TEST BANK for Lilley's Pharmacology for Canadian Health Care Practice 4th Edition by Linda Lilley, K

Lilleys Pharmacology for Canadian Health Care Practice 4th Edition Sealock Test Bank Chapter 01: Nursing Practice in Canada and Drug Therapy Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which is a judgement about a particular patient’s potential need or problem? a. A goal b. An assessment c. Subjective data d. A nursing diagnosis ANS: D

Nursing diagnosis is the phase of the nursing process during which a clinical judgement is made about how a patient responds to heath conditions and life processes or vulnerability for that response.

DIF: Cognitive Level: Knowledge 2. The patient is to receive oral furosemide (Lasix) every day; however, because the patient is unable to swallow, he cannot take

medication orally, as ordered. The nurse needs to contact the physician. What type of problem is this?

A “right time” problem A “right dose” problem A “right route” problem A “right medication” problem

a. b. c. d.

ANS: C

This is a “right route” problem: the nurse cannot assume the route and must clarify the route with the prescriber. This is not a “right time” problem because the ordered frequency has not changed. This is not a “right dose” problem because the dose is not related to an inability to swallow. This is not a “right medication” problem because the medication ordered will not change, just the route.

DIF: Cognitive Level: Application 3. The nurse has been monitoring the patient’s progress on his new drug regimen since the first dose and has been documenting signs

of possible adverse effects. What nursing process phase is the nurse practising? a. Planning b. Evaluation c. Implementation d. Nursing diagnosis ANS: B

Monitoring the patient’s progress is part of the evaluation phase. Planning, implementation, and nursing diagnosis are not illustrated by this example.

DIF: Cognitive Level: Application 4. The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes mellitus. Which statement best illustrates an

outcome criterion for this patient?

The patient will follow instructions.

The patient will not experience complications.

The patient adheres to the new insulin treatment regimen.

The patient demonstrates safe insulin self-administration technique.

a. b. c. d.

ANS: D

Having the patient demonstrate safe insulin self-administration technique is a specific and measurable outcome criterion. Following instructions and avoiding complications are not specific criteria. Adherence to the new insulin treatment regimen is not objective and would be difficult to measure.

DIF: Cognitive Level: Application 5. Which activity best reflects the implementation phase of the nursing process for the patient who is newly diagnosed with type 1

diabetes mellitus? a. Providing education regarding self-injection technique b. Setting goals and outcome criteria with the patient’s input c. Recording a history of over-the-counter medications used at home d. Formulating nursing diagnoses regarding knowledge deficits related to the new treatment regimen ANS: A

Education is an intervention that occurs during the implementation phase. Setting goals and outcome criteria reflects the planning phase. Recording a drug history reflects the assessment phase. Formulating nursing diagnoses regarding a knowledge deficit reflects analysis of data as part of the planning phase.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. The nurse is working during a very busy night shift, and the health care provider has just given the nurse a medication order over

the telephone, but the nurse does not recall the route. What is the best way for the nurse to avoid medication errors?

Recopy the order neatly on the order sheet, with the most common route indicated Consult with the pharmacist for clarification about the most common route Call the health care provider to clarify the route of administration Withhold the drug until the health care provider visits the patient

a. b. c. d.

ANS: C

If a medication order does not include the route, the nurse must ask the health care provider to clarify it. Never assume the route of administration.

DIF: Cognitive Level: Application | Cognitive Level: Analysis 7. Which constitutes the traditional Five Rights of medication administration? a. Right drug, right route, right dose, right time, and right patient b. Right drug, the right effect, the right route, the right time, and the right patient c. Right patient, right strength, right diagnosis, right drug, and right route d. Right patient, right diagnosis, right drug, right route, and right time ANS: A

The traditional Five Rights of medication administration were considered to be Right drug, Right route, Right dose, Right time, and Right patient. Right effect, right strength, and right diagnosis are not part of the traditional Five Rights.

DIF: Cognitive Level: Comprehension 8. What correctly describes the nursing process? a. Diagnosing, planning, assessing, implementing, and finally evaluating b. Assessing, then diagnosing, implementing, and ending with evaluating c. A linear direction that begins with assessing and continues through diagnosing, d.

planning, and finally implementing An ongoing process that begins with assessing and continues with diagnosing, planning, implementing, and evaluating

ANS: D

The nursing process is an ongoing, flexible, adaptable, and adjustable five-step process that begins with assessing and continues through diagnosing, planning, implementing, and finally evaluating, which may then lead back to any of the other phases.

DIF: Cognitive Level: Application 9. When the nurse is considering the timing of a drug dose, which is most important to assess? a. The patient’s identification b. The patient’s weight c. The patient’s last meal d. Any drug or food allergies ANS: C

The pharmacokinetic and pharmacodynamic properties of the drug need to be assessed with regard to any drug–food interactions or compatibility issues. The patient’s identification, weight, and drug or food allergies are not affected by the drug’s timing.

DIF: Cognitive Level: Application 10. The nurse is writing nursing diagnoses for a plan of care. Which reflects the correct format for her nursing diagnosis? a. Anxiety b. Anxiety related to new drug therapy c. Anxiety related to anxious feelings about drug therapy, as evidenced by d.

statements such as “I’m upset about having to give myself shots” Anxiety related to new drug therapy, as evidenced by statements such as “I’m upset about having to give myself shots”

ANS: D

Formulation of nursing diagnoses is usually a three-step process. The only complete answer is “Anxiety related to new drug therapy, as evidenced by statements such as ‘I’m upset about having to give myself shots.’” The answer “Anxiety” is missing the “related to” and “as evidenced by” portions. The answer “Anxiety related to new drug therapy” is missing the “as evidenced by” portion of defining characteristics. The “related to” section in “Anxiety related to anxious feelings about drug therapy, as evidenced by statements such as ‘I’m upset about having to give myself shots’” is simply a restatement of the problem “anxiety,” not a separate factor related to the response.

DIF: Cognitive Level: Analysis OTHER 1. Place the phases of the nursing process in the correct order, starting with the first phase.

a. Planning b. Evaluation c. Assessment d. Implementation e. Diagnosing ANS:

C, E, A, D, B DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 02: Pharmacological Principles Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient is receiving two different drugs, which, at their current dose forms and dosages, are both absorbed into the circulation in

identical amounts. Which term best denotes that the drugs have the same absorption rates? a. Equivalent b. Synergistic c. Compatible d. Bioequivalent ANS: D

Two drugs absorbed into the circulation at the same amount (in specific dosage forms) have the same bioavailability; thus, they are bioequivalent. “Equivalent” is incorrect because the term “bioavailability” is used to express the extent of drug absorption.

“Synergistic” is incorrect because this term refers to two drugs given together whose resulting effect is greater than the sum of the effects of each drug given alone. “Compatible” is incorrect because this term is a general term used to indicate that two substances do not have a chemical reaction when mixed (or given, in the case of drugs) together.

DIF: Cognitive Level: Comprehension 2. A patient is receiving medication via intravenous injection. Which information should the nurse provide for patient education? a. The medication will cause fewer adverse effects when given intravenously. b. The medication will be absorbed slowly into the tissues over time. c. The medication’s action will begin faster when given intravenously. d. Most of the drug is inactivated by the liver before it reaches the target area.

ANS: C

Intravenous injections are the fastest route of absorption. The intravenous route does not affect the number of adverse effects, the intravenous route is not a slow route of absorption, and the intravenous route does not cause inactivation of the drug by the liver before it reaches the target area.

DIF: Cognitive Level: Comprehension 3. Which is true regarding parenteral drugs? a. They bypass the first-pass effect. b. They decrease blood flow to the stomach. c. They are altered by the presence of food in the stomach. d. They exert their effects while circulating in the bloodstream.

ANS: A

Drugs given by the parenteral route bypass the first-pass effect, but they still must be absorbed into cells and tissues before they can exert their effects. Enteral drugs (drugs taken orally), not parenteral drugs, decrease blood flow to the stomach and are altered by the presence of food in the stomach. Parenteral drugs must be absorbed into cells and tissues from the circulation before they can exert their effects; they do not exert their effects while circulating in the bloodstream.

DIF: Cognitive Level: Analysis 4. A drug’s half-life is best defined as a. The time it takes for the drug to elicit half its therapeutic response. b. The time it takes one-half of the original amount of a drug to reach the target c. d.

cells.

The time it takes one-half of the original amount of a drug to be removed from the body.

The time it takes one-half of the original amount of a drug to be absorbed into the circulation.

ANS: C

A drug’s half-life is the time it takes for one-half of the original amount of a drug to be removed from the body. It is a measure of the rate at which drugs are removed from the body. Answers A, B, and D are not correct definitions of a drug’s half-life.

DIF: Cognitive Level: Comprehension 5. The term “duration of action” is best defined as a. The time it takes for the drug to elicit a therapeutic response. b. The time it takes a drug to reach its maximum therapeutic response. c. The length of time it takes to remove a drug from circulation. d. The time during which drug concentration is sufficient to elicit a therapeutic

response.

ANS: D

Duration of action is the time during which drug concentration is sufficient to elicit a therapeutic response. The time it takes for a drug to elicit a therapeutic response is the drug’s “onset of action.” The time it takes a drug to reach its maximum therapeutic response is a drug’s “peak effect.” “The length of time it takes to remove a drug from circulation” defines a drug’s elimination and does not correctly define a drug’s duration of action.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. A drug interacts with enzymes by a. altering cell membrane permeability. b. “fooling” a receptor on the cell wall. c. enhancing the drug’s effectiveness within the cells. d. “fooling” the enzyme into binding with it instead of its normal target cell.

ANS: D

When drugs interact with enzymes, they inhibit the action of a specific enzyme by “fooling” the enzyme into binding to it instead of to its normal target cell. Thus, the target cells are protected from the action of the enzymes to result in a drug effect. The alteration of cell membrane permeability, the “fooling” of a receptor on the cell wall, and the enhancement of the effectiveness of drugs within cells do not occur with selective enzyme interactions.

DIF: Cognitive Level: Comprehension 7. When administering a new medication to a patient, the nurse reads that it is highly protein bound. Which consequence will result

from this protein binding? a. Renal excretion will take longer. b. The drug will be metabolized quickly. c. The duration of action of the medication will be longer. d. The duration of action of the medication will be shorter.

ANS: C

Drugs that are bound to plasma proteins are characterized by a longer duration of action. Protein binding does not make renal excretion longer and does not increase metabolism of the drug. Protein binding of a drug means that the duration of action is longer, not shorter.

DIF: Cognitive Level: Application 8. When monitoring a patient on an insulin drip to reduce blood glucose levels, the nurse notes that the patient’s glucose level is

extremely low, and the patient is lethargic and difficult to awaken. Which adverse drug reaction is the nurse observing? a. An adverse effect b. An allergic reaction c. An idiosyncratic reaction d. A pharmacological reaction ANS: D

A pharmacological reaction is an extension of the drug’s normal effects in the body. In this case, the insulin lowered the patient’s blood glucose levels too much. An adverse effect is a predictable, well-known adverse drug reaction that results in minor or no changes in patient management. An allergic reaction (also known as a hypersensitivity reaction) involves the patient’s immune system. An idiosyncratic reaction is unexpected and is defined as a genetically determined abnormal response to normal dosages of a drug.

DIF: Cognitive Level: Comprehension 9. A patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where should the nurse tell the patient to

place the tablet?

Under the tongue In the space between the cheek and gum At the back of the throat, for easy swallowing On a non-hairy area on the chest

a. b. c. d.

ANS: A

Drugs taken by the sublingual route are placed under the tongue. Placing the tablet in the space between the cheek and gum is done for the buccal route; placing the tablet at the back of the throat (for easy swallowing) is done in the oral route; and placing the tablet on a non-hairy area on the chest is done in the topical or transdermal route.

DIF: Cognitive Level: Comprehension 10. The nurse is administering medications to a patient who is in liver failure due to end-stage cirrhosis. The nurse is aware that

patients with liver failure are most likely to have problems with which pharmacokinetic phase?

Absorption Distribution Metabolism Excretion

a. b. c. d.

ANS: C

The liver is the organ that is most responsible for drug metabolism. Decreased liver function will most affect a drug’s metabolism.

The absorption of a drug is not affected by liver function, and distribution is not affected by liver function. Excretion is affected only because decreased liver function may not transform drugs into water-soluble substances for elimination via the kidneys, but this is not the best answer to this question.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 03: Legal and Ethical Considerations Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. In the development of a new drug by a pharmaceutical company, the researcher must ensure that the participants in experimental

drug studies do not have unrealistic expectations of the new drug’s usefulness. What will the researcher include in the design of the study to prevent bias that may occur? a. A placebo b. Health Canada approval c. Informed consent d. Efficacy information ANS: A

To prevent bias that may occur as a result of unrealistic expectations of an investigational new drug, a placebo will be incorporated into the study. Health Canada approval, if given, does not be obtained until after phase III of the study. Informed consent is required in all drug studies. Efficacy information is not determined until the study is under way.

DIF: Cognitive Level: Comprehension 2. A member of an investigational drug study team is working with healthy volunteers whose participation will help determine the

optimal dosage range and pharmacokinetics of the drug. In what type of study is the team member participating? a. Phase I b. Phase II c. Phase III d. Phase IV ANS: A

Phase I studies involve small numbers of healthy volunteers to determine the optimal dosage range and the pharmacokinetics of the drug. Phases II, III, and IV involve progressively larger numbers of volunteers who have the disease or ailment that the drug is designed to diagnose or treat.

DIF: Cognitive Level: Application 3. A patient has a prescription for a drug classified as Schedule F. What important information should the nurse give this patient about

obtaining refills for this medication?

No prescription refills are permitted.

Refills may be obtained via telephone order.

Refills are indicated by the prescriber.

The patient may have no more than six refills in a 12-month period.

a. b. c. d.

ANS: C

Schedule F contains a list of drugs that can be sold and refilled only on prescription; prescriptions can be refilled as often as indicated by the prescriber.

DIF: Cognitive Level: Analysis 4. A patient has been chosen to be a recipient of an investigational drug for heart failure and has given informed consent. Which is

indicated by the patient’s informed consent? a. The patient has been informed of the possible benefits of the new therapy. b. The patient will be informed of the details of the study as the research continues. c. The patient will not be assured of receiving the actual drug during the experiment. d. The patient has received an explanation of the study’s purpose, procedures, and the benefits and risks involved.

ANS: D

Informed consent involves the careful explanation of the purpose of the study, procedures to be used, and the possible benefits and risks involved. Being informed of the possible benefits of the new therapy, being informed of the study details as research continues, and being assured of receiving the actual drug during the experiment do not describe informed consent.

DIF: Cognitive Level: Comprehension 5. Which is the most significant part of legislation in regard to professional nursing practice? a. Canada Health Act b. Nursing Practice Act c. Controlled Drugs and Substances Act d. Personal Information Protection and Electronic Documents Act ANS: B

Nurse practice acts (NPAs) are regulatory laws that are instrumental in defining the scope of nursing practice and that protect public health, safety, and welfare. Nursing practice in Canada is regulated by separate acts in each of the 10 provinces and 3 territories. These acts grant self-governance to the nursing profession, direct entry into nursing practice, define the scopes of practice, and identify disciplinary actions. NPAs are the most significant part of legislation in regard to professional nursing practice.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. What potential failure is identified when a patient with a documented penicillin allergy receives 1.2 g of benzylpenicillin IV? a. Failure to assess b. Failure to evaluate c. Failure to ensure safety d. Failure to identify the patient ANS: C

Failure to ensure safety includes lack of adequate monitoring, failure to identify patient allergies and other risk factors related to medication therapy, inappropriate drug administration technique, and failure to implement appropriate nursing actions because of improper assessment of the patient’s condition. Whereas failure to assess or evaluate includes failure to see significant changes in the patient’s condition after taking a medication, failure to report these changes, failure to take a complete medication history and nursing assessment/history, and failure to monitor the patient after medication administration. Failure to identify the patient’s identity is a medication error.

DIF: Cognitive Level: Application 7. Which statement correctly describes drugs in Part G, Part II of the Food and Drugs Act? a. They are drugs with high potential for misuse that have an accepted medical use. b. They are drugs with high potential for misuse that do not have an accepted c. d.

medical use.

They are medically accepted drugs that may cause mild physical or psychological dependence.

They are medically accepted drugs with very limited potential for causing mild physical or psychological dependence.

ANS: A

Part G, Part II drugs are those with high potential for misuse that have an accepted medical use (e.g., barbiturates).

DIF: Cognitive Level: Comprehension 8. Miss Knox, a 26-year-old, has returned to the surgical unit post appendectomy. The physician has prescribed intravenous (IV)

morphine for pain. According to the Controlled Drugs and Substances ACT (CDSA), morphine is classified under which schedule? a. Schedule I b. Schedule IV c. Schedule V d. Schedule III ANS: A

The CDSA is based on eight schedules that list controlled drugs and substances based on potential for misuse or harm or how easy they are to manufacture into illicit substances. A summary of Schedule I contains the most dangerous drugs, including opiates (opium, heroin, morphine, cocaine), fentanyls, and methamphetamine.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. Which are elements of ethical principles in nursing and health care according to the Canadian Nurses Association (CNA) Code of

Ethics? (Select all that apply.)

Promoting justice Maintaining anonymity Demonstrating responsibility Preserving dignity Promoting health and well-being

a. b. c. d. e.

ANS: A, D, E

Elements of ethical principles in nursing and health care according to the CNA Code of Ethics include providing safe, compassionate, competent, and ethical nursing care; maintaining privacy and confidentiality; promoting justice, being accountable, preserving dignity, and promoting and respecting informed decision making; and promoting health and well-being.

DIF: Cognitive Level: Critical Thinking 2. The personal Information Protection and Electronic Documents Act (PIPEDA) is a federal law governing the collection, use and

disclosure of personal health details. Protected health information includes? (Select all that apply.)

Patients’ health conditions Payment information Prescription numbers Dietary restrictions Medications

a. b. c. d. e.

ANS: A, B, C, E

The personal Information Protection and Electronic Documents Act (PIPEDA) requires all health care providers, health insurance and life insurance companies, public health authorities, employers, and schools to maintain patient privacy regarding protected health information. Protected health information includes any individually identifying information such as patients’ health conditions, account numbers, prescription numbers, medications, and payment information. A postal code on its own covers a wide geographical area.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 04: Patient-Focused Considerations Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. During the last trimester of pregnancy, drug transfer to the fetus is more likely to occur. Which is a reason for this possibility? a. Fetal size b. Decreased surface area c. Enhanced placental blood flow d. Increased amount of bound drug in maternal circulation ANS: C

Drug transfer to the fetus is more likely during the last trimester, as a result of enhanced placental blood flow, increased fetal surface area, and an increased amount of free drug in the mother’s circulation. Increased, not decreased, fetal surface area affects drug transfer to the fetus. The placenta’s surface area does not increase during this time. Drug transfer is increased due to an increased amount of free drug, not protein-bound drug, in the mother’s circulation. “Fetal size” is incorrect because the first trimester of pregnancy is the period of greatest danger of drug-induced developmental defects. During this period, the fetus undergoes rapid cell proliferation. Gestational age is more important than fetal size.

DIF: Cognitive Level: Comprehension 2. Which type of dosage calculation is used most commonly when calculating drug dosages for children? a. Fried’s rule b. Clark’s rule c. Young’s rule d. The mg/kg formula ANS: D

The body weight method, using the mg/kg formula, is the most common and reliable method for calculating doses for young patients. Fried’s rule, Clark’s rule, and Young’s rule are not methods used for calculating drug dosages for young patients.

DIF: Cognitive Level: Knowledge 3. While assessing an 82-year-old woman, the nurse determines that the patient is experiencing polypharmacy. What is this

experience most likely to indicate? a. The patient has a lower risk of drug interactions. b. The patient takes medications for one illness several times a day. c. The patient risks problems only if she also takes over-the-counter medications. d. The patient takes multiple medications for several different illnesses.

ANS: D

Polypharmacy usually occurs when a patient has several illnesses and takes medications for each of them, medications possibly prescribed by different specialists who may be unaware of the patient’s other treatments. This situation puts the patient at increased risk of drug interactions and adverse reactions. Polypharmacy means that the patient has a higher, not lower, risk of drug interactions, and that the patient is taking several different medications, not just one. Polypharmacy can include prescription drugs, over-the-counter medications, and natural health products.

DIF: Cognitive Level: Application 4. Which statement is true in regard to children? a. Their levels of microsomal enzymes are decreased compared to those of adults. b. Their total body water content is much less than that of adults. c. Their first-pass elimination is increased because of higher portal circulation. d. Gastric emptying is more rapid than that of adults because of increased peristaltic

activity.

ANS: A

In children, the levels of microsomal enzymes are decreased. A child’s gastric emptying is slowed because of slow or irregular peristalsis. Total body water content is greater in children than in adults, and first-pass elimination by the liver is reduced because of immaturity of the liver and reduced levels of microsomal enzymes.

DIF: Cognitive Level: Comprehension 5. For accurate medication administration to young patients, the nurse must take into account which information? a. Weight, height, age, and organ maturity b. Age, glomerular filtration rate, and weight c. Weight, height, body temperature, and age d. Weight, height, and total body water content ANS: A

To accurately administer medications to young patients, their weight, height, age, physical condition, metabolism and organ maturity must be taken into account. Glomerular filtration rate, body temperature, and total body water content are not considerations when administering medications to young patients.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. An older adult patient will often experience a reduction in the stomach’s ability to produce hydrochloric acid. This change will

result in which alteration?

Delayed gastric emptying Increased gastric acidity Decreased intestinal absorption of medications Altered absorption of select drugs

a. b. c. d.

ANS: D

This aging-related change results in a decrease in gastric acidity and may alter the absorption of some drugs. Delayed gastric emptying, increased gastric acidity, and decreased intestinal absorption of medications are not results of reduced hydrochloric acid production.

DIF: Cognitive Level: Application 7. Which is the reason drug toxicity is more likely to occur in the neonate? a. The lungs are immature. b. The kidneys are smaller. c. The liver is not fully developed. d. Renal excretion of the drug is faster.

ANS: C

A neonate’s liver is not fully developed and cannot detoxify many drugs; thus, drug toxicity is more likely to occur in the neonate.

The lungs and kidneys do not play major roles in drug metabolism. Renal excretion of the drug is slower, not faster, due to organ immaturity.

DIF: Cognitive Level: Comprehension 8. An 83-year-old female patient has been given a thiazide diuretic to treat mild heart failure. She and her daughter should be taught to

watch for which complications?

Dizziness and constipation Fatigue and dehydration Daytime sedation and lethargy Edema and blurred vision

a. b. c. d.

ANS: B

Electrolyte imbalance, fatigue, and dehydration are common complications of thiazide diuretics in older adult patients. Dizziness and constipation, daytime sedation and lethargy, and edema and blurred vision are not complications that occur when these drugs are given to older adults.

DIF: Cognitive Level: Comprehension 9. Which complication is common with an older adult patient who is taking digoxin? a. Hallucinations b. Edema c. Dry mouth d. Constipation ANS: A

Common complications for older adults taking digoxin include visual disorders, nausea, diarrhea, dysrhythmias, hallucinations, decreased appetite, and weight loss. Nonsteroidal anti-inflammatory drugs may cause edema, anticholinergics and antihistamines may cause dry mouth, and opioids may cause constipation.

DIF: Cognitive Level: Comprehension 10. The nurse is aware that confusion, ataxia, and increased risk for falls are older adult patients’ common responses to which

medication?

Laxatives Anticoagulants Sedatives Diuretics

a. b. c. d.

ANS: C

In older adults, sedatives and hypnotics often cause confusion, daytime sedation, ataxia, lethargy, and increased risk for falls.

Laxatives, anticoagulants, and diuretics may cause adverse effects in older adults, but not the adverse effects specified in the question.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

11. The nurse is trying to give a liquid medication to a 2-year-old child and notes that the medication has a strong taste. The best way

for the nurse to give this medication to a child is to Give the medication with spoonfuls of sherbet.

Add the medication to the child’s bottle.

Tell the child you have candy.

Add the medication to a cup of milk.

a. b. c. d.

ANS: A

Using sherbet or another non-essential food that makes the medication taste better is the best way to give a strong-tasting medication to a child. Adding the medication to the child’s bottle is not correct because the child may not drink the entire contents of the bottle, thus wasting the medication. Telling the child that the medication is candy is not correct because using the word “candy” with drugs may lead to the child’s thinking that drugs are actually candy. Adding the medication to a cup of milk is not correct because the child may not drink the entire cup of milk, and the distasteful drug may cause the child to refuse milk in the future.

DIF: Cognitive Level: Application 12. For which cultural group must the nurse respect the value placed on natural health products, the use of heat, and a concern for the

balance of opposing forces that lead to illness or health?

Hispanic Canadians Asian Canadians Indigenous peoples Black people of African descent

a. b. c. d.

ANS: B

Some Asian Canadians believe in yin and yang, which are opposing forces leading to illness or health, depending on which force is in balance. Other health practices for this cultural group include belief in the use of heat and in the value of herbal remedies.

Hispanic Canadians, Indigenous peoples, and Black people of African descent do not typically engage in these practices.

DIF: Cognitive Level: Comprehension 13. A nurse is assessing an older adult Indigenous woman who is being treated for hypertension. During the assessment, what

important information should the nurse remember or expect in regard to culture?

The patient should be discouraged from using traditional remedies and rituals.

The nurse should expect the patient to value protective bracelets and herbal teas.

The nurse should remember that the balance between body, mind, and environment is important to this patient’s health beliefs. d. The assessment should include information about cultural practices and beliefs regarding medication, treatment, and healing. a. b. c.

ANS: D

All beliefs need to be strongly considered to prevent a conflict between the goals of nursing and health care and the dictates of a patient’s cultural background. Assessing cultural practices and beliefs is part of a thorough assessment. The nurse should not ignore a patient’s cultural practices. Protective bracelets, use of herbal teas, and balance between body, mind, and environment do not describe beliefs and practices that usually apply to this patient’s cultural group.

DIF: Cognitive Level: Application 14. Which ethnocultural group believes in harmony with nature and views ill spirits as causing disease? a. Black people of African descent b. South Asian Canadians c. Filipino Canadians d. Indigenous peoples ANS: D

Indigenous peoples believe in harmony with nature and view ill spirits as causing disease.

DIF: Cognitive Level: Comprehension 15. Which contributes to drug polymorphism? a. The number of drugs ordered by the physician b. The patient’s drug history c. The patient’s age, sex, and body composition d. Different dosage forms of the same drug ANS: C

A patient’s age, sex, size, and body composition are some of the factors that contribute to drug polymorphism, which is the effect of such variables on how an individual absorbs or metabolizes specific drugs. The number of drugs ordered by the physician, the patient’s drug history, and different dosage forms of the same drug are not factors that contribute to drug polymorphism.

DIF: Cognitive Level: Comprehension 16. Which best describes drug polymorphism? a. Cultural and genetic effects on drug metabolism and excretion b. Gender and cultural effects on drug absorption and distribution c. Age or body composition effects on drug absorption or metabolism d. Multidrug use resulting in impaired excretion ANS: C

Drug polymorphism is the variation in response to a drug because of a patient’s age, sex, size, and body composition.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

3

MULTIPLE RESPONSE 1. Which is true regarding young patients? (Select all that apply.) a. The levels of microsomal enzymes are decreased. b. Perfusion to the kidneys may be decreased, which may result in reduced renal c. d. e. f. g.

function.

First-pass elimination is increased because of higher portal circulation.

First-pass elimination is reduced because of the immaturity of the liver.

Total body water content is much less than in adults.

Gastric emptying is slowed because of slow or irregular peristalsis.

Gastric emptying is more rapid because of increased peristaltic activity.

ANS: A, B, D, F

In children, microsomal enzymes are decreased and first-pass elimination by the liver is reduced because of the immaturity of the liver. In addition, gastric emptying is reduced because of slow or irregular peristalsis. Perfusion to the kidneys may be decreased, resulting in reduced renal function. “First-pass elimination is increased because of higher portal circulation” and “Gastric emptying is more rapid because of increased peristaltic activity” are not correct statements. Total body water content is greater in children than in adults.

DIF: Cognitive Level: Application 2. Which is true regarding older adults? (Select all that apply.) a. The levels of microsomal enzymes are decreased. b. Fat content is increased because of decreased lean body mass. c. Fat content is decreased because of increased lean body mass. d. The number of intact nephrons is increased. e. The number of intact nephrons is decreased. f. Gastric pH is less acidic. g. Gastric pH is more acidic.

ANS: A, B, E, F

In older adults, levels of microsomal enzymes are decreased because the aging liver is less able to produce them; fat content is increased because of decreased lean body mass; the number of intact nephrons is decreased due to aging; and gastric pH is less acidic due to a gradual reduction of the production of hydrochloric acid. “Fat content is decreased because of increased lean body mass,” “The number of intact nephrons is increased,” and “Gastric pH is more acidic” are incorrect statements.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

4

Chapter 05: Gene Therapy and Pharmacogenomics Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which is the most important compound that transfers genes from parents to offspring? a. Chromatin b. Deoxyribonucleic acid (DNA) c. Alleles d. Ribonucleic acid ANS: B

It is now recognized that DNA is the most important body compound that serves to transfer genes from parents to offspring.

DIF: Cognitive Level: Knowledge 2. Which is manufactured as a result of indirect gene therapy? a. Vitamin K b. epoetin (Eprex) c. Human insulin d. Heparin ANS: C

A recombinant form of human insulin is one of the most widespread uses of indirect gene therapy.

DIF: Cognitive Level: Comprehension 3. Eugenics is defined as a. the use of gene therapy to prevent disease. b. the development of new drugs based on gene therapy. c. the intentional selection, before birth, of genotypes that are considered more d.

desirable than others. the determination of genetic factors that influence a person’s response to medications.

ANS: C

Eugenics is the intentional selection, before birth, of genotypes that are considered more desirable than others. Eugenics is a major ethical issue related to gene therapy.

DIF: Cognitive Level: Knowledge 4. What is the main purpose of the Human Genome Project? a. To study genetic diseases b. To study genetic traits in humans c. To discover new genetic diseases d. To describe the entire genome of a human being ANS: D

The Human Genome Project was undertaken to describe in detail the entire genome of a human being.

DIF: Cognitive Level: Knowledge 5. Genotyping for the presence of cytochrome P-450 2D6 (CYP2D6) enzymes and alleles will be helpful in which area of medicine? a. Cardiology b. Psychiatry c. Respirology d. Oncology ANS: B

Psychiatry and general medicine will benefit. Genotyping for the presence of CYP2D6 will determine whether patients are poor, intermediate, extensive, or ultrarapid metabolizers with these enzymes, which will help guide the prescribing of specific medications.

DIF: Cognitive Level: Comprehension SHORT ANSWER 1. Name one clinical application of pharmacogenomics.

ANS:

Several possible clinical applications are listed in Table 5-1: Clinical Applications of Pharmacogenomics.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

Chapter 06: Medication Errors: Preventing and Responding Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which situation is an example of a medication error? a. A patient refuses her morning medications. b. A patient receives a double dose of a medication because the nurse did not cut the c. d.

pill in half.

A patient develops hives after starting an intravenous antibiotic 24 hours earlier.

A patient reports severe pain still present 60 minutes after a pain medication was given.

ANS: B

A medication error is defined as a preventable adverse drug event that involves inappropriate medication use by a patient or health care provider. Refusing morning medications and reporting severe pain after having been given medication are examples of patient behaviours. The development of hives is a possible allergic reaction. None of these situations is preventable.

DIF: Cognitive Level: Application 2. Which is the proper notation for the dose of the drug ordered? a. digoxin .125 mg b. digoxin .1250 mg c. digoxin 0.125 mg d. digoxin 0.1250 mg ANS: C

Always use a leading zero for decimal dosages (e.g., digoxin 0.125 mg) with medication orders or their transcription. Omitting the leading zero may cause the order to be misread, resulting in a large drug overdose. Never use trailing zeros.

DIF: Cognitive Level: Application 3. When the nurse is giving a scheduled morning medication, the patient states, “I haven’t seen that pill before. Are you sure it’s

correct?” The nurse checks the medication administration record and sees that medication is listed. Which is the nurse’s best response to the patient? a. “It’s listed here on the medication sheet, so you should take it.” b. “Go ahead and take it, and then I’ll check with your doctor about it.” c. “It wouldn’t be listed here if it wasn’t ordered for you!” d. “I’ll check on the order first, before you take it.”

ANS: D

When giving medications, the nurse must always listen to and honour any concerns or doubts expressed by the patient. If the patient doubts an order, the nurse should check the written order, check with the prescriber, or both. The other options included with this example illustrate the nurse’s not listening to the patient’s concerns.

DIF: Cognitive Level: Application 4. The physician has written admission orders, and the nurse is transcribing them. The nurse is having difficulty transcribing one order

because of the physician’s handwriting. The best action for the nurse to take is to a. ask a colleague what the order says. b. contact the physician to clarify the order. c. contact the pharmacy to clarify the order. d. ask the patient what medications are being taken at home.

ANS: B

If a prescriber writes an order that is illegible, the nurse should contact the prescriber for clarification. The nurse should not ask a colleague what the order says because the colleague did not write the order. The nurse should not contact the pharmacy to clarify the order because this action would delay implementation of the order. Asking the patient what medications are taken at home is incorrect because this question will not clarify the current order.

DIF: Cognitive Level: Comprehension 5. Health care providers should report actual and potential medication errors to which organization? a. Institute for Safe Medications Practices (ISMP) Canada b. Accreditation Canada c. Canadian Patient Safety Institute (CPSI) d. Health Canada ANS: A

Actual and potential medication errors should be reported to ISMP Canada; confidentiality of the reporter is respected.

Accreditation Canada, CPSI, and Health Canada all offer information pertaining to medication safety.

DIF: Cognitive Level: Knowledge

Copyright © 2021, Elsevier Inc. All rights reserved.

1

MULTIPLE RESPONSE 1. Which statements are true regarding an adverse drug reactions (ADRs)? (Select all that apply.) a. Adverse effects are ADRs that are usually predictable. b. ADRs always result in harm to patients. c. All ADRs are preventable if proper precautions are taken. d. ADRs can be unexpected and unintended responses to medications.

ANS: A, D

An ADR is defined as any unexpected, undesired, or excessive response to a medication. Adverse effects are ADRs that are usually not severe enough to warrant stopping the medication. Not all ADRs result in harm to the patient. Some ADRs, such as allergic or idiosyncratic reactions, may not be preventable or predicted.

DIF: Cognitive Level: Knowledge

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 07: Patient Education and Drug Therapy Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which diagnosis is appropriate for the patient who has just received a prescription for a new medication? a. Nonadherence related to a new drug therapy b. High risk for nonadherence related to new drug therapy c. Knowledge deficit related to newly prescribed drug therapy d. Deficient knowledge related to newly prescribed drug therapy ANS: D

The patient who has a limited understanding of newly prescribed drug therapy may have the nursing diagnosis of deficient knowledge. “Nonadherence” implies that the patient does not follow a recommended regimen, which is not the case with a newly prescribed drug. “High risk for nonadherence related to new drug therapy” is not a North American Nursing Diagnosis Association nursing diagnosis, and “Deficient knowledge related to newly prescribed drug therapy” is an outdated nursing diagnosis.

DIF: Cognitive Level: Analysis 2. Which statement reflects a measurable goal? a. The patient will know about insulin injections. b. The patient will understand the principles of insulin preparation. c. The patient will demonstrate the proper technique of mixing insulin. d. The patient will comprehend the proper technique of preparing insulin.

ANS: C

The word “demonstrate” is a measurable verb, and measurable terms should be used when developing goals and outcome criteria statements. The terms “know,” “understand” and “comprehend” are not measurable terms.

DIF: Cognitive Level: Analysis 3. During an assessment, which question allows the nurse to clarify and open up discussion with the patient? a. “Are you allergic to penicillin?” b. “What medications do you take?” c. “Have you had a reaction to this drug?” d. “Are you taking this medication with meals?”

ANS: B

“What medications do you take?” is an open-ended question that will encourage more clarification and discussion from the patient.

“Are you allergic to penicillin?” is a closed-ended question, as are “Have you had a reaction to this drug?” and “Are you taking this medication with meals?” Closed-ended questions prompt only a “yes” or “no” answer and provide limited information.

DIF: Cognitive Level: Application 4. The nurse is setting up a teaching–learning session with an 85-year-old patient who will be going home on anticoagulant therapy.

Which strategy will reflect consideration of aging changes that may occur?

Showing a colourful video about anticoagulation therapy Presenting all the information in one session just before discharge Giving the patient pamphlets about the medications to read at home Developing large-print handouts that reflect the verbal information presented

a. b. c. d.

ANS: D

Developing large-print handouts that reflect the verbal information presented will address altered perception in two ways. First, using visual aids reinforces the verbal instructions by addressing the patient’s possibly decreased ability to hear high-frequency sounds. Second, developing the handouts in large print addresses the possibility of decreased visual acuity. Showing a colourful video about anticoagulation therapy does not allow for discussion of the information; furthermore, the text and print may be small and difficult to read and understand. Presenting all the information in one session just before discharge also does not allow for discussion, and the patient may not be able to hear or see the information sufficiently. Because of the possibility of decreased short-term memory and slowed cognitive function, giving the patient pamphlets about the medications to read at home is not appropriate.

DIF: Cognitive Level: Application 5. When the nurse is teaching a manual skill, such as self-injection of insulin, the best way to set up the teaching-learning session is to a. provide written pamphlets for instruction. b. show a video and allow the patients to practice as needed on their own. c. verbally explain the procedure and provide written handouts for reinforcement. d. allow the patients to do several “return” demonstrations after the nurse has

demonstrated the procedure.

ANS: D

Return demonstrations allow the nurse to evaluate the patient’s newly learned skills. Providing written pamphlets for instruction, showing a video and then allowing patients to practice as needed on their own, and verbally explaining the procedure and providing written handouts for reinforcement do not allow for evaluation of the patient’s technique.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. A patient and the dietitian have just reviewed the patient’s new diet, which is low protein and low potassium. This reviewing

constitutes learning in which domain?

Physical Affective Cognitive Psychomotor

a. b. c. d.

ANS: C

The cognitive domain refers to problem-solving abilities and may involve recall and knowledge of facts. The physical domain is not one of the learning domains. The affective domain refers to values and beliefs. The psychomotor domain may involve actions such as learning how to perform a procedure.

DIF: Cognitive Level: Comprehension 7. The nurse needs to teach a 16-year-old patient, newly diagnosed with diabetes, about blood glucose monitoring and the importance

of regulating glucose intake. When the nurse is developing the teaching plan, which of Erickson’s stages of development should be considered? a. Trust versus mistrust b. Intimacy versus isolation c. Industry versus inferiority d. Identity versus role confusion ANS: D

According to Erickson, the adolescent, 12 to 18 years of age, is in the “identity versus role confusion” stage of development.

According to Erikson, “trust versus mistrust” reflects the infancy stage; “intimacy versus isolation” reflects the young adulthood stage; and “industry versus inferiority” reflects the school-age stage of development.

DIF: Cognitive Level: Comprehension 8. A 60-year-old patient is on several new medications and expresses worry that she will forget to take her pills. For a patient in this

situation, the most helpful response from the nurse is to do what?

Teach effective coping strategies.

Reduce the number of drugs prescribed.

Assure the patient that she won’t forget once she is accustomed to the routine.

Help the patient obtain and learn to use a calendar or a pill container.

a. b. c. d.

ANS: D

Calendars, pill containers, or diaries may be helpful to patients who may forget to take prescribed drugs as scheduled. The nurse must ensure that the patient knows how to use these reminder tools. Teaching the patient effective coping strategies is a helpful suggestion but will not help the patient to remember to take medications. Reducing the number of drugs prescribed is not an appropriate action by the nurse. Assuring the patient that she won’t forget once she is accustomed to the routine is false reassurance by the nurse and inappropriate when education is needed.

DIF: Cognitive Level: Application MULTIPLE RESPONSE 1. Which are appropriate considerations when the nurse is assessing the learning needs of a patient? (Select all that apply.) a. Cultural background b. Social support c. Level of education d. Readiness to learn e. Health beliefs ANS: A, B, C, D, E

All options are appropriate to consider when the nurse is assessing learning needs.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 08: Over-the-Counter Drugs and Natural Health Products Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go “natural” with her pregnancy. She

shows the nurse a list of natural health products that she wishes to take so she can “avoid taking any drugs.” Which statement represents the nurse’s best response? a. Most natural health products are nontoxic and safe for use during pregnancy. b. Please read the labels carefully before use, to check for cautionary warnings. c. Products from different manufacturers are required to contain consistent amounts of herbal constituents. d. Natural health products are actually drugs of unproven safety and should not be taken during pregnancy without medical supervision.

ANS: D

Natural health products are actually drugs of mostly unproven safety, especially for pregnant women; many have not been tested for safety during pregnancy. Manufacturers are not required to provide cautionary statements or guarantee the reliability of the contents. The labels on natural health products may not provide enough information for use during pregnancy. Manufacturers of natural health products are not required to guarantee the reliability of the contents.

