Pathopharm Exam 1

The client says to the nurse, "My wife and I take the same drug, but we have different side effects. Are we doing something wrong?" What is the best response by the nurse? 1. "No. Differences such as your sex can result in different side effects." 2. "I'll have to check. What is the name of the drug you were using?" 3. "Possibly. This could happen if one uses generic or brand name drugs." 4. "I'm not sure. Maybe the drug is not the same; you should check it."

1. "No. Differences such as your sex can result in different side effects." Rationale 1: Drugs may elicit different responses depending on individual client factors such as age, sex, body mass, health status, and genetics. Rationale 2: The nurse should not have to check the drug; basic knowledge should include knowing that the sex of clients can result in different side effects. Rationale 3: There are differences between some generic and brand name drugs, but this is not the best answer. Rationale 4: Asking the client to check a medication is fine, but this does not answer the client's question. Global Rationale: Drugs may elicit different responses depending on individual client factors such as age, sex, body mass, health status, and genetics. Asking the client to check a medication is fine, but this does not answer the client's question. There are differences between some generic and brand name drugs, but this is not the best answer. The nurse should not have to check the drug; basic knowledge should include knowing that the sex of clients can result in different side effects.

What is kwashiorkor? 1. A condition seen in individuals suffering from severe protein starvation 2. A condition where blood pressure within the aorta and systemic arterial circulation is elevated 3. A condition where prostate gland cells increase in number because of testosterone stimulation 4. A condition that causes defective cholesterol metabolism

1. A condition seen in individuals suffering from severe protein starvation Feedback 1 Kwashiorkor is a form of malnutrition caused by protein deficiency in the diet. 2 Hypertension is a condition in which blood pressure within the aorta and systemic arterial circulation is elevated. 3 Benign prostatic hyperplasia is a condition in which prostate gland cells increase in number because of testosterone stimulation. 4 Hypercholesterolemia is a condition that is caused by an excess of cholesterol in the bloodstream.

Which are the key proteins in the contractile units of the muscle cells? 1. Actin and myosin 2. Myosin and tubulin 3. Tubulin and actin 4. None of the above

1. Actin and myosin Feedback 1 Actin and myosin are the key proteins in the contractile unit of the muscle cells. 2 Myosin and tubulin are not the key elements in the contractile units of the muscle cells because tubulin is associated with microtubules formation. 3 Tubulin and actin are not the key proteins in the contractile units of the muscle cells. Microtubules are hollow filaments composed of tubulin. So tubulin is associated with microtubules formation. 4 The answer option none of the above is incorrect. Actin and myosin are the key proteins in the contractile unit of the muscle cells.

Which organ is most susceptible to damage and death due to prolonged ischemia? 1. Brain 2. Skeletal muscles 3. Heart 4. None of the above

1. Brain Feedback 1 The brain is the organ that is most sensitive to reduction in its blood supply. The brain undergoes infarction and cell death within minutes. 2 Skeletal muscles can tolerate lack of blood circulation for a few hours. 3 Cardiac ischemia occurs when the heart muscle or myocardium receives insufficient blood flow. In such condition, cell death can occur within minutes but generally not as quickly as the brain. 4 The brain is the organ that is most susceptible to damage and death due to prolonged ischemia.

A client is diagnosed with cellular apoptosis. Which disease can this condition lead to? 1. Cancer 2. Degenerative neurological diseases 3. Necrosis 4. Infarction

1. Cancer Feedback 1 Certain cancers arise when cells lose the ability to program their own destruction, a process known as apoptosis, and go on to have an abnormally prolonged life span. These cells begin to divide uncontrollably and invade other tissues. 2 Degenerative neurological diseases are caused when the cells, due to dysfunctional apoptosis, die excessively and prematurely. For example, spinal muscular atrophy develops when nerve cells undergo increased apoptotic rates and die prematurely. 3 Necrosis is the death of cells in a tissue or organ through injury or disease. It is irreversible. 4 Infarction is the death of tissue due to prolonged restriction of blood flow to it.

A hiker experiences muscle pain and acidosis as he or she ascends a mountain during a long, steep climb. What is the reason for these symptoms? 1. Cellular hypoxia 2. Autolysis 3. Heterolysis 4. Cellular edema

1. Cellular hypoxia Feedback 1 Muscle cramping and acidosis occur when the cells are deprived of adequate oxygen supply during energy metabolism. The oxygen level decreases slightly as the hiker climbs up the mountain into higher altitudes. 2 Autolysis is the process in which lysosomes release digestive enzymes to destroy the parts of the dead cells. This process does not cause muscle cramping and acidosis in a hiker. 3 Heterolysis is the process in which the lysosomes are used to digest the foreign bodies ingested by the macrophage. This process does not cause muscle cramping and acidosis in a hiker. 4 When the plasma membrane configuration is altered because of diseases, excess fluids enter the cell's internal environment and cause swelling, resulting in cellular edema.

The nurse is caring for four clients diagnosed with different systemic illnesses. Client Disorder: Client 1 Systemic inflammatory response syndrome (SIRS) Client 2 Multiple organ dysfunction syndrome (MODS) Client 3 Adult respiratory distress syndrome (ARDS) Client 4 Abdominal compartment syndrome Which client requires monitoring of the blood glucose levels? 1. Client 1 2. Client 2 3. Client 3 4. Client 4

1. Client 1 Feedback 1 Client 1 with SIRS requires monitoring of blood glucose levels due to impaired functioning of the pancreas. 2 Client 2 with MODS requires monitoring for elevated blood lactate levels. 3 Client 3 with ARDS requires monitoring of the platelet count, INR, and for low urine output. 4 Client 4 with abdominal compartment syndrome requires monitoring for elevated blood lactate levels.

The client is receiving a brand name drug and wants to change to the generic form because it is cheaper. What is the best outcome for this client? 1. Client will state two ways a brand name drug differs from a generic name drug. 2. Client will take the brand name drug after speaking with the physician. 3. Client will ask the nurse why brand name drugs are better than generic drugs. 4. Client will state two ways to obtain the medication at a reduced cost.

1. Client will state two ways a brand name drug differs from a generic name drug. Rationale 1: The dosage of drugs may be the same with a brand name and generic drug, but the bioavailability may be affected by the inert ingredients and tablet compression. Rationale 2: Referring the client to the physician is inappropriate because the nurse can educate the client about the difference between generic and brand name drugs. Rationale 3: The client asking the nurse a question is not an outcome. Rationale 4: Knowing ways to obtain medication at a reduced cost is an appropriate outcome, but the client will not learn why a brand name drug may be preferable over a generic drug. Global Rationale: The dosage of drugs may be the same with a brand name and generic drug, but the bioavailability may be affected by the inert ingredients and tablet compression. Knowing ways to obtain medication at a reduced cost is an appropriate outcome, but the client will not learn why a brand name drug may be preferable over a generic drug. Referring the client to the physician is inappropriate because the nurse can educate the client about the difference between generic and brand name drugs. The client asking the nurse a question is not an outcome.

A client is suffering from atherosclerosis. What are directly detrimental to the client's condition? Select all that apply. 1. Depletion of endothelial nitric oxide 2. Helicobacter pylori infection 3. Low-density lipoprotein (LDL) deposition 4. Inflammatory changes of the endothelium 5. Acid reflux

1. Depletion of endothelial nitric oxide 3. Low-density lipoprotein (LDL) deposition 4. Inflammatory changes of the endothelium Feedback 1. This is correct. Depletion of endothelial nitric oxide can impede the dilatory capacity of arteries, thus affecting blood flow. Restriction of coronary artery blood flow to the heart can have a serious negative effect on cardiac health. 2. This is incorrect. Helicobacter pylori is a bacterium that causes peptic ulcers in the gastrointestinal system. 3. This is correct. LDL cholesterol accumulates to form atherosclerotic plaque along the artery walls and directly impacts cardiac health. 4. This is correct. Endothelial injury causes inflammation, which in turn causes diminished vasodilatory capacity of the artery. This results in LDL cholesterol deposition and clot formation in coronary arteries, resulting in a detrimental effect on cardiac health. 5. This is incorrect. Acid reflux irritates the lower esophageal cells, causing inflammation of the esophagus. Prolonged irritation and lack of treatment could lead to a condition known as Barrett's esophagus.

Which statement regarding endoplasmic reticulum (ER) stress is correct? 1. During ER stress, proteins are rapidly degraded. 2. During ER stress, lipids cannot travel to their proper intracellular locations. 3. During ER stress, accumulation of long chain fatty acids occurs in the nervous system. 4. During ER stress, accumulation of non-degraded substances occurs in the cells.

1. During ER stress, proteins are rapidly degraded. Feedback 1 Proteins are rapidly degraded during ER stress. 2 Proteins cannot travel to their exact intracellular locations during ER stress. 3 Accumulation of long chain fatty acids in the nervous system is not associated with ER stress. 4 Accumulation of non-degraded substances in the cells occurs because of the lack of lysosomal enzymes, but not as a result of ER stress.

When does physiological apoptosis occur? Select all that apply. 1. During the embryonic development of the hand 2. During menopause in female adult ovaries 3. When cells die because of stressors 4. When cells have completed their function and need elimination 5. When the liver gets exposed to excessive amounts of alcohol

1. During the embryonic development of the hand 2. During menopause in female adult ovaries 4. When cells have completed their function and need elimination Feedback 1. This is correct. Apoptosis of select cells occurs within the paddle-shaped hand plate to form indentations to shape the individual fingers. The apoptotic cells disintegrate in a stepwise manner without disrupting other cells. 2. This is correct. Physiological apoptosis also occurs in female adult ovaries during menopause. 3. This is incorrect. Cell necrosis occurs when cells die because of stressors or insults that overwhelm the cell's ability to survive. 4. This is correct. Cells such as the white blood cells undergo apoptosis when they become exhausted after participation in immune reactions. 5. This is incorrect. Intracellular accumulation can occur in the liver when exposed to excessive amounts of alcohol.

The nurse is categorizing a client's list of medications completing a health history. Which agents would be categorized as complementary and alternative medicine? Standard Text: Select all that apply. 1. Garlic 2. Vitamin C 3. Zinc 4. Aspirin 5. Benadryl

1. Garlic 2. Vitamin C 3. Zinc Rationale 1: Garlic is considered an herb, which is considered complementary and alternative medicine therapy. Rationale 2: Vitamins are considered complementary and alternative medicine therapy. Rationale 3: Zinc is a mineral and is considered complementary and alternative medicine therapy. Rationale 4: Aspirin is an over-the-counter medication. Rationale 5: Benadryl is an over-the-counter medication. Global Rationale: Garlic is considered an herb, which is considered complementary and alternative medicine therapy. Vitamins and the mineral zinc are considered complementary and alternative medicine therapies. Aspirin and Benadryl are over-the-counter medications.

The increase in size of a weightlifter's muscles is due to muscular 1. Hypertrophy 2. Metaplasia 3. Atrophy 4. Dysplasia

1. Hypertrophy Feedback 1 Hypertrophy is the increase in size of an organ or tissue due to the enlargement of its component cells. Muscle growth is due to physiological hypertrophy, which is caused by angiogenesis. 2 Metaplasia is the replacement of one cell type by another cell type. It could be due to a cell's genetic programming because of a change in environment, or more commonly it could be in response to chronic inflammation. 3 Atrophy is a wasting or decrease in size of a body organ, tissue, or part due to disease, injury, or lack of use. 4 Dysplasia is abnormal cellular growth within a specific tissue, often as a result of chronic inflammation or a precancerous condition.

How does oxidative stress occur? 1. In cells that undergo transient ischemia and subsequent resumption of circulation 2. When estrogen stimulation results in mitotic division of breast gland cells 3. When a blood clot that obstructs a coronary artery causes cardiac muscle ischemia 4. When a cell's environment cannot support its metabolic requirements

1. In cells that undergo transient ischemia and subsequent resumption of circulation Feedback 1 Oxidative stress is a form of cell injury that occurs when free radical generation exceeds the mechanisms of removal. Oxidative stress commonly occurs in cells that undergo transient ischemia and subsequent resumption of circulation. 2 Hormonal stimulation of hyperplasia occurs in pregnancy. It occurs when estrogen stimulation results in mitotic division of breast gland cells. 3 Ischemic reperfusion injury occurs when a blood clot obstructs a coronary artery and results in cardiac muscle ischemia. 4 Atrophy occurs when a cell's environment cannot support its metabolic requirements. The smaller size of the cells allows for less metabolic demand and more efficient functioning that is compatible with survival.

A client is diagnosed with systemic inflammatory response syndrome. What physiological changes does the nurse suspect in the client with this condition? Select all that apply. 1. Increased heart rate 2. Increased urine output 3. Increased cardiac output 4. Increased respiratory rate 5. Increased gastrointestinal activity

1. Increased heart rate 3. Increased cardiac output 4. Increased respiratory rate Feedback 1. This is correct. Clients with systemic inflammatory response syndrome have an increased heart rate. 2. This is incorrect. Clients with systemic inflammatory response syndrome have a decreased urine output. 3. This is correct. Clients with systemic inflammatory response syndrome have an increased cardiac output. 4. This is correct. Clients with a systemic inflammatory response syndrome have an increased respiratory rate. 5. This is incorrect. Clients with systemic inflammatory response syndrome have decreased gastrointestinal activity.

Which type of shock occurs as a result of injury to the spinal cord or brain? 1. Neurogenic 2. Cardiogenic 3. Anaphylactic 4. Hypovolemic

1. Neurogenic Feedback 1 Neurogenic shock occurs from injury to the spinal cord or brain. 2 Cardiogenic shock occurs from the failure of the heart. 3 Anaphylactic shock is triggered by a severe allergic reaction. 4 Hypovolemic shock occurs from a large depletion of blood or fluids from the body.

The DNA is a polymer of 1. Nucleotides. 2. Amino acids. 3. Fatty acids. 4. Phosphates.

1. Nucleotides. Feedback 1 The DNA is a polymer of nucleotides. 2 The DNA is not a polymer of amino acids. 3 The DNA is not a polymer of fatty acids 4 The DNA is not a polymer of phosphate.

Which is the cell's "master mind"? 1. Nucleus 2. Ribosome 3. Golgi apparatus 4. Endoplasmic reticulum

1. Nucleus Feedback 1 The nucleus is the master mind of a cell. It consists of the body's genetic material, which regulates all cell structures and functions. 2 Ribosomes are spherical, small organelles composed of ribosomal ribonucleic acid. They are called as the "protein factories" of the cell. 3 The synthesized proteins from ribosomes are transported to Golgi apparatus through endoplasmic reticulum. Proteins are processed, packaged, and secreted by the Golgi apparatus. 4 The endoplasmic reticulum is a network of tubules within the cell, which acts as a transport system. Lipid production takes place in endoplasmic reticulum.

After assessing the best motor response of a client using the Glasgow Coma Scale, the nurse documents the score as 6. Which response of the client supports the nurse's documentation? 1. Obeys command to move 2. Withdraws from a painful stimulus 3. Flexion, abnormal decorticate posturing 4. Extension, abnormal decerebrate posturing

1. Obeys command to move Feedback 1 If the client obeys the command to move, then the client is assigned a score of 6 according to the Glasgow Coma Scale. This response of the client supports the nurse's documentation. 2 If the client withdraws from a painful stimulus, then the client is assigned a score of 4 according to the Glasgow Coma Scale. 3 If the client performs flexion of limb and an abnormal decorticate posturing, then the client is assigned a score of 3 according to the Glasgow Coma Scale. 4 If the client performs extension of the limb, and abnormal decerebrate posturing, the client is assigned a score of 2 according to the Glasgow Coma Scale.

What are the characteristics of ribonucleic acid? Select all that apply. 1. Presence of ribose pentose sugar 2. Presence of single stranded helix 3. Presence of double stranded helix 4. Presence of deoxyribose pentose sugar 5. Presence of uracil and cytosine as pyrimidine base

1. Presence of ribose pentose sugar 2. Presence of single stranded helix 5. Presence of uracil and cytosine as pyrimidine base Feedback 1. This is correct. The pentose sugar present in ribonucleic acid is ribose. 2. This is correct. Ribonucleic acid consists of a single stranded helix and can travel to sites outside the nucleus. 3. This is incorrect. Double stranded helix is present in deoxyribonucleic acid. 4. This is incorrect. The pentose sugar present in deoxyribonucleic acid is deoxyribose. 5. This is correct. The pyrimidine base thymine in deoxyribonucleic acid is replaced with uracil in ribonucleic acid.

Which is referred to as the protein factory of the cell? 1. Ribosome 2. Mitochondria 3. Golgi apparatus 4. Endoplasmic reticulum

1. Ribosome Feedback 1 Ribosomes are known as the protein factories of the cell. Different types of cells produce different types of proteins. For example, the ribosomes in thyroid cells manufacture proteins that build thyroxine. 2 Mitochondria are known as the power house of the cell. Mitochondria produce the energy that is required by the cell for performing various functions. 3 The Golgi apparatus is not the protein factory of the cell. The Golgi apparatus is responsible for processing and secreting the proteins once they are made in the ribosomes. Hormones are stored in Golgi apparatus until they are secreted by the glands. 4 The endoplasmic reticulum is a network of tubules that act as a transport system within the cell. For example, endoplasmic reticulum helps in the transport of proteins.

The nurse is caring for a client who has status asthmaticus and is admitted to the emergency department for life-threatening hypoxemia. The nurse finds that the client has developed a systemic infection due to lung infection. Which stage of the disease progression is the nurse observing in the client? 1. Sepsis 2. Septic shock 3. Multiple organ dysfunction syndrome (MODS) 4. Compensatory anti-inflammatory response syndrome (CARS)

1. Sepsis Feedback 1 Sepsis, also known as septicemia, is described as widespread infection from the beginning site to the bloodstream. 2 Sepsis, if left untreated develops into septic shock. It is characterized by loss of consciousness, fluid loss, cardiac, and respiratory changes. 3 MODS is the final stage of the disease progression and leads to the death of the client due to irreversible damage. 4 CARS is a condition that is associated with a period of low immunity and high susceptibility to infection following a systemic inflammatory response syndrome.

The nurse is assessing a confused client who was admitted to the emergency department with decreased urinary output and cyanotic fingers. The nurse finds decreased blood pressure, increased heart rate, increased respiratory rate, and hypothermia. The laboratory report shows respiratory acidosis. What does the nurse interpret from the findings? 1. The client has septic shock. 2. The client has cardiac shock. 3. The client has neurogenic shock. 4. The client has hypovolemic shock.

1. The client has septic shock. Feedback 1 The characteristic clinical parameters of septic shock include decreased blood pressure, increased heart rate and respiratory rate, and hypothermia. The ABG report shows respiratory acidosis. Flush or cyanotic skin color is characteristic of the client with septic shock. 2 The characteristic clinical parameters of cardiac shock include decreased blood pressure, increased or decreased heart rate, and increased respiratory rate. In such clients, hypothermia is absent. 3 The characteristic clinical parameters of neurogenic shock include decreased blood pressure, increased or decreased heart rate, and increased respiratory rate. The skin color of the client varies, and respiratory acidosis is present. 4 The characteristic clinical parameters of septic shock include decreased blood pressure, increased heart rate, and increased respiratory rate.

The nurse is assessing a group of clients in a community health care setting. Which groups of clients are at risk of developing hypovolemic shock? Select all that apply. 1. The clients with ascites 2. The clients with tuberculosis 3. The clients with severe burns 4. The clients with hymenoptera 5. The clients with systemic lupus erythematous

1. The clients with ascites 3. The clients with severe burns Feedback 1. This is correct. A client with ascites is at risk of developing hypovolemic shock due to the loss of extracellular fluid. 2. This is incorrect. A client with tuberculosis does not have loss of extracellular fluid and, therefore, does not have the risk of developing hypovolemic shock. However, the client is at risk of developing cardiogenic shock due to tachycardia and hypotension. 3. This is correct. A client with severe burns is at risk of developing hypovolemic shock due to the loss of extracellular fluid. 4. This is incorrect. A client with hymenoptera does not have a loss of extracellular fluid and, therefore, does not have the risk of developing hypovolemic shock. However, the client is at risk of developing anaphylactic shock due to allergic reactions. 5. This is incorrect. A client with systemic lupus erythematous does not have any loss of extracellular fluid and, therefore, does not have the risk of developing hypovolemic shock. However, the client is at risk of developing cardiogenic shock due to tachycardia and hypotension.

Which factor provides DNA the unique molecular ability to replicate? 1. The precise pairing of the nitrogenous bases 2. The presence of pyrimidines bases 3. The presence of nucleotides 4. The nitrogenous base and phosphate bond

1. The precise pairing of the nitrogenous bases Feedback 1 The pairing of nitrogenous bases provides the DNA with the unique molecular ability to replicate. For example, adenine always binds with thymine. 2 DNA nucleotides contain nitrogenous bases that are either purines or pyrimidines. 3 DNA consists of long, double stranded helical chains containing variable sequences of nucleotides. Nucleotides consist of a nitrogenous base and a phosphate group attached to a sugar molecule. The presence of nucleotides does not provide DNA molecules the unique ability to replicate. 4 Nitrogenous bases and phosphate groups are parts of the nucleotide. The presence of nitrogenous bases and phosphate groups do not provide DNA molecules with the unique ability to replicate.

Which type of classification system is being used when drugs are grouped together because they help treat a particular disease or condition? 1. Therapeutic 2. Mechanism of action 3. Chemical 4. Pharmacological

1. Therapeutic Rationale 1: Therapeutic classification is based on the drug's usefulness in treating a particular disease. Rationale 2: Mechanism of action is how a drug produces its physiological effect in the body. Rationale 3: Chemical classification relates to a substance's physical and chemical properties. Rationale 4: Pharmacological classification addresses a drug's mechanism of action. Global Rationale: Therapeutic classification is based on the drug's usefulness in treating a particular disease. Mechanism of action is how a drug produces its physiological effect in the body. Chemical classification relates to a substance's physical and chemical properties. Pharmacological classification addresses a drug's mechanism of action.

Which body part contains pluripotent stem cells? 1. Umbilical cord 2. Skeletal muscle 3. Cardiac muscle 4. None of the above

1. Umbilical cord Feedback 1 Stem cells obtained from the umbilical cord during the birthing process are capable of developing into other cell types and are, therefore, referred to as pluripotent stem cells. 2 Skeletal muscle stem cells are adult stem cells that are capable of generating only new skeletal muscle tissue. 3 Cardiac muscle stem cells are adult stem cells that are capable of regeneration of only the host tissue or cardiac muscle tissue. 4 Umbilical cord stem cells are pluripotent, which means that they are capable of developing into any tissue in the body.

Which vitamins are fat-soluble? Select all that apply. 1. Vitamin A 2. Vitamin C 3. Vitamin D 4. Vitamin K 5. Vitamin B6

1. Vitamin A 3. Vitamin D 4. Vitamin K Feedback 1. This is correct. Fat-soluble vitamins are vitamins A, D, E, and K. Fat is necessary for storage of these vitamins in the body. 2. This is incorrect. Individuals can counteract free radical injury through consumption of antioxidants such as vitamin C. 3. This is correct. Fat-soluble vitamins are vitamins A, D, E, and K. Fat is necessary for storage of these vitamins in the body. 4. This is correct. Fat-soluble vitamins are vitamins A, D, E, and K. Fat is necessary for storage of these vitamins in the body. 5. This is incorrect. Individuals can counteract free radical injury through consumption of antioxidants such as vitamin E and beta-carotene.

The cellular organelle responsible for propelling mucous and inhaled debris out of the lungs is 1. cilia. 2. microfilament. 3. secretory vesicle. 4. endoplasmic reticulum.

1. cilia. Feedback 1 The cilia are responsible for propelling the mucous and inhaled debris out of the lungs using a sweeping motion. 2 Microfilaments help in changing the shape of the certain cells, such as macrophages, and also help with contraction of muscle. 3 Secretory vesicles store substances, such as hormones, that are secreted by cells before they are released into the extracellular space. 4 The endoplasmic reticulum aids in the transport of the synthesized protein from the ribosomes to the Golgi apparatus.

The nursing instructor teaches the student nurses about the pharmacological classification of drugs. The instructor evaluates that learning has occurred when the students make which response? 1. "An anti-anginal treats angina." 2. "A calcium channel blocker blocks heart calcium channels." 3. "An antihypertensive lowers blood pressure." 4. "An anticoagulant influences blood clotting."

2. "A calcium channel blocker blocks heart calcium channels." Rationale 1: To say that a drug treats angina addresses the therapeutic usefulness of the drug, not the pharmacological classification. Rationale 2: The pharmacological classification addresses a drug's mechanism of action, or how a drug produces its effect in the body. Rationale 3: To say that a drug lowers blood pressure addresses the therapeutic usefulness of the drug, not the pharmacological classification. Rationale 4: To say that a drug influences blood clotting addresses the therapeutic usefulness of the drug, not the pharmacological classification. Global Rationale: The pharmacological classification addresses a drug's mechanism of action, or how a drug produces its effect in the body. To say that a drug influences blood clotting addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug treats angina addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug lowers blood pressure addresses the therapeutic usefulness of the drug, not the pharmacological classification.

The student nurse has completed an initial pharmacology course and tells the nursing instructor that it was difficult and she is glad it is over. What is the best response by the nursing instructor? 1. "It may be over, but now you must apply what you have learned to patient care." 2. "Learning is gradual and continuous; we never completely master all areas of pharmacology." 3. "Learning is always painful, but we must continue anyway." 4. "It really isn't over; you should take a graduate course next."

2. "Learning is gradual and continuous; we never completely master all areas of pharmacology." Rationale 1: It is true that the student must apply what has been learned to patient care, but this response implies that learning is over. Rationale 2: Learning pharmacology is a gradual, continuous process that does not end with graduation. Rationale 3: Learning is not always painful. Rationale 4: There is no reason for the student nurse to take a graduate level pharmacology course at this time. Global Rationale: Learning pharmacology is a gradual, continuous process that does not end with graduation. Never does one completely master every facet of drug action and application. There is no reason for the student nurse to take a graduate level pharmacology course at this time. It is true that the student must apply what has been learned to patient care, but this response implies that learning is over. Learning is not always painful.

The nursing instructor is teaching a pharmacology class to student nurses. The current focus is pharmacology and therapeutics. The nursing instructor determines that learning has occurred when the students make which comments? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Pharmacology is the development of medicines." 2. "Pharmacology is the study of medicines." 3. "Therapeutics relates to drug use to treat suffering." 4. "Therapeutics is the study of drug interactions." 5. "Pharmacology is the study of drugs to prevent disease."

2. "Pharmacology is the study of medicines." 3. "Therapeutics relates to drug use to treat suffering." 5. "Pharmacology is the study of drugs to prevent disease." Rationale 1: Pharmacology is not the development of medicines Rationale 2: Pharmacology is the study of medicines. Rationale 3: Therapeutics is the use of drugs in the treatment of suffering. Rationale 4: Therapeutics is not related to study of drug interactions. Rationale 5: Pharmacotherapy is the application of drugs for the purpose of disease prevention. Global Rationale: Pharmacology is the study of medicines and the use of drugs to relieve suffering. Therapeutics is the study of disease prevention and treatment of suffering. Pharmacotherapy is the application of drugs for the purpose of disease prevention.

Modern pharmacology was introduced to the United States by the opening of the first department of pharmacology at the University of Michigan in which year? 1. 1805 2. 1890 3. 1847 4. 1908

2. 1890 Rationale 1: This event occurred after 1805. Rationale 2: John Jacob Abel, who is considered the father of American pharmacology owing to his many contributions to the field, founded the first pharmacology department in the United States at the University of Michigan in 1890. Rationale 3: This event did not occur in 1847. Rationale 4: This event occurred earlier than 1908. Global Rationale: John Jacob Abel, who is considered the father of American pharmacology owing to his many contributions to the field, founded the first pharmacology department in the United States at the University of Michigan in 1890.

How many nitrogenous bases compose a single codon? 1. 2 2. 3 3. 4 4. None of the above

2. 3 Feedback 1 A codon contains three nitrogenous bases instead of just two. 2 Three nitrogenous bases form a codon. Codons are interpreted by the ribosomes during protein synthesis to form specific proteins to meet the cell's need. 3 A codon is not made of three nitrogenous bases instead of four. 4 The option, none of the above is incorrect because a codon is made of three nitrogenous bases.

What is the percentage of ICU mortality of a client with sepsis, if the APACHE II score is 28? 1. 40 2. 55 3. 75 4. 85

2. 55 Feedback 1 If the client's APACHE II score is between 20 and 24, then the client's ICU mortality is 40%. 2 The client's APACHE II score is 28, so it is between 25 and 29. Therefore, the client's ICU mortality is 55%. 3 If the client's APACHE II score is between 30 and 34, then the client's ICU mortality is 75%. 4 If the client's APACHE II score is greater than 34, then the client's ICU mortality is 85% or higher.

The nurse assigns a double point score for serum creatinine while calculating the physiologic variables of a client with septic shock. For which condition is a double point score assigned? 1. Hepatic failure 2. Acute renal failure 3. Intra-abdominal hypertension 4. Disseminated Intravascular Coagulopathy

2. Acute renal failure Feedback 1 Hepatic failure is incorrect because it occurs from decreased blood supply to the liver. 2 Acute renal failure is correct, and serum creatinine is an important indicator that helps in diagnosing renal injury. 3 Intra-abdominal hypertension is incorrect because it is caused by ischemia and necrosis of tissues. 4 Disseminated intravascular coagulopathy is incorrect because it is an impairment of the coagulation cascade.

Which are the purine bases found in deoxyribonucleic acid and ribonucleic acid? Select all that apply. 1. Uracil 2. Adenine 3. Guanine 4. Thymine 5. Cytosine

2. Adenine 3. Guanine Feedback 1. This is incorrect. Uracil is a pyrimidine base present in ribonucleic acid. 2. This is correct. Adenine is a purine base present in deoxyribonucleic acid and ribonucleic acid. 3. This is correct. Guanine is a purine base present in deoxyribonucleic acid and ribonucleic acid. 4. This is incorrect. Thymine is a pyrimidine base present in deoxyribonucleic acid. 5. This is incorrect. Cytosine is a pyrimidine base present in deoxyribonucleic acid and ribonucleic acid.

