knowledge that this client faces a priority increased risk of: A. osteoporosis.

B. dementia.

C. myocardial infarction.

D. deep vein thrombosis.

ANS: C Rationale: For women 35 years of age and older who smoke, there is an increased risk of myocardial infarction and other cardiovascular disorders, even with low-dose oral contraceptives. The increase in this risk supersedes that of osteoporosis, dementia, or DVT. PTS: 1 REF: p. 122, Adverse Effects OBJ: 7 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A 20-year-old college student has presented to the campus medical clinic seeking to begin oral contraceptive therapy. The nurse has recognized the need for adequate health education related to the client’s request. The nurse should emphasize the fact that successful prevention of pregnancy depends primarily on the client’s: A. current health status.

B. vigilant adherence to the drug regimen.

C. knowledge of sexual health.

D. risk factors for adverse effects.

ANS: B

Rationale: It is necessary to assess each client’s need and desire for contraception, as well as the willingness to comply with the prescribed regimen. Compliance is essential for effective contraception. Health status, knowledge, and risk factors are all valid focuses for health education, but these do not primarily determine success of therapy.

PTS: 1 REF: p. 117, Use OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A nurse is teaching a young adult client about oral contraceptives, which the client will soon begin taking. The client’s primary concern is the effectiveness of the medication in preventing pregnancy. The nurse should teach the client that oral contraceptives, when taken consistently, are how effective in preventing pregnancy?

A. Between 96% and 98% B. Approximately 98.5% C. Highly effective but partially dependent on genetic factors D. Nearly 100% ANS: D Rationale: When taken correctly, estrogen–progestin contraceptive preparations are nearly 100% effective in preventing pregnancy. Genetics do not significantly affect treatment.

PTS: 1 REF: p. 117, Use OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 19. An adult client began using oral contraceptives several months ago and has presented for an appointment to discuss recent worrisome changes in health status. Which change in the client’s health may the nurse potentially attribute to the use of oral contraceptives?

A. Fatigue B. Frequent high blood pressure readings C. Frequent headaches without aura D. Nausea and vomiting ANS: B Rationale: It is very important to monitor for adverse drug effects such as high blood pressure, gallbladder disease, and blood-clotting disorders, which may be associated with oral contraceptive use. Headaches, nausea and vomiting, and fatigue are not among the more common adverse effects of oral contraceptives.

PTS: 1 REF: p. 122, Adverse Effects OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

20. A 37-year-old woman has just experienced the end of a long-term relationship and has expressed a desire to begin using oral contraceptives. What aspect of this client’s current health status would contraindicate this treatment?

A. The client has a diagnosis of type 2 diabetes.

B. The client has asthma and uses inhaled corticosteroids and bronchodilators.

C. The client has a family history of breast cancer.

D. The client takes an antiplatelet medication for coronary artery disease.

ANS: D Rationale: Coronary artery disease is a contraindication to the use of oral contraceptives.

Diabetes and asthma do not necessarily contraindicate this treatment. A family history of breast cancer is relevant but would not absolutely contraindicate oral contraceptive use.

PTS: 1 REF: p. 122, Adverse Effects OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 21. Medroxyprogesterone acetate is indicated for the treatment of women with what disorder?

A. Uterine bleeding B. Cervical cancer C. Ovarian cancer D. Fibromyalgia ANS: A Rationale: Health care providers use progestins to suppress ovarian function in dysmenorrhea, endometriosis, endometrial cancer, and uterine bleeding. Progestins are not normally used to treat cervical cancer, ovarian cancer, and fibromyalgia.

PTS: 1 REF: p. 117, Use OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 7: Pharmacology and Women's Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

Chapter 8, Pharmacology and Men’s Health 1. A woman has been prescribed anabolic steroids. What effect related to the administration of anabolic steroids will result?

A. Breast enlargement B. Rapid bone growth C. Decrease in hair D. Amenorrhea ANS: D Rationale: Women who are prescribed anabolic steroids will experience amenorrhea.

They will not experience breast atrophy, diminished bone growth, and decrease in hair.

PTS: 1 REF: p. 131, Androgens and Anabolic Steroids OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A client is taking an anabolic steroid. The client has an undiagnosed prostate tumor.

What effect will the anabolic steroid have on the prostate tumor?

A. Decrease the size B. Increase the size C. Increase vascularization D. Limit metastasis ANS: B Rationale: Clients with an enlarged prostate may have additional enlargement, and clients with prostatic cancer may experience tumor growth. An anabolic steroid will not decrease the tumor size, increase the vascularity of the tumor, or limit metastasis.

PTS: 1 REF: p. 133, Contraindications OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A client has been diagnosed with impotence and is started on a regimen of androgens.

Which statement by the client indicates that the client has understood the teaching?

A. “I should expect to see increasing baldness.”

B. “If my skin appears yellow or my urine turns dark, I will contact my health care provider.”

C. “My blood count will drop, but if I have bruising, I will contact my health care provider.”

D. “I know headaches are common, so I won’t get alarmed if it is severe.”

ANS: B

Rationale: Clients taking anabolic steroids can experience jaundice. It is important for the client to notify the health care provider of this condition. The normal effect of the medication is an increase in hair growth, not baldness. The clotting factor will increase as a result of anabolic steroids. This places the client at increased risk for cerebrovascular accident (CVA). Since severe headache is a potential sign of CVA, the client should be instructed to report it.

PTS: 1 REF: p. 133, Adverse Effects OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A client is taking androgens and warfarin. What effect will these two medications have on the client’s coagulation?

A. Coagulation will be increased.

B. Coagulation will be decreased.

C. Coagulation will not be affected.

D. The RBC will be decreased.

ANS: B Rationale: Concurrent use of androgens and warfarin will increase the concentration of warfarin in the blood; thus, the coagulation will be decreased, placing the client at risk for hemorrhage. The medications will not decrease coagulation or cause it to be unaffected. The red blood cell count will not be decreased unless bleeding results.

PTS: 1 REF: p. 133, Preventing Interactions OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A client is using a transdermal testosterone patch for treatment of hormonal deficiency.

The client is also taking glyburide, a sulfonylurea. Which laboratory value should be monitored closely?

A. Blood glucose B. Red blood cell C. White blood cell D. Creatinine ANS: A Rationale: Sulfonylureas should be administered in low doses when combined with androgens, and the blood glucose should be monitored closely. Red blood cells, white blood cells, and creatinine will not be affected.

PTS: 1 REF: p. 133, Concept Mastery Alert OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

6. An 8-year-old child is being administered testosterone injections for treatment of hypogonadism. What should be measured every 6 months?

A. Electrocardiogram B. Electroencephalogram C. Visual acuity D. Hand and wrist epiphyseal growth plates ANS: D Rationale: Because androgens can cause epiphyseal closure, hands and wrists should undergo radiographic examination every 6 months to detect bone maturation and prevent the loss of adult height. No evidence exists that suggests that the electrocardiogram, electroencephalogram, or visual acuity need to be assessed.

PTS: 1 REF: p. 132, QSEN Alert: Safety OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client has been prescribed testosterone for cryptorchidism. Which statement indicates that the client teaching was effective?

A. “My body hair will increase.”

B. “My sexual desire will decrease.”

C. “My voice may become higher.”

D. “My skin will be clear and soft.”

ANS: A Rationale: The administration of testosterone will cause an increase in body hair. It will not decrease sexual desire, but increase it. The client’s voice will deepen and skin will likely have acne-related reactions.

PTS: 1 REF: p. 132, Use OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A middle-aged client with erectile dysfunction has sought care and is receiving health education from the nurse. The client has expressed a desire to understand the physiology of the sex hormone production and the sexual response. The nurse should describe the fact that testosterone is normally secreted in response to: A. sexual arousal.

B. stimulation by luteinizing hormone.

C. ACTH release by the adrenal cortex.

D. decreased cortisol levels.

ANS: B

Rationale: Certain cells in the testes, called Leydig cells, secrete testosterone in response to stimulation by luteinizing hormone (LH) from the anterior pituitary gland.

Testosterone secretion is not the result of sexual arousal, ACTH, or low cortisol.

PTS: 1 REF: p. 129, Overview of Reproductive Health Problems in Men OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice 9. A 41-year-old male client with a complex medical history has been referred to the endocrinology department. Diagnostic testing and assessment have resulted in a diagnosis of secondary hypogonadism. Which health problem is the most likely etiology of his diagnosis?

A. Diabetes B. Mumps C. An inflammatory process in the testicles D. Testicular trauma ANS: A Rationale: Chronic diseases (e.g., metabolic syndrome, diabetes) can lead to secondary hypogonadism. Common diseases that can cause primary hypogonadism are mumps, testicular inflammation, and trauma.

PTS: 1 REF: p. 130, Androgen Deficiency OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 10. A 52-year-old client has made an appointment with the health care provider and has reluctantly admitted that the primary health concern is erectile dysfunction (ED). The client describes the problem as increasing in severity and consequent distress. Which of the nurse’s assessment questions is the most likely to address a common cause of ED? A. “How would you describe your overall level of health?”

B. “Are you taking any medications for high blood pressure?”

C. “How has this problem been affecting your relationship with your spouse?”

D. “Have you suffered any injuries of any kind in the last several months?”

ANS: B Rationale: Causes of ED may include drugs such as antidepressants, antihypertensive agents, and histamine receptor antagonists. Injuries are a rare cause. Addressing the impact of the problem and the client’s perceptions of health are important, but neither question addresses causation.

PTS: 1 REF: p. 130, Erectile Dysfunction OBJ: 7 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Teaching/Learning

BLM: Cognitive Level: Apply

NOT: Multiple Choice

11. After experiencing several months of worsening nocturia, a client has been assessed for benign prostatic hypertrophy (BPH) and has begun drug treatment. In addition to nocturia, what other sign or symptom is the most likely to accompany BPH? A. Hematuria B. Erectile dysfunction C. Urinary frequency D. Flank pain ANS: C Rationale: Clinical manifestations of BPH include urinary frequency, hesitancy, urgency, dribbling, and decreased force of the urinary stream. Hematuria, ED, and flank pain are not characteristic of this problem.

PTS: 1 REF: p. 131, Benign Prostatic Hypertrophy OBJ: 7 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. An 8-year-old child has been diagnosed with a sex hormone deficiency and has begun a course of treatment with testosterone. What change in the child’s health status would necessitate a stop to the course of treatment?

A. Excessive growth in height B. Signs of puberty C. Recurrent urinary tract infections D. Increased blood pressure ANS: B Rationale: If premature puberty occurs in a child being treated with androgens (e.g., precocious sexual development, enlarged penis), it is necessary to stop the drug.

Changes in blood pressure, increased growth, and urinary tract infections are unlikely causes for the cessation in treatment.

PTS: 1 REF: p. 132, Use in Children OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. The nurse is closely following a client who began treatment with testosterone several months earlier. When assessing the client for potential adverse effects of treatment, the nurse should prioritize which assessment?

A. Skin inspection for growing lesions B. Lung function testing C. Assessment of serum calcium levels D. Assessment of arterial blood gases

ANS: C Rationale: In the client taking testosterone, the nurse should monitor serum calcium levels and observe for signs of hypercalcemia (e.g., kidney stones, polyuria, abdominal pain, nausea, vomiting, and depression). ABGs, respiratory function, and skin integrity are not typically affected by testosterone.

PTS: 1 REF: p. 133, Assessing for Therapeutic and Adverse Effects OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. A 17-year-old boy has been admitted to the emergency department after suffering a knee sprain during a football practice. The nurse notes that the client has exceptional muscle mass, and the client quietly admits that this is mostly attributable to the use of steroids, which the client obtains from a teammate. What should the nurse teach the client about anabolic steroid abuse?

A. The ability of anabolic steroids to build muscle is greatly exaggerated in the media.

B. Anabolic steroids are universally dangerous but are especially harmful to adolescents.

C. The muscle mass resulting from steroid use will atrophy unless doses are continually increased.

D. Anabolic steroids will reduce the client’s ability to perform weight-bearing exercise later in life.

ANS: B Rationale: Although steroids have a reputation for being dangerous to adult athletes, such as body builders and football players, they are considered even more dangerous for teens because teens are still growing. These drugs do not necessarily require increasing doses to be effective. They carry numerous health consequences later in life, but reduced weight bearing is not among the most common consequences.

PTS: 1 REF: p. 134, QSEN Alert: Safety OBJ: 2 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 15. On the advice of his brother, a 53-year-old man has made an appointment to request a prescription for sildenafil. The nurse who works at the clinic is reviewing the client’s medical history and would recognize what health problem as being prohibitive to this treatment?

A. Type 2 diabetes, treated with metformin B. Hypercholesterolemia, treated with simvastatin C. Angina, treated with nitroglycerin D. Hypertension, treated with metoprolol ANS: C

Rationale: Prescribers should not order sildenafil for men who also take organic nitrates, commonly used to treat angina, because the sildenafil–nitrate combination can cause severe hypotension resulting in dizziness, syncope, heart attack, or stroke. Metformin, metoprolol, and simvastatin are not likely to cause adverse effects.

PTS: 1 REF: p. 136, QSEN Alert: Safety OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Nursing Assessment BLM: Cognitive Level: Analyze NOT: Multiple Choice 16. A 70-year-old man has enjoyed good overall health for all his adult life, but he has been experiencing urinary frequency and dribbling that has culminated in a diagnosis of benign prostatic hypertrophy (BPH). As a result, the client has been prescribed finasteride. When teaching the client about the potential adverse effects of the drug, the nurse should ensure that the client knows about the possibility of: A. sexual dysfunction.

B. urethral burning.

C. kidney stones.

D. visual disturbances.

ANS: A Rationale: Adverse effects of finasteride include various sexual dysfunctions, such as impotence, gynecomastia, reduced libido, and ejaculatory disorders. Urethral burning, kidney stones, and visual disturbances are not common adverse effects of finasteride.

PTS: 1 REF: p. 139, Adverse Effects and Contraindications OBJ: 5 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 17. An older adult man has moved to a long-term care facility, and the nurse is performing a medication reconciliation. The resident’s current medication regimen includes alfuzosin.

After considering the most likely indication for this drug, the nurse should include what potential problem in the resident’s interdisciplinary plan of care?

A. Impaired urinary elimination B. Ineffective sexual pattern C. Sexual dysfunction D. Functional urinary incontinence ANS: A Rationale: Alfuzosin is classed as a nonreceptor subtype selective alpha1-adrenergic blocker also used to treat BPH. Impaired urinary elimination is the hallmark of BPH. Incontinence may result from BPH, but it is less commonly the functional subtype.

There is no known relationship between the use of alfuzosin and instances of either sexual dysfunction or functional urinary incontinence.

PTS:

1

REF: p. 141, Adverse Effects

OBJ: 6

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A young client has received a diagnosis of androgen deficiency and has been prescribed testosterone. At clinic follow-up appointments, the nurse should prioritize which assessment?

A. Bladder ultrasound and urine testing for glucose and ketones B. Weight and measurement of blood pressure C. Hearing assessment and abdominal girth measurement D. Deep tendon reflexes and random blood glucose testing ANS: B Rationale: For clients who are being treated with androgens, the nurse should regularly assess the client’s blood pressure and body weight, as these may be affected by androgens. Urine testing and bladder ultrasound are generally unnecessary. It is prudent to monitor blood glucose levels, but assessment of DTRs is not required.

PTS: 1 REF: p. 133, Use in Older Adults OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. The nurse is educating an adult client diagnosed with erectile dysfunction about the prescribed sildenafil. Which statement made by the client establishes the need for further clarification?

A. “If I have an erection lasting longer than 4 hours, I need to seek medical attention because it could cause permanent damage to my penis.”

B. “If I eat a fatty meal, I will need to take two pills instead of one so the drug will take effect faster.”

C. “If I lose vision or hearing after taking the drug, I will seek medical attention and notify my prescriber immediately.”

D. “Sildenafil taken with nitrates can lead to extremely low blood pressure, dizziness, passing out, heart attack, or stroke.”

ANS: B Rationale: The nurse needs to clarify the statement that the client made regarding doubling the dosage after eating a fatty meal. Fatty foods delay the action of the drug.

Taking two tablets could lead to excessive dosing and the adverse effect, priapism. The other statements are correct. If the client develops an erection for longer than 4 hours, medical attention is needed to prevent permanent damage to the penis. A rare event, nonarteritic ischemic optic neuropathy (NAION) is an adverse effect of the drug, which leads to the obstruction of circulation to the optic nerve resulting in irreversible loss of vision in one or both eyes. Permanent loss of hearing with ringing in the ears (tinnitus) may also occur. A client taking sildenafil should not take nitrates, because it can cause a serious drop in blood pressure, dizziness, syncope, heart attack, or stroke.

PTS:

1

REF: p. 137, Administering the Medication

OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 20. The nurse is educating an older adult client with a history of hypertension diagnosed with benign prostatic hypertrophy (BPH) about the prescribed finasteride. Which statement made by the client establishes the need for further clarification?

A. “The drug may take 5 to 7 days to reach its maximum effectiveness in relieving my BPH symptoms.”

B. “The drug may cause me to feel cold, and it may cause my blood pressure (BP) to be low, so I will monitor my BP.” C. “The drug may cause sexual dysfunction such as impotence or decreased sex drive, but it is usually temporary.”

D. “I will not have my pregnant daughter crush the tabs for me, because it can cause harm to a male fetus.”

ANS: A Rationale: The nurse needs to clarify the statement that the client made regarding the drug reaching its maximum effectiveness in 5 to 7 days. The half-life of the drug is 5 to 7 days. It may take the drug 3 to 12 months to reach its maximum effectiveness for relieving symptoms of BPH. The other statements are correct. The drug’s actions can lead to hypotension and hypothermia. The client should monitor blood pressure and report if it becomes low so the prescriber may make adjustments with the antihypertensive the client takes for the history of hypertension. The drug can cause sexual dysfunction, which usually is limited in nature. The FDA issued a black box warning stating that pregnant women should not handle broken or crushed tablets, because it can be absorbed and cause harm to a male fetus..

PTS: 1 REF: p. 138, Pharmacokinetics OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 21. The nurse is educating an older adult client newly diagnosed with benign prostatic hypertrophy (BPH) about the prescribed tamsulosin. Which statement made by the client establishes the need for further clarification?

A. “I will inform my dentist or eye doctor that I take tamsulosin and other drugs I am prescribed.”

B. “I will rise from bed or chair slowly because may cause hypotension or dizziness.”

C. “The drug can be taken on an empty stomach to improve absorption and effectiveness of the drug.”

D. “If I have problems falling or staying asleep, I will notify my prescriber for further help.”

ANS: C

Rationale: The nurse needs to clarify the statement that the client made regarding taking the drug on an empty stomach because this would result in altering absorption, bioavailability, and peak level of the drug. The drug needs to be taken the same time every day and after a meal. The other statements are correct. The client needs to notify other surgeons and specialists caring for the client of all medications the client takes, especially tamsulosin because there could be interactions with other drugs being used during the treatment. Use of tamsulosin can cause problems with sleeping; the client should notify the prescriber about such problems if they persist. The drug can cause orthostatic hypotension, so rising from bed or chair slowly is advised.

PTS: 1 REF: p. 140, Pharmacokinetics OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 8: Pharmacology and Men’s Health KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 9, Drug Therapy for Coagulation Disorders 1. A client who has been treated with warfarin after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors?

A. Vitamin K B. Vitamin E C. Protamine sulfate D. Acetylsalicylic acid (aspirin) ANS: A Rationale: Vitamin K is the antidote for warfarin overdosage. In this case, the client may be at the therapeutic level to control thrombus formation, but, due to the injury, it is important to control bleeding. Vitamin E is not used as an antidote for warfarin overdosage. Protamine sulfate is used as an antidote to heparin or low-molecular-weight heparin. Acetylsalicylic acid (aspirin) is used to decrease coagulation as a preventive measure for myocardial infarction.

PTS: 1 REF: p. 156, QSEN Alert: Safety OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client with a history of clot formation is scheduled for bowel resection due to colorectal cancer. What anticoagulant agent will be administered prophylactically?

A. Acetylsalicylic acid B. Heparin C. Warfarin D. Streptokinase ANS: B Rationale: Prophylactically, low doses of heparin are given to prevent thrombus formation in clients having major abdominal surgery. Acetylsalicylic acid is not used to prevent thrombus in clients having major abdominal surgery. Warfarin takes several days for therapeutic effects to occur; thus, it is not used prophylactically to prevent thrombus in a client with abdominal surgery. Streptokinase promotes thrombolysis and is not used to prevent thrombus.

PTS: 1 REF: p. 149, Drug Therapy OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A client has been administered heparin to prevent thromboembolism development status postmyocardial infarction. The client develops heparin-induced thrombocytopenia.

Which medication will be administered?

A. Argatroban 9

B. Vitamin K C. Calcium gluconate D. Aminocaproic acid ANS: A Rationale: Heparin-induced thrombocytopenia may occur in 1% to 3% of those receiving heparin and is a very serious side effect of heparin. In this client, all heparin administration must be discontinued and anticoagulation managed with a direct thrombin inhibitor such as argatroban. The client is not administered vitamin K, calcium gluconate, or aminocaproic acid.

PTS: 1 REF: p. 153, Adverse Effects OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client is receiving low-molecular-weight heparin to prevent thromboembolic complications. The nursing student asks the instructor the reason why this treatment is given instead of heparin. What is the instructor’s best explanation of the rationale for LMWH over heparin?

A. “LMWH is associated with less thrombocytopenia than standard heparin.”

B. “LMWH is associated with stronger anticoagulant effects than standard heparin.”

C. “LMWH is given to clients who have a history of blood dyscrasia.”

D. “LMWH is more effective than standard heparin for clients with hypertension.”

ANS: A Rationale: Low-molecular-weight heparins are associated with less thrombocytopenia than standard heparin. Low-molecular-weight heparin is not stronger than standard heparin. Low-molecular-weight heparin is administered cautiously in clients with blood dyscrasia and hypertension.

PTS: 1 REF: p. 155, Other Drugs in the Class OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A client who is receiving warfarin has blood in the urinary drainage bag. What medication will likely be prescribed by the health care provider?

A. Aminocaproic acid B. Platelets C. Protamine sulfate D. Vitamin K ANS: D Rationale: Vitamin K is the antidote for warfarin overdose. Aminocaproic acid is used to control excessive bleeding from systemic hyperfibrinolysis. Platelets are a blood product, not a medication. Protamine sulfate is the antidote for heparin therapy.

PTS: 1 REF: p. 155, Action OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A client has developed clots and has bruising. It is determined that there is a depletion of the client’s coagulation factors and widespread bleeding. Which medication will be administered?

A. Aminocaproic acid B. Heparin C. Warfarin D. Protamine sulfate ANS: B Rationale: The development of clots and widespread bleeding is indicative of disseminated intravascular coagulation. The client should be administered heparin to slow the formation of clots. The goal of heparin therapy in DIC is to prevent blood coagulation long enough for clotting factors to replenish and control hemorrhage.

Aminocaproic acid is used to control excessive bleeding from systemic hyperfibrinolysis. Warfarin is administered orally to decrease clot formation. Protamine sulfate would not be administered.

PTS: 1 REF: p. 150, Use OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client is admitted with thrombophlebitis and sent home on enoxaparin therapy. Which statement indicates a good understanding of why enoxaparin is being administered?

A. Enoxaparin inhibits the formation of additional clots.

B. Enoxaparin eliminates certain clotting factors.

C. Enoxaparin decreases the viscosity of blood.

D. Enoxaparin will dissolve the clots.

ANS: A Rationale: Low-molecular-weight heparins prevent the development of additional clots.

They do not eliminate clotting factors. LMWHs do not prevent the blood from clotting.

LMWHs do not dissolve the clot.

PTS: 1 REF: p. 153, Use in Patients Receiving Home Care OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client is being discharged from the hospital with warfarin to be taken at home. Which food should the client be instructed to avoid in the diet?

A. Eggs B. Dairy products C. Apples D. Spinach ANS: D Rationale: Spinach is a green leafy vegetable that is high in vitamin K and will interact to prevent adequate levels of anticoagulant therapy. Eggs, dairy products, and apples are not contraindicated with warfarin.

PTS: 1 REF: p. 154, General Considerations OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A client is discharged from the hospital with a prescription of warfarin. Which statement indicates successful client teaching?

A. “If I miss a dose, I will take two doses.”

B. “I will avoid herbal remedies.”

C. “I will eat spinach or broccoli daily.”

D. “I will discontinue my other medications.”

ANS: B Rationale: Most commonly used herbs and supplements have a profound effect on drugs for anticoagulation. The client should never double up on dosing related to a missed dose. The client should avoid green leafy vegetables because they are high in vitamin K, which decreases the effectiveness of warfarin.. The client should not discontinue medications without first consulting with the primary health care provider.

PTS: 1 REF: p. 156, Preventing Interactions OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 10. A client is being administered heparin IV and has been started on warfarin. The client asks the nurse why both medications have been prescribed. What is the nurse’s most accurate response?

A. “After a certain period of time, you must start warfarin and heparin together.”

B. “You will need both warfarin and heparin for several days.”

C. “Warfarin takes 3 to 5 days to develop anticoagulant effects, and you still need heparin.”

D. “Warfarin cannot be given without heparin due to the amount of clotting you need.”

ANS: C

Rationale: Anticoagulant effects do not occur for 3 to 5 days after warfarin is started because clotting factors already in the blood follow their normal pathway of elimination.

The statement, “After a certain period of time, you must start warfarin and heparin together” does not explain clearly the reason for the two medications concurrently. The statement “You will need both warfarin and heparin for several days” does not explain clearly the reason for the two medications. The statement “Warfarin cannot be given without heparin due to the amount of clotting you need” is not accurate.

PTS: 1 REF: p. 155, Action OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A client is prescribed eptifibatide, which inhibits platelet aggregation by preventing activation of GP IIb/IIIa receptors on the platelet surface and the subsequent binding of fibrinogen and von Willebrand factor to platelets. Which syndrome is treated with eptifibatide?

A. Blocked carotid arteries B. Intermittent claudication C. Hypertension D. Unstable angina ANS: D Rationale: Eptifibatide inhibits platelet aggregation by preventing activation of GP IIb/IIIa receptors on the platelet surface and the subsequent binding of fibrinogen and von Willebrand factor to platelets. Eptifibatide is used for acute coronary syndromes, including unstable angina, myocardial infarction, and non–Q-wave MI. Blocked carotid arteries, intermittent claudication, and hypertension are not treated with eptifibatide.

PTS: 1 REF: p. 165, Glycoprotein IIb/IIIa Receptor Antagonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A client is receiving IV heparin every 6 hours. An activated partial thromboplastin time (aPTT) is drawn 1 hour before the 08:00 am dose. The PTT is 92 seconds. What is the most appropriate action by the nurse?

A. Give the next two doses at the same time.

B. Give the dose and chart the client response.

C. Check the client’s vital signs and give the dose.

D. Hold the dose and the call the aPTT result to the health care provider’s attention.

ANS: D

Rationale: The normal control value is 25 to 35 seconds; therefore, therapeutic values are 45 to 70 seconds, approximately. A result of 92 seconds is a risk for bleeding, and the dose should be held until approval to administer is provided by the health care provider.

The nurse should not give the next two doses at the same time. The nurse should not give the dose and document the client’s response. The nurse should not check the client’s vital signs and give the dose.

PTS: 1 REF: p. 153, Administering the Medication OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A client is taking warfarin to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin monitored?

A. RBC B. aPTT C. PT and INR D. Platelet count ANS: C Rationale: The warfarin dose is regulated according to the INR. The INR is based on the prothrombin time. The red blood cell count is not indicative of warfarin dosage. The aPTT is utilized to determine heparin dose. The platelet count is required to determine warfarin dose.

PTS: 1 REF: p. 156, QSEN Alert: Safety OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. A client taking warfarin after open heart surgery reports pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of the medications and the report of pain, what should the nurse suspect is the cause of the pain?

A. Joint thrombosis B. Torn medial meniscus C. Degenerative joint disease caused by medication D. Bleeding ANS: D Rationale: The main adverse effect of warfarin is bleeding. The sudden onset of pain in the knees alerts the nurse to assess the client for bleeding. Arthritis, torn medical meniscus, and degenerative joint disease could all result in knee pain, but the onset and combination of anticoagulant therapy is not an etiology of these types of injuries and disease.

PTS:

1

REF: p. 156, Adverse Effects

OBJ: 3

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 15. A client who is recovering in hospital from a bilateral mastectomy has developed minor bleeding at one of the incision sites. During the process of clot formation, plasminogen will become part of a clot by which means?

A. By binding with fibrin B. By binding with platelets C. By activating plasmin D. By activating factor VII ANS: A Rationale: When a blood clot is being formed, plasminogen, an inactive protein present in many body tissues and fluids, is bound to fibrin and becomes a component of the clot.

Plasminogen does not bind to platelets, activate plasmin, or active factor VII. PTS: 1 REF: p. 147, Clot Lysis OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 16. A 55-year-old client has been diagnosed with coronary artery disease and begun antiplatelet therapy. The client has asked the nurse why a “blood thinner like warfarin” hasn’t been prescribed. What is the most likely rationale for the clinician’s use of an antiplatelet agent rather than an anticoagulant?

A. Antiplatelet agents do not require the client to undergo frequent blood work; anticoagulants require constant blood work to ensure safety.

B. Antiplatelet agents are more effective against arterial thrombosis; anticoagulants are more effective against venous thrombosis.

C. Antiplatelet agents are most effective in large vessels; anticoagulants are most effective in the small vessels of the peripheral circulation.

D. Antiplatelet agents have fewer adverse effects than anticoagulants.

ANS: B Rationale: Anticoagulants are more effective in preventing venous thrombosis than arterial thrombosis. Antiplatelet drugs are used to prevent arterial thrombosis. CAD has an arterial rather than venous etiology. The rationale for the use of antiplatelet agents in CAD is not likely related to the need for blood work or the presence of adverse effects.

PTS: 1 REF: p. 149, Drug Therapy OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

17. A nurse at a long-term care facility is conducting a medication reconciliation for a client who has just moved into the facility. The client is currently taking clopidogrel. The nurse is most justified suspecting that this client has a history of what condition?

A. Hemorrhagic cerebrovascular accident B. Hemophilia A C. Idiopathic thrombocytopenic purpura (ITP) D. Myocardial infarction ANS: D Rationale: Indications for use of clopidogrel include reduction of myocardial infarction, stroke, and vascular death in clients with atherosclerosis and in those after placement of coronary stents. It is not indicated in the treatment of ITP, CVA, or hemophilia.

PTS: 1 REF: p. 161, Use OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 18. A 79-year-old client has been brought to the emergency department by ambulance with signs and symptoms of ischemic stroke. The care team would consider the immediate (STAT) administration of what drug?

A. Low-molecular-weight heparin B. Vitamin K C. Clopidogrel D. Alteplase ANS: D Rationale: Alteplase is used as first-line therapy for the treatment of acute ischemic stroke in selected people. Vitamin K would exacerbate the client’s symptoms, and LMWH and clopidogrel would be ineffective.

PTS: 1 REF: p. 166, Use OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. A 50-year-old client has undergone a bunionectomy and has been admitted to the postsurgical unit. What aspect of the client’s medical history would contraindicate the use of heparin for deep vein thrombosis (DVT) prophylaxis?

A. Obesity B. Diagnosis of ulcerative colitis C. Myocardial infarction (MI) 18 months ago D. Diagnosis of type 2 diabetes mellitus ANS: B Rationale: GI ulcerations contraindicate the use of heparin since it is a frequent site of heparin-induced bleeding. Obesity, diabetes, and previous MI do not rule out the safe use of heparin.

PTS: 1 REF: p. 153, Contraindications OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 9: Drug Therapy for Coagulation Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

Chapter 10, Drug Therapy for Dyslipidemia 1. An obese client who has an elevated triglyceride level and reduced high-density lipoprotein cholesterol is seen by the primary health care provider. What do these data suggest in this client?

A. The development of arthritic syndrome B. The development of metabolic syndrome C. The development of Reye’s syndrome D. The development of Tay-Sachs disease ANS: B Rationale: Metabolic syndrome is noted when the client has elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose. Elevated triglyceride level and reduced high-density lipoprotein cholesterol are not indicative of arthritic syndrome.

Reye’s syndrome is marked by acute encephalopathy and seen in children under the age of 15 years after an acute viral infection. Tay-Sachs is a genetic disease characterized by neurologic deterioration in the first year of life.

PTS: 1 REF: p. 175, Pathophysiology OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 2. A client has an elevated total serum cholesterol of 260 mg/dL (14.4 mmol/L). Which aspect of client teaching of lifestyle changes is most important for the client?

A. Eat organic foods.

B. Stop smoking.

C. Increase rest periods.

D. Drink whole milk.

ANS: B Rationale: Therapeutic lifestyle changes to lower serum cholesterol, including exercise, smoking cessation, change in diet, and drug therapy, are recommended to lower serum cholesterol. The client with an elevated serum cholesterol should increase exercise and not increase rest periods. The client should consume low-fat dairy products and avoid whole milk. Organic foods are not specifically recommended.

PTS: 1 REF: p. 175, Introduction OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A client has been prescribed atorvastatin calcium. What is the goal of therapy?

A. A decrease of LDL levels B. A decrease of HDL levels C. An increase of triglycerides

D. An increase of VLDL ANS: A Rationale: Atorvastatin and the other statins are indicated for the treatment of hypercholesterolemia and reducing cardiovascular events in people with multiple risk factors. The statins are the most powerful drug class for reduction of LDL cholesterol.

They result in an 18% to 55% decrease in LDL levels, as well as a 5% to 15% increase in HDL levels and a 7% to 30% decrease in triglycerides.

PTS: 1 REF: p. 180, Use OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A client is taking atorvastatin calcium to reduce serum cholesterol. Which aspect of client teaching is most important?

A. Call the health care provider if muscle pain develops.

B. It is acceptable to eat saturated fats.

C. Decrease the dose if lethargy occurs.

D. Eat two eggs per day to increase protein stores.

ANS: A Rationale: Clients should be advised to notify their health care provider if unexplained muscle pain or tenderness occurs. The client should avoid saturated fats when taking statins but should not entirely eliminate fats from the diet. The client should not decrease the dose of statins without the health care provider’s knowledge. The client should not increase the intake of eggs due to the increase in cholesterol.

PTS: 1 REF: p. 181, Adverse Effects OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A client is taking lovastatin. Which are noted as the most common adverse effects?

A. Nausea, flatulence, and constipation B. Increased appetite and blood pressure C. Fatigue and mental disorientation D. Hiccups, nasal congestion, and dizziness ANS: A Rationale: The most common adverse effects of statins are nausea, constipation, diarrhea, abdominal cramps or pain, headache, and skin rash. The client will not experience increased appetite and blood pressure as adverse effects of statins. The client will not experience fatigue and mental disorientation as adverse effects of statins. The client will not experience hiccups, nasal congestion, and dizziness as adverse effects of statins.

PTS:

1

REF: p. 181, Adverse Effects

OBJ: 5

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A client who has been taking a statin has seen an improvement in cholesterol laboratory values; however, the low-density lipoprotein remains elevated. What medication will be added to the medical regime?

A. Digoxin B. Vitamin D C. Cholestyramine D. Calcium carbonate ANS: C Rationale: Cholestyramine is administered to reduce LDL cholesterol in clients who are already taking a statin drug. Digoxin is not given to lower LDL cholesterol. Vitamin D is not given to lower LDL cholesterol. Calcium carbonate is not given to lower LDL cholesterol.

PTS: 1 REF: p. 183, Bile Acid Sequestrants OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client is taking cholestyramine to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which medication?

A. Digoxin B. Ibuprofen C. Aspirin D. Acetaminophen ANS: A Rationale: Bile acid sequestrants may decrease absorption of digoxin. Cholestyramine will not decrease the absorption of ibuprofen, aspirin, or acetaminophen.

PTS: 1 REF: p. 184, Preventing Interactions OBJ: 5 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 8. A client is prescribed fenofibrate. When providing client teaching, which statement accurately describes the action of fenofibrate?

A. It binds to bile acids in the intestinal lumen.

B. It increases oxidation of fatty acids in the liver.

C. It inhibits an enzyme required for hepatic synthesis.

D. It inhibits mobilization of free fatty acids from peripheral tissues.

ANS: B

Rationale: Fibrates increase oxidation of fatty acids in the liver. Bile acid sequestrants bind to bile acids in the intestinal lumen. HMG-CoA reductase inhibitors inhibit an enzyme required for hepatic synthesis. Niacin inhibits mobilization of free fatty acids from peripheral tissues.

PTS: 1 REF: p. 185, Action OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice 9. Which single class drug is known to be most effective in reducing the major types of dyslipidemia?

A. Statins B. Bile acid sequestrants C. Fibrates D. Niacin ANS: A Rationale: For single-drug therapy, a statin is preferred for the treatment of dyslipidemia.

To lower cholesterol and triglycerides, a statin, a cholesterol absorption inhibitor, gemfibrozil, a fibrate, or the vitamin niacin may be used. To lower triglycerides, gemfibrozil, ezetimibe, a cholesterol absorption inhibitor, or niacin may be given.

PTS: 1 REF: p. 178, HMG-CoA Reductase Inhibitors OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 10. A client is taking cholestyramine and ezetimibe. What administration guideline is most important to teach this client?

A. The two medications should be taken together.

B. The ezetimibe inhibits cholesterol in the liver.

C. The cholestyramine is administered 1 hour before ezetimibe.

D. The administration of ezetimibe is 1 hour before cholestyramine.

ANS: D Rationale: Ezetimibe should be taken 1 hour before or 4 to 6 hours after a bile acid sequestrant. The two medications should not be taken together. Ezetimibe acts in the small intestine to inhibit absorption of cholesterol resulting in reduced hepatic cholesterol stores and increased clearance of cholesterol from the blood. Cholestyramine binds bile acids in the intestinal lumen, causing the bile acids to be excreted in feces, preventing recirculation to the liver.

PTS: 1 REF: p. 187, Administering the medication OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A client has been reading about the use of flax seed to lower cholesterol. What should the client be taught about the use of flax seed and cholestyramine?

A. Cholestyramine absorption will be increased with flax seed.

B. Cholestyramine absorption will be decreased with flax seed.

C. Bleeding will be increased with flax seed and cholestyramine.

D. Hypoglycemia will result from flax seed and cholestyramine.

ANS: B Rationale: Absorption of all medications including cholestyramine may be decreased when taken with flax seed, resulting in a less than therapeutic effect. Absorption of cholestyramine is not increased with flax seed. Bleeding is not increased with flax seed and cholestyramine. Hypoglycemia will not result from flax seed and cholestyramine.

PTS: 1 REF: p. 178, Flaxseed OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A client is scheduled to have serum triglyceride level assessed. How long should the client be without food of fluids prior to the serum triglyceride test?

A. 6 hours B. 8 to 10 hours C. 12 hours D. 24 hours ANS: C Rationale: For accurate interpretation of a client’s lipid profile, blood samples for laboratory testing of triglycerides should be drawn after the client has fasted for 12 hours. A fasting state of 12 hours is essential for triglycerides estimation because the effects of recently ingested foods artificially raise the results for several hours after a meal. Twenty-four–hour fasting is not necessary and would be an undue burden on the client.

PTS: 1 REF: p. 176, Clinical Manifestations OBJ: 6 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 13. A client has begun taking cholestyramine. Which are noted as the most common adverse effects?

A. Nausea, flatulence, and constipation B. Increased appetite and blood pressure C. Fatigue and mental disorientation D. Hiccups, nasal congestion, and dizziness

ANS: A Rationale: Cholestyramine is not absorbed systemically, so the main adverse effects are gastrointestinal (GI) ones (abdominal fullness, flatulence, diarrhea, and constipation).

Constipation is especially common, and a bowel program may be necessary to control this problem.

PTS: 1 REF: p. 184, Adverse Effects OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. Which herbal and dietary supplement has shown proven success in lowering LDL and total cholesterol in research studies?

A. Soy B. Flaxseed oil C. Red yeast rice D. Garlic ANS: C Rationale: Red yeast rice is used as a food source and has been researched extensively to lower cholesterol. Flaxseed oil, soy, and garlic do not have extensive scientific research to support the lowering of cholesterol.

PTS: 1 REF: p. 178, Red Yeast Rice OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 15. An older adult client who leads a sedentary lifestyle has recently been diagnosed with dyslipidemia. The client is disappointed to learn about this condition, stating, “First it was the diabetes and then the arthritis, now this.” The nurse has performed health education with the client and has described metabolic syndrome. In addition to the elevated cholesterol levels, what aspect of the client’s health is congruent with a diagnosis of metabolic syndrome?

A. Sedentary lifestyle B. Age over 65 C. Arthritis D. Diabetes mellitus ANS: D Rationale: Diagnostic criteria for metabolic syndrome include a cluster of several cardiovascular risk factors linked with obesity: increased waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose. Age, gender, and joint disorders are not among these criteria.

PTS: 1 REF: p. 175, Pathophysiology OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 10: Drug Therapy for Dyslipidemia

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A client has been diagnosed with moderately increased LDL, and the primary health care provider wishes to start statin therapy. What is a potential disadvantage of statins that the health care provider should consider? Select all that apply.

A. Statins are nephrotoxic.

B. Statins are expensive.

C. Statins are contraindicated in clients with a history of myocardial infarction.

D. Statins require regularly scheduled blood work.

E. Statins have an immunosuppressive effect.

ANS: B, D Rationale: Because liver enzymes may be elevated during atorvastatin use, clients need liver function tests and repeat lipid profile testing on a routine basis. These drugs are also expensive. They are not nephrotoxic and do not suppress the immune system. Previous MI is an indication for their use, not a contraindication.

PTS: 1 REF: p. 180, Use OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 17. A client will begin taking atorvastatin, and the nurse is conducting relevant health education. The nurse should emphasize the need to report any new onset of: A. muscle pain.

B. dry mouth.

C. pruritus (itching) D. increased thirst.

ANS: A Rationale: Myopathy is an important adverse effect of statins. Statins can injure muscle tissue, resulting in muscle ache or weakness; this should be reported promptly. Dry mouth, pruritus, and thirst are not reported adverse effects of statins.

PTS: 1 REF: p. 181, Adverse Effects OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 18. An older adult client is being treated in the hospital for a stroke and is undergoing an extended stay on a rehabilitation unit. The client’s spouse has been participating actively in the client’s care and performs much of the feeding and hygiene needs. This evening, the client’s spouse has brought in a number of healthy snacks to keep at the client’s bedside. Knowing that the client’s medication regimen includes simvastatin, the nurse would remove which item?

A. Purple grapes B. Cranberry cocktail

C. Grapefruit juice D. Trail mix (salted nuts and seeds) ANS: C Rationale: It is important to avoid taking simvastatin with grapefruit juice. Grapefruit juice increases the level of simvastatin in the blood and makes side effects more likely.

None of the other listed foods is contraindicated.

PTS: 1 REF: p. 180, Action OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. A client has been largely unsuccessful in achieving adequate control of dyslipidemia through lifestyle changes and the use of a statin. As a result, the client has been prescribed cholestyramine. What change in this client’s lipid profile will the nurse identify as the most likely goal of therapy?

A. Reduction in triglycerides B. Reduction in total serum cholesterol levels C. Increase in HDL levels D. Reduction in LDL cholesterol levels ANS: D Rationale: Cholestyramine, the prototype bile acid sequestrant, has the ability to reduce LDL cholesterol. It has little or no effect on HDL cholesterol and either no effect or an increased effect on triglyceride levels.

PTS: 1 REF: p. 183, Action OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. An older adult client’s most recent physical assessment and diagnostic workup reveal the presence of dyslipidemia. The client will soon begin treatment with atorvastatin. The nurse should anticipate what prescription from the health care provider?

A. “Atorvastatin 150 mg PO BID” B. “Atorvastatin 10 mg PO OD” C. “Atorvastatin 50 mg PO TID with meals” D. “Atorvastatin 75 mg PO BID” ANS: B Rationale: Atorvastatin is normally administered PO 10 to 80 mg daily in a single dose.

The other options present twice or thrice daily administration and total dosages of 150 mg or 300 mg.

PTS: 1 REF: p. 180, Use OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 21. An old adult client with dyslipidemia has had fenofibrate added to the existing medication regimen. In addition to having the lipid profile drawn on a regular basis, the nurse should educate the client about the need for what ongoing laboratory testing during therapy?

A. Complete blood count (CBC) B. Liver panel C. INR and aPTT D. Reticulocyte count ANS: B Rationale: Because of the risk for hepatotoxicity, clients taking fenofibrate require serial testing of liver enzyme levels. There is no specific need for follow-up with CBCs, coagulation tests, or reticulocyte counts.

PTS: 1 REF: p. 185, Use in Patients With Hepatic Impairment OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 10: Drug Therapy for Dyslipidemia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 11, Drug Therapy for Hematopoietic Disorders 1. A client with chronic renal failure is prescribed filgrastim. What is the effect of filgrastim?

A. Decreases neutropenia related to chemotherapy B. Decreases white blood cells related to infection C. Decreases growth of blood vessels due to ischemia D. Decreases platelet count related to bleeding ANS: A Rationale: Filgrastim is used to stimulate blood cell production by the bone marrow in clients undergoing bone marrow transplantation or experiencing chemotherapy-induced neutropenia.. Filgrastim does not decrease white blood cells in response to infection.

Filgrastim increases growth of blood vessels related to ischemic heart disease. Filgrastim does not decrease platelet count related to bleeding.

PTS: 1 REF: p. 199, Granulocyte Colony-Stimulating Factors OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 2. A client has suffered from a gastrointestinal hemorrhage. Which agent will assist in raising the hemoglobin?

A. Epoetin alfa B. Pentoxifylline C. Estazolam D. Dextromethorphan hydrobromide ANS: A Rationale: Epoetin alfa is used to raise the hemoglobin and reduce the need for blood transfusions in clients with anemia. Pentoxifylline is used for intermittent claudication to maintain the flexibility of red blood cells. Estazolam is a benzodiazepine agent used short term for insomnia. Dextromethorphan hydrobromide is used to relieve cough.

PTS: 1 REF: p. 196, Erythropoiesis-Stimulating Agents OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A client is undergoing a bone marrow transplant. Which medication is most effective in stimulating the production of granulocytes and macrophages?

A. Bacillus Calmette-Guérin (BCG) B. Epoetin alfa C. Aldesleukin D. Sargramostim

ANS: D Rationale: Sargramostim is a formulation of granulocyte colony-stimulating factor (G-CSF) and granulocyte–macrophage colony-stimulating factor (GM-CSF). Bacillus Calmette-Guérin is a vaccine used to treat bladder cancer. Epoetin alfa stimulates bone marrow production of red blood cells. Aldesleukin is a recombinant DNA version of interleukin-2. It activates cellular immunity.

PTS: 1 REF: p. 199, Granulocyte Colony-Stimulating Factors OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 4. A hospital client’s complex medical history includes a recent diagnosis of kidney cancer.

Which medication is used to treat metastatic kidney cancer?

A. Filgrastim B. Aldesleukin C. Interferon alfa-2b D. Darbepoetin alfa ANS: B Rationale: Aldesleukin is used to treat metastatic kidney cancer but is contraindicated in clients with serious pulmonary impairment. Filgrastim is a colony-stimulating factor that is not used for the treatment of kidney cancer. Darbepoetin alfa is a hormone that stimulates the production of red blood cells by the bone marrow. Interferon alfa-2b is normally used to treat leukemia.

PTS: 1 REF: p. 205, Adjuvant Medications Used to Stimulate the Immune System: Interleukins OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. A client diagnosed with renal failure is being treated for anemia with epoetin alfa.

Frequent assessment of which laboratory value should be prioritized before and during treatment?

A. AST B. C-reactive protein C. CBC D. ALT ANS: C Rationale: With the use of hematopoietic and immunostimulant drugs, a CBC with WBC differential and platelet count should be done before and during treatment to monitor response and prevent avoidable adverse reactions. It is not imperative to monitor liver enzymes or renal function.

PTS: 1 REF: p. 196, Erythropoiesis-Stimulating Agents OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A client is receiving epoetin alfa for anemia. Which adjunctive therapy is imperative with epoetin alfa?

A. Potassium supplements B. Sodium restriction C. Iron supplementation D. Renal dialysis ANS: C Rationale: When administering darbepoetin and epoetin, an adequate intake of iron is required for drug effectiveness, and iron supplementation is usually necessary. It is not necessary to provide the client with potassium supplements, restrict sodium, or place the client on renal dialysis.

PTS: 1 REF: p. 196, Erythropoiesis-Stimulating Agents OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client is administered a granulocyte colony-stimulating factor (G-CSF). What is the expected outcome of a G-CSF? A. Red blood cell count of 3000 mm3 B. Decreased number of infections C. Decreased fatigue and increased energy D. White blood cell count of 20,000 mm3 ANS: B Rationale: G-CSFs help to prevent infection by reducing the incidence, severity, and duration of neutropenia associated with several chemotherapy regimens. The administration of a G-CSF will not lower red blood cell count or raise white blood cell count. They assist in the prevention of infection but do not necessarily resolve fatigue.

PTS: 1 REF: p. 196, Erythropoiesis-Stimulating Agents OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client is being treated for renal carcinoma with aldesleukin. Which statement indicates that the client has understood the teaching?

A. “This drug will inhibit tumor growth.”

B. “This drug will prevent the development of an infection.”

C. “This drug will decrease the number of T cells.”

D. “This drug will promote renal failure.”

ANS: A Rationale: The administration of aldesleukin will inhibit tumor growth. The administration of aldesleukin will not prevent infection, decrease T cells, or promote renal failure.

PTS: 1 REF: p. 199, Granulocyte Colony-Stimulating Factors OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A client has been diagnosed with chronic renal failure. Which agent will assist in raising the client’s hemoglobin levels?

A. Epoetin alfa B. Pentoxifylline C. Estazolam D. Dextromethorphan hydrobromide ANS: A Rationale: Uses of epoetin alfa include the prevention and treatment of anemia associated with chronic renal failure, hepatic impairment, or anticancer chemotherapy.

Pentoxifylline is used for intermittent claudication to maintain the flexibility of red blood cells. Estazolam is a benzodiazepine agent used short term for insomnia.

Dextromethorphan hydrobromide is used to relieve cough.

PTS: 1 REF: p. 196, Erythropoiesis-Stimulating Agents OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. An oncology nurse is providing care for an adult client who is currently immunocompromised. The nurse is aware of the physiology involved in hematopoiesis and immune function, including the salient role of cytokines. What is the primary role of cytokines in maintaining homeostasis?

A. Cytokines perform phagocytosis in response to bacterial and protozoal infection.

B. Cytokines perform a regulatory role in the development of diverse blood cells.

C. Cytokines can be considered to be the basic “building blocks” of all blood cells.

D. Cytokines are formed in response to the presence of antibodies.

ANS: B

Rationale: Hematopoietic cytokines are diverse substances produced mainly by bone marrow and white blood cells (WBCs). They regulate many cellular activities by acting as chemical messengers among cells and as growth factors for blood cells. Blood cells are not made up of cytokines, and they do not perform phagocytosis. The presence of antigens, not antibodies, can prompt the expression of certain cytokines.

PTS: 1 REF: p. 194, Hematopoietic Cytokines OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 11. A client’s current medical condition is suggestive of impaired erythropoiesis. Which laboratory study would be most clinically relevant in diagnosing this health problem?

A. White blood cell count with differential B. RBC, hemoglobin, and hematocrit C. INR and aPTT D. D-dimer and C-reactive protein ANS: B Rationale: Parameters used to measure erythropoiesis include RBC count, hemoglobin concentration, hematocrit, and mean corpuscular volume. Tests related to immune function, hemostasis, and inflammation are not used to diagnose erythropoiesis.

PTS: 1 REF: p. 195, Erythropoiesis OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. An adult client has developed renal failure secondary to an overdose of a nephrotoxic drug. Which assessment finding would the nurse recognize as being most suggestive of impaired erythropoiesis?

A. Frequent infections and low neutrophil levels B. Fatigue and increased heart rate C. Agitation and changes in cognition D. Increased blood pressure and peripheral edema ANS: B Rationale: As RBCs decrease, conditions related to inadequate hematopoiesis develop.

Clinical manifestations of inadequate erythropoiesis include anemia. This results in a decrease in the oxygen-carrying capacity of blood and consequently a decreased oxygen availability to the tissues. A compensatory increase in heart rate and cardiac output initially increases cardiac output, offsetting the lower oxygen-carrying capacity of the blood. Agitation, increased blood pressure, and peripheral edema would not be expected.

Frequent infections would be associated with a decrease in WBC. PTS: 1 REF: p. 195, Clinical Manifestations OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. A client with a diagnosis of chronic renal failure will soon begin a regimen of epoetin that will be administered by the client at home. Which statement indicates that the nurse’s initial health education has been successful?

A. “I’ll make sure to take my epoetin pill on a strict schedule and make sure I never miss a dose.”

B. “I’m glad that epoetin can help to protect me from getting an infection.”

C. “I’m excited that there’s a medication that can help my kidneys work better.”

D. “I’m not all that comfortable with giving myself an injection, but I’m sure I’ll be able to learn.”

ANS: D Rationale: The client’s statement indicates an understanding of the appropriate route of administration of this medication. Epoetin is administered parenterally, not orally. It acts by stimulating erythroid progenitor cells to produce RBCs but does not enhance overall renal function. Epoetin does not enhance immune function.

PTS: 1 REF: p. 196, Erythropoiesis-Stimulating Agents OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. Which client would likely be the most appropriate candidate for treatment with filgrastim?

A. A client who has undergone a mastectomy for the treatment of breast cancer B. A client with acquired immune deficiency syndrome (AIDS) who has been diagnosed with Kaposi’s sarcoma C. A client who developed acute renal failure secondary to rhabdomyolysis D. A client whose acute myelogenous leukemia necessitated a bone marrow transplant ANS: D Rationale: Indications for filgrastim include preventing infection in clients with neutropenia induced by cancer chemotherapy or bone marrow transplantation. Surgical clients, clients with AIDS, and clients with renal failure are not typically treated with G-CSFs. PTS: 1 REF: p. 199, Granulocyte Colony-Stimulating Factors OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

15. A 69-year-old client has been diagnosed with malignant melanoma. The care team has collaborated with the client and agreed on a plan of care that includes administration of interferon alfa-2b. After administering interferon alfa-2b, the oncology nurse should anticipate that the client may develop which adverse effect?

A. Profound diaphoresis B. Decreased level of consciousness C. Flulike symptoms D. Cyanosis and pallor ANS: C Rationale: In the majority of clients, flulike symptoms (e.g., fever, chills, fatigue, muscle aches, headache, tachycardia) develop within 2 hours of administration of interferon alfa-2b and last up to 24 hours. Diaphoresis, changes in LOC, and changes in oxygenation are not associated with the use of interferon alfa-2b.

PTS: 1 REF: p. 195, Interferons OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A client has been diagnosed with renal failure. Which nursing diagnosis would provide the most plausible indication for the use of epoetin alfa?

A. Risk for infection related to decreased erythropoiesis B. Activity intolerance related to decreased oxygen-carrying capacity C. Powerlessness-related sequelae of renal failure D. Ineffective breathing pattern related to inadequate erythropoietin synthesis ANS: B Rationale: The impaired erythropoiesis that accompanies renal failure results in fatigue and decreased stamina, symptoms that can be addressed with the administration of epoetin alfa. Decreased erythropoiesis does not constitute a risk for infection, and the client may or may not experience feelings of powerlessness. Inadequate erythropoietin synthesis causes impaired oxygenation, but this does not normally manifest as breathing problems.

PTS: 1 REF: p. 196, Erythropoiesis-Stimulating Agents OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A client who is undergoing chemotherapy for the treatment of non-Hodgkin’s lymphoma will soon begin treatment with epoetin alfa. The nurse should be aware that this drug may be administered by which route? Select all that apply.

A. Subcutaneous B. Intramuscular C. Oral D. Buccal

E. Intravenous ANS: A, E Rationale: Epoetin alfa is administered by either IV or sub-Q routes. None of the other routes allow for the effective absorption of the medication.

PTS: 1 REF: p. 196, Erythropoiesis-Stimulating Agents OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 18. A nurse is providing education to a client about epoetin alfa. Which statement should the nurse include in the teaching?

A. “In 2 weeks, you will return for laboratory tests.”

B. “Take your temperature every morning and record it in your journal.”

C. “Store the medication in the coldest section of the refrigerator.”

D. “Take this medication at bedtime.”

ANS: A Rationale: Epoetin alfa is the recombinant form of human erythropoietin that helps the body to produce more RBCs. The onset of action is between 11 and 14 days. The client should be instructed to return for laboratory tests to confirm that the medication has not increased the hemoglobin level above 12 g/dL and to monitor iron levels. The medication should not be frozen or stored in the coldest part of the refrigerator as this interferes with its stability. Blood pressure may be affected by this medication but not body temperature. The medication is usually administered in the morning.

PTS: 1 REF: p. 196, Erythropoiesis-Stimulating Agents OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 19. A nurse is providing teaching to a client who has been prescribed filgrastim for use in the home setting. Which statement should the nurse include?

A. “If you have pain, you can take acetaminophen.”

B. “Store the medication in your refrigerator.”

C. “This medication is used to increase your red blood cell count.”

D. “It’s important to take this medication just before bedtime.”

ANS: A Rationale: Filgrastim is used to reduce neutropenia associated with chemotherapy by stimulating the production, maturation, and activation of neutrophils within the bone marrow. The medication can cause bone pain; the client should be instructed to take acetaminophen to relieve this pain. The medication is not stored in the refrigerator.

Interferon, not filgrastim, is administered at night to avoid flulike symptoms.

PTS: 1 REF: p. 199, Box 11.1 OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 20. A client is prescribed interferon beta-1a to be administered subcutaneously in the home setting. Which statement should the nurse include in the teaching about the medication?

A. “Be sure to shake the vial before you draw up the medication.”

B. “Store the medication at room temperature.”

C. “Administer the medication at bedtime.”

D. “Take an iron supplement daily to assist with the absorption of the medication.”

ANS: C Rationale: Clients who are prescribed an interferon should be instructed to take the medication at bedtime to reduce potential flulike effects (i.e., fever, headache, fatigue, anorexia, nausea, and vomiting). The client should be told to store the medication in the refrigerator and to avoid shaking the drug vial. An iron supplement is often taken with epoetin alfa, not with interferons, to ensure absorption.

PTS: 1 REF: p. 199, Box 11.1 OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 11: Drug Therapy for Hematopoietic Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 12, Drug Therapy: Immunizations 1. An infant is being administered an immunization. Which statement provides an accurate description of an immunization?

A. It is ideally administered to a pregnant woman prior to the infant’s birth.

B. It is the administration of an antigen for an antibody response.

C. It produces many adverse reactions, particularly autism, in the infant.

D. It protects the infant from exposure to infectious antibodies.

ANS: B Rationale: Immunization involves administration of an antigen to induce antibody formation. This protects the child against the actions of infectious agents; it does not prevent exposure to them. Immunization must be administered to the child following birth. There are limited adverse effects associated with immunization; autism is not among them.

PTS: 1 REF: p. 210, Introduction OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client is scheduled to receive immunization with a live vaccine. The nurse would hold the vaccine and contact the health care provider when noticing what information in the client record?

A. Renal insufficiency B. Hepatic failure C. Steroid therapy D. Age of 65 years ANS: C Rationale: A risk of producing disease exists with live vaccines, especially in people with impaired immune function. Clients who are on steroid therapy should not receive live vaccines due to impaired immune function. No evidence supports withholding immunizations related to renal insufficiency or hepatic failure. Clients over the age of 65 should receive immunizations as needed to protect from infectious disease.

PTS: 1 REF: p. 210, Types of Immunity OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A client is to be administered an immunization. The serum contains aluminum phosphate. What route is the most appropriate to administer this immunization?

A. Intramuscularly B. Subcutaneously C. Intravenously D. Orally

ANS: A Rationale: Products containing aluminum should be given intramuscularly only because they cannot be given intravenously, and greater tissue irritation occurs with subcutaneous injections. Immunizations containing aluminum are not administered orally.

PTS: 1 REF: p. 210, Agents for Active Immunity OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client has received a rubella immunization. The client was unaware that she was pregnant. What risk is associated with the administration of the rubella immunization in this client?

A. Risk of development of the disease in the newborn B. Risk of low birth weight infant C. Risk of preterm labor D. Risk of birth defects ANS: D Rationale: Rubella during the first trimester of pregnancy is associated with a high incidence of birth defects in the newborn. Rubella is not associated with the development of disease. Rubella is not associated with low birth weight or preterm labor.

PTS: 1 REF: p. 218, QSEN Alert: Safety OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. A nursing student is scheduled to receive the hepatitis B series. What type of immunity will this immunization provide?

A. Active immunity B. Passive immunity C. Innate immunity D. Natural immunity ANS: B Rationale: The hepatitis B series produces passive immunity. Passive immunity occurs when antibodies are formed by the immune system of another person or animal and transferred to the host. Active immunity is produced by the person’s own immune system in response to a disease caused by a specific antigen or administration of an antigen from a source outside the body, usually by injection. Innate or natural immunity, which is not produced by the immune system, includes the general protective mechanisms.

PTS: 1 OBJ: 1

REF: p. 210, Agents for Passive Immunity

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 6. It is important for the nurse to stay current with the recommendations for immunizations.

Which source is most accurate regarding immunization guidelines?

A. American Academy of Pediatrics B. National Shot Guide C. American Academy of Infectious Diseases D. Centers for Disease Control and Prevention ANS: D Rationale: The best source of information for current recommendations is the Centers for Disease Control and Prevention.

PTS: 1 REF: p. 221, Keeping Up-to-Date With Immunization Recommendations OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. An infant is seen in the clinic for first immunizations. When providing client teaching to the parent, which is no longer recommended for administration?

A. Rubella and mumps vaccine B. Polio vaccine C. Diphtheria, pertussis, and tetanus vaccine D. Smallpox vaccine ANS: D Rationale: Smallpox has been eradicated and is no longer administered to children. By 4 to 6 years of age, children should have received vaccinations for chickenpox, diphtheria, hepatitis A and B, influenza, measles, mumps, pertussis, polio, pneumococcal diseases, rubella, tetanus, and Haemophilus influenzae and rotavirus infections.

PTS: 1 REF: p. 218, Use in Children OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A nurse is administering a mumps vaccine to a child. Which medication should be available when administering an immunization?

A. Diphenhydramine B. Hydroxyzine C. Physostigmine D. Epinephrine

ANS: D Rationale: The administration of vaccines for immunization possesses the risk of an allergic reaction and anaphylaxis. The nurse should have aqueous epinephrine available in the event of an anaphylactic reaction. The administration of diphenhydramine or hydroxyzine will reduce the allergic reaction but will not be effective in the event of anaphylaxis. Physostigmine is not administered.

PTS: 1 REF: p. 221, Administering Immunizing Agents OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A public health nurse is responsible for the administration of immunizations. After each immunization, the nurse should observe the client for evidence of anaphylaxis for how long?

A. 1 minute B. 5 minutes C. 30 minutes D. 90 minutes ANS: C Rationale: The nurse should observe for allergic reactions, which usually occur within 30 minutes. Time spans of 1 and 5 minutes may be too short for development of signs of anaphylaxis, and it is not necessary to observe for longer than 30 minutes.

PTS: 1 REF: p. 221, Administering Immunizing Agents OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. When instructing the parents of a child who has received immunization in the vastus lateralis, which reaction is most common in the days after the administration?

A. Nausea, vomiting, and diarrhea B. Rash and edema C. Weakness and difficulty walking D. Tenderness and redness at the site ANS: D Rationale: Pain, tenderness, and redness at the injection site are associated with the administration of immunizations. Nausea, vomiting, diarrhea, rash, edema, weakness, or difficulty walking are not generally reactions to immunizations.

PTS: 1 REF: p. 222, Patient Teaching Guidelines for Immunizations OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations

KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A client develops fever and arthralgia 4 days after the administration of tetanus toxoid.

What reaction to the vaccine is this?

A. Infectious process B. Anaphylaxis C. Serum sickness D. Distress syndrome ANS: C Rationale: Serum sickness presents several days after the administration of a vaccine with symptoms of urticaria, fever, arthralgia, and enlarged lymph nodes. The presence of fever and arthralgia after the administration of an immunization is not noted as an infectious process, anaphylaxis, or distress syndrome.

PTS: 1 REF: p. 220, Adverse Effects OBJ: 6 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A 70-year-old client is seen in the family practice clinic. Which vaccine should be administered to prevent herpes zoster?

A. Zoster vaccine B. Haemophilus influenzae type B vaccine C. Human papillomavirus (HPV) D. Pneumococcal polyvalent ANS: A Rationale: Zoster vaccine is administered to adults 60 years and older to prevent herpes zoster (shingles). The Haemophilus influenzae type B is not administered to prevent herpes zoster. HPV and pneumococcal vaccine do not address the risk factors for shingles.

PTS: 1 REF: p. 211, Adults OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 13. When providing client teaching to parents regarding measles, mumps, and rubella vaccine administration, which is most important regarding the schedule for administration?

A. It is administered at 1 to 2 months.

B. It is administered at 3 to 4 months.

C. It is administered at 5 to 6 months.

D. It is administered at 12 to 15 months.

ANS: D

Rationale: Measles, mumps, and rubella immunization is administered initially at 12 to 15 months of age. The vaccine is not administered under the age of 1 year.

PTS: 1 REF: p. 218, Use in Children OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. An older adult client is seen in the emergency department for a laceration sustained on broken glass. The nurse assesses the client for the last tetanus toxoid received. How often should the client be administered a tetanus toxoid?

A. Every year B. Every 10 years C. Every 2 years D. Every 5 years ANS: B Rationale: Clients aged 65 and older should receive a tetanus toxoid every 10 years according to the CDC. Older adult clients do not need to receive tetanus toxoid yearly, every 2 years, or every 5 years.

PTS: 1 REF: p. 219, Use in Older Adults OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 15. When providing a health promotion presentation to a group of seniors, how often should the nurse instruct the senior group to obtain influenza vaccines?

A. One time only B. Every 10 years C. Two times per year D. Yearly ANS: D Rationale: The influenza vaccine is administered yearly so that it can be formulated to react to the current strain of the flu. It is not administered as a single dose, every 10 years, or two times per year since strains vary year to year.

PTS: 1 REF: p. 219, Use in Older Adults OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A client is scheduled to receive an immunization. In which client may the administration of a live vaccine be contraindicated?

A. A client with renal impairment B. A client with hepatic failure

C. A client taking steroid therapy D. A client over the age of 65 ANS: C Rationale: Clients receiving a systemic corticosteroid in high doses (e.g., prednisone 20 mg or equivalent daily) or for longer than 2 weeks should wait at least 3 months before receiving a live virus vaccine. No evidence supports withholding immunizations related to renal insufficiency or hepatic failure. Clients over the age of 65 should receive immunizations as needed to protect from infectious disease.

PTS: 1 REF: p. 210, Agents for Active Immunity OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 17. The college health nurse is providing health education for freshmen. Which piece of information about immunizations is applicable to individuals of this group?

A. The oral polio should be updated.

B. The yearly administration of flu vaccine is recommended.

C. The tetanus toxoid must be within 2 years.

D. The administration of hepatitis A vaccine is mandatory.

ANS: B Rationale: An annual flu vaccine is recommended for all adults. The administration of oral polio will not need to be updated in this population. The administration of tetanus toxoid should be every 10 years. HAV vaccination is not mandatory.

PTS: 1 REF: p. 219, Use in Adolescents, Young Adults, and Middle-Aged Adults OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. The nurse is preparing to administer a vaccine to a newborn. What action would the nurse take prior to administering the vaccine?

A. Warm the vaccine to well above room temperature.

B. Vigorously massage the chosen injection site.

C. Check the infant’s temperature.

D. Divide the dose for administration to three injection sites.

ANS: C Rationale: The nurse should check the infant’s temperature before administering any vaccine. Three injection sites are not normally required, and vigorous massage is not indicated. Warming the vaccine is not normally necessary.

PTS: 1 OBJ: 2

REF: p. 221, Administering Immunizing Agents

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. A 1-year-old child will receive a scheduled MMR vaccination shortly. The nurse should teach the child’s parents that the child may develop what possible adverse effect related to the administration of this medication?

A. Cough and fever B. Pallor and listlessness C. Serum sickness D. Nausea and vomiting ANS: A Rationale: Adverse effects associated with MMR vaccine include fever and cough.

Nausea and vomiting, pallor and listlessness, and serum sickness are not among the noted adverse effects of the MMR vaccine.

PTS: 1 REF: p. 222, Patient Teaching Guidelines for Immunizations OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. A primiparous woman tells the nurse that she and her partner are highly reluctant to have their infant vaccinated, stating, "We’ve read that vaccines can potentially cause a lot of harm, so we’re not sure we want to take that risk." How should the nurse respond to this family’s concerns?

A. "Vaccinations are not without some risks, but these are far exceeded by the potential benefits."

B. "The potential risks of vaccinations have been investigated and determined to be nonexistent."

C. "Unfortunately, state laws mandate that your child receive the full schedule of vaccines."

D. "Vaccines indeed cause several serious adverse effects, but these are usually treated at the site where your child receives the vaccination."

ANS: A Rationale: Mild reactions to vaccinations are common, but serious reactions are rare.

Consequently, the benefits of vaccinations exceed the risks. Parental choice is still respected in most instances.

PTS: 1 REF: p. 222, Patient Teaching Guidelines for Immunizations OBJ: 5 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

21. A health care worker has received an annual influenza vaccination and has remained at the clinic after administration so that the nurse may observe for adverse reactions. The worker reports pain at the site of IM injection. What should the nurse recommend?

A. Aspirin B. Acetaminophen C. Meperidine D. Heat application ANS: B Rationale: Most vaccines can cause fever and soreness at the site of injection.

Acetaminophen can be taken two to three times daily for 24 to 48 hours if needed to decrease fever and discomfort. Aspirin and heat are not explicitly recommended; opioids are not necessary.

PTS: 1 REF: p. 222, Patient Teaching Guidelines for Immunizations OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 22. When teaching new parents about the benefits of adhering to the recommended vaccination schedule for their infant, the nurse should cite protection against which diseases? Select all that apply.

A. Shingles B. Measles C. Varicella D. Poliomyelitis E. Hepatitis B ANS: B, C, D, E Rationale: Measles, varicella, polio, and HBV are all within the schedule of infant vaccinations. The zoster vaccination to prevent herpes zoster (shingles) is recommended for adults 60 years and older.

PTS: 1 REF: p. 218, Use in Children OBJ: 5 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 12: Drug Therapy: Immunizations KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select

Chapter 13, Drug Therapy to Decrease Immunity 1. Which is the most likely indication for the use of immunosuppressant agents?

A. Intractable seizure disorders B. Increased intracranial pressure C. Organ transplantation D. HIV/AIDS with multiple drug resistance ANS: C Rationale: Immunosuppressant agents are used for inflammatory autoimmune disorders or to prevent or treat tissue rejection reactions. Immunosuppressant agents are not administered for seizure disorders, increased intracranial pressure, or HIV/AIDS. PTS: 1 REF: p. 228, Drug Therapy OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client has received a bone marrow transplant. What will occur if the client receives inadequate immunosuppression after the transplant?

A. Graft versus host disease B. Hepatotoxicity C. Acute kidney injury D. Sepsis ANS: A Rationale: The goal after bone marrow transplantation is to provide adequate immunosuppression. If immunosuppression is inadequate, graft versus host disease will occur with bone marrow transplantation. The client will not suffer from hepatic failure.

The client will not suffer from renal failure. Inadequate immunosuppression will not place the client at risk for serious infection.

PTS: 1 REF: p. 228, Bone Marrow/Stem Cell Transplantation and Graft-Versus-Host Disease OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 3. A client with Crohn’s disease is given a corticosteroid to decrease inflammation. Which effect will occur with the use of corticosteroids?

A. Increased pain B. Increased C-reactive protein levels C. Increased T-cell counts D. Decreased antibody production ANS: D

Rationale: The administration of corticosteroids will decrease T-cell and antibody production. Corticosteroids do not cause joint pain or increase a client’s C-reactive protein levels.

PTS: 1 REF: p. 238, Corticosteroids OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 4. A client is to receive a tumor necrosis factor inhibitor (TNF inhibitor). What should the client be tested for prior to beginning therapy?

A. Allergy to ragweed B. Antigen sensitivity C. Tuberculosis D. Pneumonia ANS: C Rationale: To decrease the adverse effects of the TNF inhibitors, the client should be tested for tuberculosis. The client’s allergy to ragweed is not significant. The effect of antigen sensitivity is not noted. The client is not tested for pneumonia.

PTS: 1 REF: p. 243, Tumor Necrosis Factor-Alpha–Blocking Agents OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A client is administered mycophenolate to prevent rejection of the transplanted heart. It is recommended that the client have a CBC drawn weekly. The client asks the nurse the reason for the weekly CBC. What is the nurse’s best response?

A. “The weekly CBC is routine and prescribed for all clients.”

B. “The weekly CBC assesses for the development of bleeding.”

C. “The weekly CBC assesses for the development of infection.”

D. “The weekly CBC assesses for changes in your blood’s oxygen-carrying capacity.”

ANS: C Rationale: The weekly CBC is to assess for infection, neutropenia, and thrombocytopenia. Stating to the client that the CBC is routine does not provide client education. The weekly CBC is not indicated to assess for bleeding or a decrease in erythrocytes.

PTS: 1 REF: p. 232, Assessing for Adverse Effects OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

6. A client is administered cyclosporine to prevent rejection of a kidney transplant. Which is a major adverse effect of cyclosporine?

A. Congestive heart failure B. Nephrotoxicity C. Anaphylaxis D. Respiratory arrest ANS: B Rationale: The major adverse effect of cyclosporine is nephrotoxicity. Congestive heart failure is not noted as an adverse effect of cyclosporine. Anaphylaxis and respiratory arrest are not adverse effects of cyclosporine.

PTS: 1 REF: p. 234, Conventional Antirejection Agents OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client is receiving immunosuppressant therapy. Which adverse effects should the client be educated about regarding these effects?

A. The importance of a high-protein diet B. The need to maximize fluid intake C. The need for regular physical activity D. The importance of keeping the home clean ANS: D Rationale: Meticulous environmental cleansing and personal and hand hygiene will protect from the development of serious infection. The importance of this infection control measure is greater than that of dietary or exercise guidelines.

PTS: 1 REF: p. 231, Use in Patients Receiving Home Care OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client has been discharged from the hospital after a kidney transplant. Which nursing intervention is the first line of defense against the immunosuppressant client developing an infection?

A. Ensure visitors do not come to the home.

B. Teach the client to wear a mask consistently.

C. Administer prophylactic antibiotics.

D. Teach the client the importance of personal hygiene.

ANS: D

Rationale: With clients who are taking immunosuppressant drugs, a major role of the home care nurse is to assess the environment for potential sources of infection, assist clients and other members of the household to understand the client’s susceptibility to infection, and teach ways to decrease risks of infection. Meticulous environmental cleansing as well as personal and hand hygiene are required. Visitors do not necessarily need to be wholly barred from the home, and a mask is not always required. Prophylactic antibiotics are not normally used.

PTS: 1 REF: p. 235, Use in Patients Receiving Home Care OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 9. A client is placed on tacrolimus and has an increased blood urea nitrogen level. Based on this finding, which route of administration is preferred?

A. Oral B. Intramuscular C. Intravenous D. Subcutaneous ANS: A Rationale: The recommended route of administration for tacrolimus is oral if the client has decreased renal function. The administration of tacrolimus is not recommended intramuscularly. The route of administration can be intravenous but is not recommended in clients with decreased renal function. Tacrolimus is not administered subcutaneously.

PTS: 1 REF: p. 232, QSEN Alert: Safety OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. Sirolimus and cyclosporine are being used to prevent renal transplant rejection in an adult client. What principle should guide the nurse’s administration of these two drugs?

A. Sirolimus should be given orally; cyclosporine should be administered IV. B. The two drugs should be administered together to potentiate their effects.

C. The two drugs should be given at least 4 hours apart.

D. The drugs should be administered in a single intramuscular injection.

ANS: C Rationale: Sirolimus may have synergistic effects with cyclosporine because it has a different mechanism of action, and prescribers may order both drugs. However, because the two drugs are metabolized by the same liver CYP3A4 enzymes, cyclosporine can increase blood levels of sirolimus, potentially to toxic levels. Consequently, it is essential that the drugs not be given at the same time; clients should take sirolimus 4 hours after a dose of cyclosporine.

PTS:

1

REF: p. 236, QSEN Alert: Safety

OBJ: 2

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A client is to be administered antithymocyte globulin (ATG) to treat renal transplant rejection. What skin test should be assessed prior to the administration of the first dose of medication?

A. Allergy to horse serum B. Allergy to ragweed C. Antigen sensitivity D. Tuberculosis ANS: A Rationale: Antithymocyte globulin is obtained from horse serum, and prior to administration, the client should be tested for allergy to horse serum. The client will not need to be assessed for allergy to ragweed. The client will not be assessed for an allergy to dust mites. The client will not be assessed for tuberculosis.

PTS: 1 REF: p. 238, Antibody Preparations OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. An middle-aged adult male is being administered immunosuppressant agents on a long-term basis. Which assessments should be made routinely with the use of long-term immunosuppressant therapy?

A. Yearly bronchoscopy B. Yearly skin assessment C. Yearly bladder biopsy D. Yearly prostate examination ANS: B Rationale: The most common malignancies among transplant recipients are skin cancers and lymphomas. The client should be assessed annually for skin cancer. The client will not require a yearly bronchoscopy. The client will not require a yearly bladder biopsy.

Although it may be recommended that some male clients (i.e., those at high risk) be screened annually for prostate cancer, this screening is not required because of immunosuppressant therapy.

PTS: 1 REF: p. 231, Adverse Effects OBJ: 6 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A client is administered methotrexate for the treatment of rheumatoid arthritis. Which vaccine should the client be taught to receive to decrease the adverse effects of tumor necrosis factor (TNF) inhibitors?

A. Tetanus B. Measles C. Varicella D. Pneumococcal ANS: D Rationale: Clients receiving methotrexate should be taught that they should receive a pneumococcal and meningococcal vaccine. Tetanus, measles, and varicella are not required vaccines with the administration of methotrexate.

PTS: 1 REF: p. 243, Tumor Necrosis Factor-Alpha–Blocking Agents OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. A client is to begin treatment for rheumatoid arthritis with infliximab. What potential risk should the nurse identify as being associated with this drug?

A. Risk for infection B. Risk for decreased level of consciousness C. Risk for nephrotoxicity D. Risk for hepatotoxicity ANS: A Rationale: All TNF-alpha blockers carry a risk for infection. This risk supersedes the risks of kidney or liver damage. Changes in LOC are not typically noted.

PTS: 1 REF: p. 243, Tumor Necrosis Factor-Alpha–Blocking Agents OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. A client has been placed on tacrolimus, and the route will be changed from IV to oral prior to discharge home from the hospital. How will this change in administration route affect the client’s plan of care?

A. The client’s dose of tacrolimus will have to be increased.

B. The client will receive the drug QID rather than BID. C. The client will have to be monitored more closely for adverse effects.

D. The client will have to take tacrolimus concurrently with an antiemetic.

ANS: A Rationale: Tacrolimus, like cyclosporine, is not well-absorbed orally, so it is necessary to give higher oral doses than IV doses to obtain similar blood levels. Increased frequency is not necessarily required. Concurrent dosing with an antiemetic is not required. Regardless of the route by which the drug is provided, the client needs to be closely monitored for adverse effects.

PTS: 1 REF: p. 232, QSEN Alert: Safety OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A client is ordered to receive cyclosporine intravenously, and the nurse has explained the need for frequent blood work. This blood work is required because of what characteristic of cyclosporine?

A. It decreases erythropoiesis.

B. It has a narrow therapeutic range.

C. It has been linked to spontaneous hemolysis.

D. It can precipitate a thyroid storm.

ANS: B Rationale: Cyclosporine has a very narrow therapeutic index; therefore, prescribers use serum drug levels to regulate cyclosporine dosing, and close monitoring is necessary.

Cyclosporine does not have a significant bearing on RBC production and has not been closely linked to thyroid function or hemolysis.

PTS: 1 REF: p. 232, QSEN Alert: Safety OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A client is receiving omalizumab to treat allergic asthma that is not relieved by inhaled corticosteroids. Which nursing intervention is appropriate with each dose administration of omalizumab?

A. Administer high-flow oxygen prior to administration.

B. Instruct the client to avoid high-fat foods during the course of treatment.

C. Have epinephrine available during administration.

D. Administer a corticosteroid prior to administration.

ANS: C Rationale: Because of the risk of anaphylaxis, the FDA has issued a black box warning for omalizumab. Administration should occur only in a health care setting under direct medical supervision by a health care provider who can initiate treatment of life-threatening anaphylaxis. The client will not require oxygen therapy with every dose administration. The client will not need to avoid high-fat foods. The client will not receive corticosteroid agents.

PTS: 1 REF: p. 243, QSEN Alert: Safety OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

18. A client is administered methotrexate for the treatment of severe rheumatoid arthritis.

Administration of this drug should be performed with particular care because of the associated high risk of which condition?

A. Intracapsular bleeding B. Thrombophlebitis C. Hepatotoxicity D. Myocardial infarction or CVA ANS: C Rationale: Even in the low doses used in rheumatoid arthritis and psoriasis, methotrexate may cause hepatotoxicity. Consequently, many clinicians recommend serial liver biopsies for clients on long-term, low-dose methotrexate. This drug is not closely associated with bleeding disorders, MI, or stroke.

PTS: 1 REF: p. 232, Other Drugs in the Class OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. An older adult client has experienced a sharp decline in mobility and quality of life due to severe rheumatoid arthritis. As a result, the health care provider has recently prescribed abatacept. This fusion protein inhibitor will achieve a therapeutic effect by what means?

A. Preventing the activation of T cells B. Increasing antibody production by B cells C. Antagonizing histamine receptors D. Inhibiting the production of mast cells ANS: A Rationale: Abatacept is a fusion protein inhibitor synthesized from an IgG antibody fused to a cell protein that binds to antigen-presenting molecules. This action prevents the activation of T lymphocytes and the production of inflammatory cytokines.

Abatacept does not increase antibody production, antagonize histamine receptors, or inhibit mast cell production.

PTS: 1 REF: p. 244, Interleukin-Blocking Agents OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 20. The nurse’s medication reconciliation performed on a client who is newly admitted to the hospital reveals that the client regularly takes infliximab, a humanized IgG monoclonal antibody. The nurse is justified in suspecting that this client may have a history of what disorder?

A. Osteoporosis B. Crohn’s disease C. Organ transplant rejection

D. Severe seasonal allergies ANS: B Rationale: Infliximab is a humanized IgG monoclonal antibody used to treat inflammatory disorders like rheumatoid arthritis and Crohn’s disease. The IgG monoclonal antibody has no value in treating osteoporosis, organ transplant rejection, or seasonal allergies since they are not associated with an inflammatory process.

PTS: 1 REF: p. 243, Tumor Necrosis Factor-Alpha–Blocking Agents OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 21. An adult client experienced a kidney transplant 2 days ago, and the regimen of antirejection drugs began just prior to surgery. What nursing action should be integrated into this client’s plan of care?

A. Place the client in a single, protective isolation room.

B. Arrange for the client to receive a raw-food, organic diet.

C. Wash the client’s skin with chlorhexidine twice daily.

D. Have the client wear a gown and gloves when outside the room.

ANS: A Rationale: Clients receiving antirejection therapy are at a greatly heightened risk of infection; protective isolation is warranted. Raw foods are normally contraindicated, and the use of a gown and gloves does not protect the client sufficiently from infectious microorganisms. It is not necessary to perform twice-daily antiseptic washes.

PTS: 1 REF: p. 233, General Considerations OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 22. Following a successful kidney transplant several years ago, a 59-year-old client has presented to the clinic for a regularly scheduled follow-up appointment. The nurse at the clinic should assess the client in the knowledge that long-term use of antirejection drugs has been associated with what health condition?

A. Early onset of dementia B. Increased risk of malignancy C. Atherosclerosis D. Increased risk of venous thromboembolism ANS: B Rationale: As a consequence of long-term survival and chronic immunosuppression, clients on long-term immunosuppressants have an increased risk of developing a malignancy. These drugs have not been linked to dementia, VTE, or atherosclerosis.

PTS:

1

REF: p. 231, Adverse Effects

OBJ: 1

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 13: Drug Therapy to Decrease Immunity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 14, Drug Therapy for the Treatment of Cancer 1. A client is diagnosed with a brain tumor. The client is told that the cancer cells proliferate. The client asks the nurse what this means. What is the nurse’s best response?

A. “The proliferation is the growth of cancer cells and the rate of growth.”

B. “The proliferation of cancer cells is the metastasis of the tumor.”

C. “The proliferation of the cancer cells is the suppression of growth.”

D. “The proliferation of the cancer cells is the treatment with chemotherapy.”

ANS: A Rationale: The proliferation of cancer cells is the rate of growth of cancer cells. The proliferation of cancer cells is not the metastasis of the tumor, suppression of the cancer cells, or treatment with chemotherapy.

PTS: 1 REF: p. 251, Pathophysiology OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Understand NOT: Multiple Choice 2. A client has received a large amount of chemotherapy to treat leukemia. The client develops gastrointestinal upset, hypertension, and paresthesias. What syndrome is the client developing?

A. Fröhlich’s syndrome B. Epidermal nevus syndrome C. Irritable bowel syndrome D. Tumor lysis syndrome ANS: D Rationale: With the treatment of leukemias and lymphomas, a serious, life-threatening adverse effect called tumor lysis syndrome may occur. This syndrome occurs when large numbers of cancer cells are killed or damaged, releasing their contents into the bloodstream. The client may have metabolic imbalances, which include gastrointestinal upset, hypertension, and paresthesias. Fröhlich’s syndrome is noted in adolescent boys who have an increase in fat and atrophy of the genitals. Epidermal nevus syndrome is associated with multiple nevi. Irritable bowel syndrome is marked with abdominal pain and disturbances of evacuation.

PTS: 1 REF: p. 252, QSEN Alert: Safety OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Analyze NOT: Multiple Choice 3. A client develops lysis syndrome during the administration of chemotherapy agents.

Which treatment is implemented to resolve this health problem?

A. Administration of potassium IV B. Administration of anti-inflammatory agents C. Limiting of fluid intake and reduction in IV fluid rate

D. Administration of IV normal saline and sodium bicarbonate ANS: D Rationale: The client experiencing lysis syndrome should receive regular insulin and IV sodium bicarbonate. The client suffers from hyperkalemia and should not be administered potassium. The client would not be administered anti-inflammatory agents.

The client should be aggressively hydrated. The client should not have fluids limited or decreased.

PTS: 1 REF: p. 265, QSEN Alert: Safety OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Apply NOT: Multiple Choice 4. A client is being treated with cyclophosphamide. Which laboratory values should the nurse follow most closely?

A. D-dimer B. Complete blood count C. C-reactive protein level D. Arterial blood gases ANS: B Rationale: The client’s complete blood count should be assessed frequently because of the adverse effect of bone marrow depression. Potassium, sodium, and magnesium are important to assess because of imbalances in fluid and electrolytes but are not as critical as the CBC. PTS: 1 REF: p. 257, Nitrogen Mustard Derivatives OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Apply NOT: Multiple Choice 5. A client has been administered methotrexate, which is a purine antagonist used to treat a rapidly growing tumor. The client develops stomatitis. What is the priority nursing diagnosis for a client suffering from stomatitis?