DIF: Cognitive Level: Analysis 2. The role of the Natural and Non-prescription Health Products Directorate (NNHPD) is to see that a. natural health products are regulated for safety and quality. b. natural health products are held to the same standards as drugs. c. producers of natural health products prove the therapeutic efficacy of their d.

products. natural health products are protected by patent laws.

ANS: A

The NNHPD ensures access to safe, effective, and quality natural health products.

DIF: Cognitive Level: Analysis 3. Which is a concern regarding the use of the natural health product kava? a. Cancer risk b. Liver toxicity c. Cardiovascular incidents d. Intestinal disorders ANS: B

The herb kava is found in herbal and homeopathic preparations and sometimes in food. Kava is promoted for the treatment of anxiety, nervousness, insomnia, pain, and muscle tension. Health Canada has issued warnings about possible liver toxicity with the use of kava root. In 2012, after a 10-year ban, Health Canada regulated kava root as a new drug.

DIF: Cognitive Level: Knowledge 4. A patient tells the nurse that she wants to begin taking St. John’s wort for treatment of depression. The nurse should warn her about

which substance that may cause an interaction with St. John’s wort? digoxin All caffeine-containing products Alcoholic beverages Selective serotonin reuptake inhibitors

a. b. c. d.

ANS: D

Drug interactions may occur with the ingestion of other serotonergic drugs, such as selective serotonin reuptake inhibitors; the drug interaction may lead to serotonin syndrome.

DIF: Cognitive Level: Comprehension 5. A patient says that he eats large amounts of garlic for its cardiovascular benefits. Which drug, if taken, could have a potential

interaction with the garlic? acetaminophen warfarin digoxin phenytoin

a. b. c. d.

ANS: B

When taking garlic, taking any drugs that may interfere with platelet and clotting functions should be avoided. These drugs include antiplatelet drugs, anticoagulants (e.g., warfarin), nonsteroidal anti-inflammatory drugs (NSAIDs), and acetylsalicylic acid (Aspirin). Acetaminophen, digoxin, and phenytoin do not have interactions with garlic.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. When teaching patients about over-the-counter (OTC) and natural health products, the nurse should teach the patients that a. histamine-blocking agents should be taken with antacids to prevent b. c. d.

gastrointestinal upset. drug interactions are rare with OTC products because OTC drugs are safer than prescription drugs. manufacturers of natural health products are required to provide evidence of safety and effectiveness; therefore, check the labels carefully. natural health products and OTC drugs cannot be safely administered to infants, children, and pregnant or lactating women without first checking with the health care provider.

ANS: D

Natural health products and OTC drugs are not necessarily safe for infants, children, and pregnant or lactating women; the health care provider should be contacted before use. “Histamine-blocking agents should be taken with antacids to prevent gastrointestinal upset,” “Drug interactions are rare with OTC products because OTC drugs are safer than prescription drugs,” and “Manufacturers of natural health products are required to provide evidence of safety and effectiveness; therefore, check the labels carefully” are all false statements.

DIF: Cognitive Level: Comprehension 7. Patients from which culture will not report gastrointestinal symptoms caused by OTC drugs or natural health products? a. Chinese b. Japanese c. Hispanic d. European ANS: B

Japanese patients experiencing nausea, vomiting, or bowel changes as a result of OTC drugs or natural health products often do not mention these symptoms. Because the Japanese culture considers complaining about gastrointestinal symptoms to be unacceptable, these symptoms may go unreported. The nurse needs to be aware of this implication for this ethnocultural group.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. Which statement is true regarding the use of OTC drugs? (Select all that apply.) a. Use of OTC drugs may delay treatment of more serious ailments. b. Drug interactions with OTC medications are rare. c. OTC drugs may relieve symptoms without addressing the cause of the problem. d. OTC drugs are indicated for long-term treatment of conditions. e. Patients may misunderstand product labels and misuse the drugs.

ANS: A, C, E

“Use of OTC drugs may delay treatment of more serious ailments,” “OTC drugs may relieve symptoms without addressing the cause of the problem,” and “Patients may misunderstand product labels and misuse the drugs” are all true statements about the use of OTC drugs and should be included when patients are being taught about their use. Drug interactions may indeed occur with prescription medications and other OTC drugs. Normally, OTC drugs are intended for short-term treatment of minor ailments.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 09: Vitamins and Minerals Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Conditions such as infantile rickets, tetany, and osteomalacia are caused by a deficiency in which vitamin or mineral? a. Vitamin D b. Vitamin K c. Magnesium d. Cyanocobalamin ANS: A

Conditions such as infantile rickets, tetany, and osteomalacia are all results of long-term vitamin D deficiency.

DIF: Cognitive Level: Comprehension 2. Which nursing diagnosis is appropriate for the patient undergoing therapy with vitamin A? a. Risk for impaired skin integrity due to vitamin deficiency b. Disturbed sensory perception (visual) due to night blindness c. Impaired physical mobility (muscle weakness) due to vitamin deficiency d. Disturbed thought processes (confusion and psychosis) due to vitamin deficiency ANS: B

Vitamin A deficiency causes night blindness.

DIF: Cognitive Level: Analysis 3. Which symptom may indicate toxicity during vitamin D therapy? a. Urticaria b. Anorexia c. Diarrhea d. Tinnitus ANS: B

Anorexia may indicate vitamin D toxicity.

DIF: Cognitive Level: Comprehension 4. Which dietary information is important for the patient taking calcium supplements? a. Oral calcium supplements should be taken before meals. b. Calcium products bind with tetracyclines, making the antibiotic inactive. c. Foods high in calcium include whole grain cereals, egg yolks, and liver. d. Foods high in oxalate and zinc, such as spinach and legumes, increase the

absorption of oral calcium supplementation.

ANS: B

Calcium products chelate or bind with tetracyclines, resulting in decreased effects of tetracyclines. Foods high in calcium include milk and other dairy products, shellfish, and dark green leafy vegetables. Oral calcium supplements should be taken with meals.

DIF: Cognitive Level: Analysis 5. What adverse effect may occur from calcium salt infusion? a. Ototoxicity b. Metabolic acidosis c. Nephrotoxicity d. Respiratory arrest ANS: B

Adverse effects from calcium salts include metabolic acidosis, as well as hemorrhage, hypertension, constipation, obstruction, nausea, vomiting, flatulence, kidney dysfunction, and hypercalcemia.

DIF: Cognitive Level: Application 6. Which vitamin is given to newborns shortly after delivery? a. Vitamin B3 b. Vitamin D c. Vitamin A d. Vitamin K ANS: D

Vitamin K deficiency in newborns is a result of malabsorption attributable to inadequate amounts of bile. Thus, vitamin K is given in a single intramuscular dose to infants shortly after delivery.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. A patient with a history of alcohol abuse has been admitted to hospital for severe weakness and malnutrition. Which preparation

will he receive to prevent Wernicke’s encephalopathy?

Vitamin B3 Vitamin B1 Vitamin B2 Vitamin B6

a. b. c. d.

ANS: B

Vitamin B1 (thiamine) is useful in the treatment of a variety of thiamine deficiencies, including Wernicke’s encephalopathy.

DIF: Cognitive Level: Comprehension 8. People who live in Canada’s North often have a lack of which vitamin? a. Vitamin A b. Vitamin B c. Vitamin C d. Vitamin D ANS: D

Vitamin D, the “sunshine vitamin,” is naturally produced by the sun. People who live in Canada’s North, which lacks sunlight for much of the year, dress for intense cold, which reduces their opportunity for taking in vitamin D. DIF: Cognitive Level: Knowledge MULTIPLE RESPONSE 1. Which statement is true in regard to vitamin C? (Select all that apply.) a. Vitamin C is important in the maintenance of bones, teeth, and capillaries. b. Vitamin C is important for erythropoiesis. c. Glycogenolysis relies on the presence of vitamin C. d. Vitamin C is important for tissue repair. e. Vitamin C is essential for the synthesis of blood coagulation factors. f. Vitamin C is found in animal sources, such as dairy products and meat. g. Vitamin C is found in citrus fruits, tomatoes, cabbage, and strawberries. h. Vitamin C is essential for night vision.

ANS: A, B, D, G

Vitamin C is important in the maintenance of bones, teeth, and capillaries; for erythropoiesis; and for tissue repair. Vitamin C is found in citrus fruits, tomatoes, cabbage, and strawberries. Vitamin C deficiency is known as scurvy.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 10: Principles of Drug Administration Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Before administering any medication, which action by the nurse is most important? a. Verifying orders with another nurse b. Documenting the medications given c. Counting medications in the medication cart drawers d. Checking the patient’s identification and allergy bracelets ANS: D

Checking the patient’s identification and allergy bracelets are important for the patient’s safety and reflects some of the six (or more) Rights of medication administration. Verifying orders with another nurse is not required; only some medications require double-checking with another nurse. Documenting the medications given or counting medications in the medication cart drawers do not affect safety.

DIF: Cognitive Level: Comprehension 2. What is the proper syringe size for an intradermal (ID) injection? a. 3-mL syringe b. 1-mL tuberculin c. 2-mL tuberculin d. 2-mL syringe ANS: B

The proper syringe size for ID injection is a 1-mL tuberculin, or a 1-mL syringe with a 26- or 27-gauge needle that is 10 mm to 16 mm long.

DIF: Cognitive Level: Knowledge 3. A patient is to receive an intramuscular (IM) injection of penicillin in the ventrogluteal site. What is the proper angle for needle

insertion in an adult who is not emaciated? a. 15 degrees b. 45 degrees c. 60 degrees d. 90 degrees ANS: D

The proper angle for IM injections is 90 degrees.

DIF: Cognitive Level: Comprehension 4. When the nurse is administering medication by intravenous (IV) bolus (push), which is the correct procedure? a. Occluding the IV line by folding the tubing just above the injection port b. Clamping the tubing just above the insertion site c. Pinching the tubing just above the injection port d. Pinching the tubing at least 5 cm above the injection port ANS: C

Before injecting an IV push medication, occlude the IV line by pinching the tubing just above the injection port.

DIF: Cognitive Level: Comprehension 5. The nurse is preparing to administer IM immunization to a 2-month-old infant. Which site is acceptable for this injection? a. Deltoid b. Dorsogluteal c. Ventrogluteal d. Vastus lateralis ANS: D

The vastus lateralis is the acceptable IM site for infants.

DIF: Cognitive Level: Comprehension 6. The nurse is administering insulin subcutaneously to a patient who is obese. Proper technique for this injection requires the nurse to

do which?

Use the Z-track method Insert the needle at a 5- to 15-degree angle until resistance is felt Pinch the skin at the injection site and inject the needle below the skin fold Spread the skin tightly over the injection site, insert the needle, then release the skin

a. b. c. d.

ANS: C

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

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. When should the nurse administer IM medication with the Z-track method? a. When the medication is known to be irritating to tissues b. When the patient is emaciated and has very little muscle mass c. When the medication must be absorbed quickly into the tissues d. When the patient is obese and has a deep fat layer below the muscle mass ANS: A

The Z-track method should be used for medications known to irritate tissues. This method prevents the deposit of medication through sensitive tissues and reduces pain, irritation, and staining at the injection site.

DIF: Cognitive Level: Application 8. After administering an ID injection for a skin test, the nurse notices a small bleb at the injection site. What is the proper action for

the nurse to take? a. Apply heat b. Massage the area c. Report the bleb to the physician d. Do nothing ANS: D

The formation of a small bleb is expected after an ID injection for skin testing. It is normal to feel resistance, and a bleb that resembles a mosquito bite (about 6 mm in diameter) will form at the site if accurate technique is used.

DIF: Cognitive Level: Comprehension 9. What important action should the nurse take after administering an IV push medication through an IV lock? a. Flush the lock. b. Regulate the IV flow. c. Clamp the tubing for 10 minutes. d. Hold the patient’s arm up to improve blood flow.

ANS: A

IV locks are to be flushed before and after each use. Either a heparin or saline flush is used, depending on the particular institution’s policy. Regulating the IV flow, clamping the tubing for 10 minutes, or holding the patient’s arm up to improve blood flow are not appropriate actions.

DIF: Cognitive Level: Comprehension 10. Which is the proper method of mixing IV solutions and medications? a. Shaking the bag or bottle vigorously b. Holding the bag or bottle and gently turning it end to end c. Inverting the bag or bottle just once after injecting the medication d. Allowing the IV solution to stand for 10 minutes to enhance even distribution of

medication ANS: B

When adding medications to IV fluid containers, mix the medication and the IV solution by holding the bag or bottle and gently turning it end to end.

DIF: Cognitive Level: Comprehension 11. To measure 4 mL of a liquid cough elixir properly for a child, what should the nurse do? a. Use a teaspoon to measure and administer the elixir. b. Hold the medication cup at eye level and fill it to the desired level. c. Withdraw the elixir from the container with a syringe with a needle attached. d. Withdraw the elixir from the container with a syringe without a needle attached.

ANS: D

Liquid medication volumes of less than 5 mL should be withdrawn in a syringe without a needle. To prevent accidental ingestion of the needle during administration of the liquid, never use a needle to draw up oral medication; never withdraw the elixir from the container with a syringe with a needle attached. Using a teaspoon to measure and administer liquid medication or holding the medication cup at eye level and filling it to the desired level are not accurate methods for measuring small volumes.

DIF: Cognitive Level: Comprehension 12. The nurse is helping a patient to take his medications; however, the medication cup falls to the floor, spilling the contents. The

appropriate action for the nurse to take is to discard the medications and repeat the preparation. document the client’s refusal of the medications. wait until the next dosage time, then give the medications. retrieve the medications and administer them to avoid waste.

a. b. c. d.

ANS: A

Medications that fall onto the floor need to be discarded, and the procedure must be repeated with new medications.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

13. The patient is to receive a buccal medication. Which action is appropriate for the nurse to take? a. Encourage the patient to swallow if necessary. b. Administer water after the medication has been given. c. Place the medication between the upper molar teeth and cheek. d. Place the tablet under the client’s tongue, and allow the tablet to dissolve

completely.

ANS: C

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

DIF: Cognitive Level: Comprehension 14. How should the nurse administer medication through a nasogastric (NG) tube? a. Administer the medication with a small medication syringe. b. Apply gentle pressure on the syringe’s piston to infuse the medication. c. Flush the tubing with 30 mL of saline after the medication has been given. d. Using the barrel of the syringe, allow the fluid to flow via gravity into the NG

tube.

ANS: D

For NG tubes, medications are poured into the barrel of the syringe with the piston removed, and fluid is allowed to flow via gravity into the tube. Never force any fluid into the tube. Flush the tubing with 30 mL of tap water to ensure that the medication is cleared from the tube.

DIF: Cognitive Level: Comprehension 15. Which technique should the nurse use to facilitate the administration of a rectal suppository? a. Having the patient lie on the right side of the body, unless contraindicated b. Having the patient hold the breath during insertion of the medication c. Lubricating the suppository with a small amount of petroleum-based lubricant d. Encouraging the patient to lie on the left side of the body for 15 to 20 minutes

after insertion ANS: D

For rectal suppository insertion, the patient should be positioned on the left side of the body. Lubricate the suppository with a small amount of water-soluble lubricant, have the patient take a deep breath and exhale through the mouth during insertion, and then have the patient remain lying on the left side for 15 to 20 minutes to allow absorption of the drug.

DIF: Cognitive Level: Application 16. What is the best action for the nurse to take to reduce systemic effects after administering eye drops? a. Wiping off excess liquid immediately after instilling drops. b. Having the patient close the eye tightly after instilling drops. c. Having the patient close the eye, then moving the eye around to help distribute d.

the medication.

Applying gentle pressure to the patient’s nasolacrimal duct for 30 to 60 seconds after instilling drops.

ANS: D

When administering drugs that cause systemic effects, protect your finger with a clean tissue, then apply gentle pressure to the patient’s nasolacrimal duct for 30 to 60 seconds.

DIF: Cognitive Level: Comprehension 17. What is the proper technique for administering ear drops to a 2-year-old child? a. Administering the drops without altering the ear canal direction. b. Straightening the ear canal by pulling the lobe upward and back. c. Straightening the ear canal by pulling the pinna down and back. d. Straightening the ear canal by pulling the pinna upward and outward.

ANS: C

For an infant or a child younger than 3 years, straighten the ear canal by pulling the pinna down and back. For adults, pull the pinna up and outward.

DIF: Cognitive Level: Comprehension 18. A patient with asthma is to begin medication therapy with a metered-dose inhaler. What important reminder should the nurse

include during teaching sessions with the patient?

Repeat subsequent puffs, if ordered, after 5 minutes.

Inhale slowly while pressing down to release the medication.

Inhale quickly while pressing down to release the medication.

Administer the inhaler while holding it 7.5 to 10 cm away from the mouth.

a. b. c. d.

ANS: B

The patient should position the inhaler at the open mouth with the inhaler 3 to 5 cm away from the mouth, attach a spacer to the mouthpiece of the inhaler, or place the mouthpiece in the mouth. To administer, the patient presses down on the inhaler to release the medication while inhaling slowly, waiting 1 to 2 minutes between puffs.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

3

19. Which action is considered a standard precaution for medication administration? a. Bending the syringe to prevent reuse b. Recapping needles to prevent needlestick injury c. Discarding all syringes and needles in a wastebasket d. Discarding all syringes and needles in a puncture-resistant container ANS: D

Standard precautions include wearing clean gloves when there is potential exposure to a patient’s blood or other body fluids.

Discard all disposable syringes and needles in an appropriate puncture-resistant container. Never bend needles or syringes, never recap needles, and never discard syringes and needles in wastebaskets.

DIF: Cognitive Level: Application 20. The patient states that he prefers chewing rather than swallowing pills. The label on the container of one prescribed pill has the

abbreviation “SR” after the name of the medication. Which instruction should be followed when giving this medication?

Break the tablet into halves or quarters.

Dissolve the tablet in a small amount of water before giving it.

Do not crush or break the tablet before administration.

Use a mortar and pestle to crush the tablet if crushing it is needed to ease administration.

a. b. c. d.

ANS: C

In order to protect the gastrointestinal lining and the medication itself, sustained-release (SR) pills, enteric-coated tablets, and capsules should not be crushed before administration.

DIF: Cognitive Level: Application 21. When preparing to administer nasal spray, what should the nurse tell the patient? a. “You will need to blow your nose before I give you this medication.” b. “You will need to blow your nose after I give you this medication.” c. “When I give you this medication, you will need to hold your breath.” d. “You should sit up for 5 minutes after you receive the nasal spray.”

ANS: A

The patient will need to blow the nose before the medication is administered, because the nasal passages should be cleared before receiving nasal spray. Blowing the nose after receiving the medication will remove the medication from the nasal passages. The patient should receive the spray while inhaling through the open nostril. Afterwards, the patient should remain in a supine position for 5 minutes.

DIF: Cognitive Level: Application MULTIPLE RESPONSE 1. The nurse is preparing to give an IM injection to an average-sized adult male. Which statement applies to an IM injection? (Select

all that apply.)

A 6- to 13-mm (1 4 - to 1 2 -inch) 26- or 27-gauge needle should be chosen. b. A 13- to 16-mm (1 2 - to 5 8 -inch) 25-gauge needle should be chosen. c. A 38-mm (1 1 2 -inch) 21- to 25-gauge needle should be chosen. d. A site at least 5 cm away from the umbilicus should be selected. e. The dorsogluteal site is the preferred site for IM injections. f. The ventrogluteal site is the preferred site for IM injections. g. The needle should be inserted at a 45-degree angle. h. The needle should be inserted at a 90-degree angle. a.

ANS: C, F, H

Choose a 38-mm 21- to 25-gauge needle for an IM injection. The ventrogluteal site is preferred for IM injections; insert the needle at a 90-degree angle. Some agencies recommend that all IM injections be given by the Z-track method. Before administering the injection, pull back on the plunger and check for blood return.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

4

Chapter 11: Analgesic Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient diagnosed with migraine headache is experiencing what type of pain? a. Acute pain b. Persistent pain c. Vascular pain d. Phantom pain ANS: C

Vascular pain is thought to account for a large percentage of migraine headaches. It is believed to originate from vascular or perivascular tissues. It is characterized by persistent and recurring pain lasting 3 to 6 months. Acute pain is sudden and usually subsides when treated. Phantom pain occurs in the area of a body part that has been removed—surgically or traumatically—and is often described as burning, itching, tingling, or stabbing. It can also occur in paralyzed limbs following spinal cord injury.

DIF: Cognitive Level: Comprehension 2. An 18-year-old basketball player fell and twisted his ankle during a game. Which type of analgesic is he likely to be given? a. A synthetic opioid, such as meperidine hydrochloride b. An opium alkaloid, such as morphine sulphate c. An opioid antagonist, such as naloxone hydrochloride (Suboxone®) d. A non-opioid analgesic, such as tramadol ANS: D

Pain originating from skeletal muscles, ligaments, and joints usually responds to non-opioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs). All drugs in the NSAID class are especially useful for pain associated with inflammatory conditions because these drugs have analgesic and anti-inflammatory effects.

DIF: Cognitive Level: Application 3. A patient is in the recovery room following abdominal surgery. He is groggy but reports severe pain around his incision. What is

the most important factor for the nurse to consider during her patient assessment before administering a dose of morphine sulphate?

Temperature Respiration rate Appearance of the incision Time of last bowel movement

a. b. c. d.

ANS: B

One of the most serious side effects of opioids is respiratory depression, so respiration must be assessed prior to administering a dose of morphine.

DIF: Cognitive Level: Analysis 4. A 78-year-old patient is in the recovery room after lengthy hip surgery. While gradually awakening, the patient requests pain

medication. Within 10 minutes after receiving a dose of morphine sulphate, the patient is very lethargic; respiration is shallow, at a rate of nine respirations per minute. What necessary action may the nurse need to perform? a. Close observation for signs of opioid tolerance b. Immediate intubation and artificial ventilation c. Administration of naloxone, an opioid reversal agent d. Administration of an agonist opioid, such as fentanyl (Duragesic Mat) ANS: C

Naloxone, an opioid reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression.

DIF: Cognitive Level: Application 5. A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after his abdominal surgery. What

should the nurse teach this patient in regard to this drug?

How to manage diarrhea How to access drug addiction programs How to prevent constipation How to avoid dehydration due to polyuria

a. b. c. d.

ANS: C

Gastrointestinal occurrences such as nausea, vomiting, and constipation are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. A patient who has been treated for lung cancer for 3 years has noticed that over the past few months the opioid analgesic that is

being used is not helping as much, and says that taking more medication is needed for the same pain relief. What is this patient experiencing? a. Opioid toxicity b. Addiction c. Opioid tolerance d. Abstinence syndrome ANS: C

Opioid tolerance is a common physiological result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia.

DIF: Cognitive Level: Comprehension 7. A 38-year-old male has arrived at the urgent care centre with severe hip pain after falling from a ladder at work. He has taken

several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol®). What is the most serious toxic effect of acute acetaminophen overdose? a. Tachycardia b. Central nervous system (CNS) depression c. Hepatic necrosis d. Nephrotic necrosis ANS: C

Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. Tachycardia and CNS depression are not side effects of acute acetaminophen overdose. Long-term, not short-term, ingestion of large doses is more likely to result in nephropathy.

DIF: Cognitive Level: Comprehension 8. The drug pentazocine (Talwin®) is a narcotic agonist–antagonist. Which statement describes a characteristic of this type of

medication?

It has minimal analgesic effects.

It works to reverse the effects of opiates.

Its adverse effects differ from those of the opiate narcotics.

It has a lower addiction potential than opiate narcotics.

a. b. c. d.

ANS: D

Opioid agonist–antagonist drugs generally have lower addiction potentials than opiate narcotics.

DIF: Cognitive Level: Comprehension 9. A 57-year-old patient has been on a transdermal narcotic analgesic as part of the management of pain for end-stage breast cancer.

Lately, she has experienced “breakthrough” pain. How should this pain be addressed? a. She should be given NSAIDs. b. Her current therapy should not be changed. c. The baseline dose of the narcotic may need to be increased in increments. d. The narcotic route should be changed to the rectal route, to increase absorption.

ANS: C

If a patient is requiring larger doses for breakthrough pain, the baseline dose of the narcotic may need to be titrated upward.

DIF: Cognitive Level: Analysis 10. For which situation is the herb feverfew commonly used? a. Muscle aches b. Headaches c. Leg cramps d. Incisional pain after surgery ANS: B

Feverfew is commonly used to treat migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain.

DIF: Cognitive Level: Comprehension 11. A patient is to receive acetylcysteine as part of treatment for an acetaminophen overdose. Which action by the nurse is appropriate

when administering this medication?

Giving the medication undiluted for full effect Avoiding the use of a straw when giving the medication Disguising the flavour with a soft drink or flavoured water Preparing to give the medication via a nebulizer

a. b. c. d.

ANS: C

Acetylcysteine has the flavour of rotten eggs. It is better tolerated when the taste is disguised by mixing it with a soft drink or flavoured water to increase its palatability. Giving this medication undiluted is not recommended. The use of a straw will help minimize contact with mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not acetaminophen overdose.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

12. A patient is receiving an anticonvulsant but has no history of seizures. What is the most likely reason the patient is receiving this

drug?

Pain associated with peripheral neuropathy Inflammation pain Depression associated with chronic pain Prevention of possible seizures

a. b. c. d.

ANS: A

Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance analgesic efficacy. Pain from inflammation is best treated with NSAIDs. This patient is not receiving this anticonvulsant drug for depression associated with chronic pain or to prevent possible seizures.

DIF: Cognitive Level: Comprehension 13. A patient has been diagnosed with shingles and is experiencing postherpetic neuralgia. What would the nurse expect to administer

for pain relief? a. Transdermal lidocaine (EMLA®) b. Tramadol hydrochloride (Ultram®) c. Naloxone hydrochloride d. Fentanyl (Duragesic MAT®) ANS: A

Transdermal lidocaine is indicated for the treatment of postherpetic neuralgia, a painful skin condition that remains after a skin outbreak of shingles. Tramadol hydrochloride, naloxone hydrochloride, and fentanyl are not indicated for postherpetic neuralgia.

DIF: Cognitive Level: Application MULTIPLE RESPONSE 1. Nalbuphine (Nubain®) is a partial opioid agonist. What characterizes this type of medication? (Select all that apply.) a. Used for mild pain b. Used for moderate to severe pain c. Drug of choice for reversing the effects of opioids in cases of overdose d. Usually used for long-term conditions e. Usually used for short-term conditions f. Sometimes used in those who have a history of opioid addiction ANS: B, E, F

Partial opioid agonists are used for moderate to severe pain in conditions requiring short-term pain control, such as after surgery and for obstetric procedures. They are sometimes chosen for patients who have a history of opioid addiction.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

3

Chapter 12: General and Local Anaesthetics Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. After piercing a finger with a fish hook during a fishing trip, a patient is now at an emergency department to have the hook

removed. What type of anaesthesia will be used for this procedure? a. Topical benzocaine spray to the area b. Spinal anaesthesia with mepivacaine hydrochloride c. Topical prilocaine cream (EMLA®) around the site d. Infiltration of the area with tetracaine hydrochloride ANS: D

Infiltration anaesthesia is commonly used for minor surgical procedures. It involves injecting the local anaesthetic solution intradermally, subcutaneously, or submucosally across the path of nerves supplying the area to be anaesthetized. The local anaesthetic may be administered in a circular pattern around the operative field.

DIF: Cognitive Level: Application 2. A patient is to receive local anaesthesia for removal of a lymph node from the groin. Why does the physician add epinephrine to the

local anaesthetic during the preparation?

Epinephrine prevents an anaphylactic reaction from occurring.

The anaesthetic enhances the effect of the epinephrine.

Epinephrine contributes to a balanced anaesthetic state.

Vasoconstrictive effects keep the anaesthetic at its local site of action.

a. b. c. d.

ANS: D

Vasoconstrictors such as epinephrine are coadministered with local anaesthetics to keep the anaesthetic at its local site of action and to prevent systemic absorption.

DIF: Cognitive Level: Application 3. During the postoperative recovery period, what should be the nurse’s immediate main concern? a. Pupil responses b. Return to sensation c. Level of consciousness d. Airway, breathing, and circulation ANS: D

After surgery and the termination of general anaesthesia, the nurse’s main concern should be assessing the patient’s airway, breathing, and circulation status.

DIF: Cognitive Level: Application 4. While monitoring a patient who had surgery under general anaesthesia 2 hours earlier, the nurse notes a sudden elevation in body

temperature. What does this sudden elevation in body temperature indicate?

Tachyphylaxis Postoperative infection Malignant hypothermia Malignant hyperthermia

a. b. c. d.

ANS: D

A sudden elevation in body temperature during the postoperative period may indicate the occurrence of malignant hyperthermia, a life-threatening emergency.

DIF: Cognitive Level: Application 5. Which individual is at high risk for an altered response to anaesthesia? a. A 30-year-old male who has never had surgery before b. A 45-year-old female who stopped smoking 10 years ago c. A 20-year-old male who is to have a lymph node removed d. A 78-year-old female who is to have her gallbladder removed ANS: D

The older adult patient is more affected by anaesthesia because of the effects of aging on the hepatic, cardiac, respiratory, and renal systems. Young or middle-aged adult patients are not at high risk for an altered response to anaesthesia.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. A patient is undergoing abdominal surgery and has been anaesthetized for 3 hours. Which nursing diagnosis is appropriate for him? a. Anxiety related to the use of an anaesthetic b. Risk for injury related to increased sensorium from general anaesthesia c. Decreased cardiac output related to systemic effects of local anaesthesia d. Impaired gas exchange related to central nervous system (CNS) depression

produced by general anaesthesia ANS: D

Impaired gas exchange related to CNS depression produced by general anaesthesia is the appropriate nursing diagnosis for this patient. Because the patient is under anaesthesia, the nurse is unable to assess the patient for anxiety. Risk for injury is related to decreased sensorium, not increased sensorium from general anaesthesia. “Decreased cardiac output related to systemic effects of local anaesthesia” is incorrect because local anaesthesia should have very little systemic effect.

DIF: Cognitive Level: Application 7. When administering a neuromuscular drug such as pancuronium, what does the nurse need to remember? a. It can be used instead of general anaesthesia during surgery. b. Only skeletal muscles are paralyzed; respiratory muscles remain functional. c. It causes sedation and pain relief while allowing for lower doses of anaesthetics. d. Patients will require artificial mechanical ventilation because of paralyzed

respiratory muscles.

ANS: D

Patients receiving neuromuscular blocking agents (NMBAs) will require artificial mechanical ventilation because of the resultant paralysis of the respiratory muscles. NMBAs do not cause sedation or pain relief and cannot be used in place of general anaesthesia during surgery. Respiratory muscles are paralyzed by this drug.

DIF: Cognitive Level: Application 8. A patient has been given succinylcholine (Quelicin®) after a severe injury that necessitated controlled ventilation. The physician

now wants to reverse the paralysis. The nurse would expect to use which drug to reverse the succinylcholine? diazepam (Valium®) caffeine neostigmine methylsulphate vecuronium bromide (Norcuron®)

a. b. c. d.

ANS: C

The antidote for NMBAs such as succinylcholine is neostigmine methylsulphate. It reverses the effects of the NMBAs. DIF: Cognitive Level: Application 9. A patient is being prepared for an oral endoscopy, and the nurse reminds him that he will be awake during the procedure but

probably will not remember it. What type of anaesthetic technique is used in this situation? a. Twilight sleep b. Procedural sedation c. Adjunctive anaesthesia d. Spinal anaesthesia ANS: B

Procedural sedation effectively reduces patient anxiety, sensitivity to pain, and recall of the medical procedure, yet it preserves the patient’s ability to maintain his or her own airway and to respond to verbal commands.

DIF: Cognitive Level: Comprehension 10. Which symptom may occur if a patient is taking ginger and requires an anaesthetic? a. Decreased blood pressure b. Increased risk of bleeding c. Increased risk of stroke d. Migraine headaches ANS: B

A patient who has been taking the natural health product ginger and requires anaesthesia is at an increased risk of bleeding, especially if acetylsalicylic acid (Aspirin) or ginkgo is also being taken. Decreased blood pressure, increased risk of stroke, and migraine headaches are risks associated with the combination of anaesthesia with some natural health products, but not with ginger.

DIF: Cognitive Level: Comprehension OTHER 1. When a neuromuscular blocking drug is given, the effects occur in a certain order. Put the following drug effects in the proper

order of occurrence, using the choices A through C listed below. a. Cessation of respirations due to paralysis of diaphragm and intercostal muscles b. Total flaccid paralysis c. Weakness ANS:

C, B, A The first sensation typically experienced is muscle weakness. This is usually followed by a total flaccid paralysis. Small, rapidly moving muscles such as those of the fingers and eyes are typically the first to be paralyzed. The next are those of the limbs, neck, and trunk. Finally, the intercostal muscles and the diaphragm are paralyzed. The patient can no longer breathe independently.

DIF: Cognitive Level: Application Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 13: Central Nervous System Depressants and Muscle Relaxants Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which is a true statement about sedatives and hypnotics? a. The two terms mean the same thing. b. A hypnotic causes sleep. c. Low doses of sedatives will cause sleep. d. Compared with sedatives, hypnotics have a less potent effect on the central

nervous system.

ANS: B

A sedative reduces nervousness, excitability, and irritability without causing sleep, whereas a hypnotic causes sleep.

DIF: Cognitive Level: Knowledge 2. A patient who has been taking phenobarbital for 2 weeks as part of therapy for epilepsy reports feeling tense and that the “least

little thing” is a bother now. What is the nurse’s best explanation to the patient?

These adverse effects will often subside after a few weeks.

The drug should be stopped immediately because of possible adverse effects.

This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness. d. This drug causes deprivation of REM sleep and may cause the patient’s inability to deal with normal stress. a. b. c.

ANS: D

Barbiturates deprive people of REM sleep, which can result in agitation and an inability to deal with normal stress. A rebound phenomenon occurs when the drug is stopped, and the proportion of REM sleep increases, sometimes resulting in nightmares.

DIF: Cognitive Level: Application 3. A 50-year-old male who has been taking a benzodiazepine for 1 week is found unresponsive. His wife states that he takes no other

prescription drugs and that he did not take an overdose—the correct number of pills is in the bottle. What might have happened? a. He took a multivitamin. b. He drank a glass of wine. c. He took a dose of Aspirin. d. He developed an allergy to the drug.

ANS: B

Potential drug interactions with the benzodiazepines are significant because of their intensity, particularly when they involve other central nervous system (CNS) depressants (e.g., alcohol, opioids, muscle relaxants).

DIF: Cognitive Level: Analysis 4. A patient has been taking temazepam (Restoril®) for intermittent insomnia. She tells the nurse that when she takes it, she sleeps

well, but the next day she feels “so tired.” What is the nurse’s best explanation to the patient? a. Long-term use results in a sedative effect. b. She should take the drug every night to reduce this hangover effect. c. Benzodiazepines affect the sleep cycle, thus causing a hangover effect. d. Benzodiazepines increase CNS activity, thus causing tiredness the next day.

ANS: C

Benzodiazepines suppress rapid eye movement REM sleep to a degree (though not as much as barbiturates) and thus result in a hangover effect.

DIF: Cognitive Level: Application 5. A patient who is recovering from a minor automobile accident that occurred 1 week ago is taking cyclobenzaprine

(Novo-Cycloprine®) for muscular pain and goes to physical therapy three times a week. Which nursing diagnosis would be appropriate for him? a. Risk for falls related to decreased sensorium b. Risk for addiction related to psychological dependency c. Excess fluid volume related to potential adverse effects d. Disturbed sleep pattern related to the drug’s interference with REM sleep ANS: A

Musculoskeletal relaxants have a depressant effect on the CNS; lightheadedness, dizziness, drowsiness, and fatigue can occur, thus putting the patient at risk for falls. The patient should be taught the importance of taking measures to minimize self-injury and falls related to decreased sensorium.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. A patient is taking flurazepam (Apo-Flurazepam®) 3 to 4 nights a week for sleeplessness. She is concerned that she cannot get to

sleep without taking the medication. What measures are appropriate for this patient?

Trying to establish set sleep patterns Exercising before bedtime to become tired Consuming heavy meals in the evening to promote sleepiness Drinking warm beverages, such as tea or coffee, just before bedtime

a. b. c. d.

ANS: A

Nonpharmacological approaches to induce sleep include establishing set sleep patterns. The patient should avoid heavy exercise before bedtime, avoid heavy meals late in the evening, and should drink warm decaffeinated drinks, such as warm milk, before bedtime.

DIF: Cognitive Level: Application 7. Which is the best treatment of an acute overdose of diazepam? a. Infusion with diluted bicarbonate solution b. Administration of medications to decrease blood pressure c. Administration of flumazenil d. Administration of nalbuphine as an antagonist ANS: C

Flumazenil, a benzodiazepine antidote, can be used to acutely reverse the sedative effects of benzodiazepines. Flumazenil antagonizes the action of benzodiazepines on the CNS by directly competing with them for binding at the receptors. Flumazenil is used in cases of oral overdose or excessive intravenous sedation. Infusion with diluted bicarbonate solution and the administration of medications to decrease blood pressure are not appropriate treatments. There are no antagonists for barbiturates.

DIF: Cognitive Level: Analysis 8. A 45-year-old female has been taking dantrolene as part of the treatment for multiple sclerosis. Which laboratory value should the

nurse monitor while the patient receives dantrolene? a. Creatinine b. Sedimentation rate c. Liver function studies d. Hemoglobin and hematocrit ANS: C

Dantrolene can cause liver damage; therefore, liver function studies should be performed during therapy.

DIF: Cognitive Level: Comprehension 9. What is an adverse effect of barbiturate administration? a. Vasoconstriction b. Thrombocytopenia c. Hypertension d. Excitement ANS: B

An adverse effect of barbiturate use is thrombocytopenia. Some other effects include hypotension, vasodilation, and drowsiness and lethargy.

DIF: Cognitive Level: Comprehension 10. Which natural health product is used by some people to promote sleep and to relieve anxiety and restlessness? a. Kava b. Garlic c. Ginger d. Ginkgo ANS: A

Kava may be used to promote sleep and for relief of anxiety and restlessness.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. The nurse is preparing to administer a barbiturate. Which condition(s) or disorder(s) are contraindications to the use of these drugs?

(Select all that apply.) a. Gout b. Pregnancy c. Epilepsy d. Severe chronic obstructive pulmonary disease e. Peripheral vascular disease f. Advanced liver disease g. Current use of an opioid analgesic ANS: B, D, F, G

Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and severe liver disease. In addition, coadministration of barbiturates with alcohol, opioids, benzodiazepines, and some medications from other drug groups can result in additive CNS depression.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 14: Central Nervous System Stimulants and Related Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which condition is an indication for a central nervous system (CNS) stimulant drug? a. Insomnia b. Depression c. Appetite enhancement d. Appetite suppression ANS: D

CNS stimulant drugs can be used as appetite suppressants (anorexiants) for appetite control.

DIF: Cognitive Level: Knowledge 2. Caffeine should be used with caution in which patient? a. A male with a history of peptic ulcers b. A female with a history of migraine headaches c. A teenager with a history of asthma d. A male with a history of kidney stones ANS: A

Caffeine should be used with caution in patients who have a history of peptic ulcers or cardiac dysrhythmias or who have recently had a myocardial infarction.

DIF: Cognitive Level: Comprehension 3. A patient has a new prescription for orlistat as part of his treatment for weight loss. What important information should the nurse

include when providing patient education about orlistat?

This medication is a CNS stimulant.

This medication reduces fat absorption by about 30%.

This drug is used for obese patients with a body mass index (BMI) of 25 or higher. d. This drug is most effective for individuals with Crohn’s disease. a. b. c.

ANS: B

Orlistat (Xenical®) works by binding to gastric and pancreatic enzymes called lipases. Blocking these enzymes reduces fat absorption by approximately 30%. Orlistat is not a CNS stimulant. It is used for patients with a BMI greater than 30. It is contraindicated in individuals with Crohn’s disease.

DIF: Cognitive Level: Application 4. A 6-year-old boy has been started on methylphenidate hydrochloride (Ritalin) for the treatment of attention deficit hyperactivity

disorder (ADHD). His mother tells the nurse that she has been giving the medication at bedtime so that it will be “in his system” when he goes to school the next morning.

Which is the nurse’s best response to the patient’s mother? a. The medication dosage is being given appropriately. b. The medication should not be taken until the boy is at school. c. The medication should be taken with meals for optimal absorption. d. The medication should be given 4 to 6 hours before bedtime to diminish the insomnia it causes.

ANS: D

CNS stimulants should be taken 4 to 6 hours before bedtime to decrease insomnia.