What is the weakened area in an arterial wall called? 1. Neoplasia 2. Aneurysm 3. Hypertrophy 4. Metaplasia

2. Aneurysm Feedback 1 Neoplasia means new growth and usually refers to disorganized, uncoordinated, uncontrolled proliferative cell growth that can be cancerous or benign. 2 Aneurysm is referred to as a weakened area in an arterial wall. 3 Hypertrophy is an increase in individual cell size, resulting in an enlargement of functioning tissue mass. 4 Metaplasia is the replacement of one cell type by another cell type.

Which medications might the nurse find in the prescriptions of a client diagnosed with anaphylactic shock? Select all that apply. 1. Beta blockers 2. Antihistamines 3. Anticoagulants 4. Glucocorticoids 5. Anticholinergics

2. Antihistamines 4. Glucocorticoids Feedback 1. This is incorrect. The nurse finds beta blocker medications in the prescription of a client who is diagnosed with cardiogenic shock. 2. This is correct. The nurse finds antihistamine medications in the prescription of a client diagnosed with anaphylactic shock. 3. This is incorrect. The nurse finds anticoagulant medications in the prescription of a client diagnosed with cardiogenic shock. 4. This is correct. The nurse finds glucocorticoid medications in the prescription of a client diagnosed with anaphylactic shock. 5. This is incorrect. The nurse finds anticoagulant medications, such as atropine, in the prescription of a client diagnosed with neurogenic shock.

A genetically programmed cell death is a process that can destroy cells that are no longer needed. What is the best method to do this? 1. Necrosis 2. Apoptosis 3. Infarction 4. Gangrene

2. Apoptosis Feedback 1 Necrosis is the death of living tissue due to ischemia, physical injury, radiation, or chemicals. It is not reversible. 2 In multicellular organisms, cells that are no longer needed or are a threat to the organism are destroyed by a programmed cell death called apoptosis. An example of this process is when an embryonic, paddle-shaped hand forms indentations to shape the individual fingers. 3 Infarction is the death of tissue as a result of continued disruption of blood supply. For example, when there is a lack of adequate coronary artery blood supply to the myocardial muscle, ischemic necrosis occurs. 4 Gangrene is a potentially life-threatening condition that can occur when tissues suffer prolonged ischemia and undergo necrosis. Clostridium perfringens thrives on the decaying necrotic tissue and causes gangrene.

Which structures are found in microtubules? Select all that apply. 1. Cilia 2. Centrioles 3. Mitotic spindle 4. Actin filaments 5. Secretory vesicles

2. Centrioles 3. Mitotic spindle Feedback 1. This is incorrect. Cilia are cellular projections whose movement propels substances along the outside of the cells. Cilia contain microfilaments. 2. This is correct. Centriole is a structure present in the microtubules which are involved in cell division. 3. This is correct. Mitotic spindle is a structure present in the microtubules, which are involved in cell division. 4. This is incorrect. Microfilaments are referred to as act in filaments. They help the cell change shape. 5. This is incorrect. Secretory vesicles are formed by the endoplasmic reticulum-Golgi apparatus system. They store substances released by cells prior to their release.

What is the process whereby newly growing cells acquire the specialized structure and function of the cells they replace? 1. Apoptosis 2. Differentiation 3. Oxidative phosphorylation 4. Atherosclerosis

2. Differentiation Feedback 1 Apoptosis is an organized process that eliminates unnecessary or damaged cells without causing inflammation or any adverse effects on surrounding tissue. 2 Differentiation is the process whereby newly growing cells acquire the specialized structure and function of the cells that are replaced. 3 Oxidative phosphorylation is a process through which cells generate energy in the mitochondria. 4 Atherosclerosis is the change in metabolic processes associated with diabetes mellitus.

The nurse is teaching a pharmacology class to student nurses. What does the nurse include as key events in the history of pharmacology? Standard Text: Select all that apply. 1. Initial drugs included morphine, cocaine, and penicillin. 2. Early researchers used themselves as test subjects. 3. The initial intention of pharmacology was to relieve human suffering. 4. Modern pharmacology began in the early 1600s. 5. Pharmacologists synthesized drugs in the laboratory in the twentieth century.

2. Early researchers used themselves as test subjects. 3. The initial intention of pharmacology was to relieve human suffering. 5. Pharmacologists synthesized drugs in the laboratory in the twentieth century. Rationale 1: Initial drugs isolated from complex mixtures included morphine, colchicines, curare, and cocaine, but not penicillin. Rationale 2: Some early researchers, such as Friedrich Serturner, used themselves as test subjects. Rationale 3: The early roots of pharmacology included the application of products to relieve human suffering. Rationale 4: Modern pharmacology began in the early 1800s, not the 1600s. Rationale 5: By the twentieth century, pharmacologists could synthesize drugs in the laboratory. Global Rationale: The early roots of pharmacology included the application of products to relieve human suffering, and early researchers used themselves as test subjects. Initial drugs included morphine, colchicines, curare, and cocaine, but not penicillin. Modern pharmacology began in the early 1800s, not the 1600s. By the twentieth century, pharmacologists could synthesize drugs in the laboratory.

Arteriosclerosis is the thickening and hardening of arterial walls. Which condition acts as an initiator of arteriosclerosis? 1. Apoptosis 2. Endothelial cell injury 3. Necrosis 4. Infarction

2. Endothelial cell injury Feedback 1 Apoptosis is also known as programmed cell death. In multicellular organisms, cells that are unwanted or a threat to the organism are eliminated through a programmed sequence of events. Too little or too much apoptosis is dangerous. 2 Endothelial cell injury acts as an initiator of arteriosclerosis. The most significant injurious agents of the endothelial cells are hypertension, diabetic hyperglycemia, free radicals, persistent secretion of angiotensin II, and low-density lipoprotein cholesterol. 3 Necrosis is cell death caused by ischemia, physical injury, chemicals, or radiation, which is irreversible and may adversely affect neighboring tissues or the organ as a whole. 4 Infarction is the death of tissue due to a lack of oxygen or absence of blood supply to tissues.

What is the process in which glucose is used to create energy? 1. Autolysis 2. Glycolysis 3. Heterolysis 4. None of the above

2. Glycolysis Feedback 1 Autolysis is the process in which the lysosome releases digestive enzymes to destroy cell parts when a cell dies. 2 Glycolysis is the process in which glucose is used to create energy. 3 Heterolysis is the process in which the lysosomes digest foreign matter ingested by macrophages. 4 Glycolysis is the process in which glucose is broken down and used for energy.

Where does the conversion of a prohormone into a hormone take place? 1. Ribosome 2. Golgi apparatus 3. Secretory granule 4. Endoplasmic reticulum

2. Golgi apparatus Feedback 1 Protein is initially manufactured in the ribosome. Protein is referred to as pre-prohormone, which consists of a single peptide. 2 The conversion of prohormone into hormone takes place in the Golgi apparatus. The prohormone is processed and then converted into the actual hormone. The actual hormone is secreted by the endocrine gland's cells. 3 The secretory granule is present in the Golgi apparatus. The completed hormone is stored in the secretory granule. 4 The pre-prohormone consists of a single peptide, which directs its transfer to the endoplasmic reticulum. The single peptide of the pre-prohormone is removed when it is transferred from ribosome to endoplasmic reticulum.

A client is diagnosed with failure of the thyroid gland due to increase in apoptotic cell death. Which condition is the client most likely to have? 1. Xanthomas 2. Hashimoto's thyroiditis 3. Peptic ulcer 4. Anthracosis

2. Hashimoto's thyroiditis Feedback 1 Xanthomas are yellow, raised skin lesions that develop due to intracellular accumulation of excess cholesterol within epithelial cells. 2 Hashimoto's thyroiditis is a common autoimmune disease that causes gradual failure of the thyroid gland because of increased apoptotic cell death. 3 Peptic ulcers are caused by Helicobacter pylori, which is a bacterium that erodes the gastric mucosa. 4 Anthracosis is a benign deposition of coal dust within the lungs from inhalation of sooty air.

A client has an abnormal thickening of the lining of the uterus due to an increase in estrogen levels. How can such a condition be reversed? 1. Restoration of blood circulation 2. Hormone therapy to counteract the effects of excessive estrogen 3. Surgical removal 4. Acid suppression treatment

2. Hormone therapy to counteract the effects of excessive estrogen Feedback 1 Restoration of blood circulation has no bearing on hyperplasia of the uterine endometrium. This is because hyperplasia of the uterine endometrium is caused by an increase in the uterine endometrial cells brought on by excessive estrogen. 2 Hyperplasia of the uterine endometrium is caused by an overproduction of estrogen. Hormone therapy to counter the effects of excessive estrogen helps reverse the condition. 3 Surgical removal of the hyperplastic uterine endometrium is an irreversible treatment option. 4 Acid suppression treatment can resolve the metaplasia of Barrett's esophagus.

A client reports an itchy, bumpy scar around an old wound that is identified as a keloid. This occurs due to the increase in the number of cells in a tissue or organ. Which term best describes this condition? 1. Neoplasia 2. Hyperplasia 3. Dysplasia 4. Metaplasia

2. Hyperplasia Feedback 1 Neoplasia means new growth and usually refers to disorganized, uncoordinated, uncontrolled proliferative cell growth that can be cancerous or benign. 2 Hyperplasia is the increase in the number of cells in a tissue or organ, which only occurs in tissues such as the epithelium and glandular tissue. 3 Dysplasia is abnormal cellular growth within a specific tissue, often as a result of chronic inflammation or a precancerous condition. 4 Metaplasia is the replacement of one cell type by another cell type.

A client is diagnosed with a condition in which the brain cells cannot withstand low oxygen delivery long enough for cell reversible changes to happen. Identify the condition. 1. Organelle disruption 2. Hypoxia 3. Xanthelasma 4. Ischemic-reperfusion injury

2. Hypoxia Feedback 1 Organelles are a number of specialized structures within a living cell. Prolonged stress can cause irreversible cell damage resulting in organelle disruption. 2 Hypoxia is a condition in which the body or a part of the body is deprived of adequate oxygen. Brain cells cannot withstand hypoxia for more than 6 minutes, whereas skeletal muscle can tolerate hypoxia for prolonged periods. 3 Xanthelasma are raised skin lesions that develop because of intracellular accretion of excess cholesterol within epithelial cells. 4 Ischemic-reperfusion injury is tissue damage. It occurs when the blood supply returns to the tissue after a period of ischemia or lack of oxygen.

A client is suffering from prolonged ischemia and tissue death. Which term can be used to refer to such tissue death? 1. Gangrene 2. Infarction 3. Necrosis 4. Apoptosis

2. Infarction Feedback 1 Gangrene is a condition that occurs when tissues endure prolonged ischemia, experience infarction and necrosis, and then are exposed to bacteria such as Clostridium perfringens that proliferate in the decaying tissue. 2 Infarction is the death of tissue due to prolonged insufficient blood supply (ischemia). 3 Necrosis is the death of cells in a tissue or organ through injury or disease. It is irreversible. 4 Apoptosis is the cell's genetically programmed degeneration.

Which characteristic signs does the nurse refer to while teaching about Beck's triad? Select all that apply. 1. Stridor breath sounds 2. Low blood pressure 3. Distant heart sounds 4. Wheezing lung sounds 5. High jugular venous pressure

2. Low blood pressure 3. Distant heart sounds 5. High jugular venous pressure Feedback 1. This is incorrect. Stridor breath sounds are associated with anaphylactic shock. 2. This is correct. Beck's triad is a key sign of cardiac tamponade. One of the characteristic signs of Beck's triad is low blood pressure. 3. This is correct. One of the characteristic signs of Beck's triad is distant heart sounds. 4. This is incorrect. Wheezing lung sounds are associated with anaphylactic shock. 5. This is correct. One of the characteristic signs of Beck's triad is high jugular venous pressure.

Which cell organelles are believed to have once been self-sustaining and independent? 1. Ribosomes 2. Mitochondria 3. Ribonucleic acid 4. Deoxyribonucleic acid

2. Mitochondria Feedback 1 Ribosomes are small, spherical shaped organelles of the ribosomal ribonucleic acid. They have not likely evolved from self-sustaining or independent organisms. 2 Mitochondria are cellular organelles that have their own DNA. They are believed to have once been independent and self-sustaining but, over the course of evolution, they were incorporated into human cells. 3 Ribonucleic acid is single stranded and can travel to sites outside the nucleus, but ribonucleic acid is not likely evolved from self-sustaining or independent organisms. 4 Deoxyribonucleic acid contains double stranded helical chains containing various sequences of nucleotides. Deoxyribonucleic acid is not thought to have evolved from self-sustaining organisms.

The nurse is providing medication education to a client with hypertension. The nurse teaches the client that the physician ordered a diuretic to decrease the amount of fluid in the client's body. Which statement best describes the nurse's instruction? 1. The nurse provided appropriate medication education. 2. The nurse explained the drug's mechanism of action. 3. The nurse taught the client about a prototype drug. 4. The nurse explained the consequences of not using the drug.

2. The nurse explained the drug's mechanism of action. Rationale 1: The education was most likely appropriate, but this response is too vague. Rationale 2: A drug's mechanism of action explains how a drug produces its effect in the body. Rationale 3: There is no drug name present, so it is not known whether this is a prototype drug. Rationale 4: The nurse did not explain the consequences of not using the drug. Global Rationale: A drug's mechanism of action explains how a drug produces its effect in the body. The nurse did not explain the consequences of not using the drug. There is no drug name present, so it is not known whether this is a prototype drug. The education was most likely appropriate, but this response is too vague.

What are the events that occur during the initial stage of shock? Select all that apply. 1. The kidneys fail to filter blood wastes. 2. The sympathetic nervous system is triggered. 3. The liver and the gastrointestinal system suffer ischemia. 4. The heart and brain begin to sustain decreased perfusion. 5. The rennin-angiotensin-aldosterone system (RAAS) is triggered.

2. The sympathetic nervous system is triggered. 5. The rennin-angiotensin-aldosterone system (RAAS) is triggered. Feedback 1. This is incorrect. The kidneys fail to filter blood wastes during the progressive stage of shock. 2. This is correct. The sympathetic nervous system is triggered during the initial stage of shock. 3. This is incorrect. The liver and the gastrointestinal system suffer ischemia during the progressive stage of shock. 4. This is incorrect. The heart and brain begin to sustain decreased perfusion during the irreversible stage of shock. 5. This is correct. The rennin-angiotensin-aldosterone system (RAAS) is triggered during the initial stage of shock.

The nurse administers a vaccine to a child. What is the best understanding of the nurse as it relates to the manufacture of this vaccine? 1. The vaccine is produced by natural plant extracts in the laboratory. 2. The vaccine is naturally produced in animal cells or microorganisms. 3. The vaccine is produced by a combination of animal and plant products. 4. The vaccine is most commonly synthesized in a laboratory.

2. The vaccine is naturally produced in animal cells or microorganisms. Rationale 1: Vaccines are not produced by natural plant extracts. Rationale 2: Vaccines are naturally produced in animal cells, microorganisms, or by the body itself. Rationale 3: Vaccines are not produced by a combination of animal and plant products. Rationale 4: Vaccines are not synthesized in a laboratory. Global Rationale: Vaccines are naturally produced in animal cells, microorganisms, or by the body itself. Vaccines are not synthesized in a laboratory. Vaccines are not produced by natural plant extracts. Vaccines are not produced by a combination of animal and plant products.

Which components of the serum level should be measured to confirm myocardial infarction? Select all that apply. 1. Epinephrine 2. Troponin 3. Lysosomal enzyme 4. Acetylcholine 5. CPKmb

2. Troponin 3. Lysosomal enzyme 5. CPKmb Feedback 1. This is incorrect. Blood constituents such as norepinephrine and epinephrine are produced by the adrenal glands, and each constituent affects the vasculature's function differently and may have detrimental effects. 2. This is correct. Blood levels of CPKmb and troponin are measured to confirm myocardial infarction. 3. This is correct. Blood level of the lysosomal enzyme is measured to confirm myocardial infarction. 4. This is incorrect. Acetylcholineare is a vasodilating substance produced by the endothelial cells and may have detrimental effects. 5. This is correct. Blood level of the lysosomal enzyme, CPKmb, is measured to confirm myocardial infarction.

The application of drugs for the purpose of treating diseases and treatment of suffering is known as 1. biologics. 2. pharmacotherapeutics. 3. alternative therapies. 4. therapeutics.

2. pharmacotherapeutics. Rationale 1: Biologics are agents naturally produced in animal cells, by microorganisms, or by the body itself. Rationale 2: Pharmacotherapeutics is the application of drugs for the purpose of treating disease and the treatment of suffering. Rationale 3: Alternative therapies include natural plant extracts, herbs, vitamins, minerals, dietary supplements, and additional techniques outside the realm of conventional therapeutics. Rationale 4: Therapeutics is concerned with the prevention of disease and treatment of sufferings. Global Rationale: Pharmacotherapeutics is the application of drugs for the purpose of treating disease and the treatment of suffering.

The physician ordered a brand name drug for the client, paroxetine (Paxil). After taking this medication for a year, the client tells the nurse that it is no longer working. What is the best assessment of the nurse at this time? 1. "This sounds like your medication needs changing." 2. "Let's look for interactions with other medications you are taking." 3. "Are you taking Paxil or paroxetine?" 4. "It is time for us to do the Beck Depression assessment again."

3. "Are you taking Paxil or paroxetine?" Rationale 1: Considering a change in medication is appropriate, but another assessment takes priority. Rationale 2: Assessing for interactions with other drugs is appropriate, but another assessment takes priority. Rationale 3: The bioavailability of a generic drug may not be the same as the bioavailability of a brand name drug. Rationale 4: Assessing for worsening of depression is appropriate, but another assessment takes priority. Global Rationale: The bioavailability of a generic drug may not be the same as the bioavailability of a brand name drug. Assessing for worsening of depression is appropriate, but the nurse should first assess if the client has changed to a generic form of the drug. Assessing for interactions with other drugs is appropriate, but the nurse should first assess if the client has changed to a generic form of the drug. Considering a change in medication is appropriate, but the nurse should first assess if the client has changed to a generic form of the drug.

The client is receiving a very expensive medication. The client asks the nurse why the medicine is so expensive. What is the best response by the nurse? 1. "It is expensive, but your insurance covers it and you have a low co-pay." 2. "Drug companies are allowed to advertise medications and this adds to the cost." 3. "Drug companies must recoup the cost of developing and producing the drug." 4. "I think the drug companies should be more accountable for lowering costs."

3. "Drug companies must recoup the cost of developing and producing the drug." Rationale 1: Telling the client that insurance covers the drug doesn't answer the client's question. Rationale 2: Advertising costs are expensive, but this answer implies the drug company is raising costs unnecessarily. Rationale 3: If the cost of developing a new drug is not recouped by the drug company, there is no impetus for the company to continue drug development. Rationale 4: It is non-therapeutic for the nurse to introduce her own beliefs, such as accountability of drug companies, into a conversation with the client. Global Rationale: Telling the client that insurance covers the drug doesn't answer the client's question. It is non-therapeutic for the nurse to introduce her own beliefs, such as accountability of drug companies, into a conversation with the client.

The nurse is teaching a class for clients about over-the-counter (OTC) medications. The nurse determines that education has been effective when the clients make which statement? 1. "We should not take any over-the-counter (OTC) medicine without first calling and checking with the doctor's office." 2. "We should always ask the pharmacist about how to take the over-the-counter (OTC) medicine." 3. "We must read all the directions on the label and call the doctor's office if they are not clear." 4. "Medicines that are available over-the-counter (OTC) are really safe, or they would be prescription medicines."

3. "We must read all the directions on the label and call the doctor's office if they are not clear." Rationale 1: It is not realistic to expect clients to call the doctor's office before taking any over-the-counter (OTC) medicine. Rationale 2: Asking the pharmacist is a good idea, but does not replace reading the label directions. Also, the pharmacist might not always be in the store when the medicine is purchased. Rationale 3: In most cases, clients may treat themselves safely if they carefully follow instructions included with the medication. Rationale 4: Most OTC medicines have a high margin of safety, but none is considered completely safe. Global Rationale: In most cases, clients may treat themselves safely if they carefully follow instructions included with the medication. It is not realistic to expect clients to call the doctor's office before taking any over-the-counter (OTC) medicine. Most OTC medicines have a high margin of safety, but none is considered completely safe. Asking the pharmacist is a good idea, but does not replace reading the label directions. Also, the pharmacist might not always be in the store when the medicine is purchased.

How many adenosine triphosphates (ATPs) are produced in aerobic energy metabolism? 1. 2 2. 3 3. 34 4. None of the above

3. 34 Feedback 1 In anaerobic energy metabolism, two ATPs and pyruvic acid are produced. 2 In active transport, three sodium ions are pumped out. This takes place in the plasma membrane. 3 The process of aerobic energy requires oxygen and provides maximum amount of energy for cellular function. The process yields 34 ATPs. 4 The answer option none of the above is incorrect. Aerobic energy metabolism produces 34 ATPs.

1. The nurse finds pulmonary infiltrates in the chest x-ray reports of a client. The arterial blood gas reports show hypoxemia, and a WBC with differential count shows leukocytosis. Which condition does the nurse suspect in the client, based on these findings? 1. Sepsis 2. Septic shock 3. Adult respiratory distress syndrome 4. Disseminated intravascular coagulopathy

3. Adult respiratory distress syndrome Feedback 1 Bilateral pulmonary infiltrates that are found on the chest X-ray and hypoxemia in ABG reports are apparent in clients with sepsis. Leukocytosis in WBC differential tests is not associated with sepsis. 2 A chest x-ray showing pneumonia and ABGs showing hypoxemia are apparent in clients with septic shock. Leukocytosis in WBC differential tests is also apparent during septic shock due to an infection. 3 Chest X-ray is the first diagnostic procedure that is used in the diagnosis of adult respiratory distress syndrome (ARDS). The acute onset of bilateral pulmonary infiltrates evident on chest X-ray, hypoxemia apparent in ABG reports, and leukocytosis in WBC differential tests indicate the presence of ARDS. 4 The laboratory reports showing prolonged coagulation times, thrombocytopenia, and high levels of fibrin degradation products indicate the presence of disseminated intravascular coagulopathy.

The physician has prescribed a brand name drug for the client. The client tells the nurse that the medication is too expensive. What is the best plan by the nurse? 1. Help the client receive free medicine through a "patient assistance" program. 2. Ask the physician if a cheaper brand name drug may be substituted. 3. Ask the physician if a generic drug may be substituted. 4. Maintain the client on samples of the brand name drug from the physician's office.

3. Ask the physician if a generic drug may be substituted. Rationale 1: A patient assistance program is a good idea, but since the client may not qualify for this, it is not the best plan. Rationale 2: Another brand name drug may not be what the client needs for the illness. Rationale 3: Generic drugs are much less costly than brand name drugs. Rationale 4: Providing samples is an option, but the office may temporarily run out of samples and the client will not receive the medication. Global Rationale: Generic drugs are much less costly than brand name drugs. A patient assistance program is a good idea, but since the client may not qualify for this, it is not the best plan. Another brand name drug may not be what the client needs for the illness. Providing samples is an option, but the office may temporarily run out of samples and the client will not receive the medication.

While conducting an endoscopic examination on a client, it is found that the client has acid reflex. Which condition is associated with the gastroesophageal reflux disease (GERD) in which cell injury is reversible? 1. Parkinson's disease 2. Myocardial infarction 3. Barrett's esophagus 4. Hashimoto's thyroiditis

3. Barrett's esophagus Feedback 1 Parkinson's disease causes gradual, progressive neurological deterioration where specific brain cells undergo degeneration and die. It is irreversible. 2 Myocardial infarction is the irreversible damage caused by prolonged lack of blood supply to the myocardial muscle. 3 Barrett's esophagus is a serious complication of gastroesophageal reflux disease. In GERD, the lower esophageal squamous epithelial cells can undergo a metaplastic change into columnar stomach-like cells. This condition develops into Barrett's esophagus. 4 Hashimoto's thyroiditis is an autoimmune disorder in which the body's immune system attacks the thyroid gland. This causes cell injury that is irreversible.

A client comes in with persistently uncontrolled hypertension. The nurse informs the client's spouse that one of the consequences of prolonged raised blood pressure is a weakened area in the wall of the cerebral artery, located on the Circle of Willis. What is this condition known as? 1. Xanthelasma 2. Infarction 3. Berry aneurysm 4. Ischemia

3. Berry aneurysm Feedback 1 Xanthelasma is a yellowish deposit of cholesterol underneath the skin cells, commonly on or around the eyelids. 2 Infarction is tissue death due to prolonged obstruction of blood supply to the tissue. 3 Berry aneurysm is a small berry-like bulge that is caused by a weakened area in the wall of the cerebral artery at or near the Circle of Willis in the brain. 4 Ischemia is the lack of sufficient blood flow to tissues that leads to cell injury. Prolonged ischemia leads to infarction or death of tissue.

The nurse is teaching a group of students about shock and its specific states. The nurse states, "A specific shock state is presented with bradycardia and hypertension. Further, the condition progresses into renal, hepatic, and cerebral hypoperfusion." Which type of shock is involved in the case of extensive hypoperfusion of the tissues? 1. Neurogenic shock 2. Anaphylactic shock 3. Both A and B 4. None of the above

3. Both A and B Feedback 1 Neurogenic shock occurs due to injury to the spinal cord or brain and causes widespread vasodilation. This leads to an extensive hypoperfusion of the tissues, such as renal, hepatic, and cerebral. 2 Anaphylactic shock is triggered by a severe allergic reaction that causes massive vasodilation; it leads to the hypoperfusion of tissues and hypotension. 3 Both anaphylactic and neurogenic shock involve widespread vasodilation, which causes extensive hypoperfusion of the tissues. 4 None of the above is incorrect.

How is glucose uptake in the periphery blocked during shock? 1. By increased levels of insulin 2. By decreased levels of cortisol 3. By decreased levels of incretins 4. By increased levels of norepinephrine

3. By decreased levels of incretins Feedback 1 The glucose uptake in the periphery is blocked by decreased levels of insulin. 2 The glucose uptake in the periphery is blocked by increased levels of cortisol. 3 The glucose uptake in the periphery is blocked by decreased levels of incretins. 4 The glucose uptake in the periphery is blocked by increased levels of the neurotransmitter epinephrine.

A nurse observes that a client has developed a foul odor in the spots where necrosis of tissue has developed. What organism causes the emission of this foul odor? 1. Streptococcus 2. Helicobacter pylori 3. Clostridium perfringens 4. Human papilloma virus

3. Clostridium perfringens Feedback 1 Streptococcus bacteria distinctly alter cells. They cause inflammation and swelling. For example, the etiology of sore throats is usually streptococcus bacteria. 2 Helicobacter pylori is a bacterium that erodes the mucosal lining of the gastrointestinal tract. It causes gastric acids to damage the stomach lining and leads to peptic ulcers. 3 Clostridium perfringens is an anaerobic bacterium that multiplies in exposed necrotic tissue. This bacterium produces gas that becomes trapped in the infected tissue and emits a distinct foul odor related to gangrene. 4 Human papilloma virus (HPV) is a virus that is sexually transmitted. It can cause cancerous cell changes within the cervix.

After assessing the skin color and mental status of a client, the nurse concludes that the client has cardiac shock. Which findings observed in the client support the nurse's conclusion? 1. Hives; anxious 2. Flushed; confused 3. Cyanotic; anxious 4. Pale; anxious; thirsty

3. Cyanotic; anxious Feedback 1 A client with anaphylactic shock does not manifest cyanotic skin color and appear anxious. However, the client exhibits hives and appears anxious. 2 A client with septic shock does not exhibit cyanotic skin color and appear anxious. However, the client is flushed and appears confused. 3 Cyanosis and anxiety are noted in a client with cardiac shock. Therefore, this finding observed in the client supports the nurse's conclusion. 4 A client with hypovolemic shock does not show cyanotic skin color. However, the client manifests pale skin color, appears anxious, and is thirsty.

When does ribosomal protein synthesis cease? 1. During endoplasmic reticulum (ER) stress 2. During the synthesis of ATP 3. During severe hypoxic state 4. During the processing of prohormone

3. During severe hypoxic state Feedback 1 Ribosomal protein synthesis does not cease during endoplasmic reticulum stress. 2 ATP is synthesized in the energy metabolism. It does not interfere with protein synthesis. 3 When the cells are deprived of adequate oxygen supply, the ribosomal protein synthesis ceases. 4 The processing of prohormones to hormones does not cease the process of protein synthesis.

Tetracycline antibiotic was given to a 30 year old client with Chlamydia infection. What is the mechanism of action of the drug? 1. It prevents the replication of bacteria. 2. It alters the configuration of bacterial cytoplasm. 3. It interferes with the function of bacterial ribosomes. 4. It inhibits the functions of bacterial mitochondria.

3. It interferes with the function of bacterial ribosomes. Feedback 1 Tetracycline antibiotic does not prevent the replication of bacteria. 2 Tetracycline antibiotic does not alter the configuration of bacterial cytoplasm. 3 Tetracycline interferes with the functions of bacterial ribosomes. It inhibits bacterial protein synthesis. 4 Tetracycline antibiotic does not interfere with functions of bacterial mitochondria.

What is the function of ribosomal ribonucleic acid during protein synthesis? 1. It transports genetic information from the DNA for protein synthesis. 2. It gathers and joins the amino acids for specific proteins. 3. It is directly involved in the formation of ribosomes. 4. None of the above.

3. It is directly involved in the formation of ribosomes. Feedback 1 Messenger RNA, not ribosomal RNA, transports the message from the DNA to the ribosomes for protein synthesis. 2 Transfer RNA, not ribosomal RMA, gathers and joins the exact amino acids that will form the protein designated by the messenger RNA. 3 The r-RNA is involved in the formation of ribosomes. 4 The answer option is incorrect because ribosomal RNA is involved in the formation of ribosomes.