A. Impaired skin integrity B. Activity intolerance C. Self-care deficit: hygiene D. Risk for disuse syndrome ANS: A Rationale: Toxic effects of methotrexate include stomatitis, which is an alteration in skin integrity. Disuse syndrome, lack of hygiene, and activity intolerance are less directly related to stomatitis.

PTS: 1 REF: p. 266, Complications of Chemotherapy and Their Management

OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Apply NOT: Multiple Choice 6. A client is administered bevacizumab to treat tumor growth in a breast tumor. What is the action of a monoclonal antibody such as bevacizumab?

A. It changes the RNA of the tumor cell to a normal form.

B. It binds to the 30S ribosome.

C. It prevents the activation of intracellular growth factors.

D. It blocks the cell wall synthesis.

ANS: C Rationale: Bevacizumab binds to growth factor receptors found on blood vessels to prevent intracellular growth factors from becoming activated and stimulating cell growth. Bevacizumab does not change the RNA of the tumor cell. Bevacizumab does not bind to the 30S ribosome or block cell wall synthesis.

PTS: 1 REF: p. 270, Monoclonal Antibodies OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Understand NOT: Multiple Choice 7. An oncology nurse is preparing to administer cytotoxic chemotherapy medications.

Which measure best protects the nurse from harm related to the chemotherapy?

A. Wearing protective equipment B. Performing thorough hand hygiene C. Mixing medication in a 1000-mL bag D. Administering medication intramuscularly whenever possible ANS: A Rationale: Because of the drugs’ toxicity, nurses who administer IV cytotoxic chemotherapy should be specially trained to administer the medications safely and use protective equipment when handling the medication. Hand hygiene is important during care but will only minimally protect from harm. The medication is mixed in a variety of solutions and amounts. The medication is not administered intramuscularly.

PTS: 1 REF: p. 252, QSEN Alert: Safety OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Apply NOT: Multiple Choice 8. A 32-year-old female client is being treated with a cytotoxic antineoplastic agent. Which is the most important instruction related to the potential for teratogenicity?

A. The medication will be completely eliminated 24 hours after the administration.

B. The client should protect against infections by taking trimethoprim and sulfamethoxazole.

C. The client should not become pregnant for several months.

D. The client will not get pregnant due to the elimination of ova.

ANS: C Rationale: Most cytotoxic antineoplastic drugs are potentially teratogenic, and pregnancy should be avoided during and for several months after drug therapy is stopped. The medication is not completely eliminated in 24 hours. The client should be protected from infection, but this characteristic is not related to pregnancy. Administration of the medication does not prevent pregnancy.

PTS: 1 REF: p. 264, QSEN Alert: Safety OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Apply NOT: Multiple Choice 9. A client is administered mesna to prevent cystitis induced by ifosfamide. How will this medication combination prevent cystitis?

A. Mesna increases urine output related to ifosfamide.

B. Mesna decreases viral load related to ifosfamide.

C. Mesna increases white blood cells related to ifosfamide.

D. Mesna combines with the metabolite of ifosfamide.

ANS: D Rationale: Mesna is used with ifosfamide, which produces a metabolite that causes hemorrhagic cystitis. Mesna combines with and inactivates the metabolite, thereby decreasing cystitis.

PTS: 1 REF: p. 268, QSEN Alert: Safety OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Apply NOT: Multiple Choice 10. A client has chosen to be placed on hospice. Which is acceptable chemotherapy for a client on hospice?

A. Adjuvant chemotherapy B. Radiation combined with chemotherapy C. Palliative chemotherapy D. Neoadjuvant chemotherapy ANS: C Rationale: Palliative chemotherapy is used in advanced cancer to relieve symptoms and treat or prevent complications. Adjuvant chemotherapy is used after surgery or radiation to destroy or reduce microscopic metastasis. Radiation combined with chemotherapy is implemented to treat the cancer and not used in palliation. Neoadjuvant chemotherapy is used before surgery or radiation.

PTS: 1 OBJ: 5

REF: p. 265, QSEN Alert: Evidence-Based Practice

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Understand NOT: Multiple Choice 11. A client has been diagnosed with a brain tumor and is dealing with this diagnosis by seeking detailed information about cancer. The nurse would explain to the client that cancer is essentially a result of the disruption of what?

A. Cell cycle B. Cell wall C. Lymphatic system D. Immune system ANS: A Rationale: Malignant cells have lost the normal genetic regulation that controls cell growth, invading normal tissues and taking blood and nutrients away from these tissues.

In essence, the cell cycle has been pathologically disrupted. None of the other options accurately describe the disruption.

PTS: 1 REF: p. 250, Etiology OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Teaching/Learning MSC: Cognitive Level: Understand NOT: Multiple Choice 12. A client with colorectal cancer is being treated with oxaliplatin. Which potential adverse effect should the nurse explain to the client?

A. Dysuria B. Diarrhea C. Insomnia D. Cold-induced neurotoxicity ANS: D Rationale: Cold-induced neurotoxicity is an adverse effect of oxaliplatin resulting from an effect on peripheral nerves, especially in the hands and feet. Dysuria, diarrhea, and insomnia are not closely associated with oxaliplatin as a result of its pharmacologic actions.

PTS: 1 REF: p. 269, Patient Teaching Guidelines for Drugs Used for the Treatment of Cancer OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Teaching/Learning MSC: Cognitive Level: Apply NOT: Multiple Choice 13. Fewer adverse effects are associated with monoclonal antibody therapy than those of cytotoxic drugs. However, some of the potential adverse effects of monoclonal antibodies can be life threatening, including which effect?

A. Heart failure and bleeding problems

B. Changes in cognition and personality changes C. Ischemic heart disease D. Bronchoconstriction and pulmonary edema ANS: A Rationale: Although some adverse effects of monoclonal antibodies are rare, they are serious (e.g., heart failure, bleeding problems, electrolyte imbalances) and vary with a particular drug. None of the other options are adverse reactions associated with this therapy.

PTS: 1 REF: p. 270, Monoclonal Antibodies OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Understand NOT: Multiple Choice 14. A client is undergoing a cytotoxic chemotherapy regimen for the treatment of stage III lung cancer. What effect will this regimen likely have on the client’s hemostatic function?

A. The client’s platelet count will decline.

B. The client will be at increased risk of deep vein thrombosis (DVT).

C. The client will require prophylactic heparin.

D. The client will likely experience thrombocytosis.

ANS: A Rationale: Thrombocytopenia, not thrombocytosis, is a common adverse effect of cytotoxic chemotherapy. Heparin is consequently contraindicated, and DVT is not a priority risk. Human cells do not contain cell walls.

PTS: 1 REF: p. 265, Adverse Effects OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Analyze NOT: Multiple Choice 15. A client has chosen to receive palliative care after lung cancer metastasized to the bones and liver. Which is most appropriate during palliative cancer care?

A. Abrupt cessation of chemotherapy immediately prior to entering palliative care B. Aggressive chemotherapy to reduce malignant cell proliferation C. The use of chemotherapy to reduce pain D. The replacement of chemotherapy with complementary and alternative treatments ANS: C Rationale: Palliative chemotherapy is used in advanced cancer to prevent or treat pain and obstruction. Chemotherapy does not need to be stopped abruptly or replaced with CAM. Aggressive chemotherapy would not normally be administered in a palliative context.

PTS: 1 OBJ: 5

REF: p. 265, Use in Patients With Critical Illness

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Analyze NOT: Multiple Choice 16. An adult client has recently begun cancer treatment with methotrexate (MTX). When reviewing this client’s laboratory work, the nurse should consequently prioritize assessment of what?

A. Sodium and potassium B. BUN and creatinine C. Calcium and magnesium D. Arterial blood gases ANS: B Rationale: Antimetabolites may be nephrotoxic. MTX use in clients with impaired renal function may lead to accumulation of toxic amounts or additional renal damage.

Evaluation of the client’s renal status should take place before and during MTX therapy.

This adverse effect of MTX treatment supersedes the importance of electrolytes and ABGs, though these would also be considered.

PTS: 1 REF: p. 264, Use in Patients With Renal Impairment OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Apply NOT: Multiple Choice 17. A client is being treated on the oncology unit and has developed worsening adverse effects over the past several days of chemotherapy. Administration of filgrastim may aid in achieving what desired outcome?

A. Resolution of mucositis B. Increased leukocytes C. Increased platelet levels D. Prevention of hemorrhagic cystitis ANS: B Rationale: Severe neutropenia can be prevented or its extent and duration minimized by administering filgrastim or sargramostim to stimulate the bone marrow to produce leukocytes. Filgrastim does not address the risk of inflammation (mucositis), abnormal platelet production, or bleeding (hemorrhagic cystitis).

PTS: 1 REF: p. 266, Complications of Chemotherapy and Their Management OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Understand NOT: Multiple Choice

18. A client has just been diagnosed with liver cancer, and the care team is finalizing the extensive chemotherapy regimen that will begin imminently. Administration of chemotherapeutic drugs is best achieved through which route?

A. An intramuscular depot B. A peripheral IV in the nondominant forearm C. Peripheral intravenous access in the antecubital fossa D. A central venous catheter (CVC) ANS: D Rationale: Insertion of an indwelling central venous catheter is often appropriate for clients who have poor peripheral venous access, who require many doses of chemotherapy, or who require continuous infusions. The antecubital IV insertion site would be unlikely unsustainable for this chemotherapy regimen. Overall, a CVC is preferable to peripheral access. IM administration is uncommon.

PTS: 1 REF: p. 268, Administering the Medication OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Apply NOT: Multiple Choice 19. A 79-year-old woman has recently moved to a long-term care facility, and the nurse at the facility is conducting a medication reconciliation. The nurse notes that the client has recently been taking tamoxifen. The nurse is justified in concluding that the client has a history of what malignancy?

A. Ovarian cancer B. Breast cancer C. Malignant melanoma D. Cervical cancer ANS: B Rationale: Tamoxifen is an antiestrogen that has been widely used to prevent recurrence of breast cancer after surgical excision in women aged 40 years and older and to treat metastatic breast cancer in postmenopausal women with estrogen receptor–positive disease. Tamoxifen is not effective in preventing recurrence of any of the other options since none of those are estrogen-positive diseases.

PTS: 1 REF: p. 277, Antiestrogens OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Analyze NOT: Multiple Choice 20. An oncology nurse is reviewing the medication administration record of a client being treated for advanced prostate cancer. In addition to two chemotherapeutic agents, the nurse reads that the client has been ordered a cytoprotective agent. What is the goal of treatment with this agent?

A. Buffer the cytotoxins that result from the metabolism of chemotherapeutic agents.

B. Protect the client from pathophysiologic effects of malignancy.

C. Potentiate the beneficial effects of chemotherapy.

D. Reduce the incidence or severity of adverse drug effects.

ANS: D Rationale: Cytoprotectant agents reduce the adverse effects of cytotoxic drugs, some of which can be severe, debilitating, or life threatening. Cytoprotectant drugs do not potentiate chemotherapy, protect the client from the effects of cancer, or buffer cytotoxins.

PTS: 1 REF: p. 280, Cytoprotectant Drugs OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Understand NOT: Multiple Choice 21. A client’s chemotherapy regimen has been deemed successful, but the client is experiencing debilitating nausea and vomiting. These adverse effects should signal the nurse to the possibility of what nursing diagnosis?

A. Acute pain B. Adult failure to thrive C. Ineffective therapeutic regimen management D. Imbalanced nutrition: less than body requirements ANS: D Rationale: Nausea and vomiting are major threats to the client’s nutrition. Failure to thrive is typically a chronic, rather than acute, health problem. Pain does not necessarily accompany nausea, and there is no indication that this client is not maintaining the necessary regimen.

PTS: 1 REF: p. 266, Complications of Chemotherapy and Their Management OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 14: Drug Therapy for the Treatment of Cancer KEY: Integrated Process: Nursing Process MSC: Cognitive Level: Apply NOT: Multiple Choice

Chapter 15, Inflammation, Infection, and the Use of Antimicrobial Agents 1. A client with burns has developed a wound infection. This client is experiencing what type of wound infection?

A. Fungal infection B. Opportunistic infection C. Nosocomial infection D. Foodborne infection ANS: B Rationale: Opportunistic infections are likely to occur in people with severe burns, cancer, human immunodeficiency virus, and indwelling catheters and are often caused by drug-resistant microorganisms, are usually serious, and may be life threatening. The client may be at risk for a fungal, nosocomial (hospital-acquired), or foodborne infection, but the risk for all infections is high due to the client’s opportunistic nature of the burn.

PTS: 1 REF: p. 291, Opportunistic Pathogens OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 2. A resident of a skilled nursing facility develops methicillin-resistant Staphylococcus aureus. What type of infection has this person developed?

A. Community acquired B. Postoperative C. Sustained infection D. Hospital-acquired infection ANS: D Rationale: Hospital-acquired infection is an infection acquired from microorganisms in hospitals and other health care facilities. The client’s infection is not community acquired, postoperative, or sustained.

PTS: 1 REF: p. 293, Community-Acquired Versus Hospital-Acquired Infections OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. A client is diagnosed with a drug-resistant infection. What is the client’s greatest health risk?

A. Hepatic dysfunction B. Cardiomyopathy C. Edema D. Death

ANS: D Rationale: The client is at greatest risk for death. The client is not at risk for hepatic dysfunction, cardiomyopathy, or edema.

PTS: 1 REF: p. 293, Antibiotic-Resistant Microorganisms OBJ: 7 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 4. A nurse is instructing a client on the antibiotic regimen for the treatment of pneumonia.

Which statement is most important to share with the client?

A. Take the medication with orange juice.

B. Supplement the medication with multivitamins.

C. Complete the entire prescription of medication.

D. Administer the medication with dairy products.

ANS: C Rationale: Interruption or inadequate antimicrobial treatment of infections may contribute to the emergences of antibiotic-resistant organisms. The administration of an antibiotic with orange juice is not recommended in all instances. The medication does not need to be supplemented with multivitamins. Antibiotics need not be administered with dairy products.

PTS: 1 REF: p. 298, Combination Therapy OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A client has developed an increase in nasal drainage, fever, and muscle aches. What type of antibiotic should be administered?

A. Narrow-spectrum antibiotic B. Broad-spectrum antibiotic C. Second-generation cephalosporin D. Third-generation cephalosporin ANS: A Rationale: Avoid the use of broad-spectrum antibacterial drugs to treat trivial or viral infections; use narrow-spectrum agents if they are likely to be effective. Broad-spectrum antibiotics, including second- and third-generation cephalosporins, should be avoided.

PTS: 1 REF: p. 288, Drug Therapy OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

6. A client is to be started on an antibiotic. Which is most important to take into consideration before beginning the antibiotic regimen?

A. Duration of symptoms B. Culture and susceptibility C. Client’s hydration status D. Client’s age and weight ANS: B Rationale: Culture identifies the causative organism, and susceptibility tests determine which drugs are likely to be effective against the organism. The duration of symptoms and the client’s hydration status, age, and weight are important, but not imperative, in determining the antibiotic of choice.

PTS: 1 REF: p. 296, Culture and Sensitivity Studies OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. An adult client has been treated for strep throat with ampicillin by mouth. The client visits the occupational health nurse and reports vaginal itching. What organism is the cause of the vaginal itching?

A. Klebsiella B. Enterobacter C. Candida D. Proteus ANS: C Rationale: The yeast Candida is a normal resident of the vagina and the intestinal tract.

An antibacterial drug may destroy the normal bacterial flora without affecting the fungal organism. Klebsiella, Enterobacter, and Proteus will not contribute to the development of a yeast infection.

PTS: 1 REF: p. 291, Opportunistic Pathogens OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client has presented to the emergency department after suffering a severe laceration to the hand in a workplace accident. During the subsequent process of acute inflammation, what physiologic event took place first?

A. The client’s B cells produced antibodies.

B. The client’s blood vessels constricted.

C. Neutrophils migrated to the injury site.

D. Opsonization occurred.

ANS: B

Rationale: The process of acute inflammation occurs in three stages. The first stage is the vascular stage; notable changes occur in the small blood vessels at the site of the cellular and tissue injury. At the time of the injury, vasoconstriction results, followed by vasodilation of the capillaries and venules to increase capillary blood flow, increasing temperature and redness at the site. Opsonization, neutrophil migration, and antibody production take place in later stages of inflammation.

PTS: 1 REF: p. 288, Acute Inflammation OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 9. An adolescent client was bitten by a dog, and inflammation took place at the site of the injury. During the process of opsonization, what physiologic event occurred?

A. The client’s blood vessels dilated, allowing rapid peripheral blood flow.

B. Viscosity of the client’s blood decreased, facilitating the migration of neutrophils.

C. Antigens were coated, marking them for phagocytosis.

D. T cells were released from the client’s thymus gland.

ANS: C Rationale: The third stage of inflammation involves opsonization, which facilitates phagocytosis. During opsonization, a substance coats the foreign antigens, producing inflammation. This inflammation makes the antigens more susceptible to the macrophages and leukocytes, thus increasing phagocytic activity. Opsonization is not characterized by T-cell activity or changes in blood flow and viscosity.

PTS: 1 REF: p. 288, Acute Inflammation OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. An adult client with an autoimmune disorder regularly takes oral corticosteroids. The nurse knows that corticosteroids can be used in the successful treatment of inflammation but that they also create a risk for what condition?

A. Hypotension B. Leukocytosis C. Infection D. Hypercalcemia ANS: C Rationale: Corticosteroids impair phagocytosis by preventing phagocytic cells from leaving the bloodstream. They decrease the amount of lymphocytes, fibroblasts, and collagen needed for tissue repair. This causes a reduction in inflammation but a commensurate increase in the client’s risk for infection. Corticosteroids increase the risk for developing hypocalcemia (not hypercalcemia) and hypertension (not hypotension).

They do not increase risk for leukocytosis.

PTS:

1

REF: p. 288, Drug Therapy

OBJ: 3

NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 11. The family members of an older adult client are angered that the client has been colonized with methicillin-resistant Staphylococcus aureus during a stay in the hospital.

The nurse should explain what characteristic of colonization to the members of the family?

A. The bacteria are present but are not causing infection.

B. The bacteria are causing an infection, but the infection is not spreading.

C. The bacteria are causing tissue injury at the site of colonization.

D. The bacteria are spreading within a clearly defined body region.

ANS: A Rationale: Colonization is the presence and growth of microorganisms. The microorganisms do not necessarily cause tissue injury or elicit an immune response in the human body.

PTS: 1 REF: p. 290, Normal Flora OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. An adult client has been living with human immunodeficiency virus (HIV) for several years but has recently been admitted to the hospital after being diagnosed with herpes simplex. How would this client’s herpes infection most likely be characterized?

A. Community-acquired infection B. Opportunistic infection C. Secondary infection D. Nosocomial infection ANS: B Rationale: Microorganisms may become pathogens in hosts whose defense mechanisms are impaired. Opportunistic infections are likely to occur in people whose defenses are compromised due to human immunodeficiency virus (HIV) infection. This is not characterized as a nosocomial infection (hospital-acquired infection) or a secondary infection. The infection was likely to have been acquired in the community, but the client’s HIV diagnosis means that it would be considered to be an opportunistic infection.

PTS: 1 REF: p. 291, Opportunistic Pathogens OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

13. A group of nursing students are learning about the factors that underlie recent increases in the incidence and prevalence of antibiotic-resistant microorganisms. What factor is known to contribute to antibiotic resistance?

A. Increased survival rates from acute infections B. Increased population density C. Use of antibiotics that are ineffective against the infectious microorganism D. Overuse of antibiotics ANS: D Rationale: Antibiotic overuse can contribute to antibiotic resistance. Resistance is not typically attributable to increased age of clients, increased population density, or the use of ineffective antibiotics.

PTS: 1 REF: p. 293, Antibiotic-Resistant Microorganisms OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 14. An infant has been brought to the emergency department by the parents, and initial assessment is highly suggestive of bacterial meningitis. Consequently, the infant has been admitted, and empiric antibiotic therapy has been prescribed. The nurse should understand what characteristic of this infant’s current treatment plan?

A. Success or failure of treatment will not be apparent for several weeks.

B. The infant will receive aggressive treatment with a narrow-spectrum antibiotic.

C. Culture and sensitivity results of the infant’s cerebrospinal fluid are still pending.

D. The infant is suspected of having an antibiotic-resistant infection.

ANS: C Rationale: Empiric therapy is based on an informed estimate of the most likely pathogen(s) given the client’s signs and symptoms and the site of infection, as well as knowledge of communicable diseases currently infecting other people in the community.

Because laboratory tests used to definitively identify causative organisms and to determine susceptibility to antibiotics usually require 48 to 72 hours, the prescriber usually initiates treatment with an antimicrobial drug that is likely to be effective. The other listed statements are not true of empiric therapy.

PTS: 1 REF: p. 296, Empiric Therapy OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 15. A client with an infection has not responded appreciably to antibiotic therapy, and the nurse suspects antibiotic resistance. What phenomenon is known to contribute to acquired antibiotic resistance?

A. Bacteria take on genetic material from healthy body cells, reducing antigen recognition.

B. Microorganisms remain in resting (G0) phase during antibiotic treatment.

C. Distribution of an antibiotic is insufficient to cause resolution of the infection.

D. The strongest microorganisms survive antibiotic treatment, while the weakest are eradicated.

ANS: D Rationale: Selective pressure, or natural selection, refers to the survival of the fittest bacteria. When antibiotic therapy is initially begun, the weakest bacteria are killed first, while the strongest bacteria, which are best able to withstand the effects of antibiotic therapy, remain. This contributes to antibiotic resistance. Resistance is not the result of an extended G0 phase, impaired distribution, or bacterial appropriation of human genetic material.

PTS: 1 REF: p. 295, Mechanisms of Antibiotic Resistance in Bacteria OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 16. When participating in the care of a client who is being treated with antimicrobials, the nurse can promote the appropriate use of these medications in which way?

A. Encouraging the use of narrow-spectrum, rather than broad-spectrum, antibiotics B. Promoting the use of prophylactic antibiotics for clients possessing risk factors for infection C. Initiating empiric therapy for all older adult clients admitted to a health care facility D. Promoting the use of herbal treatment for infection rather than antimicrobial drugs ANS: A Rationale: Guidelines to promote more appropriate use of antimicrobial drugs include using a narrow-spectrum antibacterial drug instead of a broad-spectrum drug, whenever possible, in order to decrease the risk of a superinfection. Herbal alternatives are frequently not available. Antibiotics should not normally be administered in the absence of a diagnosed infection.

PTS: 1 REF: p. 288, Drug Therapy OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A critically ill client has developed a fever of 38.9°C, and blood cultures have been drawn and sent to the laboratory for culture and sensitivity testing. Determination of the culture will give the care team what information?

A. Whether the infection is antibiotic resistant B. The exact identity of the infectious microorganism C. The most likely location of the infection D. The most likely origin of the infection ANS: B

Rationale: Culture identifies the causative microorganism. It does not necessarily indicate the presence of antibiotic resistance. The origin or location of the infection may often been indirectly determined by the culture, but this is not always the case.

PTS: 1 REF: p. 296, Culture and Sensitivity Studies OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 18. A medical nurse on a night shift is reviewing a client’s medication administration record for the following day. The nurse notes that a combination antimicrobial drug is prescribed. What is implied by the fact that the client has been prescribed a combination drug?

A. The client’s infection likely has a fungal or protozoal etiology.

B. The client likely has a history of recurrent, multisystemic infections.

C. The client may be unable to tolerate treatment with a single antimicrobial.

D. The client may have an infection caused by multiple microorganisms.

ANS: D Rationale: Indications for combination therapy may include infections caused by multiple microorganisms. A fungal or protozoal infection is not implied, and the client may or may not have a history of recurrent infections. Intolerance of single antibiotics is not normally an indication for combination therapy.

PTS: 1 REF: p. 298, Combination Therapy OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 19. A hospital nurse is aware that nosocomial infections pose a significant threat to many clients’ health status. In order to reduce the spread of nosocomial infections, the nurse should prioritize which action?

A. Increased use of empiric antibiotic therapy B. Use of disinfectants when providing client hygiene C. Vigilant and thorough hand hygiene D. Client education on the causes of infection ANS: C Rationale: Good hand hygiene is probably the most effective method of preventing infections. This supersedes the importance of education regarding the causes of infection or the use of disinfectants. Antibiotic therapy should only be used on clients who clearly need this treatment.

PTS: 1 REF: p. 290, QSEN Alert: Evidence-Based Practice OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. An older adult client has been admitted to the hospital after a urinary tract infection developed into urosepsis. What assessments should the nurse prioritize when monitoring the course of this client’s infection? Select all that apply.

A. Blood urea nitrogen and creatinine B. White blood cell count C. Heart rhythm D. Temperature E. Liver panel ANS: B, D Rationale: For clients with an infection, the nurse should prioritize assessment of WBCs and temperature. Cardiac, renal, and liver function are important measures of health, but these are less directly affected by the presence of infection.

PTS: 1 REF: p. 298, Combination Therapy OBJ: 8 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 21. A client has been taking antibiotics at home for the treatment of a respiratory infection for the past 6 days, and there is no evident improvement in the infection. Which nursing assessment is most appropriate?

A. Assess the client’s adherence to the medication regimen.

B. Assess the client’s home hygiene.

C. Assess the client’s understanding of the illness.

D. Assess the client’s use of herbal or alternative remedies.

ANS: A Rationale: Nonadherence to antibiotic therapy can result in a continuation or exacerbation of the infection. Poor hygiene is a risk factor for the development of infection but is less likely to perpetuate an existing infection that is being treated appropriately with antibiotics. Herbs may be contraindicated but are unlikely to negate the therapeutic effects of an antibiotic. The nurse should gauge the client’s understanding of the illness, but this does not have a bearing on the client’s lack of improvement.

PTS: 1 REF: p. 298, Combination Therapy OBJ: 8 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 15: Inflammation, Infection, and the Use of Antimicrobial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 16, Drug Therapy to Decrease Pain, Fever, and Inflammation 1. A client is receiving acetaminophen for fever. The client also has inflammation in the knees and elbows with pain. Why will acetaminophen assist in reducing fever but not in decreasing the inflammatory process?

A. Prostaglandin inhibition is limited to the central nervous system.

B. Acetaminophen inhibits cyclooxygenase (COX-1 and COX-2) only.

C. Acetaminophen has an antiplatelet effect to decrease edema.

D. Prostaglandins decrease the gastric acid secretion.

ANS: A Rationale: The action of acetaminophen on prostaglandin inhibition is limited to the central nervous system. Aspirin and other nonselective NSAIDs inhibit COX-1 and COX-2. Acetaminophen does not produce an antiplatelet effect. Prostaglandins do not affect gastric secretions.

PTS: 1 REF: p. 311, Nonnarcotic Analgesic Antipyretic: Acetaminophen OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client experiences pain in the elbow related to playing tennis. What are the chemical mediators of inflammation?

A. Insulin, thyroid hormone, and calcitonin B. Bradykinin, histamine, and leukotrienes C. Phospholipids, arachidonic acid, and platelets D. Red blood cells, lymph, and serosa ANS: B Rationale: Prostaglandins sensitize pain receptors and increase the pain associated with other chemical mediators of inflammation and immunity, such as bradykinin, histamine, and leukotrienes. Insulin, thyroid hormone, and calcitonin are not chemical mediators of inflammation. Phospholipids, arachidonic acid, and platelets are not chemical mediators of inflammation. Red blood cells, lymph, and serosa are not chemical mediators of inflammation.

PTS: 1 REF: p. 304, Chemical Mediators of Inflammation and Immunity OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 3. A client is prescribed acetylsalicylic acid for fever and headache. What is the action of acetylsalicylic acid?

A. Inhibiting prostaglandin synthesis in the central and peripheral nervous system

B. Providing selective action by inhibiting prostaglandin synthesis in the CNS C. Inhibiting the release of norepinephrine to increase blood pressure D. Suppressing the function of the hypothalamus to decrease inflammation ANS: A Rationale: Acetylsalicylic acid inhibits prostaglandin synthesis in the central nervous system and the peripheral nervous system. Acetylsalicylic acid does not provide selective action by inhibiting prostaglandin synthesis in the CNS. Acetylsalicylic acid does not inhibit the release of norepinephrine to increase blood pressure. Acetylsalicylic acid does not suppress the function of the hypothalamus to decrease inflammation.

PTS: 1 REF: p. 302, Introduction OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 4. A client is experiencing bursitis in the right elbow. Which orally administered medication will diminish inflammation and assist in relieving this pain?

A. Acetaminophen B. Morphine sulfate C. Acetylsalicylic acid D. Codeine ANS: C Rationale: Acetylsalicylic acid is widely used to prevent and treat mild to moderate pain and inflammation associated with musculoskeletal disorders, such as bursitis.

Acetylsalicylic acid is administered orally. Acetaminophen will only relieve pain and not affect inflammation. Morphine sulfate will relieve pain but not affect inflammation.

Codeine will relieve pain but not affect inflammation.

PTS: 1 REF: p. 308, Salicylates OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. A client is diagnosed with familial adenomatous polyposis. Which nonsteroidal anti-inflammatory agent will reduce the number of polyps and decrease the risk of colon cancer?

A. Ibuprofen B. Nabumetone C. Celecoxib D. Probenecid ANS: C

Rationale: Celecoxib, a COX-2 inhibitor, is used to treat familial adenomatous polyposis, in which the drug reduces the number of polyps and may decrease risk of colon cancer. Ibuprofen and nabumetone are not recommended for use in preventing familial adenomatous polyposis since neither have effect on the reduction of polyps.

Probenecid is used to treat gouty arthritis, not for the prevention of adenomatous polyposis.

PTS: 1 REF: p. 323, Selective COX-2 Inhibitor: Celecoxib OBJ: 10 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 6. A child has symptoms of influenza, including a fever. Which medication should not be administered to the child because of the risk of Reye’s syndrome?

A. Acetaminophen B. Acetylsalicylic acid C. Ibuprofen D. Ascorbic acid ANS: B Rationale: In children and adolescents, aspirin is contraindicated in the presence of viral infections, such as influenza or chickenpox, because of its association with Reye’s syndrome. Acetaminophen and ibuprofen are safe to administer for fever reduction and pain relief in children and adolescents since no connection with Reye’s syndrome has been established. Ascorbic acid is safe to administer to children but is not used to reduce fever or pain.

PTS: 1 REF: p. 308, Salicylates OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A pregnant woman has taken acetylsalicylic acid (aspirin) throughout her pregnancy.

Following birth, what congenital heart defect should the woman’s child be assessed for?

A. Closure of the ductus arteriosus B. Tetralogy of Fallot C. Patent foramen ovale D. Cardiomyopathy ANS: A Rationale: Potential risks to the fetus of a woman who has taken acetylsalicylic acid (aspirin) include low birth weight, premature closure of the ductus arteriosus, renal toxicity, intracranial hemorrhage, and stillbirth. Tetralogy of Fallot, patent foramen ovale, and cardiomyopathy are not congenital heart defects associated with the administration of acetylsalicylic acid during pregnancy.

PTS:

1

REF: p. 308, Salicylates

OBJ: 5

NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client is admitted to a neurologic unit with a confirmed cerebrovascular bleed. Which medication that is used to treat inflammation is contraindicated in this client?

A. Furosemide B. Hydrochlorothiazide with triamterene C. Digoxin D. Ketorolac ANS: D Rationale: The NSAID ketorolac should not be administered to a client with a suspected or confirmed cerebrovascular bleed since it is known to cause bleeding. Furosemide is administered to reduce fluid volume and is not administered to treat inflammation.

Hydrochlorothiazide with triamterene is administered to reduce fluid volume and is not administered to treat inflammation. Digoxin is administered to increase cardiac output, not to treat inflammation.

PTS: 1 REF: p. 310, Other Drugs in the Class OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. An older adult client has taken ibuprofen 800 mg 2 times per day for longer than 10 years. Which laboratory test is the priority assessment?

A. Renin and aldosterone levels B. 24-hour urine for microalbumin C. Blood urea nitrogen and serum creatinine D. Complete blood count ANS: C Rationale: Nonsteroidal anti-inflammatory agents in long-term use can cause renal impairment. The client should be assessed for renal impairment with the elevation of the serum BUN and creatinine. NSAIDs do not affect renin and aldosterone levels. A 24-hour urine for microalbumin is not recommended when administering ibuprofen since protein elimination is not affected by NSAIDs. A complete blood count may not be necessary since its emphasis is not related to renal function.

PTS: 1 REF: p. 302, Concept Mastery Alert OBJ: 7 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 10. A client is taking a nonsteroidal anti-inflammatory agent. Which instruction should the client be given in regard to administration?

A. Administer the medication with orange juice.

B. Crush enteric-coated tablets for impaired swallowing.

C. Administer the medication with food.

D. Administer the medication every other day.

ANS: C Rationale: To prevent gastrointestinal irritation, instruct the client to administer the medication with food. The administration of an NSAID with orange juice will increase gastric acid and not protect the gastric mucosa. Crushing enteric-coated tablets will eliminate the protection of the gastric mucosa. Nonsteroidal anti-inflammatory agents administered every other day will not protect the client from gastric irritation.

PTS: 1 REF: p. 308, Adverse Effects OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A client experiences pain as a result of gouty arthritis. Why is probenecid administered?

A. To increase urinary excretion of uric acid B. To decrease the level of liver enzymes C. To diminish the temperature D. To increase protein metabolism ANS: A Rationale: Probenecid increases the urinary excretion of uric acid. Probenecid will not decrease the level of liver enzymes, diminish temperature, or increase protein metabolism since none of these options are associated with the excretion of uric acid.

PTS: 1 REF: p. 328, QSEN Alert: Safety OBJ: 12 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 12. Which medication will be administered for the treatment of salicylate overdose?

A. Intravenous meperidine B. Intravenous sodium bicarbonate C. Intravenous furosemide D. Inhaled acetylcysteine ANS: B Rationale: Intravenous sodium bicarbonate produces alkaline urine in which salicylates are more rapidly excreted thus helping to resolve salicylate overdose. None of the remaining options bring about the production of alkaline urine.

PTS: 1 REF: p. 310, Treatment of Overdose OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

13. Which is the antidote for acetaminophen poisoning?

A. Acetylcysteine B. Allopurinol C. Diclofenac sodium D. Ketorolac ANS: A Rationale: A specific antidote, acetylcysteine, is a mucolytic agent given for acetaminophen poisoning. It is believed to help secrete the toxic metabolite in acetaminophen. None of the other options are used as an antidote for acetylcysteine poisoning, since none seem to help secrete the metabolites.

PTS: 1 REF: p. 314, Treatment of Overdose OBJ: 6 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 14. When acetylsalicylic acid is administered in low doses, it blocks the synthesis of thromboxane A2. What physiologic effect results from this action?

A. Inflammation is relieved.

B. Core body temperature is reduced.

C. Pain is relieved.

D. Platelet aggregation is inhibited.

ANS: D Rationale: At low doses, acetylsalicylic acid blocks the synthesis of thromboxane A2 to inhibit platelet aggregation; this lasts for the life of the platelet. None of the remaining options accurately describe the physiologic action results of this medication since neither inflammation, core body temperature, nor pain is affected by the synthesis of thromboxane A2.

PTS: 1 REF: p. 308, Action OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 15. A client began taking acetylsalicylic acid several years ago to prevent platelet aggregation following a myocardial infarction. Which dose of aspirin is the client most likely taking daily?

A. 81 mg B. 180 mg C. 325 mg D. 650 mg ANS: A

Rationale: The dose of aspirin given depends mainly on the condition being treated. Low doses (325 mg initially and 81 mg daily) are used for the drug’s antiplatelet effects in preventing arterial thrombotic disorders such as myocardial infarction and stroke. Doses higher than 81 mg would produce undesired side effects while not providing additional benefit to the prevention of platelet aggregation.

PTS: 1 REF: p. 309, Administering the Medication OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A perinatal nurse is preparing a dose of IV indomethacin for administration to a neonate.

What is the most plausible indication for this treatment?

A. Patent ductus arteriosus B. Tetralogy of Fallot C. Patent foramen ovale D. Cardiomyopathy ANS: A Rationale: The FDA has approved IV indomethacin a prostaglandin inhibitor for treatment of patent ductus arteriosus in premature infants since it counteracts the effect of prostaglandins produced by the placenta to keep the ductus open. None of the other conditions would be treated with indomethacin therapy since they are not reliant upon prostaglandins.

PTS: 1 REF: p. 314, Nonsteroidal Anti-Inflammatory Drugs OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A client diagnosed with osteoarthritis has been prescribed meloxicam. Which instruction should the client be given to assure the medication’s safe administration?

A. Take the medication with orange juice.

B. Crush enteric-coated tablets to aid swallowing.

C. Take the medication with food.

D. Take the medication at bedtime.

ANS: C Rationale: Meloxicam should be taken with food to decrease the risk of gastric irritation.

Meloxicam is not an enteric-coated tablet and is never crushed. It is not always necessary to take this medication at bedtime. There is no need to take the medication with orange juice..

PTS: 1 REF: p. 319, Administering the Medication OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A client enters the emergency department with reports of visual changes, drowsiness, and tinnitus. The client is found to be confused and hyperventilating. These signs and symptoms may be attributable to which condition?

A. Acute acetaminophen toxicity B. Salicylism C. Ibuprofen overdose D. Caffeine overdose ANS: B Rationale: Salicylism, toxicity due to salicylates that may be associated with chronic use, is characterized by dizziness, tinnitus, difficulty hearing, and mental confusion.

Ibuprofen overdose will cause gastric mucosal damage. Caffeine overdose will produce tachycardia. Clients demonstrating acute acetaminophen toxicity will present with continued nausea and vomiting, abdominal pain, and a tender hepatic edge.

PTS: 1 REF: p. 308, Adverse Effects OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 19. A client is admitted to the emergency department with a suspected overdose of acetaminophen. What adverse effect is the most common in acute or chronic overdose of acetaminophen?

A. Nephrotoxicity B. Hepatotoxicity C. Pulmonary insufficiency D. Pancreatitis ANS: B Rationale: Acetaminophen is normally metabolized in the liver to metabolites that are excreted by the kidneys, and these metabolites may accumulate in clients, especially those diagnosed with renal failure. In acute or chronic overdose of acetaminophen, the client can develop hepatotoxicity. None of the other options are associated with an adverse effect of an acetaminophen overdose since none are associated with the liver.

PTS: 1 REF: p. 312, Use in Patients With Renal Impairment OBJ: 6 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

20. A nurse is conducting a medication reconciliation for an older adult client who has just relocated to the long-term care facility. The nurse notes that the resident has been taking colchicine on a regular basis. This medication regimen should signal the nurse to the possibility of what diagnosis?

A. Osteoarthritis B. Gout C. Inflammatory bowel disease (IBD) D. Bursitis or tendonitis ANS: B Rationale: Colchicine, the prototype agent for the treatment and prevention of gout, is the most commonly administered antigout medication. This medication is thought to block neutrophil-mediated inflammation. Colchicine is not indicated in the treatment of osteoarthritis, IBD, tendonitis, or bursitis since they are not a result of neutrophil-mediated inflammation.

PTS: 1 REF: p. 324, Action OBJ: 11 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 16: Drug Therapy to Decrease Pain, Fever, and Inflammation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

Chapter 17, Drug Therapy With Corticosteroids 1. Which physiologic action increases a client’s stress-related release of cortisol?

A. Negative feedback mechanism B. Stimulation of the hypothalamus C. Release of epinephrine and norepinephrine D. Atrophy of the adrenal cortex ANS: C Rationale: The stress response activates the sympathetic nervous system to produce more epinephrine and norepinephrine and the adrenal cortex to produce as much as 10 times the normal amount of cortisol. The negative feedback mechanism does not work during the stress response. Cortisol production is not based on the stimulation of the hypothalamus. The stress response will not cause atrophy to the adrenal cortex.

PTS: 1 REF: p. 333, Physiology of Endogenous Corticosteroids OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client is diagnosed with an adrenal tumor. With which abnormality of the adrenal gland will the client most likely be diagnosed?

A. Primary adrenocortical insufficiency B. Secondary adrenocortical insufficiency C. Adrenocortical hyperfunction D. Hyperaldosteronism ANS: C Rationale: Adrenocortical hyperfunction (Cushing’s disease) may be a result of a primary adrenal tumor. Primary adrenocortical insufficiency is associated with destruction of the adrenal cortex by disorders such as tuberculosis, cancer, or hemorrhage. Secondary adrenocortical insufficiency is produced by inadequate secretion of corticotropin. Hyperaldosteronism is a rare disorder caused by adenoma or hyperplasia of the adrenal cortex cells that produce aldosterone.

PTS: 1 REF: p. 334, Pathophysiology of Adrenal Cortex Disorders OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 3. A client is seen in the primary health care provider’s office with reports of polydipsia and polyuria without polyphagia. An assessment notes very edematous ankles and an elevation of blood pressure. These data support which diagnosis associated with the adrenal cortex?

A. Hyperaldosteronism

B. Adrenocortical hyperfunction C. Androgen-producing tumors D. Adrenal hyperplasia ANS: A Rationale: Hyperaldosteronism is characterized by hypokalemia, hypernatremia, hypertension, thirst, and polyuria due to an overproduction of aldosterone and the resulting effects on serum sodium and potassium levels. Adrenocortical hyperfunction causes the secretion of several corticosteroids. Androgen-producing tumors of the adrenal cortex, which are usually benign, produce masculinizing effects. Adrenal hyperplasia results from deficiencies in one or more enzymes required for cortisol production. None of the remaining options would account for the stated symptoms.

PTS: 1 REF: p. 334, Pathophysiology of Adrenal Cortex Disorders OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 4. A client is receiving hydrocortisone 40 mg by mouth daily for treatment of severe autoimmune inflammation. Which nursing intervention is appropriate to implement?

A. Increase dietary sodium.

B. Limit dietary protein.

C. Limit fluid intake.

D. Assess for signs of infection.

ANS: D Rationale: Corticosteroids create a risk for infection due to immune suppression; infection control measures are a priority. When taking hydrocortisone daily, the client should not increase dietary sodium because of a risk for fluid retention. The client should maintain a diet high in protein to assist with healing and body repair. Fluids are not restricted.

PTS: 1 REF: p. 345, Use in Older Adults OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A client suffers from recurrent sinus infections. Which medication will be prescribed to decrease sinus inflammation?

A. Cortisone B. Prednisone C. Dexamethasone D. Mometasone ANS: D

Rationale: Mometasone is formulated for nasal inhalation and decreases sinus inflammation. Cortisone is the drug of choice for adrenal insufficiency. Prednisone is the glucocorticoid of choice in nonendocrine disorders in which anti-inflammatory, antiallergic, antistress, and immunosuppressive effects are desired. Dexamethasone is considered the corticosteroid of choice for cerebral edema.

PTS: 1 REF: p. 336, Table 17.1. Adrenal Corticosteroid Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. An adult client is admitted to the emergency department after a motorcycle crash.

Assessment confirms that the client is unconscious with a widened pulse pressure.

Currently, one eye is dilated and one constricted. What corticosteroid will most likely be administered parenterally to address the cause of the client’s signs/symptoms?

A. Cortisone B. Prednisone C. Dexamethasone D. Fluticasone ANS: C Rationale: Dexamethasone is considered the corticosteroid of cerebral edema. It is thought to penetrate the blood–brain barrier more readily and achieve higher concentrations in cerebrospinal fluid. Cortisone is the drug of choice for adrenal insufficiency. Prednisone is the glucocorticoid of choice in nonendocrine disorders in which anti-inflammatory, antiallergic, antistress, and immunosuppressive effects are desired. Fluticasone is administered by oral inhalation and not parenterally.

PTS: 1 REF: p. 348, Assessing for Therapeutic Effects OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 7. A client is being treated with corticosteroids for chronic adrenocortical insufficiency.

When should the client be instructed to take the medication?

A. Between 06:00 and 09:00 B. 12:00 pm C. Between 13:00 and 14:00 D. 21:00 ANS: A Rationale: Daily administration is required in cases of chronic adrenocortical insufficiency. The entire daily dose can be taken each morning, between 06:00 and 09:00. This schedule stimulates normal endogenous corticosteroid secretion. Later times would not produce the needed stimulation and desired endogenous corticosteroid secretion.

PTS: 1 REF: p. 347, Administering the Medication OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client is to be discharged with a prescription for prednisone to be administered every other day at 09:00. When implementing discharge teaching, what is the rationale for giving the medication every other day?

A. It reduces adverse effects.

B. It prolongs therapeutic effects.

C. It prevents steroid tolerance.

D. It increases effectiveness.

ANS: A Rationale: Alternative-day therapy allows rest periods so that adverse effects are decreased. Alternative-day therapy will not prolong the therapeutic effects, prevent steroid tolerance, or increase effectiveness since its focus is minimizing adverse effects.

PTS: 1 REF: p. 348, Alternate-Day Therapy OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A child is prescribed therapy with glucocorticoids. The child is placed on alternate-day therapy. What is the advantage of alternate-day therapy in this child?

A. The child will have less chance of infection.

B. It will protect the child from hyperglycemia.

C. The child will have less chance of hypertension.

D. Adherence will be increased.

ANS: A Rationale: Intermediate-acting glucocorticoids are the drugs of choice for alternate-day therapy and will decrease the susceptibility of infection by minimizing the adverse effects on the immune system. Alternative-day therapy will not protect from hyperglycemia. Alternate-day therapy will not affect blood pressure. Alternate-day therapy is not used as a strategy for improving adherence.

PTS: 1 REF: p. 348, Alternate-Day Therapy OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A client on a daily regimen of a corticosteroid contracts a streptococcal throat infection.

How will the health care provider alter the corticosteroid dosage?

A. Skip the dose while on antibiotics.

B. Double the dosage while on antibiotics.

C. Reduce the dose by half while on antibiotics.

D. Replace the corticosteroid with an antibiotic.

ANS: B Rationale: During an upper respiratory infection, the corticosteroid dosage should be doubled and reduced to maintenance when the infection is over. The client should not skip the dose, reduce the dose, or replace it with the antibiotic.

PTS: 1 REF: p. 348, Stress Dosage Therapy OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A client reporting long-standing pain in the right hip has been prescribed an intra-articular injection of a corticosteroid. The nurse should inform the client that improvement in both pain and mobility should be experienced in what time frame?

A. 5 to 7 days B. 1 to 2 weeks C. 2 to 8 weeks D. 2 to 4 months ANS: C Rationale: An intra-articular injection of corticosteroid provides decreased pain and improved movement in 2 to 8 weeks. Timelines less than that would not provide adequate time for the medication to impact the existing pain-causing inflammation. Two to four months would be more than sufficient time to affect the desired anti-inflammatory response.

PTS: 1 REF: p. 343, Arthritis OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A client, admitted with an acute asthma attack, has been using inhaled corticosteroids two times daily for several years. Based on this information in the client’s history, what should the nurse anticipate will be required in the client’s care?

A. The client will require an antibiotic to treat infection.

B. The client will require high doses of systemic drugs.

C. The client will need to be evaluated by a pulmonologist.

D. The client will have diminished tidal volume after treatment.

ANS: B

Rationale: The client who has taken inhaled steroids will require high doses of systemic drugs during acute attacks because aerosols are not effective. The client will only require antibiotics in the presence of infection. The client’s tidal volume should be increased with the administration of systemic corticosteroids, so a referral to a pulmonologist is likely unnecessary.. Opioids are not likely indicated since their focus is the management of pain.

PTS: 1 REF: p. 343, Asthma OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. A client with a diagnosis of breast cancer is administered a corticosteroid in addition to chemotherapy agents. What effect will the corticosteroids have on this client’s course of recovery?

A. The corticosteroid will decrease signs and symptoms of cancer.

B. The corticosteroid will alter the action of the chemotherapy agent.

C. The corticosteroid will decrease metastasis to distant sites.

D. The corticosteroid will decrease hepatic effects of the chemotherapy.

ANS: A Rationale: The administration of corticosteroid agents in cancer therapy will assist in decreasing symptoms associated with cancer, destroying cancer cells, and increasing the general effectiveness of the chemotherapy. The administration of the corticosteroid will not alter the action of the chemotherapy agent. The corticosteroid will not affect metastasis. The corticosteroid will not decrease hepatic effects.

PTS: 1 REF: p. 343, Cancer OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 14. A client diagnosed with a tumor of the spinal cord is prescribed a corticosteroid. What statement by the client demonstrates an accurate understanding of this treatment?

A. “This drug will cause my tumor to be more susceptible to treatment.”

B. “This drug will decrease my chance of infection and meningitis.”

C. “This drug won’t cure my cancer, but it may help me feel much better.”

D. “This drug will stop my cancer cells from growing further.”

ANS: C Rationale: Clients tend to feel better when taking corticosteroids, although the basic disease process may be unchanged. This effect most likely is a result of helping to reduce any allergic reaction to certain chemotherapy drugs. The corticosteroid will not allow the tumor to be more susceptible to treatment or to stop growing. The corticosteroid will not prevent meningitis.

PTS: 1 OBJ: 4

REF: p. 343, Other Central Nervous System Tumors

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 15. A client who is receiving chemotherapy is administered a corticosteroid agent. What is the most likely intended effect of this drug administration?

A. Decreased pulmonary inflammation B. Decreased diarrhea C. Decreased infection susceptibility D. Decreased nausea ANS: D Rationale: Corticosteroids have strong antiemetic effects; the mechanism is unknown.

Corticosteroids diminish pulmonary inflammation, but this reaction does not seem as effective related to chemotherapy administration. The administration of corticosteroids will decrease gastric inflammation but will not decrease diarrhea resulting from GI motility. The administration of corticosteroids will diminish the client’s ability to fight infection, not decrease the client’s risk for developing an infection.

PTS: 1 REF: p. 344, Postoperative Nausea and Vomiting OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A client has been on chronic corticosteroid therapy for several years and has been scheduled for a colonoscopy. How should the client’s corticosteroid therapy be altered to accommodate this impending stressful event?

A. The client should stop taking the corticosteroid 7 days prior to the procedure.

B. The client should continue taking the regular dose of the corticosteroid.

C. The client should temporarily change to IV administration of the corticosteroid.

D. The client should temporarily take a higher dose of the corticosteroid.

ANS: D Rationale: For people receiving chronic corticosteroid therapy, dosage must be increased during periods of stress or illness since the body will require additional cortisol that it is not capable of producing. None of the remaining options accurately describe the accommodation needed of corticosteroid therapy to provide for additional cortisol.

PTS: 1 REF: p. 348, Stress Dosage Therapy OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

17. An older adult client with a history of chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) has begun tapering off of prednisone. The nurse should prioritize which assessment(s) during this phase of the client’s care? Select all that apply.

A. Daily weights B. Level of consciousness assessment C. Dyspnea D. Vital signs E. Extremity edema ANS: A, C, E Rationale: When caring for a client with COPD and a history of heart failure who takes a tapering dose of prednisone, the concern is the development of signs and symptoms resulting from the decrease of available medication. If the client’s weight increases, edema is evident, and shortness of breath develops, the client should notify the primary health care provider. Vital signs and level of consciousness are not directly associated with a decrease in available prednisone.

PTS: 1 REF: p. 344, Chronic Obstructive Pulmonary Disease OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 18. An adult client has been prescribed oral prednisone for the treatment of an acute dermatological condition. When teaching this client about this course of treatment, what teaching point should the nurse emphasize?

A. The need to supplement prednisone with high doses of vitamin D B. The need to avoid drinking grapefruit juice for the duration of treatment C. The importance of gradually reducing rather than abruptly stopping the drug D. The importance of matching each day’s dose to the severity of symptoms ANS: C Rationale: Gradually tapering the dose is necessary for any systemic corticosteroid in order to allow the adrenal glands to resume normal function. It is not imperative to avoid grapefruit juice or take vitamin D supplements. Daily doses are not normally adjusted on the basis of short-term symptoms.

PTS: 1 REF: p. 345, Prevention of Acute Adrenocortical Insufficiency OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. A client has questioned why the prescribed corticosteroid cannot be discontinued as soon as relief of the symptoms has occurred. The nurse should explain the rationale for the client’s regimen based on which statement?

A. The serum half-life of many corticosteroids can exceed 3 months.

B. Corticosteroids are sequestered in hepatocytes and released over several weeks.

C. The HPA axis does not normally resume full function for several months.

D. Abrupt cessation of corticosteroid therapy can cause nephrotoxicity.

ANS: C Rationale: When steroids are given for purposes other than replacement and then discontinued, the HPA axis usually recovers within several weeks to months, but recovery may take a year. The necessity for tapering is not based on the half-life of the drugs, storage in the liver, or the potential for nephrotoxicity since these factors are not associated with the HPA axis.

PTS: 1 REF: p. 347, Administering the Medication OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 20. An adult client is preparing to begin corticosteroid treatment for rheumatoid arthritis.

When teaching this client about the appropriate use of corticosteroids, the nurse should include what teaching point?

A. “You will likely gain some weight after you start taking this drug.”

B. “Try to eat as many organic and natural foods as possible while taking this drug.”

C. “You might have some slight bleeding in your stool after you start this drug.”

D. “Ensure that you vary the times that you take your drug in order to maximize effectiveness.”

ANS: A Rationale: An initial weight gain is likely to occur with steroid treatment and is usually attributed to increased appetite. Organic foods are not necessary, and a consistent schedule of administration is imperative. Bleeding is not expected.

PTS: 1 REF: p. 349, General Considerations OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 21. A 12-year-old client, recently diagnosed with asthma, has been prescribed a corticosteroid to be administered by metered-dose inhaler. This drug achieves a therapeutic effect by which means?

A. By increasing the number of beta-adrenergic receptors B. By increasing the muscle tone in the smooth muscle of the trachea C. By increasing the permeability of the alveolar membrane D. By increasing the number of binding sites on erythrocytes ANS: A

Rationale: Corticosteroids increase the number of beta-adrenergic receptors and increase or restore responsiveness of beta receptors to beta-adrenergic bronchodilating drugs.

They do not influence the permeability of alveoli, muscle tone, or the structure of red blood cells.

PTS: 1 REF: p. 343, Asthma OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 22. An adult client diagnosed with Crohn’s disease several years ago is experiencing an exacerbation of symptoms. The nurse should anticipate the use of what corticosteroid?

A. Oral fludrocortisone B. Topical hydrocortisone C. Oral dexamethasone D. Oral prednisone ANS: D Rationale: In moderate Crohn’s disease, oral prednisone, 40 mg daily, is usually given until inflammation-related symptoms subside. None of the other listed corticosteroids are normally used in the treatment of IBD. Topical hydrocortisone is prescribed for inflammatory skin disorders. Addison’s disease and other sodium deficient disorders are generally treated with fludrocortisone. Dexamethasone is used to treat inflammatory conditions such as allergies, skin conditions, arthritis, and breathing disorders.

PTS: 1 REF: p. 344, Inflammatory Bowel Disease OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 17: Drug Therapy with Corticosteroids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

Chapter 18, Drug Therapy With Beta-Lactam Antibacterial Agents 1. A client is prescribed penicillin V orally for a strep throat. What is the mechanism of action of this medication?

A. It inhibits protein synthesis.

B. It lowers the pH of cellular contents.

C. It causes mutations.

D. It inhibits cell wall synthesis.

ANS: D Rationale: Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. Penicillin V does not inhibit protein synthesis, cause mutations, or lower the pH of a bacterium’s cellular contents.

PTS: 1 REF: p. 357, Penicillins OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client has a history of a life-threatening anaphylactic reaction to penicillin G. Which medication should not be administered to this client?

A. Lactulose B. Ketoconazole C. Kanamycin D. Cefadroxil ANS: D Rationale: Cefadroxil is a first-generation cephalosporin. Administration of cephalosporins or carbapenems should be avoided in individuals with life-threatening allergic reactions to penicillin. Lactulose reduces blood ammonia by resident intestinal bacteria. It is not contraindicated in the event of penicillin anaphylaxis. Ketoconazole is an antifungal and does not possess cross-sensitivity to penicillin. Kanamycin is an aminoglycoside and does not possess cross-sensitivity to penicillin.

PTS: 1 REF: p. 366, Contraindications OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. Which medication should be administered as prophylaxis for rheumatic fever?

A. Cyclacillin B. Amoxicillin C. Dicloxacillin D. Penicillin G ANS: D

Rationale: Rheumatic fever is an autoimmune inflammatory disorder. Penicillin G benzathine is administered as prophylaxis for rheumatic fever for its anti-inflammatory properties. Neither cyclacillin, amoxicillin, nor dicloxacillin is routinely administered for prophylaxis of rheumatic fever since they are less effective in treating autoimmune inflammatory disorders.

PTS: 1 REF: p. 360, Administering the Medication OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. Ampicillin–sulbactam is administered to a client with Staphylococcus aureus. What type of anti-infective is ampicillin–sulbactam?

A. Extended-spectrum antipseudomonal penicillin B. Penicillin–beta-lactamase inhibitor combination C. Cephalosporin D. Aminopenicillin ANS: B Rationale: Ampicillin–sulbactam is a penicillin–beta-lactamase inhibitor combination consisting of ampicillin and sulbactam. Sulbactam helps reduce the development of resistance developing to the ampicillin. Ampicillin–sulbactam is not classified as an extended-spectrum antipseudomonal penicillin, cephalosporin, or aminopenicillin.

PTS: 1 REF: p. 361, Penicillin–Beta-Lactamase Inhibitor Combinations OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 5. How does adding a beta-lactamase inhibitor agent help achieve a therapeutic effect when prescribed for otitis media?

A. It extends the spectrum of antibacterial activity of penicillin.

B. It extends the spectrum of the beta-lactamase inhibitor.

C. It decreases the side effects of high-dose penicillin.

D. It increases the absorption of the penicillin.

ANS: A Rationale: When combined with a penicillin, the beta-lactamase inhibitor protects the penicillin from destruction by bacterial enzymes and extends the penicillin’s spectrum of antimicrobial activity. The beta-lactamase inhibitor does not achieve any of the other effects described by the remaining options.

PTS: 1 REF: p. 361, Penicillin–Beta-Lactamase Inhibitor Combinations OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 6. A client is administered a third-generation cephalosporin. The broad-spectrum agents like cephalosporins are most effective in treating which type of microorganism?

A. Gram positive B. Gram negative C. Fungi D. Virus ANS: B Rationale: Cephalosporins are broad-spectrum agents with activity against both gram-positive and gram-negative bacteria. But they are, in general, less active against gram-positive organisms and more active against gram-negative ones. Cephalosporins are not effective against fungi or viruses.

PTS: 1 REF: p. 361, Cephalosporins OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. A client is diagnosed with febrile neutropenia. Which medication is most effective in treating this client?

A. Dicloxacillin sodium B. Meropenem C. Nafcillin sodium D. Oxacillin sodium ANS: B Rationale: Meropenem is used in clients who have been diagnosed with febrile neutropenia. Dicloxacillin, nafcillin, and oxacillin are not used to treat febrile neutropenia.

PTS: 1 REF: p. 370, Other Drugs in the Class OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. What organ system is responsible for the excretion of cefotaxime sodium from the body?

A. Respiratory B. Hepatic C. Renal D. Gastrointestinal ANS: C Rationale: Cefotaxime sodium, like all cephalosporins, is excreted by the kidneys.

Cefotaxime is not excreted by the lungs, liver, or GI tract.

PTS: 1 REF: p. 360, Assessing for Therapeutic Effects OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. Which is the drug of choice for surgical prophylaxis associated with a vaginal hysterectomy?

A. Cefadroxil B. Cefazolin sodium C. Cephalexin D. Cephradine ANS: B Rationale: Cefazolin sodium is the drug of choice for surgical prophylaxis in most surgical procedures since it has demonstrated effective management of potential bacterial-related infections. While cefadroxil, cephalexin, and cephradine are all first-generation cephalosporins, they are not utilized as the drug of choice for surgical prophylaxis.

PTS: 1 REF: p. 361, First-Generation Cephalosporins OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 10. A client is diagnosed with B. fragilis, an anaerobic organism resistant to most drugs.

What is the drug of choice to treat this microorganism?

A. Cefaclor B. Cefamandole nafate C. Cefoxitin D. Cefuroxime sodium ANS: C Rationale: Cefoxitin is active against B. fragilis, an anaerobic organism resistant to most drugs. While cefaclor, cefamandole nafate, and cefuroxime sodium are all second-generation cephalosporins, they are not the drug of choice for B. fragilis since the organism has demonstrated resistance to them.

PTS: 1 REF: p. 362, Second-Generation Cephalosporins OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 11. A client is to receive imipenem–cilastatin IM to treat P. aeruginosa. What should imipenem–cilastatin be mixed with prior to administering intramuscularly?

A. Meropenem B. Gentamicin C. Lidocaine D. Epinephrine ANS: C Rationale: When preparing imipenem–cilastatin for IM injection, lidocaine is added to decrease pain. Meropenem, gentamicin, and epinephrine are not added to imipenem–cilastatin since they would not affect pain.

PTS: 1 REF: p. 370, Administering the Medication OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A client is administered probenecid with a penicillin. The client asks why this drug is being administered. What is the best response the nurse can state to the client?

A. “Probenecid will increase the serum level of penicillin.”

B. “Probenecid prevents an anaphylactic reaction.”

C. “Probenecid will break down the bacterial cell wall.”

D. “Probenecid decreases the amount of penicillin needed.”

ANS: A Rationale: Probenecid can be given concurrently with penicillins to increase serum drug levels. Probenecid will not prevent an anaphylactic reaction. Probenecid will not break down the bacterial cell wall. Probenecid will not decrease the amount of penicillin needed for the treatment of infection.

PTS: 1 REF: p. 368, Cephalosporin–Beta-Lactamase Inhibitor Combinations OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A client is prescribed aztreonam. What is the major advantage of this monobactam over the aminoglycosides in treating P. aeruginosa?

A. It is a lower-cost medication.

B. It is administered orally.

C. It causes less GI distress.

D. It has lower risk for hearing loss.

ANS: D Rationale: Aztreonam is effective against gram-negative bacteria similar to aminoglycosides, but the drug does not cause kidney damage or hearing loss. Aztreonam is not a lower-cost medication. Aztreonam is not administered orally. Aztreonam does not cause less GI upset.

PTS: 1 REF: p. 370, Other Drugs in the Class OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. A client is prescribed imipenem–cilastatin for the treatment of an E. coli infection. The nurse should be aware that cilastatin is combined with the imipenem for what purpose?

A. To eliminate adverse effects of imipenem administration B. To inhibit the destruction of imipenem C. To potentiate the therapeutic effects of imipenem D. To allow imipenem to cross the blood–brain barrier ANS: A Rationale: Cilastatin inhibits the destruction of imipenem, increasing the urinary concentration of imipenem and reducing its potential renal toxicity. Cilastatin’s effect on imipenem does not include improving its ability to cross the blood–brain barrier, increasing its effects, or eliminating all of its adverse effects.

PTS: 1 REF: p. 368, Use OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 15. An older adult client, diagnosed with community-acquired pneumonia, has been prescribed aztreonam. What action should the nurse perform before administering the first dose?

A. Administer a 500-mL bolus of normal saline.

B. Confirm the client’s allergy status.

C. Swab the client’s nares for the presence of MRSA. D. Teach the client to expect discolored urine during treatment.

ANS: B Rationale: As with all antibiotics, it is important to assess the client’s allergy status prior to drug administration. This is especially important before the initial dose. An IV bolus is unnecessary, and discoloration of urine is not expected. MRSA testing is not relevant to aztreonam administration.

PTS: 1 REF: p. 367, General Considerations OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A client previously experienced an anaphylactic reaction to penicillin G. Which medication should not be administered to this client due to the potential for cross-sensitivity?

A. Lactulose

B. Ketoconazole C. Kanamycin D. Cefadroxil ANS: D Rationale: Cefadroxil is a cephalosporin. Administration of cephalosporins or carbapenems should be avoided if possible in people with life-threatening allergic reactions to penicillin. Lactulose reduces blood ammonia by resident intestinal bacteria.

It is not contraindicated in the event of penicillin anaphylaxis. Ketoconazole is an antifungal and does not possess cross-sensitivity to penicillin. Kanamycin is an aminoglycoside and does not possess cross-sensitivity to penicillin.

PTS: 1 REF: p. 366, Contraindications OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. When conducting health education for a client prescribed an oral penicillin for an infection caused by gram-negative bacilli, the nurse should emphasize which instructions?

A. The need to take the medication on an empty stomach B. The fact that a mild rash frequently follows the first few doses C. The need to increase fluid intake for the duration of treatment D. The fact that the drug should be discontinued once symptoms subside ANS: A Rationale: Most penicillins should be best taken on an empty stomach since less medication is absorbed with food in the stomach. Increased fluid intake is not normally necessary. A rash is an unexpected finding that should be reported promptly. The client should take the full course of antibiotics to support the effectiveness of the medication.

PTS: 1 REF: p. 360, Self- or Caregiver Administration OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A client diagnosed with infective endocarditis would be most effectively treated with which medication?

A. Dicloxacillin B. Ampicillin C. Nafcillin D. Oxacillin ANS: B

Rationale: Health care providers use ampicillin in the treatment or prophylaxis of infective endocarditis. Ampicillin is effective against bacterial infections. Dicloxacillin, nafcillin, and oxacillin are typically used to treat methicillin-resistant Staphylococcus aureus.

PTS: 1 REF: p. 357, Use OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 19. Which drug is a first-generation cephalosporin used as a surgical prophylaxis?

A. Cefotetan B. Cefoxitin C. Ceftriaxone D. Cefazolin ANS: D Rationale: Cefazolin is a first-generation cephalosporin. Cefotetan and cefoxitin belong to the second generation, and ceftriaxone is a third-generation cephalosporin.

PTS: 1 REF: p. 361, First-Generation Cephalosporins OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 20. Oral ampicillin has been ordered for a client whose urinary tract infection will be treated in a home setting. When providing antibiotic teaching to this client, the nurse should stress which instruction?

A. Take the first dose together with diphenhydramine to reduce the chance of an allergic reaction.

B. Take the drug immediately before a meal, unless the meal will contain large amounts of fat.

C. Drink a full glass of water when taking a dose of the drug.

D. Taper off the drug rather than abruptly stopping it.

ANS: C Rationale: Clients taking penicillins should take oral doses with a full glass of water to ensure sufficient hydration while taking the medication. The drugs should otherwise be taken on an empty stomach. Tapering is unnecessary, and it is not advised to take the drug with diphenhydramine in an effort to reduce the allergy risk.

PTS: 1 REF: p. 360, Self- or Caregiver Administration OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

21. What aspect of a client’s history would contraindicate imipenem–cilastatin drug therapy?

A. The client has a history of type 1 diabetes mellitus.

B. The client is showing signs and symptoms of fluid volume excess.

C. The client’s most recent creatinine level was 140 mol/L (high).

D. The client has a documented allergy to penicillin.

ANS: D Rationale: It is important to avoid administering imipenem–cilastatin and the other carbapenems to people with life-threatening allergic reactions to penicillin. Diabetes, slightly increased creatinine levels, and fluid overload do not necessarily contraindicate the use of imipenem–cilastatin.

PTS: 1 REF: p. 368, Action OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 22. What potential adverse reaction is most likely to develop during cefazolin therapy?

A. Gastrointestinal upset B. Dry skin and pruritus C. Drowsiness D. Orthostatic hypotension ANS: A Rationale: Adverse effects to cefazolin and the other cephalosporins are similar to those of most other antibiotics: abdominal pain, diarrhea, gastritis, nausea, and vomiting because of its effect on the gastrointestinal lining. Integumentary, neurological, and blood pressure changes are atypical.

PTS: 1 REF: p. 361, Cephalosporins OBJ: 6 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 23. An older adult client responded well to treatment with a third-generation cephalosporin.

After being largely symptom free for 48 hours, the client has developed a fever of 38.6°C and an elevated white cell count. What phenomenon may account for this client’s current clinical presentation?

A. The client may be infected with microorganisms that were resistant to the cephalosporin.

B. The client may be experiencing a delayed (type IV) hypersensitivity reaction to the cephalosporin.

C. The client may be developing glomerulonephritis secondary to the nephrotoxic cephalosporin.

D. The cephalosporin may have initially caused leukopenia and made the client susceptible to secondary infection.

ANS: A Rationale: Clients treated with cephalosporins may be vulnerable to superinfections (infection after a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier). Delayed hypersensitivity and renal involvement are highly unlikely. Antibiotics do not cause leukopenia.

PTS: 1 REF: p. 362, Third-Generation Cephalosporins OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 18: Drug Therapy With Beta-Lactam Antibacterial Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

Chapter 19, Drug Therapy With Aminoglycosides and Fluoroquinolones 1. A client is diagnosed with an infection attributable to the gram-negative microorganism Pseudomonas. Which anti-infective agent is most reliable in treating this microorganism?

A. Aminoglycoside B. Antifungal C. Aminopenicillin D. GABA analog ANS: A Rationale: Aminoglycosides penetrate the cell walls of susceptible bacteria. As a result, the bacterial cell membrane becomes defective and cannot synthesize the proteins necessary for their function and replication. Aminoglycosides are used to treat infections caused by gram-negative microorganisms, such as Pseudomonas. Antifungals are effective in the resolution of fungus infections. Aminopenicillin agents are not effective in treating gram-negative microorganisms. A GABA analog is used to treat pain related to neuropathy.

PTS: 1 REF: p. 376, Aminoglycosides OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client is diagnosed with a gram-negative infection and is prescribed an aminoglycoside. What is the action of an aminoglycoside?

A. It blocks protein synthesis of the cell wall.

B. It blocks the process of DNA replication.

C. It destroys the integrity of the cell wall structure.

D. It increases white blood cells viability.

ANS: A Rationale: Aminoglycosides penetrate the cell walls of susceptible bacteria and bind irreversibly to 30S ribosomes, intracellular structures that synthesize proteins. Actions associated with aminoglycosides do not include blocking DNA replication, destroying cell wall structure, or increasing white blood cells.

PTS: 1 REF: p. 376, Aminoglycosides OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. The nurse is preparing to administer gentamicin when the client suddenly mentions having experienced diminished hearing. What action should the nurse take based on this statement?

A. Administer the dosage, and notify the health care provider of the alteration in hearing.

B. Hold the dosage, and notify the health care provider of the alteration in hearing.

C. Administer the dosage, and report the alteration in hearing to the audiologist.

D. Hold the dosage, and document the finding in the nurses’ notes.

ANS: B Rationale: Aminoglycosides accumulate in high concentrations in the inner ear, damaging sensory cells in the cochlea and vestibular apparatus. This accumulative effect increases the risk for the development of ototoxicity, causing in some cases irreversible damage to one’s hearing. The medication should be held and alteration in hearing reported to the health care provider. The continued administration of the medication will only cause more damage to the cochlea and vestibular apparatus. Holding the medication and documenting the information in the nurses’ notes will not allow for a new anti-infective to be administered and for the hearing to be assessed.

PTS: 1 REF: p. 377, Use in Patients With Critical Illness OBJ: 3 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client is diagnosed with multidrug-resistant tuberculosis. Which aminoglycoside medication is used in a 4- to 6-drug regimen?

A. Tetracycline hydrochloride B. Amoxicillin C. Sulfadiazine D. Streptomycin ANS: D Rationale: Streptomycin may be used as part of a 4- to 6-drug regimen for treatment of multidrug-resistant tuberculosis. The therapy includes four distinct drugs prescribed for a 6-month period. Tetracycline, amoxicillin, and sulfadiazine are not aminoglycosides or drugs of choice for multidrug-resistant tuberculosis.

PTS: 1 REF: p. 381, Table 19.3. DRUGS AT A GLANCE: Fluoroquinolones OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. A client scheduled for a bowel resection is to receive neomycin sulfate by mouth. The client asks the nurse the purpose of this medication. What is the most appropriate response the nurse can provide to the client?

A. “It will prevent renal damage from occurring.”

B. “It will minimize the risk of ototoxicity.”

C. “It will decrease the growth of intestinal bacteria.”

D. “It decreases the risk of airborne contamination of the wound.”

ANS: C Rationale: Neomycin can be given before bowel surgery to suppress intestinal bacterial growth. Neomycin when administered orally is poorly absorbed in the GI tract and so exerts local bactericide effect there. The administration of neomycin will not prevent renal damage or ototoxicity but can actually increase the risk. It will also not affect the risk of airborne contamination since is focused on local effects in the GI tract.

PTS: 1 REF: p. 380, Other Drugs in the Class OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A client diagnosed with a genitourinary infection is being treated with a fluoroquinolone.

What is the advantage of a fluoroquinolone over an aminoglycoside?

A. The fluoroquinolone does not have adverse effects.

B. The fluoroquinolone can be given orally.

C. The fluoroquinolone has a nearly immediate peak.

D. The fluoroquinolone has a broader spectrum.

ANS: B Rationale: Newer fluoroquinolones have been developed with a broader spectrum of activity that provides improved coverage of gram-positive organisms and, in one case, anaerobes. Fluoroquinolones are often given orally. Like all drugs, they have adverse effects. Peak levels are not immediately achieved, and nor they do not have a broader spectrum than an aminoglycoside.

PTS: 1 REF: p. 380, Fluoroquinolones OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. A client is receiving gentamicin to treat meningitis. The health care provider has ordered a peak serum level be drawn in association with the 07:00 dose, which will finish infusing at 07:30. When should the peak serum level be drawn?

A. 08:00 B. 09:00 C. 10:00 D. 12:00 ANS: A Rationale: With conventional dosing, it is necessary to take gentamicin peak levels 30 minutes after the end of a 30-minute IV infusion. Thus, 08:00 is the optimal peak time to assess the serum level of gentamicin. None of the other options would provide that assessment.

PTS: 1 REF: p. 376, Aminoglycosides OBJ: 5 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client is prescribed ciprofloxacin. Which nursing intervention will best prevent the possible development of crystalluria?

A. The nurse should limit oral fluids to 500 mL/day.

B. The nurse should encourage fluid intake of 2000 mL/day..

C. The nurse should insert a urinary catheter.

D. The nurse should administer phenazopyridine.

ANS: B Rationale: Guidelines to decrease the incidence and severity of adverse effects include keeping clients well hydrated to decrease drug concentrations in serum body tissues. The administration of 500 mL is not a sufficient amount to prevent crystalluria. Neither the administration of phenazopyridine nor a urinary catheter will address the need for adequate hydration to prevent the development of crystalluria.

PTS: 1 REF: p. 381, Use in Older Adults OBJ: 6 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. The nurse is caring for a client who is receiving gentamicin therapy. Why will the nurse monitor the results of a serum gentamicin level?

A. To identify possible changes in the client’s serum osmolality B. To identify whether the drug is at a therapeutic level C. To identify whether the drug is causing hepatotoxicity D. To identify possible hemolysis following administration ANS: B Rationale: Measurement of both peak and trough levels of gentamicin helps maintain therapeutic serum levels without excessive toxicity. Gentamicin is neither nephrotoxic nor hepatotoxic. Hematological changes are not assessed by measuring serum drug levels.

PTS: 1 REF: p. 376, Aminoglycosides OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. A client with a diagnosis of osteomyelitis will soon begin treatment with gentamicin.

Which schedule is most likely to maximize efficacy and minimize nephrotoxicity?

A. Gentamicin 500 mg IV OD at 12:00 B. Gentamicin 250 mg PO BID at 07:30 and 19:30 C. Gentamicin 500 mg PO TID at 08:00, 12:00, and 19:00 D. Gentamicin 125 mg IV QID at 06:00, 12:00, 18:00, and 24:00 ANS: A

Rationale: The once daily administration method uses higher doses to produce high initial drug concentrations, with no repeat dosing until the serum concentration is quite low (typically 24 hours later). The rationale for this dosing approach is a potential increase in efficacy with a reduced incidence of nephrotoxicity. Gentamicin is not administered orally.

PTS: 1 REF: p. 378, Table 19.2. DRUGS AT A GLANCE: Aminoglycosides OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. Which client has the highest risk of developing ototoxicity secondary to gentamicin?

A. A client who received the first dose of IV gentamicin 12 hours ago B. A client who has required repeated courses of gentamicin over the past several months C. A client who has a Pseudomonas infection but who has a hypersensitivity to penicillins D. A client who is immunocompromised and who is being treated with gentamicin ANS: B Rationale: Ototoxicity (auditory or vestibular) may develop after extended use of gentamicin and may not be reversible. Neither penicillin allergies nor an immunocompromised status are considered risk factors for ototoxicity.

PTS: 1 REF: p. 376, Pharmacokinetics OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 12. What is the postantibiotic effect of gentamicin therapy?

A. The tendency for clients to exhibit symptoms mimicking hypersensitivity after drug administration B. The tendency for adverse effects of a drug to be masked during administration C. The ability of microorganisms to proliferate between doses of antibiotics D. The ability of an antibiotic to kill bacteria even when serum concentrations are low ANS: D Rationale: Postantibiotic effect is the term used to identify that aminoglycosides continue killing microorganisms even at low serum concentrations. None of the remaining options accurately describe this effect.

PTS: 1 REF: p. 379, Nursing Implications OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

13. Extreme caution would be necessary with the use of gentamicin in which client?

A. A client who is morbidly obese and who has primary hypertension B. A client who has chronic renal failure secondary to diabetes mellitus C. A client who has bipolar disorder and who is on long-term lithium therapy D. A client who has an atrioventricular block ANS: B Rationale: Gentamicin is nephrotoxic, and with impaired renal function, a reduction in dosage is essential. Heart blocks, obesity, and lithium therapy do not severely complicate, or contraindicate, the use of an aminoglycoside since they are not associated with nephrotoxicity.

PTS: 1 REF: p. 377, Use in Patients With Renal Impairment OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. A client has been prescribed ciprofloxacin after being diagnosed with a sinus infection.

What medication should the client avoid taking concurrently with ciprofloxacin?

A. Antacids B. Calcium channel blockers C. Beta-adrenergic blockers D. Diuretics ANS: A Rationale: Clients should space out ciprofloxacin administration 4 to 6 hours with any of the following: antacids, multivitamins, sucralfate, or other products containing calcium, iron, or zinc. Absorption of ciprofloxacin may be impaired when these substances are administered together with ciprofloxacin, resulting in a decreased antibiotic effect. None of the other options present a barrier to ciprofloxacin absorption.

PTS: 1 REF: p. 382, Preventing Interactions OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. An older adult client has a feeding tube in place to manage dysphagia. After developing an infected pressure ulcer, ciprofloxacin suspension has been prescribed via feeding tube. How should the nurse follow-up this prescription?

A. The nurse should flush the client’s feeding tube with free water before and after administration of the ciprofloxacin suspension.

B. The nurse should dilute the suspension thoroughly before administration.

C. The nurse should liaise with the health care provider to provide an alternative route of administration.

D. The nurse should administer small, frequent doses of the drug to minimize GI upset.

ANS: C Rationale: Administration of the oral suspension of ciprofloxacin via feeding tubes should not occur, because the oil-based formulation tends to adhere to the feeding tube.

An alternative route is consequently necessary. None of the other options would address the problem of adherence sufficiently.

PTS: 1 REF: p. 382, Use in Patients Receiving Home Care OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A client has been prescribed ciprofloxacin IV for the treatment of cellulitis. After initiating the infusion of the client’s first scheduled dose, the client develops a pronounced rash on the chest and arms. How should the nurse respond initially to this event?

A. Discontinue the infusion and inform the health care provider promptly.

B. Slow down the rate so that the infusion takes place over 2 hours.

C. Administer oral diphenhydramine to the client during the infusion.

D. Administer an STAT dose of acetylcysteine.

ANS: A Rationale: Severe hypersensitivity reactions have occurred with the administration of fluoroquinolones. The nurse discontinues the antibiotic immediately if skin rash or other signs or symptoms occur. Slowing down the rate of infusion would not address the problem as it relates to exposure to the medication. Neither the administration of acetylcysteine nor diphenhydramine is indicated initially. Acetylcysteine is prescribed to treat thick mucus lung secretions. Treatment with diphenhydramine would be ineffective if the ciprofloxacin was not first discontinued.

PTS: 1 REF: p. 382, Adverse Effects OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. The nurse prepares to administer gentamicin intravenous every 8 hours to an older adult client. Which interventions should the nurse provide to decrease the risk for nephrotoxicity and ototoxicity? Select all that apply.

A. Draw the trough level 30 to 60 minutes after drug is administered, and report a level above 10 to 12 mcg/mL. B. Obtain baseline assessment of cranial nerve eight and periodic measurements during therapy.

C. Monitor estimated creatinine clearance and BUN at baseline and periodically during therapy.

D. Obtain peak level before administering the next dose of drug, and report a level above 2 mcg/mL. E. Provide the client with 2 to 3 L of noncaffeinated oral fluids daily, unless

contraindicated.

ANS: B, C, E Rationale: The trough or lowest drug concentration is obtained before administering the next scheduled dose, and the nurse would report a level above 2 mcg/mL. The peak of the drug occurs 30 minutes after the 30-minute infusion has ended. The nurse would report levels above 10 to 12 mcg/mL. When the drug levels are elevated, ototoxicity and nephrotoxicity are more likely to occur. The nurse would test cranial nerve eight for hearing and any presence of vertigo (dizziness) or tinnitus (ringing in the ears) at baseline and periodically during therapy and report changes immediately to the prescriber. The estimated creatinine clearance provides information about the glomerular filtration rate and the kidney’s ability to excrete the drug properly. The blood urea nitrogen (BUN) level reflects hydration. The client must be hydrated before beginning therapy and during to help prevent nephrotoxicity. The nurse would provide adequate hydration of 2 to 3 L with noncaffeinated fluids to help flush out the drug’s metabolites to prevent nephrotoxicity.

PTS: 1 REF: p. 376, Aminoglycosides OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 18. The nurse prepares to administer ciprofloxacin 250 mg per enteral feeding tube every 12 hours to the adult client diagnosed with pneumonia and a history of renal impairment in the critical care unit. Which measures should the nurse provide for safe and effective drug administration? Select all that apply.

A. Stop the enteral tube feeding for 1 hour before administering the drug, and resume feeding 2 hours after providing the drug.

B. Wait 1 hour before administering some other medications the client takes: sucralfate, multivitamin, iron supplement.

C. Examine the random peak and trough level, and report abnormal levels promptly to prevent further nephrotoxicity.

D. Crush the immediate release tablet, and mix with water before administering the medication via the enteral tube.

E. Monitor serum creatinine and blood urea nitrogen (BUN), and report any changes from baseline to the prescriber.

ANS: A, D, E Rationale: The nurse would stop enteral feeding for 1 hour before and 2 hours after the administration of the antibiotic because the enteral feedings reduce the serum concentration of ciprofloxacin. The nurse needs to space sucralfate, multivitamin, and iron supplement by 4 to 6 hours to prevent absorption problems with ciprofloxacin. The drug has no peak and trough level. The nurse would crush the immediate release tablet and mix it with water before administering the drug via the enteral tube. The nurse would also flush with water before and after each drug given via the tube to prevent clogging the narrow lumen. The nurse would monitor serum creatinine and BUN and report any changes from the client’s baseline that would indicate worsening of the renal system.

PTS: 1 REF: p. 382, Preventing Interactions OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 19: Drug Therapy With Aminoglycosides and Fluoroquinolones KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select

Chapter 20, Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics 1. A client has been prescribed phenazopyridine for urinary tract symptoms related to an infection. What is the most appropriate response by the nurse when the client asks why the medication has been prescribed?

A. “This medicine is used to treat urinary retention.”

B. “This medicine will stop the blood in the urine.”

C. “This medicine will decrease the pain of your infection.”

D. “The medicine will prevent hesitancy when you’re passing urine.”

ANS: C Rationale: Phenazopyridine, a urinary analgesic, is given to relieve pain associated with urinary tract infection. It is not administered for urinary retention, hematuria, or hesitancy since its function is to act directly on the urinary tract mucosa to help eliminate the sensations of burning, urgency, frequency, and irritation.

PTS: 1 REF: p. 396, Phenazopyridine OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A client is given tetracycline to treat acne-related skin eruptions. How does tetracycline work?

A. It binds to the 30S ribosome to inhibit protein synthesis.

B. It reduces central nervous system stimulation.

C. It is a beta-lactam antibiotic inhibiting cell wall synthesis.

D. It works on the final stage of cell wall synthesis.

ANS: A Rationale: Tetracycline binds with the 30S ribosome to inhibit protein synthesis. It has no effect on the central nervous system. The penicillin agents like ampicillin are beta-lactam antibiotics that work in disrupting the final stage of cell wall synthesis.

PTS: 1 REF: p. 388, Action OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 3. A client is seen in the clinic after a bite from a tick. The client has a rash over the arms and legs and arthritic pain in the joints. What drug would the nurse expect the health care provider to prescribe?

A. Ibuprofen B. Tetracycline C. Phenazopyridine D. Nitrofurantoin ANS: B

Rationale: Antibiotics like tetracyclines are useful in treating some animal bites and Lyme’s disease through their ability to inhibit microbial protein synthesis. Ibuprofen is administered for the inflammation associated with the arthritic pain but not to treat the infection. Phenazopyridine, a urinary analgesic, is not administered for Lyme’s disease.

Nitrofurantoin is administered for urinary tract infections.

PTS: 1 REF: p. 388, Use OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A teenager asks the nurse how tetracycline will improve acne. Which statement should the nurse provide to the client regarding the action of tetracycline?

A. “Tetracycline decreases redness and swelling of the pustules.”

B. “Tetracycline treats the Chlamydia organism that causes acne.”

C. “Tetracycline is used in combination with doxycycline to treat acne.”

D. “Tetracycline interferes with the production of free fatty acids.”

ANS: D Rationale: Tetracyclines interfere with the production of free fatty acids and decrease Propionibacterium acnes in sebum. Tetracycline will decrease redness and swelling, but this response is not the direct action of the medication. Tetracycline treats Chlamydia, but Chlamydia is not the cause of acne. Tetracycline is not used in combination with doxycycline.

PTS: 1 REF: p. 388, Action OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A client who sustained a burn from a gas grill has been prescribed a sulfonamide to prevent a burn infection. What route is preferred in the prevention of a burn infection?

A. Intrathecal B. Topical C. Parenteral D. Oral ANS: B Rationale: Topical sulfonamides are used in prevention of burn wound infections since neither pus, serum, nor necrotic tissue interferes with its effectiveness. Sulfonamides are not administered intrathecally (via an injection into the spinal canal or into the subarachnoid space). None of the other administration routes are recommended for the prevention of a burn infection since they are better suited for systemic infections rather than local ones.

PTS: 1 REF: p. 393, Action OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary

Antiseptics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A client is being treated for a urinary tract infection with trimethoprim–sulfamethoxazole. What assessment should the nurse make prior to the administration of the medication?

A. Assessing for the presence of asthma B. Assessing for hypertension C. Assessing for diabetes mellitus D. Assessing for renal insufficiency ANS: D Rationale: Both tetracyclines and sulfonamides are contraindicated in clients with renal failure because of the risk of increased injury since they are excreted via the kidneys.

These medications are not contraindicated in clients with asthma, hypertension, or diabetes mellitus unless there is a preexisting renal issue.