DIF: Cognitive Level: Application 5. A 22-year-old nursing student has been taking Excedrin Extra-Strength tablets for the past few weeks to “make it through” the end

of the semester and examination week. The feeling of being “exhausted” has brought the patient to the clinic today. Which nursing diagnosis is appropriate? a. Nonadherence b. Impaired physical mobility c. Disturbed sleep pattern d. Imbalanced nutrition (less than body requirements) ANS: C

Excedrin Extra-Strength is acetaminophen 500 mg with caffeine 65 mg, which is a CNS stimulant that can be used to increase mental alertness. Restlessness, anxiety, and insomnia are common adverse effects.

DIF: Cognitive Level: Analysis 6. Which CNS stimulant drug is used to treat acute migraines? a. zolmitriptan (Zomig®) b. Amphetamines c. modafinil (Alertec®) d. methylphenidate hydrochloride (Ritalin®) ANS: A

Zolmitriptan is a CNS stimulant that can be used to treat migraines.

DIF: Cognitive Level: Knowledge

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. A 10-year-old boy has been on methylphenidate hydrochloride (Ritalin) for almost 6 months. His mother reports that he seems to

have stopped growing.

Which is the nurse’s best answer to the patient’s mother? a. Growth will occur with the onset of puberty. b. Growth can be promoted with a high-protein diet. c. Growth in 10-year-old children tends to be slower. d. Temporary slowing of growth is expected with Ritalin therapy.

ANS: D

Methylphenidate hydrochloride may cause a temporary slowing of growth in prepubescent children.

DIF: Cognitive Level: Application 8. A 10-year-old will be started on methylphenidate hydrochloride (Ritalin) therapy. What important baseline assessment should be

done before therapy with this drug is started?

Eye examination Height and weight Liver studies Cognitive function

a. b. c. d.

ANS: B

Assessment of baseline height and weight is important before beginning methylphenidate hydrochloride therapy because this drug may cause a temporary slowing of growth in prepubescent children.

DIF: Cognitive Level: Application 9. Before administering sumatriptan (Imitrex®) to a patient for the treatment of a migraine headache, the nurse should assess for the

presence of which condition? a. Hypotension b. Renal disease c. Liver damage d. Coronary artery disease ANS: D

Antimigraine medication is contraindicated in patients with peripheral vascular disease, coronary artery disease, sepsis, impaired renal or hepatic function, or severe hypertension.

DIF: Cognitive Level: Comprehension 10. The nurse is evaluating a patient who is taking modafinil (Alertec). Which is an intended therapeutic effect? a. Increased wakefulness b. Increased appetite c. Suppressed appetite d. Decreased hyperactivity ANS: A

Modafinil is given to treat narcolepsy. Therefore, an intended therapeutic effect is increased wakefulness.

DIF: Cognitive Level: Analysis 11. Ginkgo biloba is a natural health product that is used for treatment of which condition what purpose? a. Improving memory b. Suppressing appetite c. Treating ADHD d. Stimulating appetite ANS: A

Ginkgo biloba is a natural health product used for improving memory.

DIF: Cognitive Level: Knowledge 12. Which CNS stimulant is commonly used in conjunction with supportive measures to treat the respiratory depression that may occur

in postoperative recovery? theophylline amphetamine benzphetamine methylphenidate hydrochloride (Ritalin)

a. b. c. d.

ANS: A

Theophylline is an analeptic commonly used with supportive measures to hasten arousal and to treat respiratory depression associated with postoperative recovery, among other causes.

DIF: Cognitive Level: Knowledge

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 15: Antiepileptic Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which antiepileptic drug allows once-a-day dosing? a. topiramate (Topamax®) b. phenobarbital sodium c. valproic acid (Depakene®) d. gabapentin (Neurontin®) ANS: B

Phenobarbital has the longest half-life of all standard antiepileptic drugs, which allows once-a-day dosing.

DIF: Cognitive Level: Comprehension 2. During the nurse’s assessment, the patient describes her seizures as initial muscular contractions throughout her body, then

alternating between contractions and relaxation. What kind of seizure is she describing? a. Convulsion b. Partial seizure c. Simple seizure d. Generalized tonic–clonic seizure ANS: D

Generalized tonic–clonic seizures are seizures that involve initial muscular contraction throughout the body (tonic phase) and that then progress to alternating contraction and relaxation (clonic phase).

DIF: Cognitive Level: Comprehension 3. While teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, what information should the nurse

emphasize? a. Driving will be allowed after 2 weeks of therapy. b. If seizures recur, the patient should take a double dose of the medication. c. Antacids can be taken with the AED to reduce gastrointestinal adverse effects. d. Regular consistent dosing is important for successful treatment.

ANS: D

Consistent medication regularly taken at the same time of day at the recommended dose and with meals to reduce the common gastrointestinal adverse effects, is the key to successful management of seizures with AEDs. Nonadherence is the most notable factor leading to treatment failure.

DIF: Cognitive Level: Application 4. A patient has a 9-year history of a seizure disorder that has been managed well with phenytoin therapy. He is to receive nothing by

mouth because he has surgery in the morning. What should the nurse do about his morning dose of phenytoin? a. Give the same dose intravenously. b. Give the morning dose with a small sip of water. c. Contact the physician for another dosage form of the medication. d. Notify the operating room that the medication has been withheld.

ANS: C

The physician should be contacted for an order of the appropriate dosage form of the medication. The route should not be changed without a physician’s order. The morning dose should not be given with a small sip of water. Withholding the medication may lead to seizure activity during the surgical procedure.

DIF: Cognitive Level: Analysis 5. A patient has been taking carbamazepine (Tegretol®) for several months and is worried because the physician has increased the

dose twice since the beginning of therapy. Which is the nurse’s best explanation to the patient?

The initial dose was not sufficient to prevent seizures.

Autoinduction results in lower-than-expected drug concentrations.

Because the seizures are difficult to manage, increased doses are needed to control them. d. Forgetting to take the medication as prescribed led to a need for increased dosage. a. b. c.

ANS: B

With carbamazepine, autoinduction occurs and leads to lower-than-expected drug concentrations. Therefore, the dose may need to be adjusted over time.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. When administering phenytoin (Dilantin®) intravenously, what must the nurse remember? a. Normal saline is the only solution to be used with phenytoin. b. Intravenous (IV) doses must be given rapidly to raise blood levels quickly. c. The patient should be monitored closely for tachycardia and increased blood d.

pressure.

Phenytoin can be combined with other solutions without fear of precipitate formation.

ANS: A

IV phenytoin should be given with normal saline solution only. The IV dose must be given slowly. The patient must be monitored for bradycardia and decreased blood pressure. To prevent precipitation formation due to incompatibilities, phenytoin cannot be combined with other solutions.

DIF: Cognitive Level: Application 7. Which teaching tips is appropriate for the nurse to give a patient taking topiramate (Topamax®)? a. Do not chew, crush, or break the tablet. b. Take the medication on an empty stomach. c. Crush the medication if needed to facilitate swallowing. d. If adverse effects are too severe, a dose may be skipped.

ANS: A

Topiramate and valproic acid tablets and delayed- or extended-release dosage forms are not to be altered in any way and must be taken as prescribed. Topiramate should be taken whole, not crushed or broken. Taking this medication with meals may help reduce the nausea that may occur. The medication should be taken at the same time each day, and doses should not be skipped. If adverse effects become a problem, the patient should contact the prescriber.

DIF: Cognitive Level: Comprehension 8. What is the drug of choice for the immediate treatment of status epilepticus? a. diazepam (Valium®) b. midazolam c. valproic acid (Depakene) d. carbamazepine (Tegretol) ANS: A

Diazepam rectally administered is an initial emergent drug for status epilepticus.

DIF: Cognitive Level: Comprehension 9. Phenytoin (Dilantin) has a narrow therapeutic index. Which statement defines this characteristic? a. The safe and toxic plasma levels are very close. b. Phenytoin has a narrow chance of being effective. c. No difference exists between safe and toxic plasma levels. d. A very small dosage can result in the desired therapeutic effect.

ANS: A

A narrow therapeutic index means that a narrow difference exists between safe and toxic drug levels. These drugs require monitoring of therapeutic plasma levels.

DIF: Cognitive Level: Application 10. A patient has been taking gabapentin (Neurontin®) for several years as part of the treatment for partial seizures. His wife has called

because he ran out of medication this morning, and she wonders whether he can go without it for a week until she can go to the drugstore. Which statement is true in this situation? a. Because the patient is taking another antiepileptic drug, he can go a week without the gabapentin. b. Stopping this medication abruptly may cause withdrawal seizures. c. The patient should temporarily increase the dosage of his other medications. d. The patient can probably stop all medication because he has been treated for several years now.

ANS: B

Abrupt discontinuation of the gabapentin can lead to withdrawal seizures.

DIF: Cognitive Level: Application MULTIPLE RESPONSE 1. Which statements about antiepileptic drug (AED) therapy are true? (Select all that apply.) a. AED therapy can be stopped when seizures are under control. b. AED therapy is usually lifelong. c. Consistent dosing is key to control of seizures. d. A dose may be skipped if the patient is experiencing adverse effects. e. Abrupt withdrawal from AEDs may cause rebound seizure activity.

ANS: B, C, E

Patients need to know that AED therapy is usually lifelong, and compliance (with consistent dosing) is important for effective seizure control. Antiepileptic drugs must never be abruptly discontinued as it may precipitate rebound seizure activity.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 16: Antiparkinsonian Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient has been taking selegiline (Anipril) for a month and says he understands the “cheese effect” that the doctor explained to

him. When the nurse questions him about it, he tells her (correctly) that the cheese effect results in which symptom? a. Hypotension b. Hypertension c. Urinary discomfort d. Gastrointestinal upset ANS: B

The cheese effect causes severe hypertension. This is a major adverse effect of monoamine oxidase inhibitors (MAOIs) because they interact with tyramine-containing foods (cheese, red wine, beer, and yogourt).

DIF: Cognitive Level: Comprehension 2. A patient newly diagnosed with Parkinson’s disease has been given a prescription for levodopa–carbidopa (Sinemet®). The patient

comments, however, that a friend was given a prescription for “plain levodopa.” What should the nurse explain to this patient about her prescription? a. Levodopa alone cannot cross the blood–brain barrier. b. There is no real difference between the two prescriptions. c. The combination drug is more efficient in increasing the dopamine level in the brain. d. Concerns about drug–food interactions with levodopa therapy do not exist with the combination therapy.

ANS: C

The addition of carbidopa allows for more of the levodopa to reach the site of action without being broken down. Thus, lower doses of levodopa are needed, and the combination is more efficient in increasing the dopamine level in the brain. Dopamine, unlike levodopa, cannot cross the blood–brain barrier. Drug–food interactions with levodopa therapy alone are not a concern. If a substance interacts with levodopa, it will also interact with the combination of levodopa–carbidopa because the levodopa is the common component in both drugs.

DIF: Cognitive Level: Application 3. When a patient is taking an anticholinergic, such as benztropine, as part of treatment for Parkinson’s disease, what important

information should the nurse give the patient as part of the teaching plan?

Avoid vitamin B6 supplements and vitamin-fortified foods.

Discontinue the medication immediately if adverse effects occur.

Take the medication on an empty stomach to enhance absorption.

Take the medication at bedtime to prevent drowsiness during the day.

a. b. c. d.

ANS: D

Anticholinergics should be taken at bedtime to prevent drowsiness during the day. Vitamin B6 interferes with dopaminergics, not anticholinergics. Anticholinergics should not be discontinued suddenly and should be taken with or after meals in order to minimize gastrointestinal upset.

DIF: Cognitive Level: Analysis 4. A patient has been treated with antiparkinsonian medications for 3 months. What therapeutic responses should the nurse look for

when assessing this patient?

Decreased appetite Gradual development of cogwheel rigidity Adverse effects such as confusion, anxiety, irritability, and headache Improved mental status and an improved ability to think clearly and to perform activities of daily living

a. b. c. d.

ANS: D

Therapeutic responses to antiparkinsonian drugs include improved mental status and an increased ability to concentrate, think clearly, and perform activities of daily living. Antiparkinsonian drugs result in an increase in appetite, less intense parkinsonian manifestations, and an improved sense of well-being.

DIF: Cognitive Level: Analysis 5. Which statement is true in regard to amantadine (Symmetrel) therapy? a. It increases the production of dopamine in the basal ganglia. b. It works by eliciting the release of dopamine from nerve endings. c. It is most effective in the later stages of Parkinson’s disease. d. It is considered a long-term therapy for Parkinson’s disease.

ANS: B

Amantadine works by eliciting the release of dopamine from nerve endings, not by increasing the production of dopamine in the basal ganglia. Amantadine is most effective in the earlier stages of Parkinson’s disease and is usually effective for only 6 to 12 months because the population of functioning nerves diminishes as the disease progresses.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. When assessing the past medication history of a patient with a new diagnosis of Parkinson’s disease, what is the nurse’s concern

regarding the patient who will be taking levodopa–carbidopa (Sinemet)?

Glaucoma Seizure disorder Bladder difficulties Benign prostatic hypertrophy

a. b. c. d.

ANS: A

Glaucoma is a contraindication to the use of levodopa–carbidopa. Seizure disorder is a contraindication to the use of dopaminergic drugs. Bladder difficulties and benign prostatic hypertrophy are contraindications to anticholinergic drugs.

DIF: Cognitive Level: Comprehension 7. Which nursing diagnosis is appropriate for patients taking anticholinergic drugs? a. Diarrhea b. Urinary retention c. Risk for infection d. Ineffective tissue perfusion ANS: B

Patients receiving anticholinergic drugs are at risk for urinary retention.

DIF: Cognitive Level: Analysis 8. Which statement describes an advantage of catechol ortho-methyltransferase (COMT) inhibitors during the treatment of

Parkinson’s disease? a. They have a shorter duration of action. b. They cause less gastrointestinal distress. c. They have a slower onset than traditional Parkinson’s disease drugs. d. They are associated with fewer “wearing-off” effects and have prolonged therapeutic benefits.

ANS: D

COMT inhibitors are associated with fewer “wearing-off” effects and have prolonged therapeutic benefits. COMT inhibitors have a longer duration of action and a quicker onset than traditional drugs and also have gastrointestinal adverse effects.

DIF: Cognitive Level: Application 9. A patient taking a levodopa preparation for the first time calls the clinic to report dark discoloration of his urine. Which statement

is true in this situation?

The discoloration of urine is a harmless effect of the drug.

The patient has taken this drug with red wine or cheese.

The patient is having an allergic reaction to the drug.

The patient has most likely taken extra drug doses.

a. b. c. d.

ANS: A

Levodopa preparations may darken the patient’s urine and sweat.

DIF: Cognitive Level: Comprehension 10. During drug therapy for Parkinson’s disease, the nurse monitors for which signs of dyskinesia? a. Rigid, tense muscles b. Involuntary movements c. Limp extremities with weak muscle tone d. Confusion and altered mental status ANS: B

Dyskinesia is the difficulty in performing voluntary movements that is experienced by some patients with Parkinson’s disease.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 17: Psychotherapeutic Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. When administering an intramuscular injection of risperidone (Risperdal Consta®), the nurse tells the patient that this medication

dosage will be effective for how long? a. 24 hours b. 48 hours c. 1 week d. 2 weeks ANS: D

The long-acting injectable form of risperidone Risperdal Consta®, and one intramuscular injection lasts approximately 2 weeks.

DIF: Cognitive Level: Application 2. Before beginning therapy with fluoxetine (Prozac), the nurse should assess for concurrent use of which medication? a. acetylsalicylic acid b. warfarin sodium c. Diuretics d. Nonsteroidal anti-inflammatory drugs ANS: B

The use of second-generation antidepressants (such as fluoxetine) with warfarin results in an increased anticoagulant effect.

DIF: Cognitive Level: Comprehension 3. When the nurse is teaching the patient about monoamine oxidase inhibitors (MAOIs), which is important to emphasize? a. Serum blood levels should be drawn every 2 weeks. b. If drowsiness occurs, stop the medication immediately. c. Drowsiness should decrease after the first few weeks of therapy. d. Foods high in tyramine—such as cheese, beer, and wine—must be avoided.

ANS: D

If a patient is taking an MAOI, caution the patient to avoid over-the-counter (OTC) cold and flu products. Foods or beverages high in tyramine must also be avoided.

DIF: Cognitive Level: Application 4. A patient has been taking haloperidol for 3 months for a psychotic disorder. Because the nurse is concerned about the development

of extrapyramidal symptoms, the patient will be monitored for which symptom?

Cogwheel rigidity and blurred vision Drowsiness and dizziness Motor restlessness and muscle spasms Dry mouth and constipation

a. b. c. d.

ANS: C

Extrapyramidal symptoms are involuntary motor symptoms similar to those associated with Parkinson’s disease. This drug-induced state is known as pseudoparkinsonism and is characterized by symptoms such as akathisia (distressing motor restlessness) and acute dystonia (painful muscle spasms).

DIF: Cognitive Level: Application 5. A patient has been taking the MAOI phenelzine (Nardil®) for 6 months. The patient says he’s going out to the local bar to meet a

few friends for a beer. What important information should the nurse tell this patient? a. Drinking beer is permitted as long as there is a designated driver. b. He has no further dietary restrictions because he has taken the last dosage. c. If he begins to experience a throbbing headache, rapid pulse, or nausea, he should stop drinking. d. He needs to avoid foods with tyramine while on this medication.

ANS: D

Patients taking an MAOI need to be cautioned about avoiding OTC cold and flu products as well as foods or beverages high in tyramine.

DIF: Cognitive Level: Analysis 6. A 22-year-old female has been taking lithium (Carbolith®) for 6 months. She has blood work every month, and the nurse assesses

her for signs of toxicity. What are the indications of toxicity?

Serum lithium level of 0.8 mmol/L and excitability Serum lithium level of 1.0 mmol/L and palpitations Serum lithium level of 1.3 mmol/L and hypertension Serum lithium level of 2.3 mmol/L and cardiac dysrhythmias

a. b. c. d.

ANS: D

Lithium levels exceeding 2.0 mmol/L produce moderate to severe toxicity, and cardiac dysrhythmias are possible adverse effects.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. A patient taking clozapine has shown marked improvement. Which statement by this patient indicates the experiencing of a

common adverse effect of clozapine?

“I have been losing weight.”

“I don’t feel like eating at all.”

“Look at how red my hands are.”

“My mouth has been so dry lately.”

a. b. c. d.

ANS: D

Adverse effects of clozapine include tachycardia, akathisia, agitation, asthenia, ataxia, seizures, dyskinesia, dizziness, drowsiness, headache, insomnia, dry mouth, dyspepsia, anxiety, increased appetite, and weight gain.

DIF: Cognitive Level: Application 8. A 44-year-old patient has been taking sertraline (Zoloft®), a selective serotonin reuptake inhibitor (SSRI), for 4 months. The patient

tells the nurse about having an interest in natural health products and wants to start taking St. John’s wort. Which statement to the patient is an appropriate response from the nurse? a. “That should be no problem.” b. “Soon you’ll be able to stop taking the Zoloft!” c. “Be sure to stop taking the herb if you notice a change in adverse effects.” d. “Taking St. John’s wort with Zoloft may cause severe interactions and is not recommended.”

ANS: D

The herbal product St. John’s wort should not be used with SSRIs. Potential interactions include confusion, agitation, muscle spasms, twitching, and tremors.

DIF: Cognitive Level: Analysis 9. Which ethnic group often requires lower doses of benzodiazepines and tricyclic antidepressants? a. Indigenous peoples b. Asians c. Latin Americans d. Somalis ANS: B

Asians have a lower activity of drug metabolism and thus often require lower doses of benzodiazepines and tricyclic antidepressants than with White people require.

DIF: Cognitive Level: Comprehension 10. St. John’s wort is a natural health product that some people use for the treatment of mild to moderate symptoms of depression. Use

of St. John’s wort is contraindicated in patients with which conditions?

Schizophrenia, Alzheimer’s disease Benign prostatic hypertrophy, diabetes Dementia, emphysema Heart disease, schizophrenia

a. b. c. d.

ANS: A

St. John’s Wort is contraindicated in patients with bipolar disorder, schizophrenia, Alzheimer’s disease, and other forms of dementia.

DIF: Cognitive Level: Comprehension 11. A nurse is monitoring a depressed patient who has just started antidepressant therapy. During which time period does the patient

have the highest potential for self-injury and suicide? a. At the beginning, before drug therapy is started b. The period between the start of therapy and symptomatic improvement c. Between 1 and 4 weeks of drug therapy d. After 6 months of drug therapy ANS: B

Several weeks may pass before the therapeutic effects of antidepressants are evident. After the start of therapy and before symptomatic improvement, careful monitoring of the patient (being readily available) and providing supportive care are critical to the therapeutic approach because during this time period, the patient may be at highest risk for self-harm and suicide.

DIF: Cognitive Level: Application 12. Which is a reason that SSRIs are more widely prescribed today than are tricyclic antidepressants (TCAs)? a. SSRIs have fewer sexual adverse effects. b. Unlike TCAs, SSRIs do not have drug–food interactions. c. TCAs can cause serious cardiac toxicities if an overdose occurs. d. SSRIs therapeutically respond faster than tricyclic antidepressants.

ANS: C

These newer antidepressants offer several attractive advantages over the traditional TCAs and MAOIs. SSRIs are associated with significantly fewer and less-severe adverse effects and systemic adverse effects.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

13. The wife of a patient who has been diagnosed with depression calls the office and says, “It’s been an entire week since he started

that new medicine for his depression, and there’s no change! What’s wrong with him?” Which statement is the best response from the nurse? a. “The medication may not be effective for him. He may need to try another type.” b. “It may take up to 4 weeks to notice any therapeutic effects. Let’s wait a little longer to see how he does.” c. “It sounds like he is tolerant to the drug. I’ll check about increasing the dosage.” d. “Some patients never recover from depression. He may not respond to this therapy.”

ANS: B

Patients should be told that antidepressant drugs commonly require several weeks before full therapeutic effects can be noted and that these drugs can take up to 6 weeks to reach their full therapeutic effect.

DIF: Cognitive Level: Application 14. A patient with a history of anxiety attacks is given a medication for these episodes. Which medication is appropriate for this

problem? fluphenazine phenobarbital bupropion buspirone hydrochloride

a. b. c. d.

ANS: D

Buspirone hydrochloride is a nonbenzodiazepine that is indicated for treatment of anxiety.

DIF: Cognitive Level: Comprehension 15. Which breakfast choice by a patient taking an MAOI indicates the need for additional teaching? a. Orange juice b. Fried eggs c. Cheddar cheese omelet d. French toast ANS: C

Aged cheeses, such a cheddar cheese, contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur.

DIF: Cognitive Level: Application MULTIPLE RESPONSE 1. Which statements are true regarding SSRIs? (Select all that apply.) a. Foods and beverages containing tyramine should be avoided. b. The nurse should monitor for extrapyramidal symptoms. c. A potentially hazardous effect called serotonin syndrome may occur. d. Therapeutic effects may not be seen for about 8 weeks after the medication is e. f. g. h.

started.

If the patient has been on an MAOI, a 2- to 5-week or longer span of time should elapse before beginning an SSRI medication.

These drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision.

SSRIs are associated with fewer side effects than are the older first-generation antidepressants.

St. John’s Wort is often recommended to reduce the side effects that may occur with SSRIs.

ANS: C, D, E, G

“A potentially hazardous effect called serotonin syndrome may occur,” “Therapeutic effects may not be seen for about 8 weeks after the medication is started,” “If the patient has been on an MAOI, a 2- to 5-week or longer span of time should elapse before beginning an SSRI medication,” and “SSRIs are associated with fewer side effects than are the older first-generation antidepressants” are true statements that apply to SSRIs. The other statements apply to other classes of psychotherapeutic agents.

St. John’s Wort is contraindicated when a patient is taking an SSRI. DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

3

Chapter 18: Substance Misuse Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A 38-year-old male has been using the “cold turkey” approach to stop smoking. Although he hasn’t smoked for 6 months, he tells

the nurse that he still feels strong cigarette cravings and wonders whether he will ever get over the cravings. Which statement is true? a. The cravings will never stop. b. The cravings may persist for months to years. c. The cravings indicate that he has been using nicotine. d. The cravings indicate that he is about to experience nicotine withdrawal.

ANS: B

Cigarette cravings may persist for months after nicotine withdrawal. “The cravings will never stop”, “The cravings indicate that he has been using nicotine,” and “The cravings indicate that he is about to experience nicotine withdrawal” are false statements.

DIF: Cognitive Level: Application 2. A patient in a rehabilitation centre is beginning to experience opioid withdrawal symptoms. What would you expect to be ordered

for this patient’s treatment? diazepam (Valium®) methadone hydrochloride disulfiram (Antabuse®) protocol Antidepressant therapy

a. b. c. d.

ANS: B

Opioid withdrawal can be managed with either methadone or clonidine hydrochloride (Catapres®). Diazepam and disulfiram are used for treatment of alcoholism. Antidepressant therapy is used for smoking-cessation programs.

DIF: Cognitive Level: Comprehension 3. If an individual drinks alcohol while on disulfiram (Antabuse) therapy, which will most likely occur? a. Euphoria b. Vomiting c. Hypertension d. Hypoventilation ANS: B

Nausea and copious vomiting occur, and occur quickly, when disulfiram is used with alcohol.

DIF: Cognitive Level: Comprehension 4. A patient has been taking naltrexone (ReVia®) as part of the treatment for addiction to heroin.

Which statement is true in this case? a. Naltrexone will prevent the patient’s cravings for opioid drugs. b. Naltrexone will work as a safer substitute for the heroin until the patient completes withdrawal. c. The patient will experience hypertension and severe nausea if the patient takes heroin while on naltrexone. d. If opioid drugs are used while taking naltrexone, euphoria is not produced; thus, the drug’s effects are lost.

ANS: D

Naltrexone works to eliminate the euphoria that occurs with opioid drug use. Therefore, the reinforcing effect of the drug is lost when the drug is taken while an opioid is being used.

DIF: Cognitive Level: Analysis 5. During a substance abuse lecture for teenage girls, the nurse is asked about “roofies.” This slang term refers to what substance? a. Cocaine b. flunitrazepam c. hydromorphone d. Methamphetamine ANS: B

Flunitrazepam (Rohypnol®) is a benzodiazepine that has recently gained popularity as a recreational drug. It is commonly called “roofies” and is also known as the “date rape” drug.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. A 29-year-old male is admitted to the Critical Care Unit with the following symptoms: restlessness, hyperactive reflexes,

talkativeness, confusion, dry mouth, and excessive sweating. The nurse suspects that he may be experiencing the effects of taking which substance? a. Opiates b. Alcohol c. Stimulants d. Depressants ANS: C

The adverse effects listed in the example may occur with the use of stimulants and are commonly an extension of their therapeutic effects.

DIF: Cognitive Level: Analysis 7. Chronic use of alcohol may result in which condition? a. Renal failure b. Stroke c. Korsakoff’s psychosis d. Alzheimer’s disease ANS: C

Chronic use of alcohol may lead to a variety of serious neurological and mental disorders, such as Korsakoff’s psychosis and Wernicke’s encephalopathy, in addition to cirrhosis.

DIF: Cognitive Level: Application 8. A patient is being treated for ethanol abuse.

What should the nurse tell this patient about disulfiram (Antabuse) therapy? a. Do not smoke cigarettes while on this drug. b. Several common over-the-counter (OTC) substances contain alcohol. c. This drug will cause the same effects as the alcohol did but without the euphoric effects. d. Any type of mouthwash or cough medicine can be used because they contain alcohol only in small amounts.

ANS: B

Using disulfiram along with alcohol-containing OTC products will elicit severe adverse reactions. As little as 7 mL of alcohol may cause symptoms in a sensitive person.

DIF: Cognitive Level: Comprehension 9. Which is the main substance of misuse among older adults? a. Cigarettes b. Alcohol c. OTC medications d. Prescription medications ANS: B

The proportion of older adults within society is increasing. Alcohol remains the main substance of misuse among this part of the population. Cigarette smoking and polypharmacy with prescription and OTC medications are also concerns, but alcohol is the main substance of misuse.

DIF: Cognitive Level: Comprehension 10. Which statement is true in regard to drugs used in cigarette smoking cessation programs? a. Slow chewing of nicotine gum releases an immediate dose of nicotine. b. Acute relief from withdrawal symptoms is most easily achieved with the use of c. d.

the transdermal patch.

Patient adherence is higher with transdermal patches than with nicotine gum.

Nicotine gum can be used only up to six times a day.

ANS: C

In a cigarette smoking cessation program, patient adherence is higher with the use of transdermal patches than with nicotine gum.

Acute relief from nicotine withdrawal symptoms is more easily achieved with the use of the gum than with the patch. Rapid chewing of the gum produces an immediate dose of nicotine, and nicotine gum can be used whenever the patient has a strong urge to smoke.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

MULTIPLE RESPONSE 1. During a party, a guest who is on disulfiram (Antabuse) therapy drinks half a glass of wine. The party guest will quickly experience

which symptoms? (Select all that apply.) a. Euphoria b. Vomiting c. Diarrhea d. Pallor e. Flushed skin f. Sweating g. Hypoventilation ANS: B, E, F

Vomiting, flushed skin, and sweating occur when disulfiram is taken with even small amounts of alcohol. Other symptoms include a throbbing sensation in the head and neck, hyperventilation, confusion, nausea, vertigo, and blurred vision. Euphoria, diarrhea, pallor, and hypoventilation do not occur in this situation.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

3

Chapter 19: Adrenergic Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Adrenergic drugs produce effects similar to which of the body’s systems? a. The central nervous system b. The somatic nervous system c. The sympathetic nervous system d. The parasympathetic nervous system ANS: C

Adrenergic drugs mimic the sympathetic nervous system neurotransmitters. Thus, adrenergic drugs are also called sympathomimetic drugs.

DIF: Cognitive Level: Knowledge 2. When an adrenergic drug stimulates 1-adrenergic receptors, the result is an increased force of contraction, which is known as what

type of positive effect? a. Inotropic b. Adrenergic c. Dromotropic d. Chronotropic ANS: A

An increased force of contraction is known as a positive inotropic effect.

DIF: Cognitive Level: Knowledge 3. When a patient is taking an adrenergic drug, the nurse expects to see which effect? a. Increased heart rate b. Bronchial constriction c. Peripheral vasodilation d. Increased intestinal peristalsis ANS: A

Increased heart rate is one of the effects of adrenergic drugs. Bronchial dilation, peripheral constriction, and decreased intestinal peristalsis are not effects of adrenergic drugs.

DIF: Cognitive Level: Knowledge 4. An adrenergic agonist is ordered for a patient in shock. The nurse notes that this drug has had its primary intended effect when

which condition occurs?

Blood volume restoration Increased blood pressure Stable urine output Reduced anxiety

a. b. c. d.

ANS: B

For a patient in shock, a primary benefit of an adrenergic agonist drug is to increase blood pressure. A drug in this category should not be used in place of volume restoration or to provide blood volume restoration (intravenous fluids should be used). Adrenergic agonists may enhance urine output if cardiac output and perfusion to the kidneys increase, but this is a secondary benefit.

Treatment of anxiety is not an indication for adrenergics.

DIF: Cognitive Level: Analysis 5. Which condition is an indication for epinephrine (Adrenalin®)? a. Severe hypertension b. Conjunctival congestion c. Acute asthma attacks d. Heart failure ANS: C

Acute asthma attack is one of the indications for the use of epinephrine.

DIF: Cognitive Level: Comprehension 6. After a near-fatal motor vehicle accident, a family has given permission for their 6-year-old son’s organs to be donated. Which

medication will be given to the child to maintain the blood pressure in his organs until transplantation can be carried out? a. epinephrine hydrochloride b. midodrine hydrochloride c. dobutamine hydrochloride d. dopamine hydrochloride ANS: D

Dopamine hydrochloride is used to maintain blood pressure in organs that are to be transplanted.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. A female patient is on a low-dose dobutamine drip for heart failure. She had been feeling “better” but now reports tightness in her

chest and a bit of anxiety. Her heart rate, which was 86, is now up to 110, and her blood pressure, which was 120/80, is now 150/98. What is the nurse’s immediate assessment of the patient’s condition? a. The patient is experiencing the normal adverse effects of dobutamine therapy. b. The patient may be experiencing an allergic reaction to the dobutamine. c. The dobutamine may be causing a worsening of a pre-existing cardiac disorder. d. The dosage of the dobutamine should be increased to better control these symptoms.

ANS: C

Because dobutamine is a vasoactive adrenergic, it works by increasing the cardiac output in heart failure patients by increasing myocardial contractility and stroke volume. However, adrenergic drugs may precipitate a myocardial infarction, especially in patients with a pre-existing cardiac disorder.

DIF: Cognitive Level: Analysis 8. A 14-year-old female patient has been treated for asthma for almost 4 months. Two weeks ago, she was given salmeterol xinafoate

as part of her medication regimen. However, her mother has called the clinic to report that it does not seem to work when her daughter is experiencing acute symptoms. What does the nurse think in response to the mother’s concerns? a. It takes time for a therapeutic response to develop. b. The patient is too young for this particular medication; it should be changed. c. The patient should take up to two puffs every 4 hours to ensure adequate blood levels. d. Salmeterol is indicated for prevention of bronchospasms; it is not to be used for relief of acute symptoms.

ANS: D

Education about dosing is very important. The dosage is usually one puff twice daily, 12 hours apart, for maintenance effects in patients older than 12 years.

DIF: Cognitive Level: Analysis 9. A patient is experiencing a severe anaphylactic reaction to an antibiotic. Which drug would be used to treat this condition? a. ephedra b. epinephrine (Adrenalin) c. phenylephrine d. pseudoephedrine ANS: B

Epinephrine is the drug of choice for the treatment of anaphylaxis.

DIF: Cognitive Level: Application 10. Inhaled salmeterol is indicated for which condition? a. Acute asthma attacks b. Nasal decongestion c. Asthma d. Anaphylaxis ANS: C

Inhaled salmeterol is indicated for long-term maintenance treatment of asthma.

DIF: Cognitive Level: Application 11. Adrenergic drugs that cause relaxation of the bronchi (i.e., bronchodilation) stimulate which receptors? a. Dopaminergic receptors b. 1-Adrenergic receptors c. 2-Adrenergic receptors d. 1-Adrenergic receptors ANS: C

Stimulation of 2-adrenergic receptors results in bronchodilation.

DIF: Cognitive Level: Comprehension 12. When an older adult is taking an adrenergic drug, what must the nurse carefully monitor? a. Blood pressure and pulse rate b. Temperature and oxygen saturation c. Urine output d. Irritability and chest pain ANS: A

Because of the cardiovascular and cerebrovascular effects of adrenergic drugs, vital signs—especially blood pressure and pulserate— must be monitored frequently in the older adult who is taking an adrenergic drug.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

MULTIPLE RESPONSE 1. Which are adrenergic receptor responses to stimulation? (Select all that apply.) a. Dilation of bronchioles b. Dilated pupils c. Decreased heart rate d. Increased heart rate e. Increased peristaltic contractions of intestinal smooth muscle f. Decreased motility of intestinal smooth muscle g. Contraction of the uterine muscle h. Increased renin secretion ANS: A, B, D, F, G, H

Dilation of bronchioles, increased heart rate, decreased motility of intestinal smooth muscle, contraction of the uterine muscle, dilated pupils, and increased renin secretion are adrenergic receptor responses to stimulation.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

3

Chapter 20: Adrenergic-Blocking Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which drug is used to help establish the diagnosis of pheochromocytoma? a. prazosin (Minipress®) b. phentolamine (Rogitine®) c. carvedilol d. tamsulosin (Flomax®) ANS: B

Phentolamine is used in the diagnosis of this catecholamine-secreting tumour.

DIF: Cognitive Level: Analysis 2. A patient is going home with a new prescription for the -blocker atenolol (Tenormin®). What important information should the

nurse tell the patient about this drug? a. Never abruptly stop taking this medication. b. The medication should be stopped once symptoms subside. c. Change positions slowly to prevent or reduce postural hypotension. d. Report any weight gain of more than 0.5 kg in a week or any problem with fluid buildup.

ANS: A

Patients should be weaned off these medications slowly because rebound hypertension and chest pain are possible with rapid withdrawal.

DIF: Cognitive Level: Application 3. A patient has been on a dopamine drip, and the nurse notices that the infusion has extravasated into the tissue of the forearm. After

stopping the infusion, the nurse immediately injects phentolamine into the interstitial catheter. What is the effect of this action?

It causes vasoconstriction and rapid uptake of the extravasated dopamine.

It causes arterial vasoconstriction and reduced pain and swelling at the site.

It increases peripheral vascular resistance and reduces arterial pressure at the site.

It increases blood flow to the ischemic site by vasodilation and prevents permanent tissue damage.

a. b. c. d.

ANS: D

Phentolamine is an 1-blocker that reduces peripheral vascular resistance. Phentolamine 5 mg to 15 mg in 10 mL of normal saline solution is administered into the interstitial catheter prior to removal, to direct phentolamine into the area of extravasation as soon as possible. This action causes -adrenergic receptor blockade and vasodilation, which in turn increases blood flow to the ischemic tissue and prevents permanent damage.

DIF: Cognitive Level: Analysis 4. A 58-year-old male has had a myocardial infarction (MI). He has begun rehabilitation and is ready for discharge. When he is given

a prescription for metoprolol (Lopressor®), he becomes upset and says, “I don’t have high blood pressure! Why did my doctor give me this medicine?” What is the nurse’s best explanation to the patient? a. This medication prevents emboli that may lead to another MI. b. -Blockers are routinely prescribed for all post-MI patients. c. It is being prescribed to prevent hypertension that often occurs post MI. d. Studies have shown that this medication greatly increases survival in post-MI patients.

ANS: D

Because of their cardioprotective properties, -blockers are frequently prescribed to patients who have suffered an MI. However, some contraindications may preclude the use of -blockers for all post-MI patients.

DIF: Cognitive Level: Analysis 5. A patient has received a prescription for prazosin (Minipress) to reduce urinary obstruction due to benign prostatic hyperplasia

(BPH). What important information about this medication should the nurse give this patient?

Fluids should be restricted while on this medication.

Take the medication with breakfast to promote the maximum effects of the drug.

Until a tolerance is built up, lightheadedness may occur when standing up after sitting or lying down. d. Blood pressure should be monitored because the medication may cause hypertension due to vasoconstriction. a. b. c.

ANS: C

This medication is used to relieve impaired urinary flow in men with BPH, but it also has antihypertensive effects. Because of these effects, blood pressure may be dramatically lowered, and orthostatic hypotension and lightheadedness may occur until tolerance is developed. Fluids do not need to be restricted while on this medication. The patient needs to maintain adequate fluid intake to prevent urinary tract infection and to stay hydrated. Because of the possibility of lightheadedness, the first few doses should be taken at bedtime.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. A female patient has been admitted to the emergency department after an accidental overdose of an -blocker. Her daughter states

that her mother called to tell her that she had taken two double doses that morning because the headache “just would not go away.”

The patient is now dizzy, nauseated, and very weak. What should the nurse do immediately? a. Administer activated charcoal b. Force intravenous and oral fluids c. Empty the stomach by gastric lavage d. Administer a cathartic such as sorbitol ANS: C

In an acute oral -blocker overdose, the patient’s stomach should be emptied, usually by gastric lavage.

DIF: Cognitive Level: Analysis 7. Which -blocker is indicated for the treatment of heart failure? a. atenolol (Tenormin) b. carvedilol c. acebutolol (Sectral®) d. esmolol (Brevibloc®) ANS: B

Certain -blockers, such as carvedilol and metoprolol, have had the best results to date in the treatment of heart failure.

DIF: Cognitive Level: Comprehension 8. The nurse is teaching a patient about self-monitoring while taking a -blocker at home. The nurse should teach the patient to

measure apical pulse daily for 1 minute. What does the nurse instruct the patient to do if the pulse rate decreases to less than 60 beats per minute? a. Contact the physician for instructions. b. Reduce the dose of the -blocker by half. c. Continue the medication, because this is an expected effect. d. Skip the medication dose that day and check the pulse again the next day.

ANS: A

Cardiac depression can occur with -blockers; thus, patients should be told to contact their physician if their pulse rate decreases to less than 60 beats per minute.

DIF: Cognitive Level: Analysis 9. A 49-year-old male patient is in the clinic for a follow-up visit 6 months after starting a -blocker for treatment of hypertension.

During this visit, his blood pressure is 169/98 mm Hg, and he eventually confesses that he stopped taking this medicine 2 months ago because of an “embarrassing problem.” What problem with this medication most likely caused him to stop taking it? a. Urge incontinence b. Dizziness when standing up c. Excessive flatus d. Erectile dysfunction ANS: D

Erectile dysfunction is a potential adverse effect of -blockers and may cause patients to stop taking them.

DIF: Cognitive Level: Analysis MATCHING

Indicate the appropriate medication in the top list for each condition listed in the lower list. a. An -blocker drug b. A -blocker drug c. Both an -blocker drug and a -blocker drug 1. Migraine headaches 2. Benign prostatic hyperplasia 3. Glaucoma 1. ANS: B 2. ANS: A 3. ANS: B

DIF: Cognitive Level: Application DIF: Cognitive Level: Application DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 21: Cholinergic Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which is a cardiovascular effect of cholinergic drugs? a. Bradycardia b. Tachycardia c. Vasoconstriction d. Palpitations ANS: A

The cardiovascular effects of cholinergic drugs are decreased heart rate (bradycardia) and vasodilation.