While teaching a group of student nurses about post-mortem changes, the nurse states, "This is a purple-red discoloration that appears on the dependent portions of the body after the heart stops." Which post-mortem change does the nurse refer to in the teaching? 1. Algor mortis 2. Rigor mortis 3. Livor mortis 4. Tardieu spots

3. Livor mortis Feedback 1 Algor mortis is not associated with the purple-red discoloration that appears on the dependent portions of the body after the heart stops. However, it is the cooling process of the body after death. 2 Rigor mortis is described as the postmortem stiffening of the body's muscles. Some muscles may be contracted and remain in position. 3 Livor mortis is the purple-red discoloration that appears on dependent portions of the body after the heart stops. This is the condition that the nurse is referring to in the question. 4 Tardieu spots are characterized by petechiae and small hemorrhages on the dependent areas of the body. They occur due to rupture of degenerating blood vessels.

Which acts as a blue print for the construction of proteins? 1. Transfer RNA 2. Ribosomal RNA 3. Messenger RNA 4. Mitochondrial DNA

3. Messenger RNA Feedback 1 Transfer RNA (tRNA) plays an important role in the assembly of proteins. 2 Ribosomal RNA (rRNA) is associated with the assembly and function of ribosomal particle. 3 Messenger RNA (mRNA) acts as a blueprint for the construction of proteins. 4 Mitochondrial DNA enables the mitochondria to reproduce on their own within the cells when there is an increased need for ATP formation.

Which statements regarding the microtubules are true? Select all that apply. 1. Microtubules are solid. 2. Microtubules are flexible. 3. Microtubules are composed of tubulin. 4. Microtubules are called actin filaments. 5. Microtubules comprise of centrioles and mitotic spindle.

3. Microtubules are composed of tubulin. 5. Microtubules comprise of centrioles and mitotic spindle. Feedback 1. This is incorrect. Microtubules are rigid. 2. This is incorrect. Microtubules are stiff. 3. This is correct. Microtubules are composed of protein subunits called tubulin. 4. This is incorrect. Microfilaments are called as actin filaments. 5. This is correct. Microtubules comprises of cell structures involved in cell division such as centrioles and mitotic spindle.

The physician orders a brand name drug for the client. The hospital formulary substitutes the generic equivalent of the brand name drug, and the nurse administers the generic drug. Which statement(s) best represent(s) the nurse's action? Standard Text: Select all that apply. 1. The nurse should have contacted the physician prior to administering the drug. 2. The nurse should have called the pharmacist to see if the drugs were bioequivalent. 3. The nurse used good judgment in administering the drug. 4. The nurse was correct; hospital policies allow for this. 5. The nurse should ask the client which brand of drug is used at home.

3. The nurse used good judgment in administering the drug. 4. The nurse was correct; hospital policies allow for this. Rationale 1: It is not feasible for the nurse to contact the physician every time there is a generic substitution. Rationale 2: The pharmacist should only fill the prescription with a bioequivalent drug from the approved formulary. Rationale 3: The nurse used good judgment as hospital policies allow for generic substitution of certain drugs. Rationale 4: Use of formularies and negative formularies support the hospital policies allowing substitution. Rationale 5: In most cases, the client will not know which brand of medication is used at home. The brand used at home would be relevant only in very few medications. Global Rationale: The nurse used good judgment as hospital policies allow for generic substitution of certain drugs. It is not feasible for the nurse to contact the physician every time there is a generic substitution. The pharmacist should only fill the prescription with a bioequivalent drug from the approved formulary. Use of formularies and negative formularies support the hospital policies allowing substitution.. In most cases, the client will not know which brand of medication is used at home. The brand used at home would be relevant only in very few medications.

A client with chronic back pain informs the nurse he has been receiving therapeutic touch in addition to his medications. What is the nurse's best classification of this client's treatment? 1. pharmacotherapy. 2. drug-absence therapy 3. complementary therapy 4. biologic therapy

3. complementary therapy Rationale 1: Pharmacotherapy is the application of drugs for the purpose of treating diseases and alleviating human suffering. Rationale 2: The client is using medications as well as an alternative therapy. Rationale 3: The client is using a non-conventional type of treatment (therapeutic touch) that is classified as complementary to his conventional pharmacotherapy. Biologic therapy involves the use of naturally produced substances by microorganisms or within the body. The client is using medications as well as an alternative therapy, which is why complementary therapy is the best choice. Rationale 4: Biologic therapy involves the use of naturally produced substances by microorganisms or within the body. Global Rationale: The client is using a non-conventional type of treatment (therapeutic touch) that is classified as complementary to his conventional pharmacotherapy. Pharmacotherapy is the application of drugs for the purpose of treating diseases and alleviating human suffering. Biologic therapy involves the use of naturally produced substances by microorganisms or within the body. The client is using medications as well as an alternative therapy, which is why complementary therapy is the best choice.

Advil, Motrin, and Nuprin are examples of 1. chemical names. 2. combination names. 3. trade names. 4. generic names.

3. trade names. Rationale 1: Advil, Motrin, and Nuprin are not chemical names. Rationale 2: Advil, Motrin, and Nuprin are not combination names. Rationale 3: Advil, Motrin, and Nuprin are trade names for ibuprofen. Rationale 4: Advil, Motrin, and Nuprin are not generic names. Global Rationale: Advil, Motrin, and Nuprin are trade names for ibuprofen. They are not chemical names, combination names, or generic names.

The student nurse asks the nursing instructor why he needs to take anatomy and physiology, as well as microbiology, when he only wants to learn about pharmacology. What is the best response by the instructor? 1. "Because pharmacology is an outgrowth of those subjects." 2. "You must learn all, since those subjects, as well as pharmacology, are part of the curriculum." 3. "Knowledge of all those subjects will prepare you to provide the best patient care, including the administration of medications." 4. "Because an understanding of those subjects is essential to understanding pharmacology."

4. "Because an understanding of those subjects is essential to understanding pharmacology." Rationale 1: Pharmacology is an outgrowth of anatomy, physiology, and microbiology, but this is not the most complete reason for the nurse to learn them. Rationale 2: The nurse must learn anatomy, physiology, and microbiology to understand pharmacology, not because they are part of the curriculum. Rationale 3: Knowledge of anatomy, physiology, and microbiology prepares the nurse to understand pharmacology, not to provide care such as administration of medications. Rationale 4: It is essential for the nurse to have a broad knowledge base of many sciences in order to learn pharmacology. Global Rationale: It is essential for the nurse to have a broad knowledge base of many sciences in order to learn pharmacology. The nurse must learn anatomy, physiology, and microbiology to understand pharmacology, not because they are part of the curriculum. Pharmacology is an outgrowth of anatomy, physiology, and microbiology, but this is not the reason for the nurse to learn them. Knowledge of anatomy, physiology, and microbiology prepares the nurse to understand pharmacology, not to provide care such as administration of medications.

The head nurse is evaluating the knowledge of a student nurse while teaching confirmatory tests for brain death. Which statement made by the student nurse does the head nurse correct? 1. "Inject technetium within 30 minutes of brain death during nuclear imaging." 2. "Obtain readings for at least 30 minutes during electroencephalography." 3. "Obtain x-ray images between 30 and 60 minutes and at 2 hours after injection during nuclear imaging." 4. "Use eight scalp electrodes with a distance of 5 centimeters between each during electroencephalography."

4. "Use eight scalp electrodes with a distance of 5 centimeters between each during electroencephalography." Feedback 1 While performing a nuclear imaging diagnostic procedure, the nurse should inject technetium within 30 minutes. This statement made by the student nurse does not require any correction. 2 While performing electroencephalography on a client, the nurse should obtain the readings for at least 30 minutes to determine the electrical activity of the brain. 3 While performing nuclear imaging, the nurse should obtain x-ray images between 30 and 60 minutes and at 2 hours to determine brain death. 4 While performing electroencephalography, the nurse should use eight scalp electrodes with a distance of 10 centimeters between each. Therefore, this statement made by the student nurse is corrected by the head nurse.

During pharmacology class, the student nurse asks the nursing instructor how students will ever learn about the individual antibiotic drugs since there are so many. What is the best response by the nursing instructor? 1. "You will learn a little trick called mnemonics." 2. "You will learn how to do a flow chart to enhance memory." 3. "You will learn how to categorize the individual drugs." 4. "You will learn a representative drug from each class."

4. "You will learn a representative drug from each class." Rationale 1: Using mnemonics is not the best way to learn about drugs. Rationale 2: Flow charts are not the best way to learn about drugs. Rationale 3: Categorizing individual drugs is not the best way to learn about drugs. Rationale 4: A prototype, or representative, drug is the well-understood drug model from which other drugs in a pharmacological class are compared. Global Rationale: A prototype, or representative, drug is the well-understood drug model from which other drugs in a pharmacological class are compared. Categorizing individual drugs is not the best way to learn about drugs. Using mnemonics is not the best way to learn about drugs. Flow charts are not the best way to learn about drugs.

The client comes to the emergency department with a myocardial infarction. The client's husband tells the nurse that his wife has been taking calcium carbonate (Tums) for years for what she thought was indigestion. What is the best response by the nurse? 1. "Your wife should not have self-diagnosed herself. I hope she will be okay." 2. "Why did you let her do that? She should have seen a doctor." 3. "Well, I am glad she is here, as it certainly wasn't indigestion." 4. "Your wife was self-diagnosing, which is generally not a good idea."

4. "Your wife was self-diagnosing, which is generally not a good idea." Rationale 1: Telling the husband "I hope she will be okay" is a very frightening response that implies she might die, and this is non-therapeutic. Rationale 2: Asking the husband why he let his wife take Tums is non-therapeutic and too accusatory; do not ask "why" questions. Rationale 3: Telling the husband that "it certainly wasn't indigestion" is judgmental and will alienate the client and husband. Rationale 4: Clients take over-the-counter (OTC) drugs for many reasons. Self-treatment is sometimes ineffective, and the potential for harm may increase if the disease is allowed to progress. Global Rationale: Clients take over-the-counter (OTC) drugs for many reasons. Self-treatment is sometimes ineffective, and the potential for harm may increase if the disease is allowed to progress. Asking the husband why he let his wife take Tums is non-therapeutic and too accusatory; do not ask "why" questions. Telling the husband that "it certainly wasn't indigestion" is judgmental and will alienate the client and husband. Telling the husband "I hope she will be okay" is a very frightening response that implies she might die, and this is non-therapeutic.

After assessing the mental status of a client using the Glasgow Coma Scale, the nurse concludes that the client has a minor head injury. Which score supports the nurse's conclusion? 1. 6 2. 10 3. 12 4. 15

4. 15 Feedback 1 According to the Glasgow Coma Scale, if the total points are less than or equal to 8, it indicates that the client has a major head injury. Therefore, the score of 6 indicates major head injury. 2 If the score falls between 9 and 12, it indicates that the client has a moderate head injury. Therefore, the score of 10 indicates moderate head injury. 3 If the score falls between 9 and 12, it indicates that the client has a moderate head injury. Therefore, the score of 12 indicates moderate head injury. 4 If the score falls between 13 and 15, it indicates that the client has a minor head injury. Therefore, the score of 15 supports the nurse's conclusion.

The older adult client has gastrointestinal bleeding. The client says to the nurse, "I don't understand this. All I did was take ibuprofen (Advil) for my arthritis." Which plan would be best as it relates to the nurse's education of this client? 1. A plan to teach the client to use drugs that bypass the gastrointestinal system, like topical drugs 2. A plan to teach the client to substitute safer drugs like acetaminophen (Tylenol) 3. A plan to teach the client to obtain physician approval prior to the use of over-the-counter (OTC) medications 4. A plan to teach the advantages and disadvantages of ibuprofen (Advil)

4. A plan to teach the advantages and disadvantages of ibuprofen (Advil) Rationale 1: The use of topical drugs may be an option, but the drug a client needs may not be available in this form. Rationale 2: Substitution of other drugs may be beneficial, but this cannot be done in all situations. Rationale 3: It is not a realistic plan to expect clients to contact their physician prior to taking any over-the-counter (OTC) medication. Rationale 4: Since elderly clients account for the use of about 40% of all over-the-counter (OTC) medications, it is essential for the nurse to teach clients about the advantages, and the disadvantages, of these medications. Global Rationale: Since older adult clients account for the use of about 40% of all over-the-counter (OTC) medications, it is essential for the nurse to teach clients about the advantages, and the disadvantages, of these medications. Substitution of other drugs may be beneficial, but this cannot be done in all situations. The use of topical drugs may be an option, but the drug a client needs may not be available in this form. It is not a realistic plan to expect clients to contact their physician prior to taking any over-the-counter (OTC) medication.

Adrenoleukodystrophy is characterized by 1. Accumulation of ganglioside. 2. Cessation of ribosomal protein synthesis. 3. Acceleration of cellular proteasome activity. 4. Accumulation of long chain fatty acid s in the nervous system.

4. Accumulation of long chain fatty acid s in the nervous system. Feedback 1 The deficiency of lysosomal enzymes causes the accumulation of ganglioside in the central nervous system. Tay-Sach's disease is characterized by the accumulation of ganglioside in the central nervous system. 2 Ribosomes are responsible for the synthesis of cellular proteins. In severe hypoxic states ribosomal protein synthesis ceases, resulting in decreased synthesis of protein. 3 Cachexia or wasting of body mass is associated with accelerated proteasome activity. It is often seen in conditions such as cancer. 4 Adrenoleukodystrophy is a disorder associated with the dysfunction of the peroxisomes. The disease is characterized by the accumulation of long chain fatty acids in the nervous system. The disease causes the deterioration of the nervous system and eventually leads to death.

Which is an intestinal hormone that increases the cellular sensitivity to insulin during shock? 1. Cortisol 2. Epinephrine 3. Vasopressin 4. Glucagon-like peptide 1(GLP-1)

4. Glucagon-like peptide 1(GLP-1) Feedback 1 Cortisol is incorrect because it is not a gastrointestinal hormone. 2 Epinephrine is incorrect because it is released from the adrenal glands. 3 Vasopressin is incorrect because it is an anti-diuretic hormone. 4 GLP-1 is correct because it is an intestinal hormone that increases cellular sensitivity to insulin.

Which deficiency causes Tay-Sach's disease? 1. Proteasome 2. Peroxisome 3. Macrophage 4. Lysosomal enzymes

4. Lysosomal enzymes Feedback 1 A deficiency of proteasome in the cell does not cause Tay-Sach's disease. Proteasome is an organelle, which contains digestive enzymes similar to lysosomes. Proteasomes degrade polypeptide chains and proteins. 2 A deficiency of peroxisomes in the cell does not cause Tay-Sach's disease. Peroxisomes contain digestive enzymes such as lysosomes. Peroxisomes break down the long chain fatty acids and free radicals. 3 A deficiency of macrophages in the body does not cause Tay-Sach's disease. Macrophage is the major defensive white blood cells of the body. Macrophages contain a large number of lysosomes. 4 Lysosomes contain digestive enzymes such as lysozyme, proteases, and lipases to degrade the ingested foreign substances and cellular debris. Tay-Sach's disease is a rare genetic disorder that is caused by the deficiency of lysosomal enzymes. It results because of the buildup of lipids in the brain and spinal cord.

While discussing antihypertensives, the instructor states that a particular agent causes a reduction in blood pressure by blocking receptor sites. The student wishing to understand this statement would research which drug information? 1. Drug-drug interaction 2. Adverse effects 3. Indication 4. Mechanism of action

4. Mechanism of action Rationale 1: Drug-drug interactions refer to possible adverse reactions from using multiple drugs at the same time. Rationale 2: Adverse effects are what can result from drug use, not a description of how the drug works. Rationale 3: Indications are the reasons the drug is being used. Rationale 4: The instructor is describing how a drug produces an effect within the body, which is known as the mechanism of action. Global Rationale: The instructor is describing how a drug produces an effect within the body, which is known as the mechanism of action. Adverse effects are what can result from drug use, not a description of how the drug works. Indications are the reasons the drug is being used, and drug-drug interactions refer to possible adverse reactions from using multiple drugs at the same time.

What are the unique histological findings that represent distinct disease processes? 1. Histology 2. Biopsy 3. Autopsy 4. None of the above

4. None of the above Feedback 1 Histology is the microscopic study of tissues and cells, and it yields important diagnostic information for the clinician. 2 Biopsy extracts a cell sample from an organ or mass of tissue to allow for histological examination. 3 Autopsy is an examination of the tissues and organs of a deceased individual that allows for a study of the cause of death. 4 The unique histological findings that represent distinct disease processes are referred to as pathognomonic changes. For instance, an inflamed, craterlike breach in the gastrointestinal mucosa is pathognomonic for peptic ulcer disease.

An overwhelmed nursing student asks the instructor whether there are any tips that will make learning pharmacology easier. The instructor gives an example of the anticoagulant heparin. The instructor indicates that knowing heparin and comparing other drugs to it will facilitate learning the many anticoagulants. Which approach is the instructor using? 1. Mechanism of action approach 2. Generic name approach 3. Trade name approach 4. Prototype drug approach

4. Prototype drug approach Rationale 1: Mechanism of action is how the drug produces its physiological effect in the body. This approach does not limit the number of drugs that must be learned. Rationale 2: Heparin is the generic name, but this does not help the student understand the drug. Rationale 3: Trade names are specific to only one drug, so learning by this approach does not limit the number of drugs that must be examined. Rationale 4: In the prototype approach, the student learns about one well-understood drug from a class of drugs. Learning about this drug helps the student understand the other drugs in the class. Global Rationale: Mechanism of action is how the drug produces its physiological effect in the body. This approach does not limit the number of drugs that must be learned. Heparin is the generic name but this does not help the student understand the drug. Trade names are specific to only one drug, so learning by this approach does not limit the number of drugs that must be examined. In the prototype approach, the student learns about one well-understood drug from a class of drugs. Learning about this drug helps the student understand the other drugs in the class.

The student nurse is documenting different stages of multiple organ dysfunction syndrome (MODS) and its associated clinical manifestations. Stages Clinical manifestations: Stage 1 Hematologic abnormalities Stage 2 Acid-base abnormalities Stage 3 Mild respiratory alkalosis Stage 4 Ischemic colitis and lactic acidosis Which documentation made by the student nurse is accurate? 1. Stage 1 2. Stage 2 3. Stage 3 4. Stage 4

4. Stage 4 Feedback 1 In stage 1 of MODS, the client has mild respiratory alkalosis due to increased volume requirements. Therefore, this documentation made by the student nurse is inaccurate. 2 In stage 2 of MODS, the client has hematological abnormalities due to moderate liver dysfunction. Therefore, this documentation made by the student nurse is inaccurate. 3 In stage 3 of MODS, the client has acid-base disturbances due to the development of shock. Therefore, this documentation made by the student nurse is inaccurate. 4 In stage 4 of MODS, the client has anuria and oliguria, followed by ischemic colitis and lactic acidosis. Therefore, this documentation made by the student nurse is accurate.

Which statement regarding the sodium-potassium pump is correct? 1. The cell's plasma membrane is more soluble to sodium ions than potassium ions. 2. The concentration of sodium ions should be higher inside the cell compartment. 3. The concentration of potassium ions should be higher outside the cell compartment. 4. The active transport involves pumping out three sodium ions and pumping in two potassium ions.

4. The active transport involves pumping out three sodium ions and pumping in two potassium ions. Feedback: 1 The plasma membrane of the cell is less soluble to sodium ions and more soluble to potassium ions. 2 The concentration of sodium ions should be higher outside the cell compartment. 3 The concentration of potassium ions should be higher inside the cell compartment. 4 In active transport, for every three sodium ions pumped out, there are two potassium ions pumped in.

Which field involves harvesting of embryonic stem cells and performing nuclear transfer on these cells? 1. Reproductive cloning 2. Restoration with stem cells 3. Transplantation 4. Therapeutic cloning

4. Therapeutic cloning Feedback 1 Reproductive cloning is the deliberate production of genetically identical individuals and it involves the production of a genetic duplicate of an existing organism. 2 The regeneration of the cells that are incapable of regeneration, such as brain, neuron, and heart muscle cells, are referred to as restoration with stem cells. 3 Transplantation is the most prevalent method to replace permanently injured tissues or organs. 4 Therapeutic cloning is a field that involves harvesting of embryonic stem cells and performing nuclear transfer on these cells.

Why is more energy produced when a person is exercising? 1. There is an increase in the synthesis of protein. 2. There is an increase in the production of pyruvic acid in the cells. 3. There is an increase in the conversion of pyruvic acid to lactic acid. 4. There is an increase in the production of mitochondria in the muscle cells.

4. There is an increase in the production of mitochondria in the muscle cells. Feedback 1 Protein synthesis is the function of ribosomes. An increase in the synthesis of proteins does not yield energy and is not directly related to exercise. 2 In aerobic energy metabolism, two adenosine triphosphate and pyruvic acid are produced. The increase in the production of pyruvic acid does not produce more energy. 3 Conversion of pyruvic acid to lactic acid in cellular hypoxia is noxious to cells and does not create energy. 4 Exercise stimulates an increase in the number of mitochondria formed in the muscle cells. This process leads to the conversion of oxygen into energy.

While performing confirmatory tests for brain death in a client, the radiographic technician places a probe at the temporal bone above the zygomatic arch or at the vertebrobasilar arteries through the suboccipital window. Which test is being done on the client through this intervention? 1. Nuclear imaging 2. Cerebral angiography 3. Electroencephalography 4. Transcranial Doppler ultrasonography

4. Transcranial Doppler ultrasonography Feedback 1 Nuclear imaging is a diagnostic test in which the technician injects technetium within 30 minutes from the beginning of a procedure and obtains the x-ray images immediately, between 30 and 60 minutes, and at 2 hours. 2 Cerebral angiography is the diagnostic test in which the nurse injects a dye in the aortic arch for visualizing the anterior and posterior cerebral circulation of the brain. 3 Electroencephalography is the diagnostic test in which the nurse places a minimum of eight scalp electrodes at a distance of 10 centimeters between each of them. 4 Transcranial Doppler ultrasonography is a diagnostic test in which a probe is placed at the temporal bone above the zygomatic arch or at the vertebrobasilar arteries through the suboccipital window. In the given scenario, the technician is performing this test for confirming brain death in the client.

Which is the most prevalent method to replace permanently injured tissues and organs? 1. Stem cell restoration 2. Therapeutic cloning 3. Reproductive cloning 4. Transplantation

4. Transplantation Feedback 1 Stem cells are capable of developing into any specialized tissue and organ and are, therefore, used to treat and regenerate injured tissues and cells. However, it is not the most prevalent method. 2 Therapeutic cloning involves harvesting of embryonic stem cells and performing nuclear transfer on these cells. With this method, it could be theoretically possible for individuals in need of organ transplant to obtain exact tissue matches of their organs. However, this is still a nascent technology with extensive ongoing research. 3 Reproductive cloning is the creation of a genetic duplicate of an existing organism. Currently, reproductive cloning is performed among livestock and other animals like cats, mice, rabbits, and mules. 4 Transplantation is the most prevalent method to replace permanently injured tissues or organs, such as kidneys. It is a complex process involving many stages that include solicitation of donors, harvesting of organs, matching of donor organs and recipients, surgical implantation, and interventions to avoid organ rejection.

The nurse is assessing the physiological variables in a client with multiple organ dysfunction syndrome (MODS), using the APACHE II scoring system. During assessment, the nurse finds a temperature of 420 C, heart rate of 150 bpm, serum sodium levels of 125 mEq/L, serum potassium levels as 3.2 mmol/Landa mean arterial pressure of 80 mm Hg. What total score does the nurse record from these findings? Record your answer as a whole number. ____________________

Answer: 10 Feedback: According to the APACHE II scoring system, the physiological variable temperature of420 C is given a score of 4, heart rate of 150 bpm is given a score of 3, serum sodium level of 125mEq/L is given a score of 2, serum potassium level of 3.2mmol/L is given a score of 1, and mean arterial pressure of 80 mmHg is given a score of 0. On addition, we get (4+3+2+1+0= 10). Therefore, the nurse records a total score of 10 based upon these findings.

While assessing the responses of a client using the Glasgow Coma Scale, the nurse finds that the client opens his/her eyes spontaneously, verbalizes inappropriate but comprehensible words, and withdraws from a painful stimulus. What total possible points does the nurse document in the client's assessment record based on these findings? Record your answer as a whole number. ____________________

Answer: 11 Feedback: According to the Glasgow Coma Scale, the client is given a score of 4 for opening the eyes spontaneously, a score of 3 for verbalizing inappropriate but comprehensible words, and a score of 4 for withdrawing from a painful stimulus. The total possible points allotted to the client are (4+3+4=11). Therefore, the nurse documents the total possible points as 11 in the client's assessment record based on these findings.

While assessing the responses of a client using the Glasgow Coma Scale, the nurse finds that the client opens his/her eyes in response to voice, verbalizing incomprehensible sounds, but does not speak any words, and has no movement or posturing. What total possible points does the nurse calculate based on these findings? Record your answer as a whole number. ____________________

Answer: 6 Feedback: According to the Glasgow Coma Scale, the client is given a score of 3 for opening his/her eyes in response to voice. The client is given a score of 2 for verbalizing incomprehensible sounds, but not speaking any words, and a score of 1 for no movement or posturing. The total possible points allotted to the client are (3+2+1=6). Therefore, the nurse calculates the total possible points as 6.

What percentage of Americans takes at least one prescription drug per year? 1. 50% 2. 10% 3. 40% 4. 25%

1. 50% Rationale 1: About half of Americans take prescription drugs while about 17% takes at least three prescription drugs. Rationale 2: The percentage of Americans taking at least one prescription drug is higher. Rationale 3: This is not the percentage of Americans taking at least one prescription drug. Rationale 4: This is not the percentage of Americans taking at least one prescription drug. Global Rationale: About half of Americans take prescription drugs while about 17% takes at least three prescription drugs.

The pharmaceutical representative comes to the physician's office and says his company's pharmaceutical laboratory is marketing a drug that does not need approval by the Food and Drug Administration (FDA). What is the best response by the nurse? 1. "Any pharmaceutical laboratory in America must have approval from the Food and Drug Administration (FDA) before marketing a drug." 2. "Is this an over-the-counter (OTC) drug? They do not need approval by the Food and Drug Administration (FDA)." 3. "Is your pharmaceutical laboratory private? Only public pharmaceutical laboratories need approval from the Food and Drug Administration (FDA)." 4. "Your pharmaceutical laboratory must be involved in academic research because they are exempt from approval by the Food and Drug Administration (FDA)."

1. "Any pharmaceutical laboratory in America must have approval from the Food and Drug Administration (FDA) before marketing a drug." Rationale 1: Any pharmaceutical laboratory must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Rationale 2: Pharmaceutical laboratories that manufacture over-the-counter (OTC) drugs must obtain approval from the Food and Drug Administration (FDA) before marketing these drugs. Rationale 3: Private pharmaceutical laboratories must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Rationale 4: Pharmaceutical laboratories involved in academic research must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Global Rationale: Any pharmaceutical laboratory, whether private, public, or academic, must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Private pharmaceutical laboratories must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Pharmaceutical laboratories involved in academic research must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Pharmaceutical laboratories that manufacture over-the-counter (OTC) drugs must obtain approval from the Food and Drug Administration (FDA) before marketing these drugs.

The nurse assesses the patient with diabetes mellitus prior to administering medications. Which questions are important to ask the patient? Standard Text: Select all that apply. 1. "Are you allergic to any medications?" 2. "Are you taking any herbal or over-the-counter medications?" 3. "How difficult is it for you to maintain your ideal body weight?" 4. "Will you please tell me about the kind of diet you follow?" 5. "What other medications are you currently taking?"

1. "Are you allergic to any medications?" 2. "Are you taking any herbal or over-the-counter medications?" 4. "Will you please tell me about the kind of diet you follow?" 5. "What other medications are you currently taking?" Rationale 1: Questions about allergies are important during assessment. Rationale 2: Questions about herbal and OTC medications are an important part of assessment. Rationale 3: Ideal body is an important question, but does not refer specifically to medication administration. Rationale 4: Questions about normal diet help to assess health management and are pertinent to drug administration. Rationale 5: Questions about current medication are important during assessment. Global Rationale: Questions about allergies and which medications are being taken are assessment questions. Questions about normal diet help to assess health management and are pertinent to drug administration. Ideal body weight is an important question but does not refer specifically to medication administration.

An older adult patient received an adrenergic eye drop to dilate the pupils for a retinal exam. What information should the nurse provide when discharging this patient? Standard Text: Select all that apply. 1. "Do not drive until the effects of the eye drops have worn off." 2. "Wear sunglasses when in bright light." 3. "You may be more comfortable in a darkened room." 4. "You may experience burning in your eyes for a couple of days." 5. "Do not eat or drink anything for at least an hour after discharge."

1. "Do not drive until the effects of the eye drops have worn off." 2. "Wear sunglasses when in bright light." 3. "You may be more comfortable in a darkened room." Rationale 1: Older adults may notice blurring of vision after receiving drops to dilate the eyes. The patient should not drive until vision is clear. Rationale 2: Photosensitivity is a common effect, and protective eyewear should be worn. Rationale 3: Photosensitivity is a common effect, and the patient may be more comfortable in a darkened room or with a soft cloth covering the eyes. Rationale 4: The burning associated with these drops should be transient. It should not last for "a couple of days." Rationale 5: There is no reason for the patient to be NPO. Global Rationale: Older adults may notice blurring of vision after receiving drops to dilate the eyes. The patient should not drive until vision is clear. Photosensitivity is a common effect, and the patient may be more comfortable in a darkened room or with a soft cloth covering the eyes. Protective eyewear should be worn in bright light. The burning associated with these drops should be transient. It should not last for "a couple of days." There is no reason for the patient to be NPO.

A patient has been prescribed an adrenergic nasal spray. What medication instruction should the nurse provide? Standard Text: Select all that apply. 1. "Do not share this spray with anyone." 2. "Sit upright while using this spray." 3. "Only use this spray for 3-5 days." 4. "Do not shake the bottle before using this spray." 5. "Keep this spray refrigerated."