PTS: 1 REF: p. 394, Use in Patients With Renal Impairment OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client is started on sulfamethoxazole–trimethoprim for a urinary infection. What adverse effect should the nurse assess with this client?

A. Liver toxicity B. Renal damage C. Bone marrow depression D. Congestive heart failure ANS: B Rationale: Renal damage is a contraindication to the administration of SMZ-TMP; the drug has been observed to cause acute renal failure. It does not cause liver toxicity, bone marrow depression, or congestive heart failure.

PTS: 1 REF: p. 394, Contraindications OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client is administered a sulfonamide for a urinary tract infection. Which intervention is most appropriate to increase alkalinity of the client’s urine and, thus, the medication’s effectiveness?

A. Provide at least 2000 mL of water daily.

B. Administer sodium bicarbonate.

C. Recommend a tub bath every evening.

D. Provide orange juice daily.

ANS: B Rationale: The urine can be alkalinized by giving sodium bicarbonate to increase the rate of urinary excretion, raising the levels of sulfonamides in the urinary tract, and increasing effectiveness in the treatment of urinary tract infections. Sufficient water is important but will not increase alkalinity. Taking of tub baths is not recommended, because doing so increases the risk of urinary tract infection. The administration of orange juice increases acid, not alkalinity.

PTS: 1 REF: p. 394, Drugs that Increase the Effects of TMP-SMZ OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. What is the rationale for not administering tetracycline to children under the age of 8 years?

A. It will not treat the infection effectively.

B. It will increase the risk of heart failure.

C. It will interfere with enamel development.

D. It will increase the risk for future infections.

ANS: C Rationale: Tetracyclines should not be used in children younger than 8 years because of their effects on teeth and bones. In teeth, the drugs interfere with enamel development.

The administration of tetracycline will not increase the risk of heart failure or the risk of future infections in children..

PTS: 1 REF: p. 388, Use in Children OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. A client seeking care for the treatment of a urinary tract infection (UTI) was prescribed nitrofurantoin. What change in the client’s health status would prompt the use of an alternative medication?

A. The client develops a fluid volume deficit.

B. Urinalysis reveals the presence of ketones.

C. The client develops leukocytosis.

D. The client’s UTI progresses to urosepsis.

ANS: D Rationale: Urinary antiseptics may be bactericidal for sensitive organisms in the urinary tract because these drugs are concentrated in renal tubules and reach high levels in urine.

They are not used in urosepsis conditions (systemic infections in the blood) because they do not attain therapeutic plasma levels. Consequently, the development of urosepsis would necessitate a systemic antibiotic. Fluid deficit, ketones in the urine, and elevated white cells would not necessarily contraindicate the use of nitrofurantoin. These conditions would be treated separately.

PTS: 1 REF: p. 396, Nitrofurantoin OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A public health nurse interacts with many members of the community who are at risk for sexually transmitted infections (STIs). The nurse should anticipate the use of tetracycline in a client who is diagnosed with what STI? A. Vaginitis B. Chlamydia C. Human papillomavirus D. Trichomoniasis ANS: B Rationale: The action of tetracycline makes it effective for treating Mycoplasma, Chlamydia, and Rickettsia. It is not efficacious in the treatment of trichomoniasis, HPV, or vaginitis.

PTS: 1 REF: p. 388, Tetracyclines OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A nurse is preparing to administer a client’s first scheduled dose of tetracycline. The nurse should first ensure that the client has not recently eaten what type of foods?

A. Dairy products B. Leafy green vegetables C. Any high-fat foods D. Acidic foods ANS: A Rationale: The combination of tetracycline with metallic ions such as aluminum, calcium, iron, or magnesium inhibits tetracycline absorption. It is important not to take tetracycline with dairy products, antacids, or iron supplements. None of other foods present significant amounts of metallic ions.

PTS: 1 REF: p. 390, Preventing Interactions OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A young adult client’s acne has responded well to treatment with tetracycline. However, the client has now returned to the clinic 6 weeks later with signs and symptoms of oral candidiasis. The nurse should recognize that this client’s current health problem is likely attributable to which occurrence?

A. A delayed (type IV) hypersensitivity reaction

B. The fact that the client may have chewed the capsules prior to swallowing them C. Superinfection following the eradication of normal oral flora D. A type I hypersensitivity reaction ANS: C Rationale: Candidal superinfections may result from the use of tetracycline. The superinfection results from the elimination of normal flora and is not a hypersensitivity reaction. This is not the result of physical contact between the drug and the oral mucosa.

Type IV hypersensitivity is often called delayed-type hypersensitivity as the reaction takes 2 to 3 days to develop. A type I hypersensitivity reaction is triggered by an innocuous foreign substance (like dust, pollen, or animal dander) that would cause no problems in the majority of people.

PTS: 1 REF: p. 391, Assessing for Adverse Effects OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. A 9-year-old client has been admitted to the pediatric unit after being diagnosed with pertussis. The pediatric nurse is processing the client’s admission orders and notes that IV demeclocycline has been prescribed. After beginning this treatment, the nurse should confirm the results of what laboratory test?

A. Mean corpuscular volume (MCV) B. D-dimer C. Bilirubin D. Blood urea nitrogen (BUN) ANS: D Rationale: When administering demeclocycline, it is important to monitor the client’s BUN. Increases in the BUN are secondary to antianabolic effects. Bilirubin levels would only be important in the presence of liver toxicity. A D-dimer test is a blood test that measures a substance that is released when a blood clot breaks up. Health care providers prescribe the D-dimer test, along with other lab tests and imaging scans, to help check for blood-clotting problems. Mean corpuscular volume (MCV) laboratory test, as part of a standard complete blood count (CBC), is used along with other RBC indices (MCH and MCHC) to help classify the cause of anemia based on red cell morphology. Neither a D-dimer nor MCV values are relevant to this situation.

PTS: 1 REF: p. 391, Other Drugs in the Class OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. The nurse prepares to administer tetracycline 500 mg PO every 6 hours to an adult client newly diagnosed with Lyme’s disease. The client takes an oral contraceptive for birth control. Which measures would the nurse provide for safe and effective drug administration? Select all that apply.

A. Assess baseline renal and hepatic profiles, complete blood count, and human chorionic gonadotropin (HCG).

B. Administer the medication with milk or food to decrease gastrointestinal side effects.

C. Instruct the client about the importance of using another form of contraceptive during the antibiotic usage.

D. Educate importance of wearing sunscreen and protective clothing when in the sun while taking the drug.

E. Report severe nausea and vomiting, diarrhea, rash, or perineal itching to the prescriber.

ANS: A, C, D, E Rationale: The nurse should assess and report abnormal serum creatinine and blood urea nitrogen reflecting impaired renal clearance, a contraindication for the drug. Abnormal liver enzymes are a contraindication since the drug could lead to liver failure. A baseline complete blood count is needed to compare with future labs for anemia, an adverse effect, and to determine if the white blood count decreases, which is an indication that the drug is effective. The HCG is assessed because pregnancy is a contraindication for tetracycline since it can lead to fatal liver necrosis in the mother and cause bone and tooth development problems in the fetus. The drug needs to be taken on an empty stomach with 8 ounces (240 mL) of water. Calcium, iron, aluminum, or magnesium inhibits absorption of tetracycline. The drug decreases effectiveness of oral contraceptives, so the client needs to take another contraceptive until the drug is completed and, depending on the oral contraceptive, through the next menstrual cycle.

The drug causes photosensitivity, so when the client must be in the sun, the client should use sunscreen and protective clothing to prevent sunburn. The client needs to report adverse reactions that indicate a need for the prescriber to change antibiotics.

PTS: 1 REF: p. 390, Adverse Effects OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 16. The nurse is educating a client diagnosed with a urinary tract infection about the prescribed trimethoprim–sulfamethoxazole (TMP-SMZ). The client has a history of type 2 diabetes and currently takes a sulfonylurea. Which statement made by the client establishes the need for further clarification?

A. “I will monitor my blood sugar carefully since the drug may lower it.”

B. “I will take the drug with 8 ounces (240 mL) of water before or after meals.”

C. “The drug will not affect the ginseng supplement that I take.”

D. “If a rash develops, I will discontinue the drug and contact my prescriber.”

ANS: C

Rationale: The nurse needs to clarify the statement that the client made in regard to continuing the ginseng because the interaction with TMP-SMZ will result in increasing the effect of the bacteriostatic drug. The other statements are correct. TMP-SMZ interacts with sulfonylurea drug leading to hypoglycemia, so close monitoring of blood sugars is warranted. The drug needs to be taken before or after a meal with at least 8 ounces (240 mL) of water to help prevent crystalluria. The client should take at least 2 to 3 L of noncaffeinated fluids each day to properly hydrate and flush kidneys of wastes.

The drug may lead to a serious life-threatening condition, Stevens-Johnson syndrome, which has a sudden development of a flat red rash that forms blisters in the center and areas of peeling skin. The client should stop the drug immediately and notify the prescriber of any rash.

PTS: 1 REF: p. 394, Herbs and Foods that Increase the Effects of TMP-SMZ OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 17. The nurse prepares to administer nitrofurantoin 100 mg PO every 12 hours to an adult client newly diagnosed with a urinary tract infection. Which measures would the nurse provide for safe and effective drug administration? Select all that apply.

A. Instruct the client that the drug is a urinary analgesic to provide pain relief of urinary tract infection symptoms.

B. Inform the client that the medication may cause the urine to turn a harmless brown coloration.

C. Administer the drug with a meal or snack because food helps with drug absorption and decreases onset of GI distress.

D. Administer antacids with magnesium to increase the drug absorption of the nitrofurantoin.

E. Educate the client that the drug is safe with pregnancy and has no adverse effects on fetal development.

ANS: B, C Rationale: Nitrofurantoin is an anti-infective agent used to treat or prevent urinary tract infections. The medication may turn urine a harmless brown. The drug is absorbed better when administered with food, and there is a decrease in GI side effects when taken with food. Administering antacids with magnesium will decrease the absorption of the nitrofurantoin. The drug is contraindicated during pregnancy and during the first trimester because it increases the risk for birth defects. Near the end of pregnancy, the drug increases risk for hemolytic anemia. Phenazopyridine is a urinary analgesic to relieve pain related to urinary burning, urgency, frequency, and irritation of the urinary tract mucosa.

PTS: 1 REF: p. 396, Nitrofurantoin OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Select

18. The nurse is educating a client newly diagnosed with a urinary tract infection about the prescribed phenazopyridine hydrochloride. Which statement made by the client establishes the need for further clarification?

A. “The drug is an azo dye that acts directly on urinary tract mucosa to provide pain relief.”

B. “If I develop a sore throat, bleeding, or bruising, I will report the symptoms to my prescriber.”

C. “I will need to take the drug with food to decrease stomach upset.”

D. “I should report reddish-orange urine immediately to the prescriber.”

ANS: D Rationale: The nurse needs to clarify the statement that the client made that reddish-orange urine needs to be immediately reported to the prescriber because this is a normal effect of the azo dye and harmless. The client must report immediately if the skin turns yellow because the drug is accumulating in the body and not being metabolized by the liver properly. The other statements are correct. The drug is taken with food to decrease GI upset. The client should be instructed to report a sore throat to the prescriber.

PTS: 1 REF: p. 396, Phenazopyridine OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 21, Drug Therapy With Macrolides and Miscellaneous Anti-infective Agents 1. The nurse is caring for a client who has been diagnosed with Legionnaires disease. What medication would the nurse expect the health care provider to prescribe?

A. Erythromycin B. Loxapine hydrochloride C. Meclizine D. Pravastatin ANS: A Rationale: Erythromycin is the prototype macrolide used to treat Legionnaires disease.

Loxapine hydrochloride is an antipsychotic agent. Meclizine is used to treat nausea and dizziness. Pravastatin is used to treat hypercholesterolemia.

PTS: 1 REF: p. 402, Use OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client is allergic to penicillin and has been diagnosed with a genitourinary infection caused by Chlamydia trachomatis. Which medication will most likely be administered?

A. Acamprosate calcium B. Atazanavir C. Erythromycin D. Flumazenil ANS: C Rationale: A client who is diagnosed with a genitourinary infection that is caused by trachomatis and who is allergic to penicillin should be administered erythromycin since there is no known cross-reaction. Acamprosate calcium is administered as a substance abuse deterrent, not in place of penicillin. Atazanavir is an antiviral agent that is used to treat HIV infection, not Chlamydia trachomatis. Flumazenil is a benzodiazepine antagonist and not used for Chlamydia trachomatis.

PTS: 1 REF: p. 402, Use OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 3. A client diagnosed with peptic ulcer disease has been prescribed clarithromycin. Which organism is this medication intended to treat in this client?

A. Streptococcus pneumoniae B. Haemophilus influenzae C. Mycobacterium avium D. Helicobacter pylori ANS: D

Rationale: Clarithromycin is approved to treat H. pylori infections associated with peptic ulcer disease. Clarithromycin is also approved to treat Streptococcus pneumoniae, Haemophilus influenza, and Mycobacterium avium complex, but these organisms do not cause peptic ulcer disease.

PTS: 1 REF: p. 404, Other Drugs in the Class OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A client has been prescribed chloramphenicol for vancomycin-resistant enterococci.

How is this medication eliminated from the body?

A. Eliminated through the liver B. Exhaled through the lungs C. Excreted in the urine D. Excreted in the bile ANS: C Rationale: Chloramphenicol is metabolized in the liver and excreted in the urine. It is not eliminated in the liver, exhaled through the lungs, or excreted in the bile.

PTS: 1 REF: p. 406, Chloramphenicol OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. The health care provider prescribed an antibacterial drug to a client for the treatment of acne. What drug does the nurse expect to be prescribed?

A. Chloramphenicol B. Clindamycin C. Daptomycin D. Tigecycline ANS: B Rationale: Clindamycin is often used to treat infections caused by B. fragilis and can be administered topically for the treatment of acne. Chloramphenicol is prescribed for Enterococcus-sourced urinary tract infections. Tigecycline is effective in treating methicillin-resistant Staphylococcus aureus (MRSA). While an anti-infective agent, daptomycin is not administered topically (only IV) for the treatment of acne.

PTS: 1 REF: p. 408, Clindamycin OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice

6. A client is prescribed daptomycin to treat a gram-negative infection caused by Staphylococcus aureus. Which symptom should be reported immediately to the health care provider based on the adverse effects of daptomycin?

A. Weakness of the legs and arms B. Decreased wound drainage C. Hematuria D. Shortness of breath ANS: A Rationale: The nurse should report weakness of the legs and arms because of increased serum creatine kinase levels. Decrease in wound drainage, lack of fever, and shortness of breath are not adverse effects of daptomycin.

PTS: 1 REF: p. 409, Daptomycin OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client has been diagnosed with a community-acquired skin infection and has been prescribed linezolid. Which food should not be eaten during the period of this medication therapy?

A. Pasta B. Garlic C. Green leafy vegetables D. Cheddar cheese ANS: D Rationale: Because linezolid is a weak monoamine oxidase inhibitor, clients should avoid food high in tyramine content, such as aged cheeses. Pasta, garlic, and green leafy vegetables are not contraindicated with linezolid since they do not contain tyramine.

PTS: 1 REF: p. 409, Linezolid OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client has developed Clostridium difficile associated with pseudomembranous colitis.

Which medication is effective in the treatment of Clostridium difficile?

A. Linezolid B. Cladribine C. Clarithromycin D. Metronidazole ANS: D

Rationale: Metronidazole is indicated for use in the treatment of Clostridium difficile.

Linezolid, while exhibiting bactericidal activity against most staphylococci, enterococci, and streptococci, is not used to treat C. difficile. Cladribine is an antineoplastic agent that is not used for C. difficile. Clarithromycin, active against the atypical mycobacteria that cause Mycobacterium avium complex (MAC) disease, is not used to treat C. difficile.

PTS: 1 REF: p. 410, Metronidazole OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. The nurse is providing education to a client diagnosed with traveler’s diarrhea caused by an E. coli infection. On what drug will the nurse provide teaching?

A. Rifaximin B. Spectinomycin C. Chloramphenicol D. Erythromycin ANS: A Rationale: Rifaximin is administered for the treatment of traveler’s diarrhea related to E. coli. Spectinomycin is used to treat gonococcal infections. Chloramphenicol is not administered to treat travelers diarrhea related to E. coli. Chloramphenicol is rarely used now to treat infections because of the effectiveness and low toxicity of alternative drugs.

However, it is still used in serious infections for which no adequate substitute drug is available. Erythromycin, effective against gram-positive cocci, including group A streptococci, pneumococci, and most staphylococci, is not used to treat traveler’s diarrhea related to E. coli.

PTS: 1 REF: p. 410, Metronidazole OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 10. A client prescribed metronidazole to treat Clostridium difficile is also prescribed which medication orally to assist in restructuring the flora of the intestinal tract?

A. Spectinomycin B. Rifaximin C. Vancomycin D. Quinupristin–dalfopristin ANS: C Rationale: Oral vancomycin, active only against gram-positive microorganisms, is used to treat pseudomembranous colitis caused by C. difficile. Spectinomycin, rifaximin, and quinupristin–dalfopristin are not administered to treat pseudomembranous colitis caused

by C. difficile.

PTS: 1 REF: p. 411, Vancomycin OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 11. The nurse providing education to a client prescribed erythromycin recognizes a need for additional instruction when the client makes which suggestion? Select all that apply.

A. Taking the medication with or without food B. Avoiding grapefruit juice while taking the medication C. Recognizing dark urine a normal side effect D. Identifying stomach cramping as an adverse effect E. Swallowing the medication with milk ANS: A, C, E Rationale: When administering erythromycin, grapefruit juice, food in general, and dairy products especially interfere with the absorption of the medication. The presence of dark urine is a condition that should be reported immediately since it indicates possible renal complications. Stomach cramping is considered an adverse effect of this medication.

PTS: 1 REF: p. 403, Erythromycin OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Select 12. A nurse is caring for an adult client who has been diagnosed with bacterial sinusitis. The nurse has cautioned the client against taking prescribed oral erythromycin together with antacids. What is the basis of this instruction?

A. Antacids delay metabolism of the drug.

B. Antacids can exacerbate nausea and reflux.

C. Antacids cause a dangerous rise in gastric pH. D. Antacids decrease the absorption of the drug.

ANS: D Rationale: People should not take erythromycin after taking antacids. Antacids decrease the absorption of both the tablet and suspension form of erythromycin. Antacids do not cause a dangerous rise in pH, exacerbate GI upset, or delay the metabolism of the drug.

PTS: 1 REF: p. 404, Administering the Medication OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A 22-year-old college student allergic to penicillin is being treated with oral erythromycin for a chlamydial infection. What assessment should the nurse prioritize during this client’s course of treatment to monitor for adverse reactions?

A. Assessment of the client’s apical heart rate B. Assessment of the client’s hearing C. Assessment of the client’s peripheral pulses

D. Assessment of the client’s renal function ANS: B Rationale: With erythromycin, it is important to assess the client’s hearing. The loss of hearing is reversible with the discontinuation of the medication. Erythromycin does not typically affect renal function or circulation. The IV form has been associated with dysrhythmias, but this is not the case with the oral form.

PTS: 1 REF: p. 404, Assessing for Adverse Effects OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. A client prescribed clindamycin is now reporting frequent diarrhea. How should the nurse best respond to this client?

A. Reemphasize the importance of taking clindamycin with food.

B. Encourage the client to temporarily use an over-the-counter antidiarrheal.

C. Encourage the client to increase fluid intake until the course of treatment is complete.

D. Liaise with the client’s health care provider to have the drug discontinued.

ANS: D Rationale: The FDA has issued a black box warning for clindamycin regarding the potential of severe and possible fatal colitis. If diarrhea develops in a client receiving clindamycin, discontinuation of the drug is essential. None of the other suggestions provided by the options are accurate statements regarding clindamycin.

PTS: 1 REF: p. 408, Clindamycin OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. Numerous residents of a long-term care facility have developed Clostridium difficile–associated diarrhea over the past week. The nurses at this facility would anticipate that many residents would require which medication therapy?

A. Linezolid B. Daptomycin C. Metronidazole D. Chloramphenicol ANS: C Rationale: Clinical indications for metronidazole include prevention or treatment of anaerobic bacterial infections (e.g., in colorectal surgery, intra-abdominal infections) and treatment of C. difficile infections associated with pseudomembranous colitis. The other listed antibiotics are not used for the treatment of Clostridium difficile–associated diarrhea.

PTS: 1 REF: p. 410, Metronidazole OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. What assessment finding would signal the nurse to the possibility that the client’s infusion of vancomycin is running too quickly?

A. The client is flushed and has a visible skin rash.

B. The client’s apical heart rate is irregular.

C. The client is reporting nausea.

D. The client reports pain at the intravenous access site.

ANS: A Rationale: It is very important to give IV infusions slowly, over 1 to 2 hours, to avoid an adverse reaction characterized by hypotension, flushing, and skin rash. This reaction, sometimes called red man syndrome, is attributed to histamine release. Irritation is likely the cause of pain at the IV access site. Neither cardiac arrhythmia nor nausea is associated with the rapid administration of this medication.

PTS: 1 REF: p. 411, Vancomycin OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 17. A nurse is preparing a client’s scheduled dose of oral vancomycin. This client’s current illness was most likely manifested by what sign or symptom?

A. Vomiting B. Inflamed, swollen skin C. Shortness of breath D. Diarrhea ANS: D Rationale: Oral vancomycin is useful only to treat staphylococcal enterocolitis and pseudomembranous colitis caused by C. difficile. These illnesses are always characterized by diarrhea, not vomiting, skin inflammation, or shortness of breath. This information about the clinical use of vancomycin eliminates the other options.

PTS: 1 REF: p. 411, Vancomycin OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 18. A client being treated in the intensive care unit has been diagnosed with ventilator-associated pneumonia. Culture and sensitivity testing of the client’s sputum indicates that erythromycin is a treatment option. Which nursing assessment is most appropriate to rule out contraindications for this medication therapy?

A. Review lab results to confirm normal liver function.

B. Question the client about any history of gastrointestinal upset.

C. Review the medical chart for a history of nephrotoxic signs or symptoms.

D. Confirm the ability to safely swallow oral medication.

ANS: A Rationale: Erythromycin is seldom used in critical care settings, partly because broader-spectrum bactericidal drugs are usually needed in critically ill clients and partly because it inhibits liver metabolism and slows elimination of several other drugs.

Erythromycin is not nephrotoxic. The drug is administered orally, and GI upset does not contraindicate use.

PTS: 1 REF: p. 402, Use in Patients With Hepatic Impairment OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 21: Drug Therapy With Macrolides and Miscellaneous Anti-Infective Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 22, Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease 1. A client seen in the clinic for symptoms of persistent cough, fever, and night sweats has recently entered the United States from India. What is the most plausible explanation for this client’s condition?

A. Latent tuberculosis B. Bacterial pneumonia C. Active tuberculosis D. Emphysema ANS: C Rationale: Emigration from countries where the disease occurs, such as India, places clients at risk for tuberculosis. Active tuberculosis is characterized by symptoms of cough, fever, and night sweats. Clients with latent tuberculosis exhibit no symptoms and do not feel sick. Bacterial pneumonia is not commonly noted with night sweats.

Emphysema is not noted with fever.

PTS: 1 REF: p. 416, Pathophysiology OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A college student has a tuberculosis (TB) test prior to starting the semester. The test site is noted to have a reddened, raised area. What phase in the progression of TB is associated with the inability to spread the disease to others?

A. Transmission B. Primary infection C. Latent tuberculosis D. Active tuberculosis ANS: C Rationale: People with inactive or latent TB have no symptoms, do not feel sick, and do not pass the disease on to others since the bacteria in their body is inactive. The transmission of the infection occurs when an uninfected person inhales infected airborne particles that are exhaled by an infected person. Primary infection occurs 6 to 8 weeks after exposure. The client has a mild, pneumonia-like illness that often is undiagnosed.

Active tuberculosis is a result of reactivation of a latent infection resulting from the client’s weakened immune system.

PTS: 1 REF: p. 416, Pathophysiology OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

3. A client hospitalized with active tuberculosis is receiving antitubercular drug therapy.

When it becomes apparent that the client is not responding to the medications, what condition will the primary health care provider identify as a possible cause?

A. Human immunodeficiency virus (HIV) B. Drug-resistant tuberculosis C. Methicillin-resistant Staphylococcus aureus D. Vancomycin-resistant Staphylococcus aureus ANS: B Rationale: A client who is being treated with antitubercular drug therapy and is not responding to the medication regimen is most likely experiencing drug-resistant tuberculosis. Human immunodeficiency virus causes tuberculosis to move more rapidly.

This scenario does not provide any indication that the tuberculosis is related to the diminished client response. The scenario does not identify methicillin-resistant or vancomycin-resistant Staphylococcus aureus.

PTS: 1 REF: p. 416, Pathophysiology OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 4. A client being treated for tuberculosis is determined to be drug resistant. Which medications will no longer be effective in the treatment of the tuberculosis?

A. Isoniazid and rifampin B. Carbamazepine and phenytoin C. Dextroamphetamine and doxapram D. Propranolol and sotalol ANS: A Rationale: Isoniazid and rifampin are used to treat tuberculosis. In multidrug resistance, the most effective drugs the client is resistant to are isoniazid and rifampin.

Carbamazepine and phenytoin are used to control seizures. Dextroamphetamine and doxapram are central nervous system stimulants. Propranolol and sotalol are beta-adrenergic blocking agents. The other options are not use in the treatment of any type of tuberculosis.

PTS: 1 REF: p. 416, Pathophysiology OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. A client diagnosed with tuberculosis (TB) is prescribed isoniazid (INH). Which adverse effect will result in discontinuation of the medication?

A. Weight gain B. Jaundice C. Fever D. Arthralgia

ANS: B Rationale: Potentially serious adverse effects of INH include hepatotoxicity.

Hepatotoxicity may be manifested by symptoms of hepatitis (e.g., anorexia, nausea, fatigue, malaise, jaundice) or elevated liver enzymes. The nurse reports the development to the health care provider promptly to prevent possible liver failure and death. Weight gain, fever, and arthralgia are not known to be serious adverse effects of INH. PTS: 1 REF: p. 420, Isoniazid OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A client receiving isoniazid (INH) and rifampin has a decreased urinary output and decreased sensation in the great toes. Which laboratory values should be assessed?

A. Hematocrit and hemoglobin B. ALT and AST C. Urine culture and sensitivity D. Complete blood count (CBC) with differential ANS: B Rationale: Hepatotoxicity and nephrotoxicity are important adverse effects of isoniazid and rifampin. The ALT/AST will assess liver function. The hematocrit and hemoglobin are associated with the oxygen-carrying capacity of the blood. A complete blood count with differential measures the levels of red blood cells, white blood cells, platelet levels, hemoglobin, and hematocrit. It is prescribed for many purposes (e.g., to detect anemia or infection), but it does not assess liver function. A urine culture is a method to grow and identify bacteria that may be in the urine. The sensitivity test helps caregivers pick the best medicine to treat the infection.

PTS: 1 REF: p. 422, Contraindications OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. How does rifampin achieve a therapeutic action against both intracellular and extracellular tuberculosis organisms?

A. It is metabolized in the liver.

B. It binds to acetylcholine.

C. It inhibits synthesis of RNA. D. It causes phagocytosis.

ANS: C Rationale: Rifampin kills Mycobacterium by inhibiting synthesis of RNA. It is metabolized in the liver, but this characteristic does not represent its action. It does not bind to acetylcholine. It does not cause phagocytosis.

PTS: 1 REF: p. 423, Rifamycins OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 8. A client is prescribed rifampin. What information should the nurse include in the client’s medication education?

A. When taking it with warfarin, an increased anticoagulant effect occurs.

B. It decreases hepatic enzymes and decreases metabolism of drugs.

C. It has an increased serum half-life, so it is more effective than rifabutin.

D. The urine, tears, sweat, and other body fluids will be a discolored red-orange.

ANS: D Rationale: The client’s urine, tears, sweat, and other body fluids will be a discolored red-orange. This adverse effect is harmless, but the client should be informed of it. The administration of this medication with warfarin will decrease the anticoagulant effect.

The medication increases hepatic cytochrome P-4503A4 enzyme and decreases serum concentration of other drugs by accelerating metabolism. The serum half-life of rifampin is shorter than that of the medication rifabutin.

PTS: 1 REF: p. 423, Rifamycins OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A client diagnosed with tuberculosis and who has been prescribed isoniazid has a yellow color in the sclera of the eye. What other finding would lead the nurse to suspect that hepatotoxicity has developed?

A. Diarrhea B. Numbness C. Diminished vision D. Light-colored stools ANS: D Rationale: The presence of light-colored stools is suggestive of hepatotoxicity. Diarrhea, numbness, and diminished vision are not related to hepatotoxicity resulting from INH therapy.

PTS: 1 REF: p. 423, Patient Teaching Guidelines for Isoniazid OBJ: 4 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A client being treated for active tuberculosis with ethambutol states difficulty in identifying the red and green on the traffic lights when driving. Based on this finding, what intervention should the nurse consider initially?

A. Assess for photosensitivity.

B. Discontinue ethambutol.

C. Decrease the ethambutol dose.

D. Administer vitamin B12.

ANS: B Rationale: The administration of ethambutol should be discontinued, not merely decreased, if optic neuritis develops. Optic neuritis is an inflammatory, demyelinating disorder of the optic nerve that decreases visual acuity and ability to differentiate red and green. Since the problem is focused on the optic nerve, there is no indication for the administration of vitamin B12. Vitamin B12 is a water-soluble vitamin that has a key role in the normal functioning of the brain and nervous system and the formation of red blood cells.

PTS: 1 REF: p. 428, Concept Mastery Alert OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A client is hospitalized due to nonadherence to an antitubercular drug treatment for a diagnosis of tuberculosis (TB). Which intervention is most important for the nurse to implement?

A. Observing the client taking the medications B. Administering the medications parenterally C. Instructing the family on the medication regimen D. Counting the number of tablets in the bottle daily ANS: A Rationale: Directly observed therapy in which a health care provider observes the client taking each dose of anti-TB drugs is recommended for all drug regimens and is considered mandatory in this case. The medications are not administered parenterally.

The family should be instructed on the medication regimen, but this action is not imperative in maintaining compliance. Tablets missing from the bottle may not necessarily have been taken correctly by the client.

PTS: 1 REF: p. 421, Use in Patients Receiving Home Care OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A client who was frequently homeless over the past several years has begun a drug regimen consisting solely of isoniazid (INH). What is this client’s most likely diagnosis?

A. Active tuberculosis B. Latent tuberculosis C. Mycobacterium avium complex (MAC) D. Human immunodeficiency virus (HIV) ANS: B

Rationale: Although use of INH by itself for the treatment of latent TB is appropriate, use with other anti-TB drugs is essential for the treatment of active TB. INH would not be used exclusively in the treatment of HIV or MAC. PTS: 1 REF: p. 416, Pathophysiology OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. A client diagnosed with human immunodeficiency virus (HIV) has been infected with Mycobacterium avium complex (MAC) from an indoor pool. Which medications are recommended for the treatment of this infection? Select all that apply.

A. Clarithromycin B. Isoniazid C. Rifabutin D. Azithromycin E. Rifampin ANS: A, C, D Rationale: The main drugs used in the treatment of MAC in clients with HIV are the macrolides azithromycin and clarithromycin as well as ethambutol and rifabutin.

Isoniazid and rifampin are prescribed for the treatment of tuberculosis.

PTS: 1 REF: p. 428, Drugs Used to Treat Mycobacterium avium Complex Disease OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Select 14. An individual who is homeless was screened for tuberculosis (TB), and the results indicate latent TB. The community health nurse would anticipate inclusion of what intervention into the client’s plan of care?

A. Conservative treatment for TB using adjuvant medications B. Treatment for TB using first-line antitubercular drugs C. Close monitoring to determine if treatment is necessary D. Rescreening in 10 to 12 weeks to determine whether the TB has become active ANS: B Rationale: Clients with latent TB cannot spread the disease to others, but treatment of the latent disease prevents progression of the disease to an active state. It is particularly important to treat latent TB in those clients who are at high risk for progression to active TB. Treatment should start immediately. Homelessness is a major risk factor for active TB. Adequate drug therapy is prescribed for clients with active TB. PTS: 1 REF: p. 416, Pathophysiology OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex

Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 15. A client diagnosed with tuberculosis (TB) has begun multidrug therapy. The client has asked the nurse why it is necessary to take several different drugs. How should the nurse respond to the client’s question?

A. “Multiple drugs are used because health care providers aren’t sure which drug will kill a particular TB strain.”

B. “The use of multiple drugs prevents the development of drug-resistant TB.” C. “Multiple drugs are prescribed because the final testing results for TB can take up to 3 months.”

D. “Multiple drugs are used to speed up the course of treatment.”

ANS: B Rationale: Use of multiple drugs to treat TB is necessary to prevent the development of drug-resistant TB. This approach to treatment is not necessitated by delays in testing, questionable diagnostic results, or the need to hasten the course of treatment.

PTS: 1 REF: p. 418, Table 22.1. Treatment Regimens for Latent Tuberculosis OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A client being treated for latent tuberculosis (TB) on an out-client basis tells the nurse, “I’ve been feeling pretty good lately, so I haven’t actually been all that consistent with taking my drugs.” Subsequent health education by the nurse should focus on what subject?

A. The fact that nonadherence to treatment exacerbates the risks of adverse effects B. The need to consistently take the prescribed drugs in order to cure TB C. The need to match drug dosages carefully to signs and symptoms D. The fact that nonadherence will necessitate the use of antiretrovirals ANS: B Rationale: Consistent adherence to treatment is imperative to ensure successful treatment of TB. Nonadherence leads to resistance and unsuccessful treatment, not increased adverse effects. Nonadherence has no relationship with matching dosage with signs and symptoms. Antivirals are ineffective against TB. PTS: 1 REF: p. 416, Pathophysiology OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A client diagnosed with tuberculosis will soon begin first-line drug treatment. How will rifampin most likely be administered to this client?

A. Orally, with food

B. Orally, on an empty stomach C. Intramuscularly D. Intravenously, as a bolus ANS: B Rationale: Rifampin should be taken on an empty stomach, either 1 hour before or 2 hours after a meal. IV administration is possible, but this takes place as a 3-hour infusion, not as a bolus. Rifampin is not administered IM. PTS: 1 REF: p. 425, Administering the Medication OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 18. A client is prescribed isoniazid and rifampin for the treatment of active tuberculosis (TB). The client’s medication education should stress that initial symptom improvement is likely to take how long?

A. 48 hours B. 1 week to 10 days C. 2 to 3 weeks D. 4 to 6 weeks ANS: C Rationale: Therapeutic effects are usually apparent within the first 2 to 3 weeks of drug therapy for active TB. This information makes the other options incorrect.

PTS: 1 REF: p. 418, Table 22.1. Treatment Regimens for Latent Tuberculosis OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. A client diagnosed with active TB has begun second-line therapy that includes the use of pyrazinamide. When monitoring this client, the nurse should suspect that adverse effects of this drug may account for which laboratory values?

A. Low hematocrit and mean corpuscular volume (MCV) B. Increased INR and aPTT C. Increased blood urea nitrogen and creatinine D. Increased AST, ALT, and GGT ANS: D Rationale: The most severe adverse effect of pyrazinamide is hepatotoxicity.

Consequently, liver enzymes such as GGT, ALT, and AST should be monitored.

Changes in erythrocytes, coagulation, and renal function are less likely to result from pyrazinamide therapy.

PTS: 1 REF: p. 426, Pyrazinamide OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. A client diagnosed with human immunodeficiency virus (HIV) has just been diagnosed with Mycobacterium avium complex (MAC) disease. The nurse should anticipate including what information when educating the client regarding the prescribed therapy?

Select all that apply.

A. There is a once-daily dose of clarithromycin.

B. A 600-mg dose of azithromycin will be prescribed.

C. Any previous prescription of ethambutol will be discontinued.

D. The therapy may include a prescription for rifabutin.

E. Clarithromycin is prescribed because it is associated with lower relapse rates.

ANS: A, B, D Rationale: Treatment of MAC begins with once-daily administration of clarithromycin 500 mg and azithromycin 600 mg. Therapy may also involve ethambutol and rifabutin.

Ethambutol is preferable because its use is associated with a lower relapse rate.

PTS: 1 REF: p. 428, Drugs Used to Treat Mycobacterium avium Complex Disease OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Select

Chapter 23, Drug Therapy for Viral Infections 1. A client is prescribed acyclovir for the treatment of genital herpes. What is the expected outcome of this medication?

A. Decreased testosterone production B. Decreased libido C. Decreased viral shedding D. Decreased bacterial replication ANS: C Rationale: Acyclovir is used to treat genital herpes, in which it decreases viral shedding and the duration of skin lesions and pain. Viral shredding is the process that occurs when a virus is present in bodily fluids or open wounds and can thereby be transmitted to another person, as with herpetic lesions. Acyclovir does not decrease testosterone or libido. Acyclovir is used to treat viral, not bacterial, infections.

PTS: 1 REF: p. 439, Action OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. The nurse is caring for a client who has been diagnosed with an autoimmune disorder.

The nurse is aware that the client is at risk for the development of which illness-causing situation?

A. Lymphocytes recognize the host’s tissue as foreign.

B. Erythrocytes destroy the T cells in the host.

C. The involution of the thymus gland increases infections.

D. The differential decreases the sedimentation rate.

ANS: A Rationale: Autoimmune diseases may be caused by viral alteration of host cells so that lymphocytes recognize the host’s own tissues as being foreign and so attempt to destroy them. Erythrocytes are responsible for circulating oxygen around the body. The function of the autoimmune system is not accurately described by the statement regarding the thymus gland or sedimentation rate.

PTS: 1 REF: p. 438, Clinical Manifestations OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 3. An older adult client with a creatinine level of 4.0 mg/dL (353.60 mol/L) and a diagnosis of herpes simplex is prescribed acyclovir. When preparing to administer this medication parenterally, what would the nurse expect in regard to medication dosage?

A. The dose is smaller due to the herpes simplex.

B. The dose is smaller based on the client’s kidney function.

C. The dose is higher if treating genital herpes.

D. The dose is higher if the creatinine is above 4.0 mg/dL (353.60 mol/L).

ANS: B Rationale: Oral and IV acyclovir are excreted in the urine, and the dose should be decreased in clients who are older or have renal impairment. The dose is not smaller when treating herpes simplex nor is the dose higher in treating genital herpes. The dose should be lower if the creatinine level is above 4.0 mg/dL (353.60 mol/L).

PTS: 1 REF: p. 440, Use in Patients With Renal Impairment OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client who has been diagnosed with human immune deficiency syndrome is prescribed ganciclovir to prevent cytomegalovirus. As a result of the therapy, the client develops granulocytopenia, resulting in severe bone marrow suppression. How long will it take for the granulocytes to regenerate after the ganciclovir is discontinued?

A. 8 hours B. 7 days C. 3 weeks D. 1 month ANS: B Rationale: Ganciclovir causes granulocytopenia and thrombocytopenia in 20% to 40% of recipients, often during the first 2 weeks of therapy. If severe bone marrow depression occurs, ganciclovir should be discontinued; recovery usually occurs within a week of stopping the drug. Eight hours after discontinuing the drug is too soon to see a change in granulocytopenia. Three weeks to 1 month is too long for change to occur.

PTS: 1 REF: p. 443, Adverse Effects OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A 23-year-old client is prescribed zidovudine for the treatment of human immunodeficiency virus (HIV). Which statement indicates that the client has understood the client teaching regarding the action of this medication?

A. “Zidovudine inactivates the virus and prevents recurrence of the disease.”

B. “Zidovudine therapy may result in the development of resistant strains.”

C. “Zidovudine slows the progression of the disease but does not cure it.”

D. “Zidovudine prevents the occurrence of opportunistic infections.”

ANS: C Rationale: Zidovudine slows the progression of the disease but does not cure the disease.

Zidovudine does not inactivate the virus, result in resistant strains, or prevent the occurrence of opportunistic infections.

PTS: 1 REF: p. 454, Nucleoside Reverse Transcriptase Inhibitors OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 6. A client is administered a nucleotide reverse transcriptase inhibitor in combination with a nonnucleotide reverse transcriptase inhibitor. What is the rationale when administering these medications together?

A. They facilitate increased adherence to treatment.

B. They decrease the length of illness.

C. They have synergistic antiviral effects.

D. They prevent the development of any opportunistic infections.

ANS: C Rationale: Because the two types of drugs inhibit reverse transcriptase by different mechanisms, they may have synergistic antiviral effects. A synergistic effect occurs when the effect between two or more substances produce an effect greater than the sum of their individual effects. The use of two medications may decrease compliance because of the burden of taking two medications. Using two medications will not decrease the length of the illness nor will it decrease all opportunistic infections.

PTS: 1 REF: p. 459, Nonnucleoside Reverse Transcriptase Inhibitors OBJ: 14 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. A client is prescribed zanamivir to treat influenza B. The client has a history of asthma.

For which symptom should the nurse assess?

A. Bradycardia B. Pneumonia C. Bronchospasm D. Pulmonary embolism ANS: C Rationale: Bronchospasm is a potential adverse effect of zanamivir. The client has asthma and should be observed or assessed for bronchospasm. Bradycardia, pneumonia, and pulmonary embolism are not adverse effects the nurse should expect.

PTS: 1 REF: p. 447, Neuraminidase Inhibitors OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. The nurse is caring for a neonate who has been given ribavirin for respiratory syncytial virus. What adverse effect should the nurse assess for?

A. Hepatotoxicity B. Renal failure C. Ventricular tachycardia D. Deteriorating pulmonary function ANS: D Rationale: Ribavirin has a common adverse effect of deteriorated pulmonary function.

Hepatotoxicity, renal failure, and ventricular tachycardia are not the primary adverse effects of ribavirin.

PTS: 1 REF: p. 445, Drugs for Respiratory Syncytial Virus OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A client is prescribed indinavir sulfate for the treatment of human immunodeficiency virus infection. What client teaching should be provided regarding renal function?

A. Drink grape juice daily for antioxidants.

B. Drink grapefruit juice to enhance absorption.

C. Report signs of pulmonary edema, a known adverse effect.

D. Consume 48 ounces (1,400 mL) of fluid per day.

ANS: D Rationale: When taking indinavir, the client should be instructed to consume 48 ounces (1,400 mL) of water or fluid per day to prevent nephrolithiasis. The consumption of grape juice with antioxidants will assist in preventing nephrolysis but must be in sufficient amounts. The consumption of grapefruit juice is usually contraindicated.

Pulmonary edema is not a known adverse effect, so there is no need to educate the client regarding it.

PTS: 1 REF: p. 464, Other Drugs in the Class OBJ: 10 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A client diagnosed with cytomegalovirus (CMV) should be educated about the possible prescription of which drugs for the treatment of this disease? Select all that apply.

A. Ribavirin B. Ganciclovir C. Foscarnet D. Valganciclovir E. Cidofovir ANS: B, C, D, E Rationale: Ganciclovir, foscarnet, cidofovir, and valganciclovir are used in the treatment of CMV. Ribavirin is administered to treat respiratory syncytial virus.

PTS: 1 REF: p. 438, Table 23.1. Drugs Administered for the Treatment of Viral Infections OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Select 11. A child is receiving ribavirin for a diagnosis of respiratory syncytial virus (RSV). Nurses caring for this client should be aware of the need to monitor themselves for what possible adverse reactions? Select all that apply.

A. Rhinitis B. Headache C. Bronchospasm D. Conjunctivitis E. Pulmonary embolism ANS: A, B, C, D Rationale: Ribavirin is inhaled systemically for the treatment of clients with RSV. Health care workers caring for children treated for RSV may report headache, conjunctivitis, nausea, rash, dizziness, chest pain, bronchospasm, pharyngitis, and rhinitis. Pulmonary embolism is not an adverse effect associated with ribavirin.

PTS: 1 REF: p. 445, Adverse Effects OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 12. A neonatal intensive care unit nurse is caring for an infant who has been diagnosed with respiratory syncytial virus. What route of delivery will the nurse use when ribavirin is administered to this infant?

A. Oral suspension B. Topical C. Intravenous D. Inhaled ANS: D Rationale: Ribavirin is inhaled systemically. This information makes the other options incorrect.

PTS: 1 REF: p. 445, Pharmacokinetics OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 13. The nurse is caring for a client who has been diagnosed with hepatitis A. What knowledge or intervention should the nurse incorporate into the care plan? Select all that apply.

A. Chlorine wipes are effective for disinfection purposes.

B. Effective handwashing is vital in the prevention of cross infection.

C. Treat jaundice as a rare but deadly symptom of a hepatitis A infection.

D. Educate the client that immunity rarely occurs and vaccination is necessary.

E. Educate personal contacts that the client is infectious for up to 10 days after symptoms appear.

ANS: A, B, E Rationale: The hepatitis A virus survives for long periods in the environment (e.g., in water and soil) and on human hands and inanimate objects. It resists freezing, detergents, and acids but can be inactivated by chlorine and temperatures above 185°F (85°C). The client is infectious during the incubation period and for 7 to 10 days after symptoms develop. In infected adults, about 70% develop symptoms, including fever and jaundice.

Most recover without treatment and develop immunity against future HAV infections, making vaccination in such clients unnecessary.

PTS: 1 REF: p. 437, Viral Hepatitis OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 14. A client has sought care from the primary health care provider after “feeling under the weather” for several days. What signs and symptoms would support the presence of a viral infection? Select all that apply.

A. Increased white cell count B. Idiopathic bleeding C. Malaise D. Fever E. Headache ANS: C, D, E Rationale: Symptoms usually associated with acute viral infections include fever, headache, cough, malaise, muscle pain, nausea and vomiting, diarrhea, insomnia, and photophobia. White blood cell counts usually remain normal since these cells are active in bacterial infections, and bleeding is uncharacteristic.

PTS: 1 REF: p. 438, Clinical Manifestations OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Select 15. A young adult client diagnosed with hepatitis B virus (HBV) has been prescribed treatment with lamivudine. Shortly after beginning treatment, the client reports experiencing intense abdominal pain. The nurse should recognize the possibility of what medication-associated adverse effect?

A. Gastroenteritis B. Gastroesophageal reflux disease C. Bowel obstruction

D. Pancreatitis ANS: D Rationale: A main adverse effect of lamivudine is pancreatitis. GERD, obstruction, and gastroenteritis do not typically result from lamivudine therapy. In addition, these problems do not typically manifest with intense and sudden abdominal pain.

PTS: 1 REF: p. 450, Use in Children OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 16. A client undergoing treatment for cytomegalovirus received an initial dose of IV ganciclovir 3 days ago. When reviewing this client’s most recent blood work, what abnormality should the nurse recognize as a possible adverse effect of this drug?

A. Hemoglobin 17 g/dL (170 g/L) (high normal) B. Prothrombin time (PT) 3.8 (high) C. Platelet count 118,000/mm3 (low) D. Leukocytes 11,900/mm3 (high) ANS: C Rationale: Ganciclovir causes granulocytopenia and thrombocytopenia (decreased platelet count) in 20% to 40% of recipients, often during the first 2 weeks of therapy.

Leukocytosis, increased hemoglobin, and hypocoagulation (PT) are not typical adverse effects associated with ganciclovir.

PTS: 1 REF: p. 443, Adverse Effects OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 17. A 42-year-old client diagnosed with human immunodeficiency virus (HIV) has been receiving antiretroviral therapy for several years. Recently, raltegravir was added to the drug regimen. When assessing the success of this addition to the treatment, the nurse should prioritize which laboratory value?

A. The client’s C-reactive protein levels B. The client’s erythrocyte sedimentation rate (ESR) C. The client’s viral load D. The client’s CD4 count ANS: D Rationale: The nurse assesses for an increase in T-helper CD4 cells. The CD4 count measures the ability to fight against infections. CD4 count is more important than viral load in this regard. CRP levels and ESR do not reflect the client’s immune function.

PTS: 1 REF: p. 464, Action OBJ: 11 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 18. When administering the fusion protein inhibitor enfuvirtide, the nurse should include which technique to assure the medication’s continued effectiveness?

A. Have the client gargle with normal saline immediately after taking the drug.

B. Flush the client’s central venous catheter with 100 Unit/mL heparin prior to administration.

C. Inject the drug into the client’s ventrogluteal site using the Z-track method.

D. Regularly rotate the subcutaneous injection sites that are used.

ANS: D Rationale: The nurse injects enfuvirtide subcutaneously into the upper arm, abdomen, or anterior thigh. Rotation of injection sites and assessment of the sites for reactions are necessary. The suggestions that the medication should be administered intravenously, orally, or intramuscularly are all incorrect.

PTS: 1 REF: p. 466, Administering the Medication OBJ: 12 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. The nurse should recognize that maraviroc belongs to what category of antiretroviral?

A. Fusion protein inhibitors B. Protease inhibitors C. CCR5 antagonists D. Integrase strand transfer inhibitors ANS: C Rationale: Currently, maraviroc is the only member of the class of CCR5 antagonists.

This information excludes all the remaining options.

PTS: 1 REF: p. 466, CCR5 Antagonists OBJ: 13 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 20. A client who has experienced repeated outbreaks of cold sores reports no success with an over-the-counter (OTC) topical cream. The nurse should recognize that this client used what OTC drug?

A. Ganciclovir B. Valacyclovir C. Famciclovir D. Docosanol ANS: D

Rationale: Docosanol is an over-the-counter topical antiviral agent that works in the early stages of intracellular events of viral entry into the target cells. Famciclovir is an oral antiviral agent administered for herpes zoster and recurrent genital herpes.

Valacyclovir is not an over-the-counter medication. Cold sores are not treated with ganciclovir.

PTS: 1 REF: p. 441, Other Drugs in the Class OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 21. A client who began antiretroviral therapy several weeks ago states to the nurse, “I’ve been pretty good about taking all my pills on time, though it was a bit hit and miss over the holiday weekend.” How should the nurse best respond to this client’s statement?

Select all that apply.

A. “Remember that if you miss a dose, you need to take a double dose at the next scheduled time.”

B. “It’s acceptable to miss an occasional dose as long as your symptoms don’t get worse, but it’s not really recommended.”

C. “Remember that your antiretroviral drugs will only be effective if you take them very consistently.”

D. “If you’re not consistent with taking your medications, you’re likely to develop more side effects.”

E. “Missing doses occasionally is alright, but be sure you make up for the missed doses.”

ANS: C, D Rationale: Effective treatment of a viral infection requires close adherence to drug therapy regimens involving several drugs and daily doses. Missing as few as one or two doses can decrease blood levels of antiretroviral drugs and result in increased virus replication and development of drug-resistant viral strains. Clients should be instructed to take the medications exactly as prescribed and to not change doses or stop the medications without consulting a health care provider. Clients should not take double doses to make up for missed doses. The drugs must be taken consistently to suppress HIV infection and minimize adverse drug effects.

PTS: 1 REF: p. 458, Patient Teaching Guidelines for Antiretroviral Drugs OBJ: 15 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 23: Drug Therapy for Viral Infections KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Select

Chapter 24, Drug Therapy for Fungal Infections 1. An adolescent client is admitted to a health care facility for a fungal infection. It has been determined that the infection was present for a long time, but there was no treatment undertaken. The client now has a systemic fungal infection for which flucytosine is prescribed. Which would be most important for the nurse to assess before beginning therapy?

A. Oral mucosa B. Weight C. Vaginal discharge D. Hydration status ANS: B Rationale: With flucytosine, it is important for the nurse to weigh the client because the dosage of the drug is determined by the weight. The client has a systemic fungal infection, so inspection of the mouth or assessment of vaginal discharge would not be important. Although it would be important to assess the client’s hydration status, this is not as important as obtaining the weight.

PTS: 1 REF: p. 488, Table 24.6 OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A client develops itching and burning of the vaginal vault while taking an anti-infective to treat strep throat. What fungal agent has caused the burning and itching?

A. Cryptococcus neoformans B. Candida albicans C. Aspergillus D. Dermatophytes ANS: B Rationale: Growth of Candida organisms is normally restrained by intact immune mechanisms and bacterial competition of nutrients. When these restraining forces are altered (antibacterial drug therapy), fungal overgrowth and opportunistic infection can occur. Primary Cryptococcus neoformans occurs in the lungs. Aspergillus organisms produce protease. Dermatophytes grow on cool body surfaces.

PTS: 1 REF: p. 473, Etiology OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. A client has been prescribed amphotericin B for treatment of a fungal infection of the urinary tract. Which statement describes the action of the drug?

A. It binds to ergosterol resulting in changes in the cell membrane.

B. It binds to an enzyme required for synthesis of ergosterol.

C. It disrupts the fungal cell walls rather than the cell membrane.

D. It inhibits glucan synthase required for glucan synthesis.

ANS: A Rationale: Amphotericin B binds to sterols within the fungal cell membrane, resulting in a change in the membrane’s permeability. This action destroys the fungal cells and prevents them from reproducing. The azole drugs bind to an enzyme that is required for synthesis of ergosterol. This action causes production of a defective cell membrane, which allows leakage of intracellular contents and destruction of the cell. Echinocandins disrupt fungal cell walls rather than fungal cell membranes. They inhibit glucan synthase, an enzyme required for synthesis of glucan.

PTS: 1 REF: p. 473, Drug Therapy OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A client is being treated with amphotericin B for a severe fungal infection. How long does the nurse expect drug therapy to last?

A. 1 to 2 weeks B. 3 to 6 weeks C. 4 to 12 weeks D. 15 to 18 weeks ANS: C Rationale: Because of the toxicity of amphotericin B, the drug is used only for serious infections. It is usually given for 4 to 12 weeks. Amphotericin B is not given for 1 to 2 weeks, 3 to 6 weeks, or 15 to 18 weeks.

PTS: 1 REF: p. 477, Polyenes OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. A client prescribed a lipid formulation of amphotericin B asks the nurse what the advantage of this formulation is over traditional amphotericin B. What should the nurse use as the basis for the response?

A. It is a newer medication with a lower cost.

B. It is the same as amphotericin B in hepatotoxicity.

C. It reaches higher concentration in diseased tissue.

D. It constricts afferent renal arterioles to reduce blood flow.

ANS: C Rationale: Lipid formulations reach higher concentrations in diseased tissues than in normal tissues, so larger doses can be given to increase therapeutic effects. The lipid formulation does not cost less than traditional amphotericin B. The lipid formulation has fewer side effects than amphotericin B. Traditional amphotericin B constricts afferent renal arterioles to reduce blood flow.

PTS: 1 REF: p. 477, Polyenes OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A child diagnosed with a serious fungal infection is prescribed amphotericin B parenterally. When considering possible adverse effects, the nurse should monitor the child’s level of which mineral?

A. Chloride B. Magnesium C. Copper D. Sodium ANS: B Rationale: Children may take amphotericin B, but such use requires assessment of electrolytes due to magnesium wasting. Hypomagnesemia may occur, which will require the administration of magnesium. The client is less at risk for changes in chloride, copper, or sodium.

PTS: 1 REF: p. 477, Polyenes OBJ: 3 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client is prescribed nystatin suspension for an oral fungal infection. The nurse should provide the client with information concerning which adverse effect associated with this form of nystatin?

A. Local irritation B. Burning C. Nausea D. Urinary urgency ANS: C Rationale: Oral use of nystatin produces the following adverse effects: nausea, vomiting, and diarrhea. The vaginal application of nystatin produces the following adverse effects: local irritation and burning. Urinary urgency is not an adverse effect associated with nystatin.

PTS: 1 REF: p. 477, Polyenes OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client is seen in the clinic for the treatment of vaginal itching and discharge. The nurse should be prepared to provide the client with information concerning which single-dose medication?

A. Caspofungin B. Terbinafine C. Ketoconazole D. Fluconazole ANS: D Rationale: Fluconazole is used for vaginal candidiasis in a single oral dose of 150 mg.

Caspofungin is not used for vaginal candidiasis but for invasive aspergillosis.

Terbinafine is used for interdigital tinea pedis. Ketoconazole is used for clients with organ transplants to manage organ rejection.

PTS: 1 REF: p. 480, Azoles OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A client diagnosed with a fungal infection is prescribed itraconazole. Prior to administration, the nurse notes that the client is taking carbamazepine for a seizure disorder. Based on this medication regime, what information should the nurse share with the client?

A. The serum level of carbamazepine will be increased.

B. The client’s carbamazepine should be discontinued.

C. The client’s antiseizure medication should be changed.

D. The client will require a higher dosage of itraconazole.

ANS: D Rationale: Drugs that induce drug-metabolizing enzymes (e.g., carbamazepine, phenytoin, rifampin) decrease serum concentrations of itraconazole, so the dose will need to be increased. The serum level of carbamazepine will not need to be increased.

The carbamazepine should not be discontinued or changed.

PTS: 1 REF: p. 480, Azoles OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A client is being treated with caspofungin for a systemic fungal infection related to Aspergillus. Prior to the administration of the first parenteral dose, the nurse notes that the client’s serum hepatic levels are elevated. How will these serum hepatic enzymes affect the administration of caspofungin?

A. The dose will need to be increased.

B. The dose will need to be decreased.

C. The dose will require a serum trough.

D. The medication should not be given.

ANS: B

Rationale: The dose of caspofungin will need to be reduced due to the risk of hepatotoxicity. The dose of caspofungin should not be increased. The peak and trough are not as vital as the reduction of the dose. The medication should be administered at a lower dose.

PTS: 1 REF: p. 484, Echinocandins OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A client is receiving intravenous amphotericin B. Which assessment warrants the discontinuation of the antifungal agent?

A. Sodium of 138 mEq/L (138 mmol/L) B. Hematocrit of 39% C. Blood urea nitrogen of 60 mg/dL (21.43 mmol/L) D. An aspartate aminotransferase (AST) test 10 Unit/L ANS: C Rationale: If the client’s BUN exceeds 40 mg/dL (14.28 mmol/L) or serum creatinine exceeds 3 mg/dL (265.20 mmol/L), the drug should be stopped or dosage should be reduced until renal function recovers. The hematocrit is in normal range and will not affect the medication administration. The AST and sodium levels are within normal range and will not affect the administration.

PTS: 1 REF: p. 477, Polyenes OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A client is being treated with amphotericin B. Which statement indicates that the client has understood the client teaching?

A. “The medication may cause diabetes.”

B. “The medication will cause liver necrosis.”

C. “The medication may cause kidney damage.”

D. “The medication will cause pancreatitis.”

ANS: C Rationale: The main concern with the administration of amphotericin B is the risk of nephrotoxicity. Thus, the statement that the medication may cause kidney damage is the most appropriate. The medication is not known to cause diabetes, liver necrosis, or pancreatitis.

PTS: 1 REF: p. 477, Polyenes OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

13. A client is being treated for a fungal infection with IV amphotericin B. In order to prevent drug discomfort, the nurse should consistently monitor the client’s levels of which component?

A. Sodium B. Hemoglobin C. Calcium D. Leukocytes ANS: A Rationale: It is essential to assess the sodium balance throughout the administration of amphotericin. By maintaining the serum sodium level within normal range, the client has decreased symptoms of drug discomfort. While monitoring serum blood levels is appropriate, none of the other options would contribute to the reduction of drug discomfort.

PTS: 1 REF: p. 479, Administering the Drug OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. When assessing for potential signs and symptoms of cryptococcosis, the nurse should prioritize what assessment?

A. Neurologic assessment B. Functional assessment C. Nutritional assessment D. Cardiac assessment ANS: A Rationale: Cryptococcosis may involve the lungs, skin, and other body organs. In clients with AIDS or other immunosuppressant disorders, it often involves the CNS and produces mental status changes, headache, dizziness, and neck stiffness. Neurologic assessment is consequently a priority. All the suggested assessments are appropriate, but none are as relevant as the neurologic assessment when considering the signs of cryptococcosis.

PTS: 1 REF: p. 474, Box 24.1 OBJ: 8 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 15. A client diagnosed with systemic candidiasis has been prescribed flucytosine. The nurse should be aware of the need to educate the client concerning its role as an adjunctive agent with which other medication?

A. Griseofulvin B. Fluconazole C. Amphotericin B D. Penicillin G

ANS: C Rationale: Flucytosine is used as an adjunctive agent with amphotericin B for the treatment of systemic fungal infections caused by Candida and Cryptococcus. None of the other options provide actions that are appropriate for the adjunctive use of flucytosine PTS: 1 REF: p. 489, Box 24.9 OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. An adult client has begun treatment with fluconazole. The nurse should recognize the need to likely discontinue the drug if the client develops which sign or symptom?

A. Jaundice B. Weight gain C. Iron deficiency anemia D. Hematuria ANS: A Rationale: The azoles may cause hepatotoxicity, and the development of jaundice usually accompanies liver damage, which may necessitate discontinuing the drug.

Fluconazole is not associated with weight gain, anemia, or hematuria.

PTS: 1 REF: p. 480, Azoles OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. An older adult client has asked health care provider for a prescription that will help to resolve “warped toenails.” The health care provider has diagnosed the client with onychomycosis. The nurse should anticipate that this client will be treated with what drug?

A. Micafungin B. Terbinafine C. Voriconazole D. Fluconazole ANS: B Rationale: Terbinafine, a miscellaneous antifungal agent, is used for the treatment of onychomycosis of the fingernails or toenails. Micafungin, voriconazole, and fluconazole are used to treat Candida.

PTS: 1 REF: p. 486, Miscellaneous Antifungal Agents for Superficial Mycoses OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Choice

18. A 43-year-old client, who has tested positive for systemic candidiasis, has been prescribed IV fluconazole. The nurse should implement which intervention to ensure the safe administration of this medication?

A. Administer the drug with lactated Ringer’s.

B. Infuse the drug no faster than 200 mg/h.

C. Avoid administering the drug through a peripheral IV. D. Administer prophylactic heparin prior to the fluconazole.

ANS: B Rationale: Continuous infusion of fluconazole occurs at a maximum rate of 200 mg/h.

The drug is not administered with either lactated Ringer’s or heparin. A peripheral IV may be used.

PTS: 1 REF: p. 480, Azoles OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. Caspofungin has been prescribed for a client who has been diagnosed with invasive aspergillosis. The nurse should teach the client to promptly report what symptom associated with an adverse reaction?

A. Cardiac distress B. Diaphoresis C. Dry mouth D. Muscle pain ANS: A Rationale: Caspofungin is administered in the acute care setting. The client should receive instruction about the histamine reaction to the medication and the necessity of reporting any cardiac symptoms. Diaphoresis, dry mouth, and muscle pain are not normally associated with the administration of caspofungin.

PTS: 1 REF: p. 484, Echinocandins OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 24: Drug Therapy for Fungal Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 25, Drug Therapy for Parasitic Infections 1. A child admitted to the pediatric unit with diarrhea and abdominal cramping is diagnosed with giardiasis. How long does it take for the symptoms of giardiasis to develop after ingestion of cysts?

A. 12 to 24 hours B. 3 to 5 days C. 1 to 2 weeks D. 2 to 3 months ANS: C Rationale: Giardiasis is caused by Giardia duodenalis (also known as Giardia lamblia), a common intestinal parasite. The disease spreads by ingestion of food or water contaminated with human feces containing noninfective cysts with a hardy protective envelope or by contact with infected people or animals. Giardia infections occur 1 to 2 weeks after the ingestion of the cysts and may be asymptomatic or produce diarrhea, abdominal cramps, and distention. This information regarding the time it takes for symptoms to be demonstrated makes all other options incorrect.

PTS: 1 REF: p. 493, Giardiasis OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. Which medication will be administered to treat the diarrhea and abdominal distention associated with giardiasis?

A. Sulfasalazine B. Metronidazole C. Trimethoprim–sulfamethoxazole D. Doxycycline ANS: B Rationale: Adults and children older than 8 years of age with symptomatic giardiasis are usually treated with oral metronidazole. The administration of sulfasalazine is used to treat ulcerative colitis. Trimethoprim–sulfamethoxazole is used to treat urinary tract infections. Doxycycline is a tetracycline agent. It is not used for giardiasis.

PTS: 1 REF: p. 495, Amebicides OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. A group of nursing students and their professor are engaged in a service learning project and will be caring for clients in a region in which malaria transmission occurs. What medication should be administered to prevent the development of malaria?

A. Metronidazole B. Oprelvekin

C. Chloroquine phosphate D. Chloroprocaine hydrochloride ANS: C Rationale: Chloroquine phosphate is administered to prevent malaria when traveling to the countries where malaria is a risk because of infected mosquitoes. Metronidazole is not administered to prevent malaria. Oprelvekin is used in the prevention of severe thrombocytopenia with antineoplastic chemotherapy. Chloroprocaine hydrochloride is a local anesthetic agent.

PTS: 1 REF: p. 495, Amebicides OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client diagnosed with Trichomonas vaginalis is being treated with metronidazole orally. What instruction is most important for the nurse to provide this client to minimize the risk for reinfection?

A. Instruct the client on safe sex.

B. Instruct the client to drink red wine.

C. Instruct the client to take two tablets if a dose is missed.

D. Instruct the client to have the partner treated.

ANS: D Rationale: The client should be instructed that the partner should also be treated.

Because trichomoniasis is transmitted by sexual intercourse, partners should be treated simultaneously to prevent reinfection. Although instruction on safe sexual practices is always important, it will not prevent reinfection, and the partner is infected asymptomatically. While the client should not drink while taking metronidazole, it has nothing to do with interfering with the spread of the infection. The client should not double the dose if it is missed; that is a dangerous and noneffective method of attempting to minimize the spread of the infection.

PTS: 1 REF: p. 494, Trichomoniasis OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A home care nurse visits a client who is bed bound and lives in a 12-story high-rise apartment complex. The client’s adult child states that the child noticed several small, itchy, red skin lesions over the client’s body. What parasite is most likely responsible for this client’s skin lesions?

A. Sarcoptes scabiei B. Pediculosis corporis C. Pediculosis pubis D. Toxoplasma gondii ANS: A

Rationale: Scabies are parasitic infestations of the skin. Scabies is caused by the itch mite (Sarcoptes scabiei), which burrows into the skin and lays eggs that hatch in 4 to 8 days. Pediculosis corporis is body lice. Pediculosis pubis is diagnosed by the presence of nits in the pubic and genital areas. Toxoplasma gondii is a parasite spread by ingesting undercooked meat or other food containing encysted forms of the organism.

PTS: 1 REF: p. 494, Clinical Manifestations OBJ: 5 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 6. A client diagnosed with extraintestinal amebiasis is receiving chloroquine. The nurse should provide information on which medication that is likely to be administered with chloroquine?

A. Iodoquinol B. Metronidazole C. Metyrosine D. Carbamazepine ANS: B Rationale: Chloroquine is used mainly for its antimalarial effects. When used as an amebicide, the drug is effective in extraintestinal amebiasis but usually ineffective in intestinal amebiasis. Treatment is usually combined with an intestinal amebicide.

Metronidazole is an intestinal amebicide. Iodoquinol is an iodine compound that acts against amebae in the intestinal lumen. Metyrosine is an enzyme inhibitor.

Carbamazepine is an antiseizure medication.

PTS: 1 REF: p. 495, Amebicides OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A nurse is educating a client about the administration of tinidazole. Which statement indicates that the client understands the administration of tinidazole?

A. “I can drink only very small amount of alcohol.”

B. “The medicine will leave a bitter or metallic taste in my mouth.”

C. “I need to take this medication on an empty stomach.”

D. “The medication won’t irritate my stomach if I take an antacid first.”

ANS: B Rationale: The most common adverse effects of tinidazole are a bitter metallic taste and nausea. Avoid alcoholic beverages while taking tinidazole and for 3 days after the drug is stopped. Take tinidazole with or after meals to decrease gastrointestinal irritation with other drugs.

PTS: 1 REF: p. 495, Amebicides OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 25: Drug Therapy for Parasitic Infections

KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 8. A parent asks the nurse how mebendazole will eradicate a child’s parasitic worms. How should the nurse best respond to the patent?

A. “Mebendazole will stop the worms from being able to reproduce.”

B. “Mebendazole robs the worms of the glucose they need to survive.”

C. “This drug will prompt your child’s body to expel the worms.”

D. “This drug causes the cells in each worm’s body to burst.”

ANS: B Rationale: Mebendazole blocks glucose uptake by susceptible helminths. The drug depletes glycogen stores that the worms need for survival and reproduction, resulting in their death. None of the other options accurately describe the action of mebendazole.

PTS: 1 REF: p. 501, Anthelmintics OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A young adult client diagnosed with hookworms has begun taking mebendazole. When monitoring this client’s health status during treatment, what diagnostic value should the nurse prioritize?

A. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) B. White blood cell differential C. International normalized ratio (INR) and activated partial thromboplastin time (aPTT) D. Hemoglobin, hematocrit, and red blood cell levels ANS: A Rationale: Because mebendazole is potentially hepatotoxic, it is important to assess the hepatic enzymes AST and ALT for elevations leading to hepatic failure. The other listed laboratory values are relevant indicators of the client’s health status, but none relates directly to the specific risks of mebendazole.

PTS: 1 REF: p. 501, Anthelmintics OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A nurse is teaching the parent of a 7-year-old child how to safely and effectively apply permethrin after the child was diagnosed with head lice. Which instruction should the nurse teach the parent?

A. Apply permethrin twice daily until the lice are eradicated.

B. Avoid using shampoo for the duration of treatment.

C. Apply the cream only to those locations where nits or lice are visible.

D. Wear gloves when applying the permethrin cream.

ANS: D Rationale: When administering permethrin for head lice, it is necessary to wear gloves.

Administration should occur again in 1 week if lice and nits are present. The cream should be applied to the entire scalp, and there is no need to avoid using shampoo.

PTS: 1 REF: p. 502, Scabicides and Pediculicides OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. Ivermectin appears on a list of a client’s recent medications. The nurse who is reviewing the medications is justified in suspecting that the client may have been receiving treatment for what parasitic infection?

A. Entamoeba histolytica B. Giardia lamblia C. Strongyloides stercoralis D. Plasmodium falciparum ANS: C Rationale: Ivermectin, which is used for numerous parasitic infections, is most active against strongyloidiasis (caused by the roundworm Strongyloides stercoralis).

Entamoeba histolytica causes amebiasis. Plasmodium falciparum causes malaria, and Giardia lamblia causes giardiasis.

PTS: 1 REF: p. 501, Anthelmintics OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 12. A client is taking chloroquine for malaria prophylaxis. The nurse should likely encourage the client to avoid ingesting which item?

A. Soy products B. Unpeeled vegetables C. High-fat food D. Alcohol ANS: D Rationale: When chloroquine is combined with alcohol, the risk of GI distress increases.

There is no particular need for this client to avoid soy, dietary fat, or unpeeled vegetables.

PTS: 1 REF: p. 498, Antimalarials OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

13. A nature photographer will be embarking on a trip overseas and is beginning a protocol for malaria prophylaxis involving 500 mg of chloroquine phosphate. What instruction should the nurse include in this client’s health education?

A. “Make sure you take your pill on the same day each week.”

B. “It’s not unusual to develop a rash on your trunk and arms, but this isn’t cause for concern.”

C. “You’ll need to plan ahead so that you take your chloroquine on an empty stomach.”

D. “We’ll need to provide you with enough syringes and teach you how to inject the drug.”

ANS: A Rationale: For malaria prophylaxis, chloroquine is taken weekly. It is administered orally and may be taken with food. A rash is not expected and would necessitate further follow-up.

PTS: 1 REF: p. 498, Antimalarials OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 14. A child has been taking mebendazole for the past 3 weeks after being diagnosed with roundworm. The nurse will determine the efficacy of the child’s treatment by referencing what diagnostic test?

A. Liver enzymes B. Stool for ova and parasites C. Colonoscopy or sigmoidoscopy D. Rectal swab for culture ANS: B Rationale: The nurse obtains a stool sample for culture for ova and parasites after 3 weeks of drug administration. A negative stool culture is the optimum outcome of drug therapy since it confirms complete eradication of the parasite and that any “worm burden” is now nonexistent. Colonoscopy, liver enzyme levels, and rectal swabs are not used to ascertain whether treatment has been successful since they are not focused on the parasites themselves.

PTS: 1 REF: p. 501, Anthelmintics OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. A client has been diagnosed with amebiasis. What sign or symptom would the nurse most likely expect to assess?

A. Red rash B. Severe diarrhea C. Intermittent fever D. Dizziness and confusion

ANS: B Rationale: Trophozoites (active amoebae) produce an enzyme that allows them to invade body tissues. They may form erosions and ulcerations in the intestinal wall with resultant diarrhea. This is a characteristic symptom of amebiasis. None of the other options are associated with symptoms of amebiasis.

PTS: 1 REF: p. 493, Amebiasis OBJ: 2 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A client taking metronidazole for the past 4 days reports to the nurse that the most recent dose caused the client to feel “flushed, sweaty, and sick in the stomach.” What assessment is most likely to address the cause of this phenomenon?

A. “Do you know if you’ve ever had an allergic reaction to penicillin?”

B. “Did you drink any alcoholic beverages around the time of taking the drug?”

C. “Did you take this dose on an empty stomach?”

D. “Are you taking any over-the-counter antihistamines?”

ANS: B Rationale: Flushing, headache, nausea, sweating, and vomiting may occur if alcohol is ingested with metronidazole. This reaction is unlikely attributable to an allergy, since the client has been taking the drug for 4 days. Taking metronidazole on an empty stomach or with antihistamines would not likely have this effect.

PTS: 1 REF: p. 495, Amebicides OBJ: 2 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A client has been prescribed 2% permethrin topically for pediculosis. Which measures would the nurse provide for safe and effective therapy? Select all that apply.

A. Follow contact isolation precautions until lice and nits are gone.

B. The nurse must wear a hair covering to prevent transmission.

C. Use the drug to saturate the hair and scalp, the area behind the ears, and the base of the neck.

D. Allow the medication to stay on affected areas overnight and then rinse off with warm water.

E. After application, assess the skin for stinging, numbness, rash, and pruritus.

ANS: A, C, E

Rationale: Lice can crawl, but they cannot jump, and they are transferred by contact from host or host’s personal items to another person. The client should be in contact isolation until all lice and nits are gone. During the first application of the drug, the nurse would wear gloves and saturate clean, towel-dried hair, the scalp, behind the ears, and the base of the neck with the cream rinse and leave it on for 10 minutes before rinsing with warm water. The nurse would use a nit comb to remove the dead nits stuck to hair shafts. The treatment is repeated in 1 week if nits and lice are still present, and that application is left on overnight before rinsing. The nurse would assess the skin for stinging, numbness, rash, or itching and report such findings to the prescriber.

PTS: 1 REF: p. 502, Scabicides and Pediculicides OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 18. A client has been prescribed metronidazole 250 mg PO. Which measures would the nurse take for safe and effective drug administration? Select all that apply.

A. Determine if vitamin B12, folate, or vitamins A, D, K deficiencies exist.

B. Assess if the client may be pregnant before proceeding with prescription.

C. Instruct the client to avoid sexual intercourse or use condoms until treatment is complete.

D. Teach the client that alcoholic drinks may be consumed once treatment is complete.

E. Provide instruction that the drug can cause metallic taste, and take with food.

ANS: B, C, E Rationale: Giardiasis, not trichomoniasis, may cause vitamin B12, folate, or fat-soluble vitamin deficiencies. The nurse would assess if the client may be pregnant because the drug readily crosses the placenta and is contraindicated. The client needs to avoid sexual intercourse or use condoms until completing the treatment to prevent spreading the trichomoniasis to the next person. Other sexual partners should be assessed for the illness and treated, if needed. To prevent a disulfiram-like reaction, alcohol must not be consumed until 3 days after finishing the drug regimen. The drug needs to be taken with food to improve absorption and will cause a metallic taste.

PTS: 1 REF: p. 497, Box 25.2 OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 19. A nurse is caring for an adult client who has been prescribed metronidazole. Which statement should the nurse include in the medication teaching? Select all that apply.

A. “The medication may cause your urine to be dark in color.”

B. “Metronidazole is safe when pregnant.”

C. “Avoid alcoholic beverages while taking the medication.”

D. “Food increases the absorption of the medication.”

E. “You may experience a metallic taste with this medication.”

ANS: A, C, E Rationale: Metronidazole is an amebicide and is 80% absorbed by the GI tract. Food decreases absorption so the client must be instructed to take the medication on an empty stomach. Metronidazole has many adverse effects that should be included in teaching about the medication; these include headache, dizziness, ataxia, darkening of the urine, diarrhea, nausea, vomiting, and an unpleasant metallic taste. Pregnancy is a contraindication to the use of this medication. Alcoholic beverages should be avoided while taking the medication and for 3 days after the medication is stopped. Flushing, headache, nausea, sweating, and vomiting may occur if alcohol is ingested.

PTS: 1 REF: p. 497, Box 25.2 OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Select 20. A nurse is caring for a client who has been prescribed chloroquine for the treatment of malaria. Which lunch option is best for the client to choose?

A. Cheeseburger, green salad, and an apple B. Turkey sandwich, celery sticks, and a plum C. Chicken salad with cranberries, wheat crackers, and an orange D. Spinach salad, carrots, and grapes ANS: D Rationale: Clients taking chloroquine should be told to avoid foods that acidify their urine. Acidification increases excretion of the urine, which decreases the effect of the medication. Foods to avoid include meats, cheeses, fish, eggs, grains, cranberries, prunes, and plums. The spinach salad option is the only meal that does not include foods that acidify the urine.

PTS: 1 REF: p. 500, Concept Mastery Alert OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 25: Drug Therapy for Parasitic Infections KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 26, Drug Therapy for Hypertension 1. A community health nurse is facilitating a health promotion session for a group of older adults. Which topic related to hypertension is most important to include in the information?

A. Hypertension will increase the risk of cancer.

B. An increase in sodium is recommended with hypertension.

C. Exercise will increase the risk of hypertension.

D. Hypertension will increase the risk of heart disease.

ANS: D Rationale: Hypertension increases risks of myocardial infarction, heart failure, cerebral infarction and hemorrhage, and renal disease. Hypertension does not increase the risk of cancer. An increase in sodium in a client’s diet is not recommended with hypertension.

Exercise will decrease the risk of hypertension.

PTS: 1 REF: p. 509, Introduction OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 2. The nurse is providing education to a client who has been recently diagnosed with hypertension. What event will the nurse identify as occurring with hypertension?

A. The kidneys excrete more fluid in response to increased blood pressure.

B. Fluid loss increases blood volume in the client with hypertension.

C. Decreased blood volume increases blood pressure.

D. Cardiac output increases and in turn causes an increase in blood pressure.

ANS: A Rationale: When arterial blood pressure is elevated, the kidneys excrete more fluid. The loss of fluid will reduce, not increase, blood volume. The decreased blood volume will decrease cardiac output. The decreased cardiac output decreases blood pressure.

PTS: 1 REF: p. 512, Response to Hypertension OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. The nurse is measuring the blood pressure of a client during a follow-up office visit.

What blood pressure reading, if it repeats a measurement taken during a previous visit, would indicate hypertension?

A. 115/85 mm Hg B. 125/75 mm Hg C. 128/70 mm Hg D. 125/79 mm Hg ANS: A

Rationale: Hypertension is defined as a systolic pressure above 129 mm Hg or a diastolic pressure above 79 mm Hg on multiple blood pressure measurements.

PTS: 1 REF: p. 511, Box 26.2 OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 4. The nurse is developing the care plan for a client who has been recently diagnosed with hypertension. What outcome would the nurse identify as most important?

A. Verbalization of an understanding of medical regimen B. Compliance with antihypertensive medications C. Multiple diastolic blood pressure readings less than 80 mm Hg D. Compliance with a low-sodium diet ANS: C Rationale: The diastolic blood pressure below 80 mm Hg is the most important outcome in this client. Verbalization of understanding of the medical regimen is a client-related outcome that is important but not the most important outcome. Compliance with antihypertensive medications is important but does not confirm a decreased blood pressure. Compliance with a low-sodium diet will assist in decreasing blood pressure but will not confirm that the blood pressure is decreased.

PTS: 1 REF: p. 511, Grades and Types of Hypertension OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. A client with which diagnosis should be prescribed captopril as the first-line treatment?

A. Diabetes mellitus B. Asthma C. Glaucoma D. Angina pectoris ANS: A Rationale: Captopril is the first-line agent for treating hypertension in diabetic clients, particularly those with type 1 diabetes. Captopril can be used for hypertension in clients with asthma, glaucoma, and angina pectoris but is not the first-line agent, as noted in diabetes mellitus.

PTS: 1 REF: p. 518, QSEN Alert: Safety OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

6. The nurse is providing education to a client who has been diagnosed with diabetes mellitus and has been prescribed captopril. What potential adverse effect will the nurse include in the teaching?

A. Hyperkalemia B. Hypokalemia C. Hypernatremia D. Hypermagnesemia ANS: A Rationale: By blocking production of angiotensin II, the ACE inhibitors decrease aldosterone production (thus reducing retention of sodium and water and increasing the retention of potassium). Hyperkalemia may develop in clients who have diabetes mellitus or renal impairment. Hypokalemia is not a risk in clients with diabetes mellitus.

Hypernatremia is not a major risk in clients with diabetes who are taking captopril.

Hypermagnesemia is not a risk in clients with diabetes who are taking captopril.

PTS: 1 REF: p. 518, Adverse Effects OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client diagnosed with hypertension has not responded adequately to treatment with losartan. What additional medication would the nurse expect the health care provider to prescribe?

A. Atorvastatin calcium B. Hydrochlorothiazide C. Hydralazine hydrochloride D. Digoxin ANS: B Rationale: If losartan alone does not control blood pressure, a low dose of diuretic may be added. Hydrochlorothiazide is a diuretic agent. Atorvastatin calcium is not a diuretic agent but rather a statin medication. Hydralazine is not a diuretic agent but rather a vasodilator. Digoxin is not a diuretic agent but rather a digitalis glycoside.

PTS: 1 REF: p. 522, Use OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client who is malnourished and hypertensive is being treated with losartan.

Considering the client’s nutritional status, how should the dose of the medication be adjusted in this client?

A. Increased B. Lowered C. Prescribed according to normal dosages D. Discontinued

ANS: B Rationale: Both losartan and the metabolite are highly bound to plasma albumin, and the metabolite has a long duration of action. Due to malnutrition, a low dose of losartan should be prescribed. The dose should not be higher than normal due to possible toxicity.

The dose should not be the same as normal due to possible toxicity. The medication will not be combined with a diuretic unless the blood pressure is not controlled.

PTS: 1 REF: p. 522, Use in Older Adults OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. Which diuretic can be combined with an ACE inhibitor to increase its effectiveness in decreasing blood pressure?

A. Loop diuretics B. Osmotic diuretics C. Potassium-sparing diuretics D. Thiazide diuretics ANS: D Rationale: ACE inhibitors may be used alone or in combination with other antihypertensive agents, such as thiazide diuretics. ACE inhibitors are not routinely combined with loop, osmotic, or potassium-sparing diuretics.

PTS: 1 REF: p. 513, Drug Management OBJ: 4 | 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 10. A client of African descent is being treated for hypertension. What antihypertensive agent would the nurse expect to be prescribed?

A. ACE inhibitor B. Angiotensin II receptor blocker C. Calcium channel blocker D. Beta-adrenergic blocker ANS: C Rationale: In a client of African descent, thiazide diuretics and calcium channel blockers are effective and recommended as initial drug therapy. ACE inhibitors, some ARBs (e.g., losartan and telmisartan), and beta-adrenergic blockers are less effective as monotherapy in clients.

PTS: 1 REF: p. 513, Drug Management OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

11. The nurse is assessing a client who has been prescribed a potassium-sparing diuretic. For what disorder would the nurse assess the client?

A. Hypernatremia B. Hyponatremia C. Hypokalemia D. Hyperkalemia ANS: D Rationale: Potassium-sparing diuretics may precipitate hyperkalemia. Potassium-sparing diuretics would not precipitate hypernatremia, hyponatremia, or hypokalemia.

PTS: 1 REF: p. 532, Diuretics OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 12. The nurse is providing education regarding lifestyle changes to a client who has been diagnosed with hypertension. When providing dietary instruction on a low-sodium diet, which dietary choice would the nurse identify as most appropriate?

A. Hot dog, baked beans, and coleslaw B. Grilled hamburger, French fries, and cola drink C. Grilled chicken, green salad, and apple D. Ham sandwich, potato chips, and cookie ANS: C Rationale: Therapeutic regimens include sodium restriction. The grilled chicken, green salad, and apple represent low-sodium dietary choices. Hot dog, baked beans, and coleslaw are high in sodium. Grilled hamburger, French fries, and cola drink are high in sodium. Ham sandwich, potato chips, and cookie are high in sodium.

PTS: 1 REF: p. 512, Dietary Management OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. The nurse is caring for a client of Asian descent who has been prescribed a beta-blocker.

The nurse is aware of what fact that explains why this client’s prescribed dose is lower than what would be prescribed to clients from other racial backgrounds?

A. Clients of Asian descent metabolize and excrete beta-blockers slowly.

B. Clients of Asian descent metabolize beta-blockers in the small intestine.

C. Clients of Asian descent have a diminished renal excretion of beta-blockers.

D. Clients of Asian descent are more likely to have a lower albumin level.

ANS: A Rationale: Clients of Asian descent in general need much smaller doses of beta-blockers because they metabolize and excrete beta-blockers slowly. They do not metabolize beta-blockers in the small intestine. They do not have diminished renal excretion of beta-blockers. They do not have a lower albumin level.

PTS: 1 REF: p. 515, Table 26.1. Drugs Administered for the Treatment of Hypertension | p.

516, Table 26.2. DRUGS AT A GLANCE: Oral Antihypertensive Combination Products OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 14. The nurse is teaching a client who has been prescribed an antihypertensive how to apply the transdermal patch used to administer the medication. What medication is the nurse describing?

A. Amlodipine B. Candesartan C. Enalapril D. Clonidine ANS: D Rationale: Clonidine is available as a transdermal patch. Enalapril, candesartan, and amlodipine are not available by this route.

PTS: 1 REF: p. 521, Self or Caregiver Administration OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 15. The nurse is caring for a client of African descent who is about to begin multidrug treatment for hypertension. Along with a calcium channel blocker, what type of diuretic would the nurse expect to be prescribed?

A. Thiazide B. Loop C. Potassium sparing D. None; diuretics are a drug of last choice for this client.

ANS: A Rationale: In clients of African descent, thiazide diuretics and calcium channel blockers are effective and recommended as initial drug therapy.

PTS: 1 REF: p. 513, Drug Management OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 16. A client has been diagnosed with hypertension following several elevated blood pressure readings. The nurse should prepare to educate the client regarding which likely drug regimen?

A. Monotherapy with a loop diuretic B. Monotherapy with an ACE inhibitor C. A beta-blocker combined with a calcium channel blocker D. A thiazide diuretic combined with a beta-blocker ANS: D Rationale: The JNC 8 guidelines suggest thiazide diuretics be used as first-line therapy, either alone (monotherapy) or with a beta-blocker, ACE inhibitor, ARB, or calcium channel blocker. Consequently, the other listed drug regimens are less likely to be implemented.

PTS: 1 REF: p. 528, Antiadrenergics | p. 532, Diuretics OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. An older adult client who resides in a care facility has been prescribed antihypertensives for the first time following many years of generally good health. When administering the first dose of the prescribed antihypertensive medication to an older adult client, the nurse should recognize the related risk to which possible side effect?

A. Falls B. Infection C. Acute confusion D. Impaired oxygenation ANS: A Rationale: Initiation of antihypertensive therapy creates a risk of acute hypotension and consequent falls. Infection, confusion, or impaired oxygenation is much less likely.