DIF: Cognitive Level: Knowledge 2. How are most direct-acting cholinergic drugs mainly used? a. As antidotes for anticholinergic poisoning b. Topically to reduce intraocular pressure c. Orally in preparation for ocular surgery d. For the diagnosis and treatment of myasthenia gravis ANS: B

Direct-acting cholinergic drugs (with the exception of bethanechol [Urecholine®]) are poorly absorbed orally and are used topically to reduce intraocular pressure in patients with glaucoma and in patients undergoing ocular surgery.

DIF: Cognitive Level: Comprehension 3. When an overdose of an intravenous cholinergic drug occurs, which drug, administered promptly, can reverse a cholinergic crisis? a. atenolol (Tenormin) b. bethanechol (Duvoid®) c. dobutamine d. atropine sulphate ANS: D

Prompt administration of atropine sulphate can reverse a toxic dose of a cholinergic drug.

DIF: Cognitive Level: Comprehension 4. A patient has had abdominal surgery and is being discharged on a cholinergic drug to assist in increasing gastrointestinal

peristalsis. Which therapeutic effects should the nurse teach the patient to watch for? a. Decreased pulse rate b. Abdominal cramping c. Passage of flatus d. Decreased frequency and urgency of voiding patterns ANS: C

Patients experiencing a postoperative decrease in gastrointestinal peristalsis should watch for an increase in bowel sounds, the passage of flatus, and the occurrence of bowel movements that indicate increased gastrointestinal peristalsis.

DIF: Cognitive Level: Analysis 5. A patient has been newly diagnosed with myasthenia gravis. What important information should the nurse give this patient about

the administration of cholinergic drugs? a. The medication should be taken with meals to avoid gastrointestinal distress. b. Daytime dosages should be given close together for maximal therapeutic effect. c. The medication should be taken 30 minutes before eating, to improve swallowing and chewing. d. Expected adverse effects are increased muscle weakness, abdominal cramping, and diarrhea, which should subside in a few days.

ANS: C

Taking the medication 30 minutes before meals allows for the onset of action and therapeutic effects during the meal. The doses should be spaced evenly apart to optimize the effects of the medication. Increased muscle weakness, abdominal cramping, and diarrhea should be reported to the physician.

DIF: Cognitive Level: Application 6. Which drug is considered to be the antidote for anticholinergic poisoning and for poisoning by organophosphates and carbonates,

such as those in common insecticides? a. pilocarpine b. bethanechol (Duvoid) c. physostigmine d. cholinesterase ANS: C

Indirect-acting drugs such as physostigmine inhibit acetylcholinesterase, thus reversing the neuromuscular blockade produced by anticholinergic poisoning.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. The nurse is providing teaching regarding drug therapy to the husband of a woman with Alzheimer’s disease. The patient was

diagnosed 3 months ago and has mild memory loss. She will be receiving donepezil (Aricept®). Which statement accurately describes the drug’s actions? a. It prevents memory loss in later stages. b. It will reverse the course of Alzheimer’s disease. c. It provides sedation to prevent agitation and restlessness. d. It may help to improve the symptoms of Alzheimer’s disease.

ANS: D

Donepezil is used to treat the mild to moderate dementia of Alzheimer’s disease and may improve the symptoms of the disease.

DIF: Cognitive Level: Comprehension 8. A patient has been taking donepezil (Aricept) for 2 weeks as part of the treatment for early stages of Alzheimer’s disease. The

patient’s daughter calls the physician’s office, upset because her mother has not shown any improvement. What is the nurse’s best response to the patient’s daughter? a. “Increase the dosage to twice daily.” b. “It takes time for the cure to take effect.” c. “It may take up to 6 weeks to see an improvement.” d. “Have her take the medication on an empty stomach for improved absorption.”

ANS: C

Donepezil therapy is not a cure for Alzheimer’s disease but may help to improve symptoms in the early stages. It may take up to 6 weeks to see improvement. The family should be taught that the medication must be taken exactly as ordered and with meals. Also, the medication should not be abruptly stopped, and the dosage should not be increased without the physician’s approval because of the possibility of serious complications.

DIF: Cognitive Level: Application 9. The desired effects of cholinergic drugs come from stimulation of which receptors? a. Muscarinic b. Nicotinic c. Cholinergic d. Ganglionic ANS: A

The desired effects come from muscarinic receptor stimulation; many of the undesirable adverse effects are due to nicotinic receptor stimulation.

DIF: Cognitive Level: Comprehension 10. A patient wants to begin taking ginkgo for memory enhancement. The nurse should warn this patient about possible drug

interactions with which substances? a. Digoxin, diuretics, and steroids b. Caffeine-containing products c. Alcoholic beverages d. Aspirin, any nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin (Coumadin®), and heparin ANS: D

Drug interactions with gingko may occur with the ingestion of Aspirin, NSAIDs, warfarin, heparin, anticonvulsants, ticlopidine, clopidogrel, dipyridamole, and tricyclic antidepressants.

DIF: Cognitive Level: Comprehension MATCHING

For each effect in the lower list, indicate which stimulation in the upper list the effect is due to. a. Muscarinic stimulation b. Nicotinic stimulation c. Both muscarinic stimulation and nicotinic stimulation 1. Pupil constriction 2. Increased heart rate 3. Decreased blood pressure 1. ANS: C 2. ANS: B 3. ANS: A

DIF: Cognitive Level: Application DIF: Cognitive Level: Application DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 22: Cholinergic-Blocking Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. The nurse is about to administer a STAT dose of atropine sulphate to a patient who is experiencing a symptomatic cardiac

dysrhythmia. During administration of this drug, the nurse monitors the patient closely for which adverse effect? a. Tachycardia b. Bradycardia c. Ectopic beats d. Cardiac standstill ANS: A

Cardiovascular effects of cholinergic blockers include an increased heart rate and dysrhythmias. One indication for use is sinus bradycardia accompanied by hemodynamic compromise.

DIF: Cognitive Level: Application 2. How long can a scopolamine patch prevent motion sickness? a. 1 day b. 2 days c. 3 days d. 4 days ANS: C

A scopolamine patch can prevent motion sickness for 3 days.

DIF: Cognitive Level: Comprehension 3. Which condition is appropriate for treatment with a cholinergic-blocking drug? a. Glaucoma b. Myasthenia gravis c. Irritable bowel disease d. Genitourinary obstruction ANS: C

Cholinergic-blocking drugs may be used to treat irritable bowel disease. Glaucoma, myasthenia gravis, and genitourinary obstruction are contraindications to the use of these drugs.

DIF: Cognitive Level: Application 4. Which medication is the antidote to severe cases of atropine overdose? a. atenolol (Tenormin®) b. bethanechol c. scopolamine patch d. physostigmine ANS: D

Physostigmine is the antidote to an atropine overdose in clients who show extreme delirium or agitation and who could injure themselves.

DIF: Cognitive Level: Knowledge 5. A 72-year-old male has a new prescription for an anticholinergic. He is an active man and enjoys outdoor activities such as hiking,

golfing, and doing yard work. During a teaching session about his drug therapy, the nurse should emphasize that drowsiness may interfere with his outdoor activities. increased salivation may occur during exercise and outdoor activities. fluid volume deficits may occur as a result of an increased incidence of diarrhea. he should take measures to reduce the occurrence of heat stroke during his activities.

a. b. c. d.

ANS: D

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

DIF: Cognitive Level: Analysis 6. When administering an anticholinergic drug, the nurse expects the patient will experience which adverse effect? a. Excessive urination b. Diaphoresis c. Dry mouth d. Pupil constriction ANS: C

Anticholinergic drugs frequently cause dry mouth, blurred vision, constipation, and urinary retention.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. For what is oxybutynin (Ditropan®) used? a. To treat symptoms associated with irritable bowel disease b. For induction of mydriasis c. As an antispasmodic for neurogenic bladder d. For reduction of secretions preoperatively ANS: C

Oxybutynin is used as an antispasmodic for the treatment of neurogenic and overactive bladder conditions. Irritable bowel disease is not an indication for oxybutynin, and the induction of mydriasis and the preoperative reduction of secretions are not uses for oxybutynin.

DIF: Cognitive Level: Comprehension 8. What is the advantage of using tolterodine (Detrol®) for urinary incontinence as compared with other drugs? a. Drowsiness is not usually a problem. b. Tolterodine may also be used for urinary retention. c. Tolterodine can be used in patients with narrow-angle glaucoma. d. The incidence of dry mouth is much lower with tolterodine.

ANS: D

Tolterodine is contraindicated if narrow-angle glaucoma or urinary retention is present, and drowsiness may occur as therapy is started. However, compared with other drugs, when using tolterodine, the incidence of dry mouth is much lower.

DIF: Cognitive Level: Application 9. The nurse working in a preoperative holding unit anticipates an order to give which anticholinergic medication to a newly admitted

patient? dicyclomine (Bentylol®) tolterodine (Detrol) donepezil glycopyrrolate

a. b. c. d.

ANS: D

Glycopyrrolate is an anticholinergic drug that can be used to control secretions during surgery.

DIF: Cognitive Level: Application 10. Solifenacin succinate (Vesicare®) is contraindicated for patients with which condition? a. Glaucoma and severe constipation b. Urinary retention and diarrhea c. Genitourinary tract problems and dry mouth d. Gastrointestinal problems and blurred vision ANS: A

Solifenacin succinate is contraindicated for patients with glaucoma, certain gastrointestinal and genitourinary tract problems, severe constipation, and urinary retention. Diarrhea, dry mouth, and blurred vision are adverse effects of solifenacin succinate.

DIF: Cognitive Level: Analysis MULTIPLE RESPONSE 1. Atropine is appropriate for which patients? (Select all that apply.) a. A patient who has suddenly developed symptomatic bradycardia, with a heart rate b. c. d. e. f.

of 32 beats per minute A patient who has suddenly developed symptomatic tachycardia, with a heart rate of 180 beats per minute A patient with severe narrow-angle glaucoma A patient who requires preoperative reduction of salivary and gastrointestinal secretions myasthenia gravis A patient newly diagnosed with myasthenia gravis A patient with severe diarrhea

ANS: A, D, F

Anticholinergic drugs are used to treat symptomatic bradycardia and certain other cardiac conditions, to preoperatively control secretions during surgery, and to decrease intestinal motility. Symptomatic tachycardia, narrow-angle glaucoma, the reduction of salivary and gastrointestinal secretions, and myasthenia gravis are contraindications to the use of atropine.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 23: Antihypertensive Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. The physician has ordered doxazosin mesylate (Cardura®) for a female patient. What important information should the nurse give

this patient? a. She should weigh herself daily and report any weight loss to the physician. b. She must increase her potassium intake by eating more bananas and apricots. c. The impaired taste associated with the medication usually goes away in 2 to 3 weeks. d. She should take her first dose while lying down, because prazosin has a first-dose effect.

ANS: D

When a patient is starting doxazosin mesylate, the first dose should be taken while lying down, because this drug has a first-dose effect.

DIF: Cognitive Level: Application 2. Which is the best angiotensin-converting enzyme (ACE) inhibitor for a patient who has liver dysfunction in addition to an acute

myocardial infarction? a. quinapril (Accupril®) because it is a prodrug b. captopril (Capoten®) because it is not a prodrug c. lisinopril (Prinivil®) because it can be dosed only once a day d. enalapril (Vasotec®) because it is also available in a parenteral form ANS: B

A prodrug relies on a functioning liver to be converted to its active form. Captopril is not a prodrug.

DIF: Cognitive Level: Comprehension 3. Why does a physician examine the fundus of a patient’s eyes during antihypertensive therapy? a. To monitor for drug toxicity b. To assess for increased intraocular pressure c. To assess for visual changes that may occur with drug therapy d. To evaluate the long-term effectiveness of the treatment ANS: D

The physician examines the fundus of a patient’s eyes during antihypertensive therapy because it is a more reliable indicator of the long-term effectiveness of treatment than blood pressure readings are.

DIF: Cognitive Level: Comprehension 4. Which parameters determine the regulation of arterial blood pressure? a. Cardiac output and vascular resistance b. Heart rate and peripheral resistance c. Blood volume and renal blood flow d. Myocardial contractility and arteriolar constriction ANS: A

Blood pressure is determined by the product of cardiac output and systemic vascular resistance.

DIF: Cognitive Level: Comprehension 5. Which adverse effect commonly occurs in male patients who are taking antihypertensive medications? a. Erectile dysfunction b. Bradycardia c. Increased libido d. Increased weight ANS: A

Sexual dysfunction is a common adverse effect of antihypertensive medications and may be manifested in males as decreased libido or as impotence.

DIF: Cognitive Level: Comprehension 6. Antihypertensive drug therapy has been prescribed for a Black male patient newly diagnosed with stage 1 hypertension. What is

most likely included in his medication therapy?

Vasodilators alone ACE inhibitors alone Calcium channel blockers with thiazide diuretic -Blockers with thiazide diuretic

a. b. c. d.

ANS: C

Calcium channel blockers and diuretics have been shown to be more effective in older adults and in Black patients than in White patients. Thiazide diuretics are also recommended for newly diagnosed stage 1 hypertension.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. Which is a potential nursing diagnosis for a patient taking antihypertensive medications? a. Diarrhea b. Sexual dysfunction c. Stress urinary incontinence d. Impaired memory ANS: B

Sexual dysfunction is a possible adverse effect of antihypertensive drug therapy.

DIF: Cognitive Level: Analysis 8. A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be

needed. What is the best answer to the patient’s question?

1 month 1 year Until symptoms disappear Lifelong

a. b. c. d.

ANS: D

Because there is no cure for hypertension, treatment will be lifelong.

DIF: Cognitive Level: Comprehension 9. A persistent cough is an adverse effect of which class of antihypertensive drugs? a. -Blockers b. ACE inhibitors c. Angiotensin receptor blockers d. Calcium channel blockers ANS: B

ACE inhibitors cause a characteristic dry, hacking, nonproductive chronic cough that reverses when therapy is stopped.

DIF: Cognitive Level: Comprehension 10. A patient diagnosed with prehypertension has which blood pressure reading? a. Systolic blood pressure of less than 120 mm Hg and diastolic blood pressure less b. c. d.

than 80 mm Hg Systolic blood pressure between 120 and 139 mm Hg and diastolic blood pressure between 80 and 89 mm Hg Systolic blood pressure between 140 and 159 mm Hg and diastolic blood pressure between 90 and 99 mm Hg Systolic blood pressure between 160 and 179 mm Hg and diastolic blood pressure 100 and 109 mm Hg

ANS: B

Prehypertension is defined as a systolic blood pressure of between 120 and 139 mm Hg and a diastolic blood pressure of between 80 and 89 mm Hg. DIF: Cognitive Level: Comprehension 11. A patient has hypertension, together with type I diabetes mellitus and proteinuria. Which drug is considered to have

renal-protective effects for these medical diagnoses? a. -Blockers b. ACE inhibitors c. Diuretics d. Calcium channel blockers ANS: B

ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This effect is one reason they are among the cardiovascular drugs of choice for diabetic patients.

DIF: Cognitive Level: Comprehension 12. Why do patients on -adrenergic agonists require close assessment of pulse, blood pressure, and weight? a. Because of strong vasoconstricting properties b. Because of hypertensive effects c. Because of strong vasodilating properties d. Because of the risk of fluid overload ANS: C

Patients on -adrenergic agonists require close assessment of pulse, blood pressure, and weight before and during treatment because of these drugs’ strong vasodilating properties and hypotensive adverse effects.

DIF: Cognitive Level: Comprehension COMPLETION 1. A patient who has diabetes has been started on antihypertensive drug therapy. The health care provider considers this treatment

effective if the blood pressure is lower than

mm Hg.

ANS: 130/80 DIF: Cognitive Level: Application Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 24: Antianginal Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which is a true statement concerning the administration of topical nitroglycerin ointment? a. The ointment should be applied on the chest over the heart. b. The ointment should be used only in the case of a mild angina episode. c. The old ointment should be removed before the new ointment is applied. d. The ointment should be massaged gently into the skin and then covered with

plastic wrap.

ANS: C

The old ointment should be removed before a new dose is applied; the ointment is not massaged or spread on the skin, and it is not indicated for the treatment of acute angina.

DIF: Cognitive Level: Comprehension 2. The nurse is administering intravenous nitroglycerin to a patient who has just been admitted for an acute myocardial infarction.

Which statement is true in regard to the administration of this medication? a. It must be contained in special non–polyvinyl chloride (non-PVC) intravenous (IV) bags. b. It is stable for only 24 hours after preparation. c. It can be given in infusions with other medications. d. An IV filter should be attached to the infusion tubing.

ANS: A

This medication must be contained in specifically designed non-PVC plastic IV bags. IV nitroglycerin is stable for 96 hours after preparation, it cannot be given with any other drugs, and IV filters will absorb the drug.

DIF: Cognitive Level: Comprehension 3. A 53-year-old male patient has been admitted for evaluation of chest pain. He has been diagnosed with angina and prescribed

sublingual nitroglycerin tablets. What important instructions for using this medication should the nurse give the patient?

Take up to five doses at 15-minute intervals after an anginal attack.

If the tablet does not dissolve quickly, chew the tablet for maximal effect.

If the chest pain is not relieved, go to hospital immediately.

Sit or lie down when taking a tablet; change positions slowly to avoid falling or fainting.

a. b. c. d.

ANS: D

Sublingual nitroglycerin may cause hypotension. Therefore, the patient should sit or lie down when taking a dose and should move slowly to avoid injury from falling or fainting. One tablet should be taken every 5 minutes, up to 3 tablets in 15 minutes. This drug should never be chewed. If chest pain is not relieved after the first tablet and within 5 minutes, call 911 to activate emergency medical services.

DIF: Cognitive Level: Application 4. A 74-year-old professional golfer has chest pain that occurs toward the end of his golf games. He says the pain usually goes away

after he takes one or two sublingual nitroglycerin tablets and rests. What type of angina does he have?

Classic angina Variant angina Unstable angina Prinzmetal’s angina

a. b. c. d.

ANS: A

The patient has classic angina. Also called chronic stable angina, it is triggered by either exertion or stress and usually subsides within 15 minutes with either rest or drug therapy.

DIF: Cognitive Level: Comprehension 5. A female patient arrives in the emergency department with severe chest pain. She has had pain off and on for a week. Which

assessment finding indicates a need for cautious use of nitrates and nitrites?

Blood pressure of 110/78 mm Hg History of liver disease History of heart failure Anemia

a. b. c. d.

ANS: D

Anemia is a contraindication to the use of nitrates and nitrites.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. A patient is taking a calcium channel blocker as part of his therapy after a myocardial infarction. What important information or

instructions should the nurse give the patient about this medication?

The tablet should be chewed for faster release of the medication.

A frequent adverse effect is hypertension, which should be reported immediately.

If adverse effects of chest pain, fainting, or dyspnea occur, discontinue the medication immediately. d. A high-fibre diet with plenty of fluids will help to prevent the constipation that may occur. a. b. c.

ANS: D

Constipation is a common effect of calcium channel blockers. Consuming a diet high in fibre and drinking fluids will help to prevent constipation. Extended-release tablets should never be chewed or crushed. Calcium channel blockers may cause hypotension; because of the risks of rebound hypertension and worsening of tissue ischemia, they should never be discontinued abruptly.

DIF: Cognitive Level: Analysis 7. A patient has been prescribed transdermal nitroglycerin patches. What important instructions for applying these patches should the

nurse give the patient?

Use the patches on any nonhairy area on the body.

Use the patches only on the chest area.

Temporarily remove the patch while swimming.

Apply the patch to the same site consistently.

a. b. c. d.

ANS: A

A transdermal patch should be applied to any nonhairy area on the body; the old patch should first be removed. The patch may be worn while swimming, but if it comes off, it should be replaced after the old site has been cleansed. Application sites should be rotated.

DIF: Cognitive Level: Application 8. A patient has developed tolerance to transdermal nitroglycerin therapy. Which instruction is the best one for the nurse to give the

patient?

Omit one dose once a week.

Leave the patch on for 2 days at a time.

Use only half of a patch until the tolerance subsides.

Remove the patch at bedtime, then apply a new one in the morning.

a. b. c. d.

ANS: D

To prevent tolerance, remove the transdermal patch at night for 8 hours and apply a new patch in the morning.

DIF: Cognitive Level: Application MULTIPLE RESPONSE 1. A person who is experiencing chest pain while playing tennis has brought along a bottle of sublingual nitroglycerin. In this

situation, which action is appropriate for this person to take? (Select all that apply.)

Stop the activity and lie down or sit down.

Call 911 immediately.

Place a tablet under the tongue.

Place a tablet in the space between the gum and cheek.

If chest pain is not relieved after 1 minute, take another sublingual tablet.

Take another sublingual tablet if chest pain is not relieved after 5 minutes.

Take a sip of liquid to help dissolve the pill.

Call 911 if the pain is not relieved within 5 minutes after taking one sublingual tablet.

a. b. c. d. e. f. g. h.

ANS: A, C, F, H

Stopping the activity and lying or sitting down, placing a tablet under the tongue, taking another sublingual tablet if chest pain is not relieved after 5 minutes, and calling 911 if the pain is not relieved within 5 minutes after taking one sublingual tablet are all correct actions. Calling 911 immediately is an incorrect action because 911 should be called only after 1 tablet has been taken and there is no relief within 5 minutes apart. “Place a tablet in the space between the gum and cheek” describes buccal administration.

Taking another sublingual tablet if chest pain is not relieved after a minute is an incorrect action because tablets should be taken 5 minutes apart, and taking a sip of liquid to help dissolve the pill is incorrect because the patient should not drink any liquids while taking sublingual tablets.

DIF: Cognitive Level: Application TRUE/FALSE 1. Unstable angina is the most dangerous type of angina.

ANS: T

The statement is true. Unstable angina is the most dangerous, as it is the clinical presentation of acute coronary syndrome with cardiac ischemia without persistent ST-segment elevation as seen on an electrocardiogram and no detectable release of the enzymes and biomarkers of myocardial necrosis. It often ends in a myocardial infarction.

DIF: Cognitive Level: Knowledge

Copyright © 2021, Elsevier Inc. All rights reserved.

2

2. Calcium channel blockers are indicated for patients experiencing an acute MI. ANS: F

The statement is false. Contraindications include known drug allergy, acute MI, second- or third-degree AV block (unless the patient has a pacemaker), and hypotension.

DIF: Cognitive Level: Knowledge 3. The onset of action of oral metoprolol is 1 hour.

ANS: T

The statement is true. The onset of action of oral metoprolol is 1 hour, with a peal plasma concentration of 2 to 4 hours, an elimination half-life of 3 to 8 hours, and a duration of action of 10 to 20 hours.

DIF: Cognitive Level: Knowledge 4. Most available -blockers demonstrate antianginal efficacy.

ANS: T

This statement is true. Most available -blockers demonstrate antianginal efficacy, although not all have been approved for this use.

DIF: Cognitive Level: Knowledge 5. Amlodipine (Norvasc®) can be used to treat both angina and hypertension.

ANS: T

This statement is true. Amlodipine is indicated for both angina and hypertension.

DIF: Cognitive Level: Knowledge

Copyright © 2021, Elsevier Inc. All rights reserved.

3

Chapter 25: Heart Failure Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient about to receive his morning dose of digoxin (Lanoxin®) has an apical pulse of 70 beats per minute. What should the

nurse do? a. Administer the dose b. Withhold the dose and notify the physician c. Notify the physician and monitor the patient’s vital signs d. Recheck the pulse, making sure to count for 1 full minute ANS: A

Administer the dose if the apical pulse is 70 beats per minute; the dose should be held and the physician notified if the apical pulse is 60 beats per minute or less or higher than 120 beats per minute.

DIF: Cognitive Level: Application 2. The nurse is assessing the patient before administration of a cardiac glycoside. Which condition can predispose a patient to digitalis

toxicity? a. Hypokalemia b. Hyperkalemia c. Hypocalcemia d. Heart failure ANS: A

Hypokalemia and hypercalcemia are two conditions that predispose a patient to digitalis toxicity. Heart failure is a therapeutic use for digitalis.

DIF: Cognitive Level: Comprehension 3. The nurse who is assessing a patient who is receiving intravenous (IV) digitalis recognizes that the drug has a negative

chronotropic effect. How is a negative chronotropic effect evident in a patient? a. By an increased heart rate b. By a decreased heart rate c. By decreased conduction d. By increased ectopic beats ANS: B

A negative chronotropic effect results in a reduced heart rate, which is one effect of cardiac glycosides.

DIF: Cognitive Level: Application 4. A patient has been taking digoxin (Lanoxin) at home but has developed toxicity. The physician has ordered digoxin immune Fab.

The patient asks the nurse why the medication has been changed. Which is the nurse’s best response? a. “It works faster than digoxin.” b. “It is safer than digoxin and can be taken orally.” c. “It helps to convert the fibrillating atria to a more normal rhythm.” d. “This new drug is an antidote to digoxin and will help to lower the blood levels.”

ANS: D

Digoxin immune Fab, which is available as an IV dose only, is the antidote for a severe digoxin overdose.

DIF: Cognitive Level: Analysis 5. A patient has been placed on a milrinone infusion as part of the therapy for end-stage heart failure. What risk should the nurse keep

in mind while assessing this patient during the infusion?

Hypotension Hyperkalemia Hypertension Decreased urine output

a. b. c. d.

ANS: A

Milrinone may cause significant hypotension.

DIF: Cognitive Level: Application 6. A patient with atrial fibrillation has been started on digoxin (Lanoxin), and 1 week later a digoxin level is drawn. Which result is

within the normal therapeutic levels for digoxin?

0.6 ng/mL 1.5 ng/mL 2.5 ng/mL 3.0 ng/mL

a. b. c. d.

ANS: B

The digoxin therapeutic window is between 0.8 and 2 ng/mL. DIF: Cognitive Level: Knowledge

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. Which medication results in a drug interaction if given to a patient taking digitalis? a. acetylsalicylic acid (Aspirin®) b. acetaminophen (Tylenol®) c. quinidine sulphate d. Vitamin K ANS: C

The most common drug–drug interactions with digoxin are with amiodarone hydrochloride, quinidine sulphate, and verapamil hydrochloride. These three drugs can increase digoxin levels by 50%.

DIF: Cognitive Level: Comprehension 8. A patient is beginning digoxin (Lanoxin) therapy. Which food should the nurse tell this patient to avoid when taking the digoxin

dose? a. Cooked vegetables b. Canned fruits c. Fried foods d. Bran muffins ANS: D

Bran, in large amounts, may decrease the absorption of oral digitalis drugs.

DIF: Cognitive Level: Comprehension 9. The nurse is assessing a patient before administration of a cardiac glycoside. Which laboratory result can increase the toxicity of

the drug? a. Potassium level of 2.8 mmol/L b. Potassium level of 4.9 mmol/L c. Sodium level of 140 mmol/L d. Calcium level of 10 mmol/L ANS: A

Hypokalemia increases the chance of digitalis toxicity.

DIF: Cognitive Level: Analysis 10. The nurse is administering the phosphodiesterase inhibitor milrinone.

What is the drug’s positive inotropic effect?

Increased heart rate Increased blood vessel dilation Increased force of cardiac contraction Increased conduction of electrical impulses across the heart

a. b. c. d.

ANS: C

Positive inotropic drugs increase myocardial contractility.

DIF: Cognitive Level: Application 11. Which condition predisposes a patient to digitalis toxicity? a. Hypercalcemia and advanced age b. Hyperthyroidism and liver dysfunction c. Ventricular fibrillation and hyperkalemia d. Dysrhythmias and hypernatremia ANS: A

Advanced age, atrioventricular block, dysrhythmias, hypercalcemia, hypokalemia, hypothyroid, respiratory or kidney disease, liver dysfunction, use of a pacemaker, and ventricular fibrillation are conditions that predispose a patient to digitalis toxicity.

DIF: Cognitive Level: Comprehension 12. Which assessment result is the most important indicator of an exacerbation of heart failure? a. Increased weight b. Hypokalemia c. Increased pulse d. Increased oxygen saturation ANS: A

Patients should be weighed at the same time each day and with the same amount of clothing because weight is an important indicator of fluid volume overload or the exacerbation of heart failure.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

MULTIPLE RESPONSE 1. When a patient is experiencing digoxin toxicity, which clinical situations necessitate the use of digoxin immune Fab? (Select all

that apply.) a. The patient reports seeing colourful halos around lights. b. The patient’s serum potassium level is above 5 mmol/L. c. The patient is experiencing nausea and anorexia. d. The patient’s heart rhythm is atrial flutter with a rate of 115 per minute. e. The patient is experiencing long runs of ventricular tachycardia. f. The patient is experiencing severe sinus bradycardia that does not respond to cardiac pacing. g. The patient has taken an overdose of greater than 10 mg of digoxin. h. The patient reports fatigue and headaches.

ANS: B, E, F, G

Clinical situations that require the use of digoxin immune Fab in a patient with digoxin toxicity include a serum potassium level above 5 mmol/L, long runs of ventricular tachycardia, severe sinus bradycardia that does not respond to cardiac pacing, and an overdose of greater than 10 mg of digoxin. Seeing colourful halos around lights, experiencing nausea and anorexia, and experiencing fatigue and headaches are potential adverse effects of digoxin therapy but are not necessarily reasons for digoxin immune Fab treatment. Digoxin immune Fab is the antidote for severe digoxin overdose and is indicated for the reversal of life-threatening cardiotoxic effects; fatigue and headache are not life-threatening.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

3

Chapter 26: Antidysrhythmic Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. The Vaughan Williams classification categorizes amiodarone as a Class III drug. How does this drug work? a. By blocking slow calcium channels b. By prolonging action potential duration c. By blocking sodium channels and affecting phase 0 d. By decreasing spontaneous depolarization and affecting phase 4 ANS: B

These drugs control dysrhythmias by inhibiting repolarization and by prolonging refractoriness and the action potential duration.

DIF: Cognitive Level: Knowledge 2. Which is an adverse effect associated with the use of procainamide (Procan SR®)? a. Tinnitus b. Shortened QT interval c. Constipation d. Diarrhea ANS: D

Diarrhea is a potential adverse effect of procainamide therapy.

DIF: Cognitive Level: Comprehension 3. Which nursing diagnosis is appropriate for a patient receiving antidysrhythmics? a. Risk for infection b. Risk for injury to self c. Excess fluid volume d. Impaired skin integrity ANS: B

Dizziness, fatigue, and orthostatic hypotension are possible adverse effects that may cause injury and put the patient at risk for falls.

DIF: Cognitive Level: Analysis 4. A patient will be discharged on quinidine sulphate (Apo-Quin-G®) extended-release tablets for the treatment of ventricular ectopy.

What important information should the nurse give the patient about this medication?

The medication should be stopped once the cardiac symptoms subside.

Signs of cinchonism (such as tinnitus, loss of hearing, or slight blurring of vision) may occur. c. Because of increased photosensitivity, sunscreen products should be used when outside. d. Any tablet or capsule visible in the stool indicates an absorption problem and should be reported immediately. a. b.

ANS: B

Quinidine, a cinchona alkaloid, may cause the symptoms of cinchonism. The medication will need to be continued even after symptoms subside, or the symptoms may return. Tablets or capsules that are visible in the stool are actually the wax matrixes; the medication is extracted while in the intestines. Photosensitivity occurs with Class III drugs but not with quinidine, which is a Class Ia drug.

DIF: Cognitive Level: Application 5. What is the drug of choice for acute ventricular dysrhythmias associated with myocardial infarction (MI)? a. diltiazem (Cardizem®) b. metroprolol tartrate (Lopressor®) c. amiodarone hydrochloride (Cordarone®) d. adenosine (Adenocard®) ANS: C

Amiodarone hydrochloride (Cordarone) is the drug of choice for ventricular dysrhythmias according to the Advanced Cardiac Life Support guidelines. Recently, it has shown promise in the management of atrial dysrhythmias that are difficult to treat with other, less toxic drugs. Metroprolol tartrate (Lopressor)is a b-blocker commonly given after an MI to reduce the risk of sudden cardiac death. It is also used in the treatment of hypertension and angina. Adenosine (Adenocard) is indicated for the conversion of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm, and diltiazem is used for treating dysrhythmias and controlling the ventricular response to atrial fibrillation and flutter by slowing conduction and prolonging refractoriness of the atrioventricular node.

DIF: Cognitive Level: Knowledge

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. The nurse needs to administer adenosine (Adenocard) to a patient who is experiencing an acute episode of PSVT. What important

information should the nurse remember when giving this medication?

The onset of action occurs in 5 minutes.

The medication must be given as a slow intravenous (IV) push.

Asystole may occur for a few seconds after administration.

The medication has a long half-life, and the duration of action is very long.

a. b. c. d.

ANS: C

A very brief episode of asystole may occur after administration of adenosine. Adenosine has an extremely short half-life of less than 10 seconds, its onset occurs within 1 minute, and it must be given as a fast IV push medication.

DIF: Cognitive Level: Analysis 7. Which medication can cause a systemic lupus erythematosus–like syndrome in about 30% of patients? a. lidocaine b. procainamide hydrochloride c. atenolol d. propranolol ANS: B

Procainamide hydrochloride (Procan SR®) can cause a systemic lupus erythematosus–like syndrome, which occurs in approximately 30% of patients on long-term therapy.

DIF: Cognitive Level: Comprehension 8. A patient has been started on lidocaine (Xylocaine®). The nurse will monitor the patient for which adverse effect of this drug? a. Drowsiness b. Nystagmus c. Dry mouth d. Convulsions ANS: D

Convulsions are possible with an overdose of lidocaine.

DIF: Cognitive Level: Application 9. What should be monitored closely in a patient who is taking Class IV antidysrhythmics? a. Urine output and specific gravity b. Temperature and skin turgor c. Heart rhythm and blood pressure d. Level of consciousness ANS: C

Patients receiving Class IV antidysrhythmics initially or having their doses altered must have their heart rhythm monitored by electrocardiography. In addition, blood pressure and other vital signs need to be monitored frequently.

DIF: Cognitive Level: Application MULTIPLE RESPONSE 1. Which instructions are appropriate for the nurse to give a patient who is taking an antidysrhythmic drug? (Select all that apply.) a. Do not chew or crush extended-release forms of medication. b. Capsules may be opened if they cannot be swallowed. c. Take the medication with food if gastrointestinal distress occurs. d. If a dose is missed, the missed dose should be taken with the next dose that is due. e. Take the medications with an antacid if gastrointestinal distress occurs. f. Limit or avoid the use of caffeine. g. The presence of a capsule in the stool should be reported to the physician

immediately.

ANS: A, C, F

“Do not chew or crush extended-release forms of medication,” “Take the medication with food if gastrointestinal distress occurs,” and “Limit or avoid the use of caffeine” are appropriate instructions to a patient who is taking an antidysrhythmic drug. Capsules should not be opened, and medications should not be taken with an antacid. What appears to be a portion of a capsule or tablet in the stool is actually the wax matrix that carried the medication, which has been absorbed, and the physician does not need to be notified. Medication doses should not be doubled.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 27: Coagulation Modifier Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A female patient has been prescribed warfarin (Coumadin®) in addition to a heparin infusion. What is the reason for her receiving

two anticoagulants? a. The oral and injection forms work synergistically. b. The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone. c. Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone is unable to do so. d. When oral anticoagulants are prescribed, heparin is often used to initiate therapy until laboratory tests indicate an adequate therapeutic response.

ANS: D

When oral anticoagulants are prescribed, heparin is often also prescribed to initiate therapy until laboratory tests indicate an adequate therapeutic response has been achieved.

DIF: Cognitive Level: Comprehension 2. Which is a true statement about dipyridamole (Persantine®)? a. It has anti-inflammatory and antipyretic properties. b. It has analgesic properties and antithrombotic effects. c. It is useful for reducing the risk of fatal and nonfatal thrombotic stroke. d. It is used as an adjunct to warfarin in the prevention of postoperative

thromboembolic complications.

ANS: D

Dipyridamole is used as an adjunct to warfarin (Coumadin) in the prevention of postoperative thromboembolic complications.

DIF: Cognitive Level: Knowledge 3. What is the most frequent adverse effect of thrombolytic therapy? a. Dysrhythmia b. Nausea and vomiting c. Anaphylactic reactions d. Internal and superficial bleeding ANS: D

Bleeding, both internal and superficial as well as intracranial, are the most frequent adverse effects of thrombolytic therapy.

DIF: Cognitive Level: Comprehension 4. What is the recommended antidote for warfarin (Coumadin) toxicity? a. Vitamin E b. Vitamin K c. Protamine sulphate d. Potassium phosphate ANS: B

High doses of vitamin K given intravenously should reverse the anticoagulation effects of warfarin toxicity.

DIF: Cognitive Level: Application 5. The nurse is administering heparin subcutaneously.

Which instruction for doing this is correct?

Aspirate before injecting.

Massage site after injection.

Apply heat to the injection site.

Use a new, sterile 1.5-cm 25- to 28-gauge needle for the injection.

a. b. c. d.

ANS: D

A new 1.5-cm 25- to 28-gauge needle is used for proper subcutaneous injection and to ensure no residual medication remains on the needle after the medication is withdrawn.

DIF: Cognitive Level: Application 6. Which statement is true for the patient receiving long-term therapy with acetylsalicylic acid (aspirin)? a. Aspirin should be taken on an empty stomach to ensure maximal absorption. b. Bleeding tendencies are not of much concern to those taking Aspirin therapy. c. Laboratory studies should be done to monitor liver, and clotting functions. d. Development of a rash is expected and does not warrant discontinuing the

medication.

ANS: C

Aspirin can alter liver and clotting functions. Laboratory studies should be performed to monitor these functions.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. A male patient will be receiving Tissue plasminogen activator (t-PA) as part of the treatment of acute myocardial infarction. He

asks why he is being prescribed this drug. The nurse’s best response is to tell him that the drug is being prescribed to relieve chest pain. prevent further clot formation. dissolve the clot in his coronary artery. control bleeding in the coronary microcirculation.

a. b. c. d.

ANS: C

Tissue plasminogen activator (t-PA,) a thrombolytic drug, dissolves thrombi in the coronary arteries.

DIF: Cognitive Level: Comprehension 8. Which laboratory study is used to monitor the therapeutic effects of heparin? a. Prothrombin time b. Activated partial thromboplastin time (aPTT) c. Vitamin K d. Hematocrit ANS: B

Ongoing aPTT values are used to monitor heparin therapy.

DIF: Cognitive Level: Comprehension 9. A patient has started on anticoagulant drugs. What is the primary goal of this therapy? a. To prevent thrombus formation b. To dissolve an existing thrombus c. To stabilize an existing thrombus d. To prevent the thrombus from becoming an embolus ANS: A

Anticoagulants prevent thrombus formation and do not dissolve an existing thrombus.

DIF: Cognitive Level: Comprehension 10. A patient is taking anticoagulant therapy. Which natural health product should the patient avoid taking? a. Valerian b. Ginkgo c. St. John’s wort d. Saw palmetto ANS: B

Capsicum pepper, feverfew, garlic, ginger, ginkgo, and ginseng are some of the natural health products that have potential interactions with anticoagulants, particularly warfarin (Coumadin).

DIF: Cognitive Level: Comprehension 11. A patient who is taking warfarin (Coumadin) therapy has a headache and wants to take a pain reliever. Which action is

recommended? a. Taking acetylsalicylic acid (Aspirin®) tablets b. Taking ibuprofen (Advil®), a nonsteroidal anti-inflammatory drug (NSAID) c. Taking acetaminophen (Tylenol®) d. Calling the physician’s office an order for an opioid ANS: C

Acetaminophen should be safe for this patient to take in regular doses. High doses of acetaminophen, Aspirin, and NSAIDs may cause an increased anticoagulant effect. However, acetaminophen is safe to take in regular doses occasionally. Taking an opioid for a headache may not be appropriate.

DIF: Cognitive Level: Analysis 12. Which laboratory study is used to monitor the therapeutic effects of warfarin (Coumadin)? a. International normalized ratio b. aPTT c. Vitamin K d. Hematocrit ANS: A

The international normalized ratio is a routine test to evaluate coagulation while patients are on warfarin.

DIF: Cognitive Level: Comprehension 13. Which drug is the recommended antidote for heparin toxicity? a. Vitamin E b. Vitamin K c. Protamine sulphate d. Potassium phosphate ANS: C

Protamine sulphate is the antidote for heparin toxicity. It reverses heparin’s anticoagulant properties.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 28: Antilipemic Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Cholestyramine (Novo-Cholamine®) and colestipol (Colestid®) are most effective in the treatment of which type of

hyperlipoproteinemia? a. Type V b. Mixed c. All types d. Type II ANS: D

Bile acid sequestrants may be used as primary or adjunct drug therapy in the management of type II (both IIa and IIb) hyperlipoproteinemia.