1. "Do not share this spray with anyone." 2. "Sit upright while using this spray." 3. "Only use this spray for 3-5 days." Rationale 1: Sharing nasal sprays may spread infection. Rationale 2: The patient should sit upright to use this medication so that it is delivered appropriately, avoiding overdosage. Rationale 3: Adrenergic nasal sprays may cause rebound congestion if used more that 3-5 days. Rationale 4: There is no indication that the bottle should not be shaken. Rationale 5: There is no indication that the medication should be refrigerated. Global Rationale: Sharing nasal sprays may spread infection. The patient should sit upright to use this medication so that it is delivered appropriately, avoiding overdosage. Adrenergic nasal sprays may cause rebound congestion if used more that 3-5 days. There is no indication that the bottle should not be shaken. There is no indication that the medication should be refrigerated.

The nurse teaches a class to patients about how to help prevent medication errors when in the hospital. What is a priority question for the nurse to ask the patients? 1. "Do you know the names of all the medications you take?" 2. "Do you trust your physician to order the correct medication?" 3. "Do you have a friend to verify that you are receiving the correct medication?" 4. "Do you know what your illness is, and if you will need surgery?"

1. "Do you know the names of all the medications you take?" Rationale 1: Knowing the names of all medications taken can reduce drug errors when a patient is admitted to the hospital. Knowing the illness and anticipating surgery do not necessarily help prevent medication errors. Asking the patients if they trust their physicians to order the correct medication is inappropriate. It is inappropriate for friends of patients to verify medications prior to administration.

A patient asks the nurse why a medication prescribed by the provider "didn't do anything at all." Which statement by the nurse accurately describes how genetics influence drug action? Standard Text: Select all that apply. 1. "Genetic differences can result in significant differences in how each patient's body handles the same medication." 2. "Genetic differences can cause mutations in enzymes, changing the way they function. This can alter how the body metabolizes and excretes drugs." 3. "Because of genetic differences, medication may accumulate to toxic levels in one patient while in another patient may be inactivated before it can have a therapeutic effect." 4. "Genetic differences can be expressed as an alteration in the structure of an enzyme, which can cause a defective receptor and an allergic response to drugs." 5. "Genetic differences in patients who are biracial result in an allergic response to medications."

1. "Genetic differences can result in significant differences in how each patient's body handles the same medication." 2. "Genetic differences can cause mutations in enzymes, changing the way they function. This can alter how the body metabolizes and excretes drugs." 3. "Because of genetic differences, medication may accumulate to toxic levels in one patient while in another patient may be inactivated before it can have a therapeutic effect." Rationale 1: 99.8% of human DNA sequences are identical. The remaining 0.2% can account for significant differences in people's ability to handle medications. Rationale 2: The structure of an enzyme is closely related to its function. A mutation can cause a change in the structure of the enzyme, resulting in a change in its function. Rationale 3: When enzymes are functionally changed by genetics, metabolism and excretion can be altered, resulting in the drug either accumulating or being inactivated. Rationale 4: Small changes in the structure of a protein may result in a defective receptor that will not accept the drug and the drug not having any therapeutic effect. This is not an allergic response. Rationale 5: Genetic differences can result in mutations of enzymes or proteins, which may result in changes in function. Being of a certain race may predispose a patient to mutations and, therefore, uncommon responses to medication, but this does not mean the patient will have an allergic response to medications. Global Rationale: 99.8% of human DNA sequences are identical. The remaining 0.2% can account for significant differences in people's ability to handle medications. The structure of an enzyme is closely related to its function. A mutation can cause a change in the structure of the enzyme, resulting in a change in its function. When enzymes are functionally changed by genetics, metabolism and excretion can be altered, resulting in the drug either accumulating or being inactivated. Small changes in the structure of a protein may result in a defective receptor that will not accept the drug and the drug not having any therapeutic effect. This is not an allergic response. Genetic differences can result in mutations of enzymes or proteins, which may result in changes in function. Being of a certain race may predispose a patient to mutations and, therefore, uncommon responses to medication, but this does not mean the patient will have an allergic response to medications.

During assessment, the patient mentions that he recently "sent off to a company for pharmacogenomic testing." What nursing responses are indicated? Standard Text: Select all that apply. 1. "Have you changed your medications any?" 2. "Have you talked with your physician about the results?" 3. "Why did you do that?" 4. "Was that test expensive?" 5. "Who told you about the testing?"

1. "Have you changed your medications any?" 2. "Have you talked with your physician about the results?" Rationale 1: The most important question is if the patient has changed therapy secondary to test results. Rationale 2: It is important for the patient to discuss the results of the tests and any indicated changes with the health care provider. Rationale 3: Asking a "why" question is confrontational and is likely to result in the patient not sharing more information. Rationale 4: The nurse may be curious as to the expense of the test, but the cost is not pertinent to this discussion. Rationale 5: Asking who suggested the test is confrontational and is likely to result in the patient not sharing more information. Global Rationale: The most important question is if the patient has changed therapy secondary to test results. It is important for the patient to discuss the results of the tests and any indicated changes with the health care provider. Asking a "why" question or asking who suggested the test is confrontational and is likely to result in the patient not sharing more information. The nurse may be curious as to the expense of the test, but the cost is not pertinent to this discussion.

The nurse is conducting a holistic assessment of a patient with alcoholism. What are the important questions to ask? Standard Text: Select all that apply. 1. "How is drinking alcohol viewed by your culture?" 2. "Have you ever attended Alcoholics Anonymous meetings?" 3. "Did you see your parents drinking alcohol when you were growing up?" 4. "Have you been in alcohol rehabilitation before now?" 5. "What blood relatives of yours are addicted to alcohol?"

1. "How is drinking alcohol viewed by your culture?" 3. "Did you see your parents drinking alcohol when you were growing up?" 5. "What blood relatives of yours are addicted to alcohol?" Rationale 1: Cultural questions are valid questions to ask during a holistic assessment. Rationale 2: Participation in Alcoholics Anonymous refers to treatment and does not have relevance to a holistic assessment. Rationale 3: Environmental questions are valid questions to ask during a holistic assessment. Rationale 4: Participation in a rehabilitation program refers to treatment and does not have relevance to a holistic assessment. Rationale 5: Biological questions are valid questions to ask during a holistic assessment. Global Rationale: Biological, environmental, and cultural questions are valid questions to ask during a holistic assessment. Participation in a rehabilitation program refers to treatment and does not have relevance to a holistic assessment. Participation in Alcoholics Anonymous refers to treatment and does not have relevance to a holistic assessment.

A patient who was recently prescribed an adrenergic drug says, "I am so nervous and I cannot sleep." The nurse would ask which questions? Standard Text: Select all that apply. 1. "How much coffee do you drink?" 2. "Have you recently increased your intake of dairy products?" 3. "Do you eat chocolate?" 4. "When was the last time you ate pickled foods or aged cheese?" 5. "How much wine or other alcoholic beverages do you drink?"

1. "How much coffee do you drink?" 3. "Do you eat chocolate?" Rationale 1: The caffeine in coffee may cause excessive nervousness, insomnia, and tremors. Rationale 2: There should be no drug-food interaction with dairy products. Rationale 3: The caffeine in chocolate may cause excessive nervousness, insomnia, and tremors. Rationale 4: There should be no drug-food interaction with pickled foods or aged cheese. Rationale 5: There should be no drug-food interaction with beverages that contain alcohol. Global Rationale: The caffeine in coffee or chocolate may cause excessive nervousness, insomnia, and tremors. There should be no drug-food interaction with dairy products, pickled foods, aged cheese, or beverages containing alcohol.

The order is for a pain medication to be given prn. Which statement, by the nurse, correctly teaches the client about this medication order? 1. "I can give you this medication anytime you need it, so I will be asking you about your pain level frequently." 2. "This medication will be given to you at a set time every day, probably just before your bath." 3. "You will be given this medication at bedtime each night so that you can rest." 4. "This medication may upset your stomach, so always take it with food or milk."

1. "I can give you this medication anytime you need it, so I will be asking you about your pain level frequently." Rationale 1: The abbreviation PRN is used to designate as needed. Rationale 2: PRN does not mean every day. Rationale 3: PRN does not mean at bedtime. Rationale 4: PRN does not mean with food. Global Rationale: PRN does not mean every day, at bedtime, or with food.

The client has skin lesions that have not responded to prescription drugs. He tells the nurse he has heard about some research going on with a new drug and questions why he can't take it. What is the best response by the nurse? 1. "I know it is frustrating, but the Food and Drug Administration (FDA) approval process is in place to ensure that drugs are safe." 2. "The Food and Drug Administration (FDA) has very strict rules about new drugs; it is important to be patient regarding the review/approval process." 3. "Your skin lesions really aren't that bad, but maybe the new drug will be available soon." 4. "Maybe you could contact the drug company about becoming involved in a clinical trial."

1. "I know it is frustrating, but the Food and Drug Administration (FDA) approval process is in place to ensure that drugs are safe." Rationale 1: Although the public is anxious to receive new drugs, the fundamental priority of the Food and Drug Administration (FDA) is to ensure that drugs are safe. Also, telling the client that the nurse knows he is frustrated is therapeutic because it communicates that the nurse recognizes what he is feeling. Rationale 2: Telling the client to be patient is a condescending response; the client wants relief from the skin condition. Rationale 3: Telling the client his skin lesions "aren't that bad" is a non-therapeutic response; the client's perception is his reality. Rationale 4: The client could contact the drug company, but this response fosters false hope as he may not be a viable candidate for this drug. Global Rationale: Although the public is anxious to receive new drugs, the fundamental priority of the Food and Drug Administration (FDA) is to ensure that drugs are safe. Also, telling the client that the nurse knows he is frustrated is therapeutic because it communicates that the nurse recognizes what he is feeling. The client could contact the drug company, but this response fosters false hope as he may not be a viable candidate for this drug. Telling the client his skin lesions "aren't that bad" is a non-therapeutic response; the client's perception is his reality. Telling the client to be patient is a condescending response; the client wants relief from the skin condition.

The nurse has been doing medication education for the patient receiving atenolol (Tenormin), a beta blocker. The nurse determines that learning has occurred when the patient makes which statement? 1. "I need to take my pulse every day." 2. "If I have any side effects, I will stop the medication." 3. "I cannot take this drug if I develop glaucoma." 4. "I cannot continue to have my morning cup of coffee."

1. "I need to take my pulse every day." Rationale 1: Beta blockers slow the heart rate; therefore, the patient must monitor his pulse every day. Rationale 2: Beta blockers should not be stopped suddenly. Rationale 3: Adrenergic blockers, not beta blockers, are used to treat glaucoma. Rationale 4: Caffeine is not prohibited with beta blockers. Global Rationale: Beta blockers slow the heart rate; therefore, the patient must monitor his pulse every day. Beta blockers should not be stopped suddenly. Caffeine is not prohibited with beta blockers. Adrenergic blockers, not beta blockers, are used to treat glaucoma.

A nurse has provided discharge medication instructions to the parents of a child being released from the emergency department. The nurse evaluates that learning has occurred when the parents make which statements? Standard Text: Select all that apply. 1. "I should give this antibiotic as prescribed until the bottle is empty." 2. "I should use a spoon to give this medication." 3. "I will keep this medication in the refrigerator as the label directs." 4. "If my child develops any adverse effects, I will discard the rest of the medicine." 5. "This antibiotic should help my child's infection clear."

1. "I should give this antibiotic as prescribed until the bottle is empty." 3. "I will keep this medication in the refrigerator as the label directs." 5. "This antibiotic should help my child's infection clear." Rationale 1: Antibiotics should be given until the medication is gone. Rationale 2: Medications should be administered with standard devices, not household objects. Rationale 3: The label will designate storage instruction. Rationale 4: The parent should notify the prescriber, not just discard the medication. Rationale 5: The parents should understand the reason the medication is being prescribed. Global Rationale: Antibiotics should be given until the medication is gone. The label will designate storage instruction. The parents should understand the reason the medication is being prescribed. Medications should be administered with standard devices, not household objects. The parent should notify the prescriber, not just discard the medication.

The nurse in the emergency department is caring for several patients from diverse cultures. Which statement shows the nurse's ability to provide culturally competent care? Standard Text: Select all that apply. 1. "I understand your religion prohibits blood transfusions. Would you consider nonblood alternatives?" 2. "I just want to make sure you and your spouse understand the risks as you consider the options." 3. "I don't really understand why you are afraid to take the medication. Do you have any questions I can answer to alleviate your fear?" 4. "I really don't understand why you won't consider an abortion. Your admission papers say you are an atheist." 5. "I'm not quite sure why the health care provider is giving you these prescriptions. You didn't get them filled the last time you were here."

1. "I understand your religion prohibits blood transfusions. Would you consider nonblood alternatives?" 2. "I just want to make sure you and your spouse understand the risks as you consider the options." 3. "I don't really understand why you are afraid to take the medication. Do you have any questions I can answer to alleviate your fear?" Rationale 1: This statement shows the nurse is respectful of religious beliefs and open to offering alternative treatment. Rationale 2: This statement shows the nurse is accepting of patients' beliefs. Rationale 3: This statement may encourage the patient to open up to the nurse about fears. Rationale 4: This is a judgmental and insensitive comment. A culturally competent nurse is sensitive to the patient's spiritual beliefs or lack thereof. Rationale 5: This statement does not consider social factors that may contribute to nonadherence. Global Rationale: The nurse providing culturally competent care is respectful of and sensitive to religious beliefs and open to alternate treatment. The nurse encourages patient to open up about fears. There are social factors that may contribute to nonadherence to therapy.

A patient has been prescribed an oral drug containing atropine. The nurse would hold the drug and contact the prescriber if which patient statements are made? Standard Text: Select all that apply. 1. "I would like to wait a few minutes to take this as I just drank some aloe juice." 2. "Can I take this at the same time as my procainamide?" 3. "I have had a headache this morning." 4. "I am allergic to penicillin." 5. "My gallbladder surgery is scheduled for next week."

1. "I would like to wait a few minutes to take this as I just drank some aloe juice." 2. "Can I take this at the same time as my procainamide?" Rationale 1: Atropine should be used with caution in those who use aloe. Rationale 2: There is a drug-drug interaction between atropine and procainamide. Rationale 3: Headache does not prevent use of atropine. Rationale 4: Allergy to penicillin does not prevent use of atropine. Rationale 5: Gallbladder surgery for next week would not prevent use of atropine. Global Rationale: Atropine should be used with caution in those who use aloe. There is a drug-drug interaction between atropine and procainamide. Headache, allergy to penicillin, and gallbladder surgery scheduled for next week do not prevent use of atropine.

A patient returns to the clinic for follow-up after taking a newly prescribed medication for a month. The nurse recognizes medication teaching was successful when the patient makes which statement? Standard Text: Select all that apply. 1. "I've been taking my medication on an empty stomach like the prescription label said to." 2. "I take my medication first thing in the morning, just like you said." 3. "I have been able to decrease my medication to every other day and that saves me some money." 4. "I switched all my medications to one pharmacy like you suggested." 5. "Did you say I need to take this medication with water or milk?"

1. "I've been taking my medication on an empty stomach like the prescription label said to." 2. "I take my medication first thing in the morning, just like you said." 4. "I switched all my medications to one pharmacy like you suggested." Rationale 1: Some medications must be taken on an empty stomach. This statement indicates the patient is following instruction. Rationale 2: This statement indicates the patient is following instruction. Rationale 3: Changing dosage schedule without direction indicates failure to follow instruction. Rationale 4: Filling all prescriptions at the same pharmacy will assist the pharmacist in comparing current and new medications for interactions. This statement indicates the patient is following the nurse's suggestion. Rationale 5: The patient is unsure of instructions. Global Rationale: Statements about taking medication as directed indicate the patient is adhering to instructions. Changing dosage schedule without direction indicates failure to follow instruction. If the patient is unsure of instructions, it is less likely that the correct administration technique is being followed.

The student nurse asks the nursing instructor why drug plateaus occur with medications. What are the best responses by the nursing instructor? Standard Text: Select all that apply. 1. "It could be that all of the receptors for the drug are occupied." 2. "It may mean that the drug has brought 100% relief to the patient." 3. "It means that the patient has developed resistance and needs another drug." 4. "It probably means that the drug is losing efficacy." 5. "It means that the patient needs a higher dose of the drug."

1. "It could be that all of the receptors for the drug are occupied." 2. "It may mean that the drug has brought 100% relief to the patient." Rationale 1: Drug plateaus occur with medications because all the receptors for the drug are occupied. Rationale 2: Drug plateaus occur with medications when the drug has brought 100% relief to the patient. Rationale 3: Drug plateaus are not associated with resistance. Rationale 4: A drug plateau is not related to efficacy of the drug. Rationale 5: When a drug has reached its plateau, giving additional amounts will not result in an increased therapeutic effect. Global Rationale: Drug plateaus occur with medications because all the receptors for the drug are occupied; the drug has brought 100% relief to the patient. A drug plateau is not related to efficacy of the drug. When a drug has reached its plateau, giving additional amounts will not result in an increased therapeutic effect. Drug plateaus are not associated with resistance.

The patient tells the nurse that he is on many medications and questions how they all get to the right places. What are the best responses by the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "It depends on how much protein you have in your body." 2. "It depends on the health of your kidneys." 3. "It depends on whether they are fat based or water based." 4. "It depends on the amount of blood flow to your body tissues." 5. "It depends on the health of your liver."

1. "It depends on how much protein you have in your body." 3. "It depends on whether they are fat based or water based." 4. "It depends on the amount of blood flow to your body tissues." Rationale 1: Distribution of drugs depends on protein binding. Rationale 2: The health of the kidneys refers to excretion, not distribution. Rationale 3: Distribution of drugs depends on the lipid solubility of the drug. Rationale 4: Distribution of drugs depends on the amount of blood flow to body tissues. Rationale 5: The health of the liver refers to metabolism, not distribution. Global Rationale: Distribution of drugs depends on the amount of blood flow to body tissues, the lipid solubility of the drug, and protein binding. The health of the liver refers to metabolism, not distribution. The health of the kidneys refers to excretion, not distribution.

The preop patient will be receiving glycopyrrolate (Robinul), an anticholinergic drug, and asks the nurse, "Why do I need to have that shot?" What is the best response by the nurse? 1. "It will decrease your respiratory secretions during surgery." 2. "It will increase your urinary output during surgery." 3. "It will help you breathe better during surgery." 4. "It will help maintain your blood pressure during surgery."

1. "It will decrease your respiratory secretions during surgery." Rationale 1: Anticholinergics dry secretions; a decrease in respiratory secretions is indicated prior to surgery. Rationale 2: Anticholinergic drugs do not increase urinary output. Rationale 3: Anticholinergic drugs do not facilitate respirations. Rationale 4: Anticholinergic drugs do not maintain blood pressure. Global Rationale: Anticholinergics dry secretions; a decrease in respiratory secretions is indicated prior to surgery. Anticholinergic drugs do not maintain blood pressure, facilitate respirations, or increase urinary output.

The patient is receiving a sustained-release capsule for his cardiac condition. The patient tells the nurse there is no way he can swallow such a large pill. What is the best response by the nurse? 1. "Let me contact your physician to see if a change can be made." 2. "Place the capsule on the back of your tongue, and drink a full glass of water." 3. "I will open the capsule and sprinkle the contents over some applesauce for you to eat." 4. "It may be difficult, but try to swallow the capsule as it is the best medicine for your heart condition."

1. "Let me contact your physician to see if a change can be made." Rationale 1: The only option is to contact the physician. Rationale 2: Placing the capsule on the back of the patient's tongue and having him drink a full glass of water may cause the patient to aspirate the capsule and/or the water. Rationale 3: Sustained-release medications cannot be opened and sprinkled on food. Rationale 4: Encouraging the patient to try to swallow the capsule is coercive and may result in the patient choking on the medication. Global Rationale: The only option is to contact the physician. Sustained-release medications cannot be opened and sprinkled on food. Placing the capsule on the back of the patient's tongue and having him drink a full glass of water may cause the patient to aspirate the capsule and/or the water. Encouraging the patient to try to swallow the capsule is coercive and may result in the patient choking on the medication.

A new nurse on the orthopedic floor makes a medication error. Which statements by the nurse manager foster a safe environment in which nurses will report medication errors? Standard Text: Select all that apply. 1. "Many of us have made a medication error in our careers. The most important issue is to identify why the error occurred." 2. "I know you could not feel any worse than you already do. We need to discuss how this error happened and how we can prevent it from happening again." 3. "It's really good that your patient is OK and did not suffer any harmful effects of this error. We should discuss why this error occurred and how it can be prevented in the future." 4. "Because you are a new nurse, we should sit down and discuss the procedure you followed to see what you could have done to prevent this error." 5. "We need to sit down as soon as possible and write up an incident report describing everything you did incorrectly that caused this error."

1. "Many of us have made a medication error in our careers. The most important issue is to identify why the error occurred." 2. "I know you could not feel any worse than you already do. We need to discuss how this error happened and how we can prevent it from happening again." 3. "It's really good that your patient is OK and did not suffer any harmful effects of this error. We should discuss why this error occurred and how it can be prevented in the future." 4. "Because you are a new nurse, we should sit down and discuss the procedure you followed to see what you could have done to prevent this error." Rationale 1: All errors should be investigated with the goal of identifying why they occurred. This investigation should be done in a manner that is not punitive and will encourage staff to report errors without fear of punishment. Rationale 2: All errors should be investigated with the goal of identifying why they occurred. This investigation should be done in a manner that is not punitive and will encourage staff to report errors without fear of punishment. Rationale 3: All errors should be investigated with the goal of identifying why they occurred. This investigation should be done in a manner that is not punitive and will encourage staff to report errors without fear of punishment. Rationale 4: All errors should be investigated with the goal of identifying why they occurred. This investigation should be done in a manner that is not punitive and will encourage staff to report errors without fear of punishment. Rationale 5: An incident report will need to be written, but the nurse who made the error should feel the report will identify factors contributing to the error rather than place blame.

The nurse is planning care for a pregnant patient prone to substance abuse. When the patient states, "My baby isn't getting my drugs, I am," how does the nurse respond? Standard Text: Select all that apply. 1. "Most illicit drugs will cross the placenta and hurt the baby." 2. "Drugs may work longer in your baby." 3. "Some drugs result in your baby not growing enough." 4. "You are correct. You are far enough along in your pregnancy that drugs will not harm your baby." 5. "If you continue to take drugs, it will make you have a very irritable infant."

1. "Most illicit drugs will cross the placenta and hurt the baby." 2. "Drugs may work longer in your baby." 3. "Some drugs result in your baby not growing enough." Rationale 1: Most illicit drugs cross the placenta and can cause premature birth, low birth weight, birth defects, and withdrawal symptoms. Rationale 2: Because the fetus lacks mature metabolic enzymes and efficient excretion mechanisms, drugs will have a prolonged duration of action within the unborn child. Rationale 3: Some drugs result in intrauterine growth retardation. Rationale 4: The effect the drug has on the fetus will depend on the stage of fetal development. There is a greater potential for harm during the first trimester, but nutrients to the fetus can be compromised by drug abuse during the latter stages of pregnancy. Rationale 5: While withdrawal can cause irritability in infants born to drug addicts, the risk for irritability is not the reason for abstaining from drug use during pregnancy. Global Rationale: Most illicit drugs cross the placenta and can cause premature birth, low birth weight, birth defects, and withdrawal symptoms. Because the fetus lacks mature metabolic enzymes and efficient excretion mechanisms, drugs will have a prolonged duration of action within the unborn child. Some drugs result in intrauterine growth retardation. The effect the drug has on the fetus will depend on the stage of fetal development. While withdrawal can cause irritability in infants born to drug addicts, the risk for irritability is not the reason for abstaining from drug use during pregnancy. There is a greater potential for harm during the first trimester, but nutrients to the fetus can be compromised by drug abuse during the latter stages of pregnancy.

The nurse has finished teaching a patient's husband how to administer drugs and enteral feeding through a gastrostomy tube. The nurse knows the husband understands the use of the tube when he makes which statements? Standard Text: Select all that apply. 1. "My wife has a gastrostomy tube instead of a nasogastric tube because she will have the tube for a long time." 2. "I will need to use liquid medications. If any of the medications are in pill form, I will use the pill crusher to crush them and mix them with water before putting them in the tube." 3. "This medication says it is enteric coated. I'm not supposed to crush this kind of medication. I will need to ask the doctor to substitute another medication that is liquid or can be crushed." 4. "There's a big difference in how the drugs work in the body when they're taken orally and when they're administered through the tube. That's why my wife has to have this tube." 5. "I have to be very careful to flush the tube after I put medication in it. If I don't, the tube could get clogged."

1. "My wife has a gastrostomy tube instead of a nasogastric tube because she will have the tube for a long time." 2. "I will need to use liquid medications. If any of the medications are in pill form, I will use the pill crusher to crush them and mix them with water before putting them in the tube." 3. "This medication says it is enteric coated. I'm not supposed to crush this kind of medication. I will need to ask the doctor to substitute another medication that is liquid or can be crushed." 5. "I have to be very careful to flush the tube after I put medication in it. If I don't, the tube could get clogged." Rationale 1: Nasogastric tubes are used for short-term care while gastrostomy tubes are placed in patients who will need long-term care. Rationale 2: Most health care providers order drugs in liquid form for NG and G tube patients. If a medication does not come in liquid form, the solid form will need to be crushed and mixed with water prior to administration unless there is a contraindication for crushing the medication. Rationale 3: Enteric-coated medications should not be crushed. To do so would expose the drug to the acid in the stomach when it is intended to bypass the stomach acid and be dissolved in the alkaline environment of the small intestine. Rationale 4: Drugs administered via gastrostomy tube are affected by the same physiological processes as those given orally. Rationale 5: While solid drugs may be crushed and dissolved in water prior to being administered, they tend to clog the tubes if the tubes are not routinely flushed. Global Rationale: Nasogastric tubes are used for short-term care while gastrostomy tubes are placed in patients who will need long-term care. Most health care providers order drugs in liquid form for NG and G tube patients. If a medication does not come in liquid form, the solid form will need to be crushed and mixed with water prior to administration unless there is a contraindication for crushing the medication. Enteric-coated medications should not be crushed. To do so would expose the drug to the acid in the stomach when it is intended to bypass the stomach acid and be dissolved in the alkaline environment of the small intestine. While solid drugs may be crushed and dissolved in water prior to being administered, they tend to clog the tubes if the tubes are not routinely flushed. Drugs administered via gastrostomy tube are affected by the same physiological processes as those given orally.

The patient has had hypertension for many years. The physician orders an antihypertensive drug that has just come on the market. The nurse teaches the patient that this drug works more effectively than his prior drug and has fewer side effects. The patient asks how this can be. What is the best response by the nurse? Standard Text: Select all that apply. 1. "Newer drugs are altered to affect your cells' receptors in a different way." 2. "Receptors tend to 'burn-out,' so newer drugs are required." 3. "Research into receptors helps 'fine-tune' drugs to be more effective." 4. "Changing the response of the drug to protein receptor-complexes produces fewer side effects." 5. "It is a process of trial and error with receptors until the new drug proves effective."

1. "Newer drugs are altered to affect your cells' receptors in a different way." 3. "Research into receptors helps 'fine-tune' drugs to be more effective." Rationale 1: Receptor research results in the development of new medications that activate very specific receptors to produce a greater therapeutic response as well as fewer side effects. Rationale 2: Receptors do not "burn-out." Rationale 3: Research into receptors has resulted in the "fine-tuning" of medications that are more effective with fewer side effects. Rationale 4: There is no such thing as a protein receptor-complex. Rationale 5: Research is not a process of trial and error with receptors. Global Rationale: Receptor research results in the development of new medications that activate very specific receptors to produce a greater therapeutic response as well as fewer side effects. Research into receptors has resulted in the "fine-tuning" of medications that are more effective with fewer side effects. Research is not a process of trial and error with receptors. Receptors do not "burn-out." There is no such thing as a protein receptor-complex.

A patient has been prescribed an adrenergic-blocker for treatment of hypertension. What information should the nurse provide? Standard Text: Select all that apply. 1. "Rise from a sitting position slowly." 2. "Sit on the side of the bed a few moments before you stand." 3. "If you feel dizzy, add more salt to your diet." 4. "If you feel dizzy, sit or lie down until the dizziness passes." 5. "Try to continue daily activities even if dizziness occurs."

1. "Rise from a sitting position slowly." 2. "Sit on the side of the bed a few moments before you stand." 4. "If you feel dizzy, sit or lie down until the dizziness passes." Rationale 1: Patients who are starting on adrenergic-blocking drugs should move slowly from the sitting position. Rationale 2: Sitting on the side of the bed will help blood pressure normalize before standing. Rationale 3: Additional salt is not indicated for people who have hypertension. Rationale 4: If the patient feels dizzy, sitting down or lying down will help to prevent falls. Rationale 5: The patient should monitor dizziness and should take safety precautions until acclimated to the medication. Global Rationale: Patients who are starting on adrenergic-blocking drugs should move slowly from the sitting position. Sitting on the side of the bed will help blood pressure normalize before standing. If the patient feels dizzy, sitting down or lying down will help to prevent falls. Additional salt is not indicated for people who have hypertension. The patient should monitor dizziness and should take safety precautions until acclimated to the medication.

The nurse suspects that the patient has not been taking his prescribed antihypertensive medication because the patient's blood pressure remains elevated. What is the best therapeutic question the nurse can ask that will assess noncompliance? 1. "Taking medication is difficult for many people. What are some of your concerns about the medication?" 2. "Your blood pressure is really high; do you realize the serious consequences of not taking your medication?" 3. "I really doubt that you are taking your medication. What would you think about talking to the doctor?" 4. "You are one of my favorite patients and I want you to be safe. Are you really taking your medication?"

1. "Taking medication is difficult for many people. What are some of your concerns about the medication?" Rationale 1: The most therapeutic question informs the patient that compliance is difficult for many people, and does not directly challenge the patient about not taking the medication. Rationale 2: Telling the patient his blood pressure is high and there are serious consequences is using the "scare tactic," and is non-therapeutic; the patient most likely is aware of the consequences. Rationale 3: Telling the patient that the nurse doubts he is taking the medication directly challenges him, and recommending that he see the physician is threatening. Rationale 4: Telling the patient that he is a favorite is manipulating. Global Rationale: The most therapeutic question informs the patient that compliance is difficult for many people, and does not directly challenge the patient about not taking the medication. Telling the patient that the nurse doubts he is taking the medication directly challenges him, and recommending that he see the physician is threatening. Telling the patient his blood pressure is high and there are serious consequences is using the "scare tactic," and is non-therapeutic; the patient most likely is aware of the consequences. Telling the patient that he is a favorite is manipulating.