PTS: 1 REF: p. 509, Neural OBJ: 9 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A client being treated in the hospital for a femoral fracture is scheduled to receive a daily dose of prescribed metoprolol. Prior to administering this drug, the nurse should assess and document which client data? Select all that apply.

A. Oxygen saturation level B. Heart rate C. Potassium level D. Blood pressure E. Capillary refill ANS: B, D Rationale: Beta-blockers reduce heart rate and blood pressure; both parameters should be assessed prior to administration. Beta-blockers do not significantly affect potassium levels, oxygen levels, or peripheral circulation.

PTS: 1 REF: p. 528, Antiadrenergics OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 19. An adult client recently diagnosed with hypertension has begun combination therapy.

Which client statement would suggest a need for additional health education?

A. “I’m going to make up a schedule for checking my blood pressure on a regular basis.”

B. “I’ll only need to take these drugs on days when my blood pressure is particularly high.”

C. “My spouse and I are thinking of ways that we can cut down the amount of salt in our diet.”

D. “I’ve made plans with my best friend to start going for walks in the morning four times a week.”

ANS: B Rationale: Antihypertensive drug therapy is usually long term and is taken regularly, except in instances of hypotension or bradycardia. Therapy should not be seen as a response to short-term hypertensive readings. The other listed statements are appropriate responses to diagnosis and treatment.

PTS: 1 REF: p. 521, Patient Teaching Guidelines for Antihypertensive Drugs OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 20. A client prescribed ramipril earlier in the week states to the nurse, “Now I have a nagging, dry cough.” How should the nurse best follow-up the client’s statement?

A. “We should speak to the health care provider about immediately discontinuing the medication.”

B. “Coughing is an adverse effect of the medication that may lead to pneumonitis.”

C. “We need to obtain a sputum sample to see whether you have developed a respiratory infection.”

D. “Drugs like ramipril often cause a cough in clients; we should speak to the health care provider.”

ANS: D Rationale: ACE inhibitors like ramipril may precipitate a cough and may necessitate discontinuation of the drug. This is not, however, an emergency or an indication of infection or lung inflammation.

PTS: 1 REF: p. 520, Adverse Effects OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 26: Drug Therapy for Hypertension

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 27, Drug Therapy for Dysrhythmias 1. What is the mechanism of action for medications prescribed to treat a rapid dysrhythmia?

A. Reducing automaticity B. Increasing conduction C. Repolarizing myocardial cells D. Reducing refractory period ANS: A Rationale: Drugs used for the treatment of rapid dysrhythmias mainly reduce automaticity. These medications achieve this by slowing the conduction of electrical impulses through the heart while spontaneously depolarizing myocardial cells and prolonging the refractory period of myocardial cells.

PTS: 1 REF: p. 538, Automaticity and Excitability OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client is admitted to the emergency department with a ventricular dysrhythmia associated with an acute myocardial infarction. What assessment should the nurse make prior to administering a bolus of lidocaine IV? A. Assess for lidocaine administration in the client’s history.

B. Determine the client’s ability to swallow.

C. Assess the client’s nutritional history for allergies.

D. Determine if the client has had a reaction to local anesthesia.

ANS: D Rationale: Lidocaine is contraindicated in clients allergic to local anesthetic agents. It is important to determine if the client has been administered lidocaine in the past, but it is imperative to ascertain any untoward effects. The medication will be administered intravenously, so it is not necessary to assess the client’s ability to swallow. However, swallowing can be impaired after administration and should be assessed then. It is not necessary to do a nutritional assessment at this time.

PTS: 1 REF: p. 545, Class IB OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A client experiencing a ventricular dysrhythmia has received a bolus of lidocaine. What is the recommended rate for continuous infusion of lidocaine IV now prescribed for this client?

A. 0.25 to 0.75 mg/min B. 10 to 20 mg/min

C. 1 to 4 mg/min D. 6 to 8 mg/min ANS: C Rationale: A continuous infusion of lidocaine IV after a bolus is 1 to 4 mg/min. The administration of 0.25 to 0.75 mg/min would be too small of a dosage. The administration of 10 to 20 or 6 to 8 mg/min would be too large.

PTS: 1 REF: p. 542, Table 27.2. DRUGS AT A GLANCE: Class I Sodium Channel Blockers OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client is admitted to the emergency department in ventricular fibrillation. The client is administered amiodarone hydrochloride. What is the major effect of this medication?

A. It produces skeletal muscle relaxation.

B. It inhibits the increase of the refractory period of the cells.

C. It stimulates the sympathetic nervous system.

D. It slows the conduction through the AV node.

ANS: D Rationale: The major effect of amiodarone is that it slows the conduction through the AV node and prolongs the refractory period. It produces smooth muscle, not skeletal muscle, relaxation. It prolongs the refractory period; it does not inhibit the increase of the refractory period. It blocks the effects of the sympathetic nervous system instead of stimulating it.

PTS: 1 REF: p. 549, Use OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. The nurse is caring for a client who is receiving amiodarone. Which assessment would be considered a priority?

A. Urine output B. Heart rate C. Lung sounds D. Muscle rigidity ANS: B

Rationale: An effect of the medication is to increase the ventricular fibrillation threshold.

The nurse assesses the client’s heart rate and the cardiac rhythm; the heart rate and rhythm should be regular, with a rate between 60 and 100 beats/min. It is important to assess urine output, but it is not the primary focus since renal function is not the focus of the therapy. Amiodarone may adversely affect the respiratory system, but assessing heart rate is a greater priority than lung sounds because the former monitors both therapeutic and adverse effects. The effect of amiodarone is to decrease muscle strength, not cause rigidity.

PTS: 1 REF: p. 550, Assessing for Therapeutic Effects OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. The nurse is developing a care plan for a client who has been diagnosed with atrial flutter. Which nonpharmacological intervention, if prescribed by the health care provider, will best assist in long-term maintenance of a normal sinus rhythm after successful treatment for atrial flutter?

A. Implantation of a cardioverter–defibrillator B. Initiation of an isometric exercise program C. A high-potassium diet D. Surgical intervention with a new mitral valve ANS: A Rationale: The implantable cardioverter–defibrillator provides nonpharmacological management of atrial flutter to maintain normal sinus rhythm. Surgical intervention with a new mitral valve will not prevent atrial flutter. A varied exercise routine and monitored potassium intake will ensure normal sinus rhythm.

PTS: 1 REF: p. 539, Nonpharmacologic Management OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. The health care provider has prescribed a class IV calcium channel blocker for a client diagnosed with acute supraventricular tachycardia. Which drug does the nurse expect to be prescribed?

A. Bethanechol chloride B. Chlorambucil C. Diltiazem D. Midazolam hydrochloride ANS: C

Rationale: Calcium channel blockers obstruct the movement of calcium into conductive and contractile myocardial cells by inhibiting the influx of calcium through its channels, causing a slower conduction through the SA and AV nodes. Diltiazem is administered intravenously to treat acute supraventricular tachycardia. Bethanechol is used to treat neurogenic bladder. Chlorambucil is an antineoplastic agent used to treat chronic lymphocytic leukemia. Midazolam hydrochloride is administered to reduce anxiety.

PTS: 1 REF: p. 551, Pharmacokinetics OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 8. A client diagnosed with digitalis-induced dysrhythmia has been prescribed magnesium sulfate IV to resolve a low potassium level. What cardiac characteristic should the nurse monitor to determine if the medication has produced its desired effect?

A. Decreased QRS complex B. Increased stroke volume C. Decreased myocardial irritability D. Elevated ST segment ANS: C Rationale: Hypomagnesemia increases myocardial irritability; magnesium sulfate would act to decrease that irritability. Magnesium deficit prolongs the QRS complex instead of decreasing the QRS complex. Hypomagnesemia does not increase stroke volume.

Hypomagnesemia will depress the ST segment, not elevate the ST segment.

PTS: 1 REF: p. 553, Unclassified Antidysrhythmic Drugs OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 9. A client who is dehydrated is being treated with quinidine to reduce automaticity. For what effect should the nurse monitor?

A. Increased cardiac contraction B. Increased vagal nerve stimulation C. Toxic drug levels D. Increased pulmonary congestion ANS: C Rationale: Quinidine is highly bound to serum albumin. The client who suffers from dehydration will have a decreased serum albumin, which contributes to toxic quinidine levels. Toxic levels of quinidine will significantly decrease cardiac contraction.

Quinidine decreases vagal nerve stimulation, and toxic drug levels will decrease vagal nerve stimulation. The client will not experience increased pulmonary congestion.

PTS: 1 REF: p. 541, Pharmacokinetics OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. The nurse is caring for a client who has been prescribed quinidine. The nurse should advocate for a lower-than-normal dose if the client has a history of what medical diagnosis?

A. Type 1 or type 2 diabetes B. Primary hypertension C. Liver disease D. Chronic obstructive pulmonary disease ANS: C Rationale: Hepatic impairment increases the plasma half-life of several antidysrhythmic drugs, including quinidine, and clients with hepatic impairment usually receive a reduced dosage. The pathophysiologies of the other conditions would not affect the half-life of quinidine since they do not affect drug metabolism.

PTS: 1 REF: p. 541, Pharmacokinetics OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 11. The nurse’s subsequent cardiac assessments and monitoring of a client prescribed disopyramide should be planned in the knowledge that this drug increases the client’s risk for developing what health problem?

A. New-onset chest pain B. Mitral valve regurgitation C. Acute renal failure D. New dysrhythmias ANS: D Rationale: For disopyramide, the Food and Drug Administration (FDA) has issued a black box warning because of the drug’s known prodysrhythmic properties. It is not specifically linked to chest pain, valvular regurgitation, or renal failure.

PTS: 1 REF: p. 544, Other Drugs in the Class OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 12. Intravenous verapamil has been ordered immediately in the treatment of a client experiencing supraventricular tachycardia. In order to ensure client safety, the nurse should be aware that concurrent use of which medication is absolutely contraindicated?

A. Sodium bicarbonate B. Propranolol C. Diltiazem D. Lidocaine

ANS: B Rationale: Use of IV verapamil with IV propranolol should not take place; it may result in potentially fatal bradycardia and hypotension. None of the other medications would result in these adverse reactions if used concurrently with verapamil.

PTS: 1 REF: p. 547, Drugs That Increase the Effects of Propranolol OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. An adult client with a long-standing dysrhythmia has been taking oral propranolol for the last several months, resulting in acceptable symptom control. What is a priority teaching point for the nurse to communicate to this client?

A. The need to measure the radial pulse for 1 minute prior to each dose of propranolol B. The importance of not stopping the medication abruptly C. The need to avoid taking over-the-counter antacids D. The need to limit intake of high-potassium foods ANS: B Rationale: Clients need to realize that they should not stop taking propranolol abruptly because this action can cause the dysrhythmia to worsen. There is no need to restrict potassium intake, to avoid antacids, or to measure the radial pulse prior to each dose of propranolol.

PTS: 1 REF: p. 547, Patient Teaching OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 14. What is a major effect of amiodarone when prescribed for ventricular fibrillation?

A. It produces skeletal muscle relaxation.

B. It decreases automaticity in the ventricles.

C. It stimulates the sympathetic nervous system.

D. It slows the process of repolarization.

ANS: D Rationale: Potassium channel blockers such as amiodarone prolong duration of the action potential, slow repolarization, and prolong the refractory period in both the atria and ventricles. Amiodarone blocks the effects of the sympathetic nervous system instead of stimulating it. Amiodarone and the other potassium channel blockers do not directly decrease automaticity. These class of medication do not relax skeletal muscles.

PTS: 1 REF: p. 548, Class III Potassium Channel Blockers OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 15. In some cases, low-dose amiodarone may be used to prevent recurrence of what cardiac disorder?

A. Atrial fibrillation B. Angina pectoris C. Ventricular hypertrophy D. Mitral valve regurgitation ANS: A Rationale: Low-dose amiodarone may be a pharmacologic choice for preventing recurrent atrial fibrillation after electrical or pharmacologic conversion. Potassium channel blockers such as amiodarone prolong duration of the action potential, slow repolarization, and prolong the refractory period in both the atria and ventricles.

Potassium channel blockers are not effective in preventing valvular disorders, ventricular hypertrophy, or angina.

PTS: 1 REF: p. 549, Use OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 16. A client is administered diltiazem IV, followed by propranolol IV. The nurse should assess for what potential side effect of this medication combination?

A. Hypertensive crisis B. Anaphylaxis C. Valve regurgitation D. Impaired myocardial contractility ANS: D Rationale: If diltiazem is used with propranolol or digoxin, it is necessary to exercise caution to avoid further impairment of myocardial contractility. The administration of IV diltiazem and propranolol will not produce hypertensive crisis, anaphylaxis, or valve regurgitation.

PTS: 1 REF: p. 552, Contraindications OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. The nurse is preparing to administer adenosine to a client. What is the rationale for administering adenosine as a bolus?

A. It has an exceptionally short half-life.

B. It undergoes an unusually high first-pass effect.

C. A sudden, high serum level provides a long-lasting effect.

D. Bolus administration lessens the risk of potential adverse effects.

ANS: A Rationale: Adenosine has a very short duration of action (serum half-life of less than 10 seconds) and a high degree of effectiveness. It must be given by a rapid bolus injection, preferably through a central venous line. If given slowly, it is eliminated before it can reach cardiac tissues and exert its action.

PTS: 1 REF: p. 553, Unclassified Antidysrhythmic Drugs OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 18. An adult client with no known history of cardiovascular disease presents with atrial flutter. The client is prescribed propafenone PO 150 mg every 8 hours for 24 hours.

What is the cardiac care nurse’s priority assessment during this period?

A. Hourly monitoring of potassium levels B. Blood pressure monitoring every 10 minutes C. Echocardiography D. Continuous ECG monitoring ANS: D Rationale: Propafenone may cause new dysrhythmias or aggravate preexisting dysrhythmias, sometimes causing sustained ventricular tachycardia or ventricular fibrillation. As a result, continuous ECG monitoring is necessary at the initiation of treatment. This is a priority over serial potassium levels or echocardiography. Blood pressure should ideally be monitored more frequently than every 10 minutes.

PTS: 1 REF: p. 545, Class IC OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. An adult client with a history of coronary artery disease is undergoing cardiac catheterization. What drug should the nurse most likely prepare for administration when the client suddenly begins exhibiting ventricular tachycardia?

A. Lidocaine B. Magnesium sulfate (MgSO4) C. Digoxin D. Epinephrine ANS: A Rationale: Lidocaine is the drug of choice for treating serious ventricular dysrhythmias associated with acute myocardial infarction, cardiac catheterization, cardiac surgery, and digitalis-induced ventricular dysrhythmias since it decreases myocardial irritability (automaticity) in the ventricles. Digoxin, MgSO4, and epinephrine are not used in this clinical situation since none affect myocardial irritability in this way.

PTS:

1

REF: p. 545, Class IB

OBJ: 7

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. Oral quinidine is prescribed for a client with a diagnosis of chronic ventricular tachycardia without heart block. In order to assess for the safety and efficacy of this treatment, the nurse should prioritize which assessment?

A. Radial and brachial pulse B. Level of consciousness C. Serum drug levels D. Blood pressure ANS: C Rationale: While all of the listed assessments are relevant and appropriate, the nurse must assess the client’s serum quinidine level to ensure it is between 2 and 5 mcg/mL (6.2 to 15.4 mol/L).

PTS: 1 REF: p. 541, Pharmacokinetics OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 27: Drug Therapy for Dysrhythmias KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 28, Drug Therapy for Coronary Heart Disease 1. A client reports substernal chest pain that radiates to the neck. The pain lasts 5 minutes and then subsides with relaxation. What is the most likely cause of the chest pain?

A. Myocardial infarction B. Intermittent claudication C. Hypertension D. Angina pectoris ANS: D Rationale: Classic angina pain related to angina pectoris is substernal chest pain that can radiate to the jaw. Chest pain that lasts longer than 5 minutes is not associated with angina but is associated with myocardial infarction. Hypertension is usually a condition in which the client is pain free. Intermittent claudication is not associated with chest pain.

PTS: 1 REF: p. 560, Stable Angina OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 2. The nurse is teaching a client about the effect of nicotine on the cardiovascular system.

What information should the nurse include?

A. It increases catecholamines to increase heart rate.

B. It diminishes the blood’s ability to clot.

C. It increases myocardial contractility of the heart.

D. It increases high-density lipoproteins.

ANS: A Rationale: Nicotine causes catecholamines, resulting in an increase of heart rate and blood pressure. Nicotine increases platelet adhesiveness and aggregation to increase, not decrease, clotting. Nicotine decreases myocardial contractility. Nicotine decreases good cholesterol, which is the high-density lipoprotein.

PTS: 1 REF: p. 561, Nonpharmacologic Therapy OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. The nurse is caring for a client whose chest pain has not been relieved with sublingual organic nitrate. What medication does the nurse suspect will most likely be prescribed by the health care provider?

A. Intravenous morphine sulfate B. Intravenous nitroglycerine C. Oral nonsteroidal anti-inflammatory agents D. Fentanyl topical patch ANS: B

Rationale: Intravenous nitroglycerin is used to manage angina that is unresponsive to organic nitrates via other routes since it quickly increases blood flow to the heart. The use of intravenous morphine sulfate will decrease pain but will not increase needed blood flow. Oral nonsteroidal anti-inflammatory agents will not assist in decreasing pain or increasing needed blood flow. The application of a fentanyl patch will not increase needed blood flow.

PTS: 1 REF: p. 562, QSEN Alert: Safety OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client is diagnosed with erectile dysfunction. The client asks the nurse what effect sildenafil has because the client is taking nitroglycerin for chest pain. What is the best explanation for why nitrates are contraindicated with sildenafil?

A. “The combination can cause a severe decrease in blood pressure.”

B. “Taking the drugs together can lead to prostate cancer.”

C. “Nitroglycerine decreases the effect of sildenafil for erectile dysfunction.”

D. “Nitroglycerine and sildenafil will diminish the effectiveness of chest pain relief.”

ANS: A Rationale: Nitrates and phosphodiesterase enzyme type 5 inhibitors decrease blood pressure, and the combined effect can produce profound, life-threatening hypotension.

The other options do not accurately describe the risk posed by concurrent use of the two medications.

PTS: 1 REF: p. 563, QSEN Alert: Safety OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A client is experiencing chest pain and self-administers nitroglycerine sublingually.

When should the client expect to notice relief of the chest pain?

A. 1 to 3 minutes B. 5 to 10 minutes C. 1 to 20 minutes D. 30 to 60 minutes ANS: A Rationale: When given sublingually, nitroglycerin is absorbed directly into the systemic circulation and acts within 1 to 3 minutes. If the medication has not produced an effect in 5 minutes, it should be repeated. The nitroglycerine tablets have an onset of action of 1 to 3 minutes, not 5 to 60 minutes.

PTS: 1 REF: p. 562, Pharmacokinetics OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Understand

NOT: Multiple Choice

6. The nurse is providing education to a client who has been prescribed the nitroglycerine patch. How would the nurse describe an advantage of this method of administration?

A. “It is only administered one time per week.”

B. “It requires rotation of application site.”

C. “It has a longer duration of action.”

D. “It has a faster action than the tablets.”

ANS: C Rationale: When nitroglycerin is applied topically, absorption occurs at a slower rate and has a longer duration of action. The topical form is usually administered more frequently than one time per week. It is not more effective than the tablets. It does not have a faster action. The nurse should instruct the client that the nitroglycerin patch site should be regularly rotated to avoid skin irritation but that is not an advantage.

PTS: 1 REF: p. 565, Self or Caregiver Administration OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. The nurse is assessing a client who has begun therapy with isosorbide dinitrate. What assessment finding will the nurse recognize as an indication that the client has achieved the maximum tolerable dose?

A. The client reports nausea.

B. The client sees halos around lights.

C. The client reports a headache.

D. The heart rate increases to 100 beats/minute.

ANS: C Rationale: Isosorbide dinitrate’s effective dose is usually determined by increasing the dose until the client experiences a headache, which will indicate maximum tolerable dose. The development of nausea, visual halos, or tachycardia does not indicate maximum tolerable dose. The client should not see halos around lights with isosorbide dinitrate. The client should not experience an increase in heart rate.

PTS: 1 REF: p. 564, Other Drugs in the Class OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client with a long-standing diagnosis of asthma is prescribed a beta-blocker for the treatment of angina. The nurse should consequently prioritize assessment for what health problem?

A. Bronchospasm B. Hyperglycemia C. Pleural effusion

D. Pneumonia ANS: A Rationale: Clients with asthma should be observed for bronchospasm from blockage of beta2 receptors in the lung. The client will not experience hyperglycemia, pleural effusion, or pneumonia as a result of this medication.

PTS: 1 REF: p. 568, Adverse Effects OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 9. A client with diabetes is prescribed propranolol. For what should the client be assessed?

A. Hypercholesterolemia B. Hypermagnesemia C. Hypocalcemia D. Hypoglycemia ANS: D Rationale: Beta-blockers should be used with caution in clients with diabetes mellitus because they conceal signs of hypoglycemia. Beta-blockers do not produce hypercholesterolemia, hypermagnesemia, or hypocalcemia.

PTS: 1 REF: p. 568, Adverse Effects OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. Which electrocardiogram change should prompt the nurse to question the use of ranolazine for the treatment of a client diagnosed with chronic angina?

A. Normal ST segment B. Inverted P wave C. Shortened QRS D. QT prolongation ANS: D Rationale: Ranolazine is contraindicated in clients with preexisting QT prolongation. It is not contraindicated with a normal ST segment, inverted P wave, or shortened QRS. PTS: 1 REF: p. 572, Ranolazine OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A client with a history of angina has sustained a mild head injury in a motor vehicle accident. When the client reports chest pain, what explanation should the nurse provide to support the decision not to treat the angina-related pain with nitroglycerin tablets?

A. Nitroglycerin will raise the client’s blood pressure.

B. Nitroglycerin will cause decreased cerebral edema.

C. Nitroglycerin will increase intracranial pressure.

D. Nitroglycerin will decrease blood glucose.

ANS: C Rationale: Nitroglycerin should be used cautiously in the presence of a head injury or cerebral hemorrhage because it may increase intracranial pressure. Nitroglycerin will lower blood pressure. Nitroglycerin can increase cerebral edema. Nitroglycerin does not have a direct effect on blood glucose.

PTS: 1 REF: p. 562, QSEN Alert: Safety OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A client diagnosed with erectile dysfunction is taking nitroglycerin for chest pain. What is the best explanation for why a nitrate-like sildenafil would be contraindicated?

A. “Nitroglycerin and sildenafil cause a severe decrease in blood pressure.”

B. “Nitroglycerin and sildenafil can lead to prostate cancer.”

C. “Nitroglycerin decreases the effect of sildenafil for erectile dysfunction.”

D. “Nitroglycerin and sildenafil will diminish the effectiveness of chest pain relief.”

ANS: A Rationale: Nitrates and phosphodiesterase enzyme type 5 inhibitors like sildenafil decrease blood pressure, and the combined effect can produce profound, life-threatening hypotension. None of the remaining options are accurate statements regarding sildenafil.

PTS: 1 REF: p. 563, QSEN Alert: Safety OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A client diagnosed with angina is prescribed atenolol. Following absorption of the drug, the nurse should monitor the client for what desired effect?

A. Relief of fatigue B. Increased oxygen saturation levels C. Mild to moderate drowsiness D. Decreased heart rate ANS: D Rationale: Beta-blockers cause a slowing of the heart rate referred to as negative chronotropy. They do not normally cause drowsiness, short-term relief from fatigue, or a notable increase in SaO2 since the action of this medication is to inhibit beta2 receptors in the bronchial and vascular musculature.

PTS: 1 REF: p. 567, Action OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. The nurse has completed administering an oral dose of 30 mg of long-lasting nifedipine.

What principle should guide the nurse’s follow-up assessment?

A. Nifedipine has the potential to induce prodysrhythmic effects.

B. Nifedipine does not affect heart rate, so assessment after administration is not normally necessary.

C. The client’s heart rate will be at its lowest approximately 45 minutes to 1 hour after oral administration of nifedipine.

D. The client’s blood pressure, heart rate, and oxygen saturation level should be assessed 30 minutes after administration of nifedipine.

ANS: B Rationale: Nifedipine inhibits the influx of calcium entering through slow channels, producing vasodilation of the peripheral blood vessels and coronary arteries. However, the drug has a minimal effect on the sinoatrial and atrioventricular nodes. Therefore, it does not affect the heart rate or rhythm.

PTS: 1 REF: p. 570, Use OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 15. The nurse is preparing to administer a scheduled dose of oral atenolol to a client. Which assessment findings would prompt the nurse to withhold the medication? Select all that apply.

A. Heart rate of 65 beats/min B. Blood pressure of 88/49 mm Hg C. Heart rate of 54 beats/min D. Blood pressure of 141/92 mm Hg E. Oxygen saturation of 90% on room air ANS: B, C Rationale: It is important to withhold atenolol and notify the prescriber for a resting heart rate below 55 beats/min and/or systolic blood pressure less than 90 mm Hg. Low SaO2 does not require withholding atenolol.

PTS: 1 REF: p. 567, Use OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 16. The nurse is providing education to a client who has been prescribed bisoprolol. During teaching, the nurse explains that the drug achieves a therapeutic effect in what way?

A. Decreasing heart rate B. Increasing the force of myocardial contractions

C. Prolonging the QT interval D. Shortening the time required for repolarization ANS: A Rationale: Bisoprolol reduces the workload of the heart and decreases myocardial oxygen demand by decreasing heart rate and the force of myocardial contractions. It does not prolong the QT interval or shorten the time required for repolarization.

PTS: 1 REF: p. 569, Other Drugs in the Class OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 17. An older adult client diagnosed with angina pectoris has been prescribed nifedipine.

After administering a dose of the drug at 08:00, the nurse should anticipate maximum effect at what time?

A. Between 08:30 and 09:00 B. 09:00 to 10:00 C. Between 12:00 and 14:00 D. 11:30 to 12:30 ANS: B Rationale: Except for sustained release forms, nifedipine reaches peak plasma levels within 1 to 2 hours. This information eliminates the other options.

PTS: 1 REF: p. 570, Pharmacokinetics OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. An adult client with a long history of heavy alcohol use and angina was diagnosed with liver cirrhosis several months ago. When considering the use of nifedipine, what consideration should the nurse be aware of?

A. The client is likely to experience an increased effect of the medication.

B. This client will require a higher dose than a client without this medical history.

C. Nifedipine is contraindicated because it is highly hepatotoxic.

D. The client’s increased albumin levels will negate the therapeutic effect.

ANS: A Rationale: In clients diagnosed with cirrhosis, bioavailability of oral drugs is greatly increased and metabolism (of both oral and parenteral drugs) is greatly decreased. Both of these effects increase plasma levels of drug from a given dose (essentially an overdose). Cirrhosis does not necessarily contradict nifedipine nor does an increased albumin level negate its therapeutic effects.

PTS: 1 REF: p. 571, Use in Patients With Hepatic Impairment OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 19. An older adult client whose medical history includes angina experiences a sudden onset of chest pain. This client would most likely administer a dose of nitroglycerin by what route?

A. Subcutaneous injection B. Oral sustained-release tablet C. Nebulized inhalation D. Transmucosal spray ANS: D Rationale: For relief of sudden-onset angina, fast-acting preparations of nitroglycerin include sublingual and chewable tablets and transmucosal spray. Subcutaneous injections, sustained-release tablets, and nebulizers are not used since they would not deliver the medication either effectively or quickly enough.

PTS: 1 REF: p. 562, Use OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. When teaching the client to safely administer nitroglycerin ointment, the nurse should convey which instruction?

A. “The backs of your hands and the tops of your feet are ideal sites for applying the ointment.”

B. “Make sure you squeeze the ointment on to a paper measuring scale before applying it.”

C. “Massage the ointment into your skin for 10 to 15 seconds after applying it.”

D. “Don’t apply the ointment unless you’re experiencing chest pain at the time.”

ANS: B Rationale: Application of nitroglycerin ointment requires using the dose-measuring application papers supplied with ointment. It is necessary to squeeze the ointment onto a measuring scale printed on paper. The ointment should be applied onto a nonhairy area of the skin, and distal extremities should be avoided. The area of application should not be massaged. All these practices would affect the absorption of the medication.

PTS: 1 REF: p. 564, Administering the Medication OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 21. Following the administration of a scheduled dose of 50-mg atenolol PO, the nurse should prioritize what assessment?

A. Level of consciousness (LOC)

B. Blood pressure C. Oxygen saturation levels D. Oral temperature ANS: B Rationale: Atenolol and other beta-blockers have an antihypertensive effect, making the monitoring of blood pressure a priority. They are unlikely to affect temperature, LOC, or oxygen saturation levels.

PTS: 1 REF: p. 567, Use OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 28: Drug Therapy for Coronary Heart Disease KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 29, Drug Therapy for Shock and Hypotension 1. A client is experiencing anaphylaxis. What drug will the nurse most likely administer?

A. Epinephrine B. Norepinephrine C. Acetylcysteine D. Dantrolene sodium ANS: A Rationale: Epinephrine is the adrenergic drug of choice for relief of anaphylactic shock, the most serious allergic reaction, as well as in the treatment of cardiac arrest.

Norepinephrine is used to treat severe hypotension and shock that persists after adequate fluid volume replacement. Acetylcysteine is used for acetaminophen overdose.

Dantrolene sodium is used to treat malignant hyperthermia.

PTS: 1 REF: p. 587, QSEN Alert: Safety OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client is suffering from hypovolemic shock. Which agents are administered if fluid volume replacement does not restore sufficient blood pressure?

A. First-line agents B. Second-line agents C. Beta-blockers D. Antianginal drugs ANS: B Rationale: In hemorrhagic or hypovolemic shock, drugs are second-line agents that may be used if adequate fluid volume replacement does not restore sufficient blood pressure and circulation to maintain organ perfusion. The first-line therapy is fluid replacement.

Beta-blockers decrease heart rate and are not administered with hypovolemic shock.

Antianginals are not administered in hypovolemia.

PTS: 1 REF: p. 581, QSEN Alert: Evidence-Based Practice OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. A client has been diagnosed with narrow-angle glaucoma. What ocular effect will be produced if the client is prescribed an adrenergic agent?

A. Hypothyroidism B. Decreased heart rate C. Mydriasis D. Hypertension ANS: C

Rationale: Narrow-angle glaucoma is a contraindication to adrenergic agents because the drugs result in mydriasis, closure of the filtration angle of the eye, and increased intraocular pressure. Hypothyroidism will not occur with the administration of adrenergic agents, and it is not an ocular effect. Decreased heart rate will not occur with the administration of adrenergic agents, and it is not an ocular effect. Hypertension is not an ocular effect.

PTS: 1 REF: p. 584, Contraindications OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A client is administered epinephrine in conjunction with a local anesthetic. What effect will epinephrine produce?

A. Decreased cerebral circulation B. Decreased coronary circulation C. Increased vasoconstrictive effects D. Increased bronchoconstriction ANS: C Rationale: Epinephrine is added to local anesthetics for vasoconstrictive effects, which include prolonging the action of the local anesthetic drug, preventing systemic absorption, and minimizing bleeding. Epinephrine will not decrease cerebral circulation or coronary circulation. Epinephrine will not increase bronchoconstriction.

PTS: 1 REF: p. 587, QSEN Alert: Safety OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. A child who is allergic to bee stings is stung by a bee at school. The school nurse administers epinephrine. Why is epinephrine the drug of choice for this client?

A. It has a long half-life.

B. It has an effect on the adrenal gland.

C. It has an antihistamine effect.

D. It is inexpensive and affordable.

ANS: C Rationale: Epinephrine is the drug of choice for management of anaphylactic shock because of its rapid onset of action and antiallergic effect. Epinephrine has a short half-life. Epinephrine is not preferred due to the effect on the adrenal gland. Epinephrine is inexpensive, but this characteristic is not the reason for its use.

PTS: 1 REF: p. 587, QSEN Alert: Safety OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

6. A client is admitted to the intensive care unit after surgery from a gunshot wound. The client’s family is very concerned and asks the nurse why dobutamine is being administered. What is the nurse’s best response?

A. “We are giving this drug to increase blood pressure and heart rate.”

B. “The medication will improve and stabilize your family member’s condition.”

C. “The medication will increase the force of the heart contraction and increase blood pressure.”

D. “The medication will increase heart rate and decrease blood pressure.”

ANS: C Rationale: Dobutamine is a synthetic catecholamine developed to provide less vascular activity than dopamine. Dobutamine increases the force of myocardial contraction with a minimal increase in heart rate. Dobutamine increases blood pressure in large doses. The statements indicating that the drug is given to increase heart rate or decrease blood pressure are incorrect. The statement that the medication will improve the client’s condition does not provide the family with an adequate explanation of the effect of dobutamine.

PTS: 1 REF: p. 587, QSEN Alert: Safety OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client suffers a cardiac arrest. Which medication will be administered in a bolus?

A. Dopamine B. Dobutamine C. Metaraminol D. Epinephrine ANS: D Rationale: Epinephrine is administered in a bolus for cardiac arrest. Dopamine, dobutamine, and metaraminol are not administered in a bolus for cardiac arrest.

PTS: 1 REF: p. 587, QSEN Alert: Safety OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client is being treated for hypovolemic shock. Which assessment is most important in the client with hypovolemic shock?

A. Intake and weight B. Lung and bowel sounds C. Temperature and peripheral pulses D. Blood pressure and pulse ANS: D

Rationale: Assess blood pressure and heart rate in clients being treated for shock. The assessment of intake is important, but weight is not a priority. The assessment of lung sounds is important, but bowel sounds are not a priority. The assessment of temperature is important, but peripheral pulses will be absent or diminished.

PTS: 1 REF: p. 581, Treatment of Hypotension and Shock OBJ: 6 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A client appears to be in hypovolemic shock with a significant loss of blood. What assessment findings might help confirm the diagnosis? Select all that apply.

A. Weak pulse B. Clammy skin C. Nausea D. Chest pain E. Fever ANS: A, B, C Rationale: Signs of hypovolemic shock include weak, rapid pulse; cool, clammy skin; faintness; postural dizziness; and nausea. Neither chest pain nor fever is associated with septic shock since blood loss is the focus of the problem.

PTS: 1 REF: p. 586, For Hypovolemic Shock OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 10. A client is prescribed phenylephrine intravenously to treat paroxysmal atrial tachycardia.

What effect is the medication producing?

A. Reflex bradycardia B. Compensated shock C. Inotropic effect D. Chronotropic effect ANS: A Rationale: When given systemically, phenylephrine produces a reflex bradycardia. The vessels vasoconstrict (due to alpha-2 receptors), and blood pressure goes up. The baroreceptors monitor blood pressure, and when they see an increase in blood pressure, they invoke a bradycardia in the heart as a compensatory measure. This effect may be used therapeutically to relieve paroxysmal atrial tachycardia. Compensated shock, also known as preshock, is characterized by compensatory responses activated in an attempt to reverse the condition. Inotropic effect causes a change in myocardial contraction.

Chronotropic effect causes a change in heart rate.

PTS: 1 REF: p. 587, QSEN Alert: Safety OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 11. A client is receiving IV norepinephrine for the treatment of shock. What is the goal of administration?

A. Increased heart rate B. Increased blood pressure C. Increased cardiac output D. Increased cardiac contractibility ANS: B Rationale: Norepinephrine is a pharmaceutical preparation of the naturally occurring catecholamine norepinephrine. It has predominant alpha-receptor agonist effects and results in potent peripheral arterial vasoconstriction. As a result, it increases blood pressure more than it increases heart rate, force of contraction, or cardiac output.

PTS: 1 REF: p. 582, Action OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 12. Norepinephrine has been prescribed for an older adult client for the treatment of shock.

The nurse should carefully monitor the client due to the increased risk of which side effect?

A. Exacerbation of chronic cardiovascular conditions B. Cerebral ischemia C. Increased intracranial pressure D. Stevens-Johnson syndrome ANS: A Rationale: Clinicians use adrenergic agents to treat asthma, hypotension, shock, cardiac arrest, and anaphylaxis in older adults. These drugs stimulate the heart to increase rate and force of contraction and blood pressure. Because older adults often have chronic cardiovascular conditions (e.g., angina, dysrhythmias, heart failure, coronary artery disease, hypertension, peripheral vascular disease) that are aggravated by adrenergic drugs, careful monitoring by the nurse is required. The actions of norepinephrine do not pose an increased risk for any of the other mentioned conditions.

PTS: 1 REF: p. 583, Use in Older Adults OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. A client has not responded normally to rescue inhaler therapy. When subcutaneous epinephrine is prescribed, the nurse should anticipate what reaction to occur?

A. Increased level of consciousness within 2 to 5 minutes B. Immediate reduction of anxiety

C. An immediate increase in respiratory rate D. Instant bronchodilation ANS: D Rationale: For acute asthma attacks, subcutaneous administration of epinephrine usually produces bronchodilation instantly; maximal effects may occur within 20 minutes, helping to eventually decrease the respiratory rate. None of the remaining options identify expected results of subcutaneous epinephrine.

PTS: 1 REF: p. 586, Other Drugs in the Class OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. The nurse is administering norepinephrine intravenous (IV) to an adult client diagnosed with septic shock. The client suddenly develops redness and edema at the right forearm IV site. The client’s systolic blood pressure (SBP) is 88 mm Hg. Which action would the nurse implement first?

A. Increase infusion and reassess SBP in 2 minutes.

B. Stop the infusion and administer diluted phentolamine.

C. Assess urine output, and report to prescriber if less than 30 mL/h.

D. Establish a new IV site with at least 20-gauge needle.

ANS: B Rationale: Extravasation (infiltration of IV fluids outside of the vein) of the norepinephrine IV site has occurred as noted by redness and edema. The nurse’s first action is to stop the infusion and immediately administer diluted phentolamine, the antidote to minimize sloughing and necrosis of the tissue. The nurse can then establish a new patent IV site and titrate the drug to keep SBP greater than 90 mm Hg. After increasing the drip, the nurse would assess the SBP again. The nurse can assess urine output and report if it is less than 30 mL/h.

PTS: 1 REF: p. 584, QSEN Alert: Safety OBJ: 6 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 15. The nurse is caring for a client who has been prescribed a vasopressor, norepinephrine.

The nurse should monitor for which therapeutic effect? Select all that apply.

A. Mean arterial pressure at least 60 mm Hg B. Alert and oriented C. Urine output greater than 30 mL/h D. White blood cells 11,000 L E. Temperature 98°F (36.6°C) ANS: B, C, E

Rationale: If the vasopressor is achieving the therapeutic effects, the client will be alert and oriented; have warm, dry skin with signs of adequate perfusion, urine output greater than 30 mL/h; and signs of adequate oxygenation: O2 saturation greater than 90%. The mean arterial pressure should be at least 65 mm Hg and preferably in the range of 80 to 100 mm Hg. The heart rate should be less than 100 beats/min. The client should be afebrile and have a normal white blood cells (5000–10,000 L). The renal profile: serum creatinine and BUN should be normal and liver profile within normal limits.

PTS: 1 REF: p. 585, Assessing for Therapeutic Effects OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 29: Drug Therapy for Shock and Hypotension KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select

Chapter 30, Drug Therapy for Heart Failure 1. A client diagnosed with heart failure asks the nurse for further details about heart failure.

Which statement is most accurate?

A. “Heart failure can be caused by atherosclerotic plaque because of high-fat diets.”

B. “Hypothyroidism will result in decreased heart rate and development of heart failure.”

C. “The administration of diuretics increases blood volume, causing symptoms to abate.”

D. “The use of digoxin will slow the heart rate to make your heart more efficient.”

ANS: D Rationale: The use of digoxin increases the force of myocardial contraction and prevents the development of congestive heart failure in clients whose heart cannot pump blood to meet tissue needs. Endothelial dysfunction allows processes that narrow the blood vessel lumen and lead to blood clot formation and vasoconstriction that further narrow the blood vessel lumen. These are major factors in coronary artery disease and hypertension, the most common conditions leading to heart failure. Hyperthyroidism, not hypothyroidism, is a cause of heart failure. The administration of diuretics decreases fluid volume, which prevents the symptoms of heart failure. A high-fat diet does not directly cause heart failure.

PTS: 1 REF: p. 597, Action OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A client reports seeing halos around lights. The client takes digoxin by mouth every day.

The health care provider orders the client to have serum digoxin level drawn. Which of the digoxin level indicates that the client is experiencing toxicity?

A. 0.5 ng/mL B. 1.0 ng/mL C. 2.0 ng/mL D. 4.0 ng/mL ANS: D Rationale: Therapeutic serum levels of digoxin are 0.8 to 2 ng/mL. Levels above that would indicate toxicity, and those below would not yet be therapeutic.

PTS: 1 REF: p. 599, Administering the Medication OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A client has an elevated BUN. The client has been prescribed digoxin for heart failure.

What aspect of care is the priority regarding this client?

A. The client should be taught to increase sodium in the diet.

B. The dose should be increased when the heart rate is below 60.

C. The dose should be decreased in this client.

D. The dosage should be 1.0 mg per mouth daily.

ANS: C Rationale: The dose must be reduced in the presence of renal failure because most of the digoxin is excreted unchanged by the kidneys, leading to drug accumulation and toxicity.

The client should be taught to limit sodium intake in the diet. The client’s heart rate should remain above 60. If the heart rate falls below 60, the digoxin should be held. The dose of 1.0 mg is too large for a client with altered renal function.

PTS: 1 REF: p. 598, Use in Patients With Renal Impairment OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client with a history of heart failure is being treated with digoxin. The nurse knows that this medication increases the force of contractions of the heart. What effect improves the contractility of the heart?

A. Positive chronotropic effect B. Positive inotropic effect C. Negative inotropic effect D. Negative dromotropic effect ANS: B Rationale: In heart failure, digoxin exerts cardiotonic or positive inotropic effect that improves the contractility and pumping ability of the heart. A positive chronotropic effect accelerates the rate of the heart, which is not recommended in a client with heart failure. A negative inotropic effect accelerates the heart, which is not recommended in a client with heart failure. A negative dromotropic effect changes the conductivity of muscle fiber, increasing heart rate.

PTS: 1 REF: p. 597, Action OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. A client is admitted to the intensive care unit with an electrolyte imbalance. Which imbalance will contraindicate the administration of digoxin?

A. Hyperkalemia B. Hypokalemia C. Hypermagnesemia D. Hypocalcemia ANS: B

Rationale: Digoxin is contraindicated in clients with hypokalemia. Digoxin is not contraindicated in clients with hyperkalemia, hypermagnesemia, or hypocalcemia because its effect would not increase the risk of dysrhythmias.

PTS: 1 REF: p. 599, Contraindications OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. The nurse administers digoxin IV to a client. When would the nurse expect the medication to take effect?

A. 30 minutes B. 60 minutes C. 90 minutes D. 120 minutes ANS: A Rationale: Digoxin administered intravenously will have an onset of action within 5 to 30 minutes. Based on this information, all the other options are incorrect.

PTS: 1 REF: p. 599, Administering the Medication OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. What is the total dose range of digoxin for rapid digitalization?

A. 0.75 to 1.5 mg B. 2.0 to 2.5 mg C. 3.75 to 4 mg D. 0.125 to 0.05 mg ANS: A Rationale: Digitalization may be accomplished rapidly by giving a total dose of 0.75 to 1.5 mg of digoxin in divided doses. A digoxin dose range of 2.0 to 4.0 mg is too large. A digoxin dose range of 0.125 to 0.5 mg is too small.

PTS: 1 REF: p. 599, Administering the Medication OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

8. A client prescribed digoxin for the treatment of heart failure has noticed fatigue, heart rate that is very slow, and an intolerance for cold. After assessing the client’s blood pressure at 88/50 mm Hg and pulse rate of 44 beats/min, the nurse instructs the client not to take the digoxin. What condition may the client be suffering from that would contraindicate the administration of digoxin?

A. Hypothyroidism B. Myocardial infarction C. Cerebrovascular accident D. Intermittent claudication ANS: A Rationale: Hypothyroidism slows digoxin metabolism and further slows the heart rate.

The client is presenting with signs and symptoms of hypothyroidism. The client is not experiencing myocardial infarction (chest pain), cerebrovascular accident (speech, cognitive, and/or motor impairment), or intermittent claudication (leg pain).

PTS: 1 REF: p. 599, Factors That Contribute to Digoxin (Lanoxin) Toxicity OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 9. A client who has been prescribed digoxin is also taking furosemide 20 mg daily. Which electrolyte imbalance will precipitate the client to develop digoxin toxicity?

A. Hyperkalemia B. Hypokalemia C. Hypermagnesemia D. Hyponatremia ANS: B Rationale: Hypokalemia will contribute to the client developing digoxin toxicity.

Hyperkalemia, hypermagnesemia, and hyponatremia will not contribute to the development of digoxin toxicity.

PTS: 1 REF: p. 599, Adverse Effects OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A client is being treated for heart failure. What assessment finding would the nurse interpret as most indicative of improved health status?

A. Decreased pitting edema B. Increased skin turgor C. Heart rate of 52 D. Improved sensorium ANS: A

Rationale: A decrease in pitting edema is an indication of diminished fluid volume, which is indicative of an improved blood supply to the body tissues. Increased skin turgor may represent an increase in fluid volume. A heart rate of 52 is too slow to provide good contractility. Improved sensorium indicates adequate perfusion but is not the most indicative of improved heart failure status.

PTS: 1 REF: p. 594, Clinical Manifestations OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 11. A client is experiencing nausea and visual disturbances when taking digoxin. Which medication will be administered?

A. Acetylsalicylic acid B. Nesiritide C. Felbamate D. Digoxin immune fab ANS: D Rationale: Digoxin immune fab is a digoxin-binding antidote recommended only for severe digitalis poisoning with life-threatening symptoms. None of the other medications are prescribed for digoxin toxicity. Acetylsalicylic acid is used to reduce fever and relieve mild to moderate pain. Nesiritide acts to compensate for deteriorating cardiac function by reducing cardiac preload and afterload. Felbamate is administered for the treatment of seizures.

PTS: 1 REF: p. 600, Management of Digoxin (Lanoxin) Toxicity OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. The client has crackles in the lower lobes of the lungs, an audible S3, and pitting edema in the feet and ankles. What condition is the client most likely experiencing?

A. Pneumonia B. Liver disease C. Heart failure D. Myocardial infarction ANS: C Rationale: The cardinal manifestations of heart failure are dyspnea and fatigue, which can lead to exercise intolerance and fluid retention. Fluid retention results in the development of pulmonary congestion and peripheral edema. An audible S3 is often present. The client is not presenting with myocardial infarction symptoms since there is no mention of chest pain. Neither pneumonia nor liver failure would present with the audible S3 sound.

PTS:

1

REF: p. 594, Clinical Manifestations

OBJ: 1

NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. A client diagnosed with heart failure has been prescribed digoxin. The nurse is aware that caution is required if the client exhibits which electrolyte imbalance? Select all that apply.

A. Hyperkalemia B. Hypokalemia C. Hypermagnesemia D. Hypocalcemia E. Hypercalcemia ANS: B, C, E Rationale: Hypokalemia, hypermagnesemia, and hypercalcemia increase the risk of dysrhythmia in clients taking digoxin.

PTS: 1 REF: p. 599, Contraindications OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 14. A client is admitted to the emergency department with severe heart failure. Milrinone is administered IV. For what adverse effect should the nurse assess?

A. Hypertension B. Bradycardia C. Thrombocytopenia D. Lethargy ANS: C Rationale: The most serious adverse effect associated with the administration of milrinone is the development of potentially fatal ventricular dysrhythmias, which reportedly affect 12% of clients. Hypotension, supraventricular dysrhythmias, chest pain, angina, headache, thrombocytopenia, and hypokalemia may also occur. Hypertension, bradycardia, and lethargy are not adverse effects of milrinone.

PTS: 1 REF: p. 603, Adverse Effects OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. The nurse is providing dietary education to a client who has been prescribed a loop diuretic. What type of foods should the nurse identify as important to individuals on this therapy? Select all that apply.

A. Potassium rich B. Low sodium C. Low fat

D. High protein E. High fiber ANS: A, B Rationale: Loop diuretics are potassium wasting; thus, a potassium-rich, low-sodium diet is recommended. High protein consumption is not indicated. While appropriate for good general health, low-fat and high-fiber diets are not necessary for therapy with loop diuretics.

PTS: 1 REF: p. 610, Loop Diuretics OBJ: 8 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 16. A client is prescribed sacubitril and valsartan for the treatment of heart failure. What laboratory blood values should the nurse monitor to assure that the treatment is successful? Select all that apply.

A. Blood urea nitrogen B. Creatinine C. Potassium D. Magnesium E. Glucose ANS: A, B, C Rationale: The nurse should assess for signs of improvement or stabilization of chronic heart failure by monitoring laboratory values to assure that blood urea nitrogen, creatinine, and potassium are within acceptable limits. It is not necessary to assess the other values to determine the success of treatment.

PTS: 1 REF: p. 605, Adverse Effects OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 17. The nurse is caring for a client who has been prescribed furosemide. What assessment should the nurse perform on a daily basis?

A. Body weight B. Arterial blood gases C. Magnesium level D. Pupillary response ANS: A Rationale: When a client is being treated with furosemide, the nurse weighs the client daily and reports any increase in weight of greater than 2 lb (1 kg) in 24 hours to the health care provider. Electrolyte levels must be assessed, but sodium and potassium levels are the priority. There is no particular need to assess ABGs or pupillary response.

PTS:

1

REF: p. 610, Loop Diuretics

OBJ: 8

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A nurse has poured a hospital client’s scheduled dose of hydrochlorothiazide (HCTZ).

The nurse should know that this drug reduces preload by which means?

A. Exerting a direct relaxant effect on the vascular smooth muscle B. Increasing renal excretion of sodium and water C. Increasing the contractility of myocardial fibers D. Stimulating the SA node to fire more frequently ANS: B Rationale: Hydrochlorothiazide inhibits the reabsorption of sodium and chloride in the distal renal tubule, increasing the excretion of sodium and water by the kidneys.

Thiazide diuretics do not relax smooth muscle, increase contractility, or stimulate the SA node.

PTS: 1 REF: p. 610, Thiazide Diuretics OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 19. Which medication reduces aldosterone-induced retention of sodium and water when prescribed for the treatment of heart failure?

A. Hydrochlorothiazide B. Enalapril maleate C. Spironolactone D. Losartan potassium ANS: C Rationale: Spironolactone is an aldosterone antagonist that reduces aldosterone-induced retention of sodium and water and impaired vascular function. Thiazide diuretics, ACE inhibitors, and angiotensin II receptor blockers do not have this mechanism of action.

PTS: 1 REF: p. 610, Aldosterone Antagonists OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 20. The nurse is caring for a client with premedication values as follows: blood pressure (BP) 180/90 mm Hg, heart rate (HR) 100, respiratory rate (RR) 12, glucose 70 mg/dL, cardiac output (CO) 5.0 L/min (normal range 4–6 L/min). The nurse would predict which assessment findings after administering an antiadrenergic to the client? Select all that apply.

A. HR 80 B. CO 4.5 L/min C. Glucose 150 mg/dL (8.32 mmol/L)

D. BP 150/70 mm Hg E. RR 24 ANS: A, B, D Rationale: An antiadrenergic medication inhibits the sympathetic nervous system. The resulting opposite response effects would include a decrease in the force and rate of heart contractions and relaxation of blood vessels. This results in decreased heart rate, cardiac output, and blood pressure. Adrenergic drug actions would result in sympathetic stimulation and effects could include increased glucose levels or increased respiratory rate.

PTS: 1 REF: p. 593, Pathophysiology OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 30: Drug Therapy for Heart Failure KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select

Chapter 31, Drug Therapy for Nasal Congestion and Cough 1. A client, after presenting at the clinic with sneezing and coughing, is diagnosed with the common cold. Which type of microorganism causes the common cold?

A. Gram-positive bacteria B. Gram-negative bacteria C. Virus D. Fungus ANS: C Rationale: The common cold, a viral infection of the upper respiratory tract, is the most common respiratory tract infection. The common cold is not caused by gram-negative or gram-positive bacteria or a fungus.

PTS: 1 REF: p. 619, The Common Cold OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. The nurse is teaching a community group about prevention measures to protect against the common cold. Which preventive measure is most important to teach?

A. Frequent handwashing B. Maintaining vaccinations C. Taking 1200 g of vitamin C D. Taking Echinacea daily ANS: A Rationale: Because of the way cold viruses are spread, frequent and thorough hand hygiene is the most important protective and preventive measure. There is no vaccine against the common cold. Neither the ingestion of vitamin C nor of Echinacea has been proven to be the most effective preventive measure for the common cold.

PTS: 1 REF: p. 619, The Common Cold OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. The nurse is providing education to parents who want to give their child a dextromethorphan-based cough suppressant. Which statement provides the most effective teaching for the parents?

A. “Dextromethorphan effectively suppresses cough in children.”

B. “Dextromethorphan is ineffective in children.”

C. “Dextromethorphan must be combined with codeine to be effective.”

D. “Dextromethorphan raises blood pressure in children.”

ANS: B

Rationale: Although antitussives continue to be used and adults report beneficial effect in reducing cough, antitussives, particularly dextromethorphan, have not been demonstrated to be effective in children and adolescents. Adverse effects of dextromethorphan in children include behavioral disturbances and respiratory depression, not high blood pressure.

PTS: 1 REF: p. 620, QSEN Alert: Evidence-Based Practice OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 4. A client is admitted after overdose with acetaminophen. What medication would the nurse expect to be administered?

A. Oxymetazoline hydrochloride B. Acetylcysteine C. Daptomycin D. Darbepoetin alfa ANS: B Rationale: Acetylcysteine is effective in the treatment of acetaminophen overdose.

Oxymetazoline hydrochloride is used for nasal congestion, not acetaminophen overdose.

Daptomycin is an antibiotic that fights bacteria in the body and used to treat bacterial infections of the skin and underlying tissues. Darbepoetin alfa injection causes the bone marrow to produce red blood cells.

PTS: 1 REF: p. 627, Use OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. A client is prescribed an antitussive agent with codeine. Which statement by the client indicates that the nurse’s teaching has been effective?

A. “I will take this medication whenever I am coughing.”

B. “This medication will make me anxious and nervous.”

C. “I will call my health care provider if I develop diarrhea when I take it.”

D. “This medication will cause drowsiness, and I will not drive.”

ANS: D Rationale: Antitussive agents suppress cough by depressing the cough center in the medulla oblongata or the cough receptors in the throat, trachea, or lungs. Since they are combined with codeine, they will also depress the CNS and induce drowsiness. The medication should not be given every time the client coughs. The medication is not known to cause anxiety and nervousness. The medication will cause constipation, not diarrhea.

PTS: 1 REF: p. 626, Other Drugs in the Class OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 6. A client has hypertension and wants to take a nasal decongestant for cold symptoms.

Which statement by the nurse indicates the effect of hypertensive medications on hypertension?

A. “The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels.”

B. “The administration of a nasal decongestant will cause bradycardia and increase peripheral blood pressure.”

C. “The administration of a nasal decongestant will decrease thyroid activity, thereby increasing blood pressure.”

D. “The administration of nasal decongestant will act on the central nervous system to cause vasodilation of blood vessels.”

ANS: A Rationale: “The administration of a nasal decongestants will increase blood pressure due to vasoconstriction of blood vessels” is indicative of good client teaching. Nasal decongestants do not cause bradycardia to increase blood pressure. The administration of nasal decongestants does not increase blood pressure through alteration of thyroid function. The administration of a nasal decongestant does not act on the central nervous system.

PTS: 1 REF: p. 622, Use in Patients Receiving Home Care OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client is taking pseudoephedrine to reduce nasal congestion. The nurse should caution the client against use of this decongestant if the client is currently taking what other type of drug?

A. Anti-infective agents B. Anti-inflammatory agents C. Proton pump inhibitors (PPIs) D. Thyroid preparations ANS: D Rationale: Thyroid preparations should be prescribed cautiously to clients being concurrently prescribed nasal decongestants. Thyroid preparations have the tendency to increase the intended effects of decongestants. PPIs, anti-infectives, and anti-inflammatories do not have this synergistic effect.

PTS: 1 REF: p. 622, Drugs That Increase the Effects of Pseudoephedrine OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client has expressed frustration stating, “I’ve been taking an over-the-counter (OTC) decongestant for several days and it still hasn’t really cured my cold.” What teaching point should the nurse convey to the client?

A. “Drugs like this can often relieve some of the symptoms of a cold, but they won’t cure it.”

B. “Most people find that cold medications are essentially ineffective.”

C. “It usually takes between 8 and 10 days for a decongestant to cure affect cold symptoms.”

D. “Sometimes a decongestant can mask the effects of your cold, essentially prolonging it.”

ANS: A Rationale: Most people experience some relief, but clients should be made aware that cold medications do not cure the common cold; they only relieve some symptoms.

Over-the-counter (OTC) cold remedies should not be used longer than 1 week. Such medications do not inhibit healing by masking symptoms.

PTS: 1 REF: p. 621, Use OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A client has self-medicated with an over-the-counter (OTC) decongestant nasal spray for several weeks in order to help prevent “getting the common cold.” The nurse should educate the client concerning the risk for which results of long-term use of OTC cold remedies? Select all that apply.

A. Chronic epistaxis B. Anticholinergic effects C. Chronic nasal congestion D. Damage to the nasal mucosa E. Hepatotoxicity ANS: C, D Rationale: Over-the-counter (OTC) cold remedies should not be used longer than 1 week. Clients should not use nose drops or sprays more often or longer than recommended. Excessive or prolonged use may damage nasal mucosa and produce chronic nasal congestion. These drugs are not associated with chronic epistaxis, anticholinergic effects, or hepatotoxicity.

PTS: 1 REF: p. 623, Other Drugs in the Class OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select

10. An adult client has asked the nurse to recommend an OTC cold remedy. Before making a recommendation, the nurse should implement which intervention?

A. Consult with a pharmacist or pharmacy technician.

B. Assess the client’s understanding of the epidemiology of the common cold and upper respiratory infections.

C. Assess the client for health problems that may contraindicate the use of a particular remedy.

D. Ensure that the client has tried some of the more common herbal and natural remedies.

ANS: C Rationale: While it is not necessary to consult with a pharmacist or pharmacy technician before recommending a particular product, the nurse needs to assess the intended recipient for conditions or other medications that contraindicate the product’s use.

Herbal options do not need to precede pharmaceuticals. The client’s understanding of the epidemiology of the common cold is not a high priority.

PTS: 1 REF: p. 622, Use in Patients Receiving Home Care OBJ: 2 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A client with allergies has expressed interest in taking pseudoephedrine for seasonal allergies. What client condition would most strongly lead the nurse to caution against taking the drug?

A. Currently breast-feeding B. History of severe hypertension C. Diagnosis of chronic obstructive pulmonary disease (COPD) D. Diagnosis of myasthenia gravis (MG) ANS: B Rationale: Contraindications to pseudoephedrine use include severe hypertension or coronary artery disease because of the drug’s cardiac stimulating and vasoconstricting effects. Breast-feeding does not necessarily contraindicate the use of pseudoephedrine, though caution would be warranted. Neither COPD nor MG contraindicates the use of pseudoephedrine.

PTS: 1 REF: p. 622, Contraindications OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 12. The parent of a toddler asks about giving an over-the-counter (OTC) cough and cold product containing pseudoephedrine to the child. What information regarding safety and efficacy should the nurse offer?

A. Cough and cold remedies are generally safe and effective for children over the age of 2.

B. There are concerns among health professionals about how safe and effective these medications are.

C. Media reports about the risks of cough and cold medications in children have greatly exaggerated the risks.

D. Risk can be minimized by using age-specific preparations of cough and cold remedies.

ANS: B Rationale: Research seems to suggest that pseudoephedrine appears to be effective in children older than 4 years of age, but the drug’s effectiveness in younger children is inconclusive. The U.S. Food and Drug Administration (FDA) does not recommend OTC use of the drug in this age group due to the risk of serious and life-threatening adverse effects, including seizures, decreased level of consciousness, tachycardia, and death. The low doses found in children’s preparations may be insufficient to produce therapeutic effects. In addition, the risk of adverse effects and overdosing, particularly with liquid preparation, pose significant threats to safety. Extended-release tablets should not be administered to children younger than 12 years of age, and children should not be given drugs that are packaged for adults.

PTS: 1 REF: p. 622, QSEN Alert: Evidence-Based Practice OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. An adult client diagnosed with type 1 diabetes has begun to experience diabetic nephropathy over the past year. How will this client’s current health status influence the possible use of pseudoephedrine in the treatment of cold symptoms?

A. The client should monitor blood glucose levels more frequently when taking pseudoephedrine.

B. The use of pseudoephedrine is absolutely contraindicated by the fact that the client has diabetes and takes insulin.

C. The client may require a higher-than-average dose of pseudoephedrine because of excess fluid volume secondary to renal failure.

D. The client should use caution and will likely require a lower dose of pseudoephedrine because of impaired renal function.

ANS: D Rationale: Because pseudoephedrine is excreted primarily via the kidneys, caution in clients with renal impairment is important. It may be necessary to reduce the dosage to avoid potential drug accumulation and drug toxicity. The presence of diabetes warrants caution, but it is not an absolute contraindication, and concern is not necessarily on the medication’s effect on blood glucose levels.

PTS: 1 REF: p. 622, Use in Patients With Critical Illness OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Choice

14. A client asks the nurse about using dextromethorphan to relieve a cough. What type of cough would the nurse explain is best treated with the drug?

A. An occasional, productive cough B. A cough that is associated with an allergy to ragweed C. A cough that occurs when the client is exposed to airborne irritants D. A dry, nonproductive cough ANS: D Rationale: The major clinical indication for use of dextromethorphan is a dry, hacking, nonproductive cough that interferes with rest and sleep. It is not desirable to suppress a productive cough because the secretions need to be removed. The character, not cause, of the cough is relevant to its treatment with dextromethorphan.

PTS: 1 REF: p. 624, Use OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 15. The nurse is assessing a client suspected of overdose with dextromethorphan. What assessment finding is suggestive of an overdose with the drug?

A. Hallucinations B. Dysrhythmias C. Kussmaul’s respirations D. Profound diaphoresis ANS: A Rationale: The nurse observes for excessive suppression of the cough reflex (inability to cough effectively when secretions are present) or hallucinations with dosages that exceed recommendations of dextromethorphan. Kussmaul’s respirations, dysrhythmias, and diaphoresis are not characteristic adverse effects associated with dextromethorphan.

PTS: 1 REF: p. 626, Assessing for Adverse Effects OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 16. A client prescribed codeine for a persistent, debilitating cough tells the nurse, “I was sure that codeine was a narcotic that people take for pain.” The nurse should cite what mechanism of action when describing this use of codeine?

A. Depression of the cough center in the medulla oblongata B. Vasodilation of the alveolar capillaries C. Stimulation of the reticular activating system (RAS) D. Desensitization of the cough receptors in the sinuses and trachea ANS: A

Rationale: Antitussives such as codeine suppress cough by depressing the cough center in the medulla oblongata. They do not influence blood flow or desensitize peripheral cough receptors. The RAS is not involved in the cough reflex.

PTS: 1 REF: p. 626, Other Drugs in the Class OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 17. The nurse is providing education to a client who has been diagnosed with the common cold. What measure should the nurse recommend implementing to help liquefy cold-related secretions?

A. Reducing salt intake B. Deep breathing C. Gargling with normal saline D. Increasing fluid intake ANS: D Rationale: Drinking plenty of water while taking guaifenesin may help loosen mucus in the lungs. Deep breathing, gargling with normal saline, and reducing salt intake do not necessarily help liquefy and mobilize secretions.

PTS: 1 REF: p. 627, Administering the Medication OBJ: 7 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A critically ill client diagnosed with ventilator-associated pneumonia has been administered acetylcysteine. The inhalation of acetylcysteine helps to liquefy secretions in the respiratory tract by what mechanism?

A. Increasing the osmolality of mucus B. Decreasing the osmolality of mucus C. Breaking the protein bonds that exist in mucus D. Drawing increased amounts of water from interstitial spaces into mucus ANS: C Rationale: Mucolytics such as acetylcysteine are drugs that liquefy mucus in the respiratory tract by attacking the protein bonds of the mucus. This information makes the other statements incorrect.

PTS: 1 REF: p. 627, Concept Mastery Alert OBJ: 5 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice

19. A client has purchased an over-the-counter (OTC) cold remedy that advertises a “nondrowsy” formulation. The nurse explains to the client that such a medication likely contains what classification of drug?

A. A nasal decongestant B. A benzodiazepine C. An antihistamine D. A narcotic analgesic ANS: A Rationale: “Nondrowsy” or “daytime” cold formulas typically contain a nasal decongestant but not an antihistamine. Such medications would contain neither a narcotic nor a benzodiazepine.

PTS: 1 REF: p. 629, QSEN Alert: Safety OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. The nurse is educating an older adult client who has been diagnosed with rhinosinusitis in an outpatient clinic about the prescribed topical oxymetazoline. The client has a history of hypertension and coronary artery disease. Which statement made by the client establishes the need for further clarification?

A. “I will blow my nose before using the nasal spray.”

B. “I will rinse the spray tip off after each use.”

C. “I can take over-the-counter pseudoephedrine, too.”

D. “The drug is used no longer than 3 days.”

ANS: C Rationale: The nurse needs to clarify the statement that the client made regarding taking pseudoephedrine PO in addition to the nasal spray the prescriber provided. The client has a history of hypertension and coronary artery disease, both contraindications for the adrenergic drug, pseudoephedrine. Pseudoephedrine would increase blood pressure, heart rate, and cause heart muscle irritability. Topical decongestants are chosen for clients with cardiovascular disease for this reason. The other statements are correct.

Blowing the nose clears the passage, so the drug is more effective. The spray tip needs rinsed off after each use. The drug causes rebound congestion if used more often than recommended on the package or longer than 3 days.

PTS: 1 REF: p. 623, Patient Teaching Guidelines for Nasal Decongestants, Antitussive Medications, Expectorants, and Mucolytics OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 21. The nurse is educating an adult client who has been diagnosed with a nonproductive cough about the prescribed dextromethorphan. Which statement made by the client establishes the need for further clarification?

A. “I will not eat or drink for 30 minutes after taking a dose.”

B. “I will dilute the drug syrup with an equal amount of water.”

C. “If I raise mucous, I will stop taking the drug and call my prescriber.”

D. “The drug should only be taken as directed on the package.”

ANS: B Rationale: The nurse needs to clarify the statement that the client made regarding diluting the drug with equal amount of water because this would decrease the soothing effect on pharyngeal mucosa. The other statements are correct. Eating or drinking decreases effectiveness of drug to soothe mucosa of the pharynx. The drug is only to be taken for nonproductive dry, hacking cough. If the cough becomes productive, the client should stop the drug and notify the prescriber. The drug should be taken only as directed on the package or by prescriber because exceeding the dosage can result in hallucinations.

PTS: 1 REF: p. 623, Patient Teaching Guidelines for Nasal Decongestants, Antitussive Medications, Expectorants, and Mucolytics OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 22. The nurse is educating an adult client who has been diagnosed with rhinosinusitis with viscous clear mucous about the prescribed guaifenesin 400 mg PO every 4 hours. Which statement made by the client establishes the need for further clarification?

A. “I will ask my pharmacist before taking any over-the-counter medications.”

B. “I will drink at least 8 ounces of water with each dose.”

C. “The drug will suppress my cough so I can sleep easier.”

D. “The drug is not affected by taking it with or without meals.”

ANS: C Rationale: The nurse needs to clarify the statement that the drug suppresses a cough. The drug liquefies respiratory secretions, so it is easier for the client to expectorate or cough the mucous out of the respiratory tract. The other statements are correct. The client needs to ask a pharmacist before using any over-the-counter preparation to prevent drug interactions or overdosing drug ingredients that are the same or similar. Drinking adequate amounts of water will help loosen the mucous making it easier to expectorate.

The drug absorption is not affected by food intake, so it may be taken with or without meals.

PTS: 1 REF: p. 626, Action OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 31: Drug Therapy for Nasal Congestion and Cough KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 32, Drug Therapy to Decrease Histamine Effects and Allergic Response 1. A client is instructed to take diphenhydramine after an allergic reaction. Which statement by the client indicates successful teaching concerning the administration of diphenhydramine?

A. “I will still be able to have my after-dinner drink with this medication.”

B. “I will eat a diet low in sodium while taking this medication.”

C. “I should not drive my car after taking this medication.”

D. “I can take this medication every 2 hours until I feel better.”

ANS: C Rationale: The administration of diphenhydramine causes drowsiness, and the client should not operate machinery or operate a vehicle. The client should not combine diphenhydramine with alcohol due to central nervous system depression. The client will not need to limit sodium with this medication. The client should adhere to the dosing schedule and not take the medication every 2 hours.

PTS: 1 REF: p. 640, Adverse Effects OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A client having an allergic reaction to mold describes chest tightness and difficulty breathing. Which process is occurring?

A. Contraction of smooth muscle in the bronchi B. Suppression of the vagus nerve endings producing tachycardia C. Decreased permeability of the veins and capillaries D. Decreased secretion of the mucous glands ANS: A Rationale: An allergic reaction produces contraction of the smooth muscle in the bronchi and bronchioles. The client will have stimulation, not suppression, of the vagus nerve endings. The client will have increased, not decreased, permeability of the veins and capillaries. The client will have increased secretion from the mucous glands, producing nasal congestion.

PTS: 1 REF: p. 635, Histamine and Its Receptors OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. A client is diagnosed with allergic rhinitis. What type of hypersensitivity reaction is causing allergic rhinitis?

A. Type I B. Type II

C. Type III D. Type IV ANS: A Rationale: A type I response to cell-mediated invasion is mild and characterized by allergic rhinitis. Type II response is mediated by IgG or IgM generating direct damage to the cell surface. The client with hemolytic anemia is having a type II response. Type III is an IgG- or IgM-mediated reaction characterized by formation of antigen–antibody complexes that induce an acute inflammatory reaction in tissues. Type IV hypersensitivity is a delayed hypersensitivity.

PTS: 1 REF: p. 635, Types of Responses to Cell-Mediated Invasion OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A client who has been suffering from repeated sinus infections is diagnosed with allergic rhinitis and prescribed a daily antihistamine. What is the mechanism of action of the antihistamine medication?

A. It depletes norepinephrine and serotonin.

B. It prevents histamine from acting on target tissues.

C. It catalyzes the enzymatic oxidation of uric acid.

D. It raises the seizure threshold by impairing vitamin D. ANS: B Rationale: Antihistamines prevent histamine from acting on target tissues.

Antihypertensive agents deplete norepinephrine and serotonin. Antigout medications catalyze the enzymatic oxidation of uric acid. Antiseizure medications, such as primidone, impair vitamin D metabolism.

PTS: 1 REF: p. 639, First-Generation H1 Receptor Antagonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. A client prescribed cephalexin for an upper respiratory infection 7 days ago develops myalgia and fever. What reaction is responsible for this symptomology?

A. A new infection B. An autoimmune disease C. Septicemia D. Serum sickness ANS: D

Rationale: Serum sickness is a delayed hypersensitivity reaction most often caused by drugs, such as antimicrobials. Within initial exposure to the antigen, symptoms usually develop within 7 to 10 days and include urticaria, lymphadenopathy, myalgia, arthralgia, and fever. Although the client has a fever, the client does not present with all the symptoms of a new infection or sepsis. Based on the client’s symptoms, an autoimmune disease is not likely since an external factor has triggered the response.

PTS: 1 REF: p. 638, Allergic Drug Reactions OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A client reports nausea and vomiting after general anesthesia. Which medication will be administered for the treatment of nausea and vomiting?

A. Chlorpheniramine B. Hydroxyzine C. Loratadine D. Cetirizine ANS: B Rationale: Hydroxyzine is a first-generation H1 receptor antagonist that can be administered as an antiemetic agent. Chlorpheniramine, loratadine, and cetirizine are not administered as antiemetic agents.

PTS: 1 REF: p. 642, Other Drugs in the Class OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. The nurse is teaching a client about self-administration with levocetirizine. How long will the nurse indicate it takes for the medication to reach maximum effect?

A. 1 hour B. 2 to 3 hours C. 8 to 12 hours D. 12 to 24 hours ANS: A Rationale: Levocetirizine reaches maximal serum concentration in 1 hour.

PTS: 1 REF: p. 647, Other Drugs in the Class OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 8. The health care provider has prescribed promethazine for a child. What client condition would the nurse identify as a contraindication to the drug?

A. Bacterial meningitis

B. Endocarditis C. Reye’s syndrome D. Hypertensive crisis ANS: C Rationale: Promethazine should not be used in children with hepatic disease or Reye’s syndrome. Reye’s syndrome most often affects children and teenagers recovering from a viral infection, most commonly the flu or chickenpox. None of the other options would contraindicate the use of promethazine, especially since none are based on a viral infection.

PTS: 1 REF: p. 642, Other Drugs in the Class OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 9. A client asks the nurse about taking an antihistamine for relief of allergic rhinitis. What condition, if identified in the client history, would the nurse indicate contraindicates antihistamine use?

A. Parkinson’s disease B. Asthma C. Diabetes mellitus D. Prostatic hypertrophy ANS: D Rationale: Antihistamines are contraindicated in clients with prostatic hypertrophy.

There is no current research to suggest that antihistamine agents cannot be administered to clients with Parkinson’s disease, asthma, and diabetes mellitus.

PTS: 1 REF: p. 640, Use in Older Adults OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 10. What is the chemical mediator released in immune and inflammatory response to allergic reactions?

A. Norepinephrine B. Mast cells C. Epinephrine D. Histamine ANS: D Rationale: Histamine is the chemical mediator released in immune and inflammatory responses. Histamine is discharged from mast cells and basophils in response to certain stimuli (e.g., allergic reactions, cellular injury, extreme cold). This histamine is discharged by mast cells. Epinephrine is the drug of choice for treating severe anaphylaxis. Norepinephrine is a chemical released from the sympathetic nervous system in response to stress.

PTS: 1 REF: p. 635, Histamine and Its Receptors OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 11. A client is experiencing allergy symptoms after being exposed to environmental dust.

This reaction involves the action of histamine, which is released by what cell?

A. Lymphocytes B. CD4 T cells C. Basophils D. Platelets ANS: C Rationale: Histamine is discharged from mast cells and basophils in response to certain stimuli, such as allergic reactions, cellular injury, and extreme cold. Lymphocytes and platelets do not release histamine. CD4 cells (often called T cells or T-helper cells) are a type of white blood cells that play a major role in protecting the body from infection.

PTS: 1 REF: p. 635, Histamine and Its Receptors OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 12. A client is prescribed epinephrine for the treatment of anaphylaxis. This client is experiencing what type of hypersensitivity reaction?

A. Type I B. Type II C. Type III D. Type IV ANS: A Rationale: Type I (also called immediate hypersensitivity because it occurs within minutes of exposure to the antigen) is an immunoglobulin E (IgE)-induced response triggered by the interaction of antigen with antigen-specific IgE bound on mast cells, causing mast cell activation. Anaphylaxis is a type I response, which can be mild or life threatening. Type II responses are mediated by IgG or IgM, generating direct damage to the cell surface. These cytotoxic reactions include blood transfusion reactions, hemolytic disease of newborns, autoimmune hemolytic anemia, and some drug reactions. Type III is an IgG- or IgM-mediated reaction characterized by formation of antigen–antibody complexes that induce an acute inflammatory reaction in the tissues. Serum sickness is the prototype of these reactions. The classic type IV hypersensitivity reaction is the tuberculin test, but similar reactions occur with contact dermatitis and some graft rejection.

PTS:

1

REF: p. 635, Types of Responses to Cell-Mediated Invasion

OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 13. Which second-generation H1 receptor antagonist antihistamine is formulated as a nasal spray for topical use by children aged 5 years and older?

A. Chlorpheniramine B. Clemastine C. Cyproheptadine D. Azelastine ANS: D Rationale: Azelastine and olopatadine are second-generation H1 receptor antagonists that have been formulated as nasal sprays for topical use by children 5 years of age and older.

Each of the other listed drugs is a first-generation H1 receptor antagonist.

PTS: 1 REF: p. 645, Other Drugs in the Class OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 14. What effect is associated with a first-generation H1 receptor antagonist?

A. It depletes norepinephrine and serotonin.

B. It decreases capillary permeability.

C. It catalyzes the enzymatic oxidation of uric acid.

D. It raises the seizure threshold by impairing vitamin D. ANS: B Rationale: Decreased capillary permeability is among the effects of first-generation drugs. H1 receptor antagonists do not affect vitamin D, uric acid, or neurotransmitters.

PTS: 1 REF: p. 639, First-Generation H1 Receptor Antagonists OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 15. A client scheduled to receive one unit of packed red blood cells has a history of an allergic reaction to a transfusion in the past. What class of medication will assist in preventing a reaction to the packed red blood cell transfusion?

A. Antipyretics B. Antimicrobials C. Antianginals D. Antihistamines ANS: D

Rationale: Premedication with an antihistamine may be used to prevent allergic reactions with the administration of a transfusion of packed red blood cells. The administration of antimicrobial or antianginal is not recommended for a transfusion reaction. An antipyretic is used to treat the symptom of fever.

PTS: 1 REF: p. 640, Use in Patients With Critical Illness OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. The nurse is assessing a client who is taking diphenhydramine for relief of seasonal allergies. Which finding should prompt the nurse to suspect that the resident is experiencing an anticholinergic effect of the medication?

A. Blurry vision B. Tinnitus C. Wheezing on expiration D. Urticaria ANS: A Rationale: Anticholinergic effects are produced by the inhibition of cholinergic neurotransmission at muscarinic receptor sites. First-generation H1 receptor antagonists are associated with anticholinergic effects such as dry mouth, urinary retention, constipation, and blurred vision. Wheezing, urticaria, and tinnitus are not anticholinergic effects since they are not related to the cholinergic neurotransmission at muscarinic receptor sites.

PTS: 1 REF: p. 640, Adverse Effects OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. When comparing the benefits of second-generation H1 receptor antagonists to those of first-generation H1 receptor antagonists, the nurse should cite what advantage?

A. Lower cost B. Decreased sedation C. Absence of adverse effects D. Once-weekly dosing ANS: B Rationale: Unlike the first-generation H1 receptor antagonists, the second-generation H1 receptor antagonists do not readily enter the brain from the blood. This selectivity significantly reduces the occurrence of adverse drug reactions, such as drowsiness and sedation, while still providing effective relief of allergic conditions. Adverse effects are not wholly absent, however. Duration of action is 12 to 24 hours, and these drugs are more expensive than first-generation drugs.

PTS:

1

REF: p. 643, Second-Generation H1 Receptor Antagonists

OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. An adult client has reported experiencing a dry mouth and urinary retention after several nights of taking an over-the-counter (OTC) sleep aid. The nurse should suspect that this medication contains what antihistamine?

A. Loratadine B. Promethazine C. Diphenhydramine D. Olopatadine ANS: C Rationale: The active ingredient in OTC sleep aids is a sedating antihistamine, usually diphenhydramine. This medication may create substantial anticholinergic effects (e.g., dry mouth, urinary retention, constipation, blurred vision). None of the other medications have such an anticholinergic effect.

PTS: 1 REF: p. 639, First-Generation H1 Receptor Antagonists OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 19. The nurse is providing education to a client who has been prescribed a second-generation antihistamine. Which client statement suggests a need for additional teaching?

A. “I know these can be a bit expensive, but hopefully it will be worth it for me.”

B. “I’m really hoping that these pills will cure my allergies before summer starts.”

C. “I’ll check with my health care provider to make sure that the diet supplements I’m taking are okay to take at the same time as these pills.”

D. “It’s handy that I don’t necessarily have to take these pills at bedtime.”

ANS: B Rationale: Antihistamines mitigate the signs and symptoms of allergies, but they do not cure the problem. Second-generation antihistamines are more expensive than earlier drugs. It is prudent to screen for potential interactions with herbal remedies. Because second-generation drugs do not cause sedation, they may generally be taken at any time.

PTS: 1 REF: p. 637, Allergic Rhinitis OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 32: Drug Therapy to Decrease Histamine Effects and Allergic Response KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 33, Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction 1. The nurse is providing education to a client who has been newly diagnosed with asthma.

Which health education topic is most important for the nurse to share?

A. “Do not become fatigued. It will trigger asthma attacks.”

B. “Exposure to cold temperatures can trigger asthma.”

C. “Do not consume foods high in sodium.”

D. “Prolonged exposure to direct sunlight will trigger asthma.”

ANS: B Rationale: Exposure to cold air can exacerbate asthma symptoms due to the bronchoconstriction of airways. Inhaled corticosteroid agents do not depress the central nervous system or reduce bronchodilation or respiratory rate.

PTS: 1 REF: p. 652, Etiology OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client with asthma has been prescribed an albuterol inhaler. What recommendation should the nurse include in client teaching?

A. “Immediately stop using the inhaler if you experience hand shaking.”

B. “Take ibuprofen to decrease inflammation associated with the condition.”

C. “Limit exercise to one session per week.”

D. “Stop smoking to reduce bronchoconstriction.”

ANS: D Rationale: Cigarette smoking will increase bronchoconstriction, so the client should be encouraged to stop. The albuterol is known to cause hand tremors as a side effect; the client should mention this sign to the health care provider, but it isn’t a reason to stop using the medication. The client will not require ibuprofen since the condition is not related to inflammation. The client should be encouraged to exercise more than once per week.

PTS: 1 REF: p. 659, General Considerations OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. The nurse is providing education to a client who has been prescribed albuterol. What adverse reaction should the nurse discuss during teaching?

A. Polydipsia B. Tachycardia C. Hypotension D. Diarrhea ANS: B

Rationale: The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The client will not experience polydipsia, hypotension, or diarrhea because of the effects of albuterol.

PTS: 1 REF: p. 654, Drug Therapy OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client is admitted to the emergency department with inspiratory stridor and air hunger.

When anticipating treatment, the nurse will prepare which medication for administration?

A. Ipratropium bromide B. Epinephrine C. Cromolyn D. Pseudoephedrine ANS: B Rationale: Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction. Ipratropium is administered by inhalation for maintenance therapy of bronchoconstriction related to chronic bronchitis and inflammation. It is not administered for an acute attack of bronchoconstriction. Cromolyn stabilizes mast cells and prevents the release of bronchoconstrictive and inflammatory substances when mast cells are confronted with allergens and other stimuli. It is not used for acute attacks.

Pseudoephedrine is not administered for acute bronchoconstriction.

PTS: 1 REF: p. 660, Other Drugs in the Class OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. The nurse is providing education to a client who has been diagnosed with asthma on the therapeutic action of inhaled corticosteroid agents. How will the nurse describe the action?

A. Inhaled corticosteroid agents depress the central nervous system.

B. Inhaled corticosteroid agents reduce respiratory rate.

C. Inhaled corticosteroid agents reduce bronchodilation.

D. Inhaled corticosteroid agents reduce airway inflammation.

ANS: D Rationale: Inhaled corticosteroid agents suppress the release of inflammatory mediators, block the generations of cytokines, and decrease the recruitment of airway eosinophils.

Inhaled corticosteroid agents do not depress the central nervous system or affect either bronchodilation or constriction.

PTS: 1 REF: p. 665, Corticosteroids OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and

Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 6. The nurse is reviewing the history of a client who has been identified as a candidate for an adrenergic bronchodilator. What condition will the nurse identify as a reason for cautious administration of the drug?

A. Liver failure B. Renal failure C. Respiratory constriction D. Seizure disorder ANS: D Rationale: The administration of adrenergic bronchodilators should be used cautiously in clients with hypertension, hyperthyroidism, diabetes mellitus, and seizure disorders. The client with liver failure and renal failure can be administered adrenergic bronchodilators.

The client with respiratory constriction should receive adrenergic bronchodilators.

PTS: 1 REF: p. 657, Adverse Effects OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 7. A child prescribed an inhaled corticosteroid agent to decrease respiratory inflammation is now receiving high doses of the drug after only 2 days of treatment. What adverse reaction is the client at risk for developing?

A. Adrenal insufficiency B. Tachycardia C. Edema D. Hypoglycemia ANS: A Rationale: Adrenal insufficiency is most likely to occur with systemic or high doses of inhaled corticosteroids. The client is not at risk for tachycardia, edema, or hypoglycemia unless related to adrenal insufficiency.

PTS: 1 REF: p. 667, Use in Children OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 8. What is the most common first-line therapy for relief of an acute asthma attack?

A. Inhaled steroid B. Leukotriene modifier C. Beta2-adrenergic agonist D. Xanthine ANS: C

Rationale: A client experiencing an acute asthma attack should be administered a beta2-adrenergic agonist. The client can receive an inhaled steroid, but it is not the first-line therapy. Leukotriene modifiers are used for maintenance in asthma, not during acute exacerbation. Xanthines are not the drug of choice in acute asthma attack.

PTS: 1 REF: p. 654, Drug Therapy OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. Albuterol is administered to a client to promote bronchodilation. Administration of albuterol, a beta2-adrenergic agonist, results in increased production of what chemical compound?

A. Leukotrienes B. Cortisol C. Cyclic adenosine monophosphate (AMP) D. Glucagon ANS: C Rationale: Beta-adrenergic drugs increase the production of cyclic AMP to produce bronchodilation. They do not increase the release of leukotrienes, cortisol, or glucagon.

PTS: 1 REF: p. 657, Action OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. A client is being assessed by the home care nurse for the appropriate use of a metered-dose inhaler. Instructions concerning which intervention will assist a client in proper use of the device?

A. Using a spacer B. Administrating corticosteroid first C. Pushing fluids D. Exhaling immediately after administration ANS: A Rationale: The client should be instructed to use a spacer to increase compliance and accuracy of administration. An asthma spacer is an add-on device used to increase the ease of administering aerosolized medication from a metered-dose inhaler (MDI). The corticosteroid should be administered after the bronchodilator. The increase in fluids will not affect the administration of the inhaler. The client should hold the breath for several seconds after administration of the inhaler.

PTS: 1 REF: p. 654, Drug Therapy OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

11. A client admitted to the intensive care unit with a diagnosis of status asthmaticus is prescribed a high dose of nebulized albuterol. The nurse should assess the client based on the increased risk for which electrolyte imbalance?

A. Hyperkalemia B. Hypermagnesemia C. Hypocalcemia D. Hypokalemia ANS: D Rationale: High doses of nebulized albuterol have been associated with tachycardia, hypokalemia, and hyperglycemia. The client’s risk for alterations of magnesium or calcium levels is not increased by albuterol therapy.

PTS: 1 REF: p. 654, Drug Therapy OBJ: 5 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 12. A client has been prescribed a medication to decrease the nighttime episodes of bronchoconstriction and prevent asthma attacks. What type of medication does the nurse suspect has been prescribed?

A. Xanthine alkaloids B. Beta2-adrenergic agonists C. Anticholinergics D. Leukotriene modifiers ANS: D Rationale: The leukotriene modifiers improve symptoms of bronchoconstriction and pulmonary function tests, decrease nighttime symptoms, and decrease the use of beta2-adrenergic drugs. Xanthines treat acute attacks but do not prevent asthma from occurring. Beta2-adrenergic agonists treat acute attacks but do not prevent asthma from occurring. Anticholinergics block the action of acetylcholine in bronchial smooth muscle when given by inhalation.