DIF: Cognitive Level: Knowledge 2. A patient is receiving an antilipemic drug. The nurse should tell the patient to do what in regard to this medication? a. Begin a vigorous aerobic exercise program. b. Eat extra servings of raw vegetables and fruit. c. If a once-a-day dosage regimen is used, take the medication in the morning. d. To maximize drug absorption, take the medication 1 hour before meals or 2 hours

after meals.

ANS: B

Extra servings of raw vegetables, bran, and fruits help to prevent constipation, a possible adverse effect of the medication.

DIF: Cognitive Level: Application 3. What should be a patient be told to do to minimize the undesirable adverse effects of nicotinic acid? a. Take the drug on an empty stomach. b. Start off with a high initial dosage. c. Take small doses of Aspirin with the drug. d. Take the drug with large amounts of fibre.

ANS: C

The adverse effects of nicotinic acid can be minimized by taking small doses of Aspirin with the drug to minimize cutaneous flushing. Adverse effects can also be minimized by starting with a low initial dose and gradually increasing the dose and also by taking the drug with meals. “Take the drug with large amounts of fibre” is an incorrect answer.

DIF: Cognitive Level: Application 4. A patient reports that the cholestyramine resin powder (Olestyr®) that was started yesterday clumps and sticks to the glass when

being mixed. What is the nurse’s best suggestion to the patient for mixing this medication for administration? a. Use a carbonated soft drink to dissolve the powder faster. b. Add the powder to any liquid and stir vigorously to dissolve it quickly. c. Mix the powder with food or with 120 to 180 mL of fluid. d. Sprinkle the powder into a spoon and take it dry, followed with a glass of water.

ANS: C

The cholestyramine powder should be mixed thoroughly with food or fluids (at least 120 to 180 mL of fluid). The powder may not mix completely at first, but patients need to be sure to mix the dose as much as possible and then dilute any undissolved portion with additional fluid.

DIF: Cognitive Level: Analysis 5. A patient is taking gemfibrozil to lower her cholesterol level.

Which adverse effect of this medication should the nurse tell the patient about?

Constipation Diarrhea Joint pain Dry mouth

a. b. c. d.

ANS: B

Gemfibrozil may cause abdominal discomfort, diarrhea, drowsiness, and dizziness.

DIF: Cognitive Level: Comprehension 6. Patients who are receiving antilipemic drugs need to be closely monitored for the development of which adverse effect? a. Photosensitivity b. Pulmonary problems c. Vitamin C deficiency d. Liver dysfunction ANS: D

Antilipemic agents may adversely affect liver function; therefore, liver function studies need to be closely monitored.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. Which patient is a likely candidate for drug therapy for cholesterol reduction? a. A female patient with a waist circumference greater than 95 cm and a triglyceride b. c. d.

level greater than or equal to 1.7 mmol/L A male patient with a high-density lipoprotein cholesterol (HDL-C) level greater than 1 mmol/L and blood pressure (BP) greater than 130/85 mm Hg A female patient with an HDL-C level greater than 1.3 mmol/L and BP greater than 130/85 mm Hg A male patient with a waist circumference greater than 102 cm and a triglyceride level of 1.7 mmol/L or higher

ANS: D

A male patient with a waist circumference greater than 102 cm and a triglyceride level greater than or equal to 1.7 mmol/L is the only patient who has the correct criteria for initiating drug therapy.

DIF: Cognitive Level: Analysis 8. Which lipoproteins are indicative of a high risk for developing an atherosclerotic plaque formation? a. Chylomicrons b. Low-density lipoproteins (LDLs) c. High-density lipoproteins (HDLs) d. Very-low-density lipoproteins ANS: B

Elevated LDL levels suggests that an individual has a high potential risk for developing an atherosclerotic plaque formation.

DIF: Cognitive Level: Comprehension 9. A patient who has recently started therapy with a statin drug asks the nurse how long it will take for an effect on his serum

cholesterol to be seen. Which is the nurse’s best response to the patient’s question?

“Blood levels return to normal within a week of beginning therapy.”

“It takes several weeks to see a change in cholesterol levels.”

“It takes at least 6 months to see a change in cholesterol levels.”

“You will need to take this medication for almost a year to see significant results.”

a. b. c. d.

ANS: B

The maximum extent to which lipid levels are lowered may not occur until 6 to 8 weeks after the start of therapy.

DIF: Cognitive Level: Application 10. The nurse should monitor for myopathy (muscle pain) when a patient is taking which class of antilipemic drugs? a. Bile acid sequestrants b. Hydroxymethylglutaryl–coenzyme A (HMG–CoA) reductase inhibitors c. Fibric acid derivatives d. Niacin ANS: B

Myopathy is a clinically important adverse effect that may occur in patients taking HMG–CoA reductase inhibitors. The myopathy may progress to a serious condition known as rhabdomyolysis. Patients receiving statin therapy should be advised to immediately report any unexplained muscular pain or discomfort to their health care providers.

DIF: Cognitive Level: Application 11. A patient is beginning antilipemic therapy with an HMG–CoA reductase inhibitor. What food should the nurse tell the patient about

when discussing possible drug–food interactions? a. Oatmeal b. Grapefruit juice c. Licorice d. Dairy products ANS: B

Taking HMG–CoA reductase inhibitors with grapefruit juice may cause complications.

DIF: Cognitive Level: Comprehension 12. Ezetimibe (Ezetrol®), a newer antilipemic drug, works by doing what? a. Preventing the resorption of bile acids from the small intestines b. Inhibiting HMG–CoA reductase c. Activating lipase, which breaks down cholesterol d. Inhibiting cholesterol absorption in the small intestine ANS: D

Ezetimibe selectively inhibits the absorption of cholesterol and related sterols in the small intestine.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

13. A patient is taking a statin drug. What important action should the nurse tell this patient to take? a. Have a hearing assessment done. b. Report unexpected muscular pain. c. See a physiotherapist. d. Take the medication with breakfast.

ANS: B

Advise patients receiving statin therapy to immediately report to the health care provider (HCP) any unexplained muscular pain or discomfort. When recognized reasonably early, rhabdomyolysis is usually reversible with discontinuation of the statin drug.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. Which are considered positive risk factors for coronary artery disease? (Select all that apply.) a. Male aged 40 years or older b. Female aged 40 years or older c. Family history that includes a sister who died of a myocardial infarction at age 58 d. Family history that includes a brother who died of a myocardial infarction at age e. f. g. h.

40 Current cigarette smoker Slight build Hypertension History of gallbladder disease

ANS: A, D, E, G

Positive risk factors for coronary artery disease (CAD) for which the patient needs to be assessed include the following: (1) male aged 40 years or older or female aged 50 years or older or postmenopausal (Anderson et al., 2013); (2) family history including premature CAD (e.g., myocardial infarction or sudden death of the father or other male first-degree relative before 55 years of age, or the same for the mother or other female first-degree relative before menopause); (3) cigarette smoking; (4) hypertension with BP higher than 140/90 mm Hg or current antihypertensive drug therapy; (5) a low HDL cholesterol level (lower than 1 mmol/L in men and lower than 1.3 mmol/L in women); and (6) diabetes.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

3

Chapter 29: Diuretic Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which is a true statement about carbonic anhydrase inhibitors (CAIs)? a. CAIs induce metabolic alkalosis. b. CAIs can elevate the blood glucose level in diabetic patients. c. CAIs are contraindicated in the presence of glaucoma. d. CAIs are effective as prolonged therapy for seizures.

ANS: B

An adverse effect of the CAIs is that they elevate the blood glucose level and cause glycosuria in patients with diabetes. The CAIs induce metabolic acidosis, are indicated for narrow-angle glaucoma, and their effectiveness for treatment of seizures decreases in a short time.

DIF: Cognitive Level: Comprehension 2. Patients who are placed on spironolactone (Aldactone®) should be assessed continuously for which condition? a. Hypokalemia b. Hyperkalemia c. Hyponatremia d. Hypercalcemia ANS: B

Hyperkalemia may occur with administration of potassium-sparing diuretics.

DIF: Cognitive Level: Comprehension 3. The physician has ordered mannitol (Osmitrol®) for a patient. How should this drug be administered? a. Intravenously, through a filter b. By rapid intravenous (IV) bolus c. 20 to 80 mg orally (PO) daily, in a single morning dose d. By oral or IV route, depending on the severity of the patient’s condition ANS: A

Mannitol should be administered via IV infusion, through a filter. It is not available in an oral form.

DIF: Cognitive Level: Comprehension 4. A patient with a new prescription for furosemide (Lasix®) is being discharged. What should the nurse say to this patient concerning

this new prescription?

“Keep a weekly journal or log of your weight.”

“Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates.” c. “If you experience weight gain, such as 2.3 kg or more a week, be sure to tell your physician during your next routine visit.” d. “Be sure to change your body position slowly and rise slowly after sitting or lying. Making slow movements will prevent dizziness and possible fainting because of blood pressure changes.” a. b.

ANS: D

Orthostatic hypotension is a possible problem with diuretic therapy. A daily log of weight should be kept, foods high in potassium should be eaten more often, and a weight gain of 2.3 kg or more a week should be reported immediately.

DIF: Cognitive Level: Analysis 5. Which statement is true of loop diuretics? a. They are also called aldosterone-inhibiting diuretics. b. They are very potent, providing a diuretic effect that lasts at least 6 hours. c. Because their onset of action is rapid, they are particularly useful when rapid d.

diuresis is desired.

They have the disadvantage of ceasing to be effective when creatinine clearance decreases below 25 mL per minute.

ANS: C

Loop diuretics have a rapid onset of action; therefore, they are useful when rapid onset is desired.

DIF: Cognitive Level: Comprehension 6. The nurse is teaching a patient about using hydrochlorothiazide. The nurse should ensure the patient knows to be cautious when

taking which medication with hydrochlorothiazide? a. digitalis b. Antacids c. Potassium supplements d. Over-the-counter Aspirin preparations ANS: A

Hydrochlorothiazide therapy may lead to hypokalemia, which can put the patient at an increased risk of digitalis toxicity.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. The manifestations of potassium deficiency include which condition? a. Dyspnea b. Diarrhea c. Weakness d. Hypertension ANS: C

Weakness is a manifestation of hypokalemia (low potassium levels).

DIF: Cognitive Level: Comprehension 8. A patient is being discharged home on a single daily dose of a diuretic. So that there will be no unnecessary disruptions to the

patient’s daily routine, the health care provider instructs the patient to take the dose at what time?

In the morning At noon With supper At bedtime

a. b. c. d.

ANS: A

Diuretic medication should be taken early in the morning to prevent urination at nighttime.

DIF: Cognitive Level: Application 9. When a patient is receiving diuretic therapy, what best reflects the patient’s fluid volume status? a. Moisture of mucous membranes b. Serum potassium and sodium levels c. Intake, output, and daily weight d. Abdominal girth and calf circumference ANS: C

Intake, output, and daily weights are the best reflections of a patient’s fluid volume status.

DIF: Cognitive Level: Comprehension 10. A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is to be used initially? a. Loop diuretics b. Osmotic diuretics c. Thiazide diuretics d. Vasodilators ANS: C

The Canadian Hypertension Education Program recommends diuretics, especially the thiazides, as one option for first-line drug treatment of hypertension.

DIF: Cognitive Level: Application 11. A patient in the neurological Critical Care Unit is being treated for cerebral edema. Which drug is the patient likely to be given to

reduce intracranial pressure? a. A loop diuretic b. An osmotic diuretic c. A thiazide diuretic d. A vasodilator ANS: B

Mannitol (Osmitrol®), an osmotic diuretic, is used to reduce intracranial pressure and cerebral edema resulting from head trauma.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency. Which

symptoms are indicative of potassium deficiency? (Select all that apply.)

Dyspnea Constipation Anorexia Tinnitus Muscle weakness Palpitations Mental confusion Lethargy

a. b. c. d. e. f. g. h.

ANS: C, E, G, H

Symptoms of hypokalemia include anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 30: Fluids and Electrolytes Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which blood product is indicated to increase clotting factor levels in patients with a demonstrated deficiency? a. Cryoprecipitate b. Fresh frozen plasma c. Packed red blood cells d. Plasma protein fractions ANS: B

Fresh frozen plasma is indicated to increase clotting factor levels in patients with a demonstrated deficiency.

DIF: Cognitive Level: Knowledge 2. Potassium supplements are contraindicated in patients with a history of which condition? a. Burns b. Diarrhea c. Kidney disease d. Cardiac tachydysrhythmias ANS: C

Potassium supplements are contraindicated in the presence of severe kidney disease. Patients with hypokalemia due to burns or diarrhea and patients with cardiac tachydysrhythmias may be treated with potassium supplements. Potassium supplements are contraindicated in patients with severe kidney disease.

DIF: Cognitive Level: Comprehension 3. During a blood transfusion, a patient begins to report chills and back pain. Which action is appropriate for the nurse to take? a. Observe for other symptoms. b. Slow the infusion rate and monitor vital signs. c. Discontinue the infusion immediately and notify the physician. d. Tell the patient that the symptoms are a normal reaction to the blood product.

ANS: C

Because of the possibility of a transfusion reaction, the infusion should be discontinued immediately and the physician notified.

DIF: Cognitive Level: Application 4. Which is a true statement about the administration of potassium? a. The intravenous rate should not exceed 30 mmol/hr. b. Oral forms should be given on an empty stomach to maximize absorption. c. The concentration of potassium in intravenous solutions should not exceed 60 d.

mmol/L. When given intravenously, potassium must always be given in diluted form.

ANS: D

Intravenous potassium must always be given in a diluted form and administered slowly. Intravenous (IV) bolus or undiluted forms may cause cardiac arrest. IV rates are not to exceed 20 mmol/hr. The generally accepted maximum concentration for peripheral infusion is 20 to 40 mmoL/L. Oral forms should be mixed with juice or water or taken according to instructions.

DIF: Cognitive Level: Comprehension 5. A patient is being treated for mild hyponatremia after spending a long day doing gardening work in the heat of the day. What is the

most appropriate method with which to treat her condition? a. Oral supplementation of fluids b. IV bolus of lactated Ringer’s solution c. Normal saline infusion, administered slowly d. Oral administration of sodium chloride tablets ANS: D

Mild hyponatremia is usually treated with the oral administration of sodium chloride tablets. Pronounced sodium depletion is treated with intravenous normal saline or lactated Ringer’s solution. Oral supplementation with fluids such as water would lower the sodium level and worsen the hyponatremia.

DIF: Cognitive Level: Application 6. Which is a symptom of early hypokalemia? a. Seizures b. Paralytic ileus c. Stomach cramps d. Muscle weakness ANS: D

Muscle weakness is an early symptom of hypokalemia. Late symptoms of hypokalemia include cardiac irregularities, neuropathies, and paralytic ileus. Seizures and stomach cramps are not symptoms of hypokalemia.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. During the infusion of albumin, the nurse should monitor the patient for the development of which event? a. Hypernatremia b. Fluid volume deficit c. Fluid volume excess d. Transfusion reaction ANS: C

During the infusion of albumin, the nurse should monitor for the development of fluid volume excess.

DIF: Cognitive Level: Application 8. A patient requires transfusion with fresh frozen plasma (FFP). What condition is noted on the patient’s medical record? a. Hypovolemic shock b. Anemia c. Coagulation disorder d. Previous transfusion reaction ANS: C

FFP is used as an adjunct to massive blood transfusion in the treatment of patients with underlying coagulation disorders.

DIF: Cognitive Level: Comprehension 9. The nurse is planning to transfuse a patient with a unit of packed red blood cells (PRBCs).

Which is the only solution with which PRBCs can be administered? a. 5% dextrose in water b. 0.9% sodium chloride c. 5% dextrose in 0.9% sodium chloride d. 5% dextrose in lactated Ringer’s solution ANS: B

Blood products should be given only with 0.9% sodium chloride. A solution of 5% dextrose in water will cause hemolysis of the blood product.

DIF: Cognitive Level: Application 10. The nurse is planning to transfuse a patient with a unit of PRBCs. Which patient is most likely to be treated with this transfusion? a. A patient with a coagulation disorder b. A patient with severe anemia c. A patient who has lost a massive amount of blood after emergency surgery d. A patient who has a clotting factor deficiency ANS: B

PRBCs are given to increase oxygen-carrying capacity in patients with anemia, in patients with substantial hemoglobin deficits, and in patients who have lost up to 25% of their total blood volume. A patient with a coagulation disorder and a patient with a clotting factor deficiency would receive fresh frozen plasma. A patient who has lost a massive amount of blood after emergency surgery would receive whole blood.

DIF: Cognitive Level: Analysis MATCHING

The nurse must monitor the fluid status of each patient. For each of the symptoms listed below, specify whether it is a symptom of hyponatremia (HYPO) or hypernatremia (HYPER). a. HYPO b. HYPER 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

Hypotension Increased thirst Decreased urination Lethargy Dry, sticky mucous membranes Diarrhea Red, flushed skin Stomach cramps Seizures Increased temperature Vomiting

1. ANS: A 2. ANS: B 3. ANS: B 4. ANS: A 5. ANS: B 6. ANS: A 7. ANS: B 8. ANS: A 9. ANS: A 10. ANS: B 11. ANS: A

DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF: DIF:

Cognitive Level: Analysis Cognitive Level: Analysis Cognitive Level: Analysis Cognitive Level: Analysis Cognitive Level: Analysis Cognitive Level: Analysis Cognitive Level: Analysis Cognitive Level: Analysis Cognitive Level: Analysis Cognitive Level: Analysis Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 31: Pituitary Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. The nurse is teaching a patient how to administer desmopressin 10 mcg intranasal. The nurse instructs the patient to press the spray

pump how many times to deliver a 10-mcg dose? a. Once b. Twice c. Five times d. Ten times ANS: A

The spray pump for desmopressin delivers a 10-mcg dose of the drug each time it is pressed.

DIF: Cognitive Level: Application 2. A 16-year-old boy who is taking somatropin (Humatrope®) has a growth on the back of his hand. When the nurse asks him about it,

he says that he has had it several weeks, but it has recently started to get bigger. What should be the next intervention?

The growth should be tested.

The somatropin dosage should be increased.

The somatropin should be stopped immediately.

The growth should be documented and monitored for changes.

a. b. c. d.

ANS: C

Somatropin should not be used in any patient showing evidence of an active tumour.

DIF: Cognitive Level: Analysis 3. A patient is taking desmopressin (DDAVP®) nasal spray. What important information should the nurse tell the patient about this

nasal spray? a. The spray should not be inhaled. b. Inhale deeply after each spray is administered. c. The spray should be taken only if symptoms are present. d. Nasal passages should be cleared after the spray is administered.

ANS: A

The spray should not be inhaled. The nasal spray should be used according to the instructions and only after the patient’s nasal passages have been cleared.

DIF: Cognitive Level: Application 4. A patient is receiving vasopressin (Pressyn®). Which therapeutic response should the nurse expect to see? a. Improved appetite b. Increased serum albumin levels c. Increased serum potassium levels d. Decreased urinary output ANS: D

Decreased severe thirst and decreased urinary output are the expected therapeutic responses.

DIF: Cognitive Level: Application 5. A patient is taking desmopressin. What important information should the nurse give the patient about this drug therapy? a. It cannot be taken while the patient is taking a glucocorticoid. b. It has an enhanced effect if taken with lithium carbonate. c. It has a reduced effect if taken with carbamazepine. d. The patient should avoid consuming alcohol during therapy.

ANS: D

Alcohol should not be consumed during therapy. A glucocorticoid will not interact with desmopressin. Carbamazepine causes an enhanced effect, and lithium carbonate causes a reduced effect.

DIF: Cognitive Level: Analysis 6. An 8-year-old girl has been diagnosed with true pituitary dwarfism. She is being treated with somatropin (Humatrope).

Which change is an expected outcome of using somatropin?

An increase in growth Decreased urinary output Increased muscle strength An increase in height when she reaches puberty

a. b. c. d.

ANS: A

Growth hormone causes an immediate increase in growth.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. Which drug is contraindicated with desmopressin (DDAVP)? a. acetylsalicylic acid (Aspirin) b. digoxin (Lanoxin®) c. lithium d. penicillin ANS: C

Lithium may cause a decreased therapeutic effect of desmopressin.

DIF: Cognitive Level: Knowledge 8. What is cosyntropin (Cortrosyn®) used to diagnosis? a. Adrenocortical insufficiency b. Myasthenia gravis c. Diabetes insipidus d. Scleroderma ANS: A

Cosyntropin is used to diagnose adrenocortical insufficiency.

DIF: Cognitive Level: Comprehension 9. Which are common adverse effects of desmopressin (DDAVP)? a. Uterine cramping and constipation b. Increased blood pressure and nausea c. Headache and chills d. Sweating and low blood pressure ANS: B

Increased blood pressure and nausea are common adverse effects of desmopressin.

DIF: Cognitive Level: Comprehension 10. Which hormone is secreted by the posterior pituitary gland? a. Growth hormone b. Follicle-stimulating hormone c. Antidiuretic hormone d. Prolactin ANS: C

The posterior pituitary gland secretes antidiuretic hormone and oxytocin. Growth hormone, follicle-stimulating hormone, and prolactin are secreted by the anterior pituitary gland.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. A patient is about to receive a dose of octreotide (Sandostatin®).

Which contraindications or cautions should the nurse assess for? (Select all that apply.)

Carcinoid crisis Diarrhea Diabetes with insulin orders Chronic renal failure Orders for oral hypoglycemic drugs Flushing

a. b. c. d. e. f.

ANS: C, D, E

Octreotide should be used with caution in patients with diabetes or chronic renal failure and patients taking insulin or oral hypoglycemic drugs. Carcinoid crisis, diarrhea, and flushing are indications for octreotide.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 32: Thyroid and Antithyroid Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient newly diagnosed with hypothyroidism received a prescription for a thyroid drug. In addition to assessing for

hypersensitivity and myocardial infarction, for what should the nurse also assess before administering the thyroid drug? a. Infections b. Diabetes mellitus c. Lupus erythematosus d. Adrenal insufficiency ANS: D

Adrenal insufficiency is a contraindication to the administration of thyroid drugs.

DIF: Cognitive Level: Comprehension 2. A patient with hypothyroidism is given a prescription for levothyroxine (Synthroid®). When the nurse explains that levothyroxine

is a synthetic form of the thyroid hormone, the patient states that a more natural form of drug would be personally preferred. What is the nurse’s best explanation to the patient for the use of levothyroxine? a. The synthetic form has a stronger effect than the natural forms. b. Levothyroxine is less expensive than the natural forms. c. The oral form has fewer adverse effects on the gastrointestinal tract. d. Because the half-life of levothyroxine is longer than that of the natural forms, once-a-day dosing is possible.

ANS: D

An advantage of levothyroxine over the natural forms is that it needs to be administered only once a day because of its long half-life. As well, its effects are more predictable than those of natural thyroid preparations.

DIF: Cognitive Level: Analysis 3. The nurse is discussing thyroid replacement therapy and establishing treatment goals with a patient. What important adverse effects

should the nurse discuss with the patient?

Edema, anemia, and hepatitis Pruritus, myalgia, leukopenia, and paresthesia Tachycardia, dysrhythmias, weight loss, and fever Skin pigment changes, bleeding, and menstrual irregularities

a. b. c. d.

ANS: C

Some of the more serious adverse effects of thyroid drugs are tachycardia, dysrhythmias, weight loss, and fever.

DIF: Cognitive Level: Analysis 4. When teaching a patient on antithyroid medication about diet, which direction should be included? a. Use iodized salt when cooking. b. Avoid foods containing iodine. c. Increase fluid intake to 2 500 mL per day. d. Increase intake of sodium- and potassium-containing foods.

ANS: B

Clients on antithyroid therapy should avoid iodine-containing foods.

DIF: Cognitive Level: Application 5. A patient is taking propylthiouracil for hyperthyroidism and asks the nurse how this medication works.

In answer to the patient’s question, the nurse tells the patient that propylthiouracil Blocks the action of thyroid hormone Impedes the formation of thyroid hormone Destroys overactive cells in the thyroid gland Inactivates already existing thyroid hormone in the bloodstream

a. b. c. d.

ANS: B

Propylthiouracil impedes the formation of thyroid hormone but has no effect on already existing thyroid hormone.

DIF: Cognitive Level: Comprehension 6. A patient has been diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid®).

After 1 week, the patient tells the nurse that she feels no better. The nurse would best tell the patient that she will probably require surgery for a cure. levothyroxine does not reach its peak effect for several months. she probably did not take her medication as instructed. her diet may be causing absorption problems.

a. b. c. d.

ANS: B

The therapeutic effects of thyroid drugs may take several months to occur. Patients taking thyroid drugs should be aware of this fact.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. Which drugs should be avoided while taking thyroid replacement preparations? a. Vitamin supplements b. Antibiotics c. Anticoagulants d. -Blockers ANS: C

Drugs that interact with thyroid replacement preparations include anticoagulants, cholestyramine, hypoglycemic drugs, and digoxin.

DIF: Cognitive Level: Knowledge 8. Which symptoms indicate a too-high dose of thyroid replacement hormone? a. Bradycardia, somnolence, and ataxia b. Anxiety, weight loss, and insomnia c. Dry skin, weakness, and weight gain d. Drowsiness, coughing, and neck pain ANS: B

The adverse effects of thyroid medications are usually the result of overdose. Anxiety, weight loss, and insomnia are a few of the more common adverse effects.

DIF: Cognitive Level: Application 9. Which condition may be caused by low levels of thyroid hormone in youth? a. Goiter b. Myxedema c. Cretinism d. Addison’s disease ANS: C

Hyposecretion of thyroid hormone during youth may lead to cretinism.

DIF: Cognitive Level: Comprehension 10. A patient has been taking levothyroxine (Synthroid) for more than a decade for primary hypothyroidism. She tells the nurse that her

cousin can get her the same medication in a generic form from a pharmaceutical supply company. What would be best for the nurse to say to the patient? a. “That would be a great way to save money.” b. “There’s no difference in brands of this medication.” c. “Switching the form of medication should never be done; once you start with a certain brand, you must stay with it.” d. “It’s better not to switch brands until we check with your doctor.”

ANS: D

Switching between different brands of levothyroxine during treatment can destabilize the course of treatment and should be minimized. If a switch is made, the patient should be closely monitored.

DIF: Cognitive Level: Analysis 11. A patient has been diagnosed with primary hypothyroidism.

Which statement accurately describes this condition? a. The hypothalamus is not secreting thyrotropin-releasing hormone; therefore, thyroid-stimulating hormone (TSH) is not released from the pituitary gland. b. The pituitary gland is dysfunctional and is not secreting TSH. c. The abnormality is in the thyroid gland itself. d. The abnormality is caused by an excess intake of iodine.

ANS: C

Primary hypothyroidism stems from an abnormality in the thyroid gland itself and occurs when the thyroid gland is not able to perform one of its many functions.

DIF: Cognitive Level: Comprehension 12. Which are the two thyroid hormones produced by the thyroid gland? a. Di-iodothyronine (T2) and tri-iodothyronine (T3) b. Thyroxine and tri-iodothyronine c. Levothyroxine and thyroxine d. Thyronine and liothyronine ANS: B

Thyroxine (T4) and tri-iodothyronine (T3) are the two hormones produced by the thyroid gland.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

SHORT ANSWER 1. The nurse is giving morning medications. The medication administration record has an order for levothyroxine 75 mcg. The drug

dispensing cabinet contains levothyroxine tablets in milligrams, not in micrograms. Calculate the milligram equivalent dose of 75 micrograms.

ANS:

0.075 mg There are 1 000 micrograms in 1 milligram.

75 mcg 1000 mcg = x = 0.075 mg x mg 1 mg DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

3

Chapter 33: Antidiabetic Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which is a true statement about Humulin-N® insulin? a. It is a long-acting insulin. b. It is a rapid-acting insulin. c. It is an intermediate-acting insulin. d. It is given based on blood glucose levels measured before meals.

ANS: C

Humulin-N insulin is an intermediate-acting insulin.

DIF: Cognitive Level: Knowledge 2. What early signs of hypoglycemia should the nurse should tell the patient about? a. Urticaria and rash b. Nausea and diarrhea c. Irritability and confusion d. Fruity, acetone odour to the breath ANS: C

Irritability and confusion are early signs of hypoglycemia.

DIF: Cognitive Level: Application 3. A patient has just been prescribed insulin.

What should the nurse tell this patient to do to take the insulin correctly? a. Use the injection site that is the most accessible. b. During times of illness, increase insulin dosage by 25%. c. When mixing insulins, draw the cloudy insulin (such as neutral protamine Hagedorn [NPH] insulin) up into the syringe first. d. When mixing insulins, draw the clear insulin (such as regular insulin) up into the syringe first.

ANS: D

When mixing insulins, the regular insulin should always be drawn up into the syringe first. Patients taking insulin should always rotate the injection sites and should notify their physician if they become ill.

DIF: Cognitive Level: Application 4. Which is a true statement regarding acarbose, a glucose-elevating drug? a. It is also naturally synthesized by the pancreas. b. It is used for the treatment of hypotensive emergencies. c. It is only available as an -glucosidase inhibitor. d. It stimulates insulin release from the pancreas.

ANS: C

Acarbose (Glucobay®) is the only available -glucosidase inhibitor. Acarbose works by blunting the elevation of blood glucose levels after a meal.

DIF: Cognitive Level: Comprehension 5. A 75-year-old patient with type 2 diabetes mellitus has recently been placed on glyburide (DiaBeta®) 10 mg daily. When is the best

time to take this medication?

At night With breakfast After the midday meal Any time of day

a. b. c. d.

ANS: B

The medication should be taken in the morning with breakfast to prevent hypoglycemia at night.

DIF: Cognitive Level: Application 6. A patient who has type 2 diabetes is scheduled for a laparoscopy and has been NPO (nil per os [taking nothing by mouth]) since

midnight. The patient is concerned about having to hold the medication. What is the best action for the nurse to take regarding the administration of the patient’s oral antidiabetic drug? a. Give the patient half the original dose. b. Hold all medications as ordered. c. Contact the physician for further orders. d. Give the patient the medication with a sip of water.

ANS: C

When a patient with diabetes is NPO, the physician should be contacted for further orders regarding the administration of the oral antidiabetic drugs.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. A patient with type 2 diabetes self-administers insulin injections as part of therapy. What should the nurse tell this patient to do if

she has hypoglycemia?

Call the physician.

Administer regular insulin.

Take an oral form of glucose.

Rest until the symptoms pass.

a. b. c. d.

ANS: C

Hypoglycemia can be reversed if the patient uses glucagon. The patient can take glucose tablets (liquid or gel), corn syrup, or honey; drink fruit juice or a nondiet soft drink; or eat a small snack, such as crackers or half a sandwich.

DIF: Cognitive Level: Application 8. The nurse is teaching a patient about self-injection of insulin.

What should the nurse tell the patient to do regarding injection sites?

Avoid the abdomen because absorption is irregular.

Choose a different site at random for each injection.

Give the injection in the same area each time to promote consistent absorption.

Rotate sites within the same location for about 1 week before rotating to a new location.

a. b. c. d.

ANS: D

Patients taking insulin injections should be instructed to rotate sites within the same location for about 1 week. That is, all injections should be rotated in one area, such as the right arm, for about 1 week before rotating to a new location, such as the left arm, the following week. Each injection should be at least 1.25 to 2.5 cm away from the previous site.

DIF: Cognitive Level: Analysis 9. A patient has been prescribed a rapid-acting insulin, such as insulin lispro. What important information should the nurse give this

patient about taking this type of insulin? a. It should be taken within 15 minutes of beginning a meal. b. It should be taken after the meal. c. Dosing is once daily at the midday meal. d. It is taken only in the evenings with a snack before bedtime.

ANS: A

Rapid-acting insulins such as insulin lispro and insulin aspart are able to more closely mimic the body’s natural rapid insulin output after a meal. For this reason, both are usually dosed within 15 minutes of beginning a meal.

DIF: Cognitive Level: Application 10. Six months after starting treatment for type 2 diabetes, a patient has a follow-up examination. Which laboratory test will best reflect

the patient’s adherence to the antidiabetic therapy over the past few months? a. Hemoglobin and hematocrit levels b. Hemoglobin A1c level c. Fingerstick fasting blood glucose d. Serum insulin levels ANS: B

The hemoglobin A1c level reflects the patient’s adherence to the therapy regimen for several months previously, thus evaluating the patient’s progress with diet and drug therapy.

DIF: Cognitive Level: Application 11. A patient with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes has been treated for pneumonia for

the past week. He has been receiving corticosteroids intravenously and antibiotics as part of his therapy. His pneumonia has resolved, but when the nurse monitors his blood glucose levels, his blood glucose is still elevated and he requires small amounts of sliding scale insulin coverage. What is the best explanation for this elevation? a. The antibiotics may have caused an increase in glucose levels. b. The corticosteroids may have caused an increase in glucose levels. c. His type 2 diabetes has converted to type 1 diabetes. d. The hypoxia from the COPD has caused an increased need for insulin.

ANS: B

Corticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels.

DIF: Cognitive Level: Analysis 12. When should the nurse administer acarbose (Glucobay), an -glucosidase inhibitor? a. Thirty minutes before breakfast b. With the first bite of each main meal c. Thirty minutes after breakfast d. Once daily, at bedtime ANS: B

When an -glucosidase inhibitor is taken with the first bite of a meal, excessive postprandial blood glucose elevation (a glucose “spike”) can be reduced or prevented.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

13. A 48-year-old male patient is diagnosed with metabolic syndrome and is started on biguanide metformin (Glucophage®). He asks

the nurse why he needs this drug. The nurse’s best explanation of the purpose of the metformin is that it increases the pancreatic secretion of insulin. decreases glucose production by the liver. increases intestinal absorption of glucose. decreases the pancreatic secretion of insulin.

a. b. c. d.

ANS: B

Metformin works by decreasing glucose production by the liver. It may also decrease intestinal absorption of glucose and improve insulin receptor sensitivity. This results in increased peripheral glucose uptake and use and in decreased liver production of triglycerides and cholesterol.

DIF: Cognitive Level: Comprehension 14. When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa

drugs. The patient has an order for sulfonylurea gliclazide (Diamicron®). What is the best action for the nurse to take? a. Give the drug as ordered 30 minutes before breakfast. b. Hold the drug, and check the order with the physician. c. Give the drug and monitor for adverse effects. d. Give a reduced dose of the drug with breakfast.

ANS: B

There is an increased risk of cross-allergy when a patient who is allergic to sulfa drugs takes a sulfonylurea drug for diabetes.

Therefore, the drug should be held and the order checked with the physician.

DIF: Cognitive Level: Analysis 15. Which types of insulin can be administered intravenously? a. Regular insulin b. NPH insulin c. insulin glargine (Lantus®) d. insulin detemir (Levemir®) ANS: A

Regular insulin is the only insulin product that can be administered intravenously.

DIF: Cognitive Level: Comprehension MATCHING

For each insulin product listed below, identify the type of action by using these designations: Rapid-acting: RA Short-acting: SA Intermediate-acting: IA Long-acting: LA

a. b. c. d.

1.

2.

3.

4.

Glargine insulin Aspart insulin Regular insulin NPH insulin

1. ANS: 2. ANS: 3. ANS: 4. ANS:

D A B C

DIF: DIF: DIF: DIF:

Cognitive Level: Application Cognitive Level: Application Cognitive Level: Application Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

3

Chapter 34: Adrenal Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which is a true statement about prednisone (Winpred®)? a. It is a short-acting glucocorticoid. b. It has potent mineralocorticoid activity. c. It is the preferred oral glucocorticoid for anti-inflammatory purposes. d. It may be administered by inhalation for the treatment of bronchial asthma.

ANS: C

Prednisone is the preferred oral glucocorticoid for anti-inflammatory purposes and is intermediate acting.

DIF: Cognitive Level: Knowledge 2. What important information about taking adrenal drugs is appropriate for the nurse to give a patient? a. To maximize their absorption, oral drugs should be taken before meals. b. The patient should rinse the oral cavity after using the steroid inhalers. c. Corticosteroids should be taken before bedtime to minimize adrenal suppression. d. The medication is to be immediately discontinued if a weight gain of more than

2.25 kg occurs in 1 week.

ANS: B

After using the steroid inhalers, rinsing the oral cavity helps to prevent oral fungal infections from developing. Adrenal drugs should be taken with meals in order to minimize gastrointestinal upset and in the morning to minimize adrenal suppression. Adrenal drugs should be discontinued by weaning, not by stopping abruptly.

DIF: Cognitive Level: Application 3. Which type of drugs can have an adverse interaction with corticosteroids? a. Nonsteroidal anti-inflammatory drugs (NSAIDs) b. Antibiotics c. Narcotic analgesics d. Oral anticoagulants ANS: A

The use of corticosteroids with NSAIDs produces adverse gastrointestinal effects.

DIF: Cognitive Level: Comprehension 4. A patient is concerned about the body changes that have resulted from long-term prednisone (Winpred®) therapy for the treatment

of lupus erythematosus. Which effect of this drug therapy supports the nursing diagnosis of disturbed body image? a. Weight loss b. Weight gain c. Pale skin colour d. Loss of hair ANS: B

Facial erythema, weight gain, hirsutism, and “moon face” (characteristic of Cushing’s syndrome) are body changes that may occur with long-term prednisone therapy.

DIF: Cognitive Level: Analysis 5. A patient is taking fludrocortisone (Florinef®) for Addison’s disease. His wife is concerned about all the problems that may occur

with this therapy.

Which is a true statement about fludrocortisone therapy? a. It may cause severe postural hypotension. b. To minimize gastrointestinal upset, the medication should be taken with food or milk. c. The medication should be stopped immediately if nausea or vomiting occurs. d. Weight gain of 2.3 kg or more in 1 week is an expected adverse effect.

ANS: B

To minimize gastrointestinal upset, patients receiving fludrocortisone should take it with food or milk. Hypotension is a sign and symptom of Addison’s disease or adrenal insufficiency; it will not result from taking fludrocortisone. Weight gain of more than 1 kg in 24 hours or 2.3 kg in 1 week should be reported to the physician. Abrupt withdrawal is not recommended, because it may precipitate an adrenal crisis.

DIF: Cognitive Level: Application 6. What may be caused by systemically administered glucocorticoids? a. Dehydration b. Hypokalemia c. Hyperkalemia d. Hypoglycemia ANS: C

Systemic glucocorticoid drugs may cause hyperkalemia.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. Which are the expected symptoms of undersecretion of adrenocortical hormones? a. Osteoporosis b. Steroid psychosis c. Dehydration and weight loss d. Water retention ANS: C

Dehydration and weight loss are associated with undersecretion of adrenocortical hormones (Addison’s disease).

DIF: Cognitive Level: Comprehension 8. Which are contraindications to the administration of glucocorticoid drugs? a. Glaucoma and mental health illnesses b. Peptic ulcer disease and dizziness c. Varicella and headaches d. Cataracts and nausea ANS: A

Contraindications to the administration of glucocorticoids include glaucoma, mental health illnesses, drug allergies, cataracts, peptic ulcer disease, and diabetes; glucocorticoids can intensify these diseases and conditions. These drugs are also often avoided in cases of infection.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. Which are indications for glucocorticoid drugs? (Select all that apply.) a. Glaucoma b. Cerebral edema c. Chronic obstructive pulmonary disease and asthma d. Organ transplantation e. Varicella f. Spinal cord injury g. Septicemia h. Rhinitis ANS: B, C, D, F, H

Cerebral edema, chronic obstructive pulmonary disease and asthma, organ transplantation, spinal cord injury, and rhinitis are indications for glucocorticoid therapy. Glaucoma, varicella, and septicemia are contraindications to glucocorticoid therapy.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 35: Women’s Health Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient is to receive estrogen replacement therapy.

Which orders for taking this medication should the nurse give the patient? a. Double up on the medication if a dose is missed. b. Do not be concerned about breast lumps or bumps that occur. c. Report any weight gain of more than 1 kg in a 24-hour period. d. Take the medication on an empty stomach to enhance absorption.

ANS: C

When a patient is taking oral estrogen therapy, a weight gain of more than 1 kg in a 24-hour period should be reported to the physician. The statements “Double up on the medication if a dose is missed,” “Do not be concerned about breast lumps or bumps that occur,” and “Take the medication on an empty stomach to enhance absorption” are not true for estrogen replacement therapy.

DIF: Cognitive Level: Application 2. For which patients is the use of the estrogens contraindicated? a. A patient who has atrophic vaginitis b. A patient who has inoperable prostate cancer c. A patient who has just given birth d. A patient who has just been diagnosed with breast cancer ANS: D

Estrogenic drugs are contraindicated in a patient who has breast cancer.

DIF: Cognitive Level: Comprehension 3. Which drug is used to treat secondary amenorrhea and endometrial cancer? a. oxytocin b. estradiol transdermal c. raloxifene d. medroxyprogesterone ANS: D

Medroxyprogesterone, a progestin, is one of the most commonly used drugs to treat secondary amenorrhea, endometrial cancer, and uterine bleeding.