A client says to the admitting nurse, "Why do you need to know the names of all the over-the-counter supplements I take? They aren't drugs." Which of the nurse's responses are appropriate? Standard Text: Select all that apply. 1. "The admitting physician needs to know everything you are taking." 2. "You're right. I'm not sure why the admitting paperwork asks for this information. Would you mind listing them anyway?" 3. "The law requires us to keep a list of over-the-counter drugs and supplements that you are taking." 4. "It is true that supplements are not considered drugs; however, some of these products can cause adverse effects with prescribed drugs." 5. "We need to know if you are having an allergic reaction to one of them."

1. "The admitting physician needs to know everything you are taking." 4. "It is true that supplements are not considered drugs; however, some of these products can cause adverse effects with prescribed drugs." Rationale 1: The health care providers involved in this client's care will need to know everything she is taking—both prescription and over-the-counter (OTC). Rationale 2: While it is true that supplements are not considered drugs, there is a specific reason why the health care team needs to know this information, which is the reason for the requested list on the paperwork. The nurse's answer did not address the client's question appropriately. Rationale 3: No law requires hospitals to keep records of OTC drugs and supplements that clients take. This information is needed, however, for other reasons. Rationale 4: Supplements are not subject to the same regulatory process as drugs, and some of these products can cause adverse effects and interact with medications. Rationale 5: It is possible that this client could be having an allergic reaction, but there is not enough information to determine this, and this is not the main reason why the health care team needs to know what OTC medications she is taking. Global Rationale: The health care providers involved in this client's care will need to know everything she is taking—both prescription and over-the-counter (OTC). While it is true that supplements are not considered drugs, there is a specific reason why the health care team needs to know this information, which is the reason for the requested list on the paperwork. No law requires hospitals to keep records of OTC drugs and supplements that clients take. Supplements are not subject to the same regulatory process as drugs, and some of these products can cause adverse effects and interact with medications. It is possible that this client could be having an allergic reaction, but there is not enough information to determine this, and this is not the main reason why the health care team needs to know what OTC medications she is taking.

The nurse teaches a class about medication used during pregnancy to pregnant women. The nurse determines that additional instruction is required when a class participant makes which response? 1. "The baby can only be harmed by medications during the first trimester." 2. "It is important to not take over-the-counter (OTC) drugs during my pregnancy." 3. "Exposure to teratogens can result in my baby's death or in malformations." 4. "If I breastfeed my baby, drugs can come through my breast milk."

1. "The baby can only be harmed by medications during the first trimester." Rationale 1: A baby can be harmed by medication used throughout the period of gestation. Rationale 2: Over-the-counter (OTC) drugs should be avoided during pregnancy. Rationale 3: Teratogens can cause fetal demise and congenital malformations. Rationale 4: Many drugs are transferred through breast milk. Global Rationale: A baby can be harmed by medication used throughout the period of gestation. Over-the-counter (OTC) drugs should be avoided during pregnancy. Many drugs are transferred through breast milk. Teratogens can cause fetal demise and congenital malformations.

The nursing instructor teaches the student nurses about the nervous system. The instructor determines that learning has occurred when the students make which statement(s)? Standard Text: Select all that apply. 1. "The central nervous system includes the brain and spinal cord." 2. "The peripheral nervous system has mainly sensory functions." 3. "The somatic nervous system gives us voluntary control over our gastrointestinal (GI) tract." 4. "The nervous system helps us react to environmental changes." 5. "The somatic nervous system gives us voluntary control over moving."

1. "The central nervous system includes the brain and spinal cord." 4. "The nervous system helps us react to environmental changes." 5. "The somatic nervous system gives us voluntary control over moving." Rationale 1: The central nervous system includes the brain and spinal cord. Rationale 2: The peripheral nervous system has both sensory and motor divisions. Rationale 3: The somatic nervous system gives voluntary control over skeletal muscles. Rationale 4: The nervous system provides reaction to environmental changes. Rationale 5: The somatic nervous system provides voluntary control over moving. Global Rationale: The central nervous system includes the brain and spinal cord. The somatic nervous system provides voluntary control over moving. The nervous system provides reaction to environmental changes. The peripheral nervous system has both sensory and motor divisions. The somatic nervous system gives voluntary control over skeletal muscles.

A client at 14-weeks gestation is seen in the clinic with a sprained ankle. The physician prescribes a mild analgesic, rest, compression, and application of an ice bag. The client is very concerned about taking the prescribed medication, telling the nurse, "I don't want to hurt my baby." How should the nurse respond? Standard Text: Select all that apply. 1. "The most dangerous time for birth defects is probably in the first semester and you are past that now." 2. "You are wise to avoid all drugs. I would only use the rest, compression, and ice." 3. "Let me check with the physician to see if he remembered you are pregnant." 4. "This is a category A drug, so there is very little risk to your baby." 5. "Don't worry, it will all be okay. You need to take care of yourself first."

1. "The most dangerous time for birth defects is probably in the first semester and you are past that now." 4. "This is a category A drug, so there is very little risk to your baby." Rationale 1: The time of highest risk of birth defects is probably in the first trimester, and this client is past that time. It is not possible to predict that there is no risk from drug consumption. Rationale 2: While drug avoidance is preferred, in some cases it is necessary. If the nurse has concerns about the drug prescribed, collaboration with the prescriber is indicated. Rationale 3: Without further information about which drug was prescribed, it is non-therapeutic to make the client doubt the prescriber's choice of therapy. Rationale 4: With category A drugs, the risk of fetal harm is unlikely. Rationale 5: This statement is non-therapeutic and dismisses the client's concern. Global Rationale: The time of highest risk of birth defects is probably in the first trimester, and this client is past that time. It is not possible to predict that there is no risk from drug consumption. With category A drugs, the risk of fetal harm is unlikely. While drug avoidance is preferred, in some cases it is necessary. If the nurse has concerns about the drug prescribed, collaboration with the prescriber is indicated. The statement of "don't' worry" is non-therapeutic and dismisses the client's concern.

The nursing instructor teaches the student nurses about the autonomic nervous system. The instructor determines that learning has occurred when the students make which statement(s)? Standard Text: Select all that apply. 1. "The sympathetic and parasympathetic systems are not always opposite in their effects." 2. "The parasympathetic nervous system is the "fight-or-flight" response." 3. "Sympathetic stimulation causes dilation of arterioles." 4. "The parasympathetic nervous system causes bronchial constriction." 5. "The sympathetic nervous system is activated under stress."

1. "The sympathetic and parasympathetic systems are not always opposite in their effects." 4. "The parasympathetic nervous system causes bronchial constriction." 5. "The sympathetic nervous system is activated under stress." Rationale 1: The sympathetic and parasympathetic systems are not always opposite in their effects. Rationale 2: The parasympathetic nervous system is the rest-and-digest response. Rationale 3: Sympathetic stimulation causes constriction of arterioles. Rationale 4: The parasympathetic nervous system causes bronchial constriction. Rationale 5: The sympathetic nervous system is activated under stress. Global Rationale: The parasympathetic nervous system causes bronchial constriction. The sympathetic and parasympathetic systems are not always opposite in their effects. The sympathetic nervous system is activated under stress. The parasympathetic nervous system is the rest-and-digest response. Sympathetic stimulation causes constriction of arterioles.

A patient has been prescribed phenylephrine (Neo-Synephrine) spray for nasal congestion. What information about adverse effects should the nurse provide in discharge teaching? Standard Text: Select all that apply. 1. "This drug may cause some stinging or burning in your nose." 2. "You may notice that your nasal secretions take on a slightly orange tint." 3. "You may feel like your blood pressure is low for the first few times you use this spray." 4. "One of the major adverse effects of this drug is rebound congestion if it is used more than a few days." 5. "Do not drink herbal teas while taking this medication."

1. "This drug may cause some stinging or burning in your nose." 4. "One of the major adverse effects of this drug is rebound congestion if it is used more than a few days." Rationale 1: Intranasal use of this drug can cause burning of the mucosa. Rationale 2: There is no indication that orange-tinted nasal secretions should be expected. Rationale 3: Intranasal medications, if used properly, should have little or no effect on blood pressure. Rationale 4: Rebound congestion is likely to occur if the drug is used for over 3-5 days. Rationale 5: There are no known drug-herbal interactions with this drug. Global Rationale: Intranasal use of this drug can cause burning of the mucosa. Rebound congestion is likely to occur if the drug is used for over 3-5 days. There is no indication that orange-tinted nasal secretions should be expected. Intranasal medications, if used properly, should have little or no effect on blood pressure. There are no known drug-herbal interactions with this drug.

The pregnant patient tells the nurse that her prescribed medication is not as effective as it was before her pregnancy. What is the best response by the nurse? 1. "This is because your blood volume has increased." 2. "Tell me how you have been taking your medication." 3. "This is because your baby is receiving part of the medication." 4. "Maybe the medication has expired; check the label."

1. "This is because your blood volume has increased." Rationale 1: Increased blood volume results in hemodilution and increased excretion of the medication. Rationale 2: Asking the patient how she is taking the medication is a good idea, but in this case, increased blood volume is responsible for decreased drug effect. Rationale 3: The medication effectiveness is not reduced because of the baby. Rationale 4: The medication has most likely not expired; most patients have it refilled monthly. Global Rationale: Increased blood volume results in hemodilution and increased excretion of the medication. The medication effectiveness is not reduced because of the baby. Asking the patient how she is taking the medication is a good idea, but in this case, increased blood volume is responsible for decreased drug effect. The medication has most likely not expired; most patients have it refilled monthly.

Which patients should the nurse be concerned about regarding nonadherence to prescribed medication regimens? Standard Text: Select all that apply. 1. A 70-year-old male patient with hypertension who has a prescription for a diuretic and is complaining that his medication is keeping him up all night 2. A 30-year-old college student who has a prescription for birth control pills and tells the nurse she has had breakthrough bleeding this past cycle 3. A 45-year-old patient with diabetes who has a prescription for insulin and whose blood sugar is within the normal range 4. A 57-year-old day laborer who has a prescription for Lipitor for high cholesterol and a prescription card for a free health clinic 5. An 18-year-old male with a prescription for an acne medication that must be taken 4 times a day

1. A 70-year-old male patient with hypertension who has a prescription for a diuretic and is complaining that his medication is keeping him up all night 5. An 18-year-old male with a prescription for an acne medication that must be taken 4 times a day Rationale 1: This patient has been taking his diuretic in the evening instead of in the morning and is most likely experiencing increased urination at night that is disrupting his sleep. Adverse side effects are common causes for nonadherence. Rationale 2: Birth control pills often cause midcycle bleeding. This does not raise any red flags for nonadherence. Rationale 3: The fact that this patient's blood sugar is within the normal range may be evidence that the patient is taking insulin as directed. Rationale 4: The means to pay for medication (free clinic prescription card) decreases the patient's risk for nonadherence. Rationale 5: One of the most common reasons for nonadherence is forgetting a dose, particularly with drugs that must be taken more than twice a day. Global Rationale: This patient has been taking his diuretic in the evening instead of in the morning and is most likely experiencing increased urination at night that is disrupting his sleep. Adverse side effects are common causes for nonadherence. One of the most common reasons for nonadherence is forgetting a dose, particularly with drugs that must be taken more than twice a day. Birth control pills often cause midcycle bleeding. This does not raise any red flags for nonadherence. The fact that this patient's blood sugar is within the normal range may be evidence that the patient is taking insulin as directed. The means to pay for medication (free clinic prescription card) decreases the patient's risk for nonadherence.

A woman who wishes to become pregnant is concerned about the drugs she must take in order to treat a serious medical condition. The nurse reviewing the drug list would be most concerned about which kind of drug? 1. A drug with a long half-life 2. A drug with no active metabolites 3. A drug with high protein-binding ability 4. A drug taken only when needed

1. A drug with a long half-life Rationale 1: Drugs with long half-lives should be avoided because they can accumulate in the infant's plasma. Rationale 2: Drugs with active metabolites should be avoided because they can accumulate in the infant's plasma. Rationale 3: Drugs with high protein-binding ability are not secreted as readily to the milk. Rationale 4: If a drug is taken on an as needed basis, the woman could schedule the drug to be taken immediately after breast feeding. Global Rationale: Drugs with long half-lives or active metabolites should be avoided because they can accumulate in the infant's plasma. Drugs with high protein-binding ability are not secreted as readily to the milk. If a drug is taken on an as needed basis, the woman could schedule the drug to be taken immediately after breast feeding.

Aspirin is ionized as it enters the small intestine. Which statement is accurate regarding the absorption of aspirin in the small intestine? 1. Absorption is decreased. 2. Absorption is increased. 3. Ionization has nothing to do with the absorption rate. 4. Aspirin must travel past the small intestine for absorption to occur.

1. Absorption is decreased. Rationale 1: The small intestine is a more alkaline environment. Aspirin is an acidic drug that is ionized in the small intestine and will have lower absorption rates. Rationale 2: Higher rates of absorption occur in the stomach (an acidic environment). Rationale 3: Ionization state affects absorption rate. Rationale 4: Absorption of aspirin occurs in the stomach. Global Rationale: The small intestine is a more alkaline environment, which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ionized in the small intestine and will have lower absorption rates. Higher rates of absorption occur in the stomach (an acidic environment). Absorption of aspirin occurs in the stomach.

Which statement is accurate regarding exogenous acetylcholine? 1. Acetylcholine has almost no therapeutic effects because it is rapidly destroyed once given. 2. Acetylcholine is broken down rapidly within the body, preventing it from producing adverse effects. 3. Acetylcholine will cause the heart rate to increase and blood pressure to drop. 4. When given in small amounts, acetylcholine will produce profound parasympathetic effects.

1. Acetylcholine has almost no therapeutic effects because it is rapidly destroyed once given. Rationale 1: Exogenous acetylcholine is not generally administered, because it is rapidly destroyed by the body. Rationale 2: It does produce many adverse effects. Rationale 3: Acetylcholine can lower blood pressure, but it also lowers heart rate. Rationale 4: Exogenous acetylcholine is not generally administered. Global Rationale: Exogenous acetylcholine is not generally administered, because it is rapidly destroyed by the body. It does produce many adverse effects. Acetylcholine can lower blood pressure, but it also lowers heart rate.

Which of the following best represents adherence to a standard of care? 1. Administering a medication within the time frame specified by hospital policy 2. Administering a medication intramuscularly when a patient refuses to take it orally 3. Using abbreviations while charting to save time 4. Discontinuing a medication at the request of a patient

1. Administering a medication within the time frame specified by hospital policy Rationale 1: Administering medications as specified by agency policy is meeting the standard of care. Discontinuing medications is outside the scope of nursing. Changing the route of medication administration requires an order, and would not be appropriate, since the patient is refusing it. Using abbreviations might save time, but is not generally considered meeting a standard of care.

When teaching the patient about a new medication, the nurse should include which information? Standard Text: Select all that apply. 1. Adverse effects that can be expected 2. Which adverse effect to report to the health care provider 3. The drug's therapeutic action 4. Chemical composition of the drug 5. Name of the drug manufacturer

1. Adverse effects that can be expected 2. Which adverse effect to report to the health care provider 3. The drug's therapeutic action Rationale 1: In order to help the patient identify and prevent adverse effects, the patient should be taught the adverse effects. Rationale 2: The patient should be taught when to notify the health care provider of adverse effects. Rationale 3: In order to help the patient identify and prevent adverse effects, the patient should be taught the therapeutic action of the drug. Rationale 4: It is not necessary to teach the patient the chemical makeup of the drug. Rationale 5: It is not necessary to teach the patient the name of the drug manufacturer. Global Rationale: In order to help the patient identify and prevent adverse effects, the patient should be taught the therapeutic action, adverse effects, and when to notify the health care provider of adverse effects. It is not necessary to teach the patient the chemical makeup of the drug or the name of the drug manufacturer.

Which method would the nurse use to administer medications to school-age children? 1. Allow the child to make decisions regarding how medications are taken 2. Provide a brief explanation 3. Administer drugs while holding the child down 4. Provide a lengthy explanation followed by quick drug administration

1. Allow the child to make decisions regarding how medications are taken Rationale 1: Allowing the child to become a participant in the process of medication administration is important for this age group. Rationale 2: At this age more detail can be included in explanations about the drug. Rationale 3: At this age it is unlikely the child will need to be restrained. Rationale 4: Lengthy explanations are more appropriate for adolescents. Global Rationale: Allowing the child to become a participant in the process of medication administration is important for this age group. At this age more detail can be included in explanations about the drug. At this age it is unlikely the child will need to be restrained. Lengthy explanations are more appropriate for adolescents.

Which patient statements would the nurse evaluate as negatively affecting access to health care? Standard Text: Select all that apply. 1. An older adult says, "If I tell my doctor that I fall frequently, I might have to go to a nursing home." 2. A young adult says, "A benefit of my new job is that it pays for my health, dental, and vision insurance." 3. A patient being discharged says, "Can you call my prescriptions in to the pharmacy?" 4. The patient's new insurance plan requires a $10 copay for office visits. 5. A patient asks to be discharged before noon as he has a 3-hour drive home.

1. An older adult says, "If I tell my doctor that I fall frequently, I might have to go to a nursing home." 4. The patient's new insurance plan requires a $10 copay for office visits. 5. A patient asks to be discharged before noon as he has a 3-hour drive home. Rationale 1: The older adult may not reveal a fall history out of concern for loss of independence and a change in living conditions. Rationale 2: Having a job that pays insurance helps ensure access. Rationale 3: Being able to call prescriptions in to the pharmacy helps ensure access. Rationale 4: Even a low cost copay may be difficult for some patients to afford. Rationale 5: Living long distances from health care sources decreases access. Global Rationale: The older adult may not reveal a fall history out of concern for loss of independence and a change in living conditions. Even a low cost copay may be difficult for some patients to afford. Living long distances from health care sources decreases access. Having a job that pays insurance helps ensure access. Being able to call prescriptions in to the pharmacy helps ensure access.

Which information is essential for the nurse to collect when reviewing a patient's medication list? Standard Text: Select all that apply. 1. Drug names 2. Drug manufacturer 3. Dosage being taken 4. Frequency of administration 5. When last refill was obtained

1. Drug names 3. Dosage being taken 4. Frequency of administration Rationale 1: Drug name is essential information for this assessment. Rationale 2: It is not necessary to record the name of the drug manufacturer. Rationale 3: Dosage being taken is essential information for this assessment. Rationale 4: Frequency of administration is essential information for this assessment. Rationale 5: It is not necessary to determine when the last prescription refill was obtained. Global Rationale: Drug name, amount being taken, and frequency of administration are all essential parts of a medication history. It is not important to record the name of the drug manufacturer or when the last prescription refill was obtained.

The nurse is providing preconception teaching to a group of women who wish to become pregnant. The nurse informs the group that which classifications of medications have shown no confirmed risk for fetal abnormalities if taken while pregnant? Standard Text: Select all that apply. 1. Category A 2. Category B 3. Category C 4. Category D 5. Category X

1. Category A 2. Category B Rationale 1: Category A drugs are those in which controlled studies have failed to show a risk to the fetus and the possibility of fetal harm appears unlikely. Rationale 2: Category B drugs are those in which animal-reproduction studies have not shown a fetal risk or adverse effect. Risks have not been confirmed in controlled studies in women. Rationale 3: Category C drugs are those in which either studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women or studies in women and animals are not advisable. Rationale 4: Category D drugs are those in which there is confirmation of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used). Rationale 5: Category X drugs are those in which animal and human studies have shown fetal abnormalities. The drug is contraindicated in women who are or may become pregnant. Global Rationale: Category A drugs are those in which controlled studies have failed to show a risk to the fetus and the possibility of fetal harm appears unlikely. Category B drugs are those in which animal-reproduction studies have not shown a fetal risk or adverse effect. Risks have not been confirmed in controlled studies in women. Category C drugs are those in which either studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women or studies in women and animals are not advisable. Category D drugs are those in which there is confirmation of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used). Category X drugs are those in which animal and human studies have shown fetal abnormalities. The drug is contraindicated in women who are or may become pregnant.

A nurse is reading about the development of drugs that inhibit the parasympathetic nervous system. The nurse would look for articles about which drug classes? Standard Text: Select all that apply. 1. Anticholinergics 2. Parasympathomimetics 3. Parasympatholytics 4. Cholinergics 5. Muscarinic blockers

1. Anticholinergics 3. Parasympatholytics 5. Muscarinic blockers Rationale 1: Anticholinergics inhibit the parasympathetic nervous system. Rationale 2: Parasympathomimetic drugs stimulate the parasympathetic nervous system. Rationale 3: Parasympatholytic drugs inhibit the parasympathetic nervous system. Rationale 4: Cholinergic drugs stimulate the parasympathetic nervous system. Rationale 5: Muscarinic blockers inhibit the parasympathetic nervous system. Global Rationale: Anticholinergics, parasympatholytics, and muscarinic blockers inhibit the parasympathetic nervous system. : Parasympathomimetic drugs and cholinergic drugs stimulate the parasympathetic nervous system.

The nurse is participating in the New Drug Review step for a new therapeutic agent. Which activities will the nurse most likely perform during this phase of the drug approval process? Standard Text: Select all that apply. 1. Attend meetings to finalize the brand name for the drug. 2. Check on the results of animal testing. 3. Survey for harmful effects in a larger population. 4. Evaluate the results of the drug on cultured cells. 5. Provide the medication to large groups of people with a particular disease.

1. Attend meetings to finalize the brand name for the drug. 2. Check on the results of animal testing. Rationale 1: During the NDA or the third stage of the drug approval process, the drug's brand name is finalized. Rationale 2: During the NDA stage of the drug approval process, animal testing may continue. Rationale 3: Surveying for harmful effects in a larger population occurs during the post-marketing surveillance step of the drug approval process. Rationale 4: Evaluation of the results of the drug on cultured cells occurs during the preclinical investigation step of the drug approval process. Rationale 5: Providing the medication to large groups of people with a particular disease occurs during the clinical phase trials, which is in the second stage of the drug approval process. Global Rationale: During the NDA or the third stage of the drug approval process, the drug's brand name is finalized. Animal testing may continue during this stage. Surveying for harmful effects in a larger population occurs during the post-marketing surveillance step of the drug approval process. Evaluation of the results of the drug on cultured cells occurs during the preclinical investigation step of the drug approval process. Providing the medication to large groups of people with a particular disease occurs during the clinical phase trials, which is in the second stage of the drug approval process.

The nurse is caring for a patient with multisystem organ failure. Which patient assessment findings are under the control of the sympathetic nervous system? Standard Text: Select all that apply. 1. Blood glucose level 210 mg/dL 2. Blood pressure 180/90 mmHg 3. Extremities are cool 4. Respiratory rate 14 and regular 5. Hyperactive bowel sounds

1. Blood glucose level 210 mg/dL 2. Blood pressure 180/90 mmHg 3. Extremities are cool Rationale 1: Metabolic effects such as an increase in blood glucose are a sympathetic nervous system function. Rationale 2: The constriction and relaxation of arterioles are controlled entirely by the sympathetic nervous system. Rationale 3: The sympathetic nervous system controls release of epinephrine and norepinephrine, which result in peripheral vasoconstriction. Rationale 4: The respiratory rate would be faster and deeper when under sympathetic nervous system control. Rationale 5: When under sympathetic nervous system control, peristalsis is temporarily suspended. Global Rationale: Metabolic effects such as an increase in blood glucose are a sympathetic nervous system function. The constriction and relaxation of arterioles is controlled entirely by the sympathetic nervous system. The sympathetic nervous system controls release of epinephrine and norepinephrine, which result in peripheral vasoconstriction. The respiratory rate would be faster and deeper when under sympathetic nervous system control. When under sympathetic nervous system control, peristalsis is temporarily suspended.

A patient states, "I stopped taking that beta blocker last week. It made me so tired, I just couldn't go on taking it." What are the priority nursing assessments? Standard Text: Select all that apply. 1. Blood pressure 2. Heart rhythm 3. Urinary output 4. Presence of chest pain 5. Presence of respiratory crackles

1. Blood pressure 2. Heart rhythm 4. Presence of chest pain Rationale 1: Abruptly discontinuing beta blockers may result in acute resurgence of symptoms such as hypertension. Rationale 2: Abruptly discontinuing beta blockers may result in acute resurgence of symptoms such as dysrhythmia. Rationale 3: Abruptly discontinuing beta blockers should not have an immediate effect on urinary output. Rationale 4: Abruptly discontinuing beta blockers may result in chest pain. Rationale 5: Abruptly discontinuing beta blockers should not result in pulmonary complications. Global Rationale: Abruptly discontinuing beta blockers may result in acute resurgence of symptoms such as hypertension, dysrhythmia, and the development of chest pain. Abruptly discontinuing beta blockers should not have an immediate effect on urinary output and should not result in pulmonary complications.

The nurse is doing a holistic assessment on a patient prior to the initiation of antihypertensive medication. What will the best assessment include? Standard Text: Select all that apply. 1. Blood pressure 2. The biologic cause of the hypertension 3. Mood 4. Level of education 5. Belief in a higher power

1. Blood pressure 3. Mood 4. Level of education 5. Belief in a higher power Rationale 1: Holistic health care incorporates the whole patient to include the biological (blood pressure) dimension. Rationale 2: The biologic cause of the hypertension focuses on a specific disease, its cause, and treatment; this is a medical model, not a holistic model. Rationale 3: Holistic health care incorporates the whole patient to include the psychological (mood) dimension. Rationale 4: Holistic health care incorporates the whole patient to include the sociocultural (level of education) dimension. Rationale 5: Holistic health care incorporates the whole patient to include the spiritual (belief in a higher power) dimension. Global Rationale: Holistic health care incorporates the whole patient to include the biological (blood pressure), psychological (mood), sociocultural (level of education), and spiritual (belief in a higher power) dimensions. The biologic cause of the hypertension focuses on a specific disease, its cause, and treatment; this is a medical model, not a holistic model.

Placement of a tablet between the cheek and gum would be which route? 1. Buccal 2. Oral 3. Transdermal 4. Sublingual

1. Buccal Rationale 1: Buccal is the term used to describe a medication placed between the cheek and gum. Rationale 2: An oral medication is swallowed. Rationale 3: A transdermal medication is applied to the skin. Rationale 4: A sublingual medication is placed under the tongue. Global Rationale: Buccal is the term used to describe a medication placed between the cheek and gum. An oral medication is swallowed. A transdermal medication is applied to the skin. A sublingual medication is placed under the tongue.

The nurse in charge of a clinical study welcomes the participants in an open forum. One patient is surprised that there are men and women from several ethnic groups. The nurse tells the group that in the past, ethnic variables were largely unknown or ignored for what reasons? Standard Text: Select all that apply. 1. Clinical trials failed to include ethnically diverse subjects. 2. Clinical trials comprised mostly Caucasian males. 3. Little attention was focused on identifying the different effects drugs had on various ethnic groups. 4. Research proved there were no differences among ethnic groups. 5. The large majority of clinical trials included Caucasian females.

1. Clinical trials failed to include ethnically diverse subjects. 2. Clinical trials comprised mostly Caucasian males. 3. Little attention was focused on identifying the different effects drugs had on various ethnic groups. Rationale 1: There was a lack of ethnic diversity in early clinical trials. Rationale 2: Until recently, clinical trials comprised mostly Caucasian males. Rationale 3: Little attention was focused on identifying the differences in pharmacologic effects in diverse ethnic groups. Rationale 4: There was insufficient research to show differences because little attention was focused on these differences. Rationale 5: The large majority of clinical trials excluded females. Global Rationale: There was a lack of ethnic diversity in early clinical trials. Little attention was focused on identifying the differences in pharmacologic effects in diverse ethnic groups. Until recently, clinical trials comprised mostly Caucasian males.

A home health nurse's patient caseload is ethnically diverse. Which interventions show understanding of cultural variables? Standard Text: Select all that apply. 1. Discussing cultural preferences for herbs and spices and possible alternatives when drug interactions are possible 2. Assessing the patient's response to acupuncture for pain 3. Discussing the patient's beliefs regarding treatment 4. Notifying the health care provider of the patient's intentions to consult with a medicine man for spiritual guidance 5. Removing the patient's collection of herbs to decrease the risk of an adverse effect when taken with Western medicine

1. Discussing cultural preferences for herbs and spices and possible alternatives when drug interactions are possible 2. Assessing the patient's response to acupuncture for pain 3. Discussing the patient's beliefs regarding treatment Rationale 1: It is important to assess the cultural use of herbs and spices and determine if there may be any interactions with prescribed medications. Rationale 2: The nurse can assess the patient's response to acupuncture and interpret the effects on prescribed treatment with respect for the patient's culture. Rationale 3: Cultures view health and wellness in different ways. An understanding of the patient's cultural beliefs allows the nurse to provide better support and guidance. Rationale 4: As long as the medicine man does not "prescribe" any herbs, the nurse does not have to discuss this with the provider. Rationale 5: The nurse need not remove the herbs but rather should discuss possible adverse effects when the herbs are mixed with prescribed medications. Global Rationale: It is important to assess the cultural use of herbs and spices and determine if there may be any interactions with prescribed medications. The nurse need not remove the herbs but rather should discuss possible adverse effects when the herbs are mixed with prescribed medications. The nurse can assess the patient's response to acupuncture and interpret the effects on prescribed treatment with respect for the patient's culture. Cultures view health and wellness in different ways. An understanding of the patient's cultural beliefs allows the nurse to provide better support and guidance. As long as the medicine man does not "prescribe" any herbs, the nurse does not have to discuss this with the provider.

The nurse recognizes that medications can be excreted by which routes? Standard Text: Select all that apply. 1. Fecal 2. Gastric 3. Glandular 4. Pulmonary 5. Renal

1. Fecal 3. Glandular 4. Pulmonary 5. Renal Rationale 1: Drugs can be excreted via feces. Rationale 2: Drugs are not excreted through the gastric system. Rationale 3: Drugs can be secreted glandularly. Rationale 4: Drugs can be secreted via the lungs. Rationale 5: Drugs can be excreted by the renal route. Global Rationale: Drugs can be excreted via feces, the glandular system, the lungs, and the kidneys. They are not excreted through the gastric tissues.