PTS: 1 REF: p. 668, Leukotriene Modifiers OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. A client is given theophylline to treat acute asthma symptoms. Which food should the client avoid?

A. Chocolate B. Bananas C. Orange juice D. Cranberry juice ANS: A

Rationale: Chocolate contains caffeine and is also a xanthine; thus, chocolate should be avoided when the client is taking theophylline. Restriction of bananas, orange juice, and cranberry juice is not required.

PTS: 1 REF: p. 662, Xanthines OBJ: 4 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. The nurse is providing education to a client who has been prescribed an antiasthmatic drug. The nurse should instruct the client to avoid excessive intake of what beverage?

A. Coffee B. Grapefruit juice C. Green tea D. Acai juice ANS: A Rationale: Clients taking antiasthmatic drugs should generally avoid excessive intake of caffeine-containing fluids such as coffee, tea, and cola drinks. These beverages may increase bronchodilation but also may increase heart rate and cause palpitations, nervousness, and insomnia with bronchodilating drugs. None of the other options contain sufficient amounts of caffeine to cause such an affect.

PTS: 1 REF: p. 659, Patient Teaching Guidelines for Antiasthmatic Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 15. A client recently diagnosed with asthma anxiously reports that the symptoms of a recent episode were not relieved despite taking several puffs of the prescribed salmeterol. How should the nurse respond to the client’s concern?

A. “Remember that your salmeterol isn’t effective when you take it at the time of an asthma attack.”

B. “It’s important to take salmeterol as soon as you feel the first sensation of an asthma attack.”

C. “Unfortunately, salmeterol can take up to 15 minutes to relieve your difficulty breathing.”

D. “It’s best to take repeated doses of salmeterol every 5 minutes, until your symptoms subside.”

ANS: A Rationale: Salmeterol is a long-acting beta2-adrenergic agonist used only for prophylaxis of acute bronchoconstriction. Salmeterol is not effective in acute attacks because it has a slower onset of action than a short-acting drug. This information makes all the other options incorrect.

PTS: 1 REF: p. 660, Other Drugs in the Class OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A client diagnosed with asthma has been prescribed ipratropium 2 puffs QID. What is the most likely goal of this treatment?

A. Promoting short-term relief of acute asthma symptoms B. Relieving acute bronchoconstriction C. Promoting long-term management of asthma symptoms D. Promoting blood flow in the alveolar capillaries ANS: C Rationale: The anticholinergic bronchodilators are most useful in the long-term management of asthma and other conditions producing bronchoconstriction. These drugs are not used in the management of acute exacerbations of asthma. They do not promote alveolar blood flow.

PTS: 1 REF: p. 661, Anticholinergics OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 17. A hospital client’s medication administration record specifies concurrent doses of nebulized ipratropium and albuterol at 08:00 and 20:00. When administering these drugs, the nurse should base the intervention on which fact?

A. The two drugs should be administered at least 30 minutes apart, with ipratropium administered first.

B. The two drugs can be mixed in the nebulizer immediately before administration.

C. The two drugs should be administered at least 30 minutes apart, with albuterol administered first.

D. The nurse should contact the prescriber due to the increased risk of adverse effects when these drugs are administered concurrently.

ANS: B Rationale: It is appropriate to mix ipratropium bromide inhalation solution in the nebulizer with albuterol or metaproterenol if the mixture is used within 1 hour. These drugs have a synergistic effect.

PTS: 1 REF: p. 672, Table 33.8. DRUGS AT A GLANCE: Combination Regimens OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

18. The nurse teaching a client about theophylline will include the identification of which possible symptoms of toxicity?

A. Polyuria and polyphagia B. Confusion and decreased level of consciousness C. Agitation and dysrhythmias D. Chest pain and shortness of breath ANS: C Rationale: Signs and symptoms of theophylline overdose include anorexia, nausea, vomiting, agitation, nervousness, insomnia, tachycardia and other dysrhythmias, and tonic–clonic convulsions. Ventricular dysrhythmias or convulsions may be the first sign of toxicity. Chest pain, shortness of breath, polyuria, polyphagia, and decreased level of consciousness do not accompany theophylline overdose.

PTS: 1 REF: p. 663, Adverse Effects OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. An adult client diagnosed with asthma has been prescribed montelukast. The nurse should teach the client that this drug will help relieve symptoms by which mechanism?

A. Reducing the muscle tone in the alveoli and facilitating gas exchange B. Relaxing smooth muscle in the bronchi and bronchioles C. Preventing the bronchoconstriction and inflammation that is caused by leukotrienes D. Preventing mast cells from releasing histamine ANS: C Rationale: Montelukast prevents leukotrienes from binding to its receptors, reducing the bronchoconstriction and ultimate inflammation caused by leukotrienes. This information makes all the remaining options incorrect.

PTS: 1 REF: p. 668, Action OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 34, Drug Therapy for Fluid Volume Excess 1. The nurse is preparing to administer the first dose of hydrochlorothiazide to a client.

What assessment should the nurse perform prior to administration?

A. Pulse rate B. Hemoglobin level C. Sulfonamide allergy D. Neutrophil level ANS: C Rationale: Thiazide diuretics must be used cautiously in clients allergic to sulfonamide drugs because there is a known cross-sensitivity of some sulfonamide-allergic clients to sulfonamide nonantibiotic. It is not imperative to assess pulse, hemoglobin, or neutrophil levels.

PTS: 1 REF: p. 686, Thiazide Diuretics OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A client has edema of the lower extremities and abdomen. What is the reason to administer a stronger diuretic than a thiazide diuretic to this client?

A. A thiazide diuretic will reabsorb potassium in the distal tubule.

B. A thiazide diuretic will be ineffective when immediate diuresis is needed.

C. A thiazide diuretic will provide peak effects in 2 hours.

D. A thiazide diuretic will be excreted in more than 72 hours.

ANS: B Rationale: Thiazide diuretics are ineffective when immediate diuresis is required. A thiazide diuretic acts to reabsorb sodium, not potassium, in the distal convoluted tubule.

A thiazide diuretic reaches its peak in 4 to 6 hours. A thiazide diuretic is excreted in 72 hours maximum.

PTS: 1 REF: p. 686, Thiazide Diuretics OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 3. A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed?

A. Loop diuretic B. Potassium-sparing diuretic C. Thiazide diuretic D. Osmotic diuretic ANS: D

Rationale: An osmotic diuretic is used to reduce intracranial pressure related to a head injury. Loop diuretics, potassium-sparing diuretics, and thiazide diuretics do not reduce intracranial pressure.

PTS: 1 REF: p. 691, Osmotic Diuretics OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A client has been prescribed a combination diuretic agent. The nurse knows that the major purpose of this combination is what?

A. It prevents sodium imbalance.

B. It is less expensive than two medications.

C. It prevents potassium imbalance.

D. It prevents allergic reactions.

ANS: C Rationale: The major purpose of the diuretic combinations is to prevent potassium imbalances. The combination products do not prevent sodium imbalance. The combination products are not less expensive than taking two medications. The combination products do not prevent allergic reactions.

PTS: 1 REF: p. 692, Combination Products OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. A client asks the nurse why two diuretics have been prescribed when a friend takes only a single combination medication. The client takes hydrochlorothiazide 75 mg every day with a potassium-sparing diuretic. What is the nurse’s best response?

A. “Maybe you should speak with health care provider about the combination medication.”

B. “I do not know why your health care provider prefers that you take two medications.”

C. “It could be that you need a larger dose than is available in the combination medications.”

D. “The combination medications are not as effective as two medications.”

ANS: C

Rationale: The fixed-dose combination of hydrochlorothiazide and a potassium-sparing diuretic contains 50 mg of hydrochlorothiazide, and this client requires 75 mg of hydrochlorothiazide. Fixed-dose combination products are not indicated for initial therapy of edema or hypertension because therapy should be titrated for the individual client. The statement, “It could be that you need a larger dose than is available in the combination medications” is the best answer. The statement “Maybe you should speak with your health care provider about the combination medication” does not provide adequate teaching. The statement “I do not know why your health care provider prefers that you take two medications” does not provide adequate client education. The combination medications are very effective, and the statement that they are not as effective is inaccurate.

PTS: 1 REF: p. 692, Combination Products OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A client has edema of the lower extremities with crackles in the lung bases. What diuretic is most likely to be prescribed for a client assessed with lower extremity edema and bilateral lung crackles?

A. Hydrochlorothiazide B. Furosemide C. Spironolactone D. Mannitol ANS: B Rationale: Acute pulmonary edema is an indication for the use of furosemide.

Hydrochlorothiazide, spironolactone, and mannitol are not used for this purpose, largely due to their slower onset of action.

PTS: 1 REF: p. 682, Loop Diuretics OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client has been prescribed both digoxin and furosemide. The nurse should monitor the client for development of what adverse effect?

A. Hyperkalemia B. Hyperglycemia C. Tachycardia D. Digoxin toxicity ANS: D Rationale: When digoxin and diuretics are used concomitantly, the risk of digoxin toxicity is increased. The client is at risk for hypokalemia, not hyperkalemia. The client is not at risk for hyperglycemia or tachycardia.

PTS:

1

REF: p. 694, Key Concepts

OBJ: 7

NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 8. A client is receiving digoxin and a potassium supplement. When monitoring daily laboratory values, what should the potassium level be for this client?

A. 1.5–3.0 mEq/L B. 3.5–5.0 mEq/L C. 5.0–7.5 mEq/L D. 6.0–6.5 mEq/L ANS: B Rationale: The normal serum potassium level is 3.5–5.0 mEq/L. A serum potassium level of 1.5–3.0 mEq/L is too low. A serum potassium level of 5.0–7.5 mEq/L is indicative of hyperkalemia. A serum potassium level of 6.0–6.5 mEq/L is indicative of hyperkalemia.

PTS: 1 REF: p. 684, Box 34.1 OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. The nurse is providing education to a client who has been prescribed furosemide 20 mg PO. The nurse should teach the client that a diet high in sodium will cause what effect?

A. Decreased blood pressure B. Decreased diuresis C. Hyperkalemia D. Hyperglycemia ANS: B Rationale: A high dietary intake of sodium can cause sodium retention and reduce or cancel the diuretic-induced sodium loss. A high dietary intake of sodium will not increase diuresis. A high dietary intake of sodium will not cause hyperkalemia. A high dietary intake of sodium will not cause hyperglycemia.

PTS: 1 REF: p. 682, Loop Diuretics OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A client asks the nurse, “Why is my prescription being switched from furosemide to spironolactone?” What is the nurse’s best response?

A. “You will lose less potassium with spironolactone than with furosemide.”

B. “You will have greater potassium losses with spironolactone than with furosemide.”

C. “You will have greater water losses with spironolactone than with furosemide.”

D. “You will have greater sodium losses with spironolactone than with furosemide.”

ANS: A Rationale: By inhibiting the effects of aldosterone in the distal tubules, spironolactone promotes potassium retention. The client will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.

PTS: 1 REF: p. 689, Potassium-Sparing Diuretics OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 11. An older adult client with a history of heart failure has presented to the emergency department in respiratory distress. Assessment reveals the presence of pulmonary edema, and an infusion of IV furosemide has been prescribed. For the duration of treatment, the nurse should prioritize assessments related to which expected age-related dysfunctions?

Select all that apply.

A. Cardiac function B. Cognitive function C. Respiratory function D. Renal function E. Hepatic function ANS: A, D, E Rationale: In general, dose selection for the older adults requires caution reflecting the increased likelihood that older adults have decreased cardiac, renal, or hepatic function.

This medication therapy has a lower risk for affecting respirations or cognition.

PTS: 1 REF: p. 682, Loop Diuretics OBJ: 7 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 12. A hospital client with a diagnosis of liver failure has been prescribed a low dose of spironolactone in order to treat ascites. The nurse who is providing this client’s care should prioritize assessments for the signs and symptoms of what health problem?

A. Peritonitis B. Liver cancer C. Cirrhosis D. Hepatic encephalopathy ANS: D Rationale: Spironolactone is used in the treatment of ascites. However, it should be used cautiously and carefully monitored in clients with significant hepatic impairment because a rapid change in fluid and electrolyte balance may lead to hepatic coma. It is important to monitor susceptible clients carefully for signs and symptoms of hepatic encephalopathy. There is no risk for liver cancer, cirrhosis, or peritonitis that results directly from the use of spironolactone.

PTS: 1 REF: p. 689, Potassium-Sparing Diuretics OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. The majority of the reabsorption process takes place in what anatomical location?

A. Ureters B. Proximal tubule C. Efferent arteriole D. Afferent arteriole ANS: B Rationale: Most reabsorption occurs in the proximal tubule. Almost all glucose and amino acids are reabsorbed; about 80% of water, sodium, potassium, chloride, and most other substances are reabsorbed. Arterial blood enters the glomerulus by the afferent arteriole, and blood that does not become part of the glomerular filtrate leaves the glomerulus through the efferent arteriole. The ureters connect the kidneys to the bladder.

PTS: 1 REF: p. 679, Tubular Reabsorption OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 14. A hospital client demonstrating peripheral edema has been prescribed furosemide. How should the nurse best determine the extent of the client’s desired fluid loss?

A. Assess the client’s skin turgor on a daily basis.

B. Test the osmolarity of the client’s urine regularly.

C. Weigh the client daily.

D. Auscultate the client’s chest each morning.

ANS: C Rationale: The nurse should measure and record weights to assist in determining the amount of mobilization of excess fluid. This is a more accurate gauge of changes in fluid status than skin turgor, urine osmolarity, or chest auscultation.

PTS: 1 REF: p. 682, Loop Diuretics OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. An adult client diagnosed with hypertension has been prescribed oral furosemide. What goal should the nurse identify when planning this client’s medication teaching session?

A. The client will identify strategies for limiting sodium intake.

B. The client will describe the rationale for increasing fluid intake.

C. The client will be able to demonstrate correct technique for blood glucose

monitoring.

D. The client will accurately describe the basic structure and functions of the kidneys.

ANS: A Rationale: The reason for furosemide use should guide client teaching. In most instances, it is necessary to initiate measures to limit sodium intake. Key considerations should include not adding salt to food during preparation or at the dinner table, reading food labels carefully to be aware of hidden sources of sodium, and avoiding processed or high-sodium foods. Blood glucose monitoring is not indicated, and there is no need for increased fluid intake. Renal anatomy and physiology are not priority teaching points.

PTS: 1 REF: p. 682, Loop Diuretics OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. An older adult client has a complex medical history that includes heart failure, type 1 diabetes, and diabetic nephropathy. The nurse has questioned a health care provider’s prescription for oral spironolactone because the client’s health problems would contribute to a high risk of which adverse reaction?

A. Metabolic acidosis B. Hypocalcemia C. Hemolytic anemia D. Hyperkalemia ANS: D Rationale: The presence of renal insufficiency is also a contraindication to the use of spironolactone because use of spironolactone may cause hyperkalemia through the inhibition of aldosterone and the subsequent retention of potassium. A prescription for spironolactone does not put this client at a greatly increased risk of anemia, hypocalcemia, or acidosis since none of these conditions are associated with potassium.

PTS: 1 REF: p. 689, Potassium-Sparing Diuretics OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A nurse notes that a newly admitted client is currently prescribed both a loop diuretic and a thiazide diuretic. The nurse understands what primary rationale for the concurrent use of these two drugs?

A. Increased diuretic effect B. Reduced risk of potassium imbalances C. Decreased blood pressure without a risk of bradycardia D. Increased adherence to treatment ANS: A

Rationale: When an inadequate diuretic response occurs with one drug, people sometimes take two potassium-losing diuretics concurrently. The combination of a loop and a thiazide diuretic has synergistic effects because the drugs act in different segments of the renal tubule. Thus, the rationale for this particular combination is not rooted in prevention of potassium imbalances, increased adherence, or maintenance of a normal heart rate.

PTS: 1 REF: p. 692, Combination Products OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 18. A client prescribed both an ACE inhibitor and a beta-blocker for the treatment of hypertension has been consistently obtaining blood pressure readings in the vicinity of 145/90 mm Hg. As a result, the client’s primary health care provider has prescribed furosemide. What order would be most consistent with this client’s health needs?

A. Furosemide 125 mg PO OD B. Furosemide 40 mg IV TID C. Furosemide 20 mg IV OD D. Furosemide 40 mg PO BID ANS: D Rationale: For hypertension, furosemide is commonly given as 40 mg PO twice daily and gradually increased if necessary. The other prescriptions include incorrect routes, frequencies, or doses.

PTS: 1 REF: p. 683, Table 34.2. DRUGS AT A GLANCE: Loop Diuretics OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 34: Drug Therapy for Fluid Volume Excess KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 35, Nutritional Support Products, Vitamins, and Mineral Supplements 1. The school nurse is providing nutritional teaching to a group of adolescent girls. Which instruction is most important?

A. Limit the amount of foods high in fiber.

B. Increase potassium chloride in the diet.

C. Calcium intake should be 1300 mg daily.

D. Increase sodium in the diet.

ANS: C Rationale: Adolescent females should consume 1000 to 1300 mg of calcium per day.

Adolescent females should not limit fiber nor is there generally a reason to increase potassium chloride or sodium in the diet.

PTS: 1 REF: p. 697, Overview of Altered Nutritional States OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A client has been prescribed sodium polystyrene sulfonate to lower the potassium level.

What is the action of the drug?

A. It decreases the absorption of exogenous potassium.

B. It increases urinary excretion of potassium.

C. It combines potassium in the colon for elimination.

D. It releases sodium to acidify urine with potassium.

ANS: C Rationale: Sodium polystyrene sulfonate, a cation exchange resin, administered orally, removes potassium from the body in the stool. Sodium polystyrene sulfonate does not decrease the absorption of potassium, increase urinary excretion of potassium, or release sodium to acidify urine with potassium.

PTS: 1 REF: p. 722, Cation Exchange: Sodium Polystyrene Sulfonate OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. A client diagnosed with hyperkalemia has been prescribed treatment with intravenous insulin and glucose. What is the action by which these substances address the disorder?

A. Insulin and glucose drive potassium into the cells.

B. Insulin and glucose bind potassium to sodium.

C. Insulin and glucose increase urinary excretion of potassium.

D. Insulin and glucose increase fecal excretion of potassium.

ANS: A

Rationale: Insulin and glucose lower serum potassium levels by driving potassium into the cells. Insulin and glucose do not bind potassium to sodium or increase urinary excretion of potassium or fecal excretion of potassium.

PTS: 1 REF: p. 722, Glucose and Insulin OBJ: 7 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A 4-year-old child has eaten the mother’s prenatal vitamins. Which medication is indicated to address possible iron toxicity?

A. Deferoxamine B. Penicillamine C. Sucralfate D. Magnesium sulfate ANS: A Rationale: Deferoxamine is a parenteral drug used to remove excess iron from storage sites in the body. Penicillamine’s main use is the removal of excess copper in clients with Wilson’s disease. Sucralfate is used to treat an active duodenal ulcer. Magnesium sulfate is used to treat hypomagnesemia.

PTS: 1 REF: p. 722, Deferoxamine and Deferasirox OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A child has been diagnosed with lead poisoning. Which medication does the nurse expect to be administered to decrease lead levels?

A. Succimer B. Folic acid C. Deferoxamine D. Deferasirox ANS: A Rationale: Succimer chelates lead to form water-soluble complexes that are excreted in the urine. Succimer is used to treat lead poisoning in children. Folic acid, deferoxamine, and deferasirox are not used to treat lead poisoning..

PTS: 1 REF: p. 722, Succimer OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. The parent of a newborn asks the nurse why the child was given vitamin K. How will the nurse best explain administration of vitamin K?

A. “The administration of vitamin K prevents bleeding.”

B. “The infant will need multiple injections of vitamin K to prevent health problems.”

C. “The infant will need the conjugated iron in vitamin K to protect from infection.”

D. “Vitamin K helps maintain nutrition until your child is able to feed more efficiently.”

ANS: A Rationale: A single dose of injected vitamin K is given to newborn infants to prevent hemorrhagic disease of newborns. The infant does not need multiple injections of vitamin K to prevent hemorrhage. The administration of vitamin K will not protect from infection. Vitamin K is not used to enhance nutrition.

PTS: 1 REF: p. 710, Vitamin K OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client in labor experiences a seizure. What medication does the nurse expect to be administered parentally?

A. Magnesium oxide B. Magnesium sulfate C. Potassium chloride D. Calcium gluconate ANS: B Rationale: Magnesium sulfate is given parenterally for convulsions related to pregnancy.

Magnesium oxide is given orally for mild hypomagnesemia. Potassium chloride is usually the drug of choice for preventing or treating hypokalemia (less than normal amount of potassium in the blood). Calcium gluconate is a mineral supplement infused to decrease the cardiotoxic effects of hyperkalemia.

PTS: 1 REF: p. 721, Magnesium OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 8. A client required several doses of furosemide and now has developed hypokalemia.

What medication will be prescribed to treat this adverse effect?

A. Potassium chloride B. Calcium gluconate C. Zinc gluconate D. Sodium polystyrene sulfonate ANS: A

Rationale: Furosemide is a potassium-depleting diuretic that can cause hypokalemia requiring potassium chloride therapy in order to be resolved. Calcium gluconate is a mineral supplement infused to decrease the cardiotoxic effects of hyperkalemia, while zinc gluconate is given orally as a dietary supplement to prevent or treat zinc deficiency.

Sodium polystyrene sulfonate would be administered for hyperkalemia not hypokalemia.

PTS: 1 REF: p. 720, Potassium OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. A client diagnosed with pernicious anemia asks the nurse why vitamin B12 is administered by injection. How will the nurse best respond?

A. “Oral forms of vitamin B12 will not be absorbed.”

B. “Foods fortified with vitamin B12 cause irritation and bleeding.”

C. “Pernicious anemia causes changes in the mucous membrane.”

D. “The pathophysiology of pernicious anemia causes oral vitamin B12 to be ineffective.”

ANS: A Rationale: In pernicious anemia, vitamin B12 must be given by injection because oral forms are not absorbed from the GI tract. Foods fortified with vitamin B12 will not cause irritation and bleeding. Pernicious anemia causes changes in the mucous membrane, but these changes do not explain why vitamin B12 is administered by injection. The ineffectiveness of oral vitamin B12 is unrelated to the pathophysiology of the disorder.

PTS: 1 REF: p. 713, Vitamin B12 (Cyanocobalamin) and Folic Acid OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A client in preterm labor is being administered magnesium sulfate. The client develops diminished reflexes and hypermagnesemia. What medication will be administered to this client?

A. Magnesium gluconate B. Glucose C. Sodium bicarbonate D. Calcium gluconate ANS: D Rationale: Hypermagnesemia is treated with calcium gluconate. Hypermagnesemia is not treated with magnesium gluconate, glucose, or sodium bicarbonate.

PTS: 1 REF: p. 721, Magnesium OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Choice

11. A client requiring frequent blood transfusions has developed iron overload. Which medication will be administered?

A. Calcium gluconate B. Deferoxamine C. Sodium polystyrene sulfonate D. Deferasirox ANS: D Rationale: Deferasirox is an oral iron-chelating agent that is used to treat chronic iron overload in clients who require frequent blood transfusions for severe chronic anemia.

Calcium gluconate is used in the treatment of cardiotoxic effects. Deferoxamine is a parenteral drug used to remove excess iron from storage sites in the body, and sodium polystyrene sulfonate removes potassium from the body in the stool.

PTS: 1 REF: p. 722, Deferoxamine and Deferasirox OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 12. The nurse is caring for a child who has ingested lead-based paint chips. What medication does the nurse expect to be prescribed?

A. Succimer B. Folic acid C. Deferoxamine D. Deferasirox ANS: A Rationale: Succimer chelates lead to form water-soluble complexes that are excreted in the urine. Succimer is used to treat lead poisoning in children. Folic acid is essential for normal metabolism of all body cells. Deferoxamine is a parenteral drug used to remove excess iron from storage sites in the body. Deferasirox is an oral iron-chelating agent that is used to treat chronic iron overload.

PTS: 1 REF: p. 722, Succimer OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A 3-year-old child has been diagnosed with an acute gastrointestinal infection that has caused severe diarrhea for the past 36 hours. The pediatric nurse should anticipate the prescription of which treatment?

A. Magnesium gluconate B. Oral electrolyte solution C. Sodium bicarbonate D. 50% dextrose

ANS: B Rationale: Oral electrolyte solutions contain several electrolytes and a small amount of dextrose. They are especially useful in children for the treatment of diarrhea and may prevent severe fluid and electrolyte depletion. Magnesium gluconate, 50% dextrose, and sodium bicarbonate are not typically used for this purpose since they are not composed of a variety of electrolytes.

PTS: 1 REF: p. 721, Multiple Mineral–Electrolyte Preparations OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. An older adult client’s compromised nutritional status has necessitated the use of a nutritional formula. When reviewing this client’s laboratory findings, the nurse should prioritize which value?

A. Erythrocyte sedimentation rate (ESR) B. Serum albumin C. Liver enzymes D. Blood urea nitrogen (BUN) ANS: B Rationale: For clients receiving nutritional formulas, the nurse observes for weight gain and increased serum albumin. In a client with compromised nutrition, there is less emphasis placed on BUN, liver enzymes, and ESR since they are less reflective of nutritional status.

PTS: 1 REF: p. 722, Nutritional Products OBJ: 7 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. A nurse is preparing to administer iron dextran by IV to a client. What action should the nurse perform prior to administration that is specific to the use of this medication?

A. Review laboratory values.

B. Confirm the presence of emergency resuscitation equipment.

C. Perform a head-to-toe assessment.

D. Check the client record for allergies.

ANS: B Rationale: Iron dextran is a parenteral form of iron useful for treating iron deficiency anemias when oral supplements cannot be used. The FDA has issued a black box warning for iron dextran regarding the risk of anaphylactic reactions and death. The nurse should confirm the availability of equipment and drugs for emergency resuscitation before administering the drug. Assessing for allergies, reviewing laboratory tests, and performing head-to-toe assessment are common nursing actions for all medication administration.

PTS: 1 REF: p. 719, Iron Dextran OBJ: 5 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A nurse is caring for a client whose laboratory values indicate hyperkalemia. What medications might the nurse expect the health care provider to prescribe? Select all that apply.

A. Sodium bicarbonate B. Calcium gluconate C. Glucose and insulin D. Sodium polystyrene sulfonate E. Succimer F. Deferoxamine ANS: A, B, C, D Rationale: A number of medications can be used in the treatment of hyperkalemia.

Sodium bicarbonate causes rapid movement of potassium into the cells. Calcium gluconate, a mineral supplement, decreases the cardiotoxic effects of hyperkalemia.

Glucose and insulin may be administered intravenously, the latter to cause potassium to move into the cells and the former to prevent hypoglycemia. Sodium polystyrene sulfonate is a cation exchange resin that removes potassium from the body in the stool.

Succimer is prescribed for lead poisoning. Deferoxamine is used in the treatment of acute iron overdose.

PTS: 1 REF: p. 722, Agents Used in the Treatment of Hyperkalemia OBJ: 5 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 17. A nurse is caring for a client who is receiving tube feedings at a rate of 40 mL/h. Which assessment data require immediate action by the nurse?

A. The client is vomiting.

B. The client has a heart rate of 100 beats/min.

C. The client has a blood pressure of 105/78 mm Hg. D. The client has a small, semiformed stool.

ANS: A Rationale: When a client is receiving tube feedings, the nurse should assess for adverse reactions every 2 to 4 hours. Adverse effects include tachycardia, hypotension, dehydration, nausea, vomiting, diarrhea, and increased urine output. If the client vomits, the nurse should immediately stop the tube feeding, sit the client upright at 90 degrees in a high Fowler’s position to prevent aspiration, and determine if additional measures are needed. The blood pressure and heart rate are within normal limits. For a client receiving tube feedings, a semiformed stool is a normal assessment.

PTS: 1 REF: p. 722, Nutritional Products OBJ: 7 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A nurse is preparing to administer tube feedings to a client with a tube in the left nare.

Which is the priority nursing action immediately prior to administration?

A. Elevate the head of the bed to 15 degrees.

B. Remove the tube feeding formula from the refrigerator.

C. Check the placement of the feeding tube.

D. Perform an assessment of the gastrointestinal (GI) system.

ANS: C Rationale: The nurse should check the placement of the feeding tube prior to the administration of the tube feeding. The client should be in an upright position and the solution at room temperature to avoid abdominal cramping. The GI assessment is not the priority prior to administration of the tube feeding, but it should be performed every 4 hours to determine if the tube feeding is being absorbed and a bowel movement has occurred in the last 24 hours.

PTS: 1 REF: p. 724, Box 35.4 OBJ: 7 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 35: Nutritional Support Products, Vitamins, and Mineral Supplements KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 36, Drug Therapy for Weight Management 1. A client has a body mass index (BMI) of 27 and weighs 160 lb (73 kg). What is this client considered to be?

A. Underweight B. Overweight C. Obese D. Desired weight ANS: B Rationale: Overweight is defined as a BMI of 25 to 29.9. Desired weight is indicated by a BMI of 18.5 to 24.9; clients below this BMI are considered underweight. Obesity is defined as a BMI of 30 or greater.

PTS: 1 REF: p. 729, Overview of Weight Management OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 36: Drug Therapy for Weight Management KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 2. A nurse is providing education on healthy weight maintenance at a public health fair.

What statement could the nurse share to provide accurate information to attendees?

A. “Consuming 3500 excess calories will result in 1 lb (0.45 kg) of fat.”

B. “Excess calories are converted to amino acids or protein.”

C. “Foods that are high in fat stimulate energy expenditure.”

D. “Women will expend more energy than men because of their body composition.”

ANS: A Rationale: Consuming an extra 500 calories each day for a week results in 3500 excess calories, or 1 lb (0.45 kg) of fat. Excess calories are converted to triglycerides and stored in fat cells. Foods that contain carbohydrates and protein stimulate energy expenditure.

Men tend to expend more energy than women because they have proportionally greater muscle mass.

PTS: 1 REF: p. 729, Physiologic Factors OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 36: Drug Therapy for Weight Management KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice 3. What environmental factor is believed to have contributed most to increased weight in today’s generation of children?

A. Playing video games B. Genetic changes C. Increased social acceptance of obesity D. Increased incidence of depression ANS: A

Rationale: For both adults and children, increased time watching television, playing video and computer games, and working on computers contributes to less physical activity and promotes weight gain. Depression, social factors, and genetic factors are not environmental influences.

PTS: 1 REF: p. 730, Environmental Factors OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 36: Drug Therapy for Weight Management KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. The nurse is providing education to the parent of a child who is classified as overweight.

The nurse should inform the parent that children who are overweight are at increased risk of developing what disease process?

A. Glaucoma B. Migraine headache C. Scoliosis D. Diabetes mellitus ANS: D Rationale: Children who are overweight or obese are at risk of developing type 2 diabetes. They are not more prone to developing glaucoma, migraine headache, or scoliosis.

PTS: 1 REF: p. 730, Overweight and Obese Children OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 36: Drug Therapy for Weight Management KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice 5. The nurse is providing education to a client who has been prescribed phentermine. What common adverse effects should the nurse include in teaching? Select all that apply.

A. Nervousness B. Bradycardia C. Slowed movements D. Constipation E. Dry mouth F. Somnolence ANS: A, D, E Rationale: Phentermine is an adrenergic drug that stimulates the release of norepinephrine and dopamine, thereby suppressing appetite. The nurse should teach the client about the most commonly reported adverse effects, which are nervousness, palpitations, tachycardia, primary pulmonary hypertension, hyperactivity, dry mouth, constipation, and systemic hypertension. Impotence, insomnia, and unpleasant taste may also occur.

PTS: 1 REF: p. 734, Noradrenergic Sympathomimetic Anorexiants OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 36: Drug Therapy for Weight Management KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Select 6. The nurse is providing education to a client who is taking orlistat. How should the nurse describe the way in which it affects weight loss?

A. “This medication increases central nervous system stimulation.”

B. “It inhibits the reuptake of serotonin and norepinephrine.”

C. “Orlistat decreases fat absorption, which leads to decreased caloric intake.”

D. “The drug’s caffeine content decreases appetite.”

ANS: C Rationale: Orlistat decreases fat absorption, which leads to decreased caloric intake.

Orlistat does not increase central nervous system stimulation nor does it inhibit reuptake of serotonin and norepinephrine. Orlistat does not contain caffeine.

PTS: 1 REF: p. 737, Lipase Inhibitors OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 36: Drug Therapy for Weight Management KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice 7. A client who is obese reports taking orlistat. The nurse should encourage the client to supplement the diet with what?

A. An iron supplement B. A multivitamin C. An omega-3 fatty acid supplement D. A potassium supplement ANS: B Rationale: Because orlistat prevents absorption of the fat-soluble vitamins A, D, E, and K, people who take it should also take a multivitamin daily 2 hours before or after orlistat. Iron supplements, potassium supplements, and omega-3 fatty acid supplements are not necessarily required.

PTS: 1 REF: p. 737, Lipase Inhibitors OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 36: Drug Therapy for Weight Management KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client who is obese has been prescribed phentermine for weight loss. The nurse should inform the prescribing health care provider of a contraindication to use when noticing what in the client history?

A. Lisinopril for hypertension B. Levothyroxine for hypothyroidism C. Famotidine for gastroesophageal reflux disease D. Amitriptyline for depression ANS: A

Rationale: Contraindications to phentermine use include moderate to severe hypertension, cardiovascular disease, hyperthyroidism, glaucoma, pregnancy, or breast-feeding and a history of drug abuse. Therefore, a client taking lisinopril for hypertension should not take phentermine. Phentermine is also contraindicated within 14 days of treatment with a monoamine oxidase inhibitor (MAOI); since amitriptyline is a tricyclic antidepressant, not an MAOI, amitriptyline presents no contraindication. GERD is not a contraindication to phentermine use.

PTS: 1 REF: p. 734, Noradrenergic Sympathomimetic Anorexiants OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 36: Drug Therapy for Weight Management KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A client with a body mass index (BMI) of 27.5 expresses interest in taking orlistat for weight loss. What statement should the nurse make to provide the most appropriate information to the client?

A. “Be sure to add a multivitamin when you start taking orlistat.”

B. “This drug isn’t intended for someone of your weight.”

C. “You’ll need to avoid high-fat meals if you take the drug.”

D. “Your health care provider will have to write a prescription first.”

ANS: B Rationale: Orlistat is intended only for clients who are clinically obese, not for those who merely want to lose a small amount of weight. A BMI of 27.5 indicates that this client is overweight, not obese, so the nurse should not encourage use of the drug.

Orlistat is available without a prescription. While clients taking orlistat should be instructed to take a multivitamin and to avoid high-fat meals, it is more important to tell this client that use of the drug isn’t appropriate.

PTS: 1 REF: p. 737, Lipase Inhibitors OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 36: Drug Therapy for Weight Management KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A nurse is caring for a client who has presented to the clinic for guidance on weight loss.

Before the client is seen by the health care provider, the nurse calculates the body mass index (BMI) and obtains vital signs. If the client is 5 feet 7 inches (1.7 m) tall and weighs 249 lb (113 kg), what will the nurse record as the BMI? A. 29.8 B. 35.0 C. 39.1 D. 43.7 ANS: C Rationale: To calculate BMI, divide the weight in kilograms by the square of the height in meters. In this scenario, BMI = 113 kg ÷ (1.7 m)2 = 39.1.

PTS: 1 REF: p. 729, Box 36.1 OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 36: Drug Therapy for Weight Management KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. The nurse is reviewing the history of a client who has been prescribed bupropion. What information in the history explains why the client has been prescribed bupropion instead of another drug for weight management?

A. Gastroesophageal reflux disease B. Smoking history C. Type 2 diabetes D. Anxiety disorder ANS: B Rationale: Bupropion is used for the prevention of weight gain during smoking cessation, as well as for the treatment of depression. It is not helpful in the treatment of GERD, type 2 diabetes, or anxiety.

PTS: 1 REF: p. 739, Other Drugs Used for Weight Management OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 36: Drug Therapy for Weight Management KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A client who is overweight reports taking a diuretic herb for weight loss. What statement should the nurse make to provide the client with the most appropriate information regarding this practice?

A. “Caffeine is the active ingredient of most of these products.”

B. “These herbs act by inhibiting the absorption of fat from foods.”

C. “Be sure to take a vitamin supplement if you use this product.”

D. “These herbs probably won’t help you lose fat.”

ANS: D Rationale: While clients taking laxative and diuretic herbs may experience weight loss, it results from a loss of body fluids and electrolytes, not fat. Lipase inhibitors such as orlistat inhibit the absorption of fat, and clients who take the drug should be instructed to take a multivitamin supplement to offset the reduced absorption of fat-soluble vitamins.

Caffeine is the active ingredient in guarana.

PTS: 1 REF: p. 740, Box 36.7 OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 36: Drug Therapy for Weight Management KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 37, Drug Therapy for Peptic Ulcer Disease and Hyperacidity 1. A client is taking nonsteroidal anti-inflammatory agents for arthritis of the knees and hips. Which disease is a result of cellular destruction of the gastrointestinal tract from this medication?

A. Esophageal cancer B. Bowel obstruction C. Liver cancer D. Peptic ulcer disease ANS: D Rationale: Cell destruction will occur from the ingestion of NSAIDs, which can lead to the development of peptic ulcer disease. Nonsteroidal anti-inflammatory agents do not cause esophageal cancer, bowel obstruction, or liver cancer.

PTS: 1 REF: p. 745, Peptic Ulcer Disease OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 2. The client has a magnesium-based antacid prescribed for administration before meals.

The nurse knows to withhold the medication if the client exhibits what?

A. Hypertension B. Heart rate of 68 C. Renal dysfunction D. Stress ulcer ANS: C Rationale: Magnesium-based antacids are contraindicated in clients with renal failure.

Magnesium-based antacids are not contraindicated with hypertension, regular heart rate, or stress ulcer.

PTS: 1 REF: p. 751, Box 37.2 OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A client is diagnosed with peptic ulcer disease complicated by H. pylori. What is the rationale for adding bismuth to the medication regimen?

A. Increases pepsin activity B. Decreases gastrin secretion C. Prevents metabolic alkalosis D. Provides antibacterial effects ANS: D

Rationale: A bismuth preparation is added to some regimens. Bismuth exerts antibacterial effects against H. pylori by disrupting bacterial cell walls, preventing the organism from adhering to the gastric epithelium, and inhibiting bacterial enzymatic and proteolytic activity. Bismuth does not increase pepsin activity, decrease gastrin secretion, or prevent metabolic alkalosis.

PTS: 1 REF: p. 759, Bismuth Subsalicylate OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client is in the intensive care unit and being administered ranitidine parenterally. How long will it take for ranitidine to reach peak blood levels?

A. 15 minutes B. 30 minutes C. 1 hour D. 2 hours ANS: A Rationale: Parenteral ranitidine reaches peak blood level in 15 minutes. Parenteral ranitidine reaches its peak prior to 30 minutes, 1 hour, and 2 hours.

PTS: 1 REF: p. 749, Histamine2 Receptor Antagonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. The nurse practitioner instructs the client to use over-the-counter ranitidine instead of cimetidine. What risk is decreased when using ranitidine over cimetidine?

A. Headache B. Drug-to-drug interaction C. Diarrhea D. Bradycardia ANS: B Rationale: Ranitidine causes fewer drug interactions than cimetidine. Ranitidine possesses the following adverse effects: headache, diarrhea, and bradycardia.

PTS: 1 REF: p. 749, Histamine2 Receptor Antagonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A client is taking cimetidine for increased gastric pain and hypersecretion. Nurses should use caution when administering cimetidine to those with which condition?

A. Hepatic disease B. Cancer C. Hypertension D. Diabetes mellitus ANS: A Rationale: No contraindications exist, but cimetidine should be used cautiously in clients with impaired hepatic and renal function. The client with cancer, hypertension, and diabetes mellitus can take cimetidine safely.

PTS: 1 REF: p. 749, Histamine2 Receptor Antagonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client is taking cimetidine. Which adverse effect is more likely to occur with cimetidine than with other histamine2 receptor antagonists?

A. Hypoxia B. Hypertension C. Gynecomastia D. Seizures ANS: C Rationale: Gynecomastia is an adverse effect that is more likely to occur with cimetidine than with other histamine2 antagonists. Hypoxia, hypertension, and seizures are not adverse effects of cimetidine.

PTS: 1 REF: p. 749, Histamine2 Receptor Antagonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A nurse is providing education to a 23-year-old female client who has been prescribed misoprostol. What instruction should the nurse include in the teaching?

A. Supplement therapy with magnesium antacids.

B. Report postmenopausal bleeding.

C. Use effective contraceptive measures.

D. Administer the drug one time per day.

ANS: C Rationale: Misoprostol is used to prevent NSAID gastric ulcer development. The medication can cause spontaneous abortion; thus, the medication should be administered with a good form of birth control. It should not be administered with magnesium antacids. It is not necessary for a client aged 23 years to report postmenopausal bleeding.

The medication should be administered two to four times per day.

PTS: 1 REF: p. 757, Prostaglandin: Misoprostol OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A client is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the client’s symptoms be resolved?

A. 1 to 2 weeks B. 6 weeks C. 10 weeks D. 12 weeks ANS: A Rationale: The symptoms of gastroesophageal reflux disease will most likely be resolved in 1 to 2 weeks after the start of the proton pump inhibitor medication regimen. It will not take 6, 10, or 12 weeks to see a change with the proton pump inhibitor.

PTS: 1 REF: p. 754, Proton Pump Inhibitors OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. The client diagnosed with peptic ulcer disease states, “I’ve never been a really anxious type of person, so I never thought I’d develop ulcers.” The nurse has responded with health education addressing the etiology of peptic ulcer disease (PUD). What causative factors should the nurse cite? Select all that apply.

A. Physiologic or psychological stress B. Diabetes mellitus C. Cigarette smoking D. Infections E. Nonsteroidal anti-inflammatory drugs ANS: A, C, D, E Rationale: There are multiple etiologic factors implicated in PUD. These include smoking, H. pylori infection, NSAID use, and stress. Diabetes is not an identified cause of PUD. PTS: 1 REF: p. 745, Peptic Ulcer Disease OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Select 11. A critical care nurse is preparing to administer an intragastric drip of an antacid to a client through a nasogastric tube. How should the nurse most accurately titrate the dose and frequency?

A. By assessing the pH of a 24-hour urine sample B. By aspirating stomach contents and measuring the pH

C. By measuring the pH of urine after each void D. By swabbing the client’s buccal mucosa and testing for pH daily ANS: B Rationale: For clients with a nasogastric tube in place, antacid dosage may be titrated by aspirating stomach contents, determining pH, and then basing the dose on the pH. Accurate measurement of gastric pH cannot be determined from the buccal mucosa or urine.

PTS: 1 REF: p. 747, Antacids OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. An older adult has been taking a calcium-based antacid on an increasingly frequent basis. When teaching this client, the nurse should include suggestions for the prevention of which adverse effect?

A. Constipation B. Urinary frequency C. Fatty stools D. Nausea ANS: A Rationale: With the antacid that contains calcium, it is important to observe for constipation. Combining this antacid with other antacids containing magnesium may prevent this effect. Frequency, fatty stools, and nausea are not noted adverse effects.

PTS: 1 REF: p. 747, Antacids OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 13. The nurse should be aware that ranitidine achieves a therapeutic effect by which means?

A. Raising the pH of gastric secretions B. Inhibiting the secretion of gastric acid C. Binding to proton pumps D. Decreasing gastric motility ANS: B Rationale: The histamine2 receptor antagonists (H2RAs) inhibit both basal secretion of gastric acid and the secretion stimulated by histamine, acetylcholine, and gastrin. These drugs, such as ranitidine, do not change the pH of gastric secretions, bind to the proton pumps, or decrease gastric motility.

PTS: 1 REF: p. 749, Histamine2 Receptor Antagonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 14. The client recently diagnosed with peptic ulcer disease states achieving adequate symptom relief with the use of over-the-counter (OTC) antacids but has asked the nurse about the optimal schedule for taking these drugs. What action should the nurse recommend?

A. At the earliest appearance of symptoms B. Immediately prior to each meal and at bedtime C. Every 4 hours during all waking hours D. 1 and 3 hours after each meal and at bedtime ANS: D Rationale: For the treatment of peptic ulcer disease, clients should take antacids 1 and 3 hours after meals and at bedtime (four to seven doses daily), 1 to 2 hours before or after other medications.

PTS: 1 REF: p. 747, Antacids OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. A client has been prescribed omeprazole by the primary health care provider. When the nurse asks whether the medication is providing relief, the client replies, “I think it’s working quite well, and I’ve gotten in the routine of taking it every morning before breakfast.” How should the nurse respond?

A. “That’s good, but remember that you shouldn’t take it on days when you’re not having any symptoms.”

B. “I’m glad it’s working for you, but you’ll probably find it works even better if you take it after eating.”

C. “That’s great. If you find later that it’s not working as well, you might want to try taking it at bedtime.”

D. “I’m glad to hear that. It sounds like you’re taking it exactly like it should be taken.”

ANS: D Rationale: It is important that omeprazole be administered before food intake.

Once-daily dosing is typical. The drug is not taken solely as a response to acute symptoms.

PTS: 1 REF: p. 754, Proton Pump Inhibitors OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

16. A client with a complex medical history states that the primary health care provider has changed the client’s proton pump inhibitor (PPI) from omeprazole to rabeprazole. The client is unsure of the rationale for this change in medication and has raised this question with the nurse. What rationale is most plausible?

A. Rabeprazole has fewer adverse effects.

B. Rabeprazole can be used long term.

C. Rabeprazole has fewer drug interactions.

D. Rabeprazole can be taken on an outclient basis.

ANS: C Rationale: The actions and pharmacokinetics of the other PPIs—esomeprazole, lansoprazole, pantoprazole, and rabeprazole—are similar to those of omeprazole.

Rabeprazole is associated with very few drug interactions. All can be used on an outclient basis and long-term, if necessary. Adverse effects are similar.

PTS: 1 REF: p. 754, Proton Pump Inhibitors OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A client diagnosed with peptic ulcer disease has begun taking sucralfate. The nurse should caution the client against the concurrent use of which classification of medications?

A. Antacids B. NSAIDs C. Acetaminophen D. Probiotics ANS: A Rationale: Antacids decrease the effects of sucralfate, and people should not take them within 30 minutes before or after administration of sucralfate. None of the other options affect the effectiveness of sucralfate.

PTS: 1 REF: p. 757, Sucralfate OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A client with ulcers has asked the nurse if it would be acceptable to take bismuth subsalicylate. Before recommending an over-the-counter (OTC) formulation of bismuth subsalicylate, the nurse should conduct which client assessment?

A. Immunization history B. Allergy status C. Cognition D. Normal bowel pattern ANS: B

Rationale: Because it is a salicylate, this drug can cause serious bleeding problems when used alone in clients with ulcers. People with an allergy to aspirin or other salicylates should not take bismuth subsalicylate. The client’s bowel pattern, immunization history, and cognition are not central considerations.

PTS: 1 REF: p. 759, Bismuth Subsalicylate OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. The nurse is educating a client diagnosed with peptic ulcer disease about the prescribed medications aluminum hydroxide–magnesium hydroxide–simethicone mixture and ranitidine. Which statement made by the client indicates the need for further clarification?

A. “Antacids should relieve my epigastric pain within minutes, and ranitidine peaks in 1 to 3 hours after taking it.”

B. “To decrease interactions with other drugs I take, I will take the drug 30 minutes before taking the rest of my medications.”

C. “I will eat fresh fruits and whole grains and drink 2 to 3 L of fluids every day to prevent constipation.”

D. “I will set a timer to remind me when to take the doses since it is important to take it exactly as prescribed.”

ANS: B Rationale: The nurse needs to clarify the statement that the client made in regard to when to space the antacid with other medications the client also takes to prevent possible interactions. Other medications need to be taken 1 to 2 hours apart from a dose of the antacid. The other statements are correct. Antacids help relieve epigastric pain within minutes, and ranitidine, a histamine2 receptor antagonist, peak action occurs 1 to 3 hours after administration orally. Eating foods high in fiber and drinking 2 to 3 L of fluid helps prevent constipation, a common adverse effect of aluminum hydroxide–magnesium hydroxide–simethicone mixture. The client needs to take the antacid doses at regularly scheduled intervals to be therapeutically effective in neutralizing the gastric acid.

PTS: 1 REF: p. 747, Antacids OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 20. The nurse is caring for an adult client presenting with recent heartburn, which the client treated with over-the-counter omeprazole 20 mg PO daily. After reviewing the client’s current list of medications, the nurse should report which medication because concurrent use may increase blood levels of omeprazole?

A. Phenytoin B. Atorvastatin C. Enteric-coated aspirin D. Clarithromycin

ANS: D Rationale: Clarithromycin increases effects of omeprazole and may increase blood levels of the latter. Omeprazole increases blood levels of phenytoin, a medication prescribed for seizure disorders. Neither aspirin nor atorvastatin increases the blood level of omeprazole.

PTS: 1 REF: p. 754, Proton Pump Inhibitors OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 37: Drug Therapy for Peptic Ulcer Disease and Hyperacidity KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 38, Drug Therapy for Nausea and Vomiting 1. What is a nonpharmacologic measure that is effective in treating nausea and vomiting in pregnant women?

A. Ginkgo biloba B. Ginger C. Garlic D. Ginseng ANS: B Rationale: Ginger 250 mg four times per day is a nonpharmacologic treatment supported by limited scientific evidence. Ginkgo biloba, garlic, and ginseng are not recommended.

PTS: 1 REF: p. 778, Herbal Supplements OBJ: 7 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A client prescribed promethazine for nausea and vomiting should be monitored for which adverse effect?

A. Urinary incontinence B. Tachycardia C. Taste alteration D. Confusion ANS: D Rationale: Confusion is an adverse effects of promethazine. Urinary retention is an adverse effect, not urinary incontinence. Tachycardia and taste alteration are not an adverse effects of promethazine.

PTS: 1 REF: p. 766, Phenothiazines OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A client who has been prescribed an antihistamine for nausea should be monitored for which adverse effect of this classification of medication?

A. Diarrhea B. Prolonged QRS complex C. Urinary retention D. Inverted T wave ANS: C Rationale: Adverse anticholinergic effects of antihistamines are dizziness, confusion, dry mouth, and urinary retention. Urinary incontinence, prolonged QRS complex, and inverted T wave are not adverse effects of antihistamines.

PTS:

1

REF: p. 769, Antihistamines

OBJ: 3

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client is administered a phenothiazine for nausea and vomiting. What is the action of phenothiazine?

A. Increases gastric motility B. Antagonizes dopamine receptors C. Blocks histamine receptors D. Antagonizes serotonin receptors ANS: B Rationale: Phenothiazines act on the chemoreceptor trigger zone CTZ and vomiting center by blocking dopamine. They do not increase gastric motility, block histamine receptors, or antagonize serotonin receptors.

PTS: 1 REF: p. 766, Phenothiazines OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. What is the recommended treatment of nausea and vomiting when caring for a child prescribed pediatric chemotherapy agents?

A. Corticosteroids and 5-HT3 receptor antagonists B. Phenothiazines and benzodiazepines C. Proton pump inhibitors and antacids D. Prokinetic agents and antihistamines ANS: A Rationale: 5-HT3 receptor antagonists and corticosteroids are used to treat nausea and vomiting in pediatric oncology clients. None of the remaining options are prescribed for nausea and vomiting triggered by pediatric chemotherapy.

PTS: 1 REF: p. 772, 5-Hydroxytryptamine3 (5-HT3) or Serotonin Receptor Antagonists OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A postoperative school-age pediatric client is experiencing nausea and vomiting. What is the antiemetic drug of choice in children?

A. Promethazine B. Benzquinamide C. Buclizine D. Cyclizine

ANS: A Rationale: Promethazine is the preferred phenothiazine because its action is more like that of the antihistamines than the phenothiazines. Benzquinamide, buclizine, and cyclizine are not the drugs of choice for antiemetic effects in children.

PTS: 1 REF: p. 766, Phenothiazines OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. An older adult client is administered dimenhydrinate. Which is the priority nursing intervention for this client?

A. Encourage fluids with this client.

B. Have the client void after administration.

C. Maintain IV access.

D. Protect from injury.

ANS: D Rationale: Dimenhydrinate causes drowsiness, especially in older adults, and therefore should be used cautiously. The nurse should protect the client from injury. There is no indication that fluids should be forced. The client will not require IV access unless fluid replacement is prescribed.

PTS: 1 REF: p. 769, Antihistamines OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A pregnant client is experiencing morning sickness. Which should be considered as a first-line treatment for the management of morning sickness?

A. Vitamin B6 B. Promethazine C. Vitamin E D. Diphenhydramine ANS: A Rationale: For pregnant women, taking pyridoxine (vitamin B6) 30 to 75 mg daily in three divided doses with or without the antihistamine doxylamine 12.5 mg every 8 hours as needed is considered a first-line treatment option that is safe and effective.

Promethazine is not a first-line treatment for morning sickness. Neither diphenhydramine nor vitamin E is used to treat nausea.

PTS: 1 REF: p. 769, Antihistamines OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

9. A client diagnosed with Parkinson’s disease develops nausea and vomiting.

Promethazine may be contraindicated because it depletes levels of what neurotransmitter?

A. Acetylcholine B. Serotonin C. Dopamine D. Adenosine ANS: C Rationale: Promethazine and other phenothiazines have widespread effects on the body.

The therapeutic effects in nausea and vomiting are attributed to their ability to block dopamine from receptor sites in the brain and chemoreceptor trigger zone (CTZ). This blockage of dopamine has the potential to exacerbate parkinsonian effects.

PTS: 1 REF: p. 766, Phenothiazines OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 10. The nurse is providing education to a client who has been prescribed hydroxyzine.

Which statement indicates that the client has understood the teaching?

A. “I will take repeated doses of this medication until my nausea resolves.”

B. “I may experience drowsiness with this medication.”

C. “I should eat before I take this medication.”

D. “I will need to take potassium with this medication.”

ANS: B Rationale: Hydroxyzine will produce drowsiness in the client. Repeated doses are unsafe. The client should not eat with nausea. The client does not need to take potassium with hydroxyzine.

PTS: 1 REF: p. 769, Antihistamines OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A 1-year-old postoperative client has been experiencing repeated vomiting. What antiemetic drug has a black box warning against use in a client of this age?

A. Promethazine B. Benzquinamide C. Buclizine D. Cyclizine ANS: A Rationale: A black box warning alerts nurses that promethazine is contraindicated in children younger than 2 years of age because of the risk of potentially fatal respiratory depression. Benzquinamide, buclizine, and cyclizine do not have such warnings.

PTS: 1 REF: p. 766, Phenothiazines OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 12. The nurse administers hydroxyzine to a client with nausea. After administration, the nurse should monitor for what adverse effect?

A. Thrombocytopenia B. Palpitations C. Hypertonic muscle tone D. Dry mouth ANS: D Rationale: Anticholinergic effects, including dry mouth, can result from the use of hydroxyzine. This drug is not associated with thrombocytopenia, palpitations, or hypertonicity.

PTS: 1 REF: p. 769, Antihistamines OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A client prescribed promethazine has an elevated creatinine level. Which action is the health care provider likely to take considering any possible related risk to this client?

A. Leave the prescription unchanged.

B. Prescribe administration of a lower dose.

C. Prescribe administration of a higher dose.

D. Reduce the dosing frequency.

ANS: B Rationale: A dose reduction may be necessary in clients with renal impairment to avoid the possibility of adverse effects, toxicity, or increased sensitivity to phenothiazines. A change in frequency is less likely.

PTS: 1 REF: p. 769, Antihistamines OBJ: 2 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. A client who has been scheduled to begin chemotherapy for the treatment of breast cancer is anxious about the possibility of experiencing nausea. When explaining the physiology of nausea and vomiting, the nurse should include what informational statement?

A. The vomiting center is a cluster of cells in the cerebellum.

B. The vomiting center sends afferent signals to the chemoreceptor trigger zone (CTZ).

C. The chemoreceptor trigger zone (CTZ) is composed of neurons in the fourth

ventricle.

D. The chemoreceptor trigger zone (CTZ) is located partly within the central nervous system and partly in the peripheral nervous system.

ANS: C Rationale: The CTZ is composed of neurons in the fourth ventricle. The vomiting center is a nucleus of cells in the medulla oblongata. Stimuli are relayed to the vomiting center by afferent signals from the chemoreceptor trigger zone (CTZ).

PTS: 1 REF: p. 765, Pathophysiology OBJ: 8 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice 15. An adult hospital client has been experiencing intractable nausea and vomiting for several hours, so the nurse has obtained a prescription for an antiemetic from the health care provider. The prescription reads: “Promethazine 25 mg subcutaneously every 6 hours PRN.” The nurse should contact the health care provider to question what aspect of this prescription?

A. The drug B. The dose C. The route D. The frequency ANS: C Rationale: A black box warning alerts nurses that promethazine is contraindicated for subcutaneous administration. The other parameters of the prescription are within recommendations.

PTS: 1 REF: p. 766, Phenothiazines OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. The nurse is providing education to a client who has been prescribed hydroxyzine. What adverse effect should the nurse mention during teaching?

A. Pruritus B. Drowsiness C. Urinary frequency D. Bradycardia ANS: B Rationale: The use of hydroxyzine is associated with drowsiness. Antihistamines do not typically cause pruritus, frequency, or bradycardia.

PTS: 1 REF: p. 769, Antihistamines OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. What antiemetic is the most common first-line drug for the treatment of postoperative nausea and vomiting?

A. Ondansetron B. Dronabinol C. Dimenhydrinate D. Hydroxyzine ANS: A Rationale: The 5-HT3 receptor antagonists are usually considered drugs of first choice for postoperative nausea and vomiting. Ondansetron is the prototype of the 5-HT3 receptor antagonists. None of the remaining options are a 5-HT3 receptor antagonist.

PTS: 1 REF: p. 772, 5-Hydroxytryptamine3 (5-HT3) or Serotonin Receptor Antagonists OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 18. A client is undergoing a course of radiotherapy for the treatment of leukemia.

Treatments in the past have caused the client severe nausea and vomiting. The oncology nurse should normally administer antiemetics on what schedule?

A. Simultaneous with radiation treatment B. The night before a scheduled radiation treatment C. 30 to 60 minutes before the treatment D. 10 to 15 minutes before the treatment ANS: C Rationale: The nurse should normally administer antiemetic drugs 30 to 60 minutes before a nausea-producing event, when possible. None of the other options will provide effective nausea and vomiting relief.

PTS: 1 REF: p. 769, Box 38.2 OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. When reviewing a newly admitted client’s previous medication record, the nurse notes that the client has previously been treated with aprepitant. The nurse is justified in suspecting that this client’s medical history includes which therapy/treatment?

A. Placement of a nasogastric tube B. Chemotherapy C. Endoscopy D. Radiation therapy

ANS: B Rationale: Prescribers often order aprepitant as part of combination therapy along with a 5-HT3 receptor antagonist and corticosteroids to treat both acute and delayed nausea and vomiting associated with chemotherapy. NG tube insertion, radiation therapy, and endoscopy are not typical indications for the use of aprepitant.

PTS: 1 REF: p. 774, Substance P/Neurokinin 1 Antagonists OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 20. A hospital client has a standing prescription for aprepitant on an as-needed basis. The client should be encouraged to request a dose of the drug in response to which event?

A. Anticipation of becoming nauseous B. The same time each day C. The onset of nausea D. When nausea results in vomiting ANS: A Rationale: The nurse instructs clients to take aprepitant as prescribed before the onset of nausea and vomiting. It does not need to be taken on a regular schedule and should not be withheld until the onset or peak of symptoms.

PTS: 1 REF: p. 774, Substance P/Neurokinin 1 Antagonists OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 38: Drug Therapy for Nausea and Vomiting KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 39, Drug Therapy for Constipation and Elimination Problems 1. A client is using psyllium hydrophilic mucilloid to promote evacuation of stool. What is the action of this medication?

A. It reduces the surface tension of bowel contents.

B. It irritates the intestinal mucosa, thus increasing intestinal motility.

C. It increases mass and water content of the stool, promoting evacuation.

D. It creates a barrier between the colon wall and feces.

ANS: C Rationale: Bulk-forming laxatives increase mass and water content of the stool, promoting evacuation. Bulk-forming laxatives do not reduce surface tension of bowel contents. Bulk-forming laxatives do not irritate the intestinal mucosa to increase intestinal motility. Bulk-forming laxatives do not create a barrier between the colon wall and feces.

PTS: 1 REF: p. 785, Laxatives OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. Which statement by a client leads the nurse to believe that the client understands how to safely and effectively use bulk-forming laxatives?

A. “I will mix the medication with around a cup of liquid and then drink the mixture.”

B. “I will mix the dry medication with applesauce and then eat prunes before bedtime.”

C. “I will use milk of magnesia in conjunction with a bulk-forming laxative until I have a bowel movement.”

D. “I will decrease the roughage in my diet while I am taking the bulk-forming laxative and eat rice.”

ANS: A Rationale: Bulk-forming laxatives increase mass and water content of the stool, promoting evacuation. Bulk-forming laxatives should be mixed with a sufficient amount of liquid (typically around 8 oz [240 mL]) before being consumed. Mixing the bulk-forming laxative with applesauce will not provide the needed fluid, and the applesauce can have a binding effect. It is not necessary to mix milk of magnesia with a bulk-forming laxative. The client should not decrease roughage in the diet or eat rice, which is binding.

PTS: 1 REF: p. 785, Laxatives OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 3. A client is taking psyllium hydrophilic mucilloid daily. What information should be included in the discharge plan?

A. Up to 30 g of the medication can be divided over several divided doses daily.

B. Mix the medication with food at the evening meal.

C. Take your other medications with the mucilloid.

D. Discontinue the mucilloid if you do not have a bowel movement daily.

ANS: A Rationale: The daily dose of up to 30 g can be divided over several doses. The client should not mix the medication with food or other medications. The mucilloid should not be discontinued if the client does not have a bowel movement.

PTS: 1 REF: p. 787, Table 39.3 OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 4. When assessing a client’s bowel habits, which description is the best indication of normal bowel elimination?

A. One bowel movement daily in the morning B. One bowel movement daily in the evening C. Soft, formed stool D. Liquid stool ANS: C Rationale: Normal bowel elimination should produce soft, formed stool. One bowel movement in the morning or evening may not be a regular bowel pattern for all clients.

Liquid stool is not an indication of normal bowel elimination.

PTS: 1 REF: p. 784, Clinical Manifestations OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. What is the result of failing to respond to the defecation reflex?

A. Involuntary evacuation B. Increased sensory stimulation C. Decreased sensory stimulation D. Diarrhea ANS: C Rationale: In people who often inhibit the defecation reflex or fail to respond to the urge to defecate, constipation develops as the reflex weakens. The client will not have involuntary evacuation (incontinence). The client will not have increased sensory stimulation. The client will not have diarrhea.

PTS: 1 REF: p. 784, Physiology and Pathophysiology OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 6. The nurse has a prescription to administer a saline cathartic to a client who has a history of congestive heart failure (CHF). Why is this type of cathartic contraindicated with this client?

A. The client is at risk for hypomagnesemia.

B. The client is at risk for excess fluid volume.

C. The client is at risk for hypochloremia.

D. The client is at risk for hyperphosphatemia.

ANS: B Rationale: Clients with congestive heart failure are at risk for fluid retention and edema with sodium-containing cathartics. The client diagnosed with CHF is not at risk for hypomagnesemia, hypochloremia, or hyperphosphatemia from the administration of a saline cathartic.

PTS: 1 REF: p. 791, Saline Cathartics OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client is scheduled for a colonoscopy in the morning. The nurse will provide information concerning which laxative?

A. Psyllium B. Polyethylene glycol–electrolyte solution C. Castor oil D. Lactulose ANS: B Rationale: Polyethylene glycol–electrolyte solution is a nonabsorbable oral solution that induces diarrhea within 30 to 60 minutes and rapidly evacuates the bowel, usually within 4 hours for a colonoscopy. Psyllium is not strong enough for a colonoscopy preparation.

Castor oil is not the most commonly prescribed preparation for a colonoscopy. Lactulose is used only when the serum ammonium level is elevated.

PTS: 1 REF: p. 791, Saline Cathartics OBJ: 4 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. The nurse should educate the client prescribed a stimulant cathartic to be alert for which common adverse effect?

A. Nausea B. Vomiting C. Diarrhea D. Rectal bleeding

ANS: C Rationale: The stimulant cathartics are the strongest and most abused laxative products.

These drugs act by irritating the GI mucosa and pulling water into the bowel lumen. As a result, feces are moved through the bowel too rapidly to allow colonic absorption of fecal water, so a watery stool is eliminated. Nausea, vomiting, and rectal bleeding should not routinely occur.

PTS: 1 REF: p. 791, Saline Cathartics OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A client diagnosed with alcoholism and chronic liver failure is confused and has an elevated serum ammonia level. What laxative will be administered to lower the serum ammonia level?

A. Docusate sodium B. Polyethylene glycol–electrolyte solution C. Lactulose D. Sorbitol ANS: C Rationale: Lactulose decreases production of ammonia in the intestine. Lactulose is a disaccharide that is not absorbed from the GI tract. It is used to treat hepatic encephalopathy. Docusate sodium only provides stool softening and has no effect on serum ammonia levels. Polyethylene glycol–electrolyte solution and sorbitol are not used to decrease serum ammonia.

PTS: 1 REF: p. 793, Table 39.5 OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A child is diagnosed with fecal impaction. What medication does the nurse expect the health care provider to prescribe?

A. Lactulose B. Polyethylene glycol–electrolyte solution C. Docusate sodium D. Sorbitol ANS: B Rationale: Polyethylene glycol–electrolyte solution is used for disimpaction in children older than 6 months. Lactulose and sorbitol are prescribed for constipation. Docusate sodium is a stool softener.

PTS: 1 REF: p. 786, Table 39.2 OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Remember

NOT: Multiple Choice

11. The nurse is educating new parents about prevention and treatment of constipation in children. What is the most effective and safest way to treat constipation in a 2-year-old child prior to bowel training?

A. Milk of magnesia B. Sorbitol C. Bisacodyl suppositories D. Glycerin suppositories ANS: D Rationale: Glycerin suppositories are often effective in infants and children. Milk of magnesia, sorbitol, and bisacodyl suppositories are not recommended.

PTS: 1 REF: p. 790, Table 39.4 OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 12. Which client is at highest risk for alteration in bowel elimination?

A. A client who is paralyzed from a spinal cord injury B. A client who has a diagnosis of type 2 diabetes C. A client who has hypertension D. A client who takes thyroid replacements ANS: A Rationale: Lack of physical exercise, even the act of walking, often results in constipation. Thyroid replacements, high blood pressure, and hypertension are not risk factors for constipation.

PTS: 1 REF: p. 784, Etiology OBJ: 2 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. Defecation is normally stimulated by what physiologic trigger?

A. Movements and reflexes in the gastrointestinal tract B. Stimulation from the medulla oblongata C. Synthesis and release of digestive enzymes D. Changes in the osmolarity of bowel contents ANS: A Rationale: Defecation is normally stimulated by movements and reflexes in the gastrointestinal tract. It does not result from changes in osmolarity, central nervous system (CNS) stimulation of the medulla, or the release of digestive enzymes.

PTS: 1 OBJ: 1

REF: p. 784, Physiology and Pathophysiology

NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 14. How is constipation best defined?

A. The passage of fewer than three stools in any 7-day period B. The passage of fewer than five stools in any 7-day period C. The infrequent and painful expulsion of hard, dry stools D. A subjective sensation of bowel fullness ANS: C Rationale: Constipation is the infrequent and painful expulsion of hard, dry stools. It is not defined by a particular number of stools or in terms of an individual’s subjective sensation.

PTS: 1 REF: p. 784, Etiology OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 15. The nurse should know that lactulose achieves a therapeutic effect by which means?

A. Decreasing the viscosity of intestinal contents in the duodenum B. Pulling water into the intestinal lumen by osmotic pressure C. Irritating the intestinal mucous membrane D. Relaxing the muscle tone of the ileocecal valve and anal sphincter ANS: B Rationale: Lactulose is a disaccharide that is not absorbed from the GI tract. It exerts laxative effects by pulling water into the intestinal lumen. It does not change muscle tone, change the viscosity of bowel contents, or irritate the intestinal epithelium.

PTS: 1 REF: p. 793, Table 39.5 OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 16. A middle-aged client who is frustrated by increasingly frequent episodes of constipation is highly reluctant to take medications. What nonpharmacologic measure should the nurse recommend?

A. Adoption of a low-fat diet B. Use of a fiber supplement C. Daily consumption of 6 to 8 L of fluids D. Use of a ginger or ginseng supplement ANS: B

Rationale: There is some evidence that fiber supplements improve the frequency and consistency of stools. No effectiveness data support increasing fluids beyond normal intake. Low fat intake, ginger, and ginseng are not noted to benefit clients with constipation.

PTS: 1 REF: p. 784, Lifestyle Changes OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A postoperative surgical client prescribed twice-daily administration of docusate sodium is concerned about developing diarrhea. What should the nurse teach the client about docusate sodium?

A. “This medication will only soften your stools over the next couple of days.”

B. “You’ll usually have a bowel movement within 2 to 3 hours of taking this.”

C. “This medication will cause your bowels to contract more strongly than they normally do.”

D. “This drug will help you pass regular stools while you’re in the hospital, but you should not take it for more than 5 days.”

ANS: A Rationale: Surfactant laxatives (e.g., docusate calcium or docusate sodium) decrease the surface tension of the fecal mass to allow water to penetrate into the stool. They also act as a detergent to facilitate admixing of fat and water in the stool. As a result, stools are softer and easier to expel. These agents have little, if any, laxative effect. Their main value is to prevent straining while expelling stool. They usually act within 1 to 3 days and should be taken daily.

PTS: 1 REF: p. 789, Surfactant Laxatives OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A community health nurse is conducting a health promotion session with a group from a local seniors’ center. The nurse has addressed the issue of laxative overuse in this population. The nurse should highlight what consequence of the overuse of laxatives?

A. Dependence B. Impaired absorption of water-soluble vitamins C. Fecal incontinence D. Abdominal pain ANS: A Rationale: Overuse of laxatives results in dependence. This is a significant problem among older adults and is more common than fecal incontinence, impaired vitamin absorption, or abdominal pain.

PTS: 1 REF: p. 788, Box 39.1 NAT: Client Needs: Health Promotion and Maintenance

OBJ: 6

TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. An adult resident of an assisted living facility has not responded appreciably to bulk-forming laxatives, so the health care provider has prescribed bisacodyl. The nurse who oversees the care at the facility should know that this drug may be administered by what route? Select all that apply.

A. Oral B. Intravenous C. Subcutaneous injection D. Suppository E. Intramuscular injection ANS: A, D Rationale: Bisacodyl can be administered orally or by suppository. Parenteral administration is not possible.

PTS: 1 REF: p. 789, Cathartics OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 20. An older adult has regularly drunk mineral oil to treat occasional episodes of constipation. The nurse should encourage the client to explore other treatments because the use of oral mineral oil can result in which adverse effect?

A. Edema from changes in intestinal solute content B. Paralytic ileus C. Rebound constipation D. Decreased absorption of drugs and vitamins ANS: D Rationale: Oral use of mineral oil may cause potentially serious adverse effects, including decreased absorption of fat-soluble vitamins and some drugs and lipid pneumonia if aspirated into the lungs. Thus, mineral oil is not an oral laxative of choice in any condition. It is not noted to cause rebound constipation, paralytic ileus, or edema.

PTS: 1 REF: p. 788, Lubricant Laxative OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 39: Drug Therapy for Constipation and Elimination Problems KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 40, Drug Therapy for Diarrhea 1. Which organism is most likely to cause gastroenteritis and vomiting among the students and staff at a local school?

A. Norwalk-like virus (calicivirus) B. Clostridium difficile C. Vibrio vulnificus D. E. coli ANS: A Rationale: An outbreak of gastroenteritis that affects both staff and students is most predominately caused by the Norwalk-like virus (calicivirus). Clostridium difficile is a nosocomial diarrhea that would not be characteristic of this population. Vibrio vulnificus is contamination of raw shellfish and would not be the cause of gastroenteritis. E. coli is more likely to occur in children rather than adults.

PTS: 1 REF: p. 799, Etiology OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. The nurse is assessing an older adult client who reports diarrhea. What should the nurse explore as the most likely cause?

A. Fluid volume deficit B. Antihypertensive agents C. Laxative abuse D. Anemia ANS: C Rationale: Laxative abuse is associated with diarrhea. This phenomenon is particularly common among older adults. Antihypertensive agents and anemia are not associated with diarrhea. Fluid volume deficit is a result, not cause, of diarrhea.

PTS: 1 REF: p. 801, Use in Older Adults OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. The nurse is preparing to administer bismuth subsalicylate to a client. What assessment is most important to make before administration?

A. Pain B. Electrolytes C. Allergy to aspirin D. Allergy to opioids ANS: C

Rationale: Bismuth salts have antibacterial and antiviral activity. Bismuth subsalicylate contains salicylate, and the client should be assessed for an aspirin allergy before administration. It is important to assess for pain and electrolyte balance but is not the primary assessment to be made. The nurse would not need to assess for allergy to opioids because bismuth does not contain opioids.

PTS: 1 REF: p. 804, Bismuth Salts OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. The nurse is preparing to administer polycarbophil to a client experiencing liquid stools.

How should the nurse describe the action of this substance?

A. It absorbs large amounts of water and decreases fluidity of stools.

B. It will correct enzyme deficiencies.

C. It will provide pain relief and decrease cramping and bloating.

D. It will diminish bacterial flora in the intestines.

ANS: A Rationale: Polycarbophil is a bulk-forming laxative that works by absorbing water and toxins, thereby reducing the fluidity of stools. It may cause abdominal discomfort and bloating. Polycarbophil has no effect on bacterial flora in the intestines. Pancreatin or pancrelipase are used to treat diarrhea caused by enzyme deficiency.

PTS: 1 REF: p. 805, Polycarbophil OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A client diagnosed with Crohn’s disease is experiencing diarrhea during an exacerbation of symptoms. What medication will the nurse most likely administer?

A. Bismuth salts B. Ciprofloxacin C. Cholestyramine D. Octreotide acetate ANS: C Rationale: Bile-binding drugs, such as cholestyramine or colestipol, are useful in treating diarrheas due to bile salt accumulation in conditions such as Crohn’s disease. Neither bismuth salts nor octreotide are typically administered to the client with Crohn’s disease.

Ciprofloxacin is an antibiotic.

PTS: 1 REF: p. 805, Bile-Binding Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

6. The nurse is caring for a female client diagnosed with chronic severe diarrhea-predominant irritable bowel syndrome that has not responded to conventional therapy. Which medication should the nurse anticipate being prescribed?

A. Rifaximin B. Nitazoxanide C. Alosetron D. Cholestyramine ANS: C Rationale: Alosetron is a selective 5-HT3 receptor antagonist indicated for treating women with chronic severe-predominate irritable bowel syndrome that has not responded to conventional therapy. Rifaximin is a nonsystemic antibiotic that would not be prescribed for this client. Nitazoxanide is an antiprotozoal agent used for Giardia lamblia. Cholestyramine is a bile-binding drug and not the drug of choice for this client.

PTS: 1 REF: p. 805, Selective 5-HT3 Receptor Antagonist OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. A client who has been treated successfully for diarrhea has had only one loose bowel movement during the day. Which food should be introduced back into the diet first?

A. Chicken breast B. Beef stew C. Baked potato D. Lentils ANS: C Rationale: Following diarrhea, bland foods should be introduced back into the diet, such as baked potato. The client should not resume a diet with chicken, beef stew, or lentils until later since they are much more difficult to digest and eliminate.

PTS: 1 REF: p. 800, Nonpharmacologic Therapy OBJ: 5 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. The nurse is reviewing the history of a client who has been prescribed diphenoxylate.

The nurse is aware that documentation of what disorder in the history requires that the drug be administered cautiously?

A. Edema B. Hepatorenal disease C. Congestive heart failure D. Cardiovascular insufficiency ANS: B

Rationale: Diphenoxylate should be used with extreme caution in clients with severe hepatorenal disease because hepatic coma may be precipitated. Edema, congestive heart failure, and cardiovascular insufficiency are not conditions in which cautious administration with diphenoxylate is needed.

PTS: 1 REF: p. 801, Use in Patients With Renal and/or Hepatic Impairment OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. A client diagnosed with HIV/AIDS has diarrhea that is not responding to antidiarrheal agents. Which medication will best assist in treating this client’s diarrhea?

A. Bismuth salts B. Ciprofloxacin C. Cholestyramine D. Octreotide acetate ANS: D Rationale: Octreotide acetate is a synthetic form of somatostatin that is effective in diarrhea related to HIV/AIDS. Bismuth salts are not used for diarrhea that does not respond to other agents. Ciprofloxacin is an antibiotic and so would not be used to treat diarrhea. Cholestyramine is useful in treating diarrhea due to bile salt accumulation in conditions such as Crohn’s disease or surgical excision of the ileum.

PTS: 1 REF: p. 805, Octreotide OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A 20-month-old child is experiencing diarrhea. When planning the child’s care, the nurse should prioritize assessments related to what health problem?

A. Electrolyte deficiencies B. Anorectal bleeding C. Anal fissures D. Nausea ANS: A Rationale: Acute diarrhea, if severe or prolonged, may lead to serious fluid and electrolyte depletion, especially in young children and older adults. Nausea would contribute to electrolyte deficiencies. Neither anorectal bleeding nor anal fissures are generally associated with diarrhea.

PTS: 1 REF: p. 799, Clinical Manifestations OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Choice

11. An adult client has presented to the emergency department (ED) after 36 hours of severe diarrhea that shows no sign of abating. The ED nurse should be aware that the use of diphenoxylate would be contraindicated in which circumstance?

A. The client has a documented history of laxative abuse.

B. The client’s diarrhea is caused by the ingestion of toxins.

C. The client’s diarrhea is attributable to psychosocial stress.

D. The client has an allergy to aspirin.

ANS: B Rationale: Contraindications to the use of diphenoxylate with atropine include diarrhea caused by toxic materials, microorganisms that penetrate intestinal mucosa (e.g., pathogenic E. coli, Salmonella, Shigella), and antibiotic-associated colitis. Laxative abuse, allergies to aspirin, and the presence of stress do not contraindicate the safe use of diphenoxylate.

PTS: 1 REF: p. 802, Contraindications OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 12. A client has contacted the clinic, stating to the nurse, “I have been taking loperamide for the past day-and-a-half, and my diarrhea shows no signs of slowing down.” The nurse should respond to the client in the knowledge that loperamide should be discontinued if the diarrhea does not improve within what time frame?

A. 12 hours B. 2 days C. 3 to 4 days D. 1 week ANS: A Rationale: In general, it is necessary to discontinue loperamide after 48 hours if clinical improvement has not occurred. The client has already been taking the medication over a 36-hour span of time, so the client should use the drug for no more than 12 additional hours.

PTS: 1 REF: p. 802, Other Drugs in the Class OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 13. An older adult client has received a third dose of diphenoxylate. In addition to monitoring the number and consistency of the client’s stools, the nurse should prioritize what assessment?

A. Neurologic status B. Oxygen saturation C. Nutritional status

D. Fluid and electrolyte balance ANS: D Rationale: After drug administration, the nurse monitors the number and consistency of stools and fluid and electrolyte balance. The client’s fluid and electrolyte balance are more vulnerable during prolonged diarrhea than is neurologic, nutritional, or respiratory status.

PTS: 1 REF: p. 801, Opiate-Related Antidiarrheal Agents OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. A client’s severe diarrhea has necessitated treatment with polycarbophil. The nurse should caution the client about the possibility of what adverse effect?

A. Nausea and vomiting B. Headache and visual disturbances C. Abdominal fullness and bloating D. Gastroesophageal reflux ANS: C Rationale: Polycarbophil may cause abdominal discomfort and bloating and may reduce the absorption of coadministered medications. It is not noted to cause nausea and vomiting, gastroesophageal reflux, or headache and visual disturbances.

PTS: 1 REF: p. 805, Polycarbophil OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 15. When reviewing a client’s medication history, the nurse notes that the client has recently completed a course of treatment with nitazoxanide. The nurse is justified in suspecting that the client was infected with what microorganism?

A. Giardia lamblia B. E. coli C. Salmonella D. Campylobacter jejuni ANS: A Rationale: Nitazoxanide is an antiprotozoal agent used specifically for treating diarrhea resulting from infection with Giardia lamblia or Cryptosporidium parvum. It is not used in the treatment of diarrhea associated with E. coli, Salmonella, or Campylobacter jejuni.

PTS: 1 REF: p. 805, Antibacterial Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Choice

16. Cholestyramine and colestipol are useful in treating diarrhea due to which cause?

A. Gram-positive bacterial infection B. Bile salt accumulation C. Retroviruses D. Autoimmune processes ANS: B Rationale: Cholestyramine and colestipol are useful in treating diarrhea due to bile salt accumulation in conditions such as Crohn’s disease or surgical excision of the ileum.

They would not be used for treatment of diarrhea cause by bacterial infection, retrovirus, or autoimmune processes.

PTS: 1 REF: p. 805, Bile-Binding Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 17. A nurse is caring for a client who has been diagnosed with diarrhea. The prescriber has ordered a clear liquid diet for the first 24 hours of admission. What liquids can the nurse offer to the client during this period? Select all that apply.

A. Milk B. Gelatin C. Tea D. Broth E. Orange juice with pulp F. Decaffeinated cola ANS: B, C, D, F Rationale: A clear liquid diet is often prescribed for the first 24 hours of a hospitalization. Acceptable liquids include flat ginger ale, decaffeinated cola drinks or tea, broth, gelatin, and water. Milk and orange juice with pulp are not clear liquids.

PTS: 1 REF: p. 800, Nonpharmacologic Therapy OBJ: 5 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Select 18. The nurse is providing education to a client who has been prescribed diphenoxylate with atropine for diarrhea. What statement should the nurse include in teaching?

A. “Once diarrhea slows down, stop using the drug.”

B. “Continue this medication until you have a solid stool.”

C. “After 3 days, stop the medication.”

D. “Call the health care provider and give an update within 7 days.”

ANS: A

Rationale: Diphenoxylate with atropine is an opiate-related antidiarrheal agency used to treat moderate to severe diarrhea. The client should be instructed to discontinue use when the diarrhea frequency decreases. Extended use (e.g., waiting until solid stool is achieved) can cause constipation. The nurse should not specify a number of days for use; this may be different for each client. The client does not need to update the health care provider unless the medication fails to decrease diarrhea frequency.

PTS: 1 REF: p. 802, Patient Teaching OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 40: Drug Therapy for Diarrhea KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 41, Drug Therapy for Diabetes Mellitus 1. A client diagnosed with type 2 diabetes is prescribed pramlintide. How will this drug assist in controlling the client’s blood sugar?

A. It slows gastric emptying.

B. It blocks the absorption of food.

C. It absorbs with the insulin.

D. It increases the release of insulin.

ANS: A Rationale: Pramlintide slows gastric emptying, helping to regulate the postprandial rise in blood sugar. Pramlintide does not block the absorption of food. Pramlintide is not absorbed with insulin nor does it increase the release of insulin.

PTS: 1 REF: p. 840, Amylin Analogs OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. The nurse is providing education to the parents of a child who has been newly diagnosed with type 1 diabetes. What distinguishing characteristic of the disorder does the nurse include in the teaching?

A. Blood glucose levels can be controlled by diet.

B. Exogenous insulin is required for life.

C. Oral agents can control blood sugar.

D. The disease always starts in childhood.

ANS: B Rationale: Type 1 diabetes will result in eventual destruction of beta cells, and no insulin is produced. The blood glucose level can only be controlled by diet in type 2 diabetes. In type 2 diabetes, oral agents can be administered. Type 1 diabetes is diagnosed in ages 4 through 20 years, not only in childhood.

PTS: 1 REF: p. 813, Type 1 Diabetes OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. The nurse is preparing to administer insulin intravenously to a client with a blood glucose level over 600 mg/dL (33.33 mmol/L). What type of insulin will the nurse most likely give?

A. NPH insulin B. Lente insulin C. Ultralente insulin D. Regular insulin ANS: D

Rationale: Regular insulin has rapid onset of action and can be given via IV. It is the drug of choice for acute situations, such as diabetic ketoacidosis. Isophane insulin (NPH) is used for long-term insulin therapy. Lente insulin is an intermediate-acting insulin.

Ultralente insulin is a long-acting insulin.

PTS: 1 REF: p. 822, Choice of Insulin OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. During a teaching session on the care of the client with diabetes, the nurse should make which statement to explain the differences in insulin?

A. “Insulin is prescribed based on the insurer’s criteria for reimbursement.”

B. “Insulin is prescribed based on the client’s age.”

C. “Insulins have different onsets and durations of action.”

D. “Insulin type is matched with the appropriate oral hypoglycemic agent.”

ANS: C Rationale: When insulin therapy is indicated, the health care provider may choose from several preparations that vary in composition, onset, duration of action, and other characteristics. Insulin is not prescribed based solely on cost. Insulin is not prescribed based solely on the client’s age. Insulin is not usually matched with oral hypoglycemic agents.

PTS: 1 REF: p. 822, Choice of Insulin OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 5. The parent of a child with diabetes asks the nurse why a quick-acting sugar given by mouth is better in the regulation of insulin than the use of intravenous glucose for a low blood sugar. Which statement by the nurse represents the most appropriate response to the question?

A. “The ingestion of food allows the digestive tract to stimulate vagal activity and the release of incretins.”

B. “The combination of insulin and food will yield a higher blood sugar than intravenous glucose.”

C. “Both food and intravenous glucose will produce similar changes in the gastrointestinal tract to increase blood sugar.”

D. “You are mistaken. The intravenous glucose yields a higher blood glucose through the release of incretins.”

ANS: A

Rationale: Oral glucose is more effective than intravenous glucose because glucose or food in the digestive tract stimulates vagal activity and induces the release of gastrointestinal hormones called incretins. The combination of insulin and food does not yield a higher blood glucose than intravenous insulin. Food stimulates the vagal nerve activity, but intravenous glucose does not. A statement that indicates that the client is mistaken will belittle the client and should be rephrased.

PTS: 1 REF: p. 815, Regulation of Insulin Secretion OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 6. The nurse is caring for a client who has been prescribed glyburide. Which factor, if identified in the client history, would cause the nurse to inform the health care provider of a contraindication to use?

A. A diagnosis of hypertension B. The ingestion of carbohydrates C. Allergy to sulfonamides D. Increase in alkaline phosphatase ANS: C Rationale: Glyburide is a sulfonylurea used in the treatment of type 2 diabetes.

Sulfonylureas are contraindicated in clients with hypersensitivity to them, with severe renal or hepatic impairment, and who are pregnant. A diagnosis of hypertension does not cause contraindication of sulfonylureas. The client should consume carbohydrates in association with the oral hypoglycemic agent. An increase in alkaline phosphatase does not result in the contraindication of glyburide.

PTS: 1 REF: p. 829, Sulfonylureas OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client has been prescribed acarbose. What is the advantage of acarbose over alternative drugs?