DIF: Cognitive Level: Knowledge 4. A 48-year-old female patient has been started on estrogen hormone therapy after experiencing the symptoms of menopause.

Which condition is a contraindication to the administration of estrogen drugs for this patient?

Osteoporosis Uterine bleeding Thrombophlebitis Atrophic vaginitis

a. b. c. d.

ANS: C

The most serious adverse effects of the estrogens are thromboembolic events; therefore, thrombophlebitis is a contraindication to the use of estrogens. Osteoporosis, uterine bleeding, and atrophic vaginitis are indications for the use of estrogen.

DIF: Cognitive Level: Application 5. Which adverse effect may be experienced by patients receiving fertility drugs, such as clomiphene? a. Dizziness b. Drowsiness c. Dysmenorrhea d. Increased appetite ANS: A

Dizziness is one of the possible adverse effects of fertility drugs.

DIF: Cognitive Level: Analysis 6. A patient is receiving oxytocin to induce labour. During administration of this medication, which is an appropriate nursing

measure?

Giving magnesium sulphate along with the oxytocin Administering the medication in an intravenous (IV) bolus Administering the medication with an IV infusion pump Monitoring fetal heart rate and maternal vital signs every 4 hours

a. b. c. d.

ANS: C

Oxytocin is infused via an infusion pump, not via IV bolus. Magnesium sulphate should be kept at the bedside for emergency use, and fetal heart rate and maternal vital signs should be monitored frequently.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. What is an effect of a tocolytic drug? a. Uterine relaxation b. Uterine stimulation c. Ovulation stimulation d. Ovulation suppression ANS: A

Tocolytics relax uterine smooth muscles and stop the uterus from contracting.

DIF: Cognitive Level: Comprehension 8. A 51-year-old female will be starting raloxifene as part of treatment of postmenopausal osteoporosis. The nurse should inform this

patient about which possible occurrence?

Pregnancy Breast cancer Stress fractures Venous thromboembolism

a. b. c. d.

ANS: D

Selective estrogen receptor modulators (SERMs), such as raloxifene, increase the risk of venous thromboembolism.

DIF: Cognitive Level: Application 9. A patient who is on estrogen therapy should be counselled that smoking may cause what? a. An increased incidence of nausea b. An increased tendency to bleed during menstruation c. Increased levels of triglycerides d. An increased risk for thrombosis ANS: D

Smoking should be avoided during estrogen therapy, because it adds to the risk for thrombosis formation.

DIF: Cognitive Level: Application 10. Which type of contraceptive drug most closely duplicates the normal hormonal levels of the female menstrual cycle? a. Monophasic b. Biphasic c. Triphasic d. Long-acting ANS: C

Triphasic oral contraceptive products most closely duplicate the normal hormonal levels of the female menstrual cycle.

DIF: Cognitive Level: Comprehension 11. A woman visiting a health centre requests oral contraception. Which laboratory test is most important for the nurse to assess before

the patient begins oral contraception therapy?

Complete blood count Urinalysis Vaginal cultures Pregnancy test

a. b. c. d.

ANS: D

Pregnancy should be ruled out before beginning oral contraceptive therapy because the medications, which are pregnancy category X, can be harmful to the fetus.

DIF: Cognitive Level: Application 12. A patient will be taking bisphosphonate alendronate (Fosamax®). What instruction should the nurse provide to the patient regarding

administration? As instructed by the nurse, when should the patient take this medication? a. In the evening just before bedtime b. In the morning, with an 240-mL glass of water c. With the first bite of the morning meal d. Between meals, on an empty stomach ANS: B

Bisphosphonates must be taken in the morning, with 240 mL of plain water, to prevent esophageal erosion. In addition, the patient must sit upright for 30 minutes.

DIF: Cognitive Level: Application 13. A female patient lives in Toronto and is preparing to take a plane trip to Australia. She has been taking raloxifene, a SERM. Which

instruction is appropriate for this patient? a. Stop taking the drug at least 72 hours before the trip. b. Remember to take this drug with a full glass of water each morning. c. Increase the calcium supplements that are taken with the drug. d. No change in interventions is needed.

ANS: A

The patient taking a SERM should be informed that to prevent the development of a thrombosis, the drug needs to be discontinued 72 hours before and during prolonged immobility.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

14. The nurse is reviewing natural health products that are available for prevention of osteoporosis. Which product is considered for

osteoporosis prevention?

Soy St. John’s wort Ginger Iodized salt

a. b. c. d.

ANS: A

Common uses of soy (glycine max) include reduction of cholesterol level, relief of menopause symptoms (as an alternative to hormonal therapy), and prevention of osteoporosis.

DIF: Cognitive Level: Comprehension 15. A patient who is taking the bisphosphonate alendronate (Fosamax®) has been instructed to lie flat in bed for 2 days after having

plastic surgery. What must the nurse tell the patient at this time?

Continue to take the alendronate with water.

Do not take the alendronate until it is possible to sit up for 30 minutes.

Take the medication with breakfast.

Stop taking the medication 72 hours before surgery.

a. b. c. d.

ANS: B

The nurse must emphasize that the patient should remain upright in either a standing or sitting position for approximately 30 minutes after taking a bisphosphonate, to help prevent esophageal erosion or irritation.

DIF: Cognitive Level: Application 16. The nurse is preparing to administer the contraceptive form of medroxyprogesterone (Depo-Provera®). What route should be

planned? a. Oral b. Intramuscular c. Vaginal d. Transdermal ANS: B

Medroxyprogesterone is a progestin-only injectable contraceptive that is given by the intramuscular route.

DIF: Cognitive Level: Comprehension 17. A couple is being treated for infertility with ovulation-inducing drugs.

The nurse should instruct the couple about the increased likelihood of which?

Severe weight gain Irregular menses Multiple births Alopecia

a. b. c. d.

ANS: C

Multiple births are a possible consequence of treating infertility with ovulation-inducing drugs.

DIF: Cognitive Level: Application MULTIPLE RESPONSE 1. The patient taking an oral contraceptive should be aware of potential drug interactions with which medications? (Select all that

apply.) a. penicillin, an antibiotic b. guaifenesin (Robitussin®), an antitussive c. warfarin (Coumadin®), an anticoagulant d. atenolol (Tenormin®), a b-blocker e. isoniazid (INH), an antituberculosis drug f. ibuprofen (Motrin®), a nonsteroidal anti-inflammatory drug g. theophylline (Theo-Dur®), a bronchodilator h. omeprazole (Prilosec®), a proton pump inhibitor ANS: A, C, D, E, G

Antibiotics and isoniazid have interactions with oral contraceptives. b-Blockers, oral anticoagulants, and theophylline may have reduced effectiveness when taken with oral contraceptives.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

3

Chapter 36: Men’s Health Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which drug is indicated for erectile dysfunction? a. oxandronlone b. tadalafil c. testosterone d. finasteride ANS: B

Medications used for erectile dysfunction include tadalafil, sildenafil citrate, and vardenafil hydrochloride.

DIF: Cognitive Level: Comprehension 2. Which organ may have the most devastating adverse effects from androgenic steroids? a. Heart b. Pancreas c. Liver d. Spleen ANS: C

Although rare, some of the most devastating effects of androgenic steroids occur in the liver, where they cause the formation of blood-filled cavities, a condition known as peliosis of the liver.

DIF: Cognitive Level: Analysis 3. In male patients receiving hormone therapy, which condition may indicate excessive amounts of androgen? a. Priapism b. Tachycardia c. Muscle weakness d. Fluid volume depletion ANS: A

Priapism is a common adverse effect with androgen therapy.

DIF: Cognitive Level: Analysis 4. A patient is receiving finasteride (Proscar®) for treatment of benign prostatic hypertrophy (BPH). Which is a possible adverse effect

of this medication? a. Alopecia b. Urinary retention c. Increased hair growth d. Increased prostate size ANS: C

Finasteride is given to reduce prostate size in men with BPH. It has also been noted that men taking this medication experience increased hair growth.

DIF: Cognitive Level: Comprehension 5. Which male health drug may be prescribed for women with inoperable breast cancer? a. danazol b. sildenafil c. finasteride d. testosterone ANS: D

Testosterone (Androderm®) is a naturally occurring anabolic steroid. It is used for primary and secondary hypogonadism but may also be used to treat oligospermia in men as well as inoperable breast cancer in women.

DIF: Cognitive Level: Knowledge 6. A patient is receiving androgenic anabolic steroids. This patient should be monitored for which serious adverse effect? a. Renal failure b. Peliosis of the liver c. Cirrhosis of the liver d. Heart failure ANS: B

Peliosis of the liver, the formation of blood-filled cavities, is a potential adverse effect of androgenic anabolic steroid therapy and may be life-threatening.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. When administering finasteride (Proscar), which important precaution should the nurse remember? a. It must be taken on an empty stomach. b. It should not be handled by pregnant women. c. It is given by deep intramuscular injection to avoid tissue irritation. d. The patient should be warned that alopecia is a common adverse effect.

ANS: B

Finasteride should not be handled by a pregnant woman due to teratogenic effects. It is taken orally and without regard to meals.

Increased hair growth, not alopecia, is a possible adverse effect.

DIF: Cognitive Level: Application 8. A male patient is requesting a prescription for sildenafil (Viagra®). He should be assessed for the presence of which condition? a. Fluid retention b. Hypogonadism c. The use of nitrates d. Benign prostatic hypertrophy ANS: C

Use of sildenafil lowers blood pressure substantially in patients with pre-existing cardiovascular disease, especially those taking nitrates.

DIF: Cognitive Level: Application 9. A patient has a medication order for finasteride (Proscar). This medication is prescribed for which conditions? a. Acromegaly b. Baldness (in men and women) c. Low sperm counts d. BPH ANS: D

Finasteride is indicated for BPH and male androgenetic alopecia, but is not indicated for use by women with baldness.

DIF: Cognitive Level: Knowledge 10. A patient in the early stage of benign prostatic hypertrophy wants to try natural health products instead of conventional

medications. Which natural health product is often used for this condition? a. Ginkgo b. Saw palmetto c. Ginseng d. Hawthorn ANS: B

Saw palmetto is a natural health product that is often taken to relieve symptoms of enlarged prostate.

DIF: Cognitive Level: Comprehension 11. Which ethnocultural group has the highest rate of prostate cancer in North America? a. Indigenous men b. Asian men c. White men d. Black men ANS: D

Men of African ancestry have the highest rate of prostate cancer. They also have a greater chance of dying from prostate cancer than White men have. Asian men and Indigenous men have lower rates of prostate cancer.

DIF: Cognitive Level: Comprehension 12. What is one of the main reasons that older men are at higher risk when using sildenafil (Viagra)? a. Most older men also use nitrates. b. Older men have better liver function. c. Sildenafil is a highly protein-bound drug. d. A larger dosage is required for older men.

ANS: C

Sildenafil is highly protein bound, which causes it to stay in the body longer and thus create more drug interactions. Older men are at higher risk because they are often taking other medications for additional medical conditions. Liver function starts to decline at age 65 years. Smaller doses are recommended for older men.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

MULTIPLE RESPONSE 1. Which are indications for the use of minoxidil? (Select all that apply.) a. Porphyria b. Male alopecia c. Decreased libido d. Hypertension e. Fibrocystic breast disease f. Female alopecia g. Metastatic breast cancer ANS: B, D, F

Minoxidil indications for use are male alopecia, hypertension, and female alopecia.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

3

Chapter 37: Antihistamines, Decongestants, Antitussives, and Expectorants Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which instruction is correct for a patient taking an antihistamine? a. Eat chocolate bars to ease the discomfort of dry mouth. b. Antihistamines are generally safe to take with over-the-counter (OTC) c. d.

medications.

Take the medication on an empty stomach to maximize absorption of the drug.

Take the medication with food, even though doing so may slightly reduce the absorption of the drug.

ANS: D

Antihistamines should be taken with food to minimize the gastrointestinal upset that can occur, even though doing so slightly reduces the absorption of the drug. The patient can suck on candy or chew gum to ease dry mouth discomfort. OTC medications should not be taken with an antihistamine unless approved by the physician; taking antihistamines with OTC medications may lead to serious drug interactions.

DIF: Cognitive Level: Analysis 2. How does the antitussive dextromethorphan (Benylin DM-E®) work to suppress the cough reflex? a. By causing central nervous system (CNS) depression b. By anaesthetizing the stretch receptors c. Through a direct action on the cough centre d. By decreasing the viscosity of the bronchial secretions ANS: C

Dextromethorphan suppresses the cough reflex through direct action on the cough centre.

DIF: Cognitive Level: Knowledge 3. Which antihistamine is commonly used in the treatment of motion sickness? a. cyproheptadine hydrochloride b. Loratadine (Claritin) c. Reactine® d. Codeine phosphate ANS: A

Cyproheptadine hydrochloride is commonly used in the treatment of motion sickness.

DIF: Cognitive Level: Knowledge 4. During a routine checkup, the patient reports an inability to take the prescribed antihistamine because of one of its most common

adverse effects. The physician prescribes another antihistamine, loratadine (Claritin®). What adverse effect has probably been bothering this patient? a. Diarrhea b. Urticaria c. Drowsiness d. Decreased libido ANS: C

People who take antihistamines chiefly report drowsiness. Loratadine is a unsedating antihistamine which eliminates many of the adverse effects of the older antihistamines, particularly drowsiness.

DIF: Cognitive Level: Comprehension 5. A gardener needs a decongestant because of seasonal allergy problems. Which is a benefit of orally administered decongestants? a. Onset is immediate. b. The effect is more potent. c. Rebound congestion is almost nonexistent. d. The adverse effects of restlessness and nervousness are reduced.

ANS: C

Rebound congestion is almost nonexistent with the use of oral decongestants. Compared with topically applied decongestants, the onset of orally administered decongestants is more delayed, and the effect is less potent. Nervousness is an adverse effect of decongestants.

DIF: Cognitive Level: Comprehension 6. A patient is taking guaifenesin (Balminil®) as part of treatment of influenza. What should the nurse also instruct the patient to do? a. Increase fluids to help loosen and liquefy secretions. b. Report a fever to the doctor if body temperature is above 38.3C. c. Avoid driving a car or operating heavy machinery, because of the drug’s sedating d.

effects.

To retain the effects of the medication for a longer period, avoid coughing.

ANS: A

Increasing fluids helps to loosen and liquefy secretions.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. What systemic effect may occur with the administration of a topically applied adrenergic nasal decongestant? a. Heartburn b. Bradycardia c. Hypotension d. Nervousness ANS: D

If a topically administered adrenergic nasal decongestant is absorbed into the bloodstream, CNS effects such as nervousness may occur; hypertension and palpitations may also occur. Heartburn is not an adverse effect of topically applied adrenergic nasal decongestants.

DIF: Cognitive Level: Application 8. Which drug is most likely to be chosen to aid in the removal of excessive mucus in the respiratory tract? a. guaifenesin b. benzonatate c. codeine d. dextromethorphan ANS: A

Expectorants, such as guaifenesin, work to loosen and thin sputum and bronchial secretions, thereby indirectly diminishing the tendency to cough. Benzonatate, codeine, and dextromethorphan are antitussives (cough suppressants).

DIF: Cognitive Level: Knowledge 9. The nurse knows that an antitussive drug is most appropriate for which patient? a. A patient with pneumonia who has a productive cough b. A patient who has a tracheostomy and thick mucus secretions c. A patient who has had a productive cough for 2 weeks d. A patient who has developed bronchitis 2 days after hernia repair surgery ANS: D

In a patient who has developed bronchitis 2 days after hernia repair surgery, antitussive drugs help to prevent coughing that is considered harmful rather than useful. Coughing is beneficial in a patient with pneumonia who has a productive cough, in a patient who has a tracheostomy and thick mucus secretions, and in a patient who has had a productive cough for 2 weeks.

DIF: Cognitive Level: Analysis 10. A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. What should the nurse tell the patient

in regard to the nasal spray?

Expect the spray’s effects to be delayed for at least 1 week.

Administer as ordered with no increase in frequency.

Continue using the spray until the nasal stuffiness has resolved.

Avoid using the spray if a fever develops.

a. b. c. d.

ANS: B

Counsel patients to use nasal decongestant dosage forms exactly as ordered and with no increase in frequency. Excessive use of decongestant nasal sprays or drops may lead to rebound congestion.

DIF: Cognitive Level: Application 11. Because of many reported adverse events, which groups of children should not be given cough and cold medications? a. Children younger than 2 years of age b. Children younger than 4 years of age c. Children younger than 6 years of age d. Children younger than 8 years of age ANS: C

Children younger than 6 years of age should not be given cough and cold medication. Many adverse events have been reported in regard to these medications and children younger than 6 years of age. Insufficient research has been done into the use of these medications in children.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 38: Respiratory Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient is taking aminophylline intravenously for a severe exacerbation of chronic obstructive pulmonary disease. Which effect

does the nurse expect to note when evaluating for a therapeutic response to the medication? a. Drowsiness b. Increased heart rate c. Increased respiratory rate d. Increased ease of breathing ANS: D

The therapeutic effects of bronchodilating drugs such as xanthine derivatives include increased ease of breathing.

DIF: Cognitive Level: Comprehension 2. Which is an adverse effect associated with the use of xanthine derivatives? a. Diarrhea b. Palpitations c. Bradycardia d. Drowsiness ANS: B

Common adverse effects of xanthine derivatives include palpitations, sinus tachycardia, extrasystole nausea, vomiting, anorexia, and transient increased urination.

DIF: Cognitive Level: Comprehension 3. What is the rationale for using inhaled budesonide (Pulmicort®)? a. It causes bronchodilation. b. It thins bronchial secretions. c. It inhibits the activity of -agonists. d. It provides an anti-inflammatory response.

ANS: D

Inhaled budesonide is administered for its anti-inflammatory effects. Corticosteroids act by stabilizing the membranes that normally release harmful bronchoconstricting substances.

DIF: Cognitive Level: Knowledge 4. A patient has been prescribed a respiratory corticosteriod medication. What should the nurse tell this patient about the proper

method for taking this medication?

Rinsing of the mouth after using the inhaler is recommended.

The tubings and mouthpieces should be cleaned with only hot water.

The medication is to be inhaled deeply, with the head tipped backward to maximize opening of the airway. d. After taking an inhaler medication, the patient should remove the inhaler and hold the breath for at least 20 seconds. a. b. c.

ANS: A

Rinsing of the mouth after using an inhaler or nebulizer is recommended in order to prevent fungal infections. Nebulizer tubings and mouthpieces should be cleaned with soap, water, and white vinegar. With intranasal dosage forms, the medication should be inhaled with the head tipped slightly forward.

DIF: Cognitive Level: Analysis 5. The physician has prescribed fluticasone (Flovent®) to treat a patient’s asthma. What important information should the nurse

emphasize when teaching the patient about this medication?

The patient must use the proper technique for inhalation.

The medication should be kept on the patient’s person at all times for treatment of an acute asthma attack. c. The medication is to be taken every day on a continuous schedule, even if symptoms improve. d. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued. a. b.

ANS: C

This drug is used for asthma prophylaxis and maintenance treatment.

DIF: Cognitive Level: Analysis 6. Which drug is used in the treatment of acute attacks of bronchial asthma? a. nedocromil b. salbutamol (Ventolin®) c. zafirlukast (Accolate®) d. triamcinolone ANS: B

Salbutamol is the only drug listed above that is useful in the treatment of acute attacks of bronchial asthma.

DIF: Cognitive Level: Knowledge

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. A patient has prescriptions for two inhalers. One inhaler is a bronchodilator; the other is a corticosteroid. Which instruction should

the nurse give the patient regarding these inhalers?

The corticosteroid should be taken first.

The bronchodilator should be taken first.

The two drugs should be taken at least 2 hours apart.

The order of administration does not matter with these two drugs.

a. b. c. d.

ANS: B

The bronchodilator should be taken several minutes before the corticosteroid so that the airways will be more open when the second drug is administered.

DIF: Cognitive Level: Analysis 8. A patient has recently been placed on inhaled corticosteroids. Which common adverse effects should the nurse discuss with the

patient?

Fatigue and depression Anxiety and peripheral vasoconstriction Headache and rapid heart rate Oral candidiasis and dry mouth

a. b. c. d.

ANS: D

Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids.

DIF: Cognitive Level: Comprehension 9. After receiving a nebulizer treatment with a -agonist, the patient reports feeling slightly nervous and wonders whether the asthma

is getting worse. What is the nurse’s best answer to the patient’s concern? a. “Feeling a little nervous is an expected adverse effect. Let me take your pulse to check it.” b. “The next scheduled nebulizer treatment should be skipped.” c. “I will notify the physician about this adverse effect.” d. “We will hold the treatment for 24 hours.”

ANS: A

Nervousness, tremors, and cardiac stimulation are possible adverse effects of -agonists.

DIF: Cognitive Level: Analysis 10. For which condition would the nurse anticipate treatment with montelukast (Singulair®)? a. Acute bronchospasm b. Exacerbation of chronic obstructive pulmonary disease c. Long-term treatment of emphysema d. Prophylaxis of asthma in children ANS: D

Montelukast belongs to the newer class of medications known as antileukotriene drugs and is used for prophylaxis and long-term treatment of asthma in adults and children.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. Which drugs are used for acute asthma attacks? (Select all that apply.) a. zafirlukast (Accolate®) tablets b. salbutamol (Ventolin) nebulizer solution c. Cromolyn® metered-dose inhaler (MDI) d. Intravenous (IV) epinephrine e. fluticasone (Flovent) f. beclomethasone (Qvar®) MDI g. aminophylline IV infusion ANS: B, D, G

Salbutamol (a 2-agonist) is used for acute bronchospasms. Epinephrine can be used intravenously for relief of bronchospasm.

Aminophylline can be used for mild to moderate asthma attacks. Zafirlukast is an antileukotriene drug; Cromolyn is a mast cell stabilizer; and fluticasone and beclomethasone are inhaled corticosteroids. These three types of medications—antileukotrienes, mast cell stabilizers, and inhaled corticosteroids—are used for asthma prophylaxis.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 39: Acid-Controlling Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Antacids that contain aluminum salts may result in which adverse effect? a. Diarrhea b. Constipation c. Intestinal flatulence d. Abdominal cramping ANS: B

Aluminum-based antacids have a constipating effect and an acid-neutralizing capacity.

DIF: Cognitive Level: Knowledge 2. Antacids containing magnesium should be used cautiously in patients with which condition? a. Peptic ulcer disease b. Renal failure c. Hypertension d. Heart failure ANS: B

The failing kidney cannot excrete the extra magnesium, and accumulation may occur.

DIF: Cognitive Level: Application 3. H2 antagonists, such as cimetidine, may inhibit the absorption of drugs that require an acidic gastrointestinal environment. Which

drug requires an acidic gastrointestinal environment? a. Nonsteroidal anti-inflammatory drugs b. Ranitidine (Zantac®) c. Tetracycline d. Ketoconazole ANS: D

Ketoconazole requires an acidic gastrointestinal environment for gastric absorption.

DIF: Cognitive Level: Comprehension 4. A patient has been taking cimetidine for hyperacidity but says that the medication has not been effective. What is the patient doing

that may be influencing the effectiveness of this drug?

The patient is taking the cimetidine with meals.

The patient is smoking two packs of cigarettes a day.

The patient is avoiding caffeine, alcohol, and harsh spices.

The patient is taking an antacid 1 hour before or after taking the cimetidine dose.

a. b. c. d.

ANS: B

Smoking may impair the absorption of H2 antagonists. Taking cimetidine with meals; avoiding caffeine, alcohol, and harsh spices; and taking an antacid 1 hour before or after the cimetidine dose are proper interventions for this medication.

DIF: Cognitive Level: Analysis 5. A patient is taking omeprazole (Losec®) for the treatment of gastroesophageal reflux disease. What important information should

the nurse give the patient about this medication?

The medication is taken once a day after meals.

The patient will be taking this medication for long-term therapy.

The medication may be dissolved in a liquid for better absorption.

The entire capsule should be taken whole and not crushed, chewed, or opened.

a. b. c. d.

ANS: D

An entire omeprazole capsule should be taken whole and not crushed, chewed, or opened. Omeprazole is intended for short-term therapy and should be taken before meals.

DIF: Cognitive Level: Application 6. Which drug is used for the management of conditions associated with excessive gas production? a. famotidine (Pepcid®) b. aluminum hydroxide and magnesium hydroxide (Maalox®) c. calcium carbonate d. simethicone (Oval®) ANS: D

Simethicone alters the elasticity of mucus-coated bubbles, causing them to break, and is used as an over-the-counter antiflatulent.

DIF: Cognitive Level: Knowledge

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. A 75-year-old woman reports experiencing indigestion, stomach pain, and frequent belching. She tells the nurse that she has been

taking sodium bicarbonate five or six times a day for the past 3 weeks. Which hazard does the nurse know can possibly result from excessive use of sodium bicarbonate? a. Excess belching b. Constipation c. Systemic alkalosis d. Stomach secretion of excess mucus ANS: C

Excessive use of sodium bicarbonate may lead to systemic alkalosis.

DIF: Cognitive Level: Application 8. A patient has been diagnosed with a peptic ulcer caused by Helicobacter pylori. The physician has recommended 2 weeks of

combination therapy with omeprazole and an antibiotic. Which antibiotic will be chosen for this therapy? cephalexin hydrochloride ampicillin sodium sulfisoxazole clarithromycin

a. b. c. d.

ANS: D

Clarithromycin is active against H. pylori and is used in combination with omeprazole to eradicate the bacteria.

DIF: Cognitive Level: Comprehension 9. A patient asks why calcium carbonate is not often used as an antacid. What is the nurse’s best explanation to the patient? a. Its use may result in kidney stones. b. It causes decreased gastric acid production. c. It often causes severe constipation. d. It may result in fluid retention and edema.

ANS: A

Calcium carbonate is not often used as an antacid because it may cause kidney stones. It also causes increased gastric acid production.

DIF: Cognitive Level: Comprehension 10. A patient is taking several medications, including twice-daily dosages of antacids. What important information about taking the

antacids should the nurse give this patient? a. The medications can be taken with the antacids. b. The antacids should be taken 1 to 2 hours before or after the other medications. c. The antacids should be taken at least 4 hours apart from the other medications. d. The patient will not be able to take the antacid therapy at this time.

ANS: B

The antacids should be given as ordered but not within 1 to 2 hours of other medications because of the effect of antacids on the absorption of oral medications.

DIF: Cognitive Level: Application 11. Which classification of medications is considered triple therapy for treatment of erosive esophagitis? a. H2 antagonists b. Proton pump inhibitors c. General antacids d. Prostaglandin inhibitors ANS: B

Proton pump inhibitors are currently indicated as triple therapy for erosive esophagitis.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. Which are true statements about antacids? (Select all that apply.) a. Antacids prevent the overproduction of acid in the stomach. b. Antacids neutralize acid in the stomach. c. Antacids promote a mucous barrier in the stomach. d. Rebound hyperacidity may occur with calcium-based antacids. e. Aluminum-based antacids cause diarrhea. f. Magnesium-based antacids cause diarrhea. g. Stomach acidity is reduced by 90% if the pH is raised an entire point.

ANS: B, C, D, F, G

Antacids neutralize acid in the stomach and promote gastric mucosal defensive mechanisms. Calcium-based antacids often cause rebound hyperacidity; magnesium-based antacids cause diarrhea; and stomach acidity is reduced by 90% if the pH is raised by 1 point. Aluminum-based antacids cause constipation. Antacids generally should not be given with other drugs, because antacids will alter their absorption.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 40: Antidiarrheal Drugs and Laxatives Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient is on laxative therapy. What important information about this therapy should the nurse provide the patient? a. All laxative tablets should be crushed for improved action. b. Bisacodyl should be given with water only. c. A normal bowel pattern is when a bowel movement occurs daily. d. Psyllium (Metamucil® preparations) can be mixed in food, such as applesauce, or

stirred into fruit juice.

ANS: B

Bisacodyl is best taken on an empty stomach and should be given with water only, because interactions with milk and antacids may occur. All laxative tablets should be swallowed whole. A normal bowel pattern does not necessarily mean one bowel movement a day. Psyllium should be taken with at least 240 mL of fluid.

DIF: Cognitive Level: Application 2. What type of laxative is glycerin? a. A saline laxative b. An emollient laxative c. A hyperosmotic laxative d. A stimulant/irritant laxative ANS: C

Glycerin is classified as a hyperosmotic laxative.

DIF: Cognitive Level: Knowledge 3. When preparing the bulk-forming laxative methylcellulose for administration, the nurse will mix the medication with how much

water to avoid possible obstruction?

100 mL 12 mL 240 mL 360 mL

a. b. c. d.

ANS: C

Methylcellulose should be mixed with at least 240 mL of water.

DIF: Cognitive Level: Comprehension 4. The nurse advises a patient to try bismuth subsalicylate (Pepto-Bismol®) to control diarrhea. Which medication will interact

significantly with the Pepto-Bismol? digoxin Antacids acetaminophen (Tylenol®) tricyclic antidepressants

a. b. c. d.

ANS: A

Taking digoxin with an adsorbent such as Pepto-Bismol may result in decreased absorption of the digoxin.

DIF: Cognitive Level: Comprehension 5. Which drug is commonly used to induce total cleansing of the bowel before diagnostic or surgical bowel procedures? a. polyethylene glycol b. lactulose c. mineral oil d. milk of magnesia ANS: A

Polyethylene glycol is a very potent laxative that induces total cleansing of the bowel and is most commonly used before diagnostic or surgical bowel procedures.

DIF: Cognitive Level: Application 6. While recovering from surgery, a 74-year-old woman started taking senna (Senokot®) to relieve constipation caused by the pain

medications. She is also taking digoxin and tetracycline. She tells the nurse that she likes how “regular” her bowel movements are now that she is taking the laxative. What important information should the nurse give to this patient? a. Use of a stimulant laxative will not affect the absorption of her other medications. b. It is important to have a daily bowel movement to promote bowel health. c. Long-term use of laxatives often results in decreased bowel tone and may lead to dependency. d. She should switch to glycerin suppositories to continue having daily bowel movements.

ANS: C

Long-term use of laxatives or cathartics often results in decreased bowel tone and may lead to dependency. Patients should be taught that daily bowel movements are not necessary for bowel health.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. What is a major difference between diphenoxylate with atropine (Lomotil®) and loperamide (Imodium®)? a. Lomotil acts faster. b. Loperamide does not cause dependence. c. Lomotil is available as a parenteral form. d. Loperamide is a natural antidiarrheal drug.

ANS: B

Although loperamide exhibits many characteristics of the opiate class, physical dependence has not been reported. All antidiarrheal agents are orally administered. Lomotil and loperamide act similarly; lomotil does not act faster. Loperamide is a synthetic antidiarrheal, not a natural product.

DIF: Cognitive Level: Comprehension 8. Which type of laxatives is most likely to cause dependence if overused? a. Emollient laxatives b. Bulk-forming laxatives c. Hyperosmotic laxatives d. Stimulant laxatives ANS: D

Stimulant laxatives are the most likely of all the laxative classes to cause dependence.

DIF: Cognitive Level: Comprehension 9. Mineral oil can interfere with the absorption of which vitamin? a. Vitamin A b. Vitamin B2 c. Vitamin B12 d. Vitamin C ANS: A

Mineral oil can decrease the absorption of vitamin A and other fat-soluble vitamins (D, E, and K).

DIF: Cognitive Level: Comprehension 10. Which type of antidiarrheal medication works by decreasing the intestinal muscle tone and peristalsis of the intestines? a. Adsorbents b. Anticholinergics c. Intestinal flora modifiers d. Lubricants ANS: B

Anticholinergic drugs work to slow peristalsis by reducing the rhythmic contractions and smooth muscle tone of the gastrointestinal tract.

DIF: Cognitive Level: Comprehension 11. A patient is taking an adsorbent, such as bismuth subsalicylate (Pepto-Bismol). What possible adverse effects should the nurse

warn this patient about?

Darkened stools Urinary hesitancy Drowsiness Blurred vision

a. b. c. d.

ANS: A

Dark stools are one of the possible adverse effects of bismuth subsalicylate. Urinary hesitancy, drowsiness, and blurred vision may occur with the use of anticholinergic drugs.

DIF: Cognitive Level: Comprehension 12. A patient who has been on antibiotic therapy for 2 weeks has developed persistent diarrhea. Which drug will likely be

recommended for this patient?

Mineral oil An adsorbent An anticholinergic An intestinal flora modifier

a. b. c. d.

ANS: D

Intestinal flora modifiers work by exogenously replenishing bacteria that may have been destroyed by antibiotic therapy, thus restoring the balance of normal flora and suppressing the growth of diarrhea-causing bacteria.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

MULTIPLE RESPONSE 1. Regarding the uses for laxatives, which conditions are general contraindications to the use of oral laxatives? (Select all that apply.) a. High ammonia levels due to liver failure b. The presence of parasites and intestinal worms c. Abdominal pain of unknown origin d. Nausea and vomiting e. Pregnancy f. Ingestion of toxic substances g. Acute surgical abdomen ANS: C, D, G

Cautious use of laxatives is recommended in the presence of acute surgical abdomen; appendicitis symptoms, such as abdominal pain, nausea, and vomiting; intestinal obstruction; and undiagnosed abdominal pain. High ammonia levels due to liver failure, the presence of parasites and intestinal worms, and ingestion of toxic substances are indications for laxative use. Certain laxatives may be used to treat constipation during pregnancy.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

3

Chapter 41: Antiemetic and Antinausea Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. The nurse has just completed the intravenous administration of a drug to a patient for the prevention of chemotherapy-induced

nausea and vomiting. What antiemetic drug has the patient received? a. granisetron b. lorazepam c. dexamethasone d. prochlorperazine ANS: A

Granisetron hydrochloride (Kytril®), palonosetron (Aloxi®), and ondansetron (Zofran®) are beneficial in preventing nausea and vomiting caused by chemotherapy. Lorazepam is an anxiolytic, and dexamethasone is a corticosteroid. Prochlorperazine is an antidopaminergic medication.

DIF: Cognitive Level: Comprehension 2. Which primary anticholinergic medication is used as an antiemetic? a. Meclizine hydrochloride b. Prochlorperazine c. Scopolamine hydrobromide d. Metoclopramide hydrochloride ANS: C

Scopolamine hydrobromide injection is the primary anticholinergic drug used as an antiemetic. It has potent effects on the vestibular nuclei, which are within the area of the brain that controls balance.

DIF: Cognitive Level: Comprehension 3. A patient receiving chemotherapy is prescribed ondansetron (Zofran) for treatment of nausea. Which is an adverse effect of this

antiemetic drug? a. Dizziness b. Headache c. Dry mouth d. Blurred vision ANS: B

Headache is an adverse effect of the serotonin blockers, in addition to diarrhea, rash, bronchospasm, and prolonged QT interval.

DIF: Cognitive Level: Comprehension 4. A patient is experiencing intractable hiccups. Which drug will the nurse expect to administer to this patient? a. metoclopramide b. prochlorperazine c. scopolamine d. granisetron ANS: B

Prochlorperazine, indications for the use of which include psychotic disorders and intractable hiccups, as well as nausea and vomiting.

DIF: Cognitive Level: Comprehension 5. Which antiemetic drug works by blocking dopamine in the chemoreceptor trigger zone, causing the zone to be desensitized to

impulses received from the gastrointestinal tract? ondansetron metoclopramide meclizine prochlorperazine

a. b. c. d.

ANS: B

Prokinetic drugs, particularly metoclopramide, work by blocking dopamine in the chemoreceptor trigger zone, causing the zone to be desensitized to impulses received from the gastrointestinal tract.

DIF: Cognitive Level: Knowledge 6. Which statement is correct regarding the management of nausea and vomiting? a. Give antiemetics immediately after chemotherapy is administered. b. Antiemetics are often administered 30 to 60 minutes before a chemotherapy drug c. d.

is given.

Taking antiemetics at night may cause restlessness and interfere with sleep.

Antiemetics may be taken with a glass of wine to help settle the stomach.

ANS: B

Antiemetics should be given before any chemotherapy drug is administered, often 30 to 60 minutes before treatment. Antiemetics are given before, not after chemotherapy is administered. Most antiemetics cause drowsiness, and taking antiemetics with alcohol may increase central nervous system (CNS) depression.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. Which antiemetic drug is effective in preventing chemotherapy-induced and postoperative nausea and vomiting? a. meclizine b. ondansetron c. scopolamine d. diphenhydramine ANS: B

Serotonin blockers such as ondansetron have proved to be very effective in preventing chemotherapy-induced and postoperative nausea and vomiting.

DIF: Cognitive Level: Comprehension 8. A patient with motion sickness is planning a cross-country car trip to attend a family reunion. What medication will the nurse tell

the patient prevents motion sickness? a. scopolamine b. ondansetron c. promethazine d. prochlorperazine ANS: C

Scopolamine is indicated as prophylaxis for motion sickness.

DIF: Cognitive Level: Comprehension 9. Tetrahydrocannabinol (THC) is an antiemetic used for treatment of nausea and vomiting associated with which situation? a. Ménière’s disease b. Motion sickness c. Chemotherapy treatment d. Surgical treatment ANS: C

THC is approved for treatment of nausea and vomiting associated with cancer chemotherapy.

DIF: Cognitive Level: Comprehension 10. A patient who has been newly diagnosed with vertigo will be taking an antihistamine antiemetic drug. What is important for the

nurse to emphasize when teaching the patient about this drug? a. Doses may be skipped if the patient is feeling well. b. Because of possible drowsiness, the patient should avoid driving. c. The patient may experience transient taste problems. d. It is safe to take the dose with a glass of wine in the evening to help settle the stomach.

ANS: B

Because drowsiness may occur as a result of CNS depression and possible sedation, patients taking this drug should avoid driving or working with heavy machinery. The medication should be taken as instructed and not skipped. Transient taste problems are not an adverse effect of antihistamine antiemetic drugs. These drugs should not be taken with alcohol or other CNS depressants because of possible additive depressant effects.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 42: Nutritional Supplements Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. What is the most common adverse effect from nutritional supplements? a. Diarrhea b. Constipation c. Fluid overload d. Peptic ulcer disease ANS: A

Diarrhea is the most common result of the gastrointestinal intolerance that occurs with nutritional supplementation.

DIF: Cognitive Level: Knowledge 2. An older adult patient needs to take an enteral supplement to improve overall nutritional status. Which formulation provides

complex nutrients? a. Ensure® b. Moducal® c. ProMod® d. Microlipid® ANS: A

Ensure is a polymeric formulation that contains complex nutrients, including proteins, carbohydrates, and fat. Moducal provides carbohydrates only. ProMod is a protein formulation. Microlipid supplies only fats.

DIF: Cognitive Level: Application 3. A female patient has been receiving both radiation and chemotherapy for her cancer. She has developed anorexia caused by the

treatments and needs nutritional supplementation. The nurse knows that the physician will likely initiate which therapy? a. Central total parenteral nutrition (TPN) b. Peripheral TPN c. Oral nutritional supplementation d. Nasogastric enteral supplementation ANS: B

Peripheral TPN is indicated for anorexia caused by radiation or cancer chemotherapy.

DIF: Cognitive Level: Application 4. Which is a potential adverse effect of TPN? a. Anorexia b. Headache c. Fluid overload d. Diarrhea ANS: C

Fluid overload is a potential adverse effect of TPN. DIF: Cognitive Level: Comprehension 5. During the night shift, a patient’s TPN infusion finished, but no TPN solution is on hand. Which condition does the nurse know

may occur if the TPN infusion is discontinued abruptly? a. Fluid overload b. Hyperglycemia c. Dumping syndrome d. Rebound hypoglycemia ANS: D

Rebound hypoglycemia may occur if TPN is discontinued abruptly and may be prevented with the infusion of 5 to 10% glucose when TPN must be stopped abruptly.

DIF: Cognitive Level: Analysis 6. A patient is receiving an enteral tube feeding at 100 mL per hour. When the nurse checks the residual, 210 mL is obtained. Which

action by the nurse is appropriate?

Slowing the rate to 50 mL per hour Returning the aspirate and continuing the feeding as ordered Returning the aspirate, stopping the feeding, and contacting the physician Discarding the aspirate, stopping the feeding, and contacting the physician

a. b. c. d.

ANS: C

For continuous feedings, the feeding should be stopped if the residual volume is greater than the volume from 2 hours of continuous feeding. The aspirate should be returned, and the physician should be notified.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. What is a possible complication of long-term administration of peripheral TPN? a. Diarrhea b. Phlebitis c. Hypokalemia d. Hypoglycemia ANS: B

The long-term administration of nutritional supplements via a peripheral vein may lead to phlebitis and possibly to the loss of a limb.

DIF: Cognitive Level: Application 8. A patient has been receiving TPN. Upon assessment, the nurse notes that the patient’s blood pressure is elevated, and pulse is weak

and elevated. The patient seems confused, and there is new pitting edema around the ankles. What does the nurse suspect? a. Hyperglycemia b. Hypoglycemia c. Infection d. Fluid overload ANS: D

These signs and symptoms reflect the potential complication of fluid overload.