The nurse would classify which sympathomimetics as binding to and activating adrenergic receptors? Standard Text: Select all that apply. 1. Epinephrine 2. Dopamine 3. Amphetamine 4. Cocaine 5. Ephedrine

1. Epinephrine 2. Dopamine 5. Ephedrine Rationale 1: Epinephrine is an endogenous catecholamine that acts directly by binding to and activating adrenergic receptors. Rationale 2: Dopamine is an endogenous catecholamine that acts directly by binding to and activating adrenergic receptors. Rationale 3: Amphetamine acts indirectly by affecting norepinephrine release. Rationale 4: Cocaine acts indirectly by affecting norepinephrine release. Rationale 5: Ephedrine acts both directly and indirectly. Global Rationale: Epinephrine and dopamine are endogenous catecholamines that act directly by binding to and activating adrenergic receptors. Amphetamine and cocaine act indirectly by affecting norepinephrine release. Ephedrine acts both directly and indirectly.

The nurse is reviewing the medication administration record for a group of patients and recognizes that which agents have nonspecific cellular responses? Standard Text: Select all that apply. 1. Ethyl alcohol 2. General anesthetics 3. Osmotic diuretics 4. Calcium channel blockers 5. Alpha-adrenergic antihypertensives

1. Ethyl alcohol 2. General anesthetics 3. Osmotic diuretics Rationale 1: Ethyl alcohol is an example of an agent that acts by nonspecific mechanisms, independently of cellular receptors. Rationale 2: General anesthetics are an example of agents that act by nonspecific mechanisms, independently of cellular receptors. Rationale 3: Osmotic diuretics are an example of agents that act by nonspecific mechanisms, independently of cellular receptors. Rationale 4: Calcium channel blockers have a specific mechanism of action. Rationale 5: Alpha-adrenergic antihypertensives have a specific mechanism of action. Global Rationale: Ethyl alcohol is an example of an agent that acts by nonspecific mechanisms, independently of cellular receptors. General anesthetics are an example of agents that act by nonspecific mechanisms, independently of cellular receptors. Osmotic diuretics are an example of agents that act by nonspecific mechanisms, independently of cellular receptors. Calcium channel blockers have a specific mechanism of action. Alpha-adrenergic antihypertensives have a specific mechanism of action.

A patient's genetic testing indicates presence of a genetic polymorphism of the CYP 450 enzyme. The nurse expects this difference to be one of which classifications? Standard Text: Select all that apply. 1. Extensive 2. Poor 3. Normal 4. Ultrarapid 5. Inefficient

1. Extensive 2. Poor 4. Ultrarapid Rationale 1: "Extensive" is one of the classifications used to describe this change in drug metabolism. Rationale 2: "Poor" is one of the classifications used to describe this change in drug metabolism Rationale 3: Since this patient has a change, the metabolism would not be classified as "normal." Rationale 4: "Ultrarapid" is one of the classifications used to describe this change in drug metabolism. Rationale 5: "Inefficient" is not used to describe this change. Global Rationale: "Extensive," "poor," and "ultrarapid" are all classifications used to describe this change in drug metabolism. Since this patient has a change, the metabolism would not be classified as "normal." "Inefficient" is not used to describe this change.

A patient is prescribed a medication that will block muscarinic receptors. The nurse realizes that this medication has implications for which body systems? Standard Text: Select all that apply. 1. Eyes 2. Respiratory 3. Cardiac 4. Endocrine 5. Metabolic

1. Eyes 2. Respiratory 3. Cardiac Rationale 1: Medications that block muscarinic receptors are used during ophthalmic procedures. Rationale 2: Medications that block muscarinic receptors are used in the pharmacologic treatment of asthma. Rationale 3: Medications that block muscarinic receptors are used in the pharmacologic treatment of bradycardia. Rationale 4: Medications that block muscarinic receptors are not used in the treatment of endocrine disorders. Rationale 5: Medications that block muscarinic receptors are not used in the treatment of metabolic disorders. Global Rationale: Medications that block muscarinic receptors are used during ophthalmic procedures, treatment of asthma, and to increase heart rate. They are not used in endocrine or metabolic disorders.

The nurse makes a medication error, but the patient is not harmed. The patient's family asks the nurse manager what is considered a medication error. Which of the following are potential responses by the nurse manager? Standard Text: Select all that apply. 1. Failure to follow health care provider's orders 2. Failure to give the right medication 3. Failure to give a medication at the ordered time 4. Failure to call the pharmacy and report that the medication has been given 5. Failure to give the right dose of the medication

1. Failure to follow health care provider's orders 2. Failure to give the right medication 3. Failure to give a medication at the ordered time 5. Failure to give the right dose of the medication Rationale 1: In this medication error, the patient does not receive the drug as the health care provider intended it to be given. Rationale 2: In this medication error, the patient does not receive the drug the health care provider intended to be given. Rationale 3: In this medication error, the patient does not receive the drug at the time the health care provider intended it to be given. Rationale 4: The delivery of the medication is recorded on the medical administration record (MAR); the nurse does not report to the pharmacy each time a medication has been given. Rationale 5: In this medication error, the patient does not receive the dose of the drug the health care provider intended to be given.

A nurse administering medications to a variety of patients on a medical-surgical floor recognizes that which patients may need additional education about medication adherence? Standard Text: Select all that apply. 1. Fifty-year-old recently remarried male taking antihypertensive medication 2. Thirty-four-year-old female with family history of blood clots taking an estrogen oral contraceptive 3. Thirty-eight-year-old male recently started on an antidepressant 4. Twenty-eight-year-old female started on acne medication known to cause male-patterned hair growth 5. Seventy-eight-year-old female being treated for shingles

1. Fifty-year-old recently remarried male taking antihypertensive medication 2. Thirty-four-year-old female with family history of blood clots taking an estrogen oral contraceptive 3. Thirty-eight-year-old male recently started on an antidepressant 4. Twenty-eight-year-old female started on acne medication known to cause male-patterned hair growth Rationale 1: Antihypertensive medications can cause impotence. This patient will need additional education about this possible side effect. Rationale 2: Estrogen can cause an increased risk for thrombolytic events, especially in patients who have a positive family history. Rationale 3: Taking an antidepressant may result in the man feeling weak, unhealthy, or dependent. Rationale 4: Some acne medications cause increased hair growth in a male pattern, such as on the face. While controlling acne is a goal, the patient may not want the extra hair growth. Rationale 5: There is no indication that treatment for shingles requires education in excess of that which is generally provided. Global Rationale: Antihypertensive medications can cause impotence. This patient will need additional education about this possible side effect. Estrogen can cause an increased risk for thrombolytic events, especially in patients who have a positive family history. Taking an antidepressant may result in the man feeling weak, unhealthy, or dependent. Some acne medications cause increased hair growth in a male pattern, such as on the face. While controlling acne is a goal, the patient may not want the extra hair growth. There is no indication that treatment for shingles requires education in excess of that which is generally provided.

Which of the following best indicates an ethnic characteristic that can affect pharmacotherapy? 1. Genetic differences 2. Diet 3. Health beliefs 4. Alternative therapies

1. Genetic differences Rationale 1: Ethnicity relates to biology and genetics. Rationale 2: Diet is a cultural characteristic. Rationale 3: Health belief is a cultural characteristic. Rationale 4: Alternative therapies are cultural characteristics. Global Rationale: Ethnicity relates to biology and genetics. Diet, alternative therapies, and health beliefs are cultural characteristics.

A patient has sustained a large blood loss. During the assessment, the nurse realizes that which findings are under the control of the nervous system? Standard Text: Select all that apply. 1. Heart rate 2. Blood pressure 3. Pupil size 4. Bowel sounds 5. Fluid volume

1. Heart rate 2. Blood pressure 3. Pupil size 4. Bowel sounds Rationale 1: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as heart rate. Rationale 2: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as blood pressure. Rationale 3: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as pupil size. Rationale 4: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as intestinal motility. Rationale 5: Although the brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions, fluid volume is not under the control of the nervous system. Global Rationale: The brain, spinal cord, and peripheral nerves act as a smoothly integrated whole to accomplish minute-to-minute changes in essential functions such as heart rate, blood pressure, pupil size, and intestinal motility. Fluid volume is not under the control of the nervous system.

A patient who is in heart failure is administered a beta1 agonist. The nurse would evaluate that the drug is effective if which changes occur? Standard Text: Select all that apply. 1. Heart rate increases 2. Pulse becomes stronger 3. Pupils dilate 4. Dysrhythmias dissipate 5. Blood pressure drops

1. Heart rate increases 2. Pulse becomes stronger Rationale 1: One of the effects of beta1 agonists is to increase the heart rate. Rationale 2: One of the effects of beta1 agonists is to increase force of cardiac contraction, which would be felt as a stronger pulse. Rationale 3: Pupil dilation is an effect of alpha1 drugs. Rationale 4: Beta1 antagonists are given to control dysrhythmias. Rationale 5: Beta1 antagonists are given to control hypertension. Global Rationale: The effects of beta1 agonists are to increase the heart rate and the force of cardiac contraction. Pupil dilation is an effect of alpha1 drugs. Beta1 antagonists are given to control dysrhythmias and hypertension.

The nursing instructor is teaching pharmacology to student nurses. What will the nursing instructor include as the four major components of pharmacokinetics? Standard Text: Select all that apply. 1. How drugs move from the site of administration to circulating fluids 2. How drugs are converted to a form that is easily removed from the body 3. How drugs change body illnesses and pathogens 4. How drugs are transported throughout the body 5. How drugs are removed from the body

1. How drugs move from the site of administration to circulating fluids 2. How drugs are converted to a form that is easily removed from the body 4. How drugs are transported throughout the body 5. How drugs are removed from the body Rationale 1: Absorption describes how drugs move from the site of administration to circulating fluids. Rationale 2: Metabolism describes how drugs are converted to a form that is easily removed from the body. Rationale 3: Pharmacodynamics describes how drugs change body illnesses and pathogens. Rationale 4: Distribution describes how drugs are transported throughout the body. Rationale 5: Excretion describes how drugs are removed from the body. Global Rationale: Absorption describes how drugs move from the site of administration to circulating fluids. Distribution describes how drugs are transported throughout the body. Metabolism describes how drugs are converted to a form that is easily removed from the body. Excretion describes how drugs are removed from the body. Pharmacodynamics describes how drugs change body illnesses and pathogens.

The nurse has made a medication error. The nurse manager determines the error was based on a common misinterpretation of which abbreviation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. IU 2. SQ 3. Q.O.D. 4. U 5. mcg

1. IU 2. SQ 3. Q.O.D. 4. U Rationale 1: This is the abbreviation for international unit but can be mistaken for IV or 10. The prescriber should write out "international unit." Rationale 2: This is the abbreviation for subcutaneous but can be mistaken for 5q or 5 every. The prescriber should write out "subcutaneous." Rationale 3: This is the abbreviation for every other day but can be mistaken for every day or four times a day. The prescriber should write out "every other day." Rationale 4: This is the abbreviation for unit but can be mistaken for 4. The prescriber should write out "unit." Rationale 5: This abbreviation for microgram is not commonly misinterpreted.

A nurse is providing discharge medication instruction regarding use of injectable epinephrine (EpiPen). What information should the nurse include? Standard Text: Select all that apply. 1. If you need to use this pen, seek medical advice as follow-up. 2. You can dispose of a used EpiPen in your regular trash. 3. Keep an extra EpiPen on hand. 4. Store this device in your refrigerator. 5. Carry an EpiPen in your car's glovebox.

1. If you need to use this pen, seek medical advice as follow-up. 3. Keep an extra EpiPen on hand. Rationale 1: If it is necessary to use the EpiPen, it is important to seek immediate follow-up by calling 911 or the provider. Rationale 2: The used EpiPen should be taken to an emergency department or the provider's office for disposal. Rationale 3: It is recommended that the patient have an extra EpiPen on hand in case of emergency or failure of the original unit. Rationale 4: It is not necessary to refrigerate the EpiPen. Rationale 5: The EpiPen should be kept in a cool, dark place. The glovebox of a car becomes too hot. Global Rationale: If it is necessary to use the EpiPen, it is important to seek immediate follow-up by calling 911 or the provider. It is recommended that the patient have an extra EpiPen on hand in case of emergency or failure of the original unit. The used EpiPen should be taken to an emergency department or the provider's office for disposal. The EpiPen should be kept in a cool, dark place. The glovebox of a car becomes too hot. It is not necessary to refrigerate the EpiPen.

A 48-year-old male patient tells the nurse, "I have stopped taking my prazosin (Minipress). I don't like its effect on me." The nurse should ask further assessment questions about which possible effects? Standard Text: Select all that apply. 1. Impotence 2. Nasal congestion 3. Somnolence 4. Nervousness 5. Slow heart rate

1. Impotence 2. Nasal congestion 3. Somnolence Rationale 1: Some alpha blockers result in impotence or inhibition of ejaculation. Rationale 2: Nasal congestion is a common adverse effect of alpha blockade. Rationale 3: Drowsiness may occur with alpha blockers. Rationale 4: Anxiety is not a common adverse effect of this drug. Rationale 5: Reflex tachycardia may occur, but bradycardia is not expected. Global Rationale: Some alpha blockers result in impotence or inhibition of ejaculation. Nasal congestion is a common adverse effect of alpha blockade. Drowsiness may occur with alpha blockers. Anxiety is not a common adverse effect of this drug. Reflex tachycardia may occur, but bradycardia is not expected.

A patient has an increased reaction to a drug following a change in her dietary habits. Which change would most likely be the cause? 1. Increased intake of grapefruit juice 2. Reduced intake of alcohol 3. Increased fiber intake 4. Reduced intake of citrus fruit

1. Increased intake of grapefruit juice Rationale 1: Grapefruit juice lowers the activity of enzymes in the GI system that break down medications. This in turn results in higher medication absorption into the bloodstream. Rationale 2: A reduced intake of alcohol would not likely produce an increased reaction to a drug. Rationale 3: A reduced intake of fiber would not likely produce an increased reaction to a drug. Rationale 4: A reduction in citrus fruit intake would likely cause a lowered drug reaction. Global Rationale: Grapefruit juice lowers the activity of enzymes in the GI system that break down medications. This in turn results in higher medication absorption into the bloodstream. A reduction in citrus fruit intake would likely cause a lowered drug reaction. A reduced intake of alcohol or fiber would not likely produce an increased reaction to a drug.

A nurse working in an obstetric practice should consider which fact when discussing medication use with pregnant patients? 1. Inhaled drugs may be absorbed to a greater extent. 2. Drug excretion rates are lowered. 3. Oral drug absorption rate is lowered. 4. Drugs should not be used during pregnancy.

1. Inhaled drugs may be absorbed to a greater extent. Rationale 1: Increases in tidal volume and pulmonary vasodilation during pregnancy may lead to inhaled drugs being absorbed to a greater extent. Rationale 2: Renal blood flow is increased, leading to higher excretion rates. Rationale 3: Gastric emptying is delayed, leading to prolonged oral drug absorption rates. Rationale 4: Some circumstances call for drug administration during pregnancy. Global Rationale: Increases in tidal volume and pulmonary vasodilation during pregnancy may lead to inhaled drugs being absorbed to a greater extent. Gastric emptying is delayed, leading to prolonged oral drug absorption rates. Renal blood flow is increased, leading to higher excretion rates. Some circumstances call for drug administration during pregnancy.

A patient is prescribed a drug that activates alpha2 receptors. The nurse would plan care based on which physiological response? 1. Inhibition of norepinephrine release 2. Absence of monoamine oxidase 3. Increased lipolysis 4. Destruction of presynaptic nerve terminals

1. Inhibition of norepinephrine release Rationale 1: The action of alpha2 receptors is to inhibit release of norepinephrine. Rationale 2: Alpha2 receptors do not destroy monoamine oxidase. Rationale 3: Alpha2 receptors do not increase lipolysis. Rationale 4: Alpha2 receptors do not destroy presynaptic nerve terminals. Global Rationale: The action of alpha2 receptors is to inhibit release of norepinephrine. Alpha2 receptors do not increase lipolysis or destroy monoamine oxidase or presynaptic nerve terminals.

The physician ordered prazosin (Minipress), an alpha-adrenergic blocker, for the patient. The nurse plans to do medication education. What will the best plan of the nurse include? 1. Instruct the patient to not take OTC herbal preparations containing saw palmetto. 2. Instruct the patient to not take tub baths. 3. Instruct the patient to decrease his intake of sodium. 4. Instruct the patient to wear sunglasses when outdoors.

1. Instruct the patient to not take OTC herbal preparations containing saw palmetto. Rationale 1: A hypotensive response may occur when saw palmetto is taken concurrently. Rationale 2: Patients should be careful when taking tub baths, especially if the drug causes dizziness, but such baths are not prohibited. Rationale 3: There is no relationship between alpha blockers and sodium intake. Rationale 4: Alpha blockers do not cause photophobia; sunglasses are not required with this drug. Global Rationale: A hypotensive response may occur when saw palmetto is taken concurrently. Patients should be careful when taking tub baths, especially if the drug causes dizziness, but such baths are not prohibited. Alpha blockers do not cause photophobia; sunglasses are not required with this drug. There is no relationship between alpha blockers and sodium intake. It is a good idea to avoid herbal preparations, but this is not the primary plan.

Which statement is accurate regarding the Institute for Safe Medication Practices (ISMP)? 1. It publishes a consumer newsletter regarding medication errors. 2. It is a governmental agency. 3. It accepts reports from anyone for a nominal fee. 4. It only accepts reports from health care professionals.

1. It publishes a consumer newsletter regarding medication errors. Rationale 1: The ISMP is a non-profit organization that accepts reports from consumer and health care providers. It also publishes a newsletter titled Safe Medicine

A patient has been prescribed an alpha1 adrenergic agonist drug. The nurse would plan to monitor for effects from which organs? Standard Text: Select all that apply. 1. Kidneys 2. Eyes 3. Heart 4. Bowels 5. Lungs

1. Kidneys 2. Eyes 4. Bowels 5. Lungs Rationale 1: Alpha1 receptors have potential to affect the renal system. Rationale 2: Alpha1 receptors result in dilation of the pupils. Rationale 3: Alpha1 receptors do not affect receptors in the heart. Rationale 4: Alpha1 receptors have potential to affect receptors in the gastrointestinal tract. Rationale 5: Alpha1 receptors have potential to affect receptors in the respiratory system. Global Rationale: Alpha1 receptors do not affect receptors in the heart. Alpha1 receptors have potential to affect the renal, gastrointestinal, and respiratory systems. Alpha1 receptors result in dilation of the pupils.

The nurse is reviewing the role of diffusion in the distribution of medications. Drugs that cannot be distributed by simple diffusion include those with which characteristics? Standard Text: Select all that apply. 1. Large molecules 2. Ionization 3. Water-soluble agents 4. Alcohol 5. Urea

1. Large molecules 2. Ionization 3. Water-soluble agents Rationale 1: Large molecules have difficulty crossing plasma membranes by simple diffusion. Rationale 2: Ionized drugs have difficulty crossing plasma membranes by simple diffusion. These drugs may require carrier, or transport, proteins to cross membranes. Rationale 3: Water-soluble agents have difficulty crossing plasma membranes by simple diffusion. Rationale 4: Diffusion assumes that the chemical is able to freely cross the plasma membrane. Drugs may also enter through open channels in the plasma membrane; however, the molecule must be very small, such as alcohol. Rationale 5: Diffusion assumes that the chemical is able to freely cross the plasma membrane. Drugs may also enter through open channels in the plasma membrane; however, the molecule must be very small, such as urea. Global Rationale: Large molecules have difficulty crossing plasma membranes by simple diffusion. Ionized drugs have difficulty crossing plasma membranes by simple diffusion. These drugs may require carrier, or transport, proteins to cross membranes. Water-soluble agents have difficulty crossing plasma membranes by simple diffusion. Diffusion assumes that the chemical is able to freely cross the plasma membrane. Drugs may also enter through open channels in the plasma membrane; however, the molecule must be very small, such as alcohol or urea.

A patient has been prescribed phenylephrine (Neo-Synephrine). Prior to administering this drug the nurse would review the patient's medication history for presence of which drugs? Standard Text: Select all that apply. 1. MAO inhibitors 2. Tricyclic antidepressants 3. Iron supplements 4. Digoxin 5. Aspirin

1. MAO inhibitors 2. Tricyclic antidepressants 3. Iron supplements 4. Digoxin Rationale 1: Concurrent use with MAO inhibitors may result in hypertensive crisis. Rationale 2: Tricyclic antidepressants can potentiate the effects of phenylephrine (Neo-Synephrine). Rationale 3: Iron supplements are incompatible with phenylephrine (Neo-Synephrine). Rationale 4: Dysrhythmias may occur when phenylephrine (Neo-Synephrine) and digoxin are used concurrently. Rationale 5: There is no incompatibility with aspirin. Global Rationale: Concurrent use with MAO inhibitors may result in hypertensive crisis. Tricyclic antidepressants can potentiate the effects of phenylephrine (Neo-Synephrine). Iron supplements are incompatible with phenylephrine (Neo-Synephrine). Dysrhythmias may occur when phenylephrine (Neo-Synephrine) and digoxin are used concurrently. There is no incompatibility with aspirin.

A nurse is preparing care for a newly admitted patient with diabetes. Which information would be critical for the nurse to assess? Standard Text: Select all that apply. 1. Medical history 2. Current lab results 3. Medication allergies 4. Use of dietary supplements 5. Number of previous hospitalizations

1. Medical history 2. Current lab results 3. Medication allergies 4. Use of dietary supplements Rationale 1: Medical history may reveal conditions that contraindicate the use of certain drugs. Rationale 2: Current lab results may reveal important information about the health of organs, such as the kidneys and liver, which would be important to metabolism and excretion of drugs. Rationale 3: Allergies to one drug may cross over to another drug and would need to be avoided. Rationale 4: Some dietary supplements can interact with drugs. Rationale 5: While this is good information, it is not critical to this admission. Global Rationale: Medical history may reveal conditions that contraindicate the use of certain drugs. Current lab results may reveal important information about the health of organs, such as the kidneys and liver, which would be important to metabolism and excretion of drugs. Allergies to one drug may cross over to another drug and would need to be avoided. Some dietary supplements can interact with drugs. While knowledge about number of previous hospitalization is good to know it is not critical to this admission.

A nurse on the medical-surgical unit is caring for several very ill patients. One patient says, "I was supposed to get my medications an hour ago." The nurse recognizes that medication errors can have what repercussions? Standard Text: Select all that apply. 1. Medication errors can potentially extend the patient's length of hospital stay. 2. Medication errors can result in expensive legal costs to the facility. 3. Medication errors can damage the facility's reputation. 4. Medication errors can be physically devastating to nurse and patient. 5. Medication errors cause preventable deaths during hospitalizations.

1. Medication errors can potentially extend the patient's length of hospital stay. 2. Medication errors can result in expensive legal costs to the facility. 3. Medication errors can damage the facility's reputation. 5. Medication errors cause preventable deaths during hospitalizations. Rationale 1: Medication errors can cause harm, which can extend the patient's length of stay. Rationale 2: If a medication error causes a patient harm, it can result in expensive legal fees for hospital defense. Rationale 3: If the incidence of medication errors is publicized, it can cause the facility to be seen as unsafe or to be delivering substandard care. Rationale 4: Medication errors can be physically devastating to patients but would be emotionally devastating to the nurse. Rationale 5: Medication errors are the most common cause of morbidity and preventable death within hospitals.

The patient is receiving albuterol (Proventil) for treatment of bronchospasm related to asthma. What is the primary nursing intervention as it relates to this medication? 1. Monitor the patient for relief of bronchospasms. 2. Monitor the patient for nausea and headache. 3. Monitor the patient's serum drug levels. 4. Provide the patient with age-appropriate education about albuterol (Proventil).

1. Monitor the patient for relief of bronchospasms. Rationale 1: Monitoring drug effects, in this case, the relief of bronchospasms, is a primary intervention that nurses perform. Rationale 2: Nausea and headache are expected side effects, but monitoring for these side effects is not part of the primary intervention. Rationale 3: Monitoring of serum drug levels for albuterol (Proventil) is not indicated. Rationale 4: Education about medication is important but is not part of the primary intervention. Global Rationale: Monitoring drug effects, in this case, the relief of bronchospasms, is a primary intervention that nurses perform. Nausea and headache are expected side effects, but monitoring for these side effects is not part of the primary intervention. Education about medication is important but is not part of the primary intervention. Monitoring of serum drug levels for albuterol (Proventil) is not indicated.

The nurse is participating in the clinical trial of a new medication for the treatment of hypertension. To assess the effectiveness of the medication, which interventions would the nurse perform to help determine whether the average dose is effective for the patient? Standard Text: Select all that apply. 1. Monitoring blood pressure 2. Monitoring heart rate 3. Interpreting laboratory values 4. Monitoring diet 5. Monitoring sleep habits

1. Monitoring blood pressure 2. Monitoring heart rate 3. Interpreting laboratory values Rationale 1: By monitoring the patient's vital signs, the nurse helps to determine whether the average dose is effective for the patient. Rationale 2: By monitoring the patient's vital signs, the nurse helps to determine whether the average dose is effective for the patient. Rationale 3: By interpreting any associated laboratory data, the nurse helps to determine whether the average dose is effective for the patient. Rationale 4: Monitoring the patient's diet will not help determine if the average dose of a medication is effective for the patient. Rationale 5: Monitoring the patient's sleep habits will not help determine if the average dose of a medication is effective for the patient. Global Rationale: By monitoring the patient's vital signs and associated laboratory data, the nurse helps to determine whether the average dose is effective for the patient. Monitoring the patient's diet and sleeping habits will not help determine if the average dose of a medication is effective for the patient.

A patient is being assessed for the presence of pheochromocytoma. The nurse would prepare for which interventions? Standard Text: Select all that apply. 1. Monitoring blood pressure 2. Monitoring bowel sounds 3. Administration of phentolamine (Regitine) 4. Rapid administration of normal saline 5. Urinary catheterization to bypass prostatic enlargement

1. Monitoring blood pressure 3. Administration of phentolamine (Regitine) Rationale 1: Pheochromocytoma affects blood pressure, so continuous monitoring is necessary. Rationale 2: While monitoring bowel sounds is part of all ongoing assessment, it is not particular to pheochromocytoma. Rationale 3: Sudden and marked reduction of blood pressure results when a patient with pheochromocytoma is administered phentolamine (Regitine) parenterally. Rationale 4: Rapid administration of normal saline is treatment for hypotension. This patient will be hypertensive. Rationale 5: A urinary catheter may be inserted, but this is not because of prostatic enlargement. Global Rationale: Pheochromocytoma affects blood pressure, so continuous monitoring is necessary. Sudden and marked reduction of blood pressure results when a patient with pheochromocytoma is administered phentolamine (Regitine) parenterally. While monitoring bowel sounds is part of all ongoing assessment, it is not particular to pheochromocytoma. Rapid administration of normal saline is treatment for hypotension. This patient will be hypertensive. A urinary catheter may be inserted, but this is not because of prostatic enlargement.

A client says, "I don't understand why so much money is spent on trying to find a cure for cancer. I have epilepsy and wish more money went into epilepsy drugs." What should the nurse consider prior to responding? Standard Text: Select all that apply. 1. More people are affected by cancer than by epilepsy. 2. Drugs that are effective in treating epilepsy exist. 3. The amounts of money spent on drug development are determined at the federal level. 4. It would be easier to achieve a cure for cancer than to achieve a cure for epilepsy. 5. The client should realize that personal family may develop cancer one day.

1. More people are affected by cancer than by epilepsy. 2. Drugs that are effective in treating epilepsy exist. Rationale 1: According to the tenets of pharmacoeconomics, more money should be spent on development of drugs that will impact the most people. Rationale 2: There are more drugs to successfully treat epilepsy than to cure cancer. Rationale 3: Money spent on drug development is determined at several levels, including individual corporations, universities, and governments. Rationale 4: There is no indication that curing cancer is easier than curing epilepsy. Rationale 5: The nurse should not judge this client's statement as good or bad, but should attempt to explain the allocation of resources. Global Rationale: According to the tenets of pharmacoeconomics, more money should be spent on development of drugs that will impact the most people. There are more drugs to successfully treat epilepsy than to cure cancer. Money spent on drug development is determined at several levels, including individual corporations, universities, and governments. There is no indication that curing cancer is easier than curing epilepsy. The nurse should not judge this client's statement as good or bad, but should attempt to explain the allocation of resources.

Which statements regarding the preclinical research stage of drug development are true? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Most drugs do not proceed past the preclinical stage because they are found to be too toxic or just ineffective. 2. At the end of the preclinical research stage, client variability is determined and potential drug-to-drug interactions are examined. 3. The preclinical stage of research involves extensive testing on animals in the laboratory to determine if the drug will cause harm to humans. 4. Preclinical research results are always inconclusive. 5. The Food and Drug Administration (FDA) is responsible for extensive testing for safety before the pharmaceutical company can begin the preclinical research stage of development.

1. Most drugs do not proceed past the preclinical stage because they are found to be too toxic or just ineffective. 3. The preclinical stage of research involves extensive testing on animals in the laboratory to determine if the drug will cause harm to humans. 4. Preclinical research results are always inconclusive. Rationale 1: Most drugs do not proceed past the preclinical research stage of development because they are found to be either too toxic or just ineffective. Rationale 2: Client variability and potential drug-to-drug interactions are examined in Phase 3 of the clinical investigation process after Food and Drug Administration (FDA) approval. Rationale 3: The preclinical stage involves extensive testing on human, microbial cells, and animals to determine drug action and to predict whether the drug will cause harm to humans. Rationale 4: Because lab tests cannot accurately predict human response to a drug, these results are always inconclusive. Rationale 5: This extensive testing is done by the pharmaceutical company in the preclinical research stage of drug development, not the FDA. Global Rationale: Most drugs do not proceed past the preclinical research stage of development because they are found to be either too toxic or just ineffective. Client variability and potential drug-to-drug interactions are examined in Phase 3 of the clinical investigation process after Food and Drug Administration (FDA) approval. The preclinical stage involves extensive testing on human, microbial cells, and animals to determine drug action and to predict whether the drug will cause harm to humans. Because lab tests cannot accurately predict human response to a drug, these results are always inconclusive. This extensive testing is done by the pharmaceutical company in the preclinical research stage of drug development, not the FDA.