A. It can replace the use of insulin.

B. The client does not have to limit food intake.

C. It delays the digestion of complex carbohydrates.

D. It prevents alkalosis.

ANS: C Rationale: Acarbose delays the digestion of complex carbohydrates into glucose and other simple sugars. Acarbose may be combined with insulin or an oral agent, usually a sulfonylurea. The client will still need to remain on a diabetic dietary regimen. The drug does not directly prevent acid–base imbalances.

PTS:

1

REF: p. 834, Alpha-Glucosidase Inhibitors

OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 8. A client who regularly takes metformin has developed a severe infection. How will the infection change the established diabetic regimen?

A. Metformin is contraindicated in the presence of an infection.

B. Metformin will be given more frequently to decrease blood sugar.

C. Metformin will result in better regulation of blood sugar.

D. Metformin will allow the client to decrease the absorption of glucose.

ANS: A Rationale: Metformin is contraindicated in clients with diabetes complicated by fever, severe infections, severe trauma, major surgery, acidosis, and pregnancy. Metformin will not be given more frequently to decrease blood sugar. Metformin should be discontinued and is not administered for better regulation of blood sugar. Metformin will not decrease the absorption of glucose in this client.

PTS: 1 REF: p. 832, Biguanide OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. An 8-month-old infant admitted with a new diagnosis of diabetes is to receive 1 unit of regular insulin. How will that 1 unit be administered?

A. Orally B. Intravenously C. With a TB syringe D. Dilution strength of U-10 ANS: D Rationale: An infant should receive the dosage in a dilution strength of U-10. It is not administered orally, intravenously, or with a TB syringe.

PTS: 1 REF: p. 817, Insulins OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. The nurse knows that the lunch trays are usually distributed at approximately 12:15. The nurse should plan to administer the client’s prescribed 4 units of regular insulin at what time?

A. 12:15 B. 12:10 C. 11:45 D. 11:15

ANS: C Rationale: It is very important that regular insulin be injected 30 to 45 minutes before meals so that the insulin will be available when blood sugar increases after the meal.

Keeping this in mind, the only correct option is 11:45.

PTS: 1 REF: p. 817, Types of Insulin OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. What is the expected action of sitagliptin on type 2 diabetes?

A. It blocks the S phase of the cell cycle.

B. It slows the rate of inactivation of the incretin hormones.

C. It inhibits insulin release.

D. It inhibits hydrogen, potassium, and ATPase.

ANS: B Rationale: Sitagliptin minimizes the rate of inactivation of the incretin hormones to increase hormone levels and prolong their activity. Sitagliptin does not block the S phase of the cell cycle. Sitagliptin indirectly increases insulin release, and it does inhibit hydrogen, potassium, and ATPase.

PTS: 1 REF: p. 839, Dipeptidyl Peptidase 4 Inhibitors OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 12. The nurse is providing education to a client who has been prescribed therapy with an antidiabetic medication. During teaching, the nurse will caution the client against heavy intake of which herb?

A. Garlic B. Anise C. Basil D. Oregano ANS: A Rationale: Garlic has been known to cause hypoglycemia when taken with antidiabetic medications. Anise, basil, and oregano are not noted to carry this risk.

PTS: 1 REF: p. 819, Herbs That Increase the Risk of Hypoglycemia When Used With Antidiabetic Drugs OBJ: 9 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

13. A client newly diagnosed with type 2 diabetes has attended educational sessions to provide insight into the diagnosis. Which of the client’s statements should prompt the nurse to provide further teaching?

A. “I don’t like getting this diagnosis, but I know that treatment now can prevent future health consequences.”

B. “I’m disappointed, but I take some solace in the fact that I won’t ever have to have insulin injections.”

C. “People always tried to encourage me to lose weight, and I suppose they might have been right.”

D. “From what I’ve learned, I know that the basic problem is that my pancreas can’t keep up with my insulin needs.”

ANS: B Rationale: Among people with type 2 diabetes, 20% to 30% require exogenous insulin at some point in their lives. Obesity is a major cause, and vigilant treatment can prevent future sequelae. The essence of type 2 diabetes is the pancreas’ inability to meet insulin needs.

PTS: 1 REF: p. 814, Type 2 Diabetes OBJ: 9 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. A client newly diagnosed with diabetes reports “constant, insatiable thirst.” When providing teaching to the client, how should the nurse explain the symptom?

A. “The excess glucose in your blood accumulates in your blood vessels and neurons, including the neurons that control thirst.”

B. “Excess glucose pulled more water through your kidneys and the increased urination caused thirst.”

C. “Increased thirst is your body’s attempt to dilute your blood because it contains too much glucose.”

D. “When your body cells are starved for useful glucose, they signal your body to increase food and fluid intake.”

ANS: B Rationale: When large amounts of glucose are present, water is pulled into the renal tubule. This results in a greatly increased urine output (polyuria). The excessive loss of fluid in urine leads to increased thirst (polydipsia). Glucose does not directly affect the thirst center.

PTS: 1 REF: p. 816, Clinical Manifestations OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

15. A hospital client diagnosed with type 1 diabetes is prescribed regular insulin on a sliding scale. Based on the client’s blood glucose reading, the nurse administered 8 units of insulin at 07:45. The nurse should consequently check the client’s blood glucose level at what time to monitor peak effectiveness of the medication?

A. 08:15 B. Between 08:45 and 09:45 C. Between 09:45 and 10:45 D. Between 11:15 and 11:45 ANS: C Rationale: Humulin R peaks between 2 and 3 hours after administration, so monitoring should occur between 09:45 and 10:45.

PTS: 1 REF: p. 817, Types of Insulin OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. The nurse is preparing to administer 20 units of NPH insulin to a client. Before administering the medication, the nurse should implement which intervention?

A. Massage the chosen injection site.

B. Assess the client’s understanding of diabetes.

C. Assess the client’s urine for the presence of glucose.

D. Have a colleague confirm the dosage.

ANS: D Rationale: Before administering insulin, client safety requires that two nurses always check the dosage. Assessing the client’s understanding of the disease may or may not be appropriate or necessary at this time. Injection sites are not massaged before administration. It is not necessary to assess urine for the presence of glucose.

PTS: 1 REF: p. 825, QSEN Alert: Safety OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. Which condition must be met in order for glyburide treatment to be effective?

A. The client must have functioning pancreatic beta cells.

B. The client must have hemoglobin A1C of 7%.

C. The client must not have hyperglycemia.

D. The client must be able to self-administer the medication.

ANS: A Rationale: Because glyburide stimulates pancreatic beta cells to produce more insulin, it is effective only when functioning pancreatic beta cells are present. The presence of normal blood glucose levels would render the medication unnecessary.

Self-administration is common but not absolutely necessary.

PTS: 1 REF: p. 829, Sulfonylureas OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. An older adult client has been prescribed metformin for the treatment of type 2 diabetes for several years. Which change in the client’s laboratory values may demonstrate a need to discontinue the medication?

A. A decrease in hemoglobin and hematocrit B. An increase in serum lactate C. A decrease in potassium accompanied by an increase in sodium D. An increase in white blood cells ANS: B Rationale: It is essential to discontinue metformin if renal impairment occurs or if serum lactate increases. The other listed changes in laboratory values do not necessarily indicate that metformin should be discontinued.

PTS: 1 REF: p. 832, Biguanide OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 19. A 4-year-old child with type 1 diabetes mellitus becomes angry and then lethargic. What should the nurse educate the parents regarding the behavioral changes?

A. The child is rebelling against the disease process.

B. The child may be experiencing a hypoglycemic response.

C. The child may be experiencing elevated levels of glucose.

D. The child may be experiencing a systemic infection.

ANS: B Rationale: In young children, hypoglycemia may be manifested by changes in behavior, including severe hunger, irritability, and lethargy. At age 4, the child is not in the developmental stage where rebellion is experienced regarding the disease process. The signs of hyperglycemia may be very similar with high levels of glucose, although other symptoms are more prominent such as excessive thirst and urination. If the child were experiencing a systemic infection, there would be fever and other signs of infection present.

PTS: 1 REF: p. 817, Insulins OBJ: 9 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 20. The nurse is educating a client regarding the use of pramlintide acetate for the treatment of diabetes mellitus type 1. What statement made by the client indicates that further education is required?

A. “Since I am on this new medication, I don’t have to take my insulin any longer.”

B. “This medication may make me feel full and possibly lose some weight.”

C. “I need to use this medication immediately before meals.”

D. “I may experience some nausea at first but it will go away with time.”

ANS: A Rationale: Pramlintide is a synthetic analog of amylin, a peptide hormone secreted with insulin by the beta cells of the pancreas, important in the regulation of glucose control during the postprandial period. The medication does not replace insulin, and the client should continue to take the prescribed dosage. It increases the sense of satiety, possibly reducing food intake and promoting weight loss. The medication should be taken immediately before mealtime in order to sustain the maximum benefit of the drug.

Nausea when first beginning the drug is a common side effect, but it abates with time.

PTS: 1 REF: p. 840, Amylin Analogs OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 21. A client eats a large meal of pasta. When does the nurse inform the client the insulin levels will rise?

A. The insulin levels will rise to a peak in a matter of minutes then decrease to baseline in 2 to 3 hours.

B. The insulin levels will remain the same as long as the client doesn’t eat any bread with the meal.

C. The insulin levels will peak in 1 hour and then return to baseline within 30 minutes.

D. The insulin levels will peak within 2 hours and then decrease to baseline in 4 hours.

ANS: A Rationale: After a meal, serum insulin levels increase and peak in a few minutes, then decrease to baseline levels in 2 to 3 hours.

PTS: 1 REF: p. 814, Endogenous Insulin OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 22. A client will be using an insulin pump to deliver a consistent amount of insulin to meet the client’s needs. Where should the nurse insert the pump for the maximum amount of absorption?

A. Abdomen B. Deltoid C. Thigh D. Hip ANS: A

Rationale: Studies indicate that insulin is absorbed fastest from the abdomen, followed by the deltoid, thigh, and hip.

PTS: 1 REF: p. 826, Selection of Subcutaneous Sites for Injections and Pumps OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 23. A client has not had anything to eat or drink within the past 12 hours and has a fasting blood glucose level of 125 mg/dL. What does the nurse interpret these findings to indicate?

A. The client has a normal blood glucose level.

B. The client has an impaired fasting blood glucose level.

C. The client has diabetes mellitus type 1.

D. The client probably had a carbohydrate-rich diet the day before.

ANS: B Rationale: The client has fasting blood glucose level between 100 and 125 mg/dL, which indicates impaired fasting glucose (IFG), or prediabetes. The glucose level under 100 mg/dL would be a normal fasting blood glucose level. There is insufficient testing to indicate that the client has diabetes mellitus type 1 and further testing is required. A 12-hour fasting window would not correlate with the amount of carbohydrates the client ate the day before.

PTS: 1 REF: p. 813, Overview of Diabetes OBJ: 1 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 41: Drug Therapy for Diabetes Mellitus KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

Chapter 42, Drug Therapy for Hyperthyroidism and Hypothyroidism 1. A child is born with congenital hypothyroidism. What element was lacking in the mother’s diet during pregnancy?

A. Potassium B. Iodine C. Sodium D. Magnesium ANS: B Rationale: Cretinism is uncommon in the United States but may occur with a lack of iodine in the mother’s diet. A lack of potassium, sodium, and magnesium in the mother’s diet will not cause cretinism.

PTS: 1 REF: p. 852, Hypothyroidism OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client is diagnosed with hyponatremia and hypoglycemia and is currently experiencing lactic acidosis. What condition is most consistent with this clinical presentation?

A. Myxedema coma B. Psychotic depression C. Cretinism D. Congenital hypothyroidism ANS: A Rationale: Myxedema coma is severe, life-threatening hypothyroidism characterized by coma, hypothermia, cardiovascular collapse, hypoventilation, and severe metabolic disorders, such as hyponatremia, hypoglycemia, and lactic acidosis. The described symptomology is not consistent with the other disorders. The terms cretinism and congenital hypothyroidism describe the same disorder.

PTS: 1 REF: p. 852, Hypothyroidism OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. The nurse is providing education to a client who has been newly prescribed propylthiouracil. What information should the nurse provide about the drug’s primary mode of action?

A. Destroys part of the thyroid gland B. Inhibits production of thyroid hormone C. Suppresses the anterior pituitary hormones D. Stimulates the thyroid cells ANS: B

Rationale: The thioamide drugs inhibit synthesis of thyroid hormone. Propylthiouracil does not destroy part of the thyroid gland. Propylthiouracil does not suppress the anterior pituitary hormones. Propylthiouracil does not stimulate the thyroid cells.

PTS: 1 REF: p. 854, Propylthiouracil and Related Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client diagnosed with hypothyroidism is started on levothyroxine. What should the client be taught regarding medication administration in the home setting?

A. Take medication with milk or food.

B. Do not exercise while taking the medication.

C. Take the medication on an empty stomach.

D. Levothyroxine has a short half-life.

ANS: C Rationale: Levothyroxine should be taken on an empty stomach to increase absorption.

The medication should not be taken with food. The implementation of exercise has no effect on the administration of the medication. Levothyroxine has a long half-life of about 6 to 7 days.

PTS: 1 REF: p. 860, Administering the Medication OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A client diagnosed with myxedema currently takes ibuprofen for knee pain. For what is this client at increased risk?

A. Nephrotoxicity B. Pulmonary congestion C. Tachycardia D. Apnea ANS: A Rationale: A client diagnosed with myxedema cannot metabolize and excrete drugs and so is at increased risk of developing nephrotoxicity. Pulmonary congestion, tachycardia, and apnea are not adverse effects related to myxedema or the administration of ibuprofen.

PTS: 1 REF: p. 852, Hypothyroidism OBJ: 5 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

6. A client has been scheduled for a thyroidectomy to treat thyroid cancer. What medication would the nurse expect to be administered preoperatively?

A. Sodium iodide131 B. Methimazole C. Propylthiouracil D. Propranolol ANS: C Rationale: Propylthiouracil is administered preoperatively for thyroidectomy. Sodium iodide131 is a radioactive iodide that is used to destroy thyroid tissue. Methimazole is similar to propylthiouracil but is not the drug of choice preoperatively. Propranolol is used to treat cardiovascular conditions, such as hypertension. It is not used in the preoperative phase of thyroidectomy.

PTS: 1 REF: p. 854, Propylthiouracil and Related Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. What expectorant is sometimes prescribed for the treatment of hyperthyroidism?

A. Propylthiouracil B. Methimazole C. Saturated solution of potassium iodide D. Sodium iodide131I ANS: C Rationale: Saturated solution of potassium iodide is more often used as an expectorant but may be given as a preparation for thyroidectomy. Propylthiouracil, methimazole, and sodium iodide131I are not administered as an expectorant.

PTS: 1 REF: p. 854, Propylthiouracil and Related Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 8. A client diagnosed with hyperthyroidism is scheduled to receive a medication to destroy the thyroid gland. Which medication will be administered?

A. Propylthiouracil B. Methimazole C. Saturated solution of potassium iodide D. Sodium iodide131I ANS: D

Rationale: Sodium iodide131I is a radioactive isotope of iodine. Therapeutic doses act by emitting beta and gamma rays, which destroy thyroid tissue and thereby decrease the production of thyroid hormones. Propylthiouracil, methimazole, and saturated solution of potassium iodide are not administered to destroy thyroid tissue.

PTS: 1 REF: p. 854, Propylthiouracil and Related Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. The nurse is caring for a client who has been receiving propranolol for the treatment of hyperthyroidism. The nurse is aware that what client condition will warrant the tapering or possible discontinuation of the medication?

A. Hyperthyroidism B. Hypertension C. Angina pectoris D. Euthyroid state ANS: D Rationale: When the client becomes euthyroid (normal thyroid functioning) and hyperthyroid symptoms are controlled by definitive treatment measures, propranolol should be tapered and discontinued. Hyperthyroidism, hypertension, and angina pectoris all warrant the administration of propranolol.

PTS: 1 REF: p. 857, Adjuvant Medication Used To Treat Hyperthyroidism OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 10. A client is started on levothyroxine for the treatment of hypothyroidism. During client teaching, the nurse indicates that the dosage may be increased how often until symptoms are relieved?

A. Every 3 to 5 days B. Weekly C. Every 2 weeks D. Monthly ANS: C Rationale: As a general rule, initial dosage is relatively small. Dosage is gradually increased at approximately 2-week intervals until symptoms are relieved. The dosage is not increased in 3 to 5 days, in 1 week, or monthly..

PTS: 1 REF: p. 858, Thyroid Drugs OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A client being treated for hypothyroidism has developed symptoms of adrenal insufficiency. What medication will be added to the client’s medication regimen?

A. Anti-infective agent B. Corticosteroid agent C. Nonsteroidal anti-inflammatory agent D. Antiadrenergic agent ANS: B Rationale: When hypothyroidism and adrenal insufficiency (Addison’s disease) coexist, the adrenal insufficiency should be treated with a corticosteroid drug before starting thyroid replacement. Anti-infective agents, nonsteroidal anti-inflammatory agents, or antiadrenergic agents are not administered for adrenal insufficiency.

PTS: 1 REF: p. 858, Thyroid Drugs OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 12. A newborn is diagnosed with hypothyroidism. What will the client likely develop if the condition is left untreated?

A. Intellectual disability B. Renal dysfunction C. An immune disorder D. Paralytic ileus ANS: A Rationale: If cretinism is untreated until the child is several months old, permanent intellectual disability is likely to result. The client will not suffer from renal dysfunction, an immune disorder, or paralytic ileus.

PTS: 1 REF: p. 852, Hypothyroidism OBJ: 3 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 13. A client diagnosed with hypothyroidism is currently taking an opioid for knee pain. This client is at increased risk for developing which adverse reaction?

A. Myxedema coma B. Pulmonary congestion C. Tachycardia D. Hyperventilation ANS: A

Rationale: People with hypothyroidism are especially likely to experience respiratory depression and myxedema coma with opioid analgesics and other sedating drugs.

Pulmonary congestion, tachycardia, and hyperventilation are not adverse effects related to hypothyroidism or the administration of opioids.

PTS: 1 REF: p. 863, Key Concepts OBJ: 6 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 14. A client diagnosed with hypothyroidism admits knowing the term “thyroid gland” but not knowing its function. The nurse should explain the fact that thyroid hormone is responsible for which action?

A. Regulating the levels of most other hormones in the body B. Stimulating the brain and sex organs C. Controlling the rate of cell metabolism throughout the body D. Regulating levels of glucose in the blood and body tissues ANS: C Rationale: Thyroid hormones control the rate of cellular metabolism and thus influence the functioning of virtually every cell in the body. The heart, skeletal muscle, liver, and kidneys are especially responsive to the stimulating effects of thyroid hormones. The brain, spleen, and gonads are less responsive. Thyroid hormone does not primarily influence glucose levels or the function of the endocrine system.

PTS: 1 REF: p. 851, Physiology OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 15. A client was successfully treated for thyroid storm earlier in the year. In subsequent health education, the nurse should caution the client against excessive intake of what foods?

A. Seafood and kelp B. Leafy green vegetables and beef C. Purine-rich foods D. Red wine and aged cheeses ANS: A Rationale: Iodine is associated with thyroid storm and is present in foods (especially seafood and kelp) and in radiographic contrast dyes. Reports of iodine-induced hyperthyroidism have been reported after ingestion of dietary sources of iodine. There is no reason to avoid the other food options, which are potentially rich in iron, purine, or tyramine.

PTS: 1 REF: p. 851, Hyperthyroidism OBJ: 2 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. Laboratory testing reveals that a client is in a severely hyperthyroid state, and propylthiouracil has been prescribed. When providing health education related to this drug, the nurse should stress what information to the client?

A. “You’ll need to take these pills every 8 hours.”

B. “I’m going to show you how to perform your daily injection.”

C. “At first, you’ll come to the outclient clinic for your IV infusion once per day.”

D. “It’s best to inject propylthiouracil into your abdomen rather than your arm.”

ANS: A Rationale: Propylthiouracil is well absorbed with oral administration. Because the half-life in the thyroid is relatively short, propylthiouracil must be given every 8 hours.

PTS: 1 REF: p. 854, Propylthiouracil and Related Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 17. The nurse is providing client education prior to administering propylthiouracil. During teaching, the nurse should inform the client about the need for what form of follow-up?

A. Serial complete blood counts B. Routine liver function testing C. Daily nonfasting blood glucose testing D. Chest radiographs every 3 months ANS: B Rationale: The FDA has issued a black box warning for propylthiouracil stating that severe liver injury resulting in death or acute liver failure may occur within 6 months of treatment. All clients should receive instructions about the signs and symptoms of acute liver failure. Routine liver function testing to assess for liver failure is important. There is no specific need for chest radiographs, CBCs, or glucose monitoring.

PTS: 1 REF: p. 854, Propylthiouracil and Related Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. The nurse is preparing to administer a scheduled dose of levothyroxine to a client. What assessment should the nurse perform prior to giving the drug?

A. Level of consciousness and orientation B. Oxygen saturation level C. Heart rate D. Respiratory rate

ANS: C Rationale: Regular monitoring of blood pressure and pulse is essential in older adults receiving levothyroxine. As a general rule, levothyroxine should not be given if the resting heart rate is more than 100 beats/min. This medication does not impact any of the other functions so assessment is not necessary.

PTS: 1 REF: p. 858, Thyroid Drugs OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. The nurse is assessing a client who has been receiving therapy with levothyroxine. What findings would suggest to the nurse that the client may be experiencing an adverse effect?

A. Constipation and abdominal distention B. Hyperactivity and insomnia C. Bradycardia and hypotension D. Joint pain and decreased mobility ANS: B Rationale: Adverse effects of levothyroxine include signs and symptoms of hyperthyroidism. Other more serious adverse effects are tachycardia, cardiac dysrhythmias, angina pectoris, myocardial infarction, and heart failure. Nervousness, hyperactivity, insomnia, diarrhea, abdominal cramps, nausea, vomiting, weight loss, fever, and an intolerance to heat have also been reported. Bradycardia and constipation are associated with hypothyroidism.

PTS: 1 REF: p. 858, Thyroid Drugs OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. An older adult client has been using levothyroxine for several years on an outclient basis. Which client statement should alert the nurse to a potential decrease in the effect of levothyroxine?

A. “I’ve been using a lot of antacids lately because of my indigestion.”

B. “My daughter and I have started the Atkins diet to try to lose some weight.”

C. “Overall, I’d say that I’m under a lot of stress lately.”

D. “I’ve stopped taking aspirin for my arthritis and started using acetaminophen.”

ANS: A Rationale: Antacids may decrease the effect of levothyroxine. Acetaminophen, stress, and high protein intake do not have this effect.

PTS: 1 REF: p. 45, Drugs That Decrease the Effects of Levothyroxine OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 42: Drug Therapy for Hyperthyroidism and Hypothyroidism

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

Chapter 43, Drug Therapy for Pituitary and Hypothalamic Dysfunction 1. A client has been newly diagnosed with Addison’s disease. Which hormone would the nurse expect to be administered to this client?

A. Adrenal corticosteroid B. Insulin C. Epinephrine D. Norepinephrine ANS: A Rationale: Adrenal corticosteroid is administered to a client diagnosed with Addison’s disease. Insulin, epinephrine, and norepinephrine are not administered for Addison’s disease.

PTS: 1 REF: p. 873, Other Anterior Pituitary Hormone Drugs OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. What hormone will be released in response to shivering as the reaction to cold?

A. Thyroid-stimulating hormone B. Luteinizing hormone C. Corticotropin D. Somatostatin ANS: A Rationale: Thyroid-stimulating hormone is released in response to stress, such as exposure to cold. Luteinizing hormone is released in response to gonadotropin-releasing hormone. Corticotropin stimulates the adrenal cortex to produce corticosteroids.

Somatostatin inhibits the release of growth hormone.

PTS: 1 REF: p. 868, Hypothalamic Hormones OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. A client has a suspected diagnosis of Cushing’s disease. What hormone does the nurse expect to be involved in confirming the diagnosis?

A. Growth hormone B. Adrenocorticotropic hormone C. Thyroid-stimulating hormone D. Corticotropin-releasing hormone ANS: D

Rationale: Corticotropin-releasing hormone can be used in the diagnosis of Cushing’s disease. Growth hormone is released in response to low blood levels of growth hormone.

Corticotropin-releasing hormone causes the release of corticotropin (adrenocorticotropic hormone) in response to stress. Thyroid-stimulating hormone regulates the secretion of thyroid hormones.

PTS: 1 REF: p. 868, Hypothalamic Hormones OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. Which hormone is responsible for increases in the size and number of muscle cells?

A. Growth hormone B. Adrenocorticotropic hormone C. Thyroid-stimulating hormone D. Corticotropin-releasing hormone ANS: A Rationale: Growth hormone stimulates the growth of body tissues, including growth of muscle cells. Corticotropin-releasing hormone causes the release of corticotropin (adrenocorticotropic hormone) in response to stress. Thyroid-stimulating hormone regulates the secretion of thyroid hormones.

PTS: 1 REF: p. 866, Anterior Pituitary Hormones OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. An adult client is diagnosed with an increased low-density lipoprotein cholesterol level.

What hormone level may be low based on this diagnosis?

A. Adrenocorticotropic hormone (ACTH) B. Oxytocin C. Growth hormone D. Somatostatin ANS: C Rationale: In adults, deficient growth hormone can cause increased fat, reduced skeletal and heart muscle mass, reduced strength, reduced ability to exercise, and worsened cholesterol levels (increased low-density lipoprotein cholesterol). Adrenocorticotropic hormone, oxytocin, and somatostatin do not affect low-density lipoprotein.

PTS: 1 REF: p. 866, Anterior Pituitary Hormones OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

6. When teaching young women about the hormones of reproduction, the nurse explains how the follicle matures and ruptures in ovulation. Which hormone is needed for this change?

A. Luteinizing hormone (LH) B. Thyroid-stimulating hormone (TSH) C. Follicle-stimulating hormone (FSH) D. Leydig cells ANS: A Rationale: LH is important in the maturation and rupture of the ovarian follicle. TSH regulates the secretion of thyroid hormones. FSH stimulates the functions of sex glands.

Leydig cells are stimulated by LH in men to secrete androgens.

PTS: 1 REF: p. 866, Anterior Pituitary Hormones OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. A nurse in the emergency department is caring for a client who experienced significant blood loss following an automobile accident. The nurse is aware that which hormone was released in response to the injury?

A. Luteinizing hormone B. Antidiuretic hormone C. Oxytocin D. Melanocyte-stimulating hormone ANS: B Rationale: Antidiuretic hormone is also called vasopressin and is released in response to blood loss. Luteinizing hormone is important in ovulation. Oxytocin functions in birth and lactation. Melanocyte-stimulating hormone plays a role in skin pigmentation.

PTS: 1 REF: p. 868, Posterior Pituitary Hormones OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 8. A client has a suspected diagnosis of Addison’s disease. What hormone would the nurse expect to be involved in confirming the diagnosis?

A. Corticotropin B. Somatotropin C. Octreotide D. Leuprolide ANS: A

Rationale: Corticotropin is used as a diagnostic test to differentiate primary adrenal insufficiency (Addison’s disease). Somatotropin is therapeutically equivalent to endogenous growth hormone. Octreotide is used for acromegaly. Leuprolide causes a decrease in testosterone and estrogen.

PTS: 1 REF: p. 873, Other Anterior Pituitary Hormone Drugs OBJ: 3 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. A female client is preparing to begin treatment for infertility. What hormone would the nurse expect to be included in treatment?

A. Thyrotropin alfa B. Pegvisomant C. Menotropins D. Somatotropin ANS: C Rationale: Menotropins is prescribed in combination with HCG to induce ovulation.

Thyrotropin alfa is a synthetic formulation of TSH used as a diagnostic adjunct for serum thyroglobulin. Pegvisomant is a growth hormone receptor antagonist used in the treatment of acromegaly in adults. Somatotropin is prescribed to children for impaired growth.

PTS: 1 REF: p. 873, Other Anterior Pituitary Hormone Drugs OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. A client who has been administered growth hormone reports a severe headache and flashes before the eyes. What assessment should the nurse make?

A. Equilibrium B. Level of anxiety C. Respiratory rate D. Blood pressure ANS: D Rationale: The administration of growth hormone can lead to hypertension. The client should be assessed for increased blood pressure. Equilibrium is important to assess, but blood pressure is the primary assessment. Growth hormone can cause anxiety but is not an objective assessment in this case. The respiratory rate is not the most important objective assessment in this case.

PTS: 1 REF: p. 866, Anterior Pituitary Hormones OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation

TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 11. A client has been newly diagnosed with acromegaly. Which medication would the nurse expect the health care provider to prescribe?

A. Goserelin B. Octreotide C. Nafarelin D. Histrelin acetate ANS: B Rationale: Health care providers prescribe octreotide for clients with acromegaly to reduce levels of growth hormone (GH). Goserelin, histrelin, and nafarelin are equivalent to gonadotropin-releasing hormone (GnRH); they are used in the treatment of central precocious puberty.

PTS: 1 REF: p. 871, Use OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 12. The nurse is assessing a child who has been receiving therapy with somatropin. What assessment should the nurse prioritize related to the drug?

A. Deep tendon reflexes B. Level of anxiety C. Respiratory rate D. Blood glucose ANS: D Rationale: Somatropin is therapeutically equivalent to endogenous GH produced by the anterior pituitary gland that decreases insulin sensitivity, resulting in hyperglycemia.

Clients most at risk for increased insulin sensitivity are those with obesity, Turner’s syndrome, or a family history of diabetes mellitus. Growth hormone can cause anxiety but is not a priority assessment in this case. Deep tendon reflexes and respiratory rate are not generally affected by this medication.

PTS: 1 REF: p. 870, Anterior Pituitary Hormone Drugs for Growth Deficiency in Children OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. An adult client has been diagnosed with a posterior pituitary lesion that has resulted in diabetes insipidus. What is the characteristic sign of this health problem?

A. Blood glucose levels 400 mg/dL (22.20 mmol/L) B. Copious urine production

C. Hyperglycemia that is unresponsive to exogenous insulin D. Hematuria ANS: B Rationale: Characteristic features of DM include polyuria, with excretion of dilute urine ranging from 4 L to as much as 30 L. Hematuria does not normally occur, and blood glucose levels are not directly affected.

PTS: 1 REF: p. 869, Diabetes Insipidus OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 14. A client begins exhibiting signs and symptoms of diabetes insipidus. What intervention should the nurse implement?

A. Falls precautions B. Keeping the environment warm C. Providing readily available oral fluids D. Promotion of high-sodium food intake ANS: A Rationale: The resulting dehydration produces dizziness, placing the client at high risk for injury related to falls. Characteristic features include polyuria, with excretion of dilute urine ranging from 4 to as much as 30 L; extreme polydipsia, with the consumption of copious amounts of water or other fluids; and hypernatremia, with increased serum osmolality. This knowledge eliminates any of the remaining options as appropriate nursing interventions.

PTS: 1 REF: p. 869, Diabetes Insipidus OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. The nurse is providing education to the parents of a child who has been prescribed somatropin. What teaching point should the nurse prioritize?

A. The correct technique for daily injections of the drug B. The importance of regular blood pressure monitoring C. The rationale for not crushing the extended-release tablet D. The need to limit the child’s activity level for the duration of treatment ANS: A Rationale: Somatropin is administered by daily injections not orally. Blood pressure monitoring and activity limitations are not necessary.

PTS: 1 REF: p. 870, Anterior Pituitary Hormone Drugs for Growth Deficiency in Children OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A 7.5-year-old female has received a diagnosis of precocious puberty from the pediatric endocrinologist. The nurse should prepare to educate the child and the parents on what drug?

A. Menotropins B. Thyrotropin alfa C. Cosyntropin D. Leuprolide acetate ANS: D Rationale: Leuprolide is useful for the treatment of central precocious puberty in children. Menotropins stimulates ovulation. Cosyntropin stimulates the adrenal cortex to synthesize and secrete adrenocortical hormones. Thyrotropin alfa stimulates the secretion of thyroglobulin.

PTS: 1 REF: p. 876, Drugs for Central Precocious Puberty OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A 13-year-old boy who is in the first percentile of height for his age has been referred for care. Which assessment finding would contraindicate the safe and effective use of somatropin to treat his growth deficiency?

A. The boy has not yet begun puberty.

B. The boy has low serum albumin levels.

C. The epiphyses of the boy’s long bones have closed.

D. The sutures of the boy’s skull have not yet fully closed.

ANS: C Rationale: Somatropin is ineffective when impaired growth is present after puberty, noted when the epiphyses of the long bones have closed. The medication is prescribed before puberty begins. Low albumin is not a contraindication to the use of somatropin.

The sutures of the skull close early in life.

PTS: 1 REF: p. 870, Anterior Pituitary Hormone Drugs for Growth Deficiency in Children OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 18. A client’s current drug regimen includes intranasal administration of desmopressin acetate. In this client’s plan of nursing care, what is the most likely desired outcome of treatment?

A. The client’s urine output will not exceed 80 mL/h.

B. The client will gain 2 cm in height over the next 6 months.

C. The client will ovulate at least once over the next 8 weeks.

D. The client’s vertical growth will cease in the next 4 weeks.

ANS: A Rationale: Desmopressin acetate is the prototype posterior pituitary hormone medication.

It is used to treat diabetes insipidus. Consequently, reduced urine output is the primary goal of treatment. The drug does not influence growth (height) or ovulation.

PTS: 1 REF: p. 874, Posterior Pituitary Hormone Drugs for Diabetes Insipidus OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 19. A nurse reviews the current medication administration record of a client who has recently been prescribed octreotide for possible drug-to-drug interactions. The nurse performs this important safety action in order to prevent drug interactions that could result in which adverse effect?

A. Increased growth B. Anaphylaxis C. Cardiac complications D. Respiratory arrest ANS: C Rationale: Numerous medications combine with octreotide to result in a prolonged QT interval with an increased risk of ventricular dysrhythmia and cardiac arrest. Increased growth, anaphylaxis, and respiratory arrest are not noted adverse effects or the result of drug interactions with octreotide.

PTS: 1 REF: p. 878, Drugs for Acromegaly OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. The ICU nurse is assessing a client who has been given desmopressin for the treatment of diabetes insipidus. What laboratory value should the nurse prioritize during assessment?

A. Hematocrit B. Platelets C. Sodium D. Calcium ANS: C

Rationale: The FDA has issued a black box warning stating that clients taking desmopressin can develop hyponatremia, leading to seizures. Consequently, assessment of sodium levels takes precedence over hematocrit, calcium, and platelet levels.

PTS: 1 REF: p. 874, Posterior Pituitary Hormone Drugs for Diabetes Insipidus OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 43: Drug Therapy for Pituitary and Hypothalamic Dysfunction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 44, Drug Therapy to Regulate Calcium and Bone Metabolism 1. An older adult client has been diagnosed with Paget’s disease. Which serum electrolyte is altered in this disease process?

A. Sodium B. Potassium C. Chloride D. Calcium ANS: D Rationale: Disorders of calcium and bone metabolism include hypocalcemia, hypercalcemia, osteoporosis, Paget’s disease, and bone breakdown associated with breast cancer and multiple myeloma. Sodium, potassium, and chloride alterations are not primarily associated with Paget’s disease.

PTS: 1 REF: p. 884, Introduction OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client has been diagnosed with hyperplasia of the parathyroid gland. The nurse expects the client to exhibit signs and symptoms most similar to what disorder?

A. Hypercalcemia B. Hypoparathyroidism C. Hyperthyroidism D. Hypocalcemia ANS: A Rationale: Hyperparathyroidism is most often caused by a tumor or hyperplasia of a parathyroid gland. Clinical manifestations (and treatment) of hyperparathyroidism are the same as those of hypercalcemia. Hypoparathyroidism, hyperthyroidism, and hypocalcemia would manifest differently.

PTS: 1 REF: p. 885, Etiology and Pathophysiology OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. When a client has an increased serum level of ionized calcium, which hormone will be released?

A. Insulin B. Estrogen C. Parathyroid hormone (PTH) D. Calcitonin ANS: D

Rationale: Calcitonin is a hormone from the thyroid gland whose secretion is controlled by the concentration of ionized calcium in the blood flowing through the thyroid gland.

When the serum level of ionized calcium is increased, secretion of calcitonin is increased. The serum level of calcium will not affect the release of insulin or estrogen.

PTH is a response to low calcium levels.

PTS: 1 REF: p. 885, Etiology and Pathophysiology OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A client has a decreased calcium level. Which vitamin will assist in raising the client’s calcium level?

A. Vitamin D B. Vitamin C C. Ferrous sulfate D. Vitamin B12 ANS: A Rationale: Vitamin D is a fat-soluble vitamin that plays an important role in calcium and bone metabolism. Vitamin C, ferrous sulfate, and vitamin B12 do not play a role in calcium and bone metabolism.

PTS: 1 REF: p. 885, Etiology and Pathophysiology OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. A client is diagnosed with a vitamin D deficit. What disorder results from this deficit?

A. Chondromalacia B. Chondritis C. Osteomalacia D. Osteopenia ANS: C Rationale: In adults, vitamin D deficiency causes osteomalacia, a condition characterized by decreased bone density and strength. Chondromalacia is characterized as a softening of the patella, and chondritis is an inflammation of the cartilage. Both typically results from overuse or injury. Osteopenia is a decrease in bone tissue resulting from age-related changes, low calcium intake, or illness.

PTS: 1 REF: p. 885, Etiology and Pathophysiology OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Understand

NOT: Multiple Choice

6. An older adult client has been diagnosed with osteoporosis. What statement would the nurse include when teaching the client about this diagnosis?

A. “Osteoporosis is usually a result of a bone injury.”

B. “Osteoporosis causes a risk for fracture.”

C. “Osteoporosis results from nonmodifiable risk factors.”

D. “Osteoporosis occurs only in women.”

ANS: B Rationale: Osteoporosis results when bone strength is impaired, leading to increased porousness and vulnerability to fracture. Osteoporosis is not a result of fracture.

Osteoporosis is partially preventable. Osteoporosis is not limited to the female gender.

PTS: 1 REF: p. 886, Clinical Manifestations OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client reports numbness and tingling around the mouth and has a positive Trousseau’s sign after a parathyroidectomy. Which medication will be administered?

A. Parenteral normal saline B. Parenteral potassium chloride C. Parenteral digoxin D. Parenteral calcium gluconate ANS: D Rationale: The client has acute hypocalcemia as evidenced by numbness and tingling around the mouth and a positive Trousseau’s sign. An intravenous calcium salt, such as calcium gluconate, is given for acute symptomatic hypocalcemia. Parenteral normal saline may be administered, but it will not increase the calcium level. The administration of potassium chloride parenterally must be diluted and will not affect the calcium level.

Parenteral digoxin will not be administered.

PTS: 1 REF: p. 888, Calcium Preparations OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A 60-year-old client with overall good health is to begin taking vitamin D3 supplements.

What dosage would the nurse recommend taking daily?

A. 200 international units B. 400 international units C. 600 international units D. 800 international units ANS: C

Rationale: The recommended dietary allowance, or RDA, for vitamin D3 is 600 international units for people 1 to 70 years of age.

PTS: 1 REF: p. 889, Table 44.2 OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. An older adult client has been prescribed oral corticosteroids to decrease the symptoms of chronic obstructive pulmonary disease. When providing teaching, the nurse should inform the client of the risk for developing what disorder?

A. Osteoporosis B. Osteoarthritis C. Oat cell carcinoma D. Paget’s disease ANS: A Rationale: Drugs used for hypercalcemia, such as corticosteroids, place the client at risk for developing osteoporosis due to the demineralization of the bone. The client is not at risk for developing osteoarthritis or oat cell carcinoma. Paget’s disease is an inflammatory condition and is not caused by corticosteroid use.

PTS: 1 REF: p. 888, Calcium Preparations OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 10. A client has been prescribed alendronate. Which instruction should the nurse give the client regarding administration?

A. Take the medication with whole milk.

B. Take the medication and lie down for 30 minutes.

C. Take the medication on an empty stomach.

D. Take the medication to increase bone resorption.

ANS: C Rationale: Alendronate must be taken on an empty stomach. Alendronate should not be taken with milk or food. The client should be sitting up or ambulatory for 30 minutes after taking the medication. The medication decreases bone resorption; it does not increase it.

PTS: 1 REF: p. 893, Bisphosphonates OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

11. A client’s morning blood work reveals a serum calcium level of 3.1 mg/dL (0.78 mmol/L) (normal 8.5–10.5 mg/dL or 2.05–2.55 mmol/L). The nurse should consequently assess this client for which function?

A. Muscle tone B. Level of consciousness C. Respiratory rhythm D. Respiratory rate ANS: A Rationale: Low calcium levels can result in tetany. Decreased LOC and altered respiratory function are not characteristic of hypocalcemia.

PTS: 1 REF: p. 888, Calcium Preparations OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A community health nurse is leading a health promotion workshop during a community health fair. A participant has asked the nurse for advice on the necessity of calcium supplements. The nurse should respond in the knowledge that which demographic group most frequently require calcium supplements? Select all that apply.

A. Elementary-aged children B. Young women C. Middle-aged men D. Middle-aged women E. Older women ANS: B, E Rationale: Experts believe that the diets of most people of all ages, but especially of young women and older adults, are deficient in calcium.

PTS: 1 REF: p. 888, Calcium Preparations OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 13. An older adult resident of a long-term care facility has been prescribed calcium citrate to address decreasing bone density. The nurse should review the resident’s medication administration record knowing that what medication may decrease the effects of calcium?

A. Hydrochlorothiazide B. Ibuprofen C. Prednisone D. Diltiazem ANS: C

Rationale: Corticosteroids reduce the effects of calcium by various mechanisms.

Thiazide diuretics have the opposite effect. NSAIDs, calcium channel blockers, and beta-blockers do not appreciably affect the pharmacokinetics of calcium supplements.

PTS: 1 REF: p. 896, Other Medications Used to Treat Bone Disorders and Hypercalcemia OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. A client’s low ionized calcium levels have necessitated an infusion of an IV calcium preparation. During the administration of this medication, the nurse should prioritize what assessment?

A. Oxygen saturation levels B. Cardiac monitoring C. Assessment of cognition D. Assessment for visual changes ANS: B Rationale: Calcium imbalances can result in alterations in heart rate and rhythm; cardiac monitoring is thus necessary. The client is less likely to experience alterations in respiratory function, cognition, or vision since they are not cardiac related.

PTS: 1 REF: p. 888, Calcium Preparations OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. A middle-aged client is proactive with personal health maintenance and reports taking 2400 international units of vitamin D daily, stating, “More is better when it comes to vitamins.” The nurse should provide health teaching to the client associated with a risk for which disorder?

A. Hypercalcemia B. Hyperphosphatemia C. Hypocalcemia D. Tetany ANS: A Rationale: It is important to take vitamin D supplements cautiously and not overuse them; excessive amounts can cause serious problems, including hypercalcemia. Tetany is associated with hypocalcemia. Hypophosphatemia typically accompanies hypercalcemia.

PTS: 1 REF: p. 888, Calcium Preparations OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

16. An older adult client has been diagnosed with osteoporosis and has begun taking alendronate. The nurse should be aware that this drug can increase bone density by which means?

A. Decreasing renal excretion of calcium B. Increasing the binding of vitamin D to calcium ions C. Suppressing the function of osteoclasts D. Enhancing the function of osteoblasts ANS: C Rationale: Alendronate suppresses osteoclast activity on newly formed resorption surfaces, which reduces bone turnover. This means that bone formation exceeds resorption at remodeling sites, leading to progressive gains in bone mass. Alendronate does not enhance osteoblast function or affect the renal excretion of calcium. It does not influence the chemical interaction between vitamin D and calcium.

PTS: 1 REF: p. 893, Bisphosphonates OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 17. An older adult client has experienced recent declines in bone density and has consequently been deemed a candidate for treatment with alendronate. During health education, what teaching point should the nurse emphasize?

A. “Your alendronate will be most effective if you couple it with an increase in your consumption of dairy products.”

B. “It’s important that you not lie down for half an hour after taking your alendronate.”

C. “Make sure to let your health care provider know promptly if you experience bone pain.”

D. “You’ll have less stomach upset if you take your alendronate with some bland food.”

ANS: B Rationale: The person must remain upright (with head elevated 90 degrees if in bed, sitting upright in a chair, or standing) for at least 30 minutes after administration of alendronate. It is always necessary to take the drug with a full glass of water, not juice or coffee, at least 30 minutes before breakfast and before taking other drugs. Bone pain is a possible adverse effect, but prevention of esophageal ulceration is a priority. Increased dairy consumption is not vital.

PTS: 1 REF: p. 893, Bisphosphonates OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 18. The nurse is providing education to a client who has been prescribed alendronate. The nurse should reinforce correct administration to reduce the risk for what disorder?

A. Esophageal bleeding B. Ischemic stroke C. Decreased joint range of motion D. Coronary artery disease (CAD) ANS: A Rationale: Clients who do not follow the dosing instructions for alendronate are at greater risk for esophagitis, dysphagia, and esophageal ulcers/erosions. There is no direct risk of CAD, stroke, or decreased joint range of motion.

PTS: 1 REF: p. 893, Bisphosphonates OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. A client has been admitted in acute hypercalcemia and has been determined to have a serum calcium level of 12.9 mg/dL (3.23 mmol/L). What is the emergency department nurse’s priority intervention?

A. Administration of IV calcitonin B. Administration of IV normal saline C. Oxygen supplementation D. Subcutaneous administration of exogenous parathyroid hormone (PTH) ANS: B Rationale: Acute hypercalcemia is a medical emergency, and rehydration is a priority; it is essential to administer an IV saline solution. Calcitonin is not administered by the IV route. PTH is not administered exogenously and would exacerbate hypercalcemia.

PTS: 1 REF: p. 897, Emergency Treatment of Hypercalcemia OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. An older adult client has been diagnosed with postmenopausal osteoporosis and has been prescribed calcitonin. The nurse should anticipate administration by what route?

A. Oral B. Topical C. Intranasal D. Intravenous ANS: C Rationale: Calcitonin can be administered by the intranasal route for the treatment of osteoporosis. It is not given orally, topically, or intravenously. Other routes include intermuscular and subcutaneous injections.

PTS: 1 REF: p. 896, Table 44.5. DRUGS AT A GLANCE: Drugs Used to Treat Other Bone

Disorders and Hypercalcemia OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 44: Drug Therapy to Regulate Calcium and Bone Metabolism KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 45, Drug Therapy for Adrenal Cortex Disorders 1. An adult client has been experiencing severe lethargy and fatigue over the past several days, as well as feeling “shaky.” Random blood glucose testing reveals a glucose level of 38 mg/dL (2.11 mmol/L), in spite of no significant change in the client’s diet. The health care team should suspect the possibility of what health problem?

A. Cushing’s disease B. Acute renal failure C. Adrenal insufficiency D. Chronic renal failure ANS: C Rationale: Any client with unexplained severe hypoglycemia requires assessment for adrenal insufficiency. Cushing’s disease and kidney disease do not result in hypoglycemia.

PTS: 1 REF: p. 902, Overview of Addison's Disease OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 2. A client who has been taking oral prednisone for the past several months abruptly ceased treatment several days ago on the advice of a family member. The client has now been admitted to the emergency department with signs and symptoms that are characteristic of addisonian crisis. When assessing this client, the nurse should prioritize what assessment?

A. Assessment of urine for ketones B. Assessment of serum potassium levels C. Assessment for adventitious lung sounds D. Assessment for venous thromboembolism ANS: B Rationale: In addisonian crisis, the loss of sodium leads to retention of potassium, resulting in symptoms of hyperkalemia. As a result, vigilant monitoring of serum potassium levels is more important than respiratory effects, urinalysis, or hypercoagulation.

PTS: 1 REF: p. 902, Overview of Addison's Disease OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

3. A 38-year-old client has been living with Addison’s disease for many years and has achieved adequate symptom control through lifestyle modifications and drug therapy.

However, the client has now been admitted to the hospital in addisonian crisis. Which of the nurse’s assessment question is most appropriate?

A. “Have you been under an unusual amount of stress lately?”

B. “How would you describe your diet over the last few days?”

C. “When was the last time that you drank any alcohol?”

D. “Has your urine output been typical for the past few days?”

ANS: A Rationale: Acute adrenal crisis, or addisonian crisis, is a life-threatening condition that occurs when Addison’s disease is the underlying problem and the client is exposed to minor illness or increased stress. Diet, alcohol use, and impaired urinary function are less likely contributors.

PTS: 1 REF: p. 902, Overview of Addison's Disease OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 4. An adult client underwent a short plasma corticotropin (ACTH) stimulation test this morning. What subsequent assessment finding would rule out a diagnosis of adrenal insufficiency?

A. Elevated cortisol levels B. Blood glucose 70 mg/dL (3.80 mmol/L) C. Static levels of serum cortisol D. Decreased serum sodium levels ANS: A Rationale: During the short plasma corticotropin (ACTH) stimulation test, the examiner administers corticotropin in the morning. A subnormal blood cortisol level in the morning and afternoon confirms the diagnosis. A higher cortisol level in the morning is a sign that a person does not have adrenal insufficiency. The test does not assess for glucose or sodium levels.

PTS: 1 REF: p. 902, Overview of Addison's Disease OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. A client with suspected adrenal insufficiency has been administered 1 mcg of cosyntropin as an IV bolus. Serum testing 20 minutes later reveals a markedly elevated level of cortisol. What conclusion should the nurse infer from this finding?

A. The client has normal adrenocortical function.

B. The client has primary adrenal insufficiency.

C. The client has Cushing’s disease.

D. The client has Addison’s disease.

ANS: A Rationale: Diagnosis of secondary adrenocortical insufficiency in its early stages requires the low-dose test. The low-dose test involves the administration of 1 mcg of cosyntropin as an IV bolus. In people with normal adrenocortical function, an increase in cortisol occurs in 20 minutes. The diagnosis of Cushing’s disease requires an overnight dexamethasone suppression test. Addison’s disease is a result of a primary adrenal insufficiency. Making the diagnosis of adrenocortical insufficiency involves laboratory work. This includes early morning serum cortisol and plasma ACTH levels.

PTS: 1 REF: p. 902, Overview of Addison's Disease OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 6. A 26-year-old’s gradual development of a “moon face,” coupled with protracted weight gain, has caused the nurse practitioner to suspect the possibility of Cushing’s disease.

When explaining this health problem to the client, how should the nurse describe it?

A. “Cushing’s disease happens when your pituitary gland doesn’t stimulate your other glands enough.”

B. “Cushing’s disease is a result of an overproduction of steroid hormones by your kidneys.”

C. “Cushing’s disease most often happens when people are taking corticosteroid medications and stop them abruptly.”

D. “Cushing’s disease often results from a growth on your kidney that causes inadequate production of steroids.”

ANS: B Rationale: The cause of Cushing’s disease is adrenocortical excess. Cessation of exogenous steroids can precipitate addisonian crisis. Dysfunction of pituitary gland is an atypical cause. Tumors may cause overproduction, not underproduction, of corticosteroids.

PTS: 1 REF: p. 903, Overview of Cushing's Disease OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client diagnosed with Cushing’s disease has an increased risk of injury associated with what related disease process?

A. Hemorrhage and impaired hemostasis B. Fractures and impaired wound healing C. Neurovascular complications and rhabdomyolysis D. Bruising and hematoma

ANS: B Rationale: Cushing’s disease results in low bone density and impaired wound healing. It does not typically cause impaired hemostasis or neurovascular problems.

PTS: 1 REF: p. 903, Overview of Cushing's Disease OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. The results of a client’s plasma corticotropin (ACTH) stimulation test have confirmed a diagnosis of Addison’s disease. The nurse has consequently provided health education about the necessity of hormone replacement therapy. The client has asked the nurse, “How long am I going to have to take these medications?” How should the nurse best respond?

A. “In order to manage this condition, you’ll need to take these for the rest of your life.”

B. “You’ll have to take these until you can pass the corticotropin stimulation test without them.”

C. “You’ll have to take these until your kidneys regain their normal level of function.”

D. “You’ll need to take these until your symptoms have been stable for at least 6 months.”

ANS: A Rationale: Lifetime hormone replacement is necessary in persons with Addison’s disease. This knowledge eliminates all the remaining options.

PTS: 1 REF: p. 904, Drugs Used to Treat Addison's Disease OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A child has received a diagnosis of Addison’s disease, and the nurse is providing health education to the child’s family about hormone replacement therapy. When planning this child’s care, the nurse should know that hormone replacement therapy constitutes a risk for what nursing diagnosis?

A. Latex allergic response B. Deficient fluid volume C. Delayed growth and development D. Impaired gas exchange ANS: C Rationale: Hydrocortisone may affect growth velocity. It is unlikely to affect allergic response or respiration. Fluid volume excess, not deficit, is a possibility.

PTS:

1

REF: p. 904, Adrenocorticoids/Mineralocorticoids

OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. Hydrocortisone has been prescribed to a client for the treatment of Addison’s disease.

What action should the nurse encourage the client to take regarding the self-administration of this medication?

A. It should be taken at least 30 minutes before or 2 hours after meals.

B. The best administration time is at bedtime.

C. It should be taken before 09:00 each morning.

D. It is best to take it with an antacid.

ANS: C Rationale: Administration of hydrocortisone should take place every morning before 09:00. This minimizes hypothalamic–pituitary–adrenal (HPA) axis suppression. People should take the oral preparation with food to decrease gastric irritation. Administer antacids between doses of hydrocortisone to prevent gastric irritation.

PTS: 1 REF: p. 904, Adrenocorticoids/Mineralocorticoids OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A client will soon begin long-term treatment with hydrocortisone after being diagnosed with Addison’s disease. In order to mitigate the potential adverse effect of this treatment regimen, the nurse should encourage the client to increase the intake of what nutrient?

A. Water B. Calcium C. Sodium D. Potassium ANS: B Rationale: Due to the potential for reduced bone density, clients should be encouraged to increase calcium intake if hydrocortisone is administered for a prolonged period.

Increased sodium, potassium, and water intake are not recommended.

PTS: 1 REF: p. 904, Adrenocorticoids/Mineralocorticoids OBJ: 5 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

12. In recent weeks, the client diagnosed with Addison’s disease has experienced profound stress resulting from the collapse of their small business and subsequent conflict with the business partner. How might the presence of these stressors affect the client’s long-term hydrocortisone medication regimen?

A. The client should take the scheduled hydrocortisone later in the day.

B. The ratio of mineralocorticoids to glucocorticoids should be adjusted.

C. The client’s hydrocortisone should be temporarily withheld.

D. The client’s hydrocortisone should be temporarily increased.

ANS: D Rationale: During times of increased stress, the dosage of the medication may need to be increased. There would be no need to change the ratio of mineralocorticoids to glucocorticoids or to take the medications later in the day.

PTS: 1 REF: p. 906, Box 45.2 OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A client diagnosed with Addison’s disease has had fludrocortisone acetate added to the medication regimen. What is the most plausible rationale for this change in treatment?

A. The client’s anterior pituitary gland is overstimulated.

B. The client requires increased mineralocorticoid supplementation.

C. The client’s adrenal cortex has become resistant to hydrocortisone.

D. The client’s blood sugar has become resistant.

ANS: B Rationale: If a client with Addison’s disease requires additional mineralocorticoid supplementation, then fludrocortisone acetate may be indicated. Pituitary dysfunction, GI intolerance, and resistant blood sugar are not plausible rationales.

PTS: 1 REF: p. 906, Mineralocorticoids OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. A client diagnosed with Cushing’s disease will soon begin treatment with ketoconazole.

The nurse should be aware of the black box warning for this drug and consequently monitor what laboratory values?

A. White blood cell differential B. Blood urea nitrogen and creatinine C. AST, ALT, and GGT D. Hemoglobin, hematocrit, and red blood cell count ANS: C Rationale: The FDA has issued a black box warning stating that ketoconazole can cause hepatotoxicity. As a result, monitoring of liver function with AST, ALT, and GGT testing may be a priority over assessment of white cells, red cells, and renal function.

PTS: 1 REF: p. 908, 11-Deoxycortisol Inhibitors OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. When assessing for therapeutic effects of mitotane in a client diagnosed with adrenocortical carcinoma, the nurse should expect to identify which outcome?

A. Decrease in agitation B. An audible S3 C. Decrease in blood pressure D. Decrease in urine output ANS: C Rationale: A decrease in blood pressure is an expected therapeutic effect of mitotane. An audible S3 is not expected. Mitotane does not address agitation or high urine output.

PTS: 1 REF: p. 910, Antineoplastics OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. The nurse prepares to administer hydrocortisone 250-mg IV bolus every 4 hours and fludrocortisone 0.1 mg PO daily for an adult client newly diagnosed with Addison’s disease. Which measures would the nurse provide for safe and effective drug administration? Select all that apply.

A. Dilute hydrocortisone to 50 mg/mL and administer a 5-mL IV bolus over 30 seconds.

B. Instruct the client to limit intake of foods rich in potassium.

C. Assess vital signs for improvements in cardiac function and NA+, K+, and BUN. D. Increase sodium intake in the diet to maintain normal blood pressure.

E. Monitor for adverse effects: hypertension, heart failure, hyperglycemia, and immunosuppression.

ANS: A, C, E Rationale: The nurse should dilute the hydrocortisone to 50 mg/mL and administer 5 mL for a total of 250-mg IV bolus over 30 seconds. If the dose is 500 mg or greater, then it is pushed over 10 minutes. The client needs to eat foods rich in potassium because the fludrocortisone decreases potassium, and the mineralocorticoid action of both drugs will help the client to retain sodium and water to help stabilize blood pressure. Assessing for therapeutic effects includes examining for normal vital signs, sodium, potassium, and BUN and improved cardiac function. Sodium intake needs to be reduced to 2 g/day for a heart healthy diet because the drugs enhance sodium retention. The nurse should monitor for adverse effects, including hypertension, and signs of heart failure, including weight gain, swelling of dependent areas, heart gallop, or crackles in lungs. The nurse should also, monitor for high glucose levels and signs of infection because of the risk of drugs lowering the white blood count leading to immunosuppression.

PTS: 1 REF: p. 904, Adrenocorticoids/Mineralocorticoids OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 17. The nurse is educating an adult client who has been diagnosed with Addison’s disease about the prescribed hydrocortisone PO and fludrocortisone PO. Which statement made by the client establishes the need for further clarification?

A. “I will take hydrocortisone at 09:00 every day and other doses will be spaced evenly.”

B. “I will go to my local clinic and receive my mumps, measles, rubella (MMR) vaccine.”

C. “The antacids will help decrease gastric irritation, and I will take them in between doses of hydrocortisone.”

D. “Additional vitamin B6, vitamin C, folate, zinc, and phosphorous supplements need to be taken daily.”

ANS: B Rationale: The nurse needs to clarify the statement that the client made regarding planning to receive a live virus vaccine, which is contraindicated since the client is receiving drugs that increase the risk for immunocompromise. Hydrocortisone first dose is at 09:00 to mimic the body’s natural rhythm for the hormone, and spacing the drug doses evenly provides the optimal hormone support. Antacids spaced in between the hormones will help decrease the risk for developing a gastric ulcer. Fludrocortisone interferes with various nutrients, so a supplement with vitamins B6, C, folate, zinc, and phosphorous is necessary daily. The client also needs to have a diet rich in calcium and vitamin D or take supplements to prevent osteoporosis, another long-term adverse effect of the drugs.

PTS: 1 REF: p. 904, Adrenocorticoids/Mineralocorticoids OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. The nurse prepares to administer ketoconazole 200 mg PO BID to an adult client diagnosed with Cushing’s disease. Which measure would the nurse provide for safe and effective drug administration?

A. Administer the medication with 240 mL of milk to increase absorption.

B. Report yellow sclera, clay-colored stools, and elevated liver enzymes to the prescriber.

C. Teach that the drug will increase serum cortisol.

D. Instruct that the drug will lower serum cortisol to normal within 10 hours.

ANS: B

Rationale: The nurse should administer the drug with water, fruit juice without calcium, coffee, or tea on an empty stomach so the acid will enhance absorption. Since the drug is absorbed rapidly, providing food shortly after administration will decrease GI upset. The drug can cause hepatotoxicity, so the nurse monitors for yellow sclera, clay-colored stools, and elevations in liver enzymes and reports them to the prescriber. Other adverse effects to report include skin irritation with pruritus and nausea and vomiting. Etomidate lowers cortisol levels to normal within 10 hours.

PTS: 1 REF: p. 908, 11-Deoxycortisol Inhibitors OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. The nurse is educating an adult client who has been diagnosed with adrenocortical carcinoma about the prescribed mitotane 6 g PO in divided doses. Which statement made by the client establishes the need for further clarification?

A. “I should not drive or operate machinery while taking the drug.”

B. “The drug will eradicate my tumor and cure my cancer.”

C. “If I have a trauma or go into shock, the drug is temporarily stopped.”

D. “I should not drink alcoholic beverages while taking the drug.”

ANS: B Rationale: The nurse needs to clarify the statement that the client made regarding the drug eliminating the tumor and curing the cancer. The drug is administered for inoperable tumors and does not cure the cancer. It helps to shrink the tumor and decrease the production of cortisol. The drug causes central nervous system (CNS) depression, so taking it with alcohol would increase its effects and could cause serious problems with lethargy, dizziness, and gait disturbances. The client should not drive or operate machinery because of CNS depression. If the client has a traumatic injury or goes into shock, the drug should be temporarily stopped so the client may receive steroid therapy.

PTS: 1 REF: p. 910, Antineoplastics OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 45: Drug Therapy for Adrenal Cortex Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 46, Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy 1. During ambulation after surgery, the skeletal muscle produces contraction. What receptor is located in motor nerves and skeletal muscle?

A. Acetylcholine B. Muscarinic C. Beta adrenergic D. Nicotinic ANS: D Rationale: Nicotinic receptors are located in motor and skeletal muscle. When they are activated by acetylcholine, the cell membrane depolarizes and produces muscle contraction. Acetylcholine is a neurotransmitter. Beta adrenergic is the receptor for the release of epinephrine and norepinephrine. Muscarinic are receptors located in most internal organs to address the affected cells with the release of acetylcholine.

PTS: 1 REF: p. 921, Parasympathetic Nervous System OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client has a decrease in calcium. Which receptor will be stimulated to increase the intracellular concentration of calcium?

A. Acetylcholine B. Muscarinic C. Beta adrenergic D. Nicotinic ANS: B Rationale: Muscarinic receptors are located in most internal organs to address the affected cells with the release of acetylcholine. Muscarinic1 receptors increase the intracellular concentration of calcium. Nicotinic receptors are located in motor and skeletal muscle. When they are activated by acetylcholine, the cell membrane depolarizes and produces muscle contraction. Acetylcholine is a neurotransmitter. Beta adrenergic is the receptor for the release of epinephrine and norepinephrine.

PTS: 1 REF: p. 922, Cholinergic Receptors OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. A client has a decreased heart rate. Which receptor will activate the potassium channels to increase the cardiac output and rate?

A. Acetylcholine B. Muscarinic1 C. Muscarinic2

D. Neuromuscular junctions ANS: C Rationale: Muscarinic2 receptors activate as a result of inhibition of adenyl cyclase in the heart. Receptor stimulation also results in activation of potassium channels in cell membranes of the heart. Muscarinic1 receptors are expressed primarily in the CNS, autonomic ganglia, and the gastric and salivary glands. Activation of these receptors results from a series of processes during which phospholipids in the cell membrane and inside the cell are broken down. Acetylcholine is a neurotransmitter. Neuromuscular junctions are sites for parasympathetic response.

PTS: 1 REF: p. 922, Cholinergic Receptors OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. Which ion is required for neurotransmitter release from storage sites in the small sacs known as synaptic vesicles?

A. Potassium B. Calcium C. Sodium D. Chloride ANS: B Rationale: The basis for the action potential is the transient opening of ion channels. The entry of calcium ions is required for neurotransmitter release from storage sites in small sacs, called synaptic vesicles. Potassium ions are principal cations in intracellular fluid.

Sodium ions are principal cations in extracellular fluid. Chloride is the major cellular ion.

PTS: 1 REF: p. 920, Adrenergic Receptors OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 5. A client has been diagnosed with Parkinson’s disease. The client’s spasticity is related to a decrease in what neurotransmitter?

A. Acetylcholine B. Dopamine C. Adrenocorticotropic hormone D. Serotonin ANS: B Rationale: A client with Parkinson’s disease develops symptoms of spasticity related to a decrease in dopamine. A client with Parkinson’s disease will have an increase in acetylcholine. Adrenocorticotropic hormone and serotonin will not be influenced in relation to the disease process.

PTS: 1 REF: p. 922, Cholinergic Receptors OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. Which system uses acetylcholine as a neurotransmitter?

A. Cholinergic B. Dopaminergic C. GABA-ergic D. Noradrenergic ANS: A Rationale: The cholinergic system uses acetylcholine as a neurotransmitter. The dopaminergic system uses dopamine as its neurotransmitter. The GABA-ergic system uses GABA as its neurotransmitter. The noradrenergic system uses norepinephrine as its neurotransmitter.

PTS: 1 REF: p. 917, Structure and Function of the Autonomic Nervous System OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. The nurse is caring for a client with premedication data as follows: blood pressure (BP) 88/40 mm Hg, heart rate (HR) 45, respiratory rate (RR) 12, glucose 70 mg/dL, cardiac output (CO) 3.8 L/min (normal range 4–6 L/min). The nurse would predict which assessment findings after administering a sympathomimetic to the client? Select all that apply.

A. HR 40 B. BP 100/60 C. CO 3.5 L/min D. Glucose 150 mg/dL (8.32 mmol/L) E. RR 20 ANS: B, D, E Rationale: A sympathomimetic medication has the same effects on the body as the sympathetic nervous system when activated. The “stress or emergency” or also called “fight-or-flight” response effects would include increased heart rate and blood pressure, increased cardiac output, hyperglycemia, or increased glucose, and increased respirations.

PTS: 1 REF: p. 919, Sympathetic Nervous System OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select

8. The nurse is preparing to administer an adrenergic medication to a client. What instructions will the nurse include in client teaching related to the drug’s actions on the body? Select all that apply.

A. Recommend that the client wear sunglasses.

B. Instruct the client to increase fluid intake.

C. Inform the client that the drug will increase the urge to urinate.

D. Remind the client to report bronchoconstriction immediately.

E. Monitor for abdominal cramping and diarrhea.

ANS: A, B Rationale: An adrenergic medication has the same effects on the body as the sympathetic nervous system when activated. The “fight-or-flight” response effects would include increased dilation of the pupil, which helps to see in the distance. There would be increased sweating, constriction of bladder smooth muscles, bronchodilation, and decreased gastrointestinal motility. Sunglasses protect dilated eyes. Fluid intake needs to be increased because of diaphoresis and fluid lost. The drug constricts smooth muscle of the bladder, decreasing the urge to urinate. The drug leads to bronchodilation, so suggesting that bronchoconstriction may result is not appropriate. The drug may lead to constipation rather than diarrhea, so recommending increased dietary fiber may be an appropriate intervention.

PTS: 1 REF: p. 919, Sympathetic Nervous System OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 9. The nurse has administered a parasympathomimetic medication to a client. What assessment findings would the nurse expect following administration? Select all that apply.

A. Pupils are constricted bilaterally.

B. Droplets of sweat appear on the forehead and body.

C. The client states, “I am able to empty my bladder more easily.”

D. Respirations before medication: 16 and after medication: 22.

E. Pulse before medication: 90 and after medication: 70.

ANS: A, C, E Rationale: A parasympathomimetic medication has the same effects on the body as the parasympathetic nervous system when activated. The “rest or digest” response effects would include increased constriction of pupils to enable near vision. There would be a decrease in sweating since the body is at rest. The medication would also cause contraction of the bladder smooth muscles resulting in urination. With the medication, heart rate and respiratory rate would decrease.

PTS: 1 REF: p. 921, Parasympathetic Nervous System OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and

Indications for the Use of Drug Therapy BLM: Cognitive Level: Apply

KEY: Integrated Process: Nursing Process NOT: Multiple Select

10. The nurse administers intravenous (IV) norepinephrine to the client diagnosed with shock. The nurse would predict which receptor subtypes to be activated resulting in a stimulatory response? Select all that apply.

A. Alpha1 B. Alpha2 C. Beta1 D. Beta2 E. Nicotinicm ANS: A, B, C Rationale: Norepinephrine, an adrenergic drug, acts mainly on alpha1 and alpha2 receptors, resulting in vasoconstriction of blood vessels and increasing blood pressure. It does have effects on beta1 receptors in the heart, resulting in an increase heart rate and blood flow to the heart, but not on beta2 receptors in the lungs. Nicotinicm receptors, which are cholinergic receptors located in skeletal muscles, would not be activated by an adrenergic agonist.

PTS: 1 REF: p. 919, Sympathetic Nervous System OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 11. The nurse administers intravenous (IV) dopamine to a client diagnosed with shock. The nurse would predict which receptor subtypes to be activated resulting in a stimulatory response? Select all that apply.

A. Alpha1 B. Alpha2 C. Beta1 D. Beta2 E. Dopaminergic receptors ANS: A, C, E Rationale: Dopamine acts like endogenous dopamine in the body and the effects depends upon the dosage. Dopamine activates alpha1 receptors resulting in vasoconstriction and increase of blood pressure and beta1 receptors increasing the heart rate, strength of heart muscle contraction, and cardiac output. Dopamine activates dopaminergic receptors, which results in vasodilation of blood vessels in the brain, kidneys, and viscera.

Dopamine does not activate alpha2 or beta2 receptor.

PTS: 1 REF: p. 919, Sympathetic Nervous System OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select

12. The nurse is scheduled to administer pancuronium, a neuromuscular-blocking medication, to a client receiving mechanical ventilation. The nurse would predict which receptor subtype(s) to be activated resulting in a stimulatory response?

A. All muscarinic receptors B. Specifically nicotinicn receptors C. Specifically nicotinicm receptors D. Both muscarinic and nicotinic receptors ANS: C Rationale: Pancuronium is selective in only stimulating the nicotinicm receptors of the autonomic nervous system, resulting in the paralysis of the skeletal muscles. This is beneficial in the ventilated client; complete relaxation of the muscles prevents interference with mechanical ventilation. The client can only safely receive the medication while being ventilated. The medication does not affect the other nicotinic or muscarinic receptors, so the client’s body may rest and digest.

PTS: 1 REF: p. 922, Cholinergic Receptors OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 13. The nurse administers an anticholinergic medication to a client. The nurse would predict which receptor subtypes to be blocked? Select all that apply.

A. Alpha B. Beta C. Dopaminergic D. Muscarinic E. Nicotinic ANS: D, E Rationale: Anticholinergic medication blocks the cholinergic receptor subtypes, including muscarinic and nicotinic, resulting in blocking the parasympathetic nervous system effects. An anticholinergic does not block the adrenergic neurotransmitters—alpha, beta, and dopaminergic—found in the sympathetic nervous system.

PTS: 1 REF: p. 919, Sympathetic Nervous System OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 14. The nurse administers epinephrine intravenously to a client diagnosed with heart block.

In what order would the nurse predict the steps of signal transduction and intracellular events that occur when the beta-adrenergic receptors are stimulated? Drag the statements into the proper order.

A. Epinephrine binds to the beta receptor and initiates intercellular activity.

B. Epinephrine–beta receptor complex activates G protein, which reacts with guanosine triphosphate.

C. Activated G protein activates the enzyme adenyl cyclase.

D. Increases in cyclic adenosine monophosphate (cAMP) occur.

E. Cyclic adenosine monophosphate (cAMP) initiates intracellular activities, including an increase in atrioventricular conduction.

ANS: A, B, C, D, E Rationale: First, epinephrine, the first messenger, binds to the beta receptor and initiates intercellular activity. Next, the epinephrine–beta receptor complex activates G protein, which reacts with guanosine triphosphate. Activated G protein then activates cAMP. Next, increases in cAMP occur. Last, cAMP, the second messenger, initiates intracellular activities, including an increase in atrioventricular (AV) conduction.

PTS: 1 REF: p. 919, Sympathetic Nervous System OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Drag and Drop 15. The nurse is caring for a client who for the past several days has been receiving norepinephrine intravenously for shock. The nurse recognizes the presence of which beta-adrenergic response(s) when the client suddenly fails to respond to the prescribed dose of medication? Select all that apply.

A. Hypersensitization B. Desensitization C. Up-regulation D. Down-regulation E. Antagonist ANS: B, D Rationale: Down-regulation is also called desensitization, which occurs when high doses of an adrenergic are taken over a long period of time, causing a reduction in the number of beta receptors and their ability to stimulate adenyl cyclase. The client received the norepinephrine for several days and needed an increased dose because of desensitization.

An antagonist is a medication that binds to a receptor and, as a result, inactivates the physiologic response normally associated with that receptor. Norepinephrine is an adrenergic agonist. Up-regulation is also called hypersensitization, which occurs with chronic exposure to a drug that blocks receptor function. This would cause an increase in the number of beta receptors and their ability to stimulate adenyl cyclase.

PTS: 1 REF: p. 920, Adrenergic Receptors OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select

16. The nurse educates a client diagnosed with asthma concerning the prescribed selective beta2-adrenergic agonist inhaler. Which client statement indicates the need for further clarification?

A. “The inhaler will cause my bronchi to dilate and make it easier for me to breathe.”

B. “Beta2 receptors are in the respiratory tract and the bronchi.”

C. “The medication will cause my heart rate to increase and will cause palpitations.”

D. “The medication will bind to beta2 receptors and activate the physiologic response.”

ANS: C Rationale: The nurse should emphasize that the medication is selective to beta2 receptors that affect bronchodilation. The medication does not significantly activate beta1 receptors leading to tachycardia or palpitations. The definition of agonist is that the medication will bind to the beta2 receptors and activate the physiologic response, and in this case, the sympathetic nervous system.

PTS: 1 REF: p. 920, Adrenergic Receptors OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice 17. Which outcomes should the nurse consider to be side effects of a selective cholinergic agonist based upon the characteristics of the prescribed medication? Select all that apply.

A. Increased drooling B. Heart rate 110 C. Abdominal cramping D. Pupil dilation E. Blood pressure 88/50 mm Hg ANS: A, C, E Rationale: The cholinergic medication acts as an agonist and selectively binds to the muscarinic receptors, altering the function of the receptors and eliciting the physiologic responses associated with them. The medication stimulates the activity of the parasympathetic nervous system, resulting in the side effects of sweating, increased salivation, abdominal cramping because of smooth muscle contractions in the gastric area, and low blood pressure or hypotension. Tachycardia and pupil dilation would occur when an adrenergic medication was administered, resulting in sympathetic nervous system stimulation.

PTS: 1 REF: p. 922, Cholinergic Receptors OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select

18. The nurse prepares to administer a selective alpha1-adrenergic antagonist medication to a client diagnosed with hypertension. What would the nurse consider to be side effects based upon the characteristics of the prescribed medication? Select all that apply.

A. Dry mouth B. Blood pressure (BP) lying 130/70 mm Hg, pulse 70; sitting BP 120/60, pulse 90; standing BP 100/50, pulse 110 C. Dizziness D. Reflex tachycardia E. Glucose 180 mg/dL ANS: B, C, D Rationale: The adrenergic medication acts as an antagonist and selectively binds to the alpha1 receptors but fails to elicit the physiologic responses for the receptors. The medication inhibits the activity of the sympathetic nervous system, resulting in symptoms of the “rest or digest” response. Among the side effects is orthostatic hypotension, which results from a sudden decrease in peripheral resistance and inhibition of vascular smooth muscle. (Orthostatic hypotension, or postural hypotension, is determined by a decrease in blood pressure of at least 20 mm Hg and an increase in the heart rate least 10 beats/min associated with changing position from lying to sitting and to standing.) Other side effects stemming from orthostatic hypotension include light-headedness or dizziness from a decreased blood flow to the brain. Reflex tachycardia is a result of the heart compensating for the orthostatic hypotension. Dry mouth and an increase in cardiac output and blood glucose would occur with an adrenergic agonist, which activates sympathetic nervous system responses.

PTS: 1 REF: p. 920, Adrenergic Receptors OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 19. The nurse prepares to administer a selective alpha-adrenergic agonist medication to a client diagnosed with shock. What would the nurse consider to be therapeutic or desired effects based upon the characteristics of the prescribed medication? Select all that apply.

A. Increased blood pressure B. Bronchodilation C. Increased cardiac output D. Tachycardia E. Glycogenolysis ANS: A, C Rationale: The adrenergic medication acts as an agonist and selectively binds to the alpha1 and alpha2 receptors and elicits the physiologic responses for the receptors. The medication stimulates the activity of the sympathetic nervous system via the alpha1 receptors in smooth muscle cells leading to vasoconstriction and gastrointestinal and bladder sphincter contraction. The drug stimulates alpha2 receptors in the brain leading to smooth muscle contraction. The therapeutic effects include increased blood pressure and cardiac output. The other effects of bronchodilation, tachycardia, and glycogenolysis result from beta stimulation, and the drug is a selective alpha receptor stimulant.

PTS: 1 REF: p. 920, Adrenergic Receptors OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 20. A client is experiencing stimulation of receptors in the parasympathetic nervous system.

What symptom does the nurse assess in this client?

A. Urinary retention B. Constipation C. Sweating D. Dry mouth ANS: C Rationale: Stimulation of receptors in the parasympathetic nervous system produces cholinergic effects. Blockade of receptors produces anticholinergic effects. Cholinergic effects include increased secretions from glands in the lungs, stomach, intestines, and skin, including the sweat glands. Constipation, dry mouth, and urinary retention are signs of anticholinergic effects.

PTS: 1 REF: p. 921, Parasympathetic Nervous System OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 46: Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

Chapter 47, Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents 1. A client has atony of the smooth muscle of the gastrointestinal tract. Which type of medication will be administered to increase smooth muscle strength?

A. Anticholinergic drugs B. Cholinergic drugs C. Muscle relaxants D. Selective serotonin reuptake inhibitors ANS: B Rationale: Cholinergic drugs are used to treat atony of the smooth muscle of the gastrointestinal tract and urinary systems. Anticholinergic agents and muscle relaxants will decrease muscle strength. Selective serotonin reuptake inhibitors have no effect on atony of the smooth muscle of the gastrointestinal tract.

PTS: 1 REF: p. 927, Overview of Myasthenia Gravis OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client is diagnosed with Alzheimer’s disease. The nurse should anticipate administering which medication?

A. Bethanechol B. Neostigmine C. Donepezil D. Physostigmine salicylate ANS: C Rationale: Donepezil is used to treat mild to moderate Alzheimer’s disease. Bethanechol produces smooth muscle contractions and is not used to treat Alzheimer’s disease.

Neostigmine is not used to treat Alzheimer’s disease; it is used to treat myasthenia gravis. Physostigmine is not used to treat Alzheimer’s disease; it is an antidote for overdose of anticholinergic drugs.

PTS: 1 REF: p. 933, Cholinesterase Inhibitors: Reversible Indirect-Acting Cholinergics OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. A client diagnosed with myasthenia gravis is administered a cholinergic drug named neostigmine. How does this drug produce its therapeutic effect?

A. It stimulates the sympathetic nervous system.

B. It stimulates the parasympathetic nervous system.

C. It stimulates the cardiac smooth muscle.

D. It stimulates the respiratory system.

ANS: B Rationale: As a cholinergic drug, neostigmine stimulates the parasympathetic nervous system. It does not stimulate the sympathetic nervous system, cardiac system, or respiratory system.

PTS: 1 REF: p. 928, Acetylcholinesterase Inhibitors (Indirect-Acting Cholinergics) OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A client is administered edrophonium to confirm the diagnosis of myasthenia gravis.

What effect will the edrophonium have 30 minutes after the medication administration, which will confirm the diagnosis?

A. Improved breathing B. Decreased fatigue C. Decreased muscle spasms D. Increased urinary output ANS: A Rationale: Edrophonium is used to diagnose myasthenia gravis. After administration, it will improve breathing in clients who have myasthenia gravis. Edrophonium will not decrease fatigue or muscle spasms nor will it increase urinary output.

PTS: 1 REF: p. 927, Overview of Myasthenia Gravis OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. A client diagnosed with myasthenia gravis is administered sustained-release pyridostigmine for the first time. The client asks the nurse the reason why the prescription has been changed from the immediate-release form. What is the nurse’s best response?

A. “The new form will allow you to awaken with the ability to swallow.”

B. “The new form can be taken every other day.”

C. “The new form is a faster-release form of cholinergic agent.”

D. “The new form is taken one time per day for better control.”

ANS: A

Rationale: The sustained-release form of pyridostigmine can be taken at bedtime, eliminating the need to take a dose during the night and allowing the client the ability to swallow in the morning. The extended-release form is usually taken two times per day, not every day or every other day. The immediate-release form is faster acting.

PTS: 1 REF: p. 928, Acetylcholinesterase Inhibitors (Indirect-Acting Cholinergics) OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 6. A nurse administers an anticholinesterase drug to a client. What assessment finding would the nurse interpret as evidence of a toxic effect of the medication?

A. Decreased level of consciousness (LOC) B. Abdominal distention C. Hypertension D. Muscle weakness ANS: D Rationale: The administration of anticholinesterase medications can result in profound muscle weakness. Decreased LOC, abdominal distention, and hypertension are not characteristic adverse effects of the anticholinesterase medications.

PTS: 1 REF: p. 928, Acetylcholinesterase Inhibitors (Indirect-Acting Cholinergics) OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 7. A client has been receiving bethanechol for 1 week. One hour after the dose is administered, the client develops sweating, flushing, abdominal cramps, and nausea. The nurse prepares to intervene for what condition?

A. Myasthenic crisis B. Cholinergic overdose C. Anaphylactic reaction D. Pulmonary edema ANS: B

Rationale: A client who suffers cholinergic overdose will experience sweating, flushing, abdominal cramps, and nausea. An accurate diagnosis may be determined from timing in relation to medication. Signs and symptoms having an onset within approximately 1 hour after a dose of anticholinesterase drug are likely to be caused by cholinergic crisis.

Signs and symptoms beginning 3 hours or more after a drug dose are more likely to be caused by myasthenic crisis. These symptoms are not generally associated with anaphylaxis or pulmonary edema since there is no respiratory dysfunction.

PTS: 1 REF: p. 937, Cholinergic Agonist OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 8. A client being treated for myasthenia gravis is receiving neostigmine. When the client’s pulse drops to 50 after the administration, which medication should be administered to treat the bradycardia?

A. Atropine B. Pseudoephedrine C. Propranolol D. Bethanechol ANS: A Rationale: Atropine will reverse the muscarinic effects of cholinergic crisis, including bradycardia. Neither pseudoephedrine nor propranolol will affect the bradycardia.

Bethanechol will likely increase the bradycardia.

PTS: 1 REF: p. 929, Toxicity of Neostigmine and Other Acetylcholinesterase Inhibitors OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A client arrives at the emergency department with a suspected diagnosis of mushroom poisoning. What drug does the nurse expect to be administered if the diagnosis is confirmed?

A. Pyridostigmine B. Donepezil C. Rivastigmine D. Atropine sulfate ANS: D Rationale: Atropine sulfate is the specific antidote for mushroom poisoning.

Pyridostigmine, donepezil, and rivastigmine are all cholinergic agents that would contribute to the symptoms of toxicity.

PTS: 1 REF: p. 929, Toxicity of Neostigmine and Other Acetylcholinesterase Inhibitors OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. After the nurse administers a cholinergic medication to the client, the nurse would provide which interventions because of the drug’s actions on the body? Select all that apply.

A. Auscultate lung sounds and report bronchoconstriction.

B. Monitor for hyperglycemia.

C. Instruct the client to report diarrhea.

D. Check for improved mental activity.

E. Compare muscle strength to baseline assess for improvement.

ANS: A, C, E Rationale: A cholinergic medication has the same effects on the body as the parasympathetic nervous system when activated. The “rest or digest” response effects would include an increase in gastrointestinal motility, so the nurse should instruct the client to report abdominal cramping and diarrhea. Cholinergic agent can improve muscle strength, so the nurse should compare the strength of affected muscles to the baseline (before treatment) level. The nurse should listen to the lungs and report bronchoconstriction, or narrowed airways, a side effect of the drug. The sympathetic nervous system when activated would increase the glucose level and the mental activity, which are not effects of a cholinergic drug.

PTS: 1 REF: p. 927, Overview of Myasthenia Gravis OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 11. An adult client with a recent history of visual disturbances and dysphagia has just been diagnosed with myasthenia gravis. The nurse should recognize that this client’s health problem is ultimately attributable to what pathophysiologic process?

A. Idiopathic overproduction of anticholinesterase B. Autoimmune destruction of acetylcholine receptors C. Demyelination of parasympathetic nerve pathways D. Deficient synthesis of dopamine by the substantia nigra ANS: B Rationale: Myasthenia gravis occurs when antibodies produced by the body’s own immune system block, alter, or destroy the receptors for acetylcholine at the neuromuscular junction, which prevents muscle contraction from occurring. The disease does not involve dopamine deficits, demyelination, or excess anticholinesterase.

PTS: 1 REF: p. 927, Overview of Myasthenia Gravis OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 12. A 40-year-old client diagnosed with myasthenia gravis (MG) is scheduled to begin treatment with oral neostigmine. When providing relevant health education, the nurse should emphasize that successful control of MG symptoms will primarily depend on what personal behavior?

A. Matching each dose of neostigmine to the severity of symptoms at that time B. Making lifestyle modifications to prioritize a healthy diet and regular activity C. Adhering strictly to the prescribed administration schedule D. Developing acceptance of the functional deficits that result from MG ANS: C Rationale: Strict adherence to timely medication administration promotes optimal blood levels of neostigmine and optimal symptom control. Doses are not typically matched to short-term symptom severity, except in emergencies. Lifestyle modifications and acceptance may be of benefit, but pharmacologic therapy is of paramount importance in the treatment of MG. PTS: 1 REF: p. 928, Acetylcholinesterase Inhibitors (Indirect-Acting Cholinergics) OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. An accidental overdose of neostigmine has prompted the emergency administration of atropine. When assessing the client, the emergency department nurse should take into account that this intervention will not relieve the effects of neostigmine on what type of tissue?

A. Skeletal B. Smooth C. Cardiac D. Glandular ANS: A Rationale: Atropine reverses only the muscarinic effects of cholinergic drugs, primarily in the heart, smooth muscle, and glands. Atropine does not interact with nicotinic receptors and therefore cannot reverse the nicotinic effects of skeletal muscle weakness due to overdose of indirect anticholinergic drugs.

PTS:

1

REF: p. 929, Specific Effects

OBJ: 2

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. An middle-aged client has been admitted to the outclient treatment unit of the hospital for an edrophonium test. Shortly after the administration of the medication, the client reports that the muscle strength is significantly weaker than before the test. The nurse who is participating in the test should recognize that this finding is listed of what diagnosis?

A. Alzheimer’s disease B. Anticholinergic crisis C. Myasthenia gravis D. Cholinergic crisis ANS: D Rationale: If the edrophonium test makes the client even weaker, the diagnosis is cholinergic crisis. Edrophonium does not produce the effects necessary to trigger any of the other suggestive diagnoses.

PTS: 1 REF: p. 927, Overview of Myasthenia Gravis OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 15. Following recent changes in memory and personality, a an older adult client is undergoing neurologic testing to rule out Alzheimer’s disease. The nurse is aware that this disease is characterized by what pathophysiologic phenomena? Select all that apply.