DIF: Cognitive Level: Application 9. A patient’s peripheral parenteral nutrition bag has run dry before the physician has ordered a new bag. The best action by the nurse

is to hang which solution until the new bag arrives? a. 10% dextrose in water b. 20% dextrose in water c. 0.9% sodium chloride d. Lactated Ringer’s solution ANS: A

If TPN is discontinued abruptly, rebound hypoglycemia may occur. This complication can be prevented with an infusion of 5 to 10% glucose in situations in which TPN must be discontinued immediately. For peripheral solutions, the proportion of dextrose must not be more than 12.5%.

DIF: Cognitive Level: Application 10. To ensure patient safety, how often should the nurse assess the TPN infusion? a. Every 15 minutes b. Every 30 minutes c. Every 60 minutes d. Every 2 hours ANS: C

Cautious and astute nursing care is required for the patient receiving TPN. Infusions of TPN should be assessed every hour or according to agency policy.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 43: Antibiotics Part 1: Sulfonamides, Penicillins, Cephalosporins, Macrolides, and Tetracyclines Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Patients who are allergic to penicillin may also be hypersensitive to which drugs? a. Tetracyclines b. Sulfonamides c. Cephalosporins d. Imipenem-cilastatin ANS: C

Allergy to penicillin may also result in hypersensitivity to cephalosporins.

DIF: Cognitive Level: Comprehension 2. A patient has been prescribed a tetracycline. What important information should the nurse tell the patient about taking this

medication? a. Acidic foods, such as citrus fruit juices, help to enhance absorption. b. Milk and cheese products result in decreased levels of tetracycline. c. Antacids taken with the medication help to reduce gastrointestinal distress. d. The medication should be taken with high-fibre foods to prevent constipation.

ANS: B

Milk and cheese products result in decreased levels of tetracycline when taken with the medication. Antacids also interfere with absorption and should not be taken with tetracycline.

DIF: Cognitive Level: Comprehension 3. Which drug may result in an interaction if taken with penicillin? a. Antacids b. acetaminophen (Tylenol®) c. digoxin (Lanoxin®) d. Nonsteroidal anti-inflammatory drugs (NSAIDs) ANS: D

Drug interactions may occur when both penicillin and NSAIDs are taken.

DIF: Cognitive Level: Application 4. A patient taking an antibiotic suddenly develops hives. The hives are an example of which reactions? a. A desired reaction b. An allergic reaction c. An idiosyncratic reaction d. An unpredictable reaction ANS: B

Hives are an allergic reaction known to occur in some patients receiving antibiotics.

DIF: Cognitive Level: Comprehension 5. A patient is admitted with a fever of 39C of unknown origin. The assessment reveals bilateral crackles and a productive cough.

The physician has ordered sputum and blood cultures and the administration of ampicillin 500 mg intravenous stat and then every 6 hours. Which is the correct sequence for the nurse to follow to complete these orders? a. Blood culture, ampicillin dose, sputum culture b. Sputum culture, ampicillin dose, blood culture c. Ampicillin dose, blood and sputum cultures d. Blood and sputum cultures, ampicillin dose ANS: D

Blood and sputum culture specimens should be obtained before initiating drug therapy; otherwise, the presence of antibiotics in the tissues may result in misleading culture results.

DIF: Cognitive Level: Analysis 6. During antibiotic therapy, a significant drug interaction may occur with which drug group? a. Anticoagulants b. Estrogen-containing contraceptives c. Antihypertensives d. Antihistamines ANS: B

Effectiveness of oral contraceptives may be decreased with certain antibiotics.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. A patient with an infection is being by monitored by the nurse for therapeutic results of antibiotic therapy. Which laboratory value

indicates the effectiveness of this therapy?

Increased red blood cell (RBC) count Increased white blood cell (WBC) count Decreased WBC count Decreased platelet count

a. b. c. d.

ANS: C

A decreased WBC count is an indication of the reduction of infection and the therapeutic effect of antibiotic therapy.

DIF: Cognitive Level: Application 8. How are the four generations of cephalosporins differentiated? a. By varying levels of toxicity b. By adverse-effect profiles c. By -lactam resistance d. By antimicrobial activity ANS: D

By antimicrobial activity, Depending on the generation, these drugs may be active against gram-positive, gram-negative, or anaerobic bacteria.

DIF: Cognitive Level: Comprehension 9. A patient has received an antibiotic to take for 1 week before planned oral surgery. This is an example of what type of therapy? a. Empirical therapy b. Prophylactic therapy c. Bactericidal therapy d. Resistance therapy ANS: B

Prophylactic antibiotic therapy is used to prevent an infection.

DIF: Cognitive Level: Comprehension 10. Which class of antibiotics is often used with -lactamase inhibitors to extend the effectiveness of the antibiotics? a. Cephalosporins b. Tetracyclines c. Sulfonamides d. Penicillins ANS: D

Because -lactamase inhibitors block the effect of the enzyme -lactamase, penicillin antibiotics have an extended usefulness against the bacteria.

DIF: Cognitive Level: Comprehension 11. During drug therapy for pneumonia, a female patient develops a superinfection. She asks the nurse how this could have happened.

Which is the nurse’s best explanation to the patient? a. Large doses of antibiotics kill normal flora. b. The infection has spread from her lungs to the new site of infection. c. The pneumonia-causing bacteria are resistant to the drugs. d. She is having an allergic reaction to the antibiotics.

ANS: A

Normally occurring bacteria are killed during antibiotic therapy, allowing other flora to take over, resulting in superinfections.

DIF: Cognitive Level: Application MULTIPLE RESPONSE 1. During antibiotic therapy, the nurse should monitor the patient closely for signs and symptoms of a hypersensitivity reaction. What

may be an indication of a hypersensitivity reaction? (Select all that apply.)

Wheezing Diarrhea Shortness of breath Swelling of the feet Swelling of the tongue Itching Black, hairy tongue Angioedema

a. b. c. d. e. f. g. h.

ANS: A, C, E, F, H

Hypersensitivity reactions may be manifested by wheezing; shortness of breath; swelling of the face, tongue, or hands (angioedema); itching; or rash.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 44: Antibiotics Part 2: Aminoglycosides, Fluoroquinolones, and Other Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. When a patient is on gentamicin therapy, what symptoms or laboratory results could indicate a potentially serious toxicity? a. Skin rash and fever b. A peak level of 7 mcg/mL c. Tinnitus and hearing loss d. Decreased blood urea nitrogen (BUN) and creatinine levels ANS: C

Tinnitus and hearing loss could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising BUN and creatinine levels. Skin rash and fever are less common adverse effects, and a peak level of 7 mcg/mL does not indicate a potentially serious toxicity.

DIF: Cognitive Level: Comprehension 2. A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains methicillin-resistant Staphylococcus

aureus (MRSA). Which antibiotic does the nurse expect will be chosen for his therapy? a. penicillin b. nitrofurantoin (MacroBID®) c. vancomycin (Vancocin®) d. Quinupristin/dalfopristin (Synercid®) ANS: C

Vancomycin is the drug of choice for the treatment of MRSA. DIF: Cognitive Level: Comprehension 3. What is the main advantage of levofloxacin (Levaquin®) over other quinolones? a. Once-daily dosing b. Twice-daily dosing c. A more potent anti-infective effect d. Fewer adverse effects ANS: A

The main advantage of levofloxacin over the other quinolones is the once-daily dosing.

DIF: Cognitive Level: Comprehension 4. Metronidazole (Flagyl®) is widely used for which type of infection? a. Skin infection b. Gynecological infection c. Aerobic infection d. Respiratory infection ANS: B

Metronidazole is widely used for gynecological and intra-abdominal infections caused by anaerobic organisms.

DIF: Cognitive Level: Comprehension 5. When administering vancomycin (Vancocin), what important information should the nurse keep in mind? a. It is ineffective in the treatment of MRSA. b. It should be infused over at least 30 minutes. c. Fluids should be restricted during vancomycin therapy. d. Infuse the drug over 1 hour to reduce red man syndrome.

ANS: D

Vancomycin should be infused over at least 60 minutes to reduce red man syndrome. Vancomycin is the antibiotic of choice for the treatment of MRSA, and adequate hydration (at least 2 litres of fluid in 24 hours) is important to prevent nephrotoxicity.

DIF: Cognitive Level: Comprehension 6. Which nursing diagnosis is appropriate for the patient who has started aminoglycoside therapy? a. Constipation b. Risk for injury (hearing loss) c. Disturbed body image related to gynecomastia d. Imbalanced nutrition, less than body requirements, related to nausea ANS: B

Patients on aminoglycoside therapy have a high risk for injury due to ototoxicity.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. When patients are taking aminoglycosides, which are potent antibiotics, which laboratory result must the nurse carefully monitor? a. Alanine aminotransferase (ALT) b. Glycosylated hemoglobin c. Serum creatinine d. Aspartate aminotransferase (AST) ANS: C

Nephrotoxicity occurs in 5 to 25% of patients taking aminoglycosides. The nurse must carefully monitor increased blood urea nitrogen and serum creatinine levels and monitor for urinary casts and proteinuria.

DIF: Cognitive Level: Comprehension 8. Which medication is commonly prescribed to treat recurrent pulmonary infections associated with cystic fibrosis? a. gentamicin sulphate b. tobramycin c. amikacin sulphate d. norfloxacin (Apo-Norflox®) ANS: B

Tobramycin has similar indications to gentamicin, but unlike gentamicin, it is commonly used to treat recurrent pulmonary infections associated with cystic fibrosis.

DIF: Cognitive Level: Comprehension 9. Which laboratory value is sometimes increased by quinolones? a. BUN levels b. Creatinine levels c. ALT levels d. Glucose levels ANS: C

Quinolones can increase ALT and AST levels.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. The nurse is administering aminoglycoside therapy. For which signs of toxicity does the nurse closely monitor the patient? (Select

all that apply.)

Electrocardiogram changes Urinary casts Hearing loss Dizziness Blood dyscrasias Increased BUN levels Jaundice Proteinuria

a. b. c. d. e. f. g. h.

ANS: B, C, D, F, H

Patients on aminoglycoside therapy must be monitored for signs of urinary casts (visible remnants of destroyed kidney cells), proteinuria, and increased BUN and serum creatinine levels, as well as ototoxicity (hearing loss and dizziness).

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 45: Antiviral Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient diagnosed with shingles is prescribed topical acyclovir (Zovirax®). What important adverse effects should the nurse warn

this patient about? a. Insomnia and nervousness b. Temporary swelling and rash c. Burning of the skin d. No adverse effects ANS: C

Burning of the skin may occur with the topical application of acyclovir.

DIF: Cognitive Level: Comprehension 2. A patient who has had a bone marrow transplant has contracted cytomegalovirus (CMV) retinitis. Which drug is preferable for this

patient? acyclovir (Zovirax®) foscarnet (Foscavir®) ganciclovir (Cytovene®) amantadine (Dom-Amantidine®)

a. b. c. d.

ANS: B

Foscarnet is indicated for the treatment of CMV retinitis and is less toxic to the bone marrow than ganciclovir is.

DIF: Cognitive Level: Knowledge 3. Which is a true statement about amantadine (Dom-Amantidine) therapy? a. It causes less central nervous system (CNS) toxicity than rimantadine. b. It is commonly used to treat influenza A and influenza B. c. It should not be given to women who are breastfeeding. d. It has a longer half-life than rimantadine and may be dosed less frequently.

ANS: C

Amantadine is contraindicated in lactating women, in patients with a hypersensitivity to it, in children younger than 12 months, and in patients with an eczematic rash. Amantadine is active only against influenza A viruses. Compared with amantadine, rimantadine has a longer half-life, may be dosed less frequently, and causes less CNS toxicity.

DIF: Cognitive Level: Comprehension 4. A patient with acquired immune deficiency syndrome (AIDS) has been taking zidovudine (AZT) therapy for almost 1 year. The

physician has decided to change the medication to didanosine (Videx EC®). The patient is very concerned about this medication change. What is the nurse’s best explanation to the patient? a. Didanosine has fewer toxic effects than zidovudine. b. Didanosine has been shown to improve survival rates. c. Taking the zidovudine with the didanosine might have led to serious toxicity. d. The patient may have been experiencing bone marrow suppression due to the zidovudine therapy.

ANS: D

Bone marrow suppression is often the reason why a patient with a human immunodeficiency virus (HIV) infection needs to be switched to another anti-HIV drug, such as didanosine. Zidovudine and didanosine can be taken together by cutting back on the doses of both, thus decreasing the likelihood of toxicity.

DIF: Cognitive Level: Comprehension 5. The nurse is administering acyclovir (Zovirax).

Which statement is true? a. Intravenous (IV) infusions should be administered slowly, over at least 1 hour. b. IV infusions should be administered by rapid IV bolus. c. IV acyclovir is compatible with many other IV solutions. d. Oral fluids should be restricted while the client is taking IV acyclovir.

ANS: A

IV infusions of acyclovir should be given slowly, over at least 1 hour. Many IV agents and solutions are incompatible with IV acyclovir. A fluid intake of at least 2 400 mL per day should be encouraged for clients receiving acyclovir, unless contraindicated.

DIF: Cognitive Level: Analysis 6. Which is a therapeutic effect of antiviral drugs? a. Elimination of the virus b. Eradication of herpetic lesions c. Delayed progression of HIV infection d. Prevention of future infections with the same virus ANS: C

One of the therapeutic effects of antiviral agents is delayed progression of HIV infection.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. A patient who is taking a combination of antiretroviral drugs as treatment of early stages of HIV infection asks the nurse whether

the drugs will kill the virus. Which statement is the nurse’s best response to this patient?

Antiretroviral drugs are rarely beneficial and are given for palliative reasons only.

Antiretroviral drugs will be effective as long as the patient is not exposed to the virus again. c. Antiretroviral drugs can be given in large enough doses to eradicate the virus without harming the body’s healthy cells. d. Antiretroviral drugs are effective only while the virus is replicating, and replication is often finished by the time symptoms appear. a. b.

ANS: D

Antiretroviral drugs are effective only while the virus is replicating, and replication is often finished by the time symptoms appear.

Antiretroviral drugs are beneficial and treat patients with active HIV infection. The body’s healthy cells are often harmed during antiretroviral therapy, resulting in the possible occurrence of toxic adverse effects.

DIF: Cognitive Level: Analysis 8. A young adult calls the clinic to ask for a prescription for “the flu drug.” He says he has had “the flu” for almost 4 days and just

heard about a drug that can reduce the symptoms. Which statement about oseltamivir (Tamiflu®) and zanamivir (Relenza®) is true? a. These drugs do not stop the spread of influenza. b. These drugs have few adverse effects. c. As long as this patient starts treatment within the next 24 hours, the drug should be effective. d. Treatment with these drugs should begin within 2 days of the onset of influenza symptoms.

ANS: D

Treatment with these drugs should be started within 2 days of the onset of influenza symptoms. These drugs may cause nausea or vomiting, and they do work to stop the spread of influenza.

DIF: Cognitive Level: Analysis 9. Which drug belongs to the newer class of antiviral drugs called fusion inhibitors? a. enfuvirtide (Fuzeon®) b. tenofovir (Viread®) c. nevirapine (Viramune®) d. indinavir (Crixivan®) ANS: A

Enfuvirtide is the drug that belongs to the newer class of antiviral drugs, which are called fusion inhibitors.

DIF: Cognitive Level: Knowledge 10. A patient with late-stage AIDS has developed Kaposi’s sarcoma. What type of infection is Kaposi’s sarcoma? a. A drug-resistant infection b. An opportunistic infection c. A co-infection d. A superinfection ANS: B

Kaposi’s sarcoma is an example of an opportunistic situation; it is an HIV-associated neoplasm.

DIF: Cognitive Level: Comprehension 11. Which is a common adverse effect of oseltamavir (Tamiflu)? a. Diarrhea b. Sinusitis c. Nausea d. Constipation ANS: C

The most common adverse effects associated with oseltamavir are nausea and vomiting.

Sinusitis, diarrhea, and nausea are associated with zanamivir. Constipation is not an adverse effect of oseltamavir.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

MULTIPLE RESPONSE 1. A patient diagnosed with genital herpes is taking topical acyclovir (Zovirax). What should the nurse say to the patient about this

drug? (Select all that apply.) a. “Be sure to wash your hands thoroughly before and after applying this medicine.” b. “Apply this ointment until the lesion stops hurting.” c. “Sterile gloves are required when applying this ointment.” d. “Use a clean glove or finger cot when applying this ointment.” e. “If your partner develops these lesions, then he can also use the medication.” f. “You need to avoid touching around your eyes.” g. “You will need to practice abstinence when these lesions are active.” h. “Ask your health care provider about getting a Pap smear every 6 months due to an increased risk for cervical cancer.”

ANS: A, D, F, G, H

Hands should be thoroughly washed before and after applying this medicine, clean gloves should be used when applying the ointment, the patient should avoid touching around the eyes, abstinence must be practised while the lesions are active, and female patients should have a Pap smear every 6 months due to an increased risk for cervical cancer. This medication should be applied as long as prescribed, and sterile gloves are not needed. Prescriptions should not be shared; if the partner develops these lesions, then the partner will need to be evaluated before medication is prescribed if needed.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

3

Chapter 46: Antitubercular Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Patients taking isoniazid (Isotamine®) should watch for and report which potential adverse effect(s)? a. Rash b. Headache and nervousness c. Insomnia d. Numbness and tingling of extremities ANS: D

Patients on isoniazid therapy should report numbness and tingling of extremities. Rash, headache, nervousness, and insomnia are not adverse effects of isoniazid. Headache and insomnia are adverse effects of levofloxacin and some of the other antibiotics used to treat tuberculosis.

DIF: Cognitive Level: Application 2. A patient who has been taking isoniazid (Isotamine) has a new prescription for pyridoxine (vitamin B6) and asks the nurse why this

medication is needed. The nurse explains that pyridoxine is given concurrently with the isoniazid to prevent which condition? a. Hair loss b. Renal failure c. Neurological adverse effects d. Heart failure ANS: C

The neurological adverse effects of isoniazid—such as isoniazid-precipitated peripheral neuropathies and numbness, tingling, or burning of extremities—may be prevented with the administration of pyridoxine.

DIF: Cognitive Level: Application 3. When assessing patients who are to receive antitubercular therapy, the nurse should monitor for which sign? a. Glaucoma b. Weight gain c. Heart failure d. Hepatic impairment ANS: D

Isoniazid (INH) and rifampin (Rifadin®) may cause hepatic impairment. Therefore, liver function and alcohol use should be assessed.

DIF: Cognitive Level: Comprehension 4. Which antitubercular drug may cause retrobulbar neuritis? a. rifampin (Rifadin) b. isoniazid (Isotamine) c. ethambutol (Etibi®) d. streptomycin ANS: C

Ethambutol may cause retrobulbar neuritis and blindness.

DIF: Cognitive Level: Knowledge 5. What indicates a patient’s therapeutic response to antitubercular drugs? a. Cessation of the chronic cough b. Two consecutive negative purified protein derivative tuberculin skin test results c. d.

over 2 months An increased tolerance to the medication therapy and fewer reports of adverse effects A decrease in symptoms of tuberculosis (TB) and improved chest X-rays and sputum cultures

ANS: D

A therapeutic response to the therapy is indicated by a decrease in symptoms of TB, supported by improved chest X-rays, sputum cultures and sensitivities.

DIF: Cognitive Level: Analysis 6. What information is the nurse to provide to a woman who is beginning rifampin therapy and is currently taking an oral

contraceptive? a. There is an increased risk of thrombophlebitis. b. A higher dose of rifampin will be necessary. c. Oral contraceptives are ineffective while the patient is taking rifampin. d. The incidence of adverse effects is greater when the two drugs are taken together.

ANS: C

Women taking oral contraceptives and rifampin should be counselled on other forms of birth control because of the impaired effectiveness of the oral contraceptives during concurrent use of rifampin.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. Which has a significant drug interaction with isoniazid (Isotamine)? a. Alcohol b. Nicotine c. Antacids d. Laxatives ANS: C

Antacids reduce the absorption of isoniazid and thus reduce serum levels.

DIF: Cognitive Level: Comprehension 8. A patient who has started drug therapy for TB asks the nurse how long the medications will have to be taken. Which statement is

the nurse’s best response to the patient’s question?

Drug therapy will last until the symptoms have stopped.

Drug therapy will continue until the TB develops resistance.

The patient should expect to take these drugs for up to 24 months.

The tuberculosis drug therapy will continue for the rest of the patient’s life.

a. b. c. d.

ANS: C

Drug therapy often lasts for up to 24 months if patient adherence has been maintained.

DIF: Cognitive Level: Application 9. Which is the reason for using multidrug therapy in the treatment of TB? a. Multiple drugs are required to eradicate TB. b. The use of multiple medications reduces the chance of TB becoming drug c. d.

resistant.

Multidrug therapy will have a faster effect than will single-drug therapy.

Using multidrug therapy enhances the effect of each drug.

ANS: B

The use of multiple medications reduces the possibility of the organism becoming drug resistant.

DIF: Cognitive Level: Application 10. Family members exposed to a patient with active TB may require prophylactic drug therapy. How long do they need to take this

therapy? a. 6 months b. 9 months c. 18 months d. 24 months ANS: B

Some family members exposed to an individual with active TB may require prophylactic drug therapy for up to 9 months.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. A patient has been prescribed an anti-TB therapy. What should the nurse say about this medication to the patient? (Select all that

apply.)

“Take the medications until the symptoms disappear.”

“Take the medications at the same time every day.”

“You are considered contagious for most of the illness and must take precautions to prevent spreading the disease.” d. “The medications may be stopped if you have severe adverse effects.” e. “Alcoholic beverages should be avoided while on this therapy.” f. “If you notice reddish-brown or reddish-orange urine, stop the drug and contact your doctor right away.” g. “If you experience a burning or tingling in your fingers or toes, report this to your physician immediately.” h. “Oral contraceptives may not work while on these drugs, so you will need to use another form of birth control.” a. b. c.

ANS: B, E, G, H

“Take the medications at the same time every day,” “Alcoholic beverages should be avoided while on this therapy,” “If you experience a burning or tingling in your fingers or toes, report this to your physician immediately,” and “Oral contraceptives may not work while on these drugs, so you will need to use another form of birth control” are all appropriate teaching statements for antitubercular drug therapy. A second form of birth control should be used because antitubercular drug therapy will make oral contraceptives ineffective. Medication therapy for TB may last up to 24 months, long after the symptoms disappear, and patients are infectious during only the early part of the treatment. Patient adherence to antitubercular drug therapy is key; if symptoms become severe, the prescriber should be contacted for an adjustment of drug therapy. The medication should not be stopped.

Because of potential liver toxicity, patients on this drug therapy should not drink alcohol. Discoloration of the urine is an expected adverse effect, which the patient should be warned about.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 47: Antifungal Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient has been prescribed fluconazole. What should the nurse tell the patient to do in regard to this medication? a. Have liver function tested. b. Take antacids with the drug to minimize gastrointestinal upset. c. Take the drug with a large glass of orange juice or water. d. Take the drug 2 hours before a meal or 2 hours after a meal.

ANS: A

Patients receiving fluconazole requires close assessment of pre-existing GI problems and kidney and liver functioning due to drug-induced adverse effects impacting these systems.

DIF: Cognitive Level: Comprehension 2. Which is a contraindication to the use of griseofulvin? a. Porphyria b. Renal disease c. Cardiac disease d. Meningitis ANS: A

Griseofulvin is contraindicated in patients with porphyria.

DIF: Cognitive Level: Knowledge 3. The nurse is administering an antifungal medication. What assessment finding may indicate medication-induced renal damage? a. Rash and chills b. Increased urinary output c. Decreased levels of blood urea nitrogen (BUN) and creatinine d. A weight gain of 2.5 kg in 1 week ANS: D

A weight gain of more than 1 kg in in a 24-hour period or 2.3 kg or more in 1 week may indicate possible medication-induced kidney damage and the need for prompt medical attention. BUN and creatinine levels will increase, not decrease, if renal damage occurs. Urine output would decrease if renal damage were indicated. Rash and chills are not symptoms of renal damage.

DIF: Cognitive Level: Comprehension 4. Which antifungal drug causes increased effects of oral anticoagulants? a. miconazole b. fluconazole c. ketoconazole d. amphotericin B (Fungizone®) ANS: B

Fluconazole causes increased effects of oral anticoagulants.

DIF: Cognitive Level: Knowledge 5. During administration of amphotericin B (Fungizone), the patient may experience severe adverse effects, such as fever, chills,

hypotension, tachycardia, malaise, nausea, and headache. The correct action for the nurse to take is to a. discontinue the infusion immediately. b. reduce the infusion rate gradually until the adverse effects subside. c. administer the medication by rapid intravenous (IV) infusion to reduce the potential adverse effects. d. anticipating these effects, pretreat the patient with an antipyretic, such as acetaminophen, an antihistamine, and an antiemetic drug.

ANS: D

Pretreatment with an antipyretic (acetaminophen), an antihistamine, and an antiemetic drug is the appropriate action to reduce the adverse effects of amphotericin B therapy.

DIF: Cognitive Level: Analysis 6. The nurse is administering Amphotec, one of the newer formulations of amphotericin B. When giving this drug, what important

information does the nurse need to remember?

The new formulation may be given in an oral form.

The newer doses are much lower than the older doses.

The newer doses are much higher than the older doses.

The newer and older forms have no differences in their doses.

a. b. c. d.

ANS: C

The newer forms of amphotericin B use much higher doses, ranging from IV: 3–4 mg/kg/day, infused at 1 mg/kg/ hr. Doses of older forms of amphotericin B range from 0.25 to 1.5 mg/kg per day.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. A patient has been prescribed a vaginal antifungal drug. What important information should the nurse teach the patient about this

drug?

The medication is to be continued even if menstruation begins.

The health care provider should be contacted if symptoms are not gone in 48 hours. c. Daily douching is part of the treatment for vaginal fungal infections. d. Consumption of alcohol is to be avoided. a. b.

ANS: A

The nurse should advise the patient to continue to take the medication even if menstruation begins; the course of treatment must be completed. Daily douching is not part of the treatment for vaginal fungal infections, and the patient does not need to avoid consumption of alcohol. It may take up to 7 to 10 days for symptoms to disappear.

DIF: Cognitive Level: Analysis 8. Which drug may be used for severe invasive aspergillosis in patients who cannot tolerate other antifungal drugs? a. fluconazole (Diflucan®) b. flucytosine (5-FC) c. caspofungin (Cancidas®) d. nystatin ANS: C

Caspofungin is used for treating a severe Aspergillus infection (invasive aspergillosis) in patients who are intolerant of or refractory to other drugs.

DIF: Cognitive Level: Comprehension 9. The nurse is reviewing the history of a patient who will be taking an antifungal drug. Which condition is a contraindication to this

treatment therapy?

Diabetes Kidney failure Hyperthyroidism Meningitis

a. b. c. d.

ANS: B

Liver failure and kidney failure are the most common contraindications to antifungal drugs. The other conditions listed are not contraindications to the use of antifungal drugs.

DIF: Cognitive Level: Comprehension 10. A patient with a severe fungal infection has been prescribed voriconazole (Vfend®). Which assessment finding should the nurse be

concerned about before the medication is started?

Decreased breath sounds in the lower lobes History of cardiac dysrhythmias History of type 2 diabetes Potassium level of 3.8 mmol/L

a. b. c. d.

ANS: B

Voriconazole is contraindicated when coadministered with certain other drugs metabolized by the cytochrome P-450 enzyme CYP3A4 (e.g., quinidine) because of the risk for inducing serious cardiac dysrhythmias.

DIF: Cognitive Level: Application 11. A patient is receiving therapy with amphotericin B (Fungizone). The nurse will monitor for known adverse effects that are reflected

by which laboratory result? a. A serum potassium level of 2.9 mmol/L b. A serum potassium level of 5.6 mmol/L c. A white blood cell count of 6 500 mm3 d. A platelet count of 300 000 per microlitre ANS: A

The nurse should monitor for hypokalemia, a possible adverse effect of amphotericin B. DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

2

MULTIPLE RESPONSE 1. The nurse is administering amphotericin B (Fungizone). Which actions by the nurse are appropriate? (Select all that apply.) a. Administering the medication by rapid IV infusion b. Discontinuing the drug immediately if the patient develops tingling and numbness c. d. e. f. g. h.

in the extremities If adverse effects occur, reducing the IV rate gradually until the adverse effects subside Using an infusion pump with IV therapy Monitoring the IV site for signs of phlebitis and infiltration Administering premedication for fever and nausea as ordered Ensuring that the IV solution for amphotericin B is cloudy Monitoring for muscle twitching, which may indicate hypokalemia

ANS: B, D, E, F

When administering amphotericin B, the nurse should discontinue the drug immediately if the patient develops tingling and numbness in the extremities An infusion pump should be used with IV therapy. The nurse should monitor the IV site for signs of phlebitis and infiltration and note that premedication for fever and nausea may be ordered. The medication should be administered at the recommended rate and stopped, not slowed, if adverse reactions occur. The IV solution should be clear and without precipitates, and muscle weakness, not twitching, may indicate hypokalemia.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

3

Chapter 48: Antimalarial, Antiprotozoal, and Anthelmintic Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient has giardiasis. The health care provider has prescribed metronidazole. What adverse effect should the nurse tell the

patient about? a. Vertigo b. Seizures c. Diarrhea d. Insomnia ANS: C

Diarrhea is one of the many gastrointestinal effects of metronidazole.

DIF: Cognitive Level: Comprehension 2. Which drug is used to kill flukes? a. praziquantel (Biltricide®) b. pyrantel pamoate (Combantrin®) c. mebendazole (Vermox®) d. diethylcarbamazine ANS: A

Praziquantel is an anthelmintic that can kill flukes.

DIF: Cognitive Level: Comprehension 3. A patient who has started therapy with quinine and tetracycline for treatment of malaria asks the nurse why an antibiotic has been

prescribed when malaria is caused by a parasite. What is the nurse’s best explanation to the patient?

The tetracycline prevents reinfection with the malaria parasite.

The antibiotic is combined with quinine to reduce the adverse effects of the quinine. c. An antibacterial drug prevents the occurrence of superinfection during antimalarial therapy. d. The combination of both drugs takes advantage of their synergistic protozoacidal effects. a. b.

ANS: D

Antimalarial drugs are often given in various combinations to achieve an additive or synergistic antimalarial effect. For example, the combination of quinine and tetracycline takes advantage of their synergistic protozoacidal effects.

DIF: Cognitive Level: Analysis 4. A woman is travelling to a country that poses a high risk for malarial infections. What important information should the nurse teach

her regarding prophylactic therapy with chloroquine for her child?

The medication is better absorbed and has fewer adverse effects if taken on an empty stomach. b. This drug should be started 3 weeks before exposure but can be discontinued after the patient leaves the area. c. This drug is to be taken only when mosquito bites are seen, because it can have toxic effects if taken unnecessarily. d. This drug is usually started 1 week before exposure to malarial areas and continued for 4 weeks after the patient leaves the area. a.

ANS: D

Prophylaxis of malaria with chloroquine for children is usually started 1 week before exposure and continued for 4 weeks after the patient leaves the area. The medication should be taken with food to lessen gastrointestinal upset.

DIF: Cognitive Level: Application 5. Which drug is used for the treatment of Pneumocystis jirovecii pneumonia in late-stage human immunodeficiency virus infection? a. iodoquinol b. pentamidine c. praziquantel (Biltricide) d. metronidazole (Flagyl®) ANS: B

Pentamidine is used for the treatment of pneumonia caused by P. jirovecii.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. A patient is prescribed metronidazole (Flagyl) to treat the most common intestinal protozoal infection, caused by Giardia lamblia.

What important information should the nurse give the patient about using this drug? a. The urine may become dilute and pale during therapy. b. Taking the medications with food reduces gastrointestinal upset. c. The medication should be taken on an empty stomach. d. The drug may be discontinued once the diarrhea subsides.

ANS: B

Antiprotozoal drugs should be taken with food to reduce gastrointestinal upset. These drugs may cause the urine to turn dark and should be administered for the prescribed length of time to ensure complete eradication of the infection.

DIF: Cognitive Level: Application 7. A patient is prescribed anthelmintic therapy. Which adverse effect should the nurse tell this patient about? a. Nervousness b. Nausea c. Decreased appetite d. Constipation ANS: B

Patients on anthelmintic therapy should be taught that nausea is one of the adverse events that may occur.

DIF: Cognitive Level: Comprehension 8. Which statement about anthelmintic therapy is true? a. Anthelmintics may cause severe drowsiness. b. Anthelmintics are very specific in their actions. c. Anthelmintics are effective against broad classes of infestations. d. Anthelmintics are used to treat protozoal infections, such as intestinal amoebiasis.

ANS: B

Anthelmintics are very specific in their actions; the cause of the infestation should be identified before beginning treatment.

DIF: Cognitive Level: Comprehension 9. A patient is travelling to a country where malaria is endemic. Which antimalarial drug will a health care provider likely recommend

as prophylaxis? a. quinine sulphate b. chloroquine diphosphate c. mefloquine hydrochloride d. primaquine phosphate ANS: C

Mefloquine hydrochloride (Lariam®) is commonly used prophylactically by travellers to prevent malarial infection while visiting malaria-endemic areas.

DIF: Cognitive Level: Comprehension COMPLETION 1. Certain antimalarial drugs work only during specific phases of the parasite’s life cycle. Drugs that work in the “tissue” phase are

known as

drugs.

ANS: exoerythrocytic-phase DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 49: Anti-inflammatory and Antigout Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which types of effects are possible therapeutic effects of nonsteroidal anti-inflammatory drugs (NSAIDs)? a. Anxiolytic effects b. Diuretic effects c. Antipyretic effects d. Antimicrobial effects ANS: C

NSAIDs have antipyretic effects but not the other effects listed.

DIF: Cognitive Level: Knowledge 2. A 75-year-old female patient has been given naproxen sodium (Aleve®) for the treatment of rheumatoid arthritis. Which type of

medication will have a possible interaction with this NSAID? a. Antibiotics b. Decongestants c. Anticoagulants d. Antihistamines ANS: C

Anticoagulants taken with NSAIDs may cause increased bleeding tendencies because of platelet inhibition and hypoprothrombinemia.

DIF: Cognitive Level: Comprehension 3. An older adult patient tells the nurse that he uses acetylsalicylic acid for “anything that ails me.” What are the most common signs

of chronic salicylate intoxication in adults? a. Photosensitivity and nervousness b. Tinnitus and hearing loss c. Acute gastrointestinal bleeding and anorexia d. Hyperventilation and central nervous system (CNS) effects ANS: B

The most frequent manifestations of chronic intoxication in adults are tinnitus and hearing loss. Hyperventilation and CNS effects are manifestations of chronic intoxication in children.

DIF: Cognitive Level: Comprehension 4. A patient is being treated with allopurinol (Zyloprim®) for gout. Which therapeutic result should the nurse monitor for? a. Decreased uric acid levels b. Adequate prothrombin time c. Increased white blood cell count d. Increased hemoglobin and hematocrit levels ANS: A

Treatment of gout with allopurinol should result in a decrease in uric acid levels.

DIF: Cognitive Level: Application 5. A patient is prescribed colchicine for the treatment of gout. What important information should the nurse give the patient about this

drug?

Fluids should be restricted while on colchicine therapy.

Colchicine should be taken with meals.

The drug should be discontinued when symptoms are reduced.

Report to the health care provider the occurrence of increased pain, blood in the urine, or excessive fatigue.

a. b. c. d.

ANS: D

Colchicine may cause renal effects; therefore, these symptoms must be reported immediately. Colchicine should be taken on an empty stomach for better absorption, and fluids should be increased unless contraindicated. Patients should not discontinue the drug on their own; they should seek advice from the physician regarding discontinuation of the medication.

DIF: Cognitive Level: Analysis 6. A 55-year-old female patient is being administered ketorolac intramuscularly. What information should the nurse give this patient

about this drug? a. Laboratory work will be monitored weekly. b. The medication is given slowly intramuscularly into a large muscle mass. c. The medication is given subcutaneously, and the sites are rotated. d. Therapeutic blood levels will occur within a month of therapy.

ANS: B

With ketorolac, dosing is not to exceed a 5- to 7-day time period with either the oral or intramuscular dosage forms. Administer intramuscular injections slowly into a large muscle mass. Laboratory work are monitored monthly, and patients should be told that therapeutic blood levels may not occur until after 3 to 4 months of therapy.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. A 6-year-old patient has a fever of 39.5C during a bout of chicken pox. His mother asks the nurse for advice to help reduce his

fever. The nurse will likely suggest which medication? a. acetylsalicylic acid (Aspirin) b. ketorolac (Toradol®) c. indomethacin d. ibuprofen (Motrin®) ANS: D

Ibuprofen is available in many preparations as an over-the-counter antipyretic. The nurse should teach parents that Aspirin inappropriate for children younger than age 12 years because of the risk for Reye’s syndrome. Ketorolac and indomethacin are prescription medications that are not used as antipyretics.

DIF: Cognitive Level: Application 8. A patient has used buffered acetylsalicylic acid (Aspirin) for several years as treatment for osteoarthritis. However, the patient’s

symptoms are worsening, and now something stronger is needed. The physician prescribes an NSAID and misoprostol. The patient asks the nurse why two pills now have to be taken for the arthritis. Which is the nurse’s best response to the patient? a. Misoprostol will also reduce the symptoms of arthritis. b. Misoprostol potentiates the action of the NSAID so that it will work better. c. Misoprostol reduces the mucous secretions in the stomach, which reduces gastric irritation. d. Misoprostol may help to prevent gastric ulcers that may occur when taking NSAIDs. ANS: D

Misoprostol inhibits gastric acid secretions and stimulates mucous secretions and has proved successful in preventing the gastric ulcers that may occur in patients taking NSAIDs. DIF: Cognitive Level: Analysis 9. A patient who has a history of coronary artery disease has been instructed to take one 81-mg tablet of acetylsalicylic acid (Aspirin)

each day. What is the purpose of this dose of acetylsalicylic acid?

To prevent fever To reduce inflammation To relieve pain To prevent thrombus formation

a. b. c. d.

ANS: D

Acetylsalicylic acid can reduce platelet aggregation. A daily Aspirin tablet (81 mg or 325 mg) is now routinely recommended as prophylactic therapy for adults who have strong risk factors for developing coronary artery disease or stroke, even if they have no prior history of such an event. The 81-mg tablets (traditionally thought of as “children’s” Aspirin) and the 325-mg pills appear to be equally beneficial for the prevention of thrombotic events.

DIF: Cognitive Level: Application 10. Which natural health product is sometimes used to treat the pain of osteoarthritis? a. St. John’s wort b. Ginger c. Glucosamine d. Dandelion root ANS: C

Glucosamine and chondroitin are often used in combination, although each is also used individually to treat pain from osteoarthritis.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. Which are contraindications to the use of NSAIDs? (Select all that apply.) a. Rhinitis b. Arthralgia c. Peptic ulcer disease d. Breastfeeding e. Neuropathy f. Epistaxis g. Pericarditis ANS: A, C, D, F

Contraindications to NSAIDs include a known drug allergy and conditions that place the patient at bleeding risk, such as rhinitis (risk of epistaxis, or nosebleed) and peptic ulcer disease. NSAIDs are also not advised for mothers who are breastfeeding.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 50: Immunosuppressant Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. How is cyclosporine (Neoral®) usually given intravenously? a. In a single intravenous (IV) injectable form to minimize adverse effects b. Initiated by an oral test dose, then an IV infusion started after 2 hours c. Diluted and infused with an infusion pump d. Given as an IV bolus for the first dose, then with an infusion pump for following

doses ANS: C

With intravenously administered cyclosporine, the dose must be diluted as recommended by the manufacturer and given according to the standards of care and institutional policy. Always infuse using an infusion pump and over the recommended period. Monitor the patient closely during the infusion, especially during the first 30 minutes, for any allergic reactions. Cyclosporine is not given by using an IV bolus or with an oral test dose.

DIF: Cognitive Level: Application 2. A patient about to undergo kidney transplantation will be given azathioprine (Imuran®) to minimize organ rejection. What

important preoperative information should the nurse give the patient about this drug? a. Before the surgery, the medication will be administered orally. b. The oral doses should be taken 1 hour before meals, to maximize absorption. c. Blood pressure should be monitored for the development of moderate hypertension. d. For several days before surgery, the patient will need to visit the office daily for intramuscular (IM) injections.

ANS: A

Several days before transplant surgery, immunosuppressant drugs should be taken by the oral route, if possible, to avoid IM injections and the risk of infections caused by them.

DIF: Cognitive Level: Application 3. A female patient has started azathioprine (Imuran®) therapy in preparation for her kidney transplant surgery. Which expected

adverse effect of azathioprine therapy should the nurse tell the patient about? a. Tremors b. Diarrhea c. Leukopenia d. Fluid retention ANS: C

Leukopenia is an expected adverse effect of azathioprine therapy.