The nurse preparing a teaching plan for an adolescent postpartum mother includes which topics? Standard Text: Select all that apply. 1. Most medications are secreted into breast milk. 2. Dietary supplements should be avoided. 3. Over-the-counter (OTC) herbal products are secreted into breast milk and have the potential to cause harm to the infant. 4. All tobacco products should be avoided. 5. Most drugs are safe to take right after breastfeeding because they will clear the bloodstream prior to the next feeding.

1. Most medications are secreted into breast milk. 2. Dietary supplements should be avoided. 3. Over-the-counter (OTC) herbal products are secreted into breast milk and have the potential to cause harm to the infant. 4. All tobacco products should be avoided. Rationale 1: The majority of drugs are secreted into breast milk. Rationale 2: The safety of these products has not been determined. Rationale 3: OTC drugs can be secreted into breast milk and have the potential to harm the infant. All products should be approved by the provider prior to use. Rationale 4: Tobacco products should be avoided during lactation. Rationale 5: Drugs should only be taken during breastfeeding if the benefits to the mother outweigh the risks to the infant. Global Rationale: The majority of drugs are secreted into breast milk. The safety of these products has not been determined. OTC drugs can be secreted into breast milk and have the potential to harm the infant. All products should be approved by the provider prior to use. Tobacco products should be avoided during lactation. Drugs should only be taken during breastfeeding if the benefits to the mother outweigh the risks to the infant.

A patient who was administered prazosin (Minipress) became unconscious 30 minutes after the first dose. What medications should the nurse prepare for resuscitation? Standard Text: Select all that apply. 1. Normal saline 2. Dobutamine 3. Atenolol (Tenormin) 4. Carvedilol (Coreg) 5. Propranolol (Inderal)

1. Normal saline 2. Dobutamine Rationale 1: Unconsciousness after the first dose of prazosin (Minipress) is typically due to severe hypotension. Normal saline can be used as a volume expander. Rationale 2: Unconsciousness after the first dose of prazosin (Minipress) is typically due to severe hypotension. Treatment with a vasopressor such as dobutamine may be indicated. Rationale 3: Atenolol (Tenormin) is an adrenergic blocker and would exacerbate the problem. Rationale 4: Carvedilol (Coreg) is an adrenergic blocker and would exacerbate the problem. Rationale 5: Propranolol (Inderal) is an adrenergic blocker and would exacerbate the problem. Global Rationale: Unconsciousness after the first dose of prazosin (Minipress) is typically due to severe hypotension. Normal saline can be used as a volume expander. Treatment with a vasopressor such as dobutamine may be indicated. Atenolol (Tenormin), carvedilol (Coreg), and propranolol (Inderal) are adrenergic blockers and would exacerbate the problem.

The nurse is assessing several patients. For which patient does assessment reveal a psychosocial history that may affect the patient's outcome? Standard Text: Select all that apply. 1. Older adult who recently suffered a stroke, has an unsteady gait, and lives in a two-story home 2. Middle-aged patient with Down syndrome living in a group home 3. Recently divorced mother of three children with breast cancer 4. Sixteen-year-old requesting birth control without parental consent 5. Seven-year-old with asthma in a foster care home

1. Older adult who recently suffered a stroke, has an unsteady gait, and lives in a two-story home 2. Middle-aged patient with Down syndrome living in a group home 3. Recently divorced mother of three children with breast cancer Rationale 1: This patient may not be able to return to a home that requires climbing stairs. Rationale 2: A patient with Down syndrome needs additional care to ensure that treatment outcome is successful. Rationale 3: This patient may be the family's sole provider and may have financial concerns. Rationale 4: Many teens seek contraception without their parents' consent. This should not have a negative impact on outcome. Rationale 5: Residing in foster care should not have a negative impact on outcome. Global Rationale: A patient who had a stroke may not be able to return to a home that requires climbing stairs. A patient with Down syndrome needs additional care to ensure that treatment outcome is successful. The patient with breast cancer may be the family's sole provider and may have financial concerns. Many teens seek contraception without their parents' consent. This should not have a negative impact on outcome. Residing in foster care should not have a negative impact on outcome.

A community health nurse is preparing a teaching plan regarding medications and safety for a new parent class. Which topics should be addressed? Standard Text: Select all that apply. 1. Parents should maintain a list of current medications for each child. 2. Parents should be aware of each child's medication allergies. 3. Parents should know what the child's prescribed medication is for, how it should be administered, and when to expect the child to feel better. 4. Parents should be aware that any leftover medication should be appropriately disposed of, not saved for future use. 5. Parents should read the drug label for any foods the child should avoid while taking the medication and for possible adverse effects to watch out for.

1. Parents should maintain a list of current medications for each child. 2. Parents should be aware of each child's medication allergies. 3. Parents should know what the child's prescribed medication is for, how it should be administered, and when to expect the child to feel better. 4. Parents should be aware that any leftover medication should be appropriately disposed of, not saved for future use. Rationale 1: Parents should make a complete list of all prescribed medications, over-the-counter drugs, and any vitamins the child takes. Rationale 2: It is very important that parents be aware of a child's allergies in order to prevent an unnecessary allergic response. Rationale 3: Parents should know what condition the child's medication is prescribed for, and how, when, and how much to administer. It is also important for parents to know when to expect the child to feel better so a follow-up visit can be made if the child is not feeling better. Rationale 4: Parents should be aware that it is not safe to self-diagnose and treat with leftover medication. Rationale 5: Parents should be aware the label often describes food and drinks to avoid. The label will not describe possible adverse effects; the nurse will need to describe these to the parents.

The nurse is working very hard to prevent medication errors. What plan(s) will assist the nurse in preventing most errors? Standard Text: Select all that apply. 1. Plan to always check the patient's identification band prior to administration of medications. 2. Plan to open all of the medications immediately prior to administration. 3. Plan to tell physicians that verbal orders will not be accepted. 4. Plan to record the medication on the medication administration record (MAR) immediately prior to administration. 5. Plan to validate all orders with another nurse prior to administration of medications.

1. Plan to always check the patient's identification band prior to administration of medications. 2. Plan to open all of the medications immediately prior to administration. 3. Plan to tell physicians that verbal orders will not be accepted. Rationale 1: Ways to reduce medication errors include checking the patient's identification band prior to administration of medications, telling physicians that verbal orders will not be accepted, and opening all of the medications immediately prior to administration. Medications should be documented on the medication administration record (MAR) after they have been administered. All orders do not need to be validated with another nurse, only the orders that the nurse is unsure about.

A pregnant patient suspected of drug abuse is admitted to the emergency department. The nurse plans to teach the patient about which complications associated with drug use during pregnancy? Standard Text: Select all that apply. 1. Preterm birth 2. Low birth weight 3. Birth defects 4. Allergies to narcotics 5. Increased labor

1. Preterm birth 2. Low birth weight 3. Birth defects Rationale 1: Many illicit drugs can cause preterm birth. Rationale 2: Many illicit drugs can cause low birth weight. Rationale 3: Many illicit drugs can cause birth defects. Rationale 4: No research suggests that drug use can cause allergies to narcotics. Rationale 5: No research suggests that drug use can cause increased labor. Global Rationale: Illicit drugs can cause preterm birth, low birth weight, or birth defects. No research suggests that drug use can cause allergies to narcotics or increased labor.

The nurse assesses an adverse effect of a medication that has been administered. No medication error was committed. What is the best plan of the nurse at this time? 1. Report the adverse effect to the Food and Drug Administration's (FDA) MedWatch Website. 2. Report the adverse effect to the Food and Drug Administration's (FDA) Adverse Event Website. 3. Report the adverse effect to the Food and Drug Administration's (FDA) Safe Medicine Website. 4. Report the adverse effect to the Food and Drug Administration's (FDA) Med MARX Website.

1. Report the adverse effect to the Food and Drug Administration's (FDA) MedWatch Website. Rationale 1: Adverse events with medication should be reported to the FDA's Med Watch Website. There isn't any Food and Drug Administration's (FDA) Safe Medicine Website. There isn't any Food and Drug Administration's (FDA) Med MARX Website. There isn't any Food and Drug Administration's (FDA) Adverse Event Website.

During evaluation, the nurse, patient, and physician determine that the goals of antibiotic therapy have not been met. What actions are indicated? Standard Text: Select all that apply. 1. Review the dosage of the medication 2. Consider checking serum drug levels 3. Discard the idea that the infection is treatable 4. Consider prolonging therapy 5. Consider using a different antibiotic

1. Review the dosage of the medication 2. Consider checking serum drug levels 4. Consider prolonging therapy 5. Consider using a different antibiotic Rationale 1: The dosage may not be correct for the individual patient. Rationale 2: In some instances, checking serum drug levels will help identify if the dosing schedule is adequate. Rationale 3: Just because the first evaluation is that the goal is not met does not indicate that the goal is not a good one or that the therapy is not going to work. Rationale 4: The drug may work if given more time. Rationale 5: The infection may require use of a second antibiotic. Global Rationale: Just because the first evaluation is that the goal is not met does not indicate that the goal is not a good one or that the therapy is not going to work. The drug may work if the dosage is altered (which may be indicated by serum drug level) or if therapy is continued for a longer time. The antibiotic may need to be changed.

A patient asks the nurse why he experiences a metallic taste after taking certain medications. The nurse explains that some medications are secreted by glandular activity. The nurse would identify which substances as examples of this excretion? Standard Text: Select all that apply. 1. Saliva 2. Sweat 3. Breast milk 4. Urine 5. Feces

1. Saliva 2. Sweat 3. Breast milk Rationale 1: Water-soluble drugs may be secreted into the saliva, which can cause a "funny taste" after the administration of a medication. Rationale 2: Water-soluble drugs may be secreted into the sweat, which may cause an odor to be emitted by the person who has taken a medication. Rationale 3: Water-soluble drugs may be secreted into the breast milk. Breastfeeding mothers must use caution in regards to medications while lactating as the medications can be passed to their infants via the breast milk. Rationale 4: Urine is excreted by the kidneys and does not play a role in glandular activity. Rationale 5: Feces are excreted by the gastrointestinal system and do not play a role in glandular activity. Global Rationale: Water-soluble drugs may be secreted into the saliva, which can cause a "funny taste" after the administration of a medication. Water-soluble drugs may be secreted into the sweat, which may cause an odor to be emitted by the person who has taken a medication. Water-soluble drugs may be secreted into the breast milk. Breastfeeding mothers must use caution in regards to medications while lactating as the medications can be passed to their infants via the breast milk. Urine is excreted by the kidneys and does not play a role in glandular activity. Feces are excreted by the gastrointestinal system and do not play a role in glandular activity.

The adolescent is supposed to go to the school nurse at 12:00 to receive his medication for attention-deficit hyperactivity disorder (ADHD). He often does not go for the medication. What best describes the nurse's understanding of this situation? 1. The adolescent is embarrassed in front of his peers. 2. The adolescent does not understand the need for the medication. 3. The adolescent forgets that he is supposed to take the medication. 4. The adolescent has made a conscious decision not to take the medication.

1. The adolescent is embarrassed in front of his peers. Rationale 1: Adolescents relate strongly to peers and are easily embarrassed; the adolescent does not want to be made fun of. Rationale 2: Most adolescents know why they are receiving medication. Rationale 3: The adolescent is most likely not forgetting the medication. Rationale 4: Most adolescents receiving attention-deficit hyperactivity disorder (ADHD) medication recognize that it helps them. Global Rationale: Adolescents relate strongly to peers and are easily embarrassed; the adolescent does not want to be made fun of. The adolescent is most likely not forgetting the medication. Most adolescents receiving attention-deficit hyperactivity disorder (ADHD) medication recognize that it helps them. Most adolescents know why they are receiving medication.

A nurse is providing care to a patient who wears bilateral hearing aids. Which nursing interventions are indicated? Standard Text: Select all that apply. 1. Speak a bit slower than normal. 2. Speak more loudly than normal. 3. Ensure that verbal and nonverbal communication is congruent. 4. Allow extra time for communication. 5. Use bright lighting in the room.

1. Speak a bit slower than normal. 3. Ensure that verbal and nonverbal communication is congruent. 4. Allow extra time for communication. Rationale 1: Speaking clearly and slowly is beneficial when communicating with those with hearing impairment. Rationale 2: It is not necessary to speak loudly. Rationale 3: Use of gestures and body language is important, but incongruence between verbal and nonverbal communication can be very confusing for those with impaired hearing. Rationale 4: It is important to allow adequate time for communication and responses. Rationale 5: Adequate lighting is necessary in any patient encounter, but bright lighting is not always necessary. The presence of good lighting is not made more essential because the patient has a hearing impairment. Global Rationale: Speaking clearly and slowly is beneficial when communicating with those with hearing impairment. Use of gestures and body language is important, but incongruence between verbal and nonverbal communication can be very confusing for those with impaired hearing. It is important to allow adequate time for communication and responses. It is not necessary to speak loudly. Adequate lighting is necessary in any patient encounter, but bright lighting is not always necessary. The presence of good lighting is not made more essential because the patient has a hearing impairment.

Nurses should implement strategies to prevent medication errors. Which strategies would be the most beneficial for reducing common errors? 1. Strategies to prevent wrong dosage errors 2. Strategies to prevent wrong route errors 3. Strategies to prevent wrong medication errors 4. Strategies to prevent wrong patient errors

1. Strategies to prevent wrong dosage errors Rationale 1: The most common reported medication errors involve errors related to the wrong dose.

A nurse has been asked to present health promotion information at a community clinic whose clients are primary non-Hispanic Black women. After review of health disparity and inequality statistics the nurse chooses to include information about which disorders? Standard Text: Select all that apply. 1. Stroke 2. Coronary artery disease 3. Diabetes 4. Illicit drug use 5. Prenatal care

1. Stroke 2. Coronary artery disease 3. Diabetes 5. Prenatal care Rationale 1: The rate of premature death due to stroke is higher among non-Hispanic Blacks than among non-Hispanic Whites. Rationale 2: The rate of premature death due to coronary artery disease is higher among non-Hispanic Blacks than among non-Hispanic Whites. Rationale 3: Diabetes is highest among non-Hispanic Blacks and Hispanics. Rationale 4: Rates for drug-induced death (from both legal and illegal drugs) is highest among American Indians, Alaskan Natives, and non-Hispanic Whites. Rationale 5: The infant mortality rate for non-Hispanic Black women is more than double that for non-Hispanic White women. Global Rationale: The rate of premature death due to stroke and coronary artery disease is higher among non-Hispanic Blacks than among non-Hispanic Whites. Diabetes is highest among non-Hispanic Blacks and Hispanics. The infant mortality rate for non-Hispanic Black women is more than double that for non-Hispanic White women. Rates for drug-induced death (from both legal and illegal drugs) is highest among American Indians, Alaskan Natives, and non-Hispanic Whites.

Which patient situations are considered involuntary responses to autonomic nervous system control? Standard Text: Select all that apply. 1. Sweating when hot 2. Stepping over a chair to prevent falling 3. Complaining of nausea 4. Salivating at the smell of food 5. Breathing deeper when running

1. Sweating when hot 4. Salivating at the smell of food 5. Breathing deeper when running Rationale 1: Sweating is an involuntary response that is controlled by the sympathetic nervous system. Rationale 2: Muscle movement is controlled by the somatic nervous system. Rationale 3: Complaining of nausea is a result of sensory neuron input and is not part of the autonomic system. Rationale 4: Salivation is involuntary and is controlled by the autonomic nervous system. Rationale 5: Breathing deeper when running is controlled by the autonomic nervous system. The act of running is controlled by the somatic nervous system. Global Rationale: Sweating is an involuntary response that is controlled by the sympathetic nervous system. Salivation is involuntary and is controlled by the autonomic nervous system. Breathing deeper when running is controlled by the autonomic nervous system. The act of running is controlled by the somatic nervous system. Muscle movement is controlled by the somatic nervous system. Complaining of nausea is a result of sensory neuron input and is not part of the autonomic system.

Which statements regarding the role of the U.S. Food and Drug Administration (FDA) are true? Standard Text: Select all that apply. 1. The FDA is responsible for improving the health of Americans. 2. The FDA publishes a summary of the standards of drug purity and strength. 3. The FDA ensures the availability of effective drugs. 4. The FDA takes action against any supplement that is deemed to be unsafe. 5. The FDA facilitates the availability of safe drugs.

1. The FDA is responsible for improving the health of Americans. 3. The FDA ensures the availability of effective drugs. 4. The FDA takes action against any supplement that is deemed to be unsafe. 5. The FDA facilitates the availability of safe drugs. Rationale 1: The FDA mission is to protect public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biologic products, medical devices, the nation's food supply, cosmetics, and products that emit radiation. Rationale 2: It is the role of the U.S. Pharmacopeia (USP) to publish a summary of drug standards (purity and strength). Rationale 3: Ensuring the availability of effective drugs is one of the FDA's roles. Rationale 4: It is the FDA's role to take action against any supplement that is deemed to be unsafe. Rationale 5: It is the role of the FDA to facilitate the availability of safe drugs. Global Rationale: One of the missions of the CDER branch of the FDA is to improve the health of Americans. It is the role of the U.S. Pharmacopeia (USP) to publish a summary of drug standards (purity and strength). Ensuring the availability of effective drugs is one of the FDA's roles. It is the FDA's role to take action against any supplement that is deemed to be unsafe. It is the role of the FDA to facilitate the availability of safe drugs.

An adolescent patient comes to the school nurse with complaints of vague abdominal pain. What assessment data would help to confirm the nurse's suspicion that the adolescent has body image concerns? 1. The adolescent says, "Everyone makes a big deal about what I eat, so don't ask." 2. The adolescent tells the nurse, "I have been sexually active with my boyfriend." 3. The adolescent reports, "My periods are irregular. Should I see a doctor?" 4. The adolescent tells the nurse, "I just can't seem to get along with my parents."

1. The adolescent says, "Everyone makes a big deal about what I eat, so don't ask." Rationale 1: The adolescent could have an eating disorder, which may result from altered body image. Rationale 2: Being sexually active with her boyfriend does not necessarily indicate an altered body image. Rationale 3: Irregular menses do not necessarily indicate an altered body image. Rationale 4: Arguments with parents do not necessarily indicate an altered body image. Global Rationale: The adolescent could have an eating disorder, which may result from altered body image. Being sexually active with her boyfriend does not necessarily indicate an altered body image. Irregular menses do not necessarily indicate an altered body image. Arguments with parents do not necessarily indicate an altered body image

A patient who has received an oral medication for treatment of hives says, "How long will it be before my skin clears and quits itching?" Which concepts should the nurse consider when formulating a response? Standard Text: Select all that apply. 1. The amount of time between administration and the drug taking effect is known as onset of action. 2. Peak plasma levels rarely occur with oral medications 3. Duration of action is the amount of time a drug is effective. 4. Peak plasma level is dependent on the drug's plasma half-life (t1/2). 5. Drugs with short half-lives are ineffective in treating systemic illnesses.

1. The amount of time between administration and the drug taking effect is known as onset of action. 3. Duration of action is the amount of time a drug is effective. Rationale 1: Onset of drug action represents the amount of time it takes to produce a therapeutic effect after drug administration. Rationale 2: All medications have a peak plasma level. Rationale 3: Duration of drug action is the amount of time a drug maintains its therapeutic effect. Rationale 4: Peak plasma level and plasma half-life (t1/2) are related but not strictly dependent on one another. Rationale 5: The effectiveness of a drug is not dependent on half-life as long as dosing frequency is correct. Global Rationale: Onset of drug action represents the amount of time it takes to produce a therapeutic effect after drug administration. All medications have a peak plasma level. Duration of drug action is the amount of time a drug maintains its therapeutic effect. Peak plasma level and plasma half-life (t1/2) are related but not strictly dependent on one another. The effectiveness of a drug is not dependent on half-life as long as dosing frequency is correct.

While reading a medication package insert, the nurse notes the information contained within the "black box." What is the significance of this information to the nurse? Standard Text: Select all that apply. 1. The drug can cause "special problems." 2. It identifies extreme adverse drug reactions. 3. It differentiates a prescribed medication from an over-the-counter medication. 4. It highlights the cost of the medication. 5. It signifies the medication is generic.

1. The drug can cause "special problems." 2. It identifies extreme adverse drug reactions. Rationale 1: The FDA created boxed warnings in order to regulate drugs with "special problems." Rationale 2: The black box warning is a primary alert for identifying extreme adverse drug reactions. Rationale 3: Black box warnings are not a mechanism to differentiate a prescribed medication from an over-the-counter medication. Rationale 4: It does not highlight the cost of the medication. Rationale 5: It does not signify the medication as being generic. Global Rationale: The FDA created boxed warnings in order to regulate drugs with "special problems." The black box warning is a primary alert for identifying extreme adverse drug reactions. Black box warnings are not a mechanism to differentiate a prescribed medication from an over-the-counter medication, do not highlight the cost of the medication, and do not signify the medication as being generic.

The patient receives a drug that is excreted in the bile. What will the best nursing assessment of the effect of this drug on the patient include? 1. The effect of the drug will be a prolonged action. 2. The effect of the drug will be increased side effects. 3. The effect of the drug will be decreased side effects. 4. The effect of the drug will be decreased.

1. The effect of the drug will be a prolonged action. Rationale 1: Most bile is circulated back to the liver so drugs secreted into the bile will be recirculated numerous times with the bile, resulting in a prolonged action of the drug. Rationale 2: Side effects may or may not be increased; this is dose dependent. Rationale 3: Bile-excreted drugs do not have decreased side effects. Rationale 4: Bile-excreted drugs do not have a decreased effect. Global Rationale: Most bile is circulated back to the liver so drugs secreted into the bile will be recirculated numerous times with the bile, resulting in a prolonged action of the drug. Bile-excreted drugs do not have a decreased effect, nor are side effects decreased. Side effects may or may not be increased; this is dose dependent.

The nursing instructor teaches the student nurses about how medication errors can occur. What information will the nursing instructor include in the presentation? Standard Text: Select all that apply. 1. The nurse miscalculates the medication dose. 2. The nurse does not check the patient's identification band. 3. The nurse does not validate an order with the physician. 4. The nurse misinterprets a physician's order. 5. The nurse administers the incorrect drug.

1. The nurse miscalculates the medication dose. 2. The nurse does not check the patient's identification band. 4. The nurse misinterprets a physician's order. 5. The nurse administers the incorrect drug. Rationale 1: Medication errors may be related to misinterpretations, miscalculations, and misadministration. The nurse should always check the patient's identification band. As long as the nurse understands the physician's order, there is no need to validate the order with the physician. Rationale 2: Medication errors may be related to misinterpretations, miscalculations, and misadministration. The nurse should always check the patient's identification band. As long as the nurse understands the physician's order, there is no need to validate the order with the physician. Rationale 3: Medication errors may be related to misinterpretations, miscalculations, and misadministration. The nurse should always check the patient's identification band. As long as the nurse understands the physician's order, there is no need to validate the order with the physician. Rationale 4: Medication errors may be related to misinterpretations, miscalculations, and misadministration. The nurse should always check the patient's identification band. As long as the nurse understands the physician's order, there is no need to validate the order with the physician. Rationale 5: Medication errors may be related to misinterpretations, miscalculations, and misadministration. The nurse should always check the patient's identification band. As long as the nurse understands the physician's order, there is no need to validate the order with the physician.

The patient, who is an American Indian, has been admitted to the hospital for chemotherapy. At any given time, five family members are in the patient's room, which is private. The nurse tells the patient that according to hospital policy, only two visitors at a time are allowed. What does the best analysis by the nurse manager reveal about the nurse's action? 1. The nurse should have assessed the patient's preferences about how many family members she wanted to be present. 2. The nurse should have called the physician and obtained an order for additional family members to be present. 3. This was the correct action; the nurse was following protocol by informing the patient about hospital policy. 4. The nurse should have allowed the patient to have as many family members as she wanted to be present.

1. The nurse should have assessed the patient's preferences about how many family members she wanted to be present. Rationale 1: The nurse should have assessed the patient's preference about how many visitors she wanted in her room before so strictly interpreting the hospital rules. Rationale 2: This situation could be resolved by the nurse; there is no need for a physician's order at this point. Rationale 3: Many hospital rules, such as how many visitors are allowed, are flexible and do not have to be strictly interpreted; this patient is in a private room. Rationale 4: The nurse must be realistic with regard to the number of family visitors the patient wants present; five family members is acceptable; twenty would be too many. Global Rationale: The nurse should have assessed the patient's preference about how many visitors she wanted in her room before so strictly interpreting the hospital rules. Many hospital rules, such as how many visitors are allowed, are flexible and do not have to be strictly interpreted; this patient is in a private room. The nurse must be realistic with regard to the number of family visitors the patient wants present; five family members is acceptable; twenty would be too many. This situation could be resolved by the nurse; there is no need for a physician's order at this point.

For which patient would the nurse expect the health care provider to continue prescribed medications during pregnancy? Standard Text: Select all that apply. 1. The patient recently diagnosed with gonorrhea 2. The patient with a history of frequent asthma attacks 3. The patient with hypertension 4. The patient with frequent insomnia 5. The patient with a family history of stroke

1. The patient recently diagnosed with gonorrhea 2. The patient with a history of frequent asthma attacks 3. The patient with hypertension Rationale 1: Sexually transmitted infections are treated during pregnancy. Rationale 2: Asthma is treated during pregnancy. Rationale 3: Hypertension is treated during pregnancy. Rationale 4: Insomnia would not be treated during pregnancy. Rationale 5: This patient would not be treated unless she has a history of stroke. Global Rationale: Sexually transmitted infections, asthma, and hypertension are treated during pregnancy. Insomnia would not be treated during pregnancy. The patient would not be treated unless she has a history of stroke.

The nurse is preparing a teaching plan for an older patient who is taking multiple medications. Which principles should the nurse keep in mind during the planning phase? Standard Text: Select all that apply. 1. The patient should use only one pharmacy to fill prescriptions. 2. The patient should keep a list of all medications for easy accessibility. 3. Polypharmacy is a common cause of medication errors in older patients. 4. Polypharmacy is unique to older patients and is the most common cause of medication errors. 5. The patient should be aware of each prescribed medication, the dose, and possible side effects.

1. The patient should use only one pharmacy to fill prescriptions. 2. The patient should keep a list of all medications for easy accessibility. 3. Polypharmacy is a common cause of medication errors in older patients. 5. The patient should be aware of each prescribed medication, the dose, and possible side effects. Rationale 1: It is common for older patients to have medical conditions requiring the use of multiple medications that could have possible interactions. Using one pharmacy will ensure the pharmacist will discover any problematic interactions between multiple drugs. Rationale 2: Keeping a list available is important for unexpected trips to a health care facility. Rationale 3: The use of multiple drugs for multiple chronic conditions is a common cause for medications errors in older patients. Rationale 4: Polypharmacy is not unique to older patients, although it is most often seen in this group. Rationale 5: Knowing the names, dose, and possible side effects of medications will reduce the risk for

All of the patients listed have cancer and are receiving chemotherapy. Which patient does the nurse evaluate as having the highest probability for a remission? 1. The patient with a support group of cancer survivors 2. The patient who is also seeing a psychiatrist for treatment of depression 3. The wealthy patient who can afford the best medical care available 4. The patient who is a former physician

1. The patient with a support group of cancer survivors Rationale 1: Positive attitudes and high expectations toward therapeutic outcomes in the patient may influence the success of pharmacotherapy. The support group of cancer survivors would provide the best support and the highest probability for a positive outcome. Rationale 2: Treatment for depression might help the outcome, but this patient would not have as high a probability for remission as the patient with another resource. Rationale 3: A wealthy patient can afford the best medical care, but this patient may not have good psychosocial support. Rationale 4: A former physician may have a sound knowledge base about cancer, but this patient might not have good psychosocial support. Global Rationale: Positive attitudes and high expectations toward therapeutic outcomes in the patient may influence the success of pharmacotherapy. The support group of cancer survivors would provide the best support and the highest probability for a positive outcome. A wealthy patient can afford the best medical care, but this patient may not have good psychosocial support. Treatment for depression might help the outcome, but this patient would not have as high a probability for remission as the patient with another resource. A former physician may have a sound knowledge base about cancer, but this patient might not have good psychosocial support.

The nurse is preparing to administer medications to a group of patients. One of the medications is atropine, an anticholinergic drug. This drug is contraindicated in which patient? 1. The patient with glaucoma 2. The patient with hyperthyroidism 3. The patient with a hiatal hernia 4. The patient with lung cancer

1. The patient with glaucoma Rationale 1: Anticholinergic drugs can increase pressure in the eye; they must be avoided in patients with glaucoma. Rationale 2: Anticholinergic drugs are not contraindicated in patients with hyperthyroidism. Rationale 3: Anticholinergic drugs are not contraindicated in patients with a hiatal hernia. Rationale 4: Anticholinergic drugs are not contraindicated in patients with lung cancer. Global Rationale: Anticholinergic drugs can increase pressure in the eye; they must be avoided in patients with glaucoma. Anticholinergic drugs are not contraindicated in patients with a hiatal hernia. Anticholinergic drugs are not contraindicated in patients with hyperthyroidism. Anticholinergic drugs are not contraindicated in patients with lung cancer.

Due to an administration error, a patient may have received too much phenylephrine (Neo-Synephrine). Which findings would support the nurse's concerns about overdosage? Standard Text: Select all that apply. 1. The patient's heart rate has increased from 72 bpm to 114 bpm. 2. The patient reports feeling anxious. 3. The patient's blood pressure has increased from 140/86 mmHg to 180/98 mmHg. 4. The patient's stools are dark and tarry. 5. The patient reports burning at the injection site.