A. Meningiomas B. Neuritic plaques C. Neurofibrillary tangles D. Arteriovenous malformations (AVMs) E. Gliomas ANS: B, C Rationale: The neuropathologic hallmarks of Alzheimer’s disease are neuritic plaques and neurofibrillary tangles. Gliomas, meningiomas, and AVMs are not associated with Alzheimer’s disease.

PTS: 1 REF: p. 932, Overview of Alzheimer's Disease OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select

16. An older adult client has been diagnosed with early-stage Alzheimer’s disease and has begun treatment with donepezil. When providing health education to the client and the client’s spouse, the nurse should identify what goal of treatment?

A. Remission of Alzheimer’s disease B. Cure of Alzheimer’s disease C. Improvement of cognition and function D. Resolution of memory and cognitive deficits ANS: C Rationale: The goal of drug therapy for Alzheimer’s disease is to slow the loss of memory and cognition, thus preserving the independence of the individual person for as long as possible. Remission, cure, and resumption of pre-illness levels of memory and cognition are unrealistic goals.

PTS: 1 REF: p. 933, Cholinesterase Inhibitors: Reversible Indirect-Acting Cholinergics OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 17. The nurse is developing a care plan for a client who will receive donepezil in the home setting. How can the nurse best facilitate safe and effective administration of the medication?

A. Have the client explain the rationale for drug therapy repeatedly before discharge.

B. Provide a detailed drug monograph to the client and the client’s spouse and offer to answer any questions.

C. Assess the client’s need for home care.

D. Teach the client’s caregiver to administer the medication in a timely and safe manner.

ANS: D Rationale: It is important for the home care nurse to work with responsible family members/caregivers in such cases to ensure accurate drug administration. Assessing the family’s need for home care may be warranted, but this action does not necessarily ensure safe drug administration. The presence of moderate Alzheimer’s disease may preclude effective client teaching. Written teaching materials must normally be supplemented by other forms of teaching.

PTS: 1 REF: p. 933, Cholinesterase Inhibitors: Reversible Indirect-Acting Cholinergics OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

18. The nurse is providing education to the caregiver of a client who has been prescribed donepezil. What statement should the nurse include in the teaching?

A. “Donepezil should be taken 1 hour before or 2 hours after any dairy products.”

B. “It’s important to take this medication at bedtime.”

C. “Donepezil should be taken with food to reduce the chance of stomach upset.”

D. “If you don’t notice any cognitive improvement within 2 weeks, the drug should be discontinued.”

ANS: B Rationale: Donepezil should normally be taken at bedtime. It does not have to be taken with food. Dairy does not interfere with pharmacokinetics. The drug should be continued even if improvement is not noticeable.

PTS: 1 REF: p. 935, Box 47.4 OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 19. A client diagnosed with a neurogenic bladder secondary to a spinal tumor has been taking bethanechol. When the nurse finds the client anxious, diaphoretic, and visibly flushed, what action should the nurse take to best assure the client’s safety?

A. Prepare to administer an IV dose of epinephrine to mitigate the effects of acetylcholine.

B. Contact the health care provider as the client may be experiencing a cholinergic crisis.

C. Insert a Foley catheter as the client may have excessive urine in the bladder.

D. Assess the volume of the client’s bladder contents using a bladder ultrasound.

ANS: B Rationale: The presence of sweating and skin flushing in a client taking bethanechol is suggestive of a cholinergic crisis. This is a medical emergency that warrants prompt intervention by the health care team. This problem is not treated with epinephrine.

Assessing the client’s bladder or inserting a Foley catheter is not sufficient.

PTS: 1 REF: p. 937, Cholinergic Agonist OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. A military nurse is part of a team reviewing the appropriate response to chemical weapons attacks, including sarin, tabun, and soman. When reviewing the physiology of a response to such drugs, the nurse should identify what goal of treatment?

A. Restore anticholinesterase function.

B. Restore GABA function.

C. Restore dopamine function.

D. Restore appropriate serotonin reuptake.

ANS: A Rationale: These drugs are irreversible anticholinesterase agents. The goal of treatment, such as atropine administration, is to restore normal function of anticholinesterase and rid synapses of excessive acetylcholine. Treatment will not achieve any of the other stated goals.

PTS: 1 REF: p. 938, Irreversible Anticholinesterase Toxicity OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 47: Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Other Conditions Treated with Cholinergic Agents KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 48, Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy 1. Which symptom should the nurse monitor for when caring for a client whose sinus bradycardia has been treated with large doses of atropine?

A. Pallor B. Flushing C. Edema D. Incontinence ANS: B Rationale: Large doses cause facial flushing because of dilation of blood vessels in the neck. Pallor, edema, and incontinence are not caused by dilation of blood vessels in the neck.

PTS: 1 REF: p. 955, Overview of Anticholinergic Drugs OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A client scheduled for an exploratory laparoscopy has been prescribed an anticholinergic agent. Why is it important to administer the anticholinergic agent in the preoperative phase?

A. It will prevent tachycardia.

B. It will decrease respiratory secretions.

C. It will decrease gastric motility.

D. It relaxes the detrusor muscle.

ANS: B Rationale: Anticholinergics reduce intracellular GMP, a bronchoconstrictive substance.

When anticholinergic drugs are administered, they decrease respiratory secretions. The administration of an anticholinergic agent will not prevent tachycardia. Anticholinergic agents do decrease gastric motility, but this rationale is not a reason for administration in the preoperative phase. The anticholinergic agents cause relaxation of the detrusor muscle, but this rationale is not the reason for administration of the medication in the preoperative phase.

PTS: 1 REF: p. 955, Overview of Anticholinergic Drugs OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

3. What disease process would cause a nurse to question a client’s new prescription for benztropine?

A. Diabetes mellitus B. Myocardial infarction C. Narrow-angle glaucoma D. Hyperparathyroidism ANS: C Rationale: Narrow-angle glaucoma will result in increased intraocular pressure, and the client should not receive the anticholinergic agent. Clients who suffer from diabetes mellitus, myocardial infarction, or hyperparathyroidism can be prescribed anticholinergic agents.

PTS: 1 REF: p. 961, Centrally Acting Anticholinergics OBJ: 10 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. The health care provider has ordered scopolamine transdermally for motion sickness.

Which statement by the client, prescribed transdermal scopolamine, indicates an understanding of the medication’s administration guideline?

A. “I will place it on my chest each morning.”

B. “I will use it when I am sick to my stomach.”

C. “I will change the patch every 4 hours.”

D. “I will change the patch every 3 days.”

ANS: D Rationale: Scopolamine is used for motion sickness. The disk protects against motion sickness for 72 hours (3 days). The scopolamine patch is applied behind the ear, not to the chest. The patch is used prior to the client experiencing nausea. The patch is not changed every 4 hours.

PTS: 1 REF: p. 957, Belladonna Alkaloid and Derivatives OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. A client who has been diagnosed with Parkinson’s disease was prescribed levodopa. The client did not tolerate the administration of levodopa. Which medication will be administered in place of the levodopa?

A. Carbamazepine B. Guanadrel sulfate C. Benztropine D. Nafcillin sodium

ANS: C Rationale: Benztropine may be given to supplement other antiparkinsonism drugs.

Carbamazepine is administered for a seizure disorder, not for symptomatic treatment of Parkinson’s disease. Guanadrel sulfate is administered to lower blood pressure, not for Parkinson’s disease. Nafcillin sodium is an anti-infective agent that is not administered for Parkinson’s disease.

PTS: 1 REF: p. 961, Centrally Acting Anticholinergics OBJ: 10 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 6. A client with a creatinine level of 25 (1906.25 mol/L) has been diagnosed with chronic obstructive pulmonary disease. Being prescribed tiotropium bromide, the client is at risk for developing which adverse condition?

A. Drug toxicity B. Pneumonia C. Hepatotoxicity D. Central nervous system depression ANS: A Rationale: The client has an elevated creatinine level indicating a degree of renal failure.

Tiotropium bromide is eliminated by the renal system, and clients with moderate to severe renal dysfunction should be carefully monitored for drug toxicity.

PTS: 1 REF: p. 957, Belladonna Alkaloid and Derivatives OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 7. The client has recently developed extrapyramidal symptoms related to long-term administration of chlorpromazine. Which medication can be prescribed to assist in relieving these symptoms?

A. Diazepam B. Darifenacin C. Trihexyphenidyl D. Trospium chloride ANS: C Rationale: Trihexyphenidyl is used in the treatment of parkinsonism and extrapyramidal reactions caused by antipsychotic drugs. Diazepam is a benzodiazepine and is not used for this purpose. Darifenacin is used for the treatment of overactive bladder. Trospium chloride reduces the tone of the smooth muscle in the bladder.

PTS: 1 REF: p. 961, Centrally Acting Anticholinergics OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 8. A client is admitted to the emergency department with bradycardia, diarrhea, and hypotension after hiking with friends. The friends stated that they were hunting for mushrooms. Based on this information, what assessment should the nurse make?

A. Assess for an insect bite and rash.

B. Assess for a head injury and increased ICP. C. Assess for a black widow spider bite.

D. Assess for muscarinic agonist poisoning.

ANS: D Rationale: Muscarinic agonist poisoning related to the ingestion of poisoned mushrooms will result in the development of salivation, lacrimation, visual disturbances, bronchospasm, diarrhea, bradycardia, and hypotension. The client does not have the symptoms associated with an insect bite or rash. The client does not present with the symptoms of a head injury or increased intracranial pressure. The client does not have the symptoms of a black widow spider bite.

PTS: 1 REF: p. 957, Belladonna Alkaloid and Derivatives OBJ: 8 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A 60-year-old client has developed a tremor of the right hand with a pill-rolling motion.

Upon interviewing, the client states having sustained several head injuries. This information supports which possible diagnosis?

A. Seizure disorder B. Degenerative joint disease C. Amyotrophic lateral sclerosis D. Parkinson’s disease ANS: D Rationale: Parkinson’s disease is a chronic, progressive, degenerative disorder of the central nervous system characterized by resting tremor, bradykinesia, rigidity, and postural instability. The client is not experiencing degenerative joint disease. The client is not showing signs or symptoms of a seizure disorder. The client has rigidity with tremors, not the signs of muscle weakness that are found in amyotrophic lateral sclerosis.

PTS: 1 OBJ: 1

REF: p. 944, Overview of Parkinson's Disease

NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 10. A client is being treated for Parkinson’s disease and has been prescribed both levodopa (L-dopa) and carbidopa. Why is this course of treatment most effective?

A. Levodopa restores dopamine, and carbidopa decreases peripheral breakdown of levodopa.

B. Levodopa decreases the toxic effects of carbidopa to reduce the extrapyramidal reaction.

C. Carbidopa increases the peripheral breakdown of levodopa to hasten its onset and peak.

D. Levodopa and carbidopa, when combined, enhance voluntary movement to improve gait.

ANS: A Rationale: Levodopa restores dopamine levels; carbidopa decreases the peripheral breakdown of levodopa and allows more to reach the brain. Levodopa does not decrease the toxic effects of carbidopa to reduce the extrapyramidal reaction. Carbidopa does not increase the peripheral breakdown of levodopa to increase its effectiveness. Levodopa and carbidopa combined do not exacerbate abnormal voluntary movement to increase gait.

PTS: 1 REF: p. 945, Dopamine Receptor Agonists OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 11. A client who has been diagnosed with Parkinson’s disease is being treated with levodopa/carbidopa. Which disorder will result in the discontinuation of this drug based on a disease-related contraindication?

A. Human immune deficiency virus B. Human papillomavirus C. Transient ischemic attacks (TIA) D. Narrow-angle glaucoma ANS: D Rationale: Since levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma. Levodopa is not contraindicated in clients with human immune deficiency virus, human papillomavirus, or TIAs. PTS: 1 REF: p. 945, Dopamine Receptor Agonists OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and

Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 12. The nurse is providing education to a client who has been prescribed amantadine. What client statement indicates to the nurse that the client has understood the teaching?

A. “This drug is also used to decrease my drooling.”

B. “This drug is excreted in my stool and urine.”

C. “This drug will improve my tremors in 1–5 days.”

D. “This drug is effective when it is given long term.”

ANS: C Rationale: Amantadine relieves symptoms rapidly in 1–5 days. Amantadine is excreted unchanged in the urine only. It is not excreted in the stool. Amantadine is not administered on a long-term basis. It is usually given for 2- to 3-week periods.

PTS: 1 REF: p. 945, Dopamine Receptor Agonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 13. The nurse is providing education to a client who has been prescribed rasagiline therapy.

What food should the nurse instruct the client to avoid?

A. Cheddar cheese B. Bread C. Roast beef D. Low-fat milk ANS: A Rationale: Cheddar cheese is high in tyramine, which produces a life-threatening reaction of hypertension when combined with rasagiline. None of the other listed foods are high in tyramine, so they don’t have to be avoided.

PTS: 1 REF: p. 945, Dopamine Receptor Agonists OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. A client diagnosed with Parkinson’s disease has been prescribed rasagiline. When educating this client on this medication, which herbal supplement should be identified as having the potential to produce hyperpyrexia and death?

A. Ginger B. Dextromethorphan C. Garlic

D. St. John’s wort ANS: D Rationale: Rasagiline administered with the herbal supplement St. John’s wort will enhance the stimulation of serotonergic receptors to cause hyperpyrexia and death.

Dextromethorphan can produce the same reaction but is not an herbal supplement.

Ginger and garlic are herbal supplements but will not produce hyperpyrexia and death.

PTS: 1 REF: p. 945, Dopamine Receptor Agonists OBJ: 4 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 15. An older adult client has been prescribed an anticholinergic agent for the treatment of Parkinson-related symptoms. What client education should be provided by the nurse?

A. “Avoid high environmental temperatures.”

B. “Anticholinergics increase mental alertness.”

C. “It is safe to take pseudoephedrine for a cold.”

D. “You may experience urinary incontinence.”

ANS: A Rationale: Anticholinergic drugs decrease sweating, increasing the risk for heat stroke.

The client should be instructed to avoid high environmental temperatures.

Anticholinergic agents will decrease mental alertness. Pseudoephedrine will produce anticholinergic effects and should not be administered. Anticholinergic agents produce urinary retention, not incontinence.

PTS: 1 REF: p. 945, Dopamine Receptor Agonists OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A client has been prescribed an anticholinergic agent for the treatment of Parkinson-related symptoms. What client education should be provided?

A. Do not take any over-the-counter sleep aids.

B. Void before taking the medication.

C. Move to a warm climate to decrease symptoms.

D. Enroll in an exercise class at the senior center.

ANS: B

Rationale: To avoid urinary retention associated with the administration of an anticholinergic agent, the client should be instructed to void before taking the medication. The client should be instructed to avoid the use of over-the-counter sleep aids. The client should avoid high environmental temperatures. The client should avoid strenuous activity and should not enroll in an exercise class.

PTS: 1 REF: p. 957, Belladonna Alkaloid and Derivatives OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. The nurse administers a selective cholinergic antagonist medication to a client to dilate the pupil during an eye examination. What would the nurse consider to be side effects based upon the characteristics of the prescribed medication? Select all that apply.

A. Dry lips and mouth B. Heart rate 110 C. Frequent watery bowel movements D. Voids 50 mL urine, bladder scan notes 400 mL retained urine E. Blood pressure 88/50 mm Hg ANS: A, B, D Rationale: The anticholinergic medication acts as an antagonist and selectively binds to the muscarinic receptors but fails to elicit the physiologic responses for the receptors.

The medication inhibits the activity of the parasympathetic nervous system resulting in symptoms of the fight-or-flight response with the side effects of dry mouth and mucous membranes, including lips; heart rate 110, an example of tachycardia; constipation; urinary retention; and hypertension. Urinary retention may present in the client voiding a small amount of urine and then the bladder scan revealing a larger amount of retained urine. The desired or therapeutic effect of dilation of the pupils also occurs from the action of the medication.

PTS: 1 REF: p. 957, Belladonna Alkaloid and Derivatives OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 18. An older adult client diagnosed with Parkinson’s disease will soon begin treatment with levodopa, carbidopa, and entacapone. Prior to starting this course of treatment, the nurse must ensure the implementation of which intervention?

A. Monitor cardiac-related vital signs.

B. Assess renal function.

C. Review results of a pulmonary functions test.

D. Assess for lactose intolerance.

ANS: B Rationale: It is necessary to administer this medication therapy with caution in clients with severe renal impairment. None of the other interventions are necessary (related to this therapy) since the medication is not likely to be affected by or to effect the cardiac, respiratory, or gastrointestinal systems.

PTS: 1 REF: p. 954, Catechol-O-Methyltransferase Inhibitor and Decarboxylase Inhibitor/Dopamine Precursor OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 19. The nurse is educating a client diagnosed with Parkinson’s disease about the dietary implications of prescribed treatment with levodopa/carbidopa. Which statement by the nurse demonstrates an understanding of the proper administration of this medication?

A. “It’s important to take this medication on a full stomach so that it doesn’t make you nauseous.”

B. “Most people find that it’s best to take this medication at bedtime, provided you haven’t snacked in the evening.”

C. “If possible, try to eat extra protein when you’re taking this medication.”

D. “Dairy products will make this medication ineffective, so make sure you don’t take them at the same time.”

ANS: A Rationale: Levodopa/carbidopa is administered with or just after food or following a meal to reduce nausea and vomiting. Levodopa/carbidopa is not administered with a high-protein diet. Dairy products do not interfere with pharmacokinetics.

PTS: 1 REF: p. 945, Dopamine Receptor Agonists OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 20. A client diagnosed with myasthenia gravis is experiencing rhinorrhea. Which medication should not be administered to the client?

A. Azelastine hydrochloride B. Ipratropium C. Fexofenadine D. Nedocromil sodium ANS: B

Rationale: Ipratropium is administered for rhinorrhea but is contraindicated in clients who have been diagnosed with myasthenia gravis because of its anticholinergic effects.

Azelastine hydrochloride, fexofenadine, and nedocromil sodium are not contraindicated for clients with myasthenia gravis.

PTS: 1 REF: p. 957, Belladonna Alkaloid and Derivatives OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 48: Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

Chapter 49, Drug Therapy With Opioids 1. A client experiencing cancer pain is receiving morphine every 2 hours. What assessment should the nurse teach family members to make while caring for this client at home?

A. Diarrhea B. Respiratory depression C. Lung sounds D. Urinary incontinence ANS: B Rationale: The administration of morphine can result in respiratory depression. The family should be taught to assess the client for respiratory depression. Morphine sulfate can be administered to treat severe diarrhea. The client’s lung sounds are important to assess but only after the nurse assesses for respiratory depression. Morphine does not cause urinary incontinence.

PTS: 1 REF: p. 974, Opioid Agonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A client admitted to the surgical division after a mastectomy has a PCA pump and states being fearful about being overdosed on morphine. Which response is most appropriate when addressing the client’s concern of being overmedicated?

A. “The pump will administer all of the doses, so you don’t have to worry.”

B. “If you follow the instructions, that won’t happen to you.”

C. “The device is preset, so you cannot receive more than you need.”

D. “The device will give you a placebo when you activate it too often.”

ANS: C Rationale: A PCA pump will administer a basal rate of analgesic, but the client can initiate bolus doses when the basal rate is insufficient for pain relief. The total amount of the drug is preset and limited to prevent overdose due to frequent client activation.

Telling the client not to worry or to follow instructions is not effective teaching or use of therapeutic communication. The pump does not deliver a placebo at any time.

PTS: 1 REF: p. 974, Opioid Agonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 3. The nurse caring for a postanesthesia client notes a respiratory rate of 6 breaths/min.

What drug should be administered?

A. Naloxone B. Hydrocodone C. Butorphanol D. Pentazocine

ANS: A Rationale: Naloxone has long been the drug of choice to treat respiratory depression caused by an opioid. The remaining options are all opioids.

PTS: 1 REF: p. 974, Opioid Agonists OBJ: 6 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 4. A client has been administered an opioid. For what effect should the nurse regularly assess?

A. Oliguria B. Level of consciousness (LOC) C. Edema D. Tachycardia ANS: B Rationale: Opioids will produce decreased LOC. Oliguria, edema, and tachycardia do not result from the administration of an opioid.

PTS: 1 REF: p. 971, Overview of Pain OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A client is in the end of life and has developed increased respiratory secretions and labored breathing. The health care provider will order which medication to decrease these symptoms?

A. Meclizine B. Ampicillin C. Azithromycin D. Morphine sulfate ANS: D Rationale: Morphine is used for the treatment of acute pulmonary edema. Meclizine is given for dizziness. Ampicillin is used to treat infection, as is azithromycin.

PTS: 1 REF: p. 974, Opioid Agonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A client receiving morphine sulfate 5 mg IV every 4 hours for the past several days now states that the pain is not being relieved as well as it was in the past. What is the reason for this development?

A. A dependency on the morphine B. Natural response to metastatic cancer

C. Greater pain associated with inactivity D. A tolerance to morphine ANS: D Rationale: Larger-than-usual doses of morphine are required to treat pain in opiate-tolerant people. The client has not developed a dependence on morphine. A client with metastatic cancer will require increasing pain management, but this feature is not the rationale for the client’s statement. The increased pain is not related to inactivity.

PTS: 1 REF: p. 974, Opioid Agonists OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. The nurse should question the health care provider’s IV morphine prescription for which client?

A. An 88-year-old client with failure to thrive B. A 45-year-old client, 1-day postoperative mastectomy C. An 8-year-old client with a compound fracture of the femur D. A 17-year-old client, 1-day postoperative appendectomy ANS: A Rationale: Opioid analgesics should be used cautiously in older adults, especially if they are debilitated. Treatment with morphine 1 day after either a mastectomy or an appendectomy is appropriate for pain management. The treatment of pain with morphine is appropriate for a client with a compound fracture of femur.

PTS: 1 REF: p. 974, Opioid Agonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 8. A 30-year-old client has been ordered meperidine 100 mg IM every 4 hours for 2 days after a fractured femur. What action should the nurse take?

A. Give the medication as ordered.

B. Administer half the dose.

C. Call the health care provider for a smaller dose.

D. Give the dose by mouth.

ANS: A Rationale: The client should be administered the full dose of medication as prescribed.

The dose is within the normal range, and there is no indication of health conditions that would warrant a reduction (e.g., impaired hepatic or renal function) or a change in route.

If such a condition were present, the nurse would contact the HCP to recommend a change in prescription rather than take that action unilaterally.

PTS: 1 REF: p. 974, Opioid Agonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. A nurse administrates an opioid medication to a client. For what side effect should the nurse assess?

A. Lower extremity paresthesia B. Drowsiness C. Occipital headache D. Polyuria ANS: B Rationale: Drowsiness and sedation are results of central nervous system depression. The client will not develop lower extremity paresthesia, occipital headache, or polyuria. If these effects develop, they are not related to the opioid medication.

PTS: 1 REF: p. 974, Opioid Agonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A client has been prescribed a fentanyl patch for chronic pain. What client teaching should the nurse provide to the client and family upon discharge?

A. Remove the patch every 3 days.

B. Apply it to the chest only.

C. Apply it for breakthrough pain.

D. Remove it daily and clean skin.

ANS: A Rationale: A fentanyl patch has a slow onset of action, but duration lasts about 72 hours making a new application necessary every 3 days. The patch can and should be applied to other areas of the skin, not solely on the chest, with skin cleaning done prior to each new application. Fentanyl is not effective for breakthrough pain.

PTS: 1 REF: p. 974, Opioid Agonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. The nurse administers a nonopioid analgesic to a client. What is the most effective way for the nurse to evaluate the pain response following administration?

A. Observe the client when they are not aware of the assessment.

B. Ask another nurse to assess the client’s response to the medication.

C. Using a pain scale, ask the client to describe the pain.

D. Ask the family to determine the client’s response to the pain.

ANS: C

Rationale: Asking the client to describe the pain using a pain scale is the most effective assessment of pain response. Observing the client when they are unaware is an objective assessment and does not represent a true pain experience. Asking another nurse to assess the client’s response will not provide accurate data. Asking the family to determine the client’s response will not provide accurate data.

PTS: 1 REF: p. 971, Overview of Pain OBJ: 7 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 12. A client is administered the opioid antagonist naloxone for respiratory depression and a state of unresponsiveness. How does naloxone work?

A. Synergism B. Breakthrough C. Tolerance D. Displacement ANS: D Rationale: Naloxone is an opioid antagonist that works by displacement. Naloxone does not work by synergism, breakthrough, or tolerance.

PTS: 1 REF: p. 986, Opioid Antagonists OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 13. A nurse is teaching a client about the prescription for acetaminophen to be taken at home. This medication consists of acetaminophen and what other likely drug that enhances the analgesic effect of acetaminophen?

A. Codeine B. Acetylsalicylic acid C. Methadone D. Tramadol ANS: A Rationale: Codeine is often given with acetaminophen for additive analgesic effects.

None of the other medications are used in combination with acetaminophen.

PTS: 1 REF: p. 974, Opioid Agonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 14. The nurse is caring for a client who has been prescribed a nonopioid analgesic in addition to a narcotic analgesic. What effect will the nurse expect?

A. Antagonism

B. Additive effect C. Interference D. Increased exertion ANS: B Rationale: Acetaminophen is added to narcotic analgesics for additive effects of pain relief without the addition of narcotic adverse effects. Acetaminophen will neither provide an antagonistic effect nor cause an interference of action. Acetaminophen will increase excretion.

PTS: 1 REF: p. 974, Opioid Agonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. The pathophysiology of pain begins with a signal from what source?

A. Myelin sheaths B. Nociceptors C. Baroreceptors D. Synapses ANS: B Rationale: For a person to feel pain, the signal from nociceptors in peripheral tissues must be transmitted to the spinal cord, then to the hypothalamus and cerebral cortex in the brain. Myelin sheaths, synapses, and baroreceptors are not directly involved in pain transmission.

PTS: 1 REF: p. 971, Overview of Pain OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 16. The client’s care plan specifies the use of preemptive analgesia. This approach to pain control will involve what nursing intervention?

A. Frequent administration of high-dose opioids B. Simultaneous use of analgesics from different drug classes C. Alternating administration of opioid antagonists with opioid agonists D. Client-controlled analgesia (PCA) use ANS: B Rationale: Preemptive analgesia is used to reduce postsurgical pain by simultaneously administering medications from different drug classes to suppress pain by blocking multiple pain pathways. It is not synonymous with PCA, does not require alternation between opioid agonists and antagonists, and does not necessarily involve more frequent or higher dosing.

PTS: 1 REF: p. 971, Overview of Pain OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. The nurse administers prescribed naloxone to a client. Following administration, the nurse should assess for what potential adverse effect?

A. Increased blood pressure B. Decreased oxygen saturation C. Increased temperature D. Increased respiratory rate ANS: A Rationale: Potential adverse effects of naloxone include increased blood pressure and decreased respirations. It does not typically cause deoxygenation or fever.

PTS: 1 REF: p. 986, Opioid Antagonists OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. The nurse is caring for a client newly admitted for chronic opioid abuse. What medication does the nurse expect to be prescribed to the client?

A. Disulfiram B. Flumazenil C. Methadone D. Naloxone ANS: C Rationale: Opioid withdrawal symptoms are treated with methadone. Naloxone is used to treat acute opioid intoxication or overdose, but it is not used to treat opioid abuse.

Flumazenil treats benzodiazepine overdoses, while disulfiram is prescribed to support alcohol sobriety.

PTS: 1 REF: p. 974, Opioid Agonists OBJ: 4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 19. The nurse is providing education to a client who has been prescribed naltrexone. What effect should the nurse teach the client to expect if an opioid is taken?

A. A decline in neurologic function B. Visual hallucinations C. The absence of usual physiologic effects D. A sudden onset of nausea and vomiting ANS: C

Rationale: Naltrexone is a pure opioid antagonist that blocks opioids from occupying receptor sites, thereby preventing their physiologic effects. It will not cause neurologic deficits, GI upset, or hallucinations.

PTS: 1 REF: p. 986, Opioid Antagonists OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. A client has been receiving morphine sulfate for the treatment of postoperative pain. The nurse assesses that the client is profusely sweating but is afebrile. What does this finding indicate to the nurse?

A. There may be an infectious process present.

B. The client may have developed a tolerance and dependance to the morphine.

C. The client may have developed an allergy to the morphine.

D. The client is having withdrawal symptoms.

ANS: B Rationale: Sweating may be a sign of tolerance and dependence in some clients taking morphine. Pruritus and itching may indicate that the client has an allergy to the morphine. The client is afebrile and most likely is not experiencing an infectious process at this time. With the client still receiving the morphine, it is unlikely that they are withdrawing from the drug.

PTS: 1 REF: p. 974, Opioid Agonists OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 49: Drug Therapy With Opioids KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 50, Drug Therapy With Local Anesthetics 1. A client sustained a severe laceration to the right thumb and index finger that will require local anesthetic to facilitate suturing. Which statement made by the client should prompt the nurse to provide further client health education?

A. “I have to admit I’m relieved that they’ll be freezing my hand before they stitch it up.”

B. “I’m feeling pretty queasy about getting stitches, so I’m glad they’ll be knocking me out.”

C. “They told me that it will take a few hours before I can feel my hand again.”

D. “If I understand correctly, I won’t be able to move my hand normally for a while after getting the anesthesia.”

ANS: B Rationale: Local anesthesia is differentiated from general anesthesia in that there is no loss of consciousness. “Freezing” is a reasonable description. Normal motor control and sensation return after a period of time.

PTS: 1 REF: p. 993, Overview of Local Anesthesia OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 2. The nurse is providing education to a client who will receive spinal anesthesia prior to a scheduled bunionectomy. What information should the nurse include about administration?

A. It will cause a significant, but temporary, decrease in level of consciousness.

B. It will be injected at the level of C7 to T2.

C. It will be injected between T8 and T9.

D. It will be injected into the cerebrospinal fluid.

ANS: D Rationale: Spinal anesthesia involves injecting the anesthetic agent into the cerebrospinal fluid, usually in the lumbar spine. It is not injected into either the cervical or thorax spine areas. It does not cause a significant decrease in level of consciousness.

PTS: 1 REF: p. 992, Key Terms OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A client who suffered a laceration while doing woodwork will have the wound treated under local anesthesia achieved using lidocaine and epinephrine. The nurse who will assist with the procedure should recognize that epinephrine performs what function in this situation?

A. Promoting vasodilation

B. Prolonging the effects of lidocaine C. Preventing adverse effects of lidocaine D. Blocking the afferent nerve pathways ANS: B Rationale: Lidocaine has a rapid effect, and when combined with epinephrine, this effect is prolonged. Epinephrine can promote vasoconstriction, not vasodilation, and it neither prevents adverse effects nor blocks afferent nerve pathways.

PTS: 1 REF: p. 994, Amides OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A client’s chronic venous ulcer on the lower lateral surface of the leg requires incision and debridement (I & D). The nurse should anticipate that lidocaine will be administered by which route?

A. Intravenous B. Topical C. Injection D. Nebulized ANS: C Rationale: Injectable lidocaine is used for infiltration of the skin or subcutaneous administration prior to minor surgical procedures, such as I & D. Nebulized administration of lidocaine is reserved for lung procedures. Topical administration would be insufficient, and IV administration is not warranted.

PTS: 1 REF: p. 994, Amides OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. The nurse is assessing a client who received a local anesthetic 5 minutes ago. What assessment finding would the nurse interpret as possible evidence that the client has developed local anesthetic systemic toxicity (LAST)?

A. The client has become intensely anxious and agitated.

B. The client has reported feeling extremely nauseated.

C. The client’s heart rate has become bradycardic and irregular.

D. The client reports still having sensation in the hand.

ANS: A Rationale: Initial symptoms of LAST may include analgesia, circumoral numbness, metallic taste, tinnitus or auditory changes, and agitation. Nausea, dysrhythmias, and continued sensory nerve function do not suggest LAST. PTS: 1 OBJ: 2

REF: p. 993, Local Anesthetic Systemic Toxicity

NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 6. The nurse is teaching a client about a procedure that includes application of topical lidocaine. How long would the nurse say it takes to achieve full pain relief following application?

A. 3 to 5 minutes B. 10 to 20 minutes C. 20 to 60 minutes D. 90 minutes to 2 hours ANS: C Rationale: Following topical administration of lidocaine, the area becomes numb in 20 to 60 minutes.

PTS: 1 REF: p. 994, Amides OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. Oral lidocaine viscous has been prescribed for a client who has developed stomatitis. To minimize the client’s chance of aspiration, the nurse should encourage what intervention?

A. Taking small bites of food and small sips of fluid after administration B. Adopting a minced and pureed diet for the duration of treatment C. Remaining in a high Fowler’s position for 90 minutes following the use of lidocaine viscous D. Avoiding eating or drinking for 1 hour following the use of lidocaine viscous ANS: D Rationale: Clients should not drink fluids or eat after gargling with viscous lidocaine for at least 60 minutes due to risk of aspiration. Upright positioning and small bites of food will not mitigate this risk. A textured diet is unnecessary.

PTS: 1 REF: p. 996, Box 50.3 OBJ: 1 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client has been administered lidocaine in anticipation of a bronchoscopy and lung biopsy. What change in status would the nurse recognize as a possible indication of hypersensitivity to lidocaine?

A. Audible wheeze B. Pleural pain C. Audible S3 D. Hemoptysis

ANS: A Rationale: It is necessary to assess the respiratory status and lung sounds for signs of bronchospasm related to hypersensitivity after lidocaine administration. An audible wheeze is suggestive of bronchospasm. Pleural pain, audible S3, and hemoptysis are less likely to be a direct result of hypersensitivity.

PTS: 1 REF: p. 994, Amides OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A hospital client’s medication administration record specifies the parenteral administration of lidocaine before a tissue biopsy to be performed later in the day. What action should the nurse take in response to this prescription?

A. Obtain a prescription for epinephrine in order to potentiate the action of lidocaine.

B. Contact the prescriber because administration should be performed by a health care provider or nurse anesthetist.

C. Administer a 500-mL bolus of normal saline to ensure adequate vascular volume.

D. Assess the client’s need for an antihistamine to be on hold during administration of the lidocaine.

ANS: B Rationale: A health care provider or nurse anesthetist administers the injectable form of lidocaine. A fluid bolus, an antihistamine, and epinephrine are not necessarily indicated.

PTS: 1 REF: p. 994, Amides OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. How does spinal procaine achieve anesthesia?

A. Preventing the influx of sodium into nerve cells B. Increasing the action of anticholinesterase in nerve synapses C. Antagonizing nociceptors D. Agonizing opioid receptors in the CNS ANS: A Rationale: Procaine decreases the influx of sodium into the nerve cell and depresses depolarization to prevent conduction of the nerve impulse. It does not alter the function of nociceptors, opioid receptors, or anticholinesterase.

PTS: 1 REF: p. 994, Amides OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

11. The nurse is assessing a client who has received procaine. What finding would suggest to the nurse the possibility of an adverse effect?

A. Increased temperature B. Increased heart rate C. Decreased blood pressure D. Lethargy ANS: B Rationale: Following administration of procaine, the nurse assesses the central nervous system (CNS) for excitability and the cardiovascular status for tachycardia and hypertension, which could precede cardiovascular collapse. Lethargy, hypotension, and fever are not typical adverse effects.

PTS: 1 REF: p. 994, Amides OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 12. What amide local anesthetic is contraindicated for local infiltration during pregnancy?

A. Lidocaine B. Mepivacaine C. Bupivacaine D. Dibucaine ANS: C Rationale: Bupivacaine is contraindicated for local infiltration in pregnant women. None of the other amides are specifically contraindicated during pregnancy.

PTS: 1 REF: p. 994, Amides OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. The parents of a teething infant ask the nurse about over-the-counter (OCT) solutions to help minimize the pain. What assessment question has priority when preparing to provide suggestions?

A. “Is this your infant’s first tooth?”

B. “When did the pain start?”

C. “Does the pain wake your infant up?”

D. “How old is your infant?”

ANS: D Rationale: Use of oral solutions relieves mouth and gum irritation, such as teething pain in infants 4 months of age. While the other questions provide information, none are directly involved in determining the appropriateness of a local anesthetic.

PTS: 1 REF: p. 997, Esters OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care

TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. The client suddenly develops numbness, tingling of the face, tinnitus, and restlessness after receiving a nerve block with bupivacaine. Which action would the nurse implement first?

A. Assess the airway and provide emergency support.

B. Stop the infusion of bupivacaine.

C. Pad the rails and remove loose objects from the bed.

D. Activate the emergency system, and stay with the client.

ANS: B Rationale: The client has developed local anesthetic systemic toxicity (LAST), which is life-threatening and may occur with the administration of local anesthetics. The first action is to stop the medication injection. This limits the amount of drug in the client’s system. Next, notify the emergency response system according to the institution where the nurse practices. Then, the nurse would assess airway, providing support as necessary.

Preparing for the possibility of seizures would be the last step of the four possible steps presented. The nurse stays with the client because seizures, ventricular dysrhythmias, and cardiopulmonary arrest are all possible. The antidote, 20% lipid emulsion, needs to be prescribed and administered as soon as possible.

PTS: 1 REF: p. 993, Local Anesthetic Systemic Toxicity OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 15. Which measures would the nurse provide for safe and effective drug administration when applying a 5% lidocaine patch to an adult client? Select all that apply.

A. Remove the previous patch with clean gloves; fold it on itself and dispose of it.

B. Place a heating pad over the patch to increase circulation to the area.

C. Cleanse and dry the skin, and inspect for redness or rash where the previous patch was applied.

D. Apply the new patch to intact skin at the most painful site.

E. Write the client’s initials on the patch.

ANS: A, C, D Rationale: The nurse should wear gloves when removing the old patch, and confirm that all old patches have been removed to prevent overdose of the drug from a missed patch.

The skin is cleansed, dried, and inspected for redness, rash, or swelling. The old patch when removed is stuck to itself to prevent any person or animal contacting the drug after disposing of it. A new patch is administered using clean gloves on the area the client determines to be the most painful site. The new patch should have the date, time, and initials of the nurse on it. A heating pad over the patch could increase delivery of the drug, which is dangerous. The heat could also burn or break down the skin.

PTS:

1

REF: p. 994, Amides

OBJ: 1

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 16. The nurse is educating an adult client diagnosed with herpetic lesions of the throat about the prescribed 1% viscous lidocaine gargle and swallow. Which statement made by the client establishes the need for further clarification?

A. “The drug diminishes pain by blocking nerve conduction in my throat.”

B. “The drug may cause stinging and burning temporarily before the area is numb.”

C. “I can eat immediately after I use the medication.”

D. “I should report if my pain is unrelieved after taking the viscous lidocaine.”

ANS: C Rationale: The nurse needs to clarify the statement that the client made regarding eating immediately after gargling and swallowing the viscous lidocaine. The client needs to wait to drink or eat for 60 minutes to prevent the risk of aspiration. The other statements are correct. The drug decreases pain by blocking nerve conduction in the pharynx. The drug may cause side effects of stinging and burning temporarily before the area feels numb because of the local anesthetic’s action. The client should report to the nurse if the pain is unrelieved by the drug so the nurse may assess the client’s condition and take further appropriate actions.

PTS: 1 REF: p. 996, Box 50.3 OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 50: Drug Therapy With Local Anesthetics KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 51, Drug Therapy With General Anesthetics 1. Prior to elective hip replacement surgery, the nurse is explaining the basic characteristics of general anesthesia to the client. The nurse should perform this education in the understanding that general anesthesia is best described as what result?

A. A nonreversible, temporary state of unresponsiveness B. A state of reversible unconsciousness C. A stage N2 non-rapid eye movement sleep D. A stage N3 non-rapid eye movement sleep ANS: B Rationale: General anesthesia is defined as a medication-induced reversible unconsciousness with loss of protective reflexes. There is the misconception that general anesthesia is a deep sleep.

PTS: 1 REF: p. 1002, Key Terms OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A perioperative nurse is explaining the process of general anesthesia in anticipation of the adult client’s imminent bowel resection. When describing the phase of induction, the nurse should explain that this is usually achieved by what means?

A. Intramuscular (IM) injection of anesthetics and benzodiazepines B. Intravenous (IV) administration of opioid analgesics C. Subcutaneous (sub-Q) injection of a rapid-acting anesthetic D. Intravenous (IV) administration of anesthetics ANS: D Rationale: The administration of a general anesthetic can be divided into three phases.

The first phase is induction, which is rendering the client unconscious by using inhalation anesthetics, intravenous anesthetics, or both. Adult clients usually receive a rapid-acting intravenous anesthetic medication. IM medications, sub-Q medications, and opioids are not used.

PTS: 1 REF: p. 1003, Overview of General Anesthesia OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. An adult client who is currently undergoing rhinoplasty has developed the characteristic signs and symptoms of malignant hyperthermia. The operating room nurse should anticipate what intervention?

A. Hemodialysis B. Tracheal intubation C. IV administration of naloxone

D. IV administration of dantrolene sodium ANS: D Rationale: The treatment for malignant hyperthermia consists of intravenous dantrolene sodium, oxygenation and hyperventilation, hydration, and body cooling. The client will already be intubated. Neither naloxone nor dialysis is indicated.

PTS: 1 REF: p. 1004, Inhalation Anesthetics OBJ: 4 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. The nurse reads that total intravenous anesthesia (TIVA) is indicated for a client to undergo a surgical repair of a meniscus. What is the most likely rationale for this intervention?

A. The client has a diagnosis of chronic obstructive pulmonary disease (COPD).

B. The client’s insurer does not reimburse for inhaled anesthesia.

C. The client has previously experienced severe postoperative nausea and vomiting.

D. The client is in the first trimester of pregnancy.

ANS: C Rationale: In clients who have history of severe postoperative nausea and vomiting, the anesthetist may substitute the inhalation anesthetic with a technique called total intravenous anesthesia (TIVA). TIVA is not necessarily indicated in clients who are pregnant or who have COPD. Insurance considerations would not normally be an absolute indication for the use of TIVA. PTS: 1 REF: p. 1004, Inhalation Anesthetics OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. How will the addition of nitrous oxide or IV anesthetics affect the minimum alveolar concentration (MAC) of isoflurane?

A. The MAC will remain the same.

B. The MAC will decrease.

C. The MAC of isoflurane will not be relevant.

D. The MAC will be more difficult to calculate.

ANS: B Rationale: With the addition of other medications such as opioids, intravenous anesthetics, or nitrous oxide, the MAC values decrease.

PTS: 1 REF: p. 1004, Inhalation Anesthetics OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

6. A client is scheduled to undergo craniofacial surgery, a procedure that will necessitate the use of propofol. The operating room nurse should be aware that alternative medications will be absolutely necessary in order to produce what effect in the client?

A. Amnesia B. Euphoria C. Analgesia D. Hypnosis ANS: C Rationale: Propofol produces amnesia, euphoria, and hypnosis. It therefore blocks the perception of pain. It does not, however, provide analgesia.

PTS: 1 REF: p. 1007, Intravenous General Anesthetics OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. When in postanesthetic recovery, the nurse should assess for what adverse effect when ketamine is included in a surgical client’s balanced anesthesia?

A. Labile blood pressure B. Increased intracranial pressure C. Hyperventilation and respiratory alkalosis D. Delirium and agitation ANS: D Rationale: Ketamine can produce emergence delirium, hallucinations, and unpleasant dreams. Symptoms of this effect may include confusion, agitation, and nystagmus. The drug preserves blood pressure and does not cause hyperventilation or increased ICP. PTS: 1 REF: p. 1010, Neuromuscular Blocking Agents OBJ: 5 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. How does vecuronium induce paralysis required for the facilitation of intubation and balanced anesthesia?

A. Antagonizing acetylcholine (ACh) receptors at neuromuscular junctions B. Potentiating the effects of acetylcholinesterase in synapses C. Crossing the blood–brain barrier and agonizing cerebellar function D. Binding with serotonin and inhibiting its neuromuscular effects ANS: A

Rationale: Because vecuronium is structurally similar to ACh, it binds to the receptors on the muscle and prevents normal function of ACh, producing skeletal muscle paralysis. The drug does not influence the physiology of serotonin, cerebellum, or acetylcholinesterase.

PTS: 1 REF: p. 1010, Neuromuscular Blocking Agents OBJ: 6 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. The anesthetist administers vecuronium to a client prior to thyroidectomy. What is the purpose of the medication?

A. To ensure that the client does not move during surgery B. To prevent intraoperative vomiting C. To protect the client’s airway during surgery D. To induce hypnosis and amnesia ANS: A Rationale: Delicate repairs, such as neck surgery and neurosurgery, may require the use of neuromuscular agents to prevent movement and subsequent damage. Vecuronium is not used to prevent nausea and vomiting, to protect the client’s airway, or to induce hypnosis and amnesia.

PTS: 1 REF: p. 1010, Neuromuscular Blocking Agents OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. A surgical client’s balanced anesthesia includes the use of vecuronium. What nursing action should the operating room nurses prioritize?

A. Monitoring the client for signs of increased level of consciousness B. Assessing and protecting the client’s airway C. Protecting the client’s skin integrity D. Monitoring the client’s deep tendon reflexes ANS: B Rationale: The maintenance of the client’s airway and respiratory function following the administration of neuromuscular blocking agents such as vecuronium is the most important nursing implication. The importance of airway protection supersedes that of DTR assessment, assessing LOC, and maintaining skin integrity, though each of these is a valid consideration.

PTS: 1 REF: p. 1010, Neuromuscular Blocking Agents OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 51: Drug Therapy With General Anesthetics

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 11. A client will undergo an endoscopy with conscious sedation using midazolam. The nurse who is participating in this procedure should monitor the client closely for which sign of adverse reaction?

A. Increased intracranial pressure (ICP) B. Respiratory depression C. Hemorrhage D. Rhabdomyolysis ANS: B Rationale: Following administration of midazolam, continuous monitoring for respiratory depression is required, and if necessary, age-specific resuscitative measures should be implemented. Rhabdomyolysis is the rapid destruction of skeletal muscle resulting in leakage into the urine. Neither increased ICP, rhabdomyolysis, nor hemorrhage is more likely than respiratory depression.

PTS: 1 REF: p. 1014, Benzodiazepines OBJ: 7 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. The anesthesiologist has informed the operating room nurse that opioids will be used to supplement anesthesia for a client undergoing a partial mastectomy. What opioid is most likely to be utilized?

A. Codeine B. Oxycodone C. Fentanyl D. Meperidine ANS: C Rationale: A synthetic opioid that is about 100 times more potent than morphine sulfate, fentanyl can be used to supplement sedation, regional techniques, and general anesthesia.

Codeine, meperidine, and oxycodone do not have intraoperative applications.

PTS: 1 REF: p. 1014, Opioid Analgesics OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. The nurse is caring for a client in the postanesthesia care unit (PACU) after general anesthesia with isoflurane. The client suddenly develops BP 88/50, HR 110, RR 28, shallow, T 102°F (39°C), SaO2 88%, mottling of skin and profuse diaphoresis, and spasms of bilateral masseters. Which action should the nurse implement first?

A. Obtain a prescription for creatinine kinase (CK) levels, renal profile, and arterial blood gases STAT and report results.

B. Notify anesthesia immediately for evaluation and prescriptions including

intravenous dantrolene sodium.

C. Assess oxygenation and provide hyperventilation with 100% oxygen per standing orders to maintain SaO2 >92%.

D. Get a prescription to provide a cooling blanket immediately to cool the body to the prescribed range.

ANS: B Rationale: The client has developed early symptoms of malignant hyperthermia, a genetic disorder that leads to a life-threatening emergency when the client receives inhalation anesthesia, or the neuromuscular blocking agent, succinylcholine. The immediate action the nurse must take is to notify anesthesia to further evaluate and treat the client. The drug of choice is dantrolene, a direct-acting muscle relaxant, which will reverse the muscle rigidity responsible for the client’s symptoms. The other actions are appropriate but taking them first delays the quick evaluation and treatment that client requires. The client will receive 100% oxygen with hyperventilation to improve oxygenation. With standing orders, the nurse may do this action next before the anesthesia team arrives. The labs, which need to be ordered, will provide valuable information to the anesthesia team to determine if the client is experiencing metabolic acidosis and/or hypoxia. CK levels will provide information about muscle damage. The renal profile provides information about hydration, renal status, and electrolyte replacement needs. The cooling blanket needs to be ordered and is found to help improve the outcome.

PTS: 1 REF: p. 1005, Adverse Effects OBJ: 8 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. The nurse prepares to receive a client after a cesarean section who received isoflurane during general anesthesia. Based upon the drug’s adverse effects, which measures would the nurse provide postoperatively? Select all that apply.

A. Provide warm blankets.

B. Determine presence of recurarization.

C. Administer prescribed antiemetic.

D. Assess for increased bleeding.

E. Monitor oxygenation and vitals frequently.

ANS: A, C, D, E Rationale: The nurse provides warm blankets or forced-air devices to treat shivering caused by the drug’s action on the brain’s thermoregulatory system. The nurse assesses for recurarization or residual muscle weakness that can occur after the presumed reversal from the use of nondepolarizing muscle relaxants, not from the use of inhalant general anesthetic. Volatile inhalation anesthetics may cause nausea and vomiting, so administering the ordered antiemetic helps. The drug decreases the tone of uterine smooth muscle and can lead to increased bleeding. The drug depresses the cardiopulmonary system, so frequent assessment of vitals and oxygenation status is necessary to detect complications early.

PTS:

1

REF: p. 1004, Inhalation Anesthetics

OBJ: 5

NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 15. The nurse is caring for a newly admitted client requiring long-term mechanical ventilation. Which measures would the nurse provide for safe and effective long-term administration of the newly prescribed propofol intravenous (IV) drip being titrated for moderate sedation? Select all that apply.

A. Auscultate lungs since the drug can cause bronchoconstriction.

B. Assess for contraindications: pancreatitis, allergies to soy, or eggs.

C. Monitor and report elevations in triglycerides, creatine kinase, or lactic acid.

D. Report renal insufficiency because the drug will need to be discontinued.

E. Determine the level of sedation before and after titrating the drug.

ANS: B, C, E Rationale: The drug produces bronchodilation, which is helpful for clients with asthma or chronic obstructive pulmonary disease. The nurse should assess for contraindications including lipid disorders, pancreatitis, allergies to soy, or egg products. Since the client will require long-term sedation, the nurse monitors and reports any elevations in triglycerides, creatine kinase, or lactic acid to help prevent the client from developing propofol infusion syndrome. The drug is safely eliminated by clients with renal impairment. Before titrating the drug, the nurse should determine the level of sedation using the scale the health care institution has adopted to ensure that the therapeutic goal is achieved and the cardiovascular system remains stable.

PTS: 1 REF: p. 1007, Intravenous General Anesthetics OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Select 16. The nurse is caring for a client with a history of renal impairment in the postanesthesia care unit (PACU) after general anesthesia with isoflurane and vecuronium. The client has a weak and ineffective cough. Which assessments should the nurse perform to determine if recurarization has occurred? Select all that apply.

A. Assess for the ability to swallow and handle secretions.

B. Examine the medical record if neostigmine was administered.

C. Ask the client to lift the head off the bed for 5 seconds to determine strength.

D. Analyze the last recorded renal profile to determine renal status.

E. Determine what the bilateral hand grasp strength is.

ANS: A, C, E

Rationale: Recurarization is the residual muscle weakness that occurs in a client who receives a nondepolarizing neuromuscular blocking agent like vecuronium. Since this could affect the ability to breathe or handle secretions properly, the nurse should assess both functions to gauge the client’s risk for aspiration. The nurse asks the client to hold the head off the bed for 5 seconds to determine muscle strength of the upper neck and shoulders. Assessing bilateral hand grasp for strength also checks the upper muscles most affected in recurarization. The client has a history of renal impairment, which prolongs the effects of the drug. The nurse needs to focus assessments on the client’s level of residual muscle weakness and not the medical record to determine if a reversal drug, such as neostigmine, was administered. Since it is established that the client has renal impairment, there is no need for the nurse to focus on the last recorded renal profile.

PTS: 1 REF: p. 1010, Neuromuscular Blocking Agents OBJ: 6 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 17. The nurse is caring for a young adult client in the emergency department (ED) requiring rapid sequence induction and placement on mechanical ventilation. The client has no known allergies; takes no medications, over-the-counter (OTC) drugs, herbals, or alcohol; and has no history of chronic conditions. The nurse administered the prescribed intravenous (IV) succinylcholine. Which best action would the nurse take when the client remains paralyzed 30 minutes after the intubation?

A. Reassure the client that the drug will wear off shortly.

B. Do nothing because this is the therapeutic effect.

C. Notify the emergency department health care provider.

D. Call the pharmacy to send the reversal agent.

ANS: C Rationale: The nurse determines that the first possible cause for prolonged paralysis, decreased plasma cholinesterase, is not likely since the client has no history of liver disease or takes any medications, OTCs, or alcohol that could interact with succinylcholine. The client most likely has a genetic condition, atypical plasma cholinesterase, which prolongs the effects of the drug up to many hours after administration. The drug should be quick acting and wear off within 10 minutes.

Reassuring the client that it will wear off shortly is not the best action to take. The extended paralysis is an adverse effect. The ED health care provider needs to be notified, so orders for sedation and pain relief may be provided. The client will need to go to the intensive care unit and receive care until the drug effects will resolve on its own. There is no reversal agent for succinylcholine.

PTS: 1 REF: p. 1012, Depolarizing Neuromuscular Blocking Agent OBJ: 8 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 51: Drug Therapy With General Anesthetics KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Choice

Chapter 52, Drug Therapy for Migraine and Other Headaches 1. A client suffering from migraine headaches is prescribed sumatriptan. What is the action of the drug?

A. Binding to phospholipids to diminish anxiety B. Interrupting the calcium intake in the neuron C. Binding to serotonin to produce vasoconstriction D. Reducing inflammation in the temporal arteries ANS: C Rationale: Sumatriptan binds to the serotonin receptors in the intracranial blood vessels, resulting in vasoconstriction. Sumatriptan does not bind to phospholipids to diminish anxiety. Sumatriptan does not interrupt the calcium intake in the neuron. Sumatriptan does not reduce inflammation in the temporal arteries.

PTS: 1 REF: p. 1027, Triptans OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client who has been diagnosed with migraine headaches develops bruising and asks the nurse the reason for the bruising. When reviewing the client’s medication history, the nurse would interpret the presence of what substance as indicating the client could be experiencing decreased platelet aggregation?

A. Feverfew B. Chondroitin C. Glucosamine D. Celecoxib ANS: A Rationale: The administration of feverfew for migraine headaches places the client at risk for bleeding due to the herbal supplement’s antiplatelet effects. The client is unlikely to be taking the other options for migraines.

PTS: 1 REF: p. 1032, Herbal and Vitamin Supplements OBJ: 8 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. The nurse is providing education to a client who has been newly diagnosed with migraines. What information should the nurse include in the teaching?

A. The etiology of migraines is thought to have a genetic component.

B. Migraines are typically the result of prolonged psychosocial stress.

C. Migraines can be a precursor to transient ischemic attacks (TIAs) or stroke.

D. The pathophysiology of migraine headaches involves a disruption in the limbic system.

ANS: A Rationale: Migraines demonstrate a familial pattern, and authorities believe that they are inherited as autosomal dominant traits with incomplete penetrance. Stress may precipitate a migraine, but this is not an aspect of the etiology (cause). They are not a precursor to TIAs or stroke, and they do not involve disruption of the limbic system.

PTS: 1 REF: p. 1019, Overview of Headaches OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client describes headaches as “utterly debilitating” and tells the nurse, “It’s hard to explain, but I always know when one is coming.” This client’s statement suggests what diagnosis?

A. Migraines B. Cluster headaches C. Tension headaches D. Ischemic headaches ANS: A Rationale: The severity of the headaches coupled with the fact that client experiences a prodrome suggests migraines. This clinical presentation is not typical of cluster headaches or tension headaches. Ischemic headache is not a recognized subtype.

PTS: 1 REF: p. 1019, Overview of Headaches OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. A client has been prescribed naproxen for relief from migraines. The nurse should recognize that the drug achieves a therapeutic effect through which means?

A. Demyelinating pain fibers in the CNS B. Selectively antagonizing opioid receptors in the CNS C. Inhibiting the synthesis of COX-1 and COX-2 D. Slowing the reuptake of serotonin and acetylcholine in brain synapses ANS: C Rationale: Naproxen, prescribed for migraines, is a nonselective inhibitor of cyclooxygenase resulting in the inhibition of prostaglandin synthesis of COX-1 and COX-2. It does not involve serotonin, acetylcholine, or opioid receptors.

PTS: 1 REF: p. 1022, Nonsteroidal Anti-Inflammatory Agents OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

6. A nurse has administered a scheduled dose of naproxen to a hospital client who has been taking the drug for the past several weeks. What assessment finding should cause the nurse to suspect that the client is experiencing adverse effects of long-term therapy?

A. There is an increase in the client’s neutrophils but no increase in temperature.

B. The client’s stool tests positive for occult blood.

C. The client complains of itchy, dry skin.

D. The client has peripheral edema, and there is a steady increase in the client’s weight.

ANS: B Rationale: Gastrointestinal (GI) bleeding is a significant adverse effect of naproxen. This drug does not typically cause leukocytosis, dry skin, or fluid imbalances.

PTS: 1 REF: p. 1022, Nonsteroidal Anti-Inflammatory Agents OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 7. A client with a history of migraine headaches self-medicates with an over-the-counter medication that contains a common combination of drugs. The nurse recognizes the client is medicating with a combination of which drugs? Select all that apply.

A. Codeine B. Acetaminophen C. Aspirin D. Caffeine E. Naproxen ANS: B, C, D Rationale: The combination of acetaminophen, aspirin, and caffeine may be effective for the treatment of headaches. Combination drugs that include naproxen or codeine typically require a prescription.

PTS: 1 REF: p. 1023, Acetaminophen, Aspirin, and Caffeine OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 8. A client diagnosed with migraines expresses interest in taking an over-the-counter acetaminophen, aspirin, and caffeine combination drug. Which information presented in the client’s history should prompt the nurse to discourage the client from taking the drug?

A. The client has not adhered to previous treatment regimens.

B. The client has a chronic venous ulcer on the lower leg.

C. The client has a diagnosis of liver cirrhosis.

D. The client is a smoker.

ANS: C Rationale: Clients diagnosed with hepatic impairment should not receive this combination agent on an ongoing basis. They may not metabolize acetaminophen in this combined medication effectively, leading to hepatotoxicity. Lack of previous adherence, cigarette smoking, and the presence of skin ulcers do not necessarily contraindicate the use of this drug.

PTS: 1 REF: p. 1023, Acetaminophen, Aspirin, and Caffeine OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 9. A client who is 14 weeks pregnant requests a prescription for ergotamine to help manage migraine headaches that have become increasingly more severe and frequent in recent months. How will this client’s current health status affect the nurse’s response to this request?

A. The client can safely use ergotamine but must be monitored for blood dyscrasias.

B. The client must use a reduced dose of ergotamine until she has given birth.

C. The client must wait until she has given birth before taking ergotamine.

D. The client cannot safely take ergotamine until she has weaned her infant.

ANS: D Rationale: Pregnancy and lactation are contraindications to the use of ergotamine.

PTS: 1 REF: p. 1025, Ergot Alkaloids OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A client has been treated for migraines on an ongoing basis, and the health care provider has prescribed sumatriptan. What statement made by the nurse reflects the priority education intervention for a client prescribed sumatriptan?

A. “You might get dizzy and light-headed after you take sumatriptan, but this is normal.”

B. “It’s important that you never take acetaminophen within 12 hours of sumatriptan.”

C. “Make sure that you stop taking ergotamine before you get this prescription filled.”

D. “You will likely experience a brief worsening of your migraine before this drug relieves the pain.”

ANS: C Rationale: It is important to ask the client about recent administration ergot alkaloids.

The ergot alkaloids should not be given within 24 hours of the administration of triptans.

Signs of low blood pressure should be reported promptly, and there is no particular reason to avoid acetaminophen. Triptans do not make symptoms worse before they provide relief.

PTS: 1 REF: p. 1027, QSEN Alert: Safety OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 11. The nurse is providing education to a client who has been prescribed sumatriptan. In order to maximize therapeutic benefit while reducing the risk of adverse effects, the nurse should encourage the client to implement which intervention?

A. Take the medication before breakfast each day.

B. Take the medication on days when migraines may be anticipated.

C. Take the medication as soon as the earliest symptoms of migraine are sensed.

D. Take the medication when the pain of a migraine becomes too much to bear.

ANS: C Rationale: It is important to administer sumatriptan at the onset of migraine symptoms.

The drug is not taken on a daily, scheduled basis and is not used as a preventative treatment.

PTS: 1 REF: p. 1027, Triptans OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. The nurse is reviewing the medication history of a client newly diagnosed with cluster headaches. The client’s concurrent use of what medication would contraindicate treatment with frovatriptan?

A. Albuterol B. Metformin C. Atorvastatin D. Fluoxetine ANS: D Rationale: Frovatriptan interacts unfavorably with selective serotonin reuptake inhibitors and may lead to serotonin syndrome. Neither albuterol, metformin, nor atorvastatin presents a risk for drug interactions.

PTS: 1 REF: p. 1027, Triptans OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. A client diagnosed with migraines associated with the menstrual cycle has been prescribed estradiol. When providing client teaching, what preferred route of administration will the nurse describe?

A. Intravenous B. Transcutaneous C. Intramuscular

D. Sublingual ANS: B Rationale: It is thought that the natural decline in estrogen in the late luteal phase of the menstrual cycle, prior to menstruation, is associated with the increased risk of migraine.

Transcutaneous administration of estradiol prevents migraines by minimizing this decline. Estradiol is not administered by the other routes for migraine prevention.

PTS: 1 REF: p. 1030, Estrogen OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 14. A client diagnosed with migraines has been prescribed gabapentin. When providing client teaching, how will the nurse explain the role of the drug in treatment?

A. It reduces the intensity of menstrual migraines.

B. It prevents migraines from occurring.

C. It relieves acute migraine pain.

D. It lengthens the aura that precedes a migraine.

ANS: B Rationale: Studies have shown that gabapentin is effective in reducing the frequency of migraines. Gabapentin is not an abortive treatment nor does it appear to affect pain or the nature of an aura.

PTS: 1 REF: p. 1031, Gamma-Aminobutyric Acid OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 15. The nurse is providing education to a client about safe administration of prochlorperazine. What teaching point should the nurse include?

A. “Take the pill whole; do not crush or split it.”

B. “You will need to have a bimonthly complete blood count drawn.”

C. “Avoid taking the drug after eating fatty foods.”

D. “Be aware that hypotension is a potential adverse effect.”

ANS: A Rationale: When taking prochlorperazine orally, it is important to swallow it whole and not chew or crush the tablets. Blood work is not warranted, and there is no need to avoid fatty food prior to taking the drug. Prochlorperazine is not noted to cause hypotension.

PTS: 1 REF: p. 1033, Adjuvant Medications for Migraine Headaches OBJ: 9 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Choice

16. The nurse is educating an older adult client diagnosed with migraine headaches about the prescribed naproxen sodium for abortive therapy. Which statement made by the client establishes the need for further clarification?

A. “I will take the drug when I begin to experience my aura of smelling something burning.”

B. “Biofeedback and yoga will also help to decrease the frequency and severity of migraines.”

C. “I can take up to 1200 mg in 24 hours because the package states this as the maximum dosage.”

D. “The tablets should never be crushed, cut, or chewed, and the drug needs to be taken with a meal.”

ANS: C Rationale: The nurse needs to clarify the statement that the client made regarding planning to take up to the maximum dosage of 1200 mg per 24-hour period because older adults should not take more than 200 mg twice a day. The older adult through aging has less renal clearance and decreased liver metabolism. The FDA issued a black box warning regarding increased risk of GI bleeding and cardiovascular events, warranting a careful approach with the older adult and the reduced dosage. The other statements are correct. Taking the drug when the aura begins will help the drug to take effect within 1 hour and peak action of 1 to 2 hours. The client with migraines experiences fewer migraines when gaining adequate rest and relief from stress from various methods, including biofeedback and yoga. The tablets if crushed, cut, or chewed will be less effective because the tablets are sustained release. Taking the tablets with meals will help decrease GI upset.

PTS: 1 REF: p. 1022, Nonsteroidal Anti-Inflammatory Agents OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 17. The nurse is educating a young adult client diagnosed with migraine headaches about the prescribed acetaminophen–aspirin–caffeine combination for abortive therapy. Which statement made by the client establishes the need for further clarification?

A. “The caffeine in the drug helps the vessels in my brain to constrict and helps stop the headache.”

B. “I can take my over-the-counter cold remedies in addition to this drug for cold symptoms.”

C. “I should not take this drug if I plan on becoming pregnant or later want to breastfeed.”

D. “While I am taking this drug, I should not consume any foods or drinks high in caffeine.”

ANS: B

Rationale: The nurse needs to clarify the statement that the client made regarding planning to take over-the-counter (OTC) cold remedies because the preparations usually contain acetaminophen, aspirin, or caffeine. The nurse should always teach clients to consult a pharmacist to prevent potential drug interactions or overdoses of same or similar ingredients found in various OTC preparations. The other statements are correct.

Caffeine leads to vasoconstriction; this helps stop the migraine, which results from vasodilation of the vessels. The medication is contraindicated during pregnancy and breastfeeding. Consuming foods or drinks high in caffeine would increase risk for restlessness, tremors, tachycardia, hypertension, and palpitations from extra irregular heartbeats.

PTS: 1 REF: p. 1023, Acetaminophen, Aspirin, and Caffeine OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 18. The nurse is educating a young adult client diagnosed with migraine headaches about the prescribed intranasal sumatriptan for abortive therapy. Which statement made by the client indicates the need for further clarification?

A. “The onset of the drug is quick and it peaks in 90 minutes, so I will take before lying down.”

B. “I will take my blood pressure after taking the drug and notify my prescriber if I become hypertensive.”

C. “The intranasal spray will cause irritation to my nose and throat and a bad taste in my mouth.”

D. “I will administer 2 sprays into one nostril and repeat every 2 hours if needed.”

ANS: D Rationale: The nurse needs to clarify the statement regarding the method of administration. The client should administer one spray into each nostril; the client can repeat this a single time after 2 hours, if needed. The other statements are correct. The client should take the drug, check the blood pressure, and report hypertension to the prescriber. The drug has a rapid onset and peaks in 90 minutes. After taking the drug, the client should lie down and rest in a quiet, dark, cool place for 2 to 3 hours. The drug can cause dizziness and vertigo, so lying down provides safety, too. The intranasal spray irritates the mucosa of the nostrils and throat, has an unpleasant taste, and can cause nausea.

PTS: 1 REF: p. 1027, Triptans OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice

19. A client is admitted to the emergency department with a migraine headache unrelieved with current prescribed medications. The nurse administers prescribed ketorolac tromethamine 30 mg IV and metoclopramide 10 mg IV, and the client suddenly develops involuntary movement of upper limbs, facial grimacing, sticking out the tongue rhythmically, contractures of the neck and head to one side in a twisting motion, and rapid involuntary spasms of eyelids. Which action would the nurse implement first?

A. Provide a quiet, cool, dark environment to rest.

B. Receive a prescription for diphenhydramine and administer.

C. Assess for pain relief using a pain scale.

D. Monitor for urinary retention and report it if detected.

ANS: B Rationale: The client has developed a hypersensitivity reaction to metoclopramide resulting in dystonia (involuntarily movement of the limbs, face, head, and neck and rapid blinking of eyes with spasms). The nurse should inform the prescriber of the dystonia and receive and administer the antidote, diphenhydramine. The hypersensitivity reaction could affect respiration or swallowing, so it may become life threatening, if not treated promptly. The other actions may follow the first necessary action. Provide an environment to promote rest. Next, assess for pain relief, the therapeutic effect of ketorolac. Monitor for urinary retention, a potential adverse reaction of the anticholinergic action of metoclopramide.

PTS: 1 REF: p. 1033, Adjuvant Medications for Migraine Headaches OBJ: 9 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 52: Drug Therapy for Migraine and Other Headaches KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice

Chapter 53, Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders 1. A client diagnosed with a left temporal brain tumor reports an odor of ammonia just prior to experiencing rapid rhythmic jerking movements. What is the odor of ammonia classified as?

A. Chemical agent evoked by the tumor B. An aura prior to the seizure activity C. The metastatic process of tumor growth D. The inhibition of serotonin and acetylcholine ANS: B Rationale: The smell of ammonia is an aura, which is a warning prior to seizure activity.

The tumor will not evoke a chemical agent prior to the seizure. The metastatic process will not evoke a chemical smell. The chemical smell is not related to the inhibition of serotonin and acetylcholine.

PTS: 1 REF: p. 1038, Overview of Epilepsy OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client prescribed phenytoin for a seizure disorder has recently run out of medication and has not obtained a refill. What is the client at risk for developing?

A. Hypotension B. Migraine headaches C. Status epilepticus D. Depression ANS: C Rationale: In a person taking medications for a diagnosed seizure disorder, the most common cause of status epilepticus is abruptly stopping antiepileptic drugs. Abruptly stopping phenytoin will not cause hypotension, migraine headaches, or depression.

PTS: 1 REF: p. 1038, Overview of Epilepsy OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. A client who has been taking medication for a seizure disorder is asking the nurse about getting pregnant. Why is pregnancy discouraged in women who are being treated for seizure disorders?

A. Seizure disorders are genetic.

B. Seizure disorders are familial.

C. Antiepilepsy drugs decrease fertility.

D. Antiepilepsy drugs are teratogenic.

ANS: D

Rationale: Antiepileptic drugs must be used cautiously during pregnancy because they are teratogenic. Seizure disorders are not genetic or familial. Antiepilepsy medications do not decrease fertility.

PTS: 1 REF: p. 1073, Key Concepts OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. What effect will severe dehydration and a decreased albumin level have on a client’s prescribed dose of phenytoin?

A. Potentially cause a toxic serum level B. Result in a reduced serum level C. Trigger increased seizure activity D. Increase the risk for a thromboembolism ANS: A Rationale: Phenytoin is highly bound to plasma proteins and only a fraction is not bound to albumin; hypoalbuminemia will result in toxic serum levels of phenytoin. A reduced serum level of phenytoin will not be seen with hypoalbuminemia. The medication will not increase seizure activity nor increase the risk of a thromboembolism.

PTS: 1 REF: p. 1048, Hydantoins OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. The nurse has been educating the client about the self-administration of phenytoin.

Which statement by the client demonstrates an understanding of the medication?

A. “I can purchase whichever brand is cheapest each month.”

B. “All brands of phenytoin are equal in strength and action.”

C. “I should not change brands without checking with my health care provider.”

D. “I will take aspirin for a headache.”

ANS: C Rationale: All brands of phenytoin are not the same. If a client taking one form of phenytoin switches to another, there is a risk of serum phenytoin levels that are too high or too low, toxicity or loss of therapeutic effectiveness, and seizures. The client should not change forms except at the direction of the prescribing health care provider. If cost is a concern, the client should discuss the issue with the health care provider. The administration of acetylsalicylic acid is contraindicated with phenytoin.

PTS: 1 REF: p. 1046, Gamma-Aminobutyric Acid Structural Analogs OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

6. A client is diagnosed with trigeminal neuralgia. What antiepileptic agent may be used to treat this disorder?

A. Phenytoin B. Carbamazepine C. Fosphenytoin D. Ethosuximide ANS: B Rationale: Carbamazepine is prescribed to treat trigeminal neuralgia. Neither phenytoin, fosphenytoin, nor ethosuximide is administered for trigeminal neuralgia.

PTS: 1 REF: p. 1051, Table 53.6 OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. A child suffers from absence seizures. What is the drug of choice for absence seizures?

A. Phenytoin B. Carbamazepine C. Fosphenytoin D. Ethosuximide ANS: D Rationale: Ethosuximide is the drug of choice for absence seizures. Phenytoin and fosphenytoin are not recommended for absence seizures. Carbamazepine is typically prescribed for generalized tonic–clonic and mixed seizures.

PTS: 1 REF: p. 1057, Succinimides OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 8. A client with impaired liver function is suffering from a seizure disorder, which is noted to consist of partial seizures. Which medication might the health care provider prescribe to avoid risks associated with impaired liver function?

A. Oxcarbazepine B. Fosphenytoin C. Carbamazepine D. Levetiracetam ANS: D Rationale: Levetiracetam is not metabolized in the liver. The other three medications are metabolized in the liver.

PTS: 1 REF: p. 1062, Pyrrolidine Derivatives OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. During surgery to repair a ruptured Achilles tendon, the client develops severe muscle contractions and a dramatic rise in body temperature. Which medication will be administered?

A. Dantrolene sodium B. Baclofen C. Carisoprodol D. Cyclobenzaprine ANS: A Rationale: The signs indicated in the scenario suggest malignant hyperthermia. Of the choices offered, dantrolene is the only agent used to treat the condition.

PTS: 1 REF: p. 1070, Direct-Acting Skeletal Muscle Relaxants OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. Which muscle relaxant is contraindicated due to the client’s history of porphyria?

A. Baclofen B. Carisoprodol C. Diazepam D. Dantrolene ANS: B Rationale: Carisoprodol is used to relieve discomfort from acute, painful musculoskeletal disorders. It is contraindicated in clients diagnosed with intermittent porphyria. Neither baclofen, diazepam, nor dantrolene is known to be contraindicated in clients diagnosed with intermittent porphyria.

PTS: 1 REF: p. 1066, Carbamate Derivatives OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 11. The nurse is caring for a client who is receiving cyclobenzaprine for relief of muscle spasms. What adverse effect should the nurse assess for?

A. Muscle spasms B. Insomnia C. Drowsiness D. Urinary incontinence ANS: C

Rationale: A common adverse effect with cyclobenzaprine is drowsiness. The client will not experience muscle spasms, insomnia, or urinary incontinence as a result of this medication therapy.

PTS: 1 REF: p. 1071, Tricyclic Antidepressant Derivatives OBJ: 7 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. The nurse is providing education to a client who has been prescribed dantrolene. What serious adverse effect should the nurse mention during teaching?

A. Metabolic acidosis B. Hypercarbia C. Renal calculi D. Hepatitis ANS: D Rationale: The most serious adverse effect of oral dantrolene is fatal hepatitis. Metabolic acidosis, hypercarbia, and renal calculi are not adverse effects of oral dantrolene.

PTS: 1 REF: p. 1070, Direct-Acting Skeletal Muscle Relaxants OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. The nurse is providing education to a client who has been prescribed tizanidine. What adverse effect should the nurse mention during teaching?

A. Hypotension B. Dark black urine C. Excessive salivation D. Eczema ANS: A Rationale: Hypotension is the most significant adverse effect of tizanidine. Dark black urine, excessive salivation, and eczema are not adverse effects of tizanidine.

PTS: 1 REF: p. 1072, Imidazoline Derivatives OBJ: 7 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. What medication may be administered intravenously (IV) to assist in reducing status epilepticus seizure activity?

A. Diazepam B. Ethosuximide

C. Insulin D. Meperidine ANS: A Rationale: IV diazepam is an adjunctive skeletal muscle relaxant administered for the treatment of severe recurrent convulsive seizures and status epilepticus. Ethosuximide is prescribed for absence seizures, myoclonic seizures, and akinetic epilepsy. Neither meperidine nor insulin is administered for status epilepticus.

PTS: 1 REF: p. 1043, Benzodiazepines OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 15. The nurse has been educating the client about the self-administration of phenytoin.

Which statement made by the client demonstrates an understanding of the medication?

A. “I’ll only take the drug when I feel an impending seizure.”

B. “I’ll reduce my dose if I remain seizure free.”

C. “I’ll make sure to take the drug with food.”

D. “I’ll stop taking the drug if I don’t have a seizure for 8 weeks.”

ANS: C Rationale: Phenytoin should be taken with food to reduce the chance of stomach upset. It should be taken on a regular basis and not only when a seizure occurs. The client should not arbitrarily reduce the dose of phenytoin. Abrupt cessation can cause seizures.

PTS: 1 REF: p. 1050, Box 53.8 OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand NOT: Multiple Choice 16. The nurse has administered gabapentin to a client. Following administration, the nurse should assess the client for what possible adverse effect?

A. Tetany B. Hypertension C. Paradoxical seizures D. Central nervous system (CNS) depression ANS: D Rationale: The most common adverse effects of gabapentin are associated with CNS depression and include dizziness, somnolence, insomnia, and ataxia. The drug has not been noted to cause tetany, hypertension, or paradoxical seizures.

PTS: 1 REF: p. 1046, Gamma-Aminobutyric Acid Structural Analogs OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Choice

17. A client has been started on cyclobenzaprine. For the duration of treatment with cyclobenzaprine, the nurse should teach the client to eliminate what?

A. Over-the-counter vitamin supplements B. Alcohol C. Stool softeners D. Fatty foods ANS: B Rationale: Increased central nervous system (CNS) depression occurs when cyclobenzaprine is combined with alcohol or other CNS depressants. There is no particular need for the client to avoid fatty foods, stool softeners, or vitamin supplements.

PTS: 1 REF: p. 1071, Tricyclic Antidepressant Derivatives OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. Which medication will inhibit the release of calcium in skeletal muscle cells to minimize the development of muscle contractions?

A. Dantrolene sodium B. Baclofen C. Carisoprodol D. Cyclobenzaprine ANS: A Rationale: Dantrolene sodium relieves spasticity by inhibiting the release of calcium in skeletal muscle cells. All the remaining options act centrally.

PTS: 1 REF: p. 1070, Direct-Acting Skeletal Muscle Relaxants OBJ: 8 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 53: Drug Therapy for Seizure Disorders and Skeletal Muscle Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 54, Drug Therapy for Anxiety and Insomnia 1. The nurse is preparing to administer prescribed diazepam intravenously to a client. How soon after administration does the nurse expect to observe onset of action?

A. Under 1 minute B. 1 to 5 minutes C. 7 to 10 minutes D. More than 10 minutes ANS: B Rationale: Intravenous diazepam is administered intravenously to decrease seizure activity and has a 1- to 5-minute onset of action.

PTS: 1 REF: p. 1080, Benzodiazepines OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client diagnosed with insomnia is prescribed flurazepam. This medication has a longer half-life than 24 hours. Which contributes to the long half-life of this medication and other benzodiazepines?

A. Metabolism by cytochrome P-450 B. Presence of active metabolites C. Excretion by the renal system D. Movement of calcium in the cell ANS: B Rationale: Benzodiazepines differ mainly in their plasma half-lives, production of active metabolites, and clinical uses. Drugs with half-lives longer than 24 hours form active metabolites that also have long half-lives and tend to accumulate, especially in older adults and people with impaired liver function. Flurazepam is not metabolized by cytochrome P-450. Flurazepam is excreted in the renal system, but this does not contribute to the long half-life. Flurazepam does not contribute to movement of calcium in the cell.

PTS: 1 REF: p. 1080, Benzodiazepines OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. The nurse is caring for a client suspected of experiencing benzodiazepine toxicity.

Which medication does the nurse expect the health care provider to prescribe?

A. Olmesartan medoxomil B. Pancrelipase C. Pamidronate disodium D. Flumazenil ANS: D

Rationale: Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil is a specific antidote that competes with benzodiazepines for benzodiazepine receptors and reverses toxicity. Olmesartan medoxomil is an angiotensin II receptor antagonist that is used to treat hypertension.

Pancrelipase is used for enzyme replacement therapy. Pamidronate disodium is used as a bone metabolism regulator.

PTS: 1 REF: p. 1083, Adverse Effects OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A client has been administered flumazenil because of the toxic effects of benzodiazepines. The client should be observed for acute benzodiazepine withdrawal symptoms. Which sign or symptom is indicative of acute benzodiazepine withdrawal?

A. Tachycardia B. Seizures C. Lethargy D. Coma ANS: B Rationale: Signs and symptoms of acute benzodiazepine withdrawal symptoms include agitation, confusion, and seizures. Tachycardia, lethargy, and coma are not signs of acute benzodiazepine withdrawal.

PTS: 1 REF: p. 1084, Assessing for Adverse Effects OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. The nurse is caring for an older adult client who has been newly diagnosed with insomnia. What medication does the nurse expect the health care provider to prescribe?

A. Alprazolam B. Clonazepam C. Diazepam D. Temazepam ANS: D Rationale: Temazepam is the drug of choice for insomnia in older adults, those with liver disease, or those taking drugs that interfere with hepatic drug–metabolizing enzymes.

Alprazolam is prescribed for anxiety and panic disorder, clonazepam for panic disorders, and diazepam for antianxiety, hypnotic, and anticonvulsant purposes.

PTS: 1 REF: p. 1084, Other Drugs in the Class OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Analyze

NOT: Multiple Choice

6. A child is administered a benzodiazepine. How will the child’s dose differ from an adult’s dose?

A. It will be the same as an adult’s.

B. It will be the same as the dose for an older adult client.

C. It will be higher.

D. It will be lower.

ANS: D Rationale: Children will require a smaller dose of benzodiazepines for their size and weight.

PTS: 1 REF: p. 1081, Table 54.2 OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client’s medication regimen for the treatment of anxiety has been changed from a benzodiazepine. The client asks the nurse what likely prompted the health care provider to change the medication. What is the nurse’s best response?

A. “Your health care provider may have been concerned about causing depression.”

B. “Your health care provider may have been worried about the possibility of convulsions.”

C. “Long-term use of benzodiazepines can result in dependency.”

D. “Long-term use of benzodiazepines can cause insomnia.”

ANS: C Rationale: Although benzodiazepines are effective anxiolytics, long-term use is associated with concerns over tolerance, dependency, withdrawal, lack of efficacy for treating the depression that often accompanies anxiety disorders, and the need for multiple daily dosing with some agents. They do not cause insomnia, convulsions, or depression.

PTS: 1 REF: p. 1080, Benzodiazepines OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 8. The nurse is assessing a client with a suspected diagnosis of acute benzodiazepine withdrawal. What assessment findings would support that diagnosis? Select all that apply.

A. Bradycardia B. Agitation C. Lethargy D. Anhidrosis E. Palpitations

ANS: B, E Rationale: Common signs and symptoms of withdrawal include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations.

Bradycardia, lethargy, and anhidrosis are not expected signs of withdrawal.

PTS: 1 REF: p. 1084, Assessing for Adverse Effects OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 9. An older adult client diagnosed with generalized anxiety disorder is prescribed a benzodiazepine. The nurse caring for the client knows to include what intervention in the client’s care plan?

A. Seizure precautions B. Falls risk assessment C. Frequent dysrhythmias monitoring D. Education regarding sexual dysfunction ANS: B Rationale: Adverse effects of benzodiazepines (e.g., drowsiness, dizziness) may contribute to falls and other injuries unless clients are carefully monitored and safeguarded. Seizures, dysrhythmias, and sexual dysfunction are not characteristic adverse effects.

PTS: 1 REF: p. 1083, Use in Older Adults OBJ: 3 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. The nurse is developing a care plan for a child diagnosed with night terrors who is prescribed diazepam. The nurse should include monitoring for development of what disorder in the care plan?

A. Insomnia B. Dependence C. Mood disorders D. Hepatotoxicity ANS: C Rationale: Children may be more sensitive to its effects of this drug, namely mood and/or mental changes. Hepatotoxicity, insomnia, and dependence are not among the most common adverse effects.

PTS: 1 REF: p. 1083, Use in Children OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

11. In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill client?

A. Increased diffusion and perfusion B. Decreased cardiac workload C. Increased level of consciousness D. Decreased blood pH ANS: B Rationale: Antianxiety and sedative–hypnotic drugs are often useful in critically ill clients to relieve stress, anxiety, and agitation. Their calming effects decrease cardiac workload (e.g., heart rate, blood pressure, force of myocardial contraction, myocardial oxygen consumption) and respiratory effort. They do not decrease blood pH, increase diffusion and perfusion, or increase level of consciousness.

PTS: 1 REF: p. 1083, Use in Patients With Critical Illness OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A client is scheduled to undergo a bronchoscopy for the investigation of a bronchial mass. What benzodiazepine should the clinic nurse anticipate administering for conscious sedation?

A. Triazolam B. Midazolam C. Oxazepam D. Chlordiazepoxide ANS: B Rationale: Midazolam is frequently used for conscious sedation during invasive procedures. None of the remaining options are used for conscious sedation.

PTS: 1 REF: p. 1084, Other Drugs in the Class OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 13. The etiology of anxiety involves which physiologic process?

A. Stimulation of the parasympathetic nervous system B. Stimulating effects of somatotropin C. Increased activation of the autonomic nervous system D. Adrenocortical suppression ANS: C

Rationale: Clinical manifestations of anxiety include overactivity of the autonomic nervous system, such as dyspnea, palpitations, tachycardia, sweating, dry mouth, dizziness, nausea, and diarrhea. Somatotropin is not directly involved, and the adrenal cortex is not suppressed during times of anxiety. The parasympathetic nervous system is not stimulated during times of anxiety.

PTS: 1 REF: p. 1077, Overview of Anxiety OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 14. What aspect of a client’s health is most likely to cause insomnia?

A. Hypothyroidism B. Morbid obesity C. Chronic pain D. Type 2 diabetes ANS: C Rationale: Chronic pain is commonly associated with insomnia. Diabetes, obesity, and hypothyroidism are not normally associated with insomnia.

PTS: 1 REF: p. 1079, Overview of Sleep and Insomnia OBJ: 2 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 15. A client has been prescribed a benzodiazepine daily for the treatment of an anxiety disorder. In order to minimize the chances of withdrawal symptoms, the nurse knows to include what precaution in client teaching?

A. Tapering the dose of drug over a prolonged period of time B. Replacing the drug with a herbal supplement in anticipation of stopping the medication C. Substituting the immediate-acting form of the drug with a long-acting form D. Exchanging the drug for an anticonvulsant ANS: A Rationale: To avoid withdrawal symptoms, it is necessary to taper benzodiazepines gradually before discontinuing them completely. Long-acting benzodiazepines, anticonvulsants, and herbal remedies are not recommended in the effort to prevent withdrawal.

PTS: 1 REF: p. 1080, Benzodiazepines OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

16. A client in intensive care has been prescribed both lorazepam and hydromorphone. The nurse should prioritize what assessments for the client?

A. Arterial blood gases B. Respiratory rate and oxygen saturation C. Deep tendon reflexes and pupillary response D. Cardiac rate and rhythm ANS: B Rationale: The combination of opioids and benzodiazepines creates a significant risk for central nervous system depression; respiratory function is consequently an important focus of assessment. It would likely supersede other assessments, even though each may be warranted.

PTS: 1 REF: p. 1080, Benzodiazepines OBJ: 5 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. Three days after discontinuing diazepam with medical guidance, an older adult client continues to demonstrate impaired memory and confusion. The nurse should consider what possible explanation for the client’s current status?

A. Benzodiazepines can occasionally cause permanent alterations in personality and level of consciousness.

B. The client may have decreased liver function.

C. The client may have been experiencing a hypersensitivity to the drug, rather than an adverse effect.

D. The adverse effects of benzodiazepines can persist for several days after stopping the drug.

ANS: D Rationale: Both therapeutic effects and adverse effects of diazepam are more likely to occur after 2 or 3 days of therapy than initially. Such effects accumulate with chronic usage and persist for several days after the drug is discontinued. Hypersensitivity and decreased liver function are unlikely. Benzodiazepines do not cause permanent changes in cognition.

PTS: 1 REF: p. 1083, Use in Older Adults OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 18. A client reports being prescribed a hypnotic for the treatment of chronic insomnia. What drug does the nurse suspect the client is taking?