DIF: Cognitive Level: Knowledge 4. Which drug may increase the action of azathioprine (Imuran)? a. nafcillin b. rifampin c. allopurinol d. phenobarbital ANS: C

Allopurinol may increase the action of azathioprine.

DIF: Cognitive Level: Knowledge 5. When providing patient education related to immunosuppressive therapy, which items of information will the nurse include? a. If a dose is missed, double the next scheduled dose. b. Take the medication with any type of juice or water. c. It is important to have a 1-week supply of medication. d. If the blister-pack pills have an odour, discard them.

ANS: C

Tell the patient about the complexity of dosing and about the need to always have a 1-week supply of medication available so that there is never a risk of running out. If a dose is missed, the patient is to contact the health care provider. The medication cannot be taken with grapefruit juice. Pills in blister-packs normally have a characteristic odour.

DIF: Cognitive Level: Application 6. Which immunosuppressant is the only one currently indicated for the treatment of relapsing forms of multiple sclerosis? a. azathioprine (Imuran) b. fingolimod hydrochloride (Gilenya®) c. mycophenolate mofetil (CellCept®) d. sirolimus (Rapamune®) ANS: B

Fingolimod hydrochloride (Gilenya), a new sphingosine 1-phosphate receptor modulator, failed as an antirejection drug but was approved for treating multiple sclerosis. It is the only oral drug for relapsing forms of multiple sclerosis.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. The nurse will monitor which laboratory result when the patient is receiving an infusion of cyclosporine? a. Hemoglobin b. Hematocrit c. Alanine aminotransferase (ALT) d. Bilirubin ANS: C

The nurse needs to closely monitor the patient’s blood urea nitrogen, L-lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and ALT during therapy, as ordered, to detect possible kidney and liver impairment.

DIF: Cognitive Level: Analysis 8. What does the nurse tell a patient who is to take sirolimus (Rapamune®) orally? a. “Take the medication on an empty stomach.” b. “It is all right to dilute the medication in a Styrofoam cup.” c. “Change the time that you take the medication each day by 1 hour.” d. “This drug has a prolonged onset of action, so it is important to take it with your

midday meal.”

ANS: A

Oral dosages of tacrolimus are given on an empty stomach. As with cyclosporine, oral doses of tacrolimus are not to be put in Styrofoam cups or containers. Inform the patient to avoid the consumption of grapefruit within 2 hours of taking the drug. Both sirolimus and tacrolimus have long half-lives, so toxicity is an added concern because of possible cumulative effects.

DIF: Cognitive Level: Comprehension 9. Which statement is true in regard to cyclosporine? a. Any leftover solution should be refrigerated. b. It should be mixed with water only. c. The use of Styrofoam containers should be avoided. d. It can be given only intravenously.

ANS: C

Styrofoam containers should be avoided because the drug has been found to adhere to the inside of the container. Oral solutions may be mixed with chocolate milk, regular milk, or orange juice and served at room temperature. After the solution is mixed, the patient must drink it immediately. Oral solutions of cyclosporine should not be refrigerated. Cyclosporine can be given orally or intravenously.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 51: Immunizing Drugs and Pandemic Preparedness Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Two patients arrive at the clinic: a young boy with sickle-cell anemia and a 57-year-old woman with early-stage Hodgkin’s disease.

Both patients require the same vaccine. What vaccine do they require? a. Bacillus Calmette-Guérin (BCG) vaccine b. Tetanus, diphtheria, and pertussis vaccine c. Hepatitis B virus vaccine, inactivated d. Haemophilus influenzae type b conjugate vaccine ANS: D

H. influenzae type b conjugate vaccine is usually given to patients with sickle-cell anemia (an immunodeficiency syndrome) and with Hodgkin’s disease.

DIF: Cognitive Level: Analysis 2. Which type of immunity occurs when the body is exposed to a relatively harmless form of an antigen that imprints this information

on the body’s memory bank and stimulates the body’s defences to resist any subsequent exposures? a. Active immunity b. Attenuating immunity c. Naturally acquired passive immunity d. Artificially acquired passive immunity ANS: A

Active immunity causes an antigen–antibody response and stimulates the body’s defences to resist any subsequent exposures.

DIF: Cognitive Level: Knowledge 3. A 45-year-old male has had a series of equine-derived immunizing drugs in preparation for a trip to an undeveloped country. His

wife brings him to the emergency department because he has developed edema of the face, tongue, and throat and is having trouble breathing. What is he experiencing? a. Serum sickness b. Cross-sensitivity c. An adverse effect d. An anaphylactic reaction ANS: A

Serum sickness sometimes occurs after repeated injections of equine-derived immunizing agents and is characterized by edema of the face, tongue, and throat; rash; urticaria; fever; flushing; dyspnea; and other conditions.

DIF: Cognitive Level: Application 4. A 12-month-old infant has received measles, mumps, and rubella virus (MMR) vaccine. Her mother calls the clinic to ask how she

can help her infant to “feel better.” What is the nurse’s best suggestion to the mother?

Apply an ice pack to the injection site.

Give the infant pediatric Aspirin for the pain.

Apply warm compresses to the injection site.

Observe the site for further swelling and redness.

a. b. c. d.

ANS: C

Applying warm compresses to the injection site and using acetaminophen (not Aspirin, which carries the risk of Reye’s syndrome) should help to relieve the infant’s discomfort. Contraindications to the administration of immunizing agents include active infections, pregnancy, febrile illnesses, and a history of reactions to or serious adverse effects of the drugs. Patients who are already immunosuppressed should not be given these agents.

DIF: Cognitive Level: Application | Cognitive Level: Comprehension 5. A health care employee has had a needle-stick injury from a contaminated needle. Which drug is used to provide passive immunity

to hepatitis B infection?

Haemophilus influenzae type b (HIB) vaccine Varicella zoster immune globulin (VariZIG®) Hepatitis B immunoglobulin (H-BIG) HB vaccine inactivated (Recombivax HB®)

a. b. c. d.

ANS: C

H-BIG provides passive immunity in the prophylaxis and post exposure treatment of people exposed to hepatitis B virus or hepatitis B surface antigen–positive materials, such as blood, plasma, or serum. Recombivax HB promotes active immunity to hepatitis B infection in people considered at high risk for potential exposure to the virus. HIB vaccine is given to infants to prevent Haemophilus influenzae type B, and varicella zoster immune globulin is given for exposure to chicken pox.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. At what age is the first dose of DTaP-IPV (diphtheria, tetanus, and acellular pertussis [DTaP] and inactivated polio vaccine [IPV])

given?

1 month 2 months 4 months 6 months

a. b. c. d.

ANS: B

The first dose of this series is given at the age of 2 months.

DIF: Cognitive Level: Analysis 7. A 14-month-old patient is to be vaccinated with measles, mumps, rubella, and varicella (MMRV) vaccine. Which is a true

statement about this vaccine? a. It is given yearly to provide ongoing immunization. b. It is given by deep intramuscular injection. c. It is given by subcutaneous injection. d. The patient will need a total of three injections by 18 months of age.

ANS: C

Measles vaccine is available as measles, mumps, and rubella (MMR) vaccine or as MMRV vaccine. Children receive a single dose subcutaneously at 12 to 15 months of age and a second dose at 18 months of age or at 4 to 6 years of age.

DIF: Cognitive Level: Comprehension 8. The human papilloma virus (HPV) vaccine can be given to males and females beginning at what age? a. 3 years b. 6 years c. 9 years d. 12 years ANS: C

The HPV vaccine is recommended to be given to females and males beginning at 9 years of age and before the onset of sexual intercourse.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. Active immunizations are usually contraindicated in which patients? (Select all that apply.) a. Pregnant women b. Patients with active infections c. Infants under the age of 1 year d. Older adults e. Patients who are immunosuppressed f. Patients receiving cancer chemotherapy g. Patients with acquired immunodeficiency syndrome (AIDS) ANS: A, B, E, F, G

Contraindications to the administration of immunizing drugs include pregnancy, active infections, febrile illnesses, and a history of reactions to or serious adverse effects from the drugs. Those who are already immunosuppressed (patients with AIDS and patients receiving chemotherapy) should not be given these drugs. Infants under the age of 1 year and older adults may receive immunizing drugs.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 52: Antineoplastic Drugs Part 1: Cancer Overview and Cell Cycle–Specific Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. One patient has cancer of the bone; a second patient has cancer in the connective tissues of the leg muscles; and a third patient has

cancer in the vascular tissues. Which type of tumour is common to these patients? a. Sarcoma b. Leukemia c. Carcinoma d. Lymphoma ANS: A

Sarcoma, a malignant tumour that arises from connective tissues, is common to these three patients. Connective tissue can be found in bone, cartilage, muscle, blood, lymphatic, and vascular tissue.

DIF: Cognitive Level: Comprehension 2. What is the nurse’s best immediate response if extravasation of an antineoplastic drug occurs during intravenous (IV)

administration? a. Reduction of the infusion rate b. Discontinuation of the IV and application of warm compresses c. Changing the infusion to normal saline and injecting the area with hydrocortisone d. Stopping the infusion immediately but leaving the IV tube in place for administration of an antidote ANS: D

If extravasation is suspected, administration of the drug must be stopped immediately, but the IV tube should be left in place and the appropriate antidote instilled through the existing IV tube. Agency protocol should be followed.

DIF: Cognitive Level: Analysis 3. A patient is receiving a third course of 5-fluorouracil therapy and knows that stomatitis is a potential adverse effect of

antineoplastic therapy. What important information should the nurse give the patient about this adverse effect? a. Aspirin should be taken to prevent development of stomatitis. b. The patient should watch for and report black tarry stools immediately. c. The patient should increase the intake of foods containing fibre and citric acid. d. The patient should examine the mouth daily for bleeding, white spots, and ulcerations.

ANS: D

The symptoms of stomatitis consist of bleeding, white spots, and ulcerations of the mouth, all of which need to be reported to the health care provider immediately.

Assessing stools is important, but abnormal stools are not related to stomatitis. Aspirin should not be used during this therapy.

Patients on 5-fluorouracil should avoid consuming foods high in fibre, foods containing citric acid, and hot or cold foods.

DIF: Cognitive Level: Application 4. A patient has had a first course of antineoplastic therapy and is experiencing gastrointestinal adverse effects, including anorexia

and nausea. Which is an appropriate goal for the patient dealing with these adverse effects?

To eat three balanced meals a day within 4 days To return to the normal eating pattern within 1 month To maintain normal weight by consuming healthy snacks as tolerated To maintain a diet of six frequent feedings with a nutritional supplement as a snack for 2 weeks

a. b. c. d.

ANS: D

Small frequent feedings and nutritional supplementation are the ideal means of improving nutrition during antineoplastic therapy.

DIF: Cognitive Level: Analysis 5. A patient who has been on methotrexate (Metoject®) therapy has developed a fever. Her husband asks whether she can take

ibuprofen for the fever. What is the nurse’s best answer to the husband’s question?

Ibuprofen aggravates stomatitis.

Ibuprofen masks signs of infection.

Ibuprofen can lead to methotrexate toxicity.

Ibuprofen will cause no problems for the patient who is on methotrexate.

a. b. c. d.

ANS: C

Taking nonsteroidal anti-inflammatory drugs (NSAIDs) can lead to methotrexate toxicity by displacing the drug from plasma proteins.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. A patient is at risk for infection due to neutropenic effects of antineoplastic drug therapy. Which statement by the patient indicates

the need for further teaching about this care?

“I can’t wait to go to the buffet restaurant for supper.”

“I should eat plenty of fresh fruit to improve my nutrition.”

“I should report a sore throat, cough, or low-grade temperature.”

“It is important for both my family and me to practise good hand washing.”

a. b. c. d.

ANS: A

Patients who are neutropenic are susceptible to infections and should adhere to a low-microbe diet by washing fresh fruits and vegetables and making sure foods are well cooked.

DIF: Cognitive Level: Analysis 7. Which is a true statement about nadir? a. It is a therapeutic effect of radiation. b. It is the lowest level reached by bone marrow cells after chemotherapy. c. It occurs 30 days after chemotherapy treatment. d. Antiemetics will prevent it.

ANS: B

The lowest level reached by bone marrow cells after chemotherapy or radiation therapy is known as nadir. It usually occurs within 10 to 28 days following treatment.

DIF: Cognitive Level: Comprehension 8. Which unique adverse effect is characteristic of the antineoplastic enzymes, such as asparaginase (Kidrolase®)? a. Hepatotoxicity b. Impaired pancreatic function c. Nephrotoxicity d. Hypoglycemia ANS: B

Impaired pancreatic function can result from antineoplastic enzymes; this can lead to hyperglycemia and severe or fatal pancreatitis.

DIF: Cognitive Level: Comprehension 9. Leucovorin rescue, during which leucovorin enters and “rescues” normal cells from the toxic effects of antineoplastic agents, is

useful during therapy with which drug? a. cisplatin b. methotrexate (Metoject®) c. mercaptopurine (6-MP) d. cyclophosphamide ANS: B

Leucovorin rescue is useful during therapy with folate antagonists such as methotrexate.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. A patient is receiving the antineoplastic drug methotrexate (Metoject). What important instructions should the nurse give the

patient in regard to this drug? (Select all that apply.)

Report black, tarry stools.

Perform oral care with mouthwash.

Do not expect hair loss from this drug.

Prepare for hair loss by deciding whether to use a wig, a hairpiece, or a hat.

Avoid eating raw seafood.

Discontinue contraceptive measures as soon as chemotherapy is completed.

Avoid foods that are hot or that are rough in texture.

Avoid exposure to the sun.

a. b. c. d. e. f. g. h.

ANS: A, D, E, G, H

Patients who are taking methotrexate should report black, tarry stools; prepare for hair loss by deciding whether to use a wig, a hairpiece, or a hat; avoid raw seafood and foods that are hot or rough in texture; and avoid exposure to the sun.

Mouthwash can be irritating to the oral mucosa. Contraceptive measures should be continued for up to 8 weeks after therapy, to minimize possible teratogenic effects or fetal death. Hair loss is an expected adverse effect of this therapy.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 53: Antineoplastic Drugs Part 2: Cell Cycle–Nonspecific and Miscellaneous Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient is receiving bicalutamide. Which nursing diagnosis is appropriate for this hormonal antineoplastic drug? a. Ineffective tissue perfusion related to cardiotoxicity b. Disturbed sensory perception related to ototoxicity c. Activity intolerance related to anemia-induced fatigue d. Impaired urinary elimination pattern related to hyperuricemia ANS: C

Activity intolerance related to anemia is causing fatigue. Other adverse effects include peripheral edema, pain, hot flushes, gynecomastia, nausea, and diarrhea.

DIF: Cognitive Level: Application 2. Large, cumulative doses of doxorubicin (Adriamycin®), a cytotoxic antibiotic, are known to cause which adverse effect? a. Severe emesis b. Cardiomyopathy c. Lung disease d. Nephrotoxicity ANS: B

Severe cases of cardiomyopathy are associated with large, cumulative doses of doxorubicin. Routine monitoring of cardiac ejection fraction is needed.

DIF: Cognitive Level: Comprehension 3. Imatinib (Gleevec®) is indicated as treatment for which type of cancer? a. Chronic myeloid leukemia b. Acute lymphocytic leukemia c. Chronic lymphocytic leukemia d. Acute myeloid leukemia ANS: A

Imatinib is indicated for the treatment of chronic myeloid leukemia (CML), particularly after failure of interferon alfa therapy.

Imatinib is one of the newest available antineoplastic drugs.

DIF: Cognitive Level: Comprehension 4. Alkylating drugs can have a profound effect on the patient’s nutritional status. Which laboratory result will assist the nurse in

determining the impact the drug has had on the patient’s nutritional status? a. White blood cell (WBC) count b. Platelet count c. Alanine aminotransferase (ALT) levels d. Serum albumin levels ANS: D

Serum levels of albumin and protein should be noted, as should fluid and electrolyte levels.

DIF: Cognitive Level: Comprehension 5. Which is an adverse effect of estrogen receptor antagonists? a. Constipation and urinary changes b. Confusion and tachycardia c. Hot flashes and pharyngitis d. Weakness and hypoventilation ANS: C

Adverse effects of estrogen receptor antagonists include vasodilation, pain, headache, hot flushes, nausea, vomiting, and pharyngitis.

DIF: Cognitive Level: Comprehension 6. A patient is receiving alkylating drugs. Which signs may indicate an oncological emergency? a. Cracked lips b. Temperature of 38.8°C c. Diarrhea d. Dry cough ANS: B

Fever and chills with a temperature of 38.1°C or higher indicate an oncological emergency, and the physician should be contacted immediately. The physician should also be contacted immediately in the case of sores or cracks in the mouth, diarrhea that lasts more than 2 or 3 days, and a persistent cough.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. Patients receiving antineoplastic drugs should be advised to take which medication for minor aches and pains? a. ibuprofen b. acetylsalicylic acid c. acetaminophen d. naproxen ANS: C

Acetaminophen, which has no effect on bleeding. Patients receiving chemotherapy drugs should avoid nonsteroidal anti-inflammatory drugs such as ibuprofen, acetylsalicylic acid, and naproxen, due to the increased risk of bleeding.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 54: Biological Response–Modifying Drugs and Antirheumatic Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient is receiving interferon therapy. What expected adverse effect should the nurse tell this patient about? a. Anemia b. Increased appetite c. Constipation d. Flulike effects ANS: D

Patients who receive interferon therapy may experience flulike effects, fatigue, anorexia, dizziness, nausea, vomiting, and diarrhea.

Patients on interferon therapy will not experience anemia, increased appetite, or constipation.

DIF: Cognitive Level: Comprehension 2. Lymphokine-activated killer (LAK) cells, which multiply as a result of interleukin therapy, do what? a. They directly inhibit deoxyribonucleic acid (DNA) and protein synthesis. b. They destroy cancer cells and ignore normal cells. c. They destroy cancer cells by destroying all types of cells. d. They prevent virus replication and prevent viruses from penetrating healthy cells.

ANS: B

LAK cells recognize cancer cells, ignore normal cells, and destroy the cancer cells on contact, thus avoiding the toxic effects of antineoplastic drugs.

DIF: Cognitive Level: Knowledge 3. Capillary leak syndrome during interleukin therapy may result in which problem? a. Renal failure b. Asthma c. Ecchymosis d. Heart failure ANS: D

When capillary leak syndrome occurs, the capillaries lose their ability to retain vital colloids, and these substances migrate into the surrounding tissues, resulting in massive fluid retention. As a result, heart failure, myocardial infarction, and dysrhythmias may occur.

DIF: Cognitive Level: Comprehension 4. Which is an effect of colony-stimulating factors (CSFs)? a. Multiplication of T cells b. Decreased neutrophil counts c. Increased cytotoxic activity of natural killer (NK) cells d. Stimulation of certain immune cells ANS: D

CSFs prevent the decrease of neutrophil counts and stimulate certain immune cells (macrophages and granulocytes) to destroy or inhibit the growth of tumour cells and virus- or fungus-infected cells.

DIF: Cognitive Level: Knowledge 5. Which is true in regard to therapy with interferon drugs? a. Dosages should be administered in the morning. b. The patient should be encouraged to drink up to 2 to 3 L of fluids per day while c. d.

taking these medications.

To minimize allergic reactions, oral dosing is preferred.

Shake the drug vial well before drawing up a dose.

ANS: B

Encourage the patient to drink fluids up to 2 to 3 L/day (unless contraindicated) to promote excretion of the by-products of cellular breakdown and to maintain cellular hydration. Interferon has a fatiguing effect and therefore should not be taken in the morning.

Interferon is given either intramuscularly or subcutaneously. The drug vial should be swirled, not shaken.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. When providing patient education related to biological response–modifying drugs, which is important information to give the

patient?

Interleukins cannot be self-administered.

Any temperature higher than 39.5°C needs to be reported to the health care provider. c. Pregnancy should be avoided for 6 months. d. Adverse effects usually disappear within 72 to 96 hours after therapy is discontinued. a. b.

ANS: D

It is important to inform the patient that adverse effects associated with biological response–modifying drugs usually disappear within 72 to 96 hours after therapy is discontinued. Interleukins can be self-administered. Any temperature higher than 38.1°C need to be reported, and pregnancy should be avoided for at least 2 years.

DIF: Cognitive Level: Application 7. A patient with end-stage renal failure has been admitted to hospital for severe anemia but is refusing blood transfusions. Which

drugs will likely be used to stimulate the production of red blood cells (RBCs)? a. filgrastim (Neupogen®) b. interferon c. epoetin alfa (Eprex®) d. sargramostim (Leukine®) ANS: C

Epoetin alfa is a colony-stimulating factor that is responsible for erythropoiesis, or the formation of RBCs. DIF: Cognitive Level: Comprehension 8. A patient is to take antineoplastic therapy with monoclonal antibodies such as rituximab (Rituxan®). The nurse should carefully

assess this patient for which condition? a. Anorexia b. Neuropathy c. Respiratory problems d. Heart failure ANS: C

Monoclonal antibodies such as rituximab may cause respiratory problems.

DIF: Cognitive Level: Application 9. Which medication is indicated in the treatment of rheumatoid arthritis? a. thalidomide (Thalomid®) b. tretinoin (Vesanoid®) c. bacillus Calmette-Guérin (BCG) vaccine (Immuncyst®) d. etanercept (Enbrel®) ANS: D

Etanercept is a tumour necrosis factor receptor antagonist and is indicated in the treatment of rheumatoid arthritis.

DIF: Cognitive Level: Comprehension 10. A female patient is being treated with biological response–modifying drugs. After the completion of her treatment, she should be

cautioned to avoid pregnancy for what time period? a. 6 months b. 12 months c. 18 months d. 24 months ANS: D

Contraception should be used for up to 24 months following the completion of treatment with a biological response–modifying drug.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 55: Anemia Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient is to receive iron dextran (Dexiron®) injections. What should the nurse use to administer this medication? a. Intravenous (IV) injection mixed with 5% dextrose b. Intramuscular (IM) injection in the upper arm c. IM injection using the Z-track method d. Subcutaneous injection with a half-inch, 29-gauge needle ANS: C

With the Z-track method, IM iron should be given deep into a large muscle mass.

DIF: Cognitive Level: Application 2. A patient is prescribed oral iron supplementation. What should the nurse tell the patient to do while on this treatment? a. Take the iron tablets with milk or antacids. b. Crush the pills as needed to help swallowing. c. Avoid reclining positions for up to 30 minutes after taking the drug. d. You do not need to eat foods that are high in iron, such as meat, dark green leafy

vegetables, and dried beans.

ANS: C

To prevent esophageal irritation or corrosion, patients on an iron supplement should avoid reclining positions for 15 to 30 minutes after taking the drug. Antacids and milk may cause decreased iron absorption; iron tablets should be taken whole and not crushed; and clients should continue to eat foods high in iron.

DIF: Cognitive Level: Application 3. What may occur as a result of therapy with iron preparations? a. Palpitations b. Dizziness and syncope c. Black and red tarry stools d. Yellow discoloration of the urine ANS: C

Black and red tarry stools and other gastrointestinal disturbances may occur as a result of taking iron preparations.

DIF: Cognitive Level: Comprehension 4. A patient has been taking iron supplements for anemia for 4 weeks. Which therapeutic response should the patient be taught to

watch for? a. Decreased weight b. Absence of fatigue c. Decreased palpitations d. Decreased visual disturbances ANS: B

Absence of fatigue, increased activity tolerance and well-being, and increased nutritional status are therapeutic responses to iron supplementation.

DIF: Cognitive Level: Application 5. Before administering iron supplements, the nurse should assess for which contraindication? a. Poor nutrition b. Hemolytic anemia c. Weakness and fatigue d. Decreased hemoglobin ANS: B

Hemolytic anemia is a contraindication to the use of iron supplements. Poor nutrition, weakness and fatigue, and decreased hemoglobin are related to iron deficiency anemia.

DIF: Cognitive Level: Analysis 6. When ferrous fumarate (Palafer®) is given to infants, what is the onset of action time period? a. 10 to 12 hours b. 24 to 48 hours c. 3 to 10 days d. 14 to 21 days ANS: C

The onset of action for ferrous fumarate is 3 to 10 days.

DIF: Cognitive Level: Comprehension

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. The nurse is teaching a patient about the oral administration of iron preparations. What will increase the absorption of iron? a. Milk b. Yogourt c. Antacids d. Ascorbic acid ANS: D

Ascorbic acid enhances the absorption of oral iron. Antacids, milk, and yogourt may interfere with absorption.

DIF: Cognitive Level: Comprehension 8. A patient is taking a liquid form of an iron product. What should the nurse tell the patient to do when taking this product? a. Follow the dose with milk. b. Take the medication through a plastic straw. c. Mix the dose with juice and sip slowly. d. Drink the medication undiluted from a measured medicine cup.

ANS: B

Liquid oral forms of iron should be taken through a plastic straw to avoid discoloration of tooth enamel. Milk may decrease absorption. Because liquid iron can stain the teeth, the patient should not sip or drink it directly.

DIF: Cognitive Level: Comprehension 9. A woman is planning to become pregnant in the next year. To reduce the risk for fetal neural tube defects, she should ensure that

she receives adequate levels of what?

Vitamin B12 Vitamin C Iron Folic acid

a. b. c. d.

ANS: D

To reduce the risk for fetal neural tube defects, administration of folic acid is recommended to begin at least 1 month before pregnancy and to continue through early pregnancy.

DIF: Cognitive Level: Comprehension 10. The nurse is administering medications to a patient with a new diagnosis of anemia. Which is a true statement about treatment with

folic acid?

Folic acid is used to treat any type of anemia.

The cause of the anemia should be determined before treatment with folic acid.

Folic acid is used to treat pernicious anemia.

Folic acid is used to treat iron deficiency anemia.

a. b. c. d.

ANS: B

Folic acid should not be used to treat anemia until the underlying cause and type of anemia are identified. Administering folic acid to a patient with pernicious anemia may correct the hematological changes of anemia, but the symptoms of pernicious anemia (which is due to a vitamin B12 deficiency, not a folic acid deficiency) may be deceptively masked.

DIF: Cognitive Level: Application MULTIPLE RESPONSE 1. A patient will be taking oral iron supplements. Which statements should the nurse include when teaching this patient? (Select all

that apply.)

Take the iron tablets with an antacid.

Take the iron on an empty stomach 1 hour before meals.

Take the iron with meals.

Drink 250 mL of milk with each iron dose.

Taking iron supplements with orange juice enhances iron absorption.

Stools may become loose and light-coloured.

Stools may become black and tarry.

Iron tablets may be crushed to enhance iron absorption.

a. b. c. d. e. f. g. h.

ANS: C, E, G

Iron tablets should be taken with meals in order to reduce gastrointestinal distress, but antacids and milk interfere with absorption.

Stools may become black and tarry in patients who are on iron supplements. Tablets should be taken whole, not crushed, and the patient should be encouraged to eat foods high in iron. It is recommended to take oral iron with orange juice (because vitamin C helps the body to absorb more iron).

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 56: Dermatological Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A father calls the clinic because his son has head lice. He reports to the nurse that he has used “that special stuff you spray on to the

hair, but nothing is happening.” What should be the nurse’s first recommendation? a. Get a prescription for a second product, malathion. b. Add a lotion product that remains on the scalp for 8 hours. c. Use a nit comb to remove nits from the hair shafts. d. Comb through the hair with mineral oil to loosen the lice from the hair shafts.

ANS: C

Before another product is tried, the nurse should ensure that the father is performing the current product correctly. It is to be sprayed onto dry hair, massaged in, and left for 30 minutes. Then the dead lice are removed with a lice comb. Once the hair dries (8 hours), it is shampooed.

DIF: Cognitive Level: Analysis 2. A teenage boy is taking tretinoin (Rejuva-A®) for his acne. What important information should the nurse give him? a. He should avoid foods heavy in salt and oils. b. The drug may cause increased redness of the skin. c. He should use abrasive cleansers to remove old skin layers. d. Extremes of weather and sunlight should not bother him during therapy.

ANS: B

Tretinoin may cause increased skin redness and drying. Patients taking tretinoin should avoid weather extremes, ultraviolet (UV) light, and abrasive cleansers. Eating foods that are heavy in salt and oils is not a contraindication to this medication, although consumption of these types of foods is not good for one’s health.

DIF: Cognitive Level: Analysis 3. Which is a true statement regarding the dermis layer of the skin? a. The dermis does not have a direct blood supply. b. It forms the protective layer of the entire body. c. Outer dead cells contain a water-repellent protein known as keratin. d. It provides extra support with blood vessels, with nerves, and with lymphatic,

elastic, and connective tissues.

ANS: D

The dermis layer provides extra support and nourishment with the blood vessels, nerves, elastic tissue, lymphatic tissue, and connective tissue. The epidermis layer of the skin does not have a direct blood supply. It forms a protective layer for the entire body and has outer dead cells that contain a water-repellent protein known as keratin.

DIF: Cognitive Level: Knowledge 4. A patient is to receive a topical corticosteroid for the treatment of psoriasis. Which form is generally the most penetrating when

applied to the skin?

Gel Lotion Cream Ointment

a. b. c. d.

ANS: D

Ointments are generally the most penetrating vehicles for topical forms of corticosteroids.

DIF: Cognitive Level: Comprehension 5. A woman has suffered a second-degree burn on her arm and hand while cooking breakfast. After examination in the emergency

department, silver sulfadiazine (Flamazene®) is recommended for her burns. What important information should the nurse give the patient in regard to the application of this cream? a. The area should not be cleansed before reapplication. b. The cream should be massaged completely into the wound. c. A thick layer of the cream should be applied over the burned area, and the area should be left open. d. A thin layer of the cream should be applied with a sterile gloved hand to debrided, clean areas.

ANS: D

A layer 0.15 cm (1/16-inch) thick should be applied with a sterile, gloved hand to debrided, clean wounds.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

6. A patient is receiving treatment with minoxidil (Rogaine®) for thinning hair. What important information should the nurse give the

patient in regard to this treatment? a. The product is applied once daily, in the morning. b. Systemic absorption of topically applied minoxidil is rare. c. Results may be seen as soon as 2 weeks after beginning therapy. d. Systemic absorption may cause tachycardia, fluid retention, and weight gain.

ANS: D

Systemic absorption of minoxidil may cause tachycardia, fluid retention, and weight gain. Minoxidil is applied twice daily, in the morning and evening, Results may not be seen for 4 months after beginning therapy, and systemic effects may result due to absorption.

DIF: Cognitive Level: Application 7. Which medication is likely to be prescribed for a child with impetigo? a. minoxidil (Loniten®) b. nystatin (Flagylstatin®) c. acyclovir (Zovirax®) d. mupirocin (Bactroban®) ANS: D

Mupirocin is an antibacterial product available only by prescription. It is used on the skin for treatment of staphylococcal and streptococcal impetigo. Minoxidil (Loniten) is a vasodilating drug that is administered systemically to control hypertension.

Acyclovir is an antiviral drug, and nystatin is an antifungal drug.

DIF: Cognitive Level: Comprehension 8. A 55-year-old obese patient was diagnosed with candidiasis in the skin folds under her breasts. At a follow-up visit 2 months after

diagnosis, she reports that the candidiasis has returned. She tells the nurse that she applied the medicine for a week and then stopped because the itching went away and the cream was messy. What is the best information she can give this patient in regard to the patient’s fungal infection? a. Fungal infections often require prolonged therapy. b. Fungal infections usually subside in a week or so; the patient must have caught a new infection. c. If the cream is messy, the patient should apply a dressing. d. This infection will probably never be cured.

ANS: A

Topical fungal infections are difficult to treat and may require prolonged therapy of several weeks to even a year. Occlusive dressings should not be applied unless recommended by the medication’s manufacturer.

DIF: Cognitive Level: Application 9. Which medication is not to be used during pregnancy? a. clindamycin b. isotretinoin c. ciclopirox d. clotrimazole ANS: B

Isotretinoin is one of relatively few acne medications that are not to be used during pregnancy. This means that it is a proven human teratogen, or a chemical that is known to induce birth defects. Clindamycin, ciclopirox, and clotrimazole are all safe to use during pregnancy.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. Which are true statements regarding topical dermatological drugs? (Select all that apply.) a. Lotion should be applied liberally to affected sites. b. Lotion should be applied sparingly to affected areas. c. Affected areas should be covered with occlusive dressings. d. Exposure to sunlight should be avoided by using a sunscreen. e. Exposure to sunlight helps the skin by drying the affected areas. f. The use of tanning beds should be avoided. g. Treatment should be discontinued when skin condition improves.

ANS: B, D, F

Correct actions for the use of topical dermatological drugs for acne include applying lotions sparingly to affected areas, avoiding weather extremes and UV radiation, and avoiding abrasive cleansers. Applying lotion liberally to affected sites, covering affected areas with occlusive dressings, exposing the skin to sunlight to dry the affected areas, and discontinuing treatment when the skin’s condition improves are incorrect practices and may cause harm to the skin.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 57: Ophthalmic Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which drug is used to reduce intraocular pressure? a. cromolyn (Opticrom®) b. polypeptides c. osmotic diuretics d. hyperosmolar sodium chloride ANS: C

Drugs used to reduce intraocular pressure include osmotic diuretics.

DIF: Cognitive Level: Knowledge 2. Which condition is an indication for the use of direct- and indirect-acting miotics? a. Ocular infections b. Blurred vision c. Open-angle glaucoma d. Cataracts ANS: C

Indications for the direct- and indirect-acting miotics include open-angle glaucoma, convergent strabismus, and ocular surgery.

DIF: Cognitive Level: Knowledge 3. A patient is being treated for uveitis. Which drug does the nurse expect that the patient is using? a. atropine sulphate b. epinephrine c. acetylcholine (Miochol E®) d. cyclopentolate hydrochloride solution (Cyclogyl®) ANS: A

Atropine is used to treat uveal tract inflammatory states. The usual dose for uveitis (inflammation of the choroid, iris, or ciliary body) in children and adults is 1 to 2 drops of the solution 2 to 3 times daily. The dose for an eye examination is 1 drop of solution, ideally 1 hour before the procedure.

DIF: Cognitive Level: Comprehension 4. Although dipivefrin has localized effects in the eye, it mimics the effects of the sympathetic nervous system neurotransmitters and

can cause systemic effects. Which systemic effects can occur?

Dizziness and syncope Bradycardia or heart block Dry mouth and constipation Increased heart rate or blood pressure

a. b. c. d.

ANS: D

Dipivefrin can cause increased cardiovascular effects, mimicking the sympathetic nervous system and resulting in increased heart rate or blood pressure.

DIF: Cognitive Level: Application 5. A patient has been taking the corticosteroid dexamethasone (AK Dex®) but has developed bacterial conjunctivitis. The patient is

given a prescription for gentamicin (Diogent®) ointment. What interaction is possible if the two drugs are used concurrently? a. The infection may become systemic. b. The effects of the gentamicin may become more potent. c. The corticosteroid may cause the overgrowth of nonsusceptible organisms. d. Immunosuppression may make elimination of the eye infection more difficult.

ANS: D

Concurrent use of corticosteroids, such as dexamethasone, and ophthalmic antibiotics may cause immunosuppression, which may make elimination of the eye infection more difficult.

DIF: Cognitive Level: Analysis 6. A patient has been prescribed timolol maleate (Timoptic®) eye drops. What should the nurse tell the patient to do to apply these eye

drops properly? a. Apply the drops into the conjunctival sac instead of directly onto the eye. b. Apply the drops directly to the cornea for the best effectiveness. c. Blot the eye with a tissue immediately after applying the drops. d. Gently touch the tip of the dropper to the eye surface before administering the drop.

ANS: A

All ophthalmic agents should be dropped into the conjunctival sac. Touching the eye with the tip of the dropper should be avoided to prevent contamination of the product. Excess eye medication should be removed only with a tissue.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. Which medication is used for local anaesthesia in preparation for ocular surgery? a. glycerin b. tetracaine (Minims®) c. acetazolamide d. apraclonidine 1% (Iopidine®) ANS: B

Tetracaine is used as a local anaesthetic for ocular surgery or other ocular procedures.

DIF: Cognitive Level: Comprehension 8. A patient with an eye injury requires an ocular examination to detect the presence of a foreign body. Which drug is used for this

examination? dapiprazole fluorescein sodium (AK-Fluor®) atropine sulphate cromolyn sodium

a. b. c. d.

ANS: B

Fluorescein sodium is an ophthalmic diagnostic dye used to identify corneal defects and to locate foreign objects in the eye.

DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. The nurse is administering ophthalmic drops. Identify the correct administration steps and place them in the correct order. Not all

steps will be used. (Select all that apply.) a. Thoroughly shake the solution. b. Close the eye tightly. c. Apply gentle pressure to the inner canthus for 1 minute. d. Place the drop into the conjunctival sac. e. Place the drops onto the cornea. f. Clean debris from the eye with a cotton-tipped applicator. g. Have the patient tilt the head back and look up at the ceiling. h. Remove excess medication gently from around the eyes.

ANS: A, C, D, G, H

Shake all solutions and mix the contents thoroughly. Do not use any solutions with particulate matter. One of the most important standards to follow during the instillation of drops or the application of ointment is to avoid touching the eye with the tip of the dropper or container, to prevent contamination of the product. Remove any excess medication promptly, and apply pressure to the inner canthus for 1 minute (or other specified duration). Applying pressure to the inner canthus after instilling the medication is needed to prevent or decrease systemic absorption and subsequent systemic adverse effects. Apply ointments and any other ophthalmic topical drug dosage form to the conjunctival sac and never directly onto the eye (cornea). To facilitate the instillation of ophthalmic medication, tilt the patient’s head back and have the patient look up at the ceiling during administration.

DIF: Cognitive Level: Analysis

Copyright © 2021, Elsevier Inc. All rights reserved.

2

Chapter 58: Otic Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which is a contraindication to the use of neomycin sulphate otic preparation? a. Escherichia coli infection b. Perforated eardrum c. Klebsiella infection d. Bacterial otitis ANS: B

Neomycin sulphate, polymyxin B sulphate, and hydrocortisone acetate otic preparations are contraindicated in patients with a perforated eardrum because of the risk for ototoxicity. Ciprofloxacin and dexamethasone can be used with perforated eardrums.

DIF: Cognitive Level: Comprehension 2. Hydrocortisone is commonly used in combination with otic antibiotics to do what? a. To soften and eliminate cerumen b. To reduce pain associated with ear infections c. To act as an antifungal agent in certain types of ear infections d. To reduce inflammation and itching associated with ear infections ANS: D

Hydrocortisone is commonly used in combination with otic antibiotics to reduce inflammation and itching associated with ear infections.

DIF: Cognitive Level: Comprehension 3. A 12-month-old infant is prescribed ear drops. What does the nurse direct the parents to do when they administer the drops? a. Pull the child’s pinna down and back. b. Pull the child’s pinna up and back. c. Pull the child’s pinna down and forward. d. Pull the child’s pinna up and forward.

ANS: A

The pinna should be pulled down and back when giving ear drops to children under 3 years of age.

DIF: Cognitive Level: Comprehension 4. Which describes the use of carbamide peroxide? a. To reduce inflammation b. To reduce production of cerumen c. To loosen the cerumen for easier removal d. To inhibit growth of microorganisms in the external canal ANS: C

Carbamide peroxide is a commonly used earwax emulsifier. It is combined with other components (e.g., glycerin, a lubricant) that help soften and lubricate cerumen prior to irrigation and make removal easier.

DIF: Cognitive Level: Comprehension 5. A patient is prescribed ear drops. What important information about the proper use of ear drops should the nurse give the patient? a. Cerumen should be removed with a cotton-tipped swab before the drops are b. c. d.

instilled.

The drops should be instilled while still cool from refrigeration.

The ear drops should be warmed to room temperature before instillation.

The ear lobe should be massaged after the instillation of medication.

ANS: C

Ear drops should be at room temperature; cold drops may cause dizziness or other discomfort. Before drops are instilled, cerumen should be removed by irrigation, not with cotton-tipped swabs. To encourage flow through the ear canal, the tragus area should be massaged after instillation.

DIF: Cognitive Level: Analysis 6. Which is a true statement about otitis media? a. It is treated with over-the-counter (OTC) medications. b. In children, it commonly follows a lower respiratory tract infection. c. Common symptoms include pain, fever, malaise, pressure, and a sensation of d.

fullness in the ears.

Hearing deficits are associated only with inner ear infections, not with otitis media.

ANS: C

Common symptoms of otitis media include pain, fever, malaise, pressure, and a sensation of fullness in the ears. Otitis media is rarely treated with OTC medications and commonly follows an upper respiratory tract infection in children. Hearing deficits may occur if therapy is not started promptly.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

1

7. What should the nurse do when administering ear drops? a. Heat the solution in the microwave. b. Leave the solution in the refrigerator until use. c. Soak the solution for 60 seconds in a pan of very hot water. d. Warm the solution by running warm water over the side of the bottle, avoiding the

label.

ANS: D

Ear drops should be given at body temperature; if necessary, warm the solution by running warm water over the bottle, being careful not to damage the label or to allow water into the bottle.

DIF: Cognitive Level: Application

Copyright © 2021, Elsevier Inc. All rights reserved.

2