A. Lorazepam B. Eszopiclone C. Zaleplon D. Oxazepam

ANS: B Rationale: Eszopiclone is the first oral nonbenzodiazepine hypnotic to receive FDA approval for long-term use (up to 12 months). Zaleplon is a nonbenzodiazepine hypnotic used for short-term treatment (7 to 10 days) of insomnia. Oral lorazepam and oxazepam are benzodiazepines prescribed for anxiety; the latter is also used in the management of alcohol withdrawal.

PTS: 1 REF: p. 1086, Eszopiclone OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 19. A nurse has noted that a newly admitted client has been taking ramelteon for the past several weeks. The nurse is justified in suspecting that this client was experiencing what problem prior to starting this drug?

A. Somnambulism B. Difficulty falling asleep at night C. Early morning waking D. Frequent nighttime awakenings ANS: B Rationale: Ramelteon is use for the long-term treatment of insomnia characterized by difficulty with sleep onset. Ramelteon is not effective in managing any of the other suggested sleep-related issues.

PTS: 1 REF: p. 1087, Ramelteon OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 20. When administering benzodiazepines, which medication should be considered the drug of first choice?

A. Lorazepam B. Estazolam C. Temazepam D. Triazolam ANS: A Rationale: Lorazepam is probably the benzodiazepine of first choice. The drug provides rapid tranquilization of clients experiencing agitation. Administered intravenously, it reduces nausea and vomiting as well as anxiety and induces procedural amnesia.

Lorazepam has a slow onset of action (5 to 20 minutes) because of delayed brain penetration but an intermediate to prolonged duration.

PTS: 1 REF: p. 1084, Other Drugs in the Class OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Choice

21. An adult client with a diagnosis of alcoholism is to be treated with chlordiazepoxide on an in-client basis. When administering chlordiazepoxide, the nurse should implement which client-focused intervention?

A. Monitoring vital signs closely during intravenous (IV) administration B. Administering the oral form of the medication if the client is combative C. Assessing the client’s cardiac status prior to administering each dose D. Promptly stopping the medication once status improvements are noted ANS: A Rationale: The nurse should take the client’s vital signs regularly when giving the IV form of this drug, as well as observe and document subjective and objective reports by the client. Combative clients usually require a parenteral route of administration, and it is unnecessary to perform a full cardiac assessment before each dose. Usage should be tapered, and not stopped abruptly, to prevent rebound central nervous system stimulation.

PTS: 1 REF: p. 1084, Other Drugs in the Class OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 54: Drug Therapy for Anxiety and Insomnia KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 55, Drug Therapy for Depression and Mood Stabilization 1. A client has a history of long periods of depression interspersed with hypomanic episodes. What mood disorder is most likely responsible for these symptoms?

A. Bipolar disorder type I B. Bipolar disorder type II C. Situational depression D. Coping disorder ANS: B Rationale: Bipolar disorder type II is characterized by episodes of major depression plus hypomanic episodes and occurs more frequently in women. Bipolar disorder type I is characterized by episodes of major depression plus mania and occurs equally in men and women. Situation depression lasts a shorter amount of time and is related to life events.

A coping disorder is not related to hypomania.

PTS: 1 REF: p. 1095, Overview of Bipolar Disorder OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 2. A client is admitted for assessment of inappropriately flamboyant and extroverted behavior coupled with risk-taking behaviors. The client reports having periods of major depression but has never sought help before. What mood disorder is most likely responsible for this client’s behaviors?

A. Schizophrenia B. Depression C. Bipolar disorder type I D. Bipolar disorder type II ANS: C Rationale: Bipolar disorder type I is characterized by episodes of major depression plus mania and occurs equally in men and women. Schizophrenia results from abnormal brain synapses and includes a wide variety of diseases. Depression is a mood disorder but does not exhibit periods of mania. Bipolar disorder type II is characterized by episodes of major depression plus hypomanic episodes and occurs more frequently in women.

PTS: 1 REF: p. 1095, Overview of Bipolar Disorder OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 3. A client reports feelings of gloom and the inability to perform activities of daily living.

The normal function of which neurotransmitter is most likely impaired?

A. Acetylcholine B. Epinephrine C. Insulin

D. Serotonin ANS: D Rationale: Serotonin helps regulate several behaviors that are disturbed in depression.

Acetylcholine is a neurotransmitter with action in the cardiac and skeletal muscle.

Acetylcholine has a limited impact in depression. Epinephrine is not associated with depression, though norepinephrine is implicated. Insulin is released by the pancreas to regulate blood sugar.

PTS: 1 REF: p. 1094, Monoamine Neurotransmitter Dysfunction OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. An 8-year-old client has been diagnosed with enuresis. What medication does the nurse suspect the health care provider will prescribe?

A. Amitriptyline B. Duloxetine C. Imipramine D. Venlafaxine ANS: C Rationale: Imipramine is approved for treating childhood enuresis in children older than 6 years. Amitriptyline is a tricyclic antidepressant but is not used for childhood enuresis.

Duloxetine and venlafaxine are serotonin–norepinephrine reuptake inhibitors used for depression.

PTS: 1 REF: p. 1096, Tricyclic Antidepressants OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. While reviewing the medication history of an older adult client, the nurse learns that the client is taking amitriptyline 25 mg three times per day. What adverse effect should the nurse prioritize when incorporating safety measures into the care plan?

A. Incontinence B. Urinary retention C. Dry mouth D. Orthostatic hypotension ANS: D Rationale: Orthostatic hypotension is an adverse effect related to amitriptyline. The nurse should incorporate falls precautions into the care plan. Incontinence is not an adverse effect of amitriptyline. Urinary retention and dry mouth are adverse effects of amitriptyline but do not present the same safety risks posed by orthostatic hypotension.

PTS:

1

REF: p. 1096, Tricyclic Antidepressants

OBJ: 3

NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 6. The nurse is providing education to a male client who has been prescribed fluoxetine.

Which adverse effect should the nurse assess for to help ensure client adherence?

A. Sexual dysfunction B. Hypotension C. Pain and discomfort D. Cardiac dysrhythmia ANS: A Rationale: Fluoxetine is associated with a high incidence of sexual dysfunction, which is a major reason for noncompliance in men. Hypotension, pain or discomfort, and cardiac dysrhythmia are not associated with use of the drug.

PTS: 1 REF: p. 1100, Selective Serotonin Reuptake Inhibitors OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. A client has been prescribed mirtazapine. How will it decrease depression?

A. It increases concentration of endogenous epinephrine.

B. It blocks the presynaptic alpha2-adrenergic receptors.

C. It acts on the dopamine-only receptors in the brain.

D. It inhibits norepinephrine and serotonin reuptake.

ANS: B Rationale: Mirtazapine blocks presynaptic alpha2-adrenergic receptors (which increase the release of norepinephrine), serotonin receptors, and histamine H1 receptors.

Consequently, the drug decreases anxiety, agitation, insomnia, and migraine headaches as well as depression. Mirtazapine’s action on depression and migraine headaches is not related to any of the remaining options.

PTS: 1 REF: p. 1108, Mirtazapine OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 8. A client reports taking a prescribed antidepressant for the treatment of insomnia. What medication does the nurse suspect the client is using?

A. Fluoxetine B. Olanzapine C. Citalopram hydrobromide D. Trazodone

ANS: D Rationale: Trazodone is administered more often for sedation and sleep than depression.

Fluoxetine, olanzapine, and citalopram hydrobromide are not prescribed for sleep.

PTS: 1 REF: p. 1108, Trazodone OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. A client taking prescribed lithium reports being placed on dietary restrictions. The nurse understands that the client’s dose of lithium carbonate should be reduced for what type of diet?

A. Low calorie B. Low carbohydrate C. Low sodium D. Low residue ANS: C Rationale: A low-salt (sodium) diet will impair lithium excretion, so the dose of lithium should be reduced. Low-calorie, low-carbohydrate, and low-residue diets do not require decreasing the dose.

PTS: 1 REF: p. 1108, Mood-Stabilizing Agents: Drugs Used to Treat Bipolar Disorder OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 10. The nurse is reviewing serum levels of a client who is taking lithium. What range does the nurse interpret as appropriate?

A. 0.5 to 1.2 mEq/L B. 1.5 to 2.2 mEq/L C. 2.5 to 3.2 mEq/L D. 3.5 to 4.2 mEq/L ANS: A Rationale: The therapeutic serum lithium level is 0.5 to 1.2 mEq/L. The other ranges indicate toxicity.

PTS: 1 REF: p. 1108, Mood-Stabilizing Agents: Drugs Used to Treat Bipolar Disorder OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice

11. A client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication?

A. SSRIs block GABA function.

B. SSRIs prevent serotonin from being reabsorbed.

C. SSRIs increase serotonin synthesis.

D. SSRIs increase the number of serotonin binding sites.

ANS: B Rationale: Fluoxetine and the other SSRIs block the reabsorption of the neurotransmitter serotonin in the brain. This helps elevate mood. SSRIs do not increase serotonin synthesis or the number of binding sites. They do not influence the role of GABA. PTS: 1 REF: p. 1100, Action OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 12. A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating?

A. Leafy greens B. Salami C. Apples D. Ice cream ANS: B Rationale: When taking a monoamine oxidase inhibitor, such as phenelzine, foods high in tyramine or tyrosine should be avoided. Salami, like other cured and aged meats, is high in tyramine. None of the other listed foods are problematic.

PTS: 1 REF: p. 1099, Box 55.3 OBJ: 3 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. A client who has been prescribed a selective serotonin reuptake inhibitor has begun taking St. John’s wort daily. The nurse should teach the client that this combination may result in what adverse reaction?

A. Worsened symptoms of depression B. Development of blood dyscrasias C. Dangerous drug interactions D. Hemostatic instability ANS: C Rationale: Combining St. John’s wort with antidepressants can cause serious drug-to-drug interactions. These effects do not typically include worsened depression, alterations in coagulation, or dyscrasias.

PTS:

1

REF: p. 1108, Box 55.7

OBJ: 4

NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. An adult client diagnosed with depression several weeks ago began taking citalopram 10 days ago. The client has told the nurse of the intent to stop taking the drug, stating, “I don’t feel any less depressed than I did before I started taking these pills.” How should the nurse best respond to the client’s statement?

A. “I’ll pass that information along to your health care provider; a different drug might be more appropriate for you.”

B. “I’d encourage you to continue with the drug; it can take several weeks before it improves your mood.”

C. “People often have unrealistic expectations about how the drug will make them feel.”

D. “It could be that one of the other medications or supplements you’re taking is negating the effects of citalopram.”

ANS: B Rationale: Steady-state blood levels of selective serotonin reuptake inhibitors like citalopram are achieved slowly, over several weeks. The client should expect to sense an eventual improvement in mood, and it would be premature to change medications. This aspect of pharmacokinetics is more likely than a possible drug interaction. The nurse needs to educate the client, not demean feelings about the therapy.

PTS: 1 REF: p. 1100, Selective Serotonin Reuptake Inhibitors OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. The nurse is caring for a teenage client who has recently been prescribed a selective serotonin reuptake inhibitor. What assessment should the nurse prioritize?

A. Venous thromboembolism (VTE) B. Cardiac rate and rhythm C. Hypomanic state D. Suicidal ideation ANS: D Rationale: The FDA has issued a black box warning alerting health care providers to the increased risk of suicidal ideation in children, adolescents, and young adults 18 to 24 years of age when taking antidepressant medications. VTE, arrhythmias, and hypomania are not likely adverse effects.

PTS: 1 REF: p. 1100, Selective Serotonin Reuptake Inhibitors OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Choice

16. The psychiatric nurse would recognize that venlafaxine’s therapeutic effect is achieved by what means?

A. Slowing the reuptake of endorphins in the central nervous system B. Increasing levels of both serotonin and norepinephrine C. Stimulating synthesis and potentiating the action of dopamine D. Slowing the reuptake of acetylcholine in brain synapses ANS: B Rationale: Venlafaxine increases the levels of serotonin and norepinephrine in the brain by preventing the reuptake of these neurotransmitters known to play an important part in mood. It does not directly affect endorphins or acetylcholine. The drug weakly inhibits dopamine reuptake.

PTS: 1 REF: p. 1103, Serotonin–Norepinephrine Reuptake Inhibitors OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 55: Drug Therapy for Depression and Mood Stabilization KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 56, Drug Therapy for Psychotic Disorders 1. The nurse is caring for a client who has been diagnosed with schizophrenia. The nurse understands that the client’s condition is thought to be most likely related to an increased level of activity of what neurotransmitter?

A. Dopamine B. Norepinephrine C. Acetylcholine D. Adenosine ANS: A Rationale: Scientists have attributed schizophrenia to increased dopamine activity in the brain. The serotonergic and glutamatergic systems are also thought to play a role.

Norepinephrine, acetylcholine, and adenosine are not currently thought to have major involvement in the pathophysiology of schizophrenia.

PTS: 1 REF: p. 1116, Pathophysiology OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client has been prescribed an antipsychotic agent to relieve psychotic symptoms.

Which symptom will be relieved most quickly with the onset of the drug regimen?

A. Hallucinations B. Delusions C. Altered thought D. Combative behavior ANS: D Rationale: Manifestations of hyperarousal, such as anxiety, hyperactivity, insomnia, aggressive, or combative behavior, are relieved more quickly. Symptoms such as hallucinations, delusions, and altered thought processes are relieved when the medication regimen is more effectively established.

PTS: 1 REF: p. 1119, First-Generation Antipsychotics OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. While reviewing a medication history, the nurse sees that a school-age client has been prescribed haloperidol. Based on this information, the nurse suspects that the client may have been diagnosed with what disease process?

A. Muscular dystrophy B. Alzheimer’s disease C. Tourette’s syndrome D. Myasthenia gravis

ANS: C Rationale: Haloperidol is used in treating Tourette’s syndrome in children. It is not used to treat muscular dystrophy, Alzheimer’s disease, or myasthenia gravis.

PTS: 1 REF: p. 1120, Table 56.2 OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. A client is prescribed risperidone for the treatment of schizophrenia. The client is voiding three times each night and is always thirsty. Based on the adverse effects of risperidone, what should the nurse suspect is triggering the client’s reported polyuria and polydipsia?

A. Urinary tract infection B. Diabetes mellitus C. Renal calculi D. Hyperthyroidism ANS: B Rationale: The development of polyuria and polydipsia is indicative of diabetes mellitus.

Risperidone has been associated with weight gain, diabetes, and dyslipidemia. Adverse effects of risperidone do not include urinary tract infection, renal calculus, or the development of hyperthyroidism.

PTS: 1 REF: p. 1126, Second-Generation "Atypical" Antipsychotics OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 5. The nurse is preparing to provide education to a client who has been prescribed clozapine for schizophrenia. What is the most important aspect of client teaching?

A. Maintaining medication regimen B. Reporting signs of neuralgia C. Stopping medications if weight gain occurs D. Limiting alcohol to two drinks per day ANS: A Rationale: The client should be instructed to maintain the medication regimen to control symptoms of schizophrenia. Reporting signs of neuralgia is not taught because the medication does not have this effect. The medications will cause weight gain and should not be stopped in the event that weight gain develops. The use of alcohol is strictly prohibited with antipsychotic agents.

PTS: 1 REF: p. 1129, Box 56.7 OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Teaching/Learning

BLM: Cognitive Level: Apply

NOT: Multiple Choice

6. The nurse should focus on what aspects of care when preparing a caregiver to address the needs of a client who demonstrates psychotic behaviors? Select all that apply.

A. Encouraging the client to avoid people outside of family and friends B. Understanding the nature of the client’s mental health illness C. Encouraging the client to be as independent as is possible D. Being familiar with the available social services in the community E. Keeping all follow-up mental health appointments ANS: B, C, D, E Rationale: Major recurring challenges face clients with psychosis and their caregivers in the home. Supporting efforts to stabilize positive and negative symptoms and cognitive function, take medications as prescribed, manage adverse effects, and obtain follow-up psychiatric care may require the coordinated efforts of several health and social service agencies or providers. Socialization is needed when it is appropriate and safe.

PTS: 1 REF: p. 1117, Drug Therapy OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Select 7. A young client has been prescribed an antipsychotic agent to relieve psychotic symptoms. Which goal of care is the priority?

A. The client will demonstrate independent health maintenance.

B. The client will interact therapeutically with peers.

C. The client will participate in activities of daily living (ADLs).

D. The client will remain safe.

ANS: D Rationale: Safety is a priority over other goals. Goals such as participation in ADLs, health maintenance, and participation in relationships are valid, but safety is a priority.

PTS: 1 REF: p. 1132, The Nursing Process OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 8. The nurse observes that a client with a long history of chlorpromazine therapy demonstrates lip smacking and appears to be chewing continually. The nurse should recognize that this client is likely experiencing what adverse effect of the medication?

A. Tardive dyskinesia B. Akathisia C. Dystonias D. Neuroleptic malignant syndrome ANS: A

Rationale: Tardive dyskinesia occurs as the result of long-term use of chlorpromazine.

Clients may experience lip smacking, tongue protrusion, and facial grimaces and may have choreic movements of the trunk and limbs. Akathisia is a form of restlessness, and dystonias are uncoordinated movements. Neuroleptic malignant syndrome is an acute complication.

PTS: 1 REF: p. 1119, First-Generation Antipsychotics OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 9. The client reports taking a phenothiazine antipsychotic. What medication does the nurse suspect the client has been prescribed?

A. Theophylline B. Haloperidol C. Chlorpromazine D. Thiothixene ANS: C Rationale: Chlorpromazine is the prototype phenothiazine. Theophylline is a xanthine agent administered to treat some respiratory disorders. Haloperidol and thiothixene are nonphenothiazine antipsychotics.

PTS: 1 REF: p. 1119, First-Generation Antipsychotics OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. The nurse is providing education to a client who has been prescribed clozapine. The nurse should emphasize the importance of what monitoring routine during teaching?

A. Weekly liver enzymes B. Daily international normalized ratio (INR) C. Monthly creatinine levels D. Regular complete blood counts ANS: D Rationale: Clozapine is associated with life-threatening decrease in white blood cells (agranulocytosis). It is essential to monitor the complete blood count due to this risk.

Weekly liver enzymes, monthly creatinine levels (kidney function), and INR monitoring (blood clotting function) are not recommended with clozapine therapy.

PTS: 1 REF: p. 1122, Adverse Effects OBJ: 4 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

11. A client with schizophrenia has been taking haloperidol for the past several years. The health care team and the client have collaborated and chosen to transition the client to an atypical antipsychotic in an effort to reduce adverse effects and maximize therapeutic effects. In order to reduce the client’s risk of extrapyramidal effects during the transition from haloperidol to an atypical antipsycotic, the health care team should implement which intervention?

A. Gradually taper the dose of haloperidol.

B. Have a 2- to 3-week “drug holiday” between stopping the haloperidol and starting the atypical antipsychotic.

C. Administer haloperidol and the atypical antipsychotic drug concurrently for 6 to 8 weeks.

D. Arrange for weekly electroconvulsive therapy (ECT) during the time of transition.

ANS: A Rationale: When discontinuing haloperidol, it is essential to taper the dosage to prevent extrapyramidal symptoms. If the medication is abruptly discontinued, the client is at risk for this condition. A drug holiday would exacerbate symptoms, and ECT is not indicated. Concurrent administration of two drugs has the potential to exacerbate adverse effects.

PTS: 1 REF: p. 1124, First-Generation Nonphenothiazines OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A psychiatric nurse is discussing the advantages of atypical antipsychotics with the parents of a teenager who has been diagnosed with schizophrenia. When comparing these drugs with the older, typical antipsychotics, what advantage should the nurse cite?

A. Lower cost B. Possibility of oral administration C. Reduced adverse effects D. Absence of black box warnings ANS: C Rationale: Atypical antipsychotics may be more effective in relieving some symptoms than typical antipsychotics, and they usually produce milder adverse effects. A major drawback is the high cost of these drugs. All antipsychotics are available for the oral route. There are several black box warnings relating to atypical antipsychotics.

PTS: 1 REF: p. 1126, Second-Generation "Atypical" Antipsychotics OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

13. In light of current treatment modalities, the nurse should anticipate that the client newly diagnosed with schizophrenia will most likely be prescribed what drug?

A. Chlorpromazine B. Olanzapine C. Haloperidol D. Fluphenazine ANS: B Rationale: The “atypical” antipsychotics, such as olanzapine, are the drugs of choice, especially for clients who are newly diagnosed with schizophrenia. The other drugs are all “typical” (first-generation) antipsychotics.

PTS: 1 REF: p. 1126, Second-Generation "Atypical" Antipsychotics OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 14. The nurse is preparing to administer oral chlorpromazine to a client. What action should the nurse include in administration?

A. Have the client hold the drug under the tongue for at least 30 seconds.

B. Administer the drug 1 to 2 hours before bedtime.

C. Administer the drug on alternating days.

D. Instruct the client to avoid dairy products for 1 hour before and 2 hours after administration.

ANS: B Rationale: For oral administration of chlorpromazine, the nurse should give doses 1 to 2 hours before bedtime; peak sedation occurs in about 2 hours. The drug is not given on alternating days, and there is no need to avoid dairy products. It is unnecessary for the client to hold the drug under the tongue.

PTS: 1 REF: p. 1119, First-Generation Antipsychotics OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. A client has been achieving an acceptable reduction in the positive and negative signs of schizophrenia after several weeks of treatment with clozapine. The client has asked the nurse if it is acceptable to have “a few drinks from time to time.” How should the nurse best respond to the client’s enquiry?

A. “If you notice that your symptoms are worsening when you drink, you should stop doing it.”

B. “That shouldn’t present a problem, provided you make sure that you’re safe when you do it.”

C. “That’s okay in most cases, but it’s advisable to limit it to beer and wine and to avoid spirits.”

D. “When you’re taking clozapine, it’s best to avoid drinking alcohol altogether.”

ANS: D Rationale: Alcohol increases central nervous system depression in clients taking clozapine; clients should ideally abstain from drinking alcohol. All the other options inappropriately suggest that there is a safe level.

PTS: 1 REF: p. 1119, First-Generation Antipsychotics OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 16. The nurse is preparing to administer chlorpromazine intramuscularly to a client. What action should the nurse implement during administration?

A. Use a 1/2-inch (1.3-cm) needle.

B. Administer the drug into the deltoid muscle.

C. Have the client massage the site for 1 to 2 minutes after the injection.

D. Encourage the client lie down for 30 to 60 minutes after the injection.

ANS: D Rationale: For IM administration of chlorpromazine, the nurse should have the client lie down for 30 to 60 minutes after the injection to prevent orthostatic hypotension.

Massage is unnecessary, and the ventrogluteal site is used. The nurse should use a 11/2-inch (3.8-cm) needle.

PTS: 1 REF: p. 1119, First-Generation Antipsychotics OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. The nurse is assessing a client who has just received haloperidol for an acute psychotic episode. For what therapeutic effect should the nurse initially assess following administration?

A. Increased insight into delusional thinking B. Increased sophistication of thinking C. Decreased agitation and combativeness D. Decreased central nervous system (CNS) stimulation ANS: C Rationale: When haloperidol is given for acute psychotic episodes, the nurse initially observes for sedation as well as decreased agitation, combativeness, and psychomotor activity. Increased insight, increased sophistication of thinking, and decreased CNS stimulation are not considered immediate priorities during an acute psychotic episode.

PTS: 1 OBJ: 3

REF: p. 1124, First-Generation Nonphenothiazines

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 18. A client is observed wandering in the hallways and talking with people who are not present. What behavior does the nurse document the client is experiencing?

A. Paranoia B. Delusions C. Hallucinations D. Depression ANS: C Rationale: The client is experiencing hallucinations, sensory perceptions of people or objects that are not present in the external environment. Delusions are false beliefs that persist in the absence of reason or evidence and are also a symptom of a psychosis.

Persons with paranoia believe that others are attempting to control them or do them harm. The described behaviors are not suggestive of depression, a disorder associated with depressed mood and intense sadness.

PTS: 1 REF: p. 1116, Introduction OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 19. A client admitted to the postanesthesia care unit (PACU) develops confusion and states, “I see bugs up and down the walls. They are going to get me.” What do these behaviors indicate to the nurse?

A. Depression B. Delusions C. Delirium D. Schizophrenia ANS: C Rationale: The client is likely experiencing delirium as a postoperative complication.

Delusions are false beliefs that persist in the absence of reason or evidence.

Schizophrenia is a variety of disorders and not a single symptom. Depression is the expression of sadness and despair.

PTS: 1 REF: p. 1116, Introduction OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 20. The nurse is caring for a client who has been prescribed clozapine. What action should the nurse implement to ensure safe and effective administration?

A. Use a 11/2-inch (3.8-cm) needle for injections.

B. Administer the drug into the ventrogluteal muscle.

C. Review the client history for evidence of seizure disorders.

D. Mix the drug with fruit juice.

ANS: C Rationale: Clozapine is an oral drug. A history of seizure disorders, known allergy to the drug, a history of clozapine-induced agranulocytosis or severe granulocytopenia, and CNS depression all contraindicate its use. Liquid oral chlorpromazine should be mixed with at 60 mL of fruit juice prior to administration. Intramuscular chlorpromazine is injected into the ventrogluteal muscle using a 11/2-inch (3.8-cm) needle.

PTS: 1 REF: p. 1126, Second-Generation "Atypical" Antipsychotics OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 56: Drug Therapy for Psychotic Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 57, Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy 1. A client visits the occupational health office of the factory in which the client works. The client has fallen asleep on the production line and has a history of muscle weakness. This instance is not the first time the client has fallen asleep on the line. These behaviors support which medical diagnosis?

A. Sleep apnea B. Insomnia C. Narcolepsy D. Substance abuse ANS: C Rationale: Narcolepsy is characterized by daytime sleep attacks in which the person goes to sleep at any place or at any time. Sleep apnea is episodes of apnea, temporary cessation of breathing, during sleep. Insomnia is the inability to sleep. This client is not exhibiting signs and symptoms consistent with substance abuse.

PTS: 1 REF: p. 1137, Etiology and Pathophysiology OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 2. A client has been newly diagnosed with narcolepsy. What should the nurse include in client teaching?

A. “Take 250 mg of caffeine daily.”

B. “Avoid jobs that require working in shifts.”

C. “Take a nap every afternoon.”

D. “Increase the methylphenidate dose as needed.”

ANS: B Rationale: The client who is diagnosed with narcolepsy should avoid shift work.

Caffeine use may or may not be indicated. The client should ideally not take naps. The client should not increase the methylphenidate dose without the input of the health care provider.

PTS: 1 REF: p. 1138, Overview of Narcolepsy OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A child is prescribed an amphetamine for attention deficit hyperactivity disorder (ADHD). Which effect provides evidence that the medication is working?

A. Improved grades B. Increased sleep quality C. Lethargy D. Polyphagia

ANS: A Rationale: Amphetamines used with ADHD improve academic performance.

Amphetamines often decrease sleep. Amphetamines will not result in lethargy.

Amphetamines decrease appetite and do not cause polyphagia, the demonstration of excessive hunger and abnormally large intake of solids by mouth.

PTS: 1 REF: p. 1137, Overview of Attention Deficit Hyperactivity Disorder OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 4. A client is to be started on amphetamine therapy for attention deficit hyperactivity disorder. Which medication has less physical dependence and abuse than other amphetamines?

A. Dextroamphetamine and amphetamine B. Dextroamphetamine C. Methamphetamine D. Lisdexamfetamine ANS: D Rationale: Lisdexamfetamine is approved for the treatment of ADHD. The drug reportedly delays the stimulation associated with other amphetamines and may be less prone to abuse. There is no need to change any existing occurrence of dextroamphetamine. Amphetamine, dextroamphetamine, and methamphetamine are prone to abuse.

PTS: 1 REF: p. 1139, Amphetamines OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. A client reports insomnia during a routine visit. What should the nurse assess first regarding the most likely cause?

A. Daily intake of caffeine-containing products B. The amount of exercise in which the client engages C. The family history of insomnia and sleep D. Possible use of amphetamines ANS: A Rationale: The daily intake of caffeine should be assessed to determine if the intake is sufficient to disturb sleep. The amount of exercise the client engages in is important but not as critical as caffeine consumption. The family history of insomnia and sleep is not critical to assess. Amphetamines also have the potential to disrupt sleep, but caffeine use is far more prevalent.

PTS:

1

REF: p. 1138, Overview of Narcolepsy

OBJ: 4

NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. A client is being prescribed a central nervous system stimulant. Which will have the lowest risk of abuse and dependence?

A. Dextroamphetamine B. Atomoxetine C. Dexmethylphenidate D. Dextroamphetamine and amphetamine ANS: B Rationale: Atomoxetine is administered for ADHD and has a lower abuse and dependence capability. Dextroamphetamine, dextroamphetamine and amphetamine, and dexmethylphenidate have strong potential for abuse and dependence.

PTS: 1 REF: p. 1145, Other Medications Used to Treat Attention Deficit Hyperactivity Disorder and Narcolepsy OBJ: 4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. A 13-year-old child is prescribed atomoxetine to be administered at 07:00. When will this medication reach its peak plasma level?

A. 08:00 to 09:00 B. 09:45 to 10:30 C. 10:30 to 11:45 D. 13:00 to 14:00 ANS: A Rationale: Atomoxetine is rapidly absorbed with peak plasma levels in 1 to 2 hours. If the client takes the medication at 07:00, it will peak at 08:00 to 09:00.

PTS: 1 REF: p. 1145, Other Medications Used to Treat Attention Deficit Hyperactivity Disorder and Narcolepsy OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. What is the central nervous system stimulant of choice to treat narcolepsy?

A. Atomoxetine B. Guarana C. Caffeine D. Modafinil

ANS: D Rationale: Modafinil is used to treat narcolepsy. Atomoxetine is administered for attention deficit hyperactivity disorder (ADHD). Guarana is an herbal supplement high in caffeine; it is not administered for narcolepsy. Caffeine is not administered for narcolepsy.

PTS: 1 REF: p. 1142, Amphetamine-Related Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. The parents of a child on methylphenidate want to know why they need to withhold the medication during the summer months. What is the nurse’s best response?

A. “Withholding the medication will assist in evaluating psychotherapy.”

B. “Withholding the medication will allow for stabilized cardiac function.”

C. “Withholding the medication will decrease the growth suppression.”

D. “Withholding the medication will assist in better drug response.”

ANS: C Rationale: Stopping drug therapy will decrease weight loss and growth suppression.

Withholding the drug will not assist in evaluating psychotherapy; it will allow for evaluation of the treatment regimen. Withholding the medication will not assist in stabilizing cardiac function or assist in better drug response.

PTS: 1 REF: p. 1139, Amphetamines OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A client prescribed dextroamphetamine for attention deficit hyperactivity disorder (ADHD) has developed a common adverse effect of the medication since beginning therapy. Which initial intervention should the client be encouraged to implement?

A. Take an over-the-counter (OTC) laxative daily.

B. Increase fiber intake.

C. Take diphenoxylate hydrochloride.

D. Take metronidazole.

ANS: B Rationale: Constipation is a common adverse effect of dextroamphetamine. A client who is experiencing constipation should be instructed to increase fiber in the diet. The client should not take a laxative before attempting to manage the problem with dietary modifications. The client should not be instructed to take diphenoxylate hydrochloride because it is an antidiarrheal agent. The client should not be given metronidazole since it is an anti-infective agent.

PTS: 1 REF: p. 1139, Amphetamines OBJ: 3 NAT: Client Needs: Physiological Integrity: Physiological Adaptation

TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. A teenage client treated with dextroamphetamine for attention deficit hyperactivity disorder (ADHD) for the last 10 years is now diagnosed with hyperthyroidism. What intervention should be implemented with this client to provide safe management of all conditions?

A. Discontinue the high-calorie diet.

B. Assess the client for pulmonary edema.

C. Discontinue the dextroamphetamine.

D. Administer a proton pump inhibitor.

ANS: C Rationale: Dextroamphetamine, an amphetamine, is contraindicated upon the development of hyperthyroidism. The client will require a higher-calorie count, not a discontinuation of a high-calorie count. The client will not require an assessment for pulmonary edema. The client will only require a proton pump inhibitor if gastric hyperacidity occurs.

PTS: 1 REF: p. 1139, Amphetamines OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. The nurse is providing education to an adolescent client who has been prescribed an amphetamine for attention deficit hyperactivity disorder. How does the nurse explain the purpose of a “drug holiday”?

A. To minimize weight loss B. To prevent hyperthyroidism C. To allow electrolyte imbalances to resolve D. To slow bone resorption ANS: A Rationale: Dextroamphetamine often causes loss of appetite, and the health care provider may stop the medication during the months when the child is not in school. A drug holiday, as this is called, helps decrease weight loss and growth suppression. It does not address potential electrolyte imbalances, thyroid imbalances, or the process of bone remodeling.

PTS: 1 REF: p. 1139, Amphetamines OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 13. A client is being prescribed dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD). During health education, the nurse should make the client aware of the black box warning relating to what potential risk issue?

A. Kidney failure B. Potential for abuse C. Stroke with excessive doses D. Unstable blood glucose levels ANS: B Rationale: A black box warning makes users of dextroamphetamine aware of the drug’s high abuse potential. Black box warnings do not address the potential for renal failure, stroke, or unstable blood sugars.

PTS: 1 REF: p. 1139, Amphetamines OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 14. A child diagnosed with attention deficit hyperactivity disorder (ADHD) has been prescribed methylphenidate. The child’s mother tells the nurse that she does not understand why a stimulant would help since, “my child is completely overstimulated, not understimulated!” What should the nurse explain to the mother about the therapeutic use of methylphenidate?

A. Methylphenidate helps with the symptoms of ADHD, but the reasons for this are not well understood.

B. Methylphenidate stimulates the parasympathetic nervous system, resulting in increased control of behavior.

C. Methylphenidate stimulates the limbic system, which regulates control over behavior and affect.

D. Methylphenidate enhances the function of dopamine, which regulates cognition.

ANS: A Rationale: The efficacy of methylphenidate in the management of ADHD is paradoxical and not well understood. It does not significantly affect dopamine levels or the function of the limbic system and parasympathetic nervous system.

PTS: 1 REF: p. 1142, Amphetamine-Related Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 15. An adult client diagnosed with narcolepsy admits being embarrassed to receive this diagnosis and is adamant that no one find out about it. The nurse should respond to the client by explaining what aspect of the etiology?

A. “This is the result of neurologic factors over which you have no direct control.”

B. “In a lot of cases, making improvements to your sleep habits can resolve narcolepsy.”

C. “This is something that runs in certain families, and it’s not your fault that this has happened.”

D. “This usually stems from suppressed emotions, so counseling usually helps

greatly.”

ANS: A Rationale: Narcolepsy is a neurologic sleep disorder, not the result of mental illness or psychological problems. It is most likely due to several genetic abnormalities, but family history is not noted to be highly significant. Learning that improvement of sleeping habits is important, but it will not address embarrassment.

PTS: 1 REF: p. 1138, Overview of Narcolepsy OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 16. An adolescent client has been taking dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) for the last 3 years, achieving significant improvements in behavior and mood. When assessing the child during a scheduled follow-up appointment, the nurse should prioritize what physical assessment to monitor for a potential adverse reaction to the therapy?

A. Abdominal girth and assessment for peripheral edema B. Measurement of height and body weight C. Visual acuity and hearing ability D. Assessment of deep tendon reflexes and peripheral pulses ANS: B Rationale: Suppression of weight and height may occur in children taking amphetamines, and the nurse ensures that growth is monitored during drug therapy.

Assessments for edema, diminished reflexes, and sensory deficits are not normally warranted.

PTS: 1 REF: p. 1139, Amphetamines OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. A high-school-age client, brought to the emergency department (ED) by friends after taking a “whole handful of dextroamphetamine,” is now lapsing in and out of consciousness. The ED nurse should prioritize what assessment related to dextroamphetamine overdose?

A. Blood glucose monitoring B. Cognitive assessment C. Lung function testing D. Cardiac monitoring ANS: D Rationale: Dextroamphetamine misuse may cause sudden death or serious cardiovascular events. It is essential to obtain a baseline electrocardiogram (ECG) and blood pressure reading. These assessments are priorities over blood glucose monitoring, respiratory assessment, and cognitive assessment.

PTS: 1 REF: p. 1139, Amphetamines OBJ: 4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. A 12-year-old child has been prescribed dextroamphetamine therapy, and the nurse is now reviewing the correct schedule for taking the drug. The child should most likely take the daily doses of dextroamphetamine at what times?

A. 07:00 and 11:30 B. 07:30, 11:30, 16:30, and 20:00 C. 08:00 and 20:00 D. 09:00, 14:00, and 19:00 ANS: A Rationale: Clients should take the first dose of dextroamphetamine on awakening or early in the day and the last dose at least 6 hours before bedtime. Twice-daily dosing is most common.

PTS: 1 REF: p. 1139, Amphetamines OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 19. The nurse working with the family of a child prescribed methylphenidate should implement what strategy to address possible adverse effects?

A. A strategy to ensure that the child maintains normal bladder function B. A plan to address the child’s loss of appetite C. A plan to address the child’s loss of self-esteem D. A strategy to regularly monitor the child’s blood glucose levels ANS: B Rationale: Like dextroamphetamine, methylphenidate often causes loss of appetite. Plans to address this should be in place at the beginning of therapy. Frequent blood glucose monitoring and actions to maintain bladder function are not likely necessary. Self-esteem should likely be addressed during treatment, but reduced self-esteem is not an adverse effect of methylphenidate.

PTS: 1 REF: p. 1139, Amphetamines OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 57: Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 58, Drug Therapy for Substance Use Disorders 1. A client is living with his daughter after major surgery. He states, “I see a dog around the chair. Get rid of that dog. I hate dogs.” The daughter tells the home care nurse that there is no dog behind the chair. What is the most important question the nurse should ask the daughter?

A. “Does your father have health care insurance for mental health care?”

B. “Has your father been fearful of dogs in the past?”

C. “Has your father consumed alcoholic beverages on a regular basis?”

D. “What type of foods or spices has your father consumed today?”

ANS: C Rationale: Delirium tremens, the most serious form of alcohol withdrawal, is characterized by confusion, disorientation, delusions, visual hallucinations, and other signs of acute psychosis. The behavior is unlikely attributable to consumption of any food item, and a fear of dogs wouldn’t likely explain the hallucination. While insurance will be helpful if the client requires mental health care, it is more important at this time to assess for delirium tremens and the immediate risks it presents.

PTS: 1 REF: p. 1153, Alcohol (Ethanol) OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A client is admitted to the hospital for the treatment of a stasis ulcer of the right leg. The client’s history indicates alcohol abuse disorder with consumption of at least eight alcoholic beverages daily. What symptoms should the nurse assess the client for?

A. Confusion, hallucination, agitation, tremors B. Denial, manipulation, combativeness C. Depression, remorse, withdrawal from reality D. Suspicion, mania, stubbornness, fear ANS: A Rationale: Delirium tremens, the most serious form of alcohol withdrawal, is characterized by confusion, disorientation, delusions, visual hallucinations, and other signs of acute psychosis. Denial, manipulation, combativeness, depression, remorse, withdrawal from reality, suspicion, mania, stubbornness, and fear are not symptoms of alcohol withdrawal.

PTS: 1 REF: p. 1153, Alcohol (Ethanol) OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A client is admitted to the emergency room with acute alcohol intoxication. The client is combative. Which medication will be administered?

A. A sedative

B. An ACE inhibitor C. An MAO inhibitor D. A skeletal muscle relaxant ANS: A Rationale: Acute intoxication with alcohol does not usually require treatment. If the client is hyperactive and combative, a sedative-type drug may be given. An ACE inhibitor is not administered for combativeness related to acute alcohol intoxication. An MAO inhibitor would be contraindicated in acute alcohol intoxication. A skeletal muscle relaxant would not be administered for acute alcohol intoxication.

PTS: 1 REF: p. 1153, Benzodiazepines for Treatment of Alcohol Withdrawal OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A client is admitted to an alcohol rehabilitation program. What medication will the client most likely be prescribed to treat alcohol withdrawal syndrome?

A. Clonidine B. Methyldopa C. Chlordiazepoxide D. Atenolol ANS: C Rationale: Benzodiazepine antianxiety agents are the drugs of choice for treating alcohol withdrawal syndromes. Chlordiazepoxide is administered to clients for acute withdrawal syndrome. Neither clonidine, methyldopa, nor atenolol are benzodiazepines, and none are prescribed for acute alcohol syndrome.

PTS: 1 REF: p. 1153, Benzodiazepines for Treatment of Alcohol Withdrawal OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A client is prescribed disulfiram. How does this medication assist the client in refraining from ingestion of alcohol?

A. Allows the accumulation of acetaldehyde B. Increases the level of serotonin C. Increases the level of acetylcholine D. Decreases stimulation of the central nervous system (CNS) ANS: A

Rationale: Disulfiram interferes with hepatic metabolism of alcohol and allows accumulation of acetaldehyde. This accumulation of acetaldehyde produces an unpleasant reaction when disulfiram is consumed with alcohol. Disulfiram is not known to increase the levels of serotonin or acetylcholine. Disulfiram does not decrease the stimulation of the central nervous system.

PTS: 1 REF: p. 1157, Enzyme Inhibitors for Maintenance of Alcohol Sobriety OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 6. What effect will be produced from the combination of alcohol and disulfiram?

A. Hypertension B. Vomiting C. Hyperalertness D. Oral bleeding ANS: B Rationale: Disulfiram interferes with hepatic metabolism of alcohol and allows the accumulation of acetaldehyde. If alcohol is ingested during disulfiram therapy, acetaldehyde causes headaches, confusion, seizures, chest pain, flushing, palpitations, hypotension, sweating, blurred vision, nausea, vomiting, and a garlic-like aftertaste.

Disulfiram will not cause hypertension, increased alertness, or oral bleeding.

PTS: 1 REF: p. 1157, Enzyme Inhibitors for Maintenance of Alcohol Sobriety OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. A client is diagnosed with overdose of diazepam. What drug does the nurse anticipate being administered?

A. Disulfiram B. Flumazenil C. Methadone D. Naloxone ANS: B Rationale: Flumazenil is a specific antidote that can reverse benzodiazepine-induced sedation, coma, and respiratory depression. Disulfiram, methadone, and naloxone are not administered to reverse benzodiazepine overdose.

PTS: 1 REF: p. 1154, Table 58.2 OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 58: Drug Therapy for Substance Use Disorders

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 8. A client who has been using cocaine on a regular basis has run out of the drug and is unable to obtain more. Within hours of stopping the medication, the client begins to show symptoms of cocaine withdrawal. What symptoms will the client exhibit?

A. Depression, drowsiness, and fatigue B. Euphoria, hyperactivity, and hyperalertness C. Diaphoresis, clammy palms, and diarrhea D. Chest pain, palpitations, and diaphoresis ANS: A Rationale: Cocaine withdrawal begins within hours of stopping drug use and lasts up to several days. Symptoms include depression (which may be profound), drowsiness, fatigue, and sleep disturbance. Euphoria, hyperactivity, hyperalertness, clammy palms, diarrhea, chest pain, palpitations, and diaphoresis are not symptoms of withdrawal from cocaine abuse.

PTS: 1 REF: p. 1151, Clinical Manifestations OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A client is experiencing psychotic behavior related to cocaine dependence. What medication can be administered to treat the psychosis?

A. Diazepam B. Lorazepam C. Methadone D. Haloperidol ANS: D Rationale: Psychosis related to cocaine dependence is treated with haloperidol.

Diazepam does not treat psychosis related to cocaine dependence. Lorazepam and methadone are not administered to treat psychosis related to cocaine dependence.

PTS: 1 REF: p. 1160, Cocaine OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A client is admitted to the emergency department with a ketamine overdose. For what symptom of overdose should the nurse assess?

A. Metabolic acidosis B. Seizures C. Bradycardia D. Pain ANS: B

Rationale: Ketamine overdose results in seizures, polyneuropathy, increased intracranial pressure, respiratory arrest, and cardiac arrest. The client suffering from ketamine overdose will not have symptoms of metabolic acidosis, bradycardia, or pain.

PTS: 1 REF: p. 1160, Hallucinogens OBJ: 5 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 11. How should the nurse best assess the client for physical dependence on alcohol?

A. Assess the client’s perceptions of coping strategies.

B. Assess whether the client ever feels guilty about drinking.

C. Assess the client for signs and symptoms of alcohol withdrawal.

D. Assess the client’s typical alcohol intake.

ANS: C Rationale: Physical dependence involves physiologic adaptation to chronic use of a drug so that withdrawal, or unpleasant symptoms, occurs when the drug is stopped, when its action is antagonized by another drug, or when its dosage is decreased. Assessment of coping strategies, alcohol intake, and the client’s feelings about drinking are relevant, but none directly addresses the possibility of physical dependence.

PTS: 1 REF: p. 1156, Use in Patients Receiving Home Care OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A client admitted for the treatment of a fracture has a history of heavy alcohol use. What event should suggest the implementation of pharmacologic treatment for alcohol withdrawal?

A. Skeletal muscle relaxants have taken effect.

B. Signs/symptoms of withdrawal are noted.

C. Cognitive–behavioral therapy has begun.

D. Acute injuries have been treated.

ANS: B Rationale: Treatment with chlordiazepoxide should begin as soon as the clinician identifies that the client is demonstrating signs and symptoms of alcohol withdrawal. It is unsafe to delay treatment of withdrawal. Care for physical injuries is implemented independently.

PTS: 1 REF: p. 1156, Use in Patients Receiving Home Care OBJ: 2 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

13. A client has been admitted with the diagnosis of acute alcohol withdrawal. The nurse should plan care with the goal of preventing which primary sign of the disorder?

A. Bradycardia B. Hypotension C. Delirium tremens D. Gastrointestinal bleeding ANS: C Rationale: In acute alcohol withdrawal, a goal of treatment is to prevent a form of seizure called delirium tremens. Neither bradycardia nor hypotension is primary sign of acute alcohol withdrawal. Gastrointestinal bleeding results from heavy alcohol use but is not the primary sign of acute alcohol withdrawal.

PTS: 1 REF: p. 1153, Alcohol (Ethanol) OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 14. A client has been prescribed both disulfiram and phenytoin. Based on the interaction of these two medications, the nurse should contact the health care provider regarding what potential adjustment to the medication therapies?

A. More frequent administration of disulfiram B. A larger dose of disulfiram C. A reduced dose of phenytoin D. Phenytoin to be administered twice daily ANS: C Rationale: The client will require a reduced dose of phenytoin because disulfiram interferes with the metabolism of phenytoin. The client will not require more frequent administration of disulfiram. The client will not require a larger dose of disulfiram. The client will not require increased administration of phenytoin.

PTS: 1 REF: p. 1157, Enzyme Inhibitors for Maintenance of Alcohol Sobriety OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 15. The nurse is providing education to the family of a client recently admitted for the treatment of a substance use disorder. How should the nurse best explain the etiology of this disorder?

A. “Substance abuse is multifactorial and involves genetics, personality, and culture.”

B. “Substance abuse is primarily a cultural concept, since definitions vary widely across time and place.”

C. “Many different factors contribute to substance abuse, but the primary ones are lack of willpower and impaired coping.”

D. “Substance abuse is a complex phenomenon, and science has not yet begun to truly

understand the phenomenon.”

ANS: A Rationale: Researchers have identified several factors in the predisposition to substance abuse and dependence. These factors include genetics, personality, and culture. The disorder is not, however, solely rooted in culture or wholly misunderstood. It is simplistic to understand the disorder as resulting from impaired coping and lack of willpower.

PTS: 1 REF: p. 1150, Overview of Substance Use OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. A client has been admitted for the treatment of alcohol abuse disorder. Which client condition would cause the nurse to question a prescription for a benzodiazepine?

A. Acute intoxication with depressed vital signs B. Client denial of the severity of the addiction C. Previous treatment with benzodiazepines D. Concurrent addiction to nicotine ANS: A Rationale: If the client’s vital signs are depressed during acute intoxication, the use of benzodiazepines is contraindicated. Denial, previous treatment with benzodiazepines, and nicotine addiction do not contraindicate this treatment.

PTS: 1 REF: p. 1153, Benzodiazepines for Treatment of Alcohol Withdrawal OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 17. The nurse is providing education to a client who has been prescribed disulfiram therapy.

What should the nurse explain will occur if the client consumes alcohol while taking the medication?

A. Hallucinations B. Unpleasant physical reactions C. Increased central nervous system (CNS) depression D. Depressed mood ANS: B Rationale: Disulfiram inhibits the enzyme aldehyde dehydrogenase to block the oxidation of alcohol. The resulting accumulation of acetaldehyde produces an unpleasant physical reaction when disulfiram is consumed with alcohol. The effects do not include hallucinations, increased CNS depression, or depressed mood, however.

PTS: 1 REF: p. 1157, Enzyme Inhibitors for Maintenance of Alcohol Sobriety OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 18. A client with a history of heroin use has begun addiction treatment. The nurse had administered the client’s daily dose of methadone. How does methadone therapy affect opioid addiction?

A. Acts as an agonist at opioid receptors and prevents withdrawal symptoms B. Acts as an antagonist at opioid receptors and prevents withdrawal symptoms C. Acts on the limbic system and the reticular system to suppress brain activity associated with addiction D. Acts to depress the central nervous system (CNS) to a similar degree as opioids, aiding in detoxification ANS: A Rationale: Methadone is an agonist at specific opioid receptors in the CNS. Its action allows it to prevent symptoms of withdrawal. It does not cause unpleasant effects if the client uses opioids and does not act directly on the limbic system or reticular system.

PTS: 1 REF: p. 1158, Opioid Agonists and Antagonists for Treatment of Opioid Abuse OBJ: 6 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 19. What assessment should the nurse perform prior to administering pharmacologic treatments prescribed for a client diagnosed with cocaine-induced psychosis?

A. Assessment of blood glucose levels B. Assessment of cranial nerve function C. Lung auscultation D. Cardiovascular assessment ANS: D Rationale: Cocaine intoxication carries a high risk for cardiac dysrhythmias.

Consequently, cardiovascular assessment would be a priority over lung auscultation, assessment of cranial nerve function, or assessment of blood glucose levels.

PTS: 1 REF: p. 1160, Cocaine OBJ: 4 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 20. A 15-year-old client with a complex psychosocial history is being treated for inhalant abuse. When providing health education to a client being treated for inhalant abuse, the nurse should focus on which associated risks? Select all that apply.

A. Extreme hyperactivity B. Psychological dependence C. Physiologic withdrawal D. Organ damage E. Impaired brain development ANS: B, C, D, E Rationale: Inhalants can harm the brain, liver, heart, kidneys, and lungs, and abuse of any drug during adolescence may interfere with brain development. Inhalant abuse can lead to psychological dependency and physiologic withdrawal. Inhalants produce symptoms comparable with those of acute alcohol intoxication, including initial mild euphoria followed by ataxia, confusion, and disorientation.

PTS: 1 REF: p. 1161, Inhalants OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 58: Drug Therapy for Substance Use Disorders KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select

Chapter 59, Drug Therapy for Disorders of the Eye 1. When discussing intraocular pressure (IOP) with a client, the nurse should explain that normal IOP results from which physiologic process?

A. Consistent production and resorption of tears B. Consistent feedback from baroreceptors located throughout the retina C. A balance between production and drainage of aqueous humor D. Two-way interaction between the medulla oblongata and the eye ANS: C Rationale: When production and drainage of aqueous humor are approximately equal, the IOP is normal. IOP is not dependent on tear production, baroreceptors in the eye, or stimulation from the medulla.

PTS: 1 REF: p. 1169, Basic Structure and Function of the Eye OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. While providing medication education to a client, the nurse explains that fungal infection of the eye is a possible adverse reaction to the prescribed drug. What type of medication is the client likely receiving?

A. Ophthalmic corticosteroid B. Systemic antibiotic agent C. Mydriatic D. Saline ophthalmic drops ANS: A Rationale: Fungal infections commonly occur and may often be attributed to frequent use of ophthalmic antibiotics and corticosteroids. Neither systemic antibiotic agents, mydriatics, nor saline ophthalmic drops are likely to be the cause of fungal infections of the eye.

PTS: 1 REF: p. 1170, Etiology OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. A client reports excessive watering of the eye and “a gritty feeling.” What disorder does the nurse suspect?

A. Hordeolum B. Blepharitis C. Conjunctivitis D. Glaucoma ANS: C

Rationale: Conjunctivitis is a common eye disorder with redness, tearing, itching, edema, and gritty sensations of the eye. Hordeolum is a sty. Blepharitis is a chronic infection of glands and lash follicles on the margins of the eyelids. Glaucoma is a disease with an increased intraocular pressure.

PTS: 1 REF: p. 1170, Clinical Manifestations OBJ: 5 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. The nurse is preparing to assist in the removal of a foreign body from a client’s eye.

What medication does the nurse expect to administer initially?

A. Neomycin and polymyxin B sulfates and hydrocortisone B. Proparacaine eye drops C. Cephalosporin orally D. Atropine eye drops ANS: B Rationale: Proparacaine is a commonly used agent to provide anesthetic. None of the other options have anesthetizing properties.

PTS: 1 REF: p. 1172, Table 59.2 OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. The nurse is providing presurgical education to a client scheduled for cataract surgery.

What presurgical medication should the nurse mention?

A. Acetazolamide B. Pilocarpine C. Dipivefrin D. Lidocaine ANS: D Rationale: Injectable local anesthetics are administered by ophthalmologists, usually for eye surgery. Lidocaine is commonly used; it has a rapid onset and lasts 1 to 2 hours.

Acetazolamide, pilocarpine, and dipivefrin are used to treat various forms of glaucoma.

PTS: 1 REF: p. 1175, Local Anesthetic Drugs OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 6. What eye disorder would contraindicate long-term use of ophthalmic corticosteroids?

A. Conjunctivitis B. Hordeolum C. Glaucoma

D. Blepharitis ANS: C Rationale: Long-term use of corticosteroid ophthalmic agents may result in increased intraocular pressure (IOP), the cause of glaucoma. Blepharitis is the chronic infection of glands and lash follicles on the margins of the eyelids. Conjunctivitis is the inflammation of the conjunctiva. An infected sebaceous gland is referred to as a hordeolum.

PTS: 1 REF: p. 1170, Etiology OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. The nurse is teaching a client about a scheduled ophthalmic examination. What medication does the nurse indicate will be administered to help facilitate the examination?

A. Pseudoephedrine hydrochloride B. Epoetin alfa C. Phenylephrine D. Pilocarpine ANS: C Rationale: Phenylephrine is used to dilate the pupil before ophthalmic examinations.

Pseudoephedrine hydrochloride is used to relieve nasal congestion. Epoetin alfa is used to treat bone marrow depression. Pilocarpine reduces intraocular pressure.

PTS: 1 REF: p. 1174, Adrenergic Agonist OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. A client has been prescribed phenylephrine (ophthalmic). What condition in the client history would alert the nurse to a potential contraindication to use of the drug?

A. Cataracts B. Hypothyroidism C. Diabetes mellitus D. Hypertension ANS: D Rationale: Contraindications to phenylephrine include hypersensitivity reactions, hypertension, ventricular tachycardia, and narrow-angle glaucoma. Clients with cataracts, hypothyroidism, and diabetes mellitus can safely be administered phenylephrine.

PTS: 1 REF: p. 1174, Adrenergic Agonist OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Choice

9. A nurse is administering multiple eye drops of a single medication to a client. How long should the nurse wait between the instillation of drops?

A. 1 minute B. 5 minutes C. 15 minutes D. 20 minutes ANS: B Rationale: When multiple eye drops are required, there should be an interval of 5–10 minutes between drops because of limited eye capacity and rapid drainage into tear ducts. When instilling drops from different medications, a longer wait may be necessary.

PTS: 1 REF: p. 1173, Box 59.1 OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 10. A child with glaucoma is being treated with short-acting mydriatics. Which cycloplegic will be administered with the mydriatic agent?

A. Tropicamide B. Lidocaine C. Phenylephrine D. Acetazolamide ANS: A Rationale: Lidocaine, phenylephrine, and acetazolamide will not produce the desired paralytic effect. Children with glaucoma are treated with mydriatics and cycloplegics, such as tropicamide. The child with glaucoma is not treated with cortisporin, phenylephrine, or acetazolamide since none of these medications can produce the desired paralytic effect.

PTS: 1 REF: p. 1171, Drug Therapy OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 11. A client has been prescribed dexamethasone eye drops. The presence of what eye disorder would cause the nurse to question the prescription?

A. Fungal infection B. Nearsightedness C. Cataracts D. Bacterial conjunctivitis ANS: A

Rationale: Contraindications to dexamethasone include mycobacterial and fungal infection of the eye. None of the remaining options present conditions that would contraindicate the use of dexamethasone.

PTS: 1 REF: p. 1189, Corticosteroids OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. What is the expected result of timolol maleate therapy?

A. Decreased intraocular pressure (IOP) B. Constriction of pupils C. Promotion of lacrimation D. Improved visual acuity ANS: A Rationale: The purpose of the administration of beta-blocking drugs such as timolol is to decrease the IOP. Beta-blockers are not used to promote lacrimation, improve vision, or constrict the pupils.

PTS: 1 REF: p. 1178, Beta-Adrenergic Blocking Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 13. The client with elevated intraocular pressure (IOP) is at risk for what ocular condition?

A. Cataracts B. Vision loss C. Myopia D. Conjunctivitis ANS: B Rationale: Glaucoma is characterized by increased IOP, possibly damaging the optic nerve, which transmits images to the brain. If damage to the optic nerve from high IOP continues, glaucoma leads to loss of vision. Cataracts, myopia, and conjunctivitis are not the results of increased IOP. PTS: 1 REF: p. 1170, Glaucoma OBJ: 2 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 14. A client has been prescribed atropine eye drops. What education should the nurse provide prior to instillation?

A. “These drops might sting a little bit, and they will make you temporarily sensitive to light.”

B. “These eye drops will make it more difficult to close your eyes, but this will pass in a few hours.”

C. “These drops will make your pupil temporarily constrict so that your eye can be examined more closely.”

D. “These drops will make your eyes very bloodshot and sensitive, but this is only temporary.”

ANS: A Rationale: The nurse instructs clients about the effects of atropine such as photophobia and stinging on administration. Atropine does not make it difficult to close the eyes, and it causes pupil dilation, not constriction. Instillation of atropine is not expected to cause ocular redness or general sensitivity.

PTS: 1 REF: p. 1171, Anticholinergic Drugs OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 15. Phenylephrine drops have been instilled in a client’s eye. The nurse recognizes that therapeutic effect has been achieved when noting which assessment finding?

A. The cornea can be manipulated without causing the client to blink.

B. The client acknowledges an improvement in visual acuity.

C. The client’s pupils neither dilate nor constrict in response to light.

D. The inner aspect of the client’s eye can be visualized.

ANS: D Rationale: Uses of phenylephrine (ophthalmic) include mydriasis prior to ophthalmic procedures. Consequently, the nurse assesses whether the inner aspect of the eye can be visualized 15 minutes after administration. Phenylephrine does not inhibit blinking, improve vision, or eliminate light accommodation.

PTS: 1 REF: p. 1174, Adrenergic Agonist OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 16. The nurse is providing postoperative education to a client who will undergo eye surgery.

What should the nurse encourage the client to avoid following surgery? Select all that apply.

A. Heavy lifting B. Reading C. Coughing D. Straining E. Bending ANS: A, C, D, E

Rationale: To minimize intraocular pressure, the client should be encouraged to avoid straining at stool (use laxatives or stool softeners if necessary), heavy lifting, bending over, coughing, and vomiting when possible. Reading is not a known factor in the increase of intraocular pressure.

PTS: 1 REF: p. 1174, Box 59.2 OBJ: 6 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Select 17. While reviewing a client’s list of medications, the nurse sees that the client has been prescribed ciprofloxacin eye drops. What disorder of the eye does the nurse suspect the client has?

A. Astigmatism B. Cataracts C. Conjunctivitis D. Increased intraocular pressure (IOP) ANS: C Rationale: Uses of ciprofloxacin include the treatment of corneal ulcer and bacterial conjunctivitis. This drug is not used to treat cataracts, increased IOP, or astigmatism.

PTS: 1 REF: p. 1184, Antibacterial Drugs OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 18. The nurse is educating a client diagnosed with open-angle glaucoma about the prescribed ophthalmic medication bimatoprost. Which statement made by the client establishes the need for further clarification?

A. “The drug helps slow the disease progression by decreasing intraocular pressure.”

B. “Soft contact lenses may remain in place when administering the medication.”

C. “I will avoid bending over, heavy lifting, coughing, or straining during stool.”

D. “I will wash my hands before application and avoid touching the dropper to my eye.”

ANS: B Rationale: The nurse needs to clarify the statement that the client made in regard to keeping soft contacts in place when administering the eye drop because it may contain the preservative benzalkonium hydrochloride, which may be absorbed by the soft contacts. The other statements are correct. The drug decreases intraocular pressure (IOP) by increasing the outflow of aqueous humor. The client should avoid any Valsalva maneuver because it increases IOP. Handwashing before administration and not touching the dropper to the eye decrease risk for infection.

PTS: 1 REF: p. 1175, Prostaglandin Analogs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye

KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice 19. A client with bacterial conjunctivitis of the right eye has been prescribed the ciprofloxacin. The prescription calls for administration of 2 drops every 2 hours while awake for 2 days, then 2 drops every 4 hours while awake for 5 days. While assessing the success of medication education, what client statement establishes the need for further clarification?

A. “I should wear glasses instead of my contact lenses while taking the medication.”

B. “I should wash my hands before and after applying the drug.”

C. “I should never rinse the applicator with water.”

D. “I will continue to take the medication until the bottle is empty.”

ANS: D Rationale: The nurse needs to clarify the statement that the client made that the medication will continue to be used until gone because taking it longer than prescribed may result in a superinfection. The other statements are correct. Contacts need to be removed and glasses worn until the treatment for the infection has been successfully completed. Hands are washed before and after treatment, and the client avoids touching the affected eye. The eye applicator should not touch the eye or be rinsed with water.

PTS: 1 REF: p. 1184, Antibacterial Drugs OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 59: Drug Therapy for Disorders of the Eye KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 60, Drug Therapy for Disorders of the Ear 1. A school-age child has just returned home from the family’s tropical vacation and is now reporting worsening tenderness in the right ear. When the child is diagnosed with otitis externa, what causative factor of this infection should the nurse focus upon?

A. Immunocompromised state resulting from sleep deprivation while on vacation B. The potential for foodborne pathogens ingested while on vacation C. Frequent swimming and water sports while the child was on vacation D. Ear trauma related to pressurization and depressurization while flying ANS: C Rationale: People whose ears are frequently exposed to moisture are more prone to the development of otitis externa. Swimming is a more likely cause of infection than pressure changes, foodborne pathogens, or impaired immunity.

PTS: 1 REF: p. 1195, Introduction OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 2. A child is being assessed for a possible diagnosis of otitis media. When assessing the most common route of bacterial invasion, the nurse should focus on what component of the child’s ear?

A. Eustachian tube B. External ear canal C. Cochlea and vestibule D. Interstitial spaces in the middle ear ANS: A Rationale: The causative pathogens implicated in otitis media include Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. They enter the middle ear because of an alteration in the eustachian tube, not from the inner ear (cochlea and vestibule), external ear, or interstitial spaces.

PTS: 1 REF: p. 1195, Otitis Media OBJ: 1 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. The nurse is caring for a client who has been diagnosed with necrotizing otitis externa.

The nurse should monitor for potential progression to what disorder?

A. Meningitis B. Osteomyelitis C. Necrotizing fasciitis D. Epiglottitis ANS: B

Rationale: The advancement of necrotizing otitis externa results in osteomyelitis of the skull and temporomandibular joint. It does not cause meningitis, necrotizing fasciitis, or epiglottitis.

PTS: 1 REF: p. 1195, Otitis Externa OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 4. The caregiver of a 12-year-old child diagnosed with acute otitis externa has asked the nurse if oral medications might be more effective than the prescribed ear drops. The nurse should respond in the knowledge that systemic medications for the treatment of otitis externa are only indicated in what circumstances?

A. The infection is accompanied by ear discharge.

B. The client is allergic to penicillins.

C. The client is unable to self-administer eardrops.

D. A deep tissue infection develops.

ANS: D Rationale: For acute otitis externa, use of topical agents, as opposed to systemic agents, is more common. Systemic medications are indicated only if a deep tissue infection develops outside the external canal or if immunocompromised status is an issue. Allergy status, ability to self-administer, and the presence or discharge are not indications for systemic antibiotics.

PTS: 1 REF: p. 1195, Otitis Externa OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. A health care provider has prescribed neomycin–polymyxin B–hydrocortisone for a child who has otitis media in the right ear. What administration instruction should the nurse provide to the parents of the child?

A. “Put one drop into the right ear each morning.”

B. “Place two drops in the right ear each morning and then again before bedtime.”

C. “Put one to two drops in the right ear whenever you notice discharge or the child reports pain.”

D. “Place three drops into the ear four times a day.”

ANS: D Rationale: For children 6 months and older, three drops of the combination drug neomycin–polymyxin B–hydrocortisone are instilled into the affected ear three to four times daily. Dosage is not matched to acute symptoms.

PTS: 1 REF: p. 1197, Table 60.2 OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Choice

6. A nurse is demonstrating the correct technique for instilling antibiotic eardrops into a school-age child’s ear canal. The nurse should teach the child’s caregivers to implement which intervention?

A. Have the child lie supine during instillation of the eardrops.

B. Have the child lie still for 30 to 45 minutes after instilling the eardrops.

C. Place a cotton ball in the ear canal after instilling the eardrops.

D. Rinse the child’s ear canal with normal saline prior to instilling the eardrops.

ANS: C Rationale: The proper administration of eardrops requires tilting the head toward the opposite shoulder, pulling the superior aspect of the auricle upward, and instilling the eardrops into the ear canal. The client should then lie on the side opposite the side of administration for 20 minutes. To maximize medication absorption, the client should have a cotton ball placed in the ear canal. Supine positioning is not used, and the ear canal does not need to be rinsed prior to drug administration.

PTS: 1 REF: p. 1196, Anti-Infective, Antiseptic, Glucocorticoid, and Acidifying Agents OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 7. The nurse is assessing for adverse effects in a client who has been taking neomycin–polymyxin B–hydrocortisone combination drug. What question should the nurse ask the client?

A. “Have you developed a fever since you started to use the eardrops?”

B. “Have you been getting any headaches since you started taking the drops?”

C. “Have you noticed any blood in your outer ear?”

D. “Have you noticed any loss of hearing since you started taking the drops?”

ANS: D Rationale: It is necessary to assess the client taking a neomycin–polymyxin B–hydrocortisone combination drug for signs of hearing loss resulting from ototoxicity.

Fever, bleeding, and headaches are not typical adverse effects.

PTS: 1 REF: p. 1196, Anti-Infective, Antiseptic, Glucocorticoid, and Acidifying Agents OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. The health care provider has prescribed ciprofloxacin for a client diagnosed with necrotizing otitis externa. In preparation for administration, what priority intervention should the nurse implement?

A. Establish intravenous access.

B. Remove as much cerumen as possible from the client’s ear canal.

C. Flush the affected ear with warmed sterile water.

D. Establish a sterile field around the perimeter of the ear.

ANS: A Rationale: Ciprofloxacin is the drug of choice for necrotizing otitis externa. Initially, administration is intravenous, until symptoms decrease; then, it is oral. Consequently, IV access is necessary for the initiation of treatment. This is a priority over rinsing the ear or removing cerumen. It is unnecessary to create a sterile field.

PTS: 1 REF: p. 1198, Fluoroquinolone: Ciprofloxacin OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 9. A client diagnosed with necrotizing otitis externa has been prescribed ciprofloxacin.

What microorganism is the most likely cause of the disorder?

A. Aspergillus B. Candida albicans C. Pseudomonas aeruginosa D. Escherichia coli ANS: C Rationale: Health care providers use ciprofloxacin for the treatment of Pseudomonas aeruginosa in clients with necrotizing otitis externa. If the causative agent is Aspergillus, amphotericin B is the drug of choice. E. coli and Candida are not typically implicated in cases of necrotizing otitis externa.

PTS: 1 REF: p. 1198, Fluoroquinolone: Ciprofloxacin OBJ: 4 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. A preschool-age client was diagnosed with acute otitis media and began a course of oral amoxicillin. The parent has contacted the clinic and states that there has been no significant improvement in the child’s ear infection since beginning oral amoxicillin 3 days ago. The nurse should consider which explanation as most likely for this phenomenon?

A. The medication has been administered consistently.

B. The child’s ear infection has a viral etiology.

C. The child’s ear infection is caused by an antibiotic-resistant microorganism.

D. The medication would be more effective if prescribed parenterally.

ANS: B

Rationale: Many people with acute otitis media do not benefit from antibiotics because the cause of their illness is viral, not bacterial. This possibility is more likely than incorrect administration or antibiotic resistance. Parenteral administration would be no more effective in this case.

PTS: 1 REF: p. 1200, Penicillin: Amoxicillin OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 11. A client has been taking oral amoxicillin to treat otitis media for the past 6 days. The client has told the nurse that “my ear is now back to normal” and asks about stopping the antibiotics. How should the nurse respond?

A. “That’s excellent that you’re feeling better, but it’s important to keep taking the antibiotics until they’re all finished.”

B. “Try reducing your dose by half. If your ear infection gets worse, resume the dose you’ve been taking until now.”

C. “You should stop taking the antibiotics because if you don’t, it could cause antibiotic resistance.”

D. “You can likely stop taking the antibiotics, but keep them on hand in case your infection returns.”

ANS: A Rationale: The client should take the full course of antibiotics and not discontinue them, even if the otitis media seems to be improving. Stopping prematurely can cause antibiotic resistance.

PTS: 1 REF: p. 1201, Box 60.4 OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 12. A toddler has been diagnosed with otitis media. What over-the-counter medication is most likely to be safe and effective in treating the associated pain and fever?

A. Concurrent use of aspirin and ibuprofen for 3 days B. Alternating doses of acetaminophen and ibuprofen C. Monotherapy with aspirin until symptoms improve D. Use of an OTC antihistamine and acetaminophen ANS: B Rationale: Alternating acetaminophen and ibuprofen every 4 hours over a 3-day period to control fever in young children (ages 6–36 months) has been shown to be more effective than monotherapy with either agent. Aspirin is contraindicated in children, and an antihistamine is unnecessary.

PTS: 1 REF: p. 1202, Adjuvant Medications to Treat Pain and Fever Related to Infections of the Ear OBJ: 5

NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 13. The nurse is providing health education for the parents of a child whose otitis media has warranted treatment with a neomycin–polymyxin B–hydrocortisone combination drug.

The nurse should explain that this medication contains which components? Select all that apply.

A. An analgesic B. A topical anesthetic C. An antibiotic D. A steroid E. An immunomodulator ANS: C, D Rationale: Health care providers use the combination drug neomycin–polymyxin B–hydrocortisone for the treatment of acute external otitis media. Neomycin and polymyxin B are antibiotics, which combat bacterial infections. Hydrocortisone is a steroid, which reduces the actions of chemicals in the body that cause inflammation, redness, and swelling. This medication does not contain analgesics, anesthetics, or immunomodulators.

PTS: 1 REF: p. 1196, Anti-Infective, Antiseptic, Glucocorticoid, and Acidifying Agents OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 14. A client diagnosed with necrotizing otitis externa will soon begin a course of oral ciprofloxacin. When providing health education to this client, the nurse should emphasize the need to temporarily avoid what? Select all that apply.

A. Calcium antacids B. Fatty foods C. Grapefruit juice D. Foods containing purines E. Iron supplements ANS: A, E Rationale: Clients should not take oral ciprofloxacin within 2 hours of eating dairy products, calcium-fortified juices, antacids, zinc, or iron. There is no specific need to avoid fatty foods, grapefruit juice, or high-purine foods.

PTS: 1 REF: p. 1198, Fluoroquinolone: Ciprofloxacin OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Select

15. The nurse is educating a client diagnosed with otitis externa about the prescribed otic medication neomycin–polymyxin B–hydrocortisone. Which statement made by the client establishes the need for further clarification?

A. “The drug contains antibiotics to treat the bacteria and a steroid to decrease inflammation.”

B. “The drug must be shaken well before administration, and visual earwax removed before applying.”

C. “I will wear a cotton ball during swimming, and use a blow dryer on low setting to dry my ear canal.”

D. “I will report any burning, stinging, or hearing loss to my health care provider right away.”

ANS: C Rationale: The nurse needs to clarify the statement that the client made in regard to wearing a cotton ball during swimming because ear plugs must be worn to help prevent water from entering the ears. After swimming, a blow dryer is held 12 inches away from the canal and used to dry water. The rest of the statements are correct. The drug is a combination of antibiotics for the bacterial infection and a steroid to decrease inflammation. The drug suspension must be shaken and mixed well before using. Any visual cerumen should be removed from the external canal. Adverse effects of burning, stinging, and ototoxicity, including loss of hearing, tinnitus, or ringing of ears, should be reported.

PTS: 1 REF: p. 1197, Box 60.1 OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Analyze NOT: Multiple Choice 16. The nurse is educating a client newly diagnosed with necrotizing otitis externa of the left ear about the prescribed ciprofloxacin IVPB. Which statement made by the client establishes the need for further clarification?

A. “It is important to drink 2 to 3 L of noncaffeinated drinks each day.”

B. “Once the symptoms decrease, otic drops will be used to treat the infection.”

C. “While using the drug, sunscreen needs to be applied because of photosensitivity.”

D. “I should report any tendon pain immediately to the nurse or prescriber.”

ANS: B Rationale: The nurse needs to clarify the statement that the client made that once the symptoms of the necrotizing otitis externa have decreased that the client will switch from intravenous to otic drops. The client will need to switch to oral ciprofloxacin for effective treatment of the systemic infection. The other statements are correct. Drinking 2 to 3 L of noncaffeinated fluids hydrates the body and helps flush the drug wastes from the kidneys. The drug causes photosensitivity, so sunscreen needs to be used to prevent sunburn. An adverse effect of the drug is tendon rupture, so reporting tendon pain promptly is important.

PTS:

1

REF: p. 1198, Fluoroquinolone: Ciprofloxacin

OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 17. The nurse is conducting discharge teaching to the caregiver of a 6-month-old child diagnosed with acute otitis media and prescribed amoxicillin and alternating acetaminophen and ibuprofen for fever. Which statement by the caregiver establishes a need for additional teaching by the nurse?

A. “If the fever increases after alternating acetaminophen and ibuprofen, baby aspirin may be used.”

B. “Sudden development of a rash, shortness of breath, or wheezing should be reported immediately.”

C. “The entire course of the amoxicillin should be taken as directed on the bottle.”

D. “I should see an improvement in my baby in 24 hours from the time the drugs are started.”

ANS: A Rationale: The nurse needs to clarify the statement that the caregiver made that if the child’s fever increases despite using the prescribed regimen of acetaminophen and ibuprofen, then the caregiver would use baby aspirin. Children should not take aspirin because of the risk for Reye’s syndrome. The other statements are correct. The caregiver should monitor and report any signs of an allergic reaction. The entire course of antibiotics must be taken as prescribed to prevent risks for developing resistance to antibiotics. Improvement should occur in 24 hours after starting antibiotics; the fever should subside, and the baby should be less irritable, not tug at ears, and be comfortable with eating and sleeping.

PTS: 1 REF: p. 1202, Adjuvant Medications to Treat Pain and Fever Related to Infections of the Ear OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 60: Drug Therapy for Disorders of the Ear KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

Chapter 61, Drug Therapy for Disorders of the Skin 1. A teenager is being treated for acne vulgaris. Which oral antibiotics may be prescribed to treat acne?

A. Neomycin and vancomycin B. Gentamicin and ceftriaxone C. Tetracycline and erythromycin D. Bacitracin and polymyxin B ANS: C Rationale: Tetracyclines and erythromycin may be used systemically to treat acne.

Neomycin, vancomycin, gentamicin, ceftriaxone, bacitracin, and polymyxin B are not used to treat acne.

PTS: 1 REF: p. 1213, Acne Vulgaris OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. The nurse is providing health promotion education to the parents of two young children.

What is the most important information the nurse should include when discussing sun protection?

A. “Try to keep the children indoors as much as possible.”

B. “Apply SPF 30 sunscreen before going out in the sun.”

C. “Be sure the baby wears a hat at the beach.”

D. “Get sunscreen that blocks UVA rays especially.”

ANS: B Rationale: Dermatologists recommend sunscreen preparations that block both UVA and UVB and have a sun protective factor of SPF value 30 or higher. It is unnecessary to avoid outdoor exposure. The parents should apply a hat, but this advice is not the most important health promotion intervention; this does not prevent sun damage to most skin surfaces.

PTS: 1 REF: p. 1208, General Guidelines OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 3. A female client has been prescribed isotretinoin for the treatment of acne. What statement should the nurse include in teaching?

A. “You need to use effective contraception while taking this drug.”

B. “Take the medication on an empty stomach to decrease discomfort.”

C. “If the tablets are too large to swallow, crush them and take with applesauce.”

D. “Take a vitamin A supplement daily to enhance effectiveness.”

ANS: A

Rationale: The administration of retinoids requires adequate contraceptive practices in women. Retinoids should be given with food, not on an empty stomach. The tablets should not be crushed. The client should not take vitamin A because doing so increases the risk of retinoid toxicity.

PTS: 1 REF: p. 1214, Retinoids OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 4. A female client has been prescribed retinoid. Before beginning a medical regimen that includes a retinoid, which laboratory test must be negative?

A. Throat culture B. Skin culture C. Stool for occult blood D. Pregnancy test ANS: D Rationale: The female client should have a negative pregnancy test before beginning retinoid therapy. It is not necessary to have a negative throat culture or skin culture. If the client has a positive stool for occult blood, the cause should be determined but is not affected by retinoid therapy.

PTS: 1 REF: p. 1215, Administering the Medication OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 5. A client has been prescribed isotretinoin. What assessment should be routinely monitored?

A. Blood pressure B. Blood lipid levels C. Manic behaviors D. Increased weight ANS: B Rationale: The administration of isotretinoin is linked with increased blood lipid levels.

The client should be taught that lipid levels should be periodically assessed. Considering the drug’s possible adverse reactions, the assessment of blood pressure and weight are not imperative, but the client should be regularly assessed for depression and suicidal ideation.

PTS: 1 REF: p. 1215, Assessing for Adverse Effects OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Apply

NOT: Multiple Choice

6. The health care provider (HCP) has determined that a client with acne vulgaris is not a candidate for retinoid therapy. Which topical medication regimen is the HCP most likely to prescribe?

A. Azelaic acid B. Benzoyl peroxide C. Clindamycin D. Clindamycin with benzoyl peroxide ANS: D Rationale: Combination products of topical clindamycin or erythromycin and benzoyl peroxide are more effective than antibiotics alone. Azelaic acid and benzoyl peroxide are effective but not as effective as combination medications. Topical clindamycin is effective, but combination medications may be more effective.

PTS: 1 REF: p. 1213, Acne Vulgaris OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 7. A child who has not received the chickenpox vaccine has developed the chickenpox virus. What herbal preparations should the nurse suggest when asked about interventions to decrease itching triggered by chickenpox pustules?

A. Coal tar B. Colloidal oatmeal C. Clindamycin D. Bacitracin ANS: B Rationale: Oat preparations are used topically to treat minor skin irritation. Coal tar is not used for this child; it is primarily administered for psoriasis and dermatitis.

Clindamycin is not administered to treat minor skin irritation. Bacitracin is not administered to relieve itching related to chickenpox.

PTS: 1 REF: p. 1212, Box 61.2 OBJ: 3 NAT: Client Needs: Physiological Integrity: Basic Care and Comfort TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 8. Which medication is most effective in treating rosacea?

A. Topical metronidazole B. Oral nystatin C. Oral prednisone D. Topical hydrocortisone ANS: A

Rationale: Topical metronidazole is commonly used for rosacea. None of the other options are effective for the treatment of rosacea.

PTS: 1 REF: p. 1210, Table 61.1 OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. Which medication can be applied to lesions related to a bacterial skin infection?

A. Bacitracin B. Benzoyl peroxide C. Butenafine D. Clotrimazole ANS: A Rationale: Bacitracin is used to treat a bacterial skin infection. Butenafine is an antifungal agent. Clotrimazole is used to treat tinea infections. Benzoyl peroxide is used to treat acne.

PTS: 1 REF: p. 1206, Dermatitis OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. The nurse is assessing an older adult client for signs of venous insufficiency. For what signs will the nurse assess? Select all that apply.

A. Edema B. Varicose veins C. Darkened skin pigmentation D. Stasis dermatitis E. Lesions at pressure points ANS: A, B, C, D Rationale: Venous insufficiency is a result of poor venous circulation. Venous stasis ulcers, which usually occur on the legs, result from this impaired venous circulation.

Other signs of venous insufficiency include edema, varicose veins, stasis dermatitis, and brown skin pigmentation. Lesions or ulcers located on pressure points are associated with external pressure decreasing blood flow to vulnerable sites like heels, ankles, and trochanters (hips).

PTS: 1 REF: p. 1207, Ulcerations OBJ: 5 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 11. Which oral antibiotics may be prescribed to treat acne vulgaris? Select all that apply.

A. Minocycline

B. Gentamicin C. Tetracycline D. Doxycycline E. Erythromycin ANS: A, C, D, E Rationale: Commonly used oral antibiotics for acne treatment include tetracycline, doxycycline, minocycline, and erythromycin. Gentamicin is prescribed for skin infections.

PTS: 1 REF: p. 1213, Acne Vulgaris OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 12. The nurse is providing education to a client who has been prescribed isotretinoin for the treatment of acne. Which statement(s) should the nurse include in the teaching? Select all that apply.

A. “Let’s talk about the signs and symptoms of depression.”

B. “It is not unusual for your skin to be dry in areas of application.”

C. “Please report any usual muscle pain, especially after you exercise.”

D. “This medication can trigger your asthma.”

E. “We’ll need to monitor your cholesterol levels.”

ANS: A, B, C, E Rationale: Adverse effects of isotretinoin include depression, dry skin and mucous membranes, myalgia (muscle pain) particularly with vigorous exercise, and hyperlipidemia. There is no known association between isotretinoin and asthma.

PTS: 1 REF: p. 1214, Adverse Effects OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Select 13. What medication is prescribed for a severe reaction to poison ivy?

A. Topical antihistamines B. Corticosteroids C. Emollients D. Analgesics ANS: B Rationale: Corticosteroids are used to treat the inflammation present in many dermatologic conditions. They are most often applied topically but also may be given orally or parenterally. Emollients and analgesics would be ineffective. Antihistamines are not administered topically.

PTS: 1 REF: p. 1209, General Considerations OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 14. The health care provider has prescribed a coal tar preparation for a client with psoriasis.

How will the preparation be administered?

A. Topically B. Orally in divided daily doses C. Orally in the morning D. Parenterally at bedtime ANS: A Rationale: Coal tar is administered topically. This medication is not administered orally or parenterally.

PTS: 1 REF: p. 1212, Table 61.2 OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 15. What substance most commonly mediates the formation of the wheals that characterize urticaria?

A. Cytokines B. CD4+ lymphocytes C. Histamine D. Interleukin ANS: C Rationale: Histamine is the most common mediator of urticaria; it causes vasodilation, increased vascular permeability, and pruritus. Cytokines, including interleukin, and CD4+ lymphocytes do not usually mediate the development of urticaria.

PTS: 1 REF: p. 1206, Urticaria OBJ: 1 NAT: Client Needs: Physiological Integrity: Physiological Adaptation TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 16. When considering factors that may have contributed to the development of oral candidiasis, the nurse should prioritize what information provided by the client’s medical record?

A. Recently completed a course of broad-spectrum antibiotics B. Takes metformin for the treatment of type 2 diabetes C. Uses over-the-counter skin emollients several times a day D. Was immunized against the influenza virus 1 week ago ANS: A

Rationale: Oral candidiasis (thrush) involves mucous membranes of the mouth. It often occurs as a superinfection after the use of broad-spectrum systemic antibiotics. Oral antihyperglycemics, skin emollients, and vaccinations do not contribute to thrush.

PTS: 1 REF: p. 1207, Fungal Infections OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 17. The nurse is caring for an infant who has been prescribed a topical corticosteroid. What principle should guide the nurse’s actions during administration?

A. Topical medications on infants’ skin must be covered with an impermeable barrier.

B. Infants’ skin is more permeable to medication than older clients’ skin.

C. Infants have more subcutaneous fat than older clients, so higher concentrations of topical medications are often necessary.

D. Systemic drugs are preferable to topical medications in the care of infants.

ANS: B Rationale: With topical medications, cautious use is recommended with infants and young children due to the fact they have more permeable skin and are more likely to absorb the topical drugs. Infants have significant subcutaneous fat, but this does not necessitate higher concentrations of drugs. Topical drugs do not necessarily have to be covered with a barrier following administration.

PTS: 1 REF: p. 1208, Drug Therapy OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 18. The nurse is providing education to a client who has been prescribed tacrolimus ointment for atopic dermatitis. During teaching, the nurse should ensure that the client has been informed of what risk associated with therapy?

A. Risk of chemical burn injury B. Increased risk of developing psoriasis or type IV hypersensitivity C. Risk of opportunistic fungal infection that may become systemic D. Increased risks of skin cancer and lymphoma ANS: D Rationale: Tacrolimus has a black box warning about a possible increased risk of skin cancer and lymphoma. It is not noted to cause fungal infections, psoriasis, or chemical burn injuries.

PTS: 1 REF: p. 1208, General Guidelines OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice

19. An adolescent client has been prescribed a combination ointment of clindamycin and benzoyl peroxide. The nurse should teach the client to expect maximum results in how long?

A. 5 to 7 days B. 1 to 2 weeks C. 3 to 5 weeks D. 8 to 12 weeks ANS: D Rationale: Best results of combination acne treatments require 8 to 12 weeks of therapy, and maintenance therapy is usually required.

PTS: 1 REF: p. 1213, Acne Vulgaris OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 20. A young adult client who began acne treatment several weeks ago using isotretinoin has presented for a follow-up appointment at the clinic. When assessing the client for adverse effects of treatment, what question should the nurse prioritize?

A. “Have you found that the ointment makes your skin a lighter color?”

B. “Do you find that the ointment makes your pimples bleed more easily?”

C. “Do your eyes burn when you apply the ointment to your face?”

D. “Is the skin on your face uncomfortably dry since you began using the ointment?”

ANS: D Rationale: Adverse effects of topical antibiotics include erythema, peeling, dryness, and burning as well as development of resistant strains of P. acnes. Isotretinoin is not expected to produce eye irritation, bleeding, or changes in skin tone.

PTS: 1 REF: p. 1213, Acne Vulgaris OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply NOT: Multiple Choice 21. How does isotretinoin achieve a reduction in the signs and symptoms of acne? Select all that apply.

A. Inhibiting inflammation B. Suppressing the production of sebum C. Enhancing humoral immunity D. Inhibiting the function of sudoriferous glands E. Obstructing comedone formation ANS: A, B, E Rationale: The antiacne effects of isotretinoin include suppression of sebum production, inhibition of comedone formation, and inhibition of inflammation. The drug does not stimulate immune function or reduce the function of sweat (sudoriferous) glands.

PTS: 1 REF: p. 1214, Action OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 61: Drug Therapy for Disorders of the Skin KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select