1. The patient's heart rate has increased from 72 bpm to 114 bpm. 3. The patient's blood pressure has increased from 140/86 mmHg to 180/98 mmHg. Rationale 1: An overdose of phenylephrine (Neo-Synephrine) will result in tachycardia. Rationale 2: Feelings of anxiety and restlessness are expected adverse effects of phenylephrine (Neo-Synephrine). Rationale 3: Overdosage of phenylephrine (Neo-Synephrine) will result in hypertension. Rationale 4: Dark and tarry stools are not related to phenylephrine (Neo-Synephrine). Rationale 5: Burning at the injection site would indicate possible extravasation, not overdose. Global Rationale: An overdose of phenylephrine (Neo-Synephrine) will result in tachycardia and hypertension. Feelings of anxiety and restlessness are expected adverse effects of phenylephrine (Neo-Synephrine). Dark and tarry stools are not related to phenylephrine (Neo-Synephrine). Burning at the injection site would indicate possible extravasation, not overdose.

A patient admitted to the hospital tells the nurse she is very nervous about getting all her medications while she is in the hospital because her health care provider has her on a very "strict" schedule. Which principles describe how medication dosing schedules are determined? Standard Text: Select all that apply. 1. The physical and biologic characteristics of a drug may determine dosing schedule. 2. Specific times may improve effectiveness and decrease risk of adverse effects. 3. Some drugs must be taken a certain time prior to an event or immediately after an event. 4. Dosing may be set for the convenience of patient and nurse. 5. Hospitals have routine dosing intervals so that all patients receive medications at the same time each day.

1. The physical and biologic characteristics of a drug may determine dosing schedule. 2. Specific times may improve effectiveness and decrease risk of adverse effects. 3. Some drugs must be taken a certain time prior to an event or immediately after an event. 4. Dosing may be set for the convenience of patient and nurse. Rationale 1: The properties of a medication will determine how often it must be given to keep the drug at a therapeutic level in the body. Rationale 2: Some medications are administered at certain times of day to improve effectiveness or decrease adverse effects. Rationale 3: Some medications are taken to prevent or to cause an effect. For example, insulin should be given 30 minutes prior to eating to promote glucose usage. Rationale 4: If the drug does not have a characteristic that relies on a certain event to take place, then the drug can be given at the convenience of patient and/or nurse. Rationale 5: While most hospitals do have specific times of day (agency protocol) when medications are administered, this is not a principle that determines any specific dosing schedule. Global Rationale: The properties of a medication will determine how often it must be given to keep the drug at a therapeutic level in the body. Some medications are administered at certain times of day to improve effectiveness or decrease adverse effects. Some medications are taken to prevent or to cause an effect. For example, insulin should be given 30 minutes prior to eating to promote glucose usage. If the drug does not have a characteristic that relies on a certain event to take place, then the drug can be given at the convenience of patient and/or nurse. While most hospitals do have specific times of day (agency protocol) when medications are administered, this is not a principle that determines any specific dosing schedule.

The nurse manager plans to teach the graduate nurse the reason why the nursing unit has policies and procedures. What best describes the reason for policies and procedures? 1. The policies and procedures establish standards of care for the institution. 2. The policies and procedures indicate how nursing personnel are to perform skills. 3. The policies and procedures establish how the health care facility is to be run. 4. The policies and procedures indicate the steps that must be taken when a medication error occurs.

1. The policies and procedures establish standards of care for the institution. Rationale 1: The reason health care facilities have policies and procedures is to establish standards of care for the facility; the performance of skills is included under standards of care. Steps to be taken when a medication error occurs are included under standards of care. Health care facilities have policies and procedures in place to establish standards of care for the facility, not to establish how the facility is to be run. Rationale 2: The reason health care facilities have policies and procedures is to establish standards of care for the facility; the performance of skills is included under standards of care. Steps to be taken when a medication error occurs are included under standards of care. Health care facilities have policies and procedures in place to establish standards of care for the facility, not to establish how the facility is to be run. Rationale 3: The reason health care facilities have policies and procedures is to establish standards of care for the facility; the performance of skills is included under standards of care. Steps to be taken when a medication error occurs are included under standards of care. Health care facilities have policies and procedures in place to establish standards of care for the facility, not to establish how the facility is to be run. Rationale 4: The reason health care facilities have policies and procedures is to establish standards of care for the facility; the performance of skills is included under standards of care. Steps to be taken when a medication error occurs are included under standards of care. Health care facilities have policies and procedures in place to establish standards of care for the facility, not to establish how the facility is to be run.

The nurse commits a medication error. The nurse documents the error in the patient's record and completes the incident report. What does the nurse recognize as the primary reason for doing this? 1. To verify that the patient's safety was protected 2. To protect the patient from further harm 3. To protect the health care facility from litigation 4. To protect the nurse from liability

1. To verify that the patient's safety was protected Rationale 1: Documentation in the patient's medical record and completion of an incident report verify that the patient's safety was protected. Documentation of an error does not necessarily protect the health care facility from litigation. The patient has already been harmed; the documentation will not protect the patient from future harm. Documentation of an error does not necessarily protect the nurse from liability. Rationale 2: Documentation in the patient's medical record and completion of an incident report verify that the patient's safety was protected. Documentation of an error does not necessarily protect the health care facility from litigation. The patient has already been harmed; the documentation will not protect the patient from future harm. Documentation of an error does not necessarily protect the nurse from liability. Rationale 3: Documentation in the patient's medical record and completion of an incident report verify that the patient's safety was protected. Documentation of an error does not necessarily protect the health care facility from litigation. The patient has already been harmed; the documentation will not protect the patient from future harm. Documentation of an error does not necessarily protect the nurse from liability. Rationale 4: Documentation in the patient's medical record and completion of an incident report verify that the patient's safety was protected. Documentation of an error does not necessarily protect the health care facility from litigation. The patient has already been harmed; the documentation will not protect the patient from future harm. Documentation of an error does not necessarily protect the nurse from liability.

A student nurse is learning about a medication that affects the autonomic nervous system. When instructing the student about the effects of this medication, the nurse will begin by explaining the basic unit of this system. What does this include? Standard Text: Select all that apply. 1. The preganglionic neuron 2. The postganglionic neuron 3. The synaptic cleft 4. Norepinephrine 5. Dopamine

1. The preganglionic neuron 2. The postganglionic neuron 3. The synaptic cleft Rationale 1: The basic unit of the autonomic nervous system is a two-neuron chain. The first neuron, called the preganglionic neuron, originates in the central nervous system. Rationale 2: The preganglionic neuron connects with the second nerve in the autonomic nervous system two-neuron chain through the ganglia, which contains the postganglionic neuron. Rationale 3: Autonomic messages must cross the synaptic cleft. Rationale 4: Acetylcholine is the neurotransmitter released at cholinergic receptors. Rationale 5: Dopamine is a neurotransmitter within the limbic system and hypothalamus and not the autonomic nervous system. Global Rationale: The basic unit of the autonomic nervous system is a two-neuron chain. The first neuron, called the preganglionic neuron, originates in the central nervous system. The preganglionic neuron connects with the second nerve in the autonomic nervous system two-neuron chain through the ganglia, which contains the postganglionic neuron. Autonomic messages must cross the synaptic cleft. Acetylcholine is the neurotransmitter released at cholinergic receptors. Dopamine is a neurotransmitter within the limbic system and hypothalamus and not the autonomic nervous system.

The nurse is preparing medications prior to administration. To promote patient safety, the nurse uses "rights" of drug administration. What do these "rights" include? Standard Text: Select all that apply. 1. The right medication 2. The right time of delivery 3. The right dose 4. The right route of administration 5. The right nurse

1. The right medication 2. The right time of delivery 3. The right dose 4. The right route of administration Rationale 1: The right medication is an essential consideration of medication administration and is considered one of the five rights. Rationale 2: The right time of delivery is an essential consideration of medication administration and is considered one of the five rights. Rationale 3: The right dose is an essential consideration of medication administration and is considered one of the five rights. Rationale 4: The right route of delivery is an essential consideration of medication administration and is considered one of the five rights. Rationale 5: The right nurse is not one of the listed rights of medication delivery. Global Rationale: The five rights of drug administration are the right patient, the right medication, the right dose, the right route of administration, and the right time of delivery. The right nurse is not one of the listed rights.

Which of the following is an example of a medication error? 1. The wrong dose of a medication is drawn up, but is caught and corrected prior to administration. 2. A medication is administered to a patient with no allergies, yet an anaphylactic response occurs. 3. A medication is administered in liquid form instead of tablet form due to the patient's difficulty swallowing. 4. A patient experiences unexpected hypotension as a result of medication administration.

1. The wrong dose of a medication is drawn up, but is caught and corrected prior to administration. Rationale 1: A medication error can occur even when it does not reach the patient. Unexpected reactions to medications are not preventable, and would be considered adverse effects, not medication errors. Altering the form from a tablet to a liquid does not constitute a medication error.

Chemical names are assigned for each drug. What are the major reasons that nursing usually does not use the chemical name of the drugs? Standard Text: Select all that apply. 1. They are usually not brief or easy to remember. 2. They are often difficult to pronounce. 3. There is no standard for assigning names. 4. They do not explain the nature of the drug. 5. There is only one chemical name for each drug.

1. They are usually not brief or easy to remember. 2. They are often difficult to pronounce. Rationale 1: Chemical names are usually not brief or easy to remember. Rationale 2: Chemical names are often difficult to pronounce. Rationale 3: Chemical names are assigned by a standard nomenclature. Rationale 4: Chemical names do explain the nature of the drug. Rationale 5: While it is true each drug has only one chemical name, this is not one of the reasons nurses do not use the chemical name. Global Rationale: Chemical names are usually not brief or easy to remember and are often difficult to pronounce. They are assigned by a standard nomenclature and explain the nature of the drug. While it is true each drug has only one chemical name, this is not one of the reasons nurses do not use the chemical name.

Pharmacogenetics is a relatively new area within pharmacology. Which statement best describes the potential of this new area? 1. To customize drugs and prevent idiosyncratic responses 2. To reduce the overall number of drugs and their associated adverse effects 3. To reduce medication errors and provide optimal drug choices 4. To provide cost-effective pharmacotherapy and higher drug efficacy

1. To customize drugs and prevent idiosyncratic responses Rationale 1: Pharmacogenetics explores the role of heredity in drug response. It might be useful to customize drugs based on genetic makeup and reduce idiosyncratic responses. Rationale 2: Reducing the number of drugs might occur but is not the best descriptive statement. Rationale 3: Pharmacogenetics will not reduce medication errors. Rationale 4: Currently, increased cost is a deterrent. Global Rationale: Pharmacogenetics explores the role of heredity in drug response. It might be useful to customize drugs based on genetic makeup and reduce idiosyncratic responses. Pharmacogenetics will not reduce medication errors. Currently, increased cost is a deterrent. Reducing the number of drugs might occur but is not the best descriptive statement.

Which values must be known in order to determine a drug's therapeutic range? Standard Text: Select all that apply. 1. Toxic concentration 2. Onset of action 3. Peak plasma level 4. Absorption rate 5. Minimal effective concentration

1. Toxic concentration 5. Minimal effective concentration Rationale 1: Toxic concentration is an essential determinant of therapeutic range. Rationale 2: Onset of action is not related to therapeutic range. Rationale 3: Peak plasma level is not related to therapeutic range. Rationale 4: Absorption rate is not related to therapeutic range. Rationale 5: Minimal effective concentration is an essential determinant of therapeutic range. Global Rationale: Therapeutic range is the area between toxic concentration and minimum effective concentration. Onset of action, peak plasma level, and absorption rate are not related to therapeutic range.

A patient is prescribed an anticholinergic drug. What discharge instructions should the nurse provide? Standard Text: Select all that apply. 1. Wear sunglasses in bright light. 2. Limit fluid intake. 3. Increase fiber intake. 4. Avoid hot showers. 5. Avoid milk and dairy products.

1. Wear sunglasses in bright light. 3. Increase fiber intake. 4. Avoid hot showers. Rationale 1: Anticholinergic drugs may cause photosensitivity. Rationale 2: Fluids should be increased. Rationale 3: Use of anticholinergics increases risk for constipation. Fiber intake should be increased. Rationale 4: Use of anticholinergics reduces ability of patients to sweat and self-regulate temperature. Hot environments, including hot showers and baths, should be avoided. Rationale 5: There is no reason to avoid dairy products. Global Rationale: Anticholinergic drugs may cause photosensitivity. Use of anticholinergics reduces ability of patients to sweat and self-regulate temperature. Hot environments, including hot showers and baths, should be avoided. Use of anticholinergics increases risk for constipation. Fiber and fluid intake should be increased. There is no reason to avoid dairy products.

A nurse is teaching a community group about holistic medicine. Which information should the nurse include about Western medicine? Standard Text: Select all that apply. 1. Western medicine focuses on the cause of disease. 2. Western medicine is not compatible with holistic medicine. 3. The patient is at the center of concern in Western medicine. 4. Disease is often viewed as a malfunction in a specific body system. 5. Western medicine may focus on disease treatment.

1. Western medicine focuses on the cause of disease. 4. Disease is often viewed as a malfunction in a specific body system. 5. Western medicine may focus on disease treatment. Rationale 1: Western medicine often focuses on determining which disease is present and what caused it. Rationale 2: Western medicine is compatible with holistic medicine, but this requires that those providing care remain mindful of the individuality of the patient. Rationale 3: Disease and treatment are typically at the center of Western medicine. Rationale 4: In Western medicine disease is often viewed as a specific malfunction of a body part. Rationale 5: Western medicine often focuses on the treatment of a disease, not the care of the patient with the disease. Global Rationale: Western medicine often focuses on determining which disease is present and what caused it. In Western medicine disease is often viewed as a specific malfunction of a body part. Western medicine often focuses on the treatment of a disease, not the care of the patient with the disease. Western medicine is compatible with holistic medicine, but this requires that those providing care remain mindful of the individuality of the patient. Disease and treatment are typically at the center of Western medicine.

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

1. Women tend to seek medical care earlier than men do. Rationale 1: Women are quicker to seek medical care than are men. Rationale 2: Cardiac disease has traditionally been thought of as a men's issue. Rationale 3: In 1993, the FDA mandated that research studies include both male and female subjects. Rationale 4: Studies indicate that more women than men suffer from Alzheimer's disease. Global Rationale: Women are quicker to seek medical care than are men. Studies indicate that more women than men suffer from Alzheimer's disease. In 1993, the FDA mandated that research studies include both male and female subjects. Cardiac disease has traditionally been thought of as a men's issue.

When possible, drug therapy is postponed until after pregnancy and lactation. However, certain acute and chronic conditions must be managed during pregnancy, including Standard Text: Select all that apply. 1. epilepsy. 2. serious cystic acne. 3. sexually transmitted infections. 4. gestational diabetes. 5. hypertension.

1. epilepsy. 3. sexually transmitted infections. 4. gestational diabetes. 5. hypertension. Rationale 1: Epilepsy is a preexisting disease. It would not be wise to discontinue therapy during pregnancy and lactation. Rationale 2: Cystic acne may be treated with isotretinoin (Accutane). Isotretinoin is a Class X drug and can cause fetal brain damage. Other antibiotics such as tetracycline are Class D and should not be used in pregnancy. Rationale 3: Sexually transmitted infections can harm the fetus. Rationale 4: Gestational diabetes is a complication related to pregnancy that must be treated for the safety of both the mother and growing fetus. Rationale 5: If hypertension is present prior to pregnancy, it would be unwise to discontinue therapy during pregnancy and lactation. Global Rationale: Epilepsy is a preexisting disease. It would not be wise to discontinue therapy during pregnancy and lactation. Sexually transmitted infections can harm the fetus. Gestational diabetes is a complication related to pregnancy that must be treated for the safety of both the mother and growing fetus. If hypertension is present prior to pregnancy, it would be unwise to discontinue therapy during pregnancy and lactation. Cystic acne may be treated with isotretinoin (Accutane). Isotretinoin is a Class X drug and can cause fetal brain damage. Other antibiotics such as tetracycline are Class D and should not be used in pregnancy.

A person who had her adrenergic receptors activated would experience 1. fight-or-flight effects. 2. rest-and-digest effects. 3. increased blood volume. 4. bronchial constriction.

1. fight-or-flight effects. Rationale 1: Adrenergic receptors are found within the sympathetic nervous system. Sympathetic nervous system activation produces the fight-or-flight response. Rationale 2: Adrenergic receptors are found within the sympathetic nervous system. Parasympathetic nervous system activation produces the rest-and-digest response. Rationale 3: Blood volume increases are not specifically controlled by the nervous system, but distribution of blood is under nervous control. Rationale 4: Adrenergic receptors are found within the sympathetic nervous system. Parasympathetic nervous system activation initiates bronchial constriction. Global Rationale: Adrenergic receptors are found within the sympathetic nervous system. Sympathetic nervous system activation produces the fight-or-flight response. Parasympathetic nervous system activation produces the rest-and-digest response. Blood volume increases are not specifically controlled by the nervous system, but distribution of blood is under nervous control. Parasympathetic nervous system activation initiates bronchial constriction.

The nurse explains to a student nurse that the median lethal dose of drugs is often determined in laboratory preclinical trials because Standard Text: Select all that apply. 1. it would be unethical to determine these values in human subjects. 2. the safety of the medication must be determined prior to clinical trials. 3. it is difficult to obtain sufficient participants for clinical trials. 4. clinical trials determine only the effective dose of a drug. 5. it is too costly to conduct the studies during clinical trials.

1. it would be unethical to determine these values in human subjects. 2. the safety of the medication must be determined prior to clinical trials. Rationale 1: Laboratory animals are used in clinical trials to determine the LD50, or the dose that kills 50% of the subjects. It would be unethical to kill human subjects. Rationale 2: Before a drug is released for trials in human subjects, its safety must be determined. Rationale 3: It can be challenging to obtain sufficient subjects at times, but this is not the reason for doing lethal studies during preclinical trials. Rationale 4: Clinical trials determine not only the effectiveness of a drug, but also its adverse and toxic effects. Rationale 5: The cost of the trials is the reason they are conducted with animal subjects. Global Rationale: Laboratory animals are used in clinical trials to determine the LD50, or the dose that kills 50% of the subjects. It would be unethical to kill human subjects. Before a drug is released for trials in human subjects, its safety must be determined. It can be challenging to obtain sufficient subjects at times, but this is not the reason for doing lethal studies during preclinical trials. Clinical trials determine not only the effectiveness of a drug, but also its adverse and toxic effects. The cost of the trials is the reason they are conducted with animal subjects.

Graded dose-response curves are most useful for determining 1. response intensity within an individual. 2. response intensity within a large group of people with different characteristics. 3. response intensity within a large group of people with similar characteristics. 4. response intensity within a small group of people with similar characteristics.

1. response intensity within an individual. Rationale 1: Graded dose-response curves are used to determine response intensity within an individual. Rationale 2: Frequency distribution curves are used to visualize patient differences in response to medication in a population. Rationale 3: Frequency distribution curves are used to visualize patient differences in response to medication in a population. Rationale 4: Frequency distribution curves are used to visualize patient differences in response to medication in a population. Global Rationale: Graded dose-response curves are used to determine response intensity within an individual. Frequency distribution curves are used to visualize patient differences in response to medication in a population.

The ability of a person to use his arm muscles to lift a weight is primarily regulated by 1. the somatic nervous system. 2. the sympathetic nervous system. 3. the autonomic nervous system. 4. the parasympathetic nervous system.

1. the somatic nervous system. Rationale 1: The somatic nervous system (a division of the peripheral nervous system) controls voluntary movement such as lifting a weight. Rationale 2: The sympathetic nervous system is a division of the autonomic nervous system. Rationale 3: The autonomic nervous system involves involuntary responses. Rationale 4: The parasympathetic nervous system is a division of the autonomic nervous system. Global Rationale: The somatic nervous system (a division of the peripheral nervous system) controls voluntary movement such as lifting a weight. The autonomic nervous system involves involuntary responses, and is divided into the sympathetic and parasympathetic divisions.

The nurse is caring for a patient who has been involved in a motor vehicle crash. The health care provider has written orders for a transdermal patch for pain. The nurse knows that. Standard Text: Select all that apply. 1. the transdermal patch should not be applied to areas of abrasion. 2. transdermal medications undergo the first-pass effect in the liver. 3. transdermal medications completely bypass digestive enzymes. 4. the actual dose received by the patient from this pain patch may vary. 5. transdermal patches are not considered an effective means of delivering medications because the rate of delivery and actual dose can vary.

1. the transdermal patch should not be applied to areas of abrasion. 3. transdermal medications completely bypass digestive enzymes. 4. the actual dose received by the patient from this pain patch may vary. Rationale 1: Applying transdermal patches to skin that has abrasions may unintentionally increase the dose of the medication. Rationale 2: Transdermal medications avoid the first-pass effect. Rationale 3: Transdermal medications never come into contact with digestive enzymes but go straight into the bloodstream. Rationale 4: While transdermal patches do contain a specific amount of medication, the rate of delivery may vary for each patient. Rationale 5: It is true that the rate of delivery and actual dose received can vary, but this route is an effective means of delivering many medications such as birth control medications and nitroglycerin for angina. Global Rationale: Applying transdermal patches to skin that has abrasions may unintentionally increase the dose of the medication. Transdermal medications never come into contact with digestive enzymes but go straight into the bloodstream. While transdermal patches do contain a specific amount of medication, the rate of delivery may vary for each patient. Transdermal medications avoid the first-pass effect. It is true that the rate of delivery and actual dose received can vary, but this route is an effective means of delivering many medications such as birth control medications and nitroglycerin for angina.

The toddler refuses to take his oral medication. What is the best suggestion to the mother from the nurse for ensuring the toddler receives his medication? 1. "Tell him you will buy him a toy if he takes the medication." 2. "Crush the tablet and mix it with a small amount of jam." 3. "Crush the tablet and mix it with milk." 4. "Tell him he will be punished if he does not take the medicine."

2. "Crush the tablet and mix it with a small amount of jam." Rationale 1: The parent should not buy the child's compliance with a toy. Rationale 2: Mixing the medication in jam will disguise the taste. Rationale 3: Parents should avoid placing medication in milk as this may cause the toddler to avoid healthy foods. Rationale 4: Punishment will alienate the child and decrease compliance. Global Rationale: Mixing the medication in jam will disguise the taste. The parent should not buy the child's compliance with a toy. Punishment will alienate the child and decrease compliance. Parents should avoid placing medication in milk as this may cause the toddler to avoid healthy foods.

A patient looks up the drug he is taking in a drug guide. The patient asks the nurse why the physician prescribed a medication that has a lethal dose measure. What is the best response by the nurse? 1. "It just refers to what is done in research; it is not used by doctors prescribing drugs." 2. "It is a value determined during research, which helps to determine the safe dose to give." 3. "All that means is that the drug could be lethal, but I will watch you for side effects." 4. "Don't worry about that, I'll have your doctor explain it to you."

2. "It is a value determined during research, which helps to determine the safe dose to give." Rationale 1: The lethal dose measure is used by doctors prescribing drugs. Rationale 2: The difference between a median effective dose and a median lethal dose is a measure of a drug's safety margin, which helps determine the safest dose to give. Rationale 3: Telling a patient that the drug could be lethal, but he will be observed for side effects, will frighten him and most likely result in refusal of the medication. Rationale 4: Telling a patient not to worry is non-therapeutic; this is a condescending response. Global Rationale: The difference between a median effective dose and a median lethal dose is a measure of a drug's safety margin, which helps determine the safest dose to give. The lethal dose measure is used by doctors prescribing drugs. Telling a patient not to worry is non-therapeutic; this is a condescending response. Telling a patient that the drug could be lethal, but he will be observed for side effects, will frighten him and most likely result in refusal of the medication.

A client with advanced heart disease says, "I read about a new drug that was just released. Do you think my doctor could get it for me?" What should the nurse include in discussion with the client? Standard Text: Select all that apply. 1. "Since the drug is new it is dangerous to use." 2. "Decisions on using drugs are based on many different variables." 3. "We certainly can talk to your physician about the drug." 4. "When drugs are first developed they are very expensive and their use is limited to those who can afford to purchase them." 5. "People who are very sick often have unrealistic expectations of what drugs can do."

2. "Decisions on using drugs are based on many different variables." 3. "We certainly can talk to your physician about the drug." Rationale 1: It is non-therapeutic to tell the client the drug is dangerous. At this point, the nurse has no knowledge of which drug is being discussed. Rationale 2: Use of particular drugs is based on many different variables, including cost-benefit ratio. Rationale 3: The nurse should support the client's interest in this drug by advocating for a discussion about its use. Rationale 4: The nurse should not assume the drug is expensive or that the client is unable to obtain it. Rationale 5: It is non-therapeutic to tell the client that interest in this drug is unrealistic. Global Rationale: It is non-therapeutic to tell the client the drug is dangerous. At this point, the nurse has no knowledge of which drug is being discussed. Use of particular drugs is based on many different variables, including cost-benefit ratio. The nurse should support the client's interest in this drug by advocating for a discussion about its use. The nurse should not assume the drug is expensive or that the client is unable to obtain it. It is non-therapeutic to tell the client that interest in this drug is unrealistic.

A patient returns to the clinic for follow-up after taking an adrenergic blocking medication for benign prostatic hypertrophy (BPH.) What assessment questions should the nurse ask? Standard Text: Select all that apply. 1. "What color is your urine?" 2. "Do you have any difficulty starting to urinate?" 3. "Do you have the feeling that your bladder is full?" 4. "When was your last bowel movement?" 5. "Have you noticed being more hungry than usual?"

2. "Do you have any difficulty starting to urinate?" 3. "Do you have the feeling that your bladder is full?" Rationale 1: Adrenergic blockers do not change the color of the urine. Rationale 2: Adrenergic blockers may result in hesitancy. Rationale 3: Adrenergic blockers may result in retention of urine. Rationale 4: Questions about time of last BM are not indicated. Rationale 5: Adrenergic blockers do not affect appetite. Global Rationale: Adrenergic blockers may result in hesitancy or urinary retention. Adrenergic blockers do not change the color of the urine. Questions about time of last BM are not indicated. Adrenergic blockers do not affect appetite.

The patient and his wife receive the same medication for hypertension. The patient's wife asks the nurse why she is receiving a higher amount of the medication. What is the best response by the nurse? 1. "Females have a higher metabolism, so you need more medication." 2. "Everyone is unique and responds differently to medications." 3. "Your hormones are different from your husband's, so you need more medication." 4. "You have a greater percentage of body fat, so more medication is needed."

2. "Everyone is unique and responds differently to medications." Rationale 1: Females do not necessarily have higher metabolic rates than men. Rationale 2: Many variables will influence how patients will respond to medications; each patient must be individually evaluated for response to medications. Rationale 3: Hormone status is only one of the variables involved in the patient's response to medications and may not pertain to this drug. Rationale 4: The percentage of body fat is only one of the variables involved in the patient's response to medications and may not pertain to this medication. Global Rationale: Many variables will influence how patients will respond to medications; each patient must be individually evaluated for response to medications. The percentage of body fat, hormones, and the patient's rate of metabolism are only a few of the variables involved in the patient's response to medications. These factors may or may not pertain to the medication in question. Females do not necessarily have higher metabolic rates than men.

The nurse manager would determine that a nurse understands culturally sensitive care if which statements are made? Standard Text: Select all that apply. 1. "Since all of our patients have the same illnesses, I sometimes get bored." 2. "I have been helping my patient understand how to choose foods from our diet menu." 3. "I am concerned because my patient needs sterile dressing changes but has no running water at home." 4. "My patient and I worked out a way to get her medications delivered to her at home." 5. "I invited a group from my church to come and sing hymns for our patients."

2. "I have been helping my patient understand how to choose foods from our diet menu." 3. "I am concerned because my patient needs sterile dressing changes but has no running water at home." 4. "My patient and I worked out a way to get her medications delivered to her at home." Rationale 1: A nurse who believes that patients who have the same illness are alike is not seeing their psychosocial needs. Rationale 2: Helping the patient cope and navigate through the hospital "culture" is a culturally sensitive action. Rationale 3: Cultural sensitivity takes environment into consideration. Rationale 4: Helping the patient cope and navigate through potential blockers to medication adherence is a culturally sensitive action. Rationale 5: Imposing one's own religious beliefs on others is not culturally sensitive. Global Rationale: Helping the patient cope and navigate through the hospital "culture" is a culturally sensitive action. Cultural sensitivity takes environment into consideration. Helping the patient cope and navigate through potential blockers to medication adherence is a culturally sensitive action. A nurse who believes that patients who have the same illness are alike is not seeing their psychosocial needs. Imposing one's own religious beliefs on others is not culturally sensitive.

A patient has been prescribed prazosin (Minipress). What information should the nurse provide? Standard Text: Select all that apply. 1. "Stay out of the sun until you determine if you become sun-sensitive." 2. "Take this medication just before you go to bed." 3. "This medication may make you dizzy." 4. "This medication may slow your heart rate noticeably." 5. "Do not take this medication with milk."

2. "Take this medication just before you go to bed." 3. "This medication may make you dizzy." Rationale 1: There is no indication that this medication will make the patient sensitive to the sun. Rationale 2: This medication should be taken just before bedtime as it may cause drowsiness or light-headedness. Rationale 3: Dizziness is a common adverse effect of this drug. Rationale 4: Tachycardia is the expected adverse effect. Rationale 5: There is no reason to avoid milk when taking this drug. Global Rationale: This medication should be taken just before bedtime as it may cause drowsiness or light-headedness. Dizziness is a common adverse effect of this drug. There is no indication that this medication will make the patient sensitive to the sun. Tachycardia is the expected adverse effect. There is no reason to avoid milk when taking this drug.

The pregnant patient plans to breastfeed her baby. She asks the nurse about the use of herbal products during breastfeeding. What is the best response by the nurse? 1. "Be sure to check the label to see if the herbal product could be used during breastfeeding." 2. "Most drugs can be transferred to the infant during breastfeeding, so this is not recommended." 3. "Herbal products are considered natural, so it should be fine to use them during breastfeeding." 4. "This should be fine, as long as there is at least 12 hours between the time you use the product and when you breastfeed."

2. "Most drugs can be transferred to the infant during breastfeeding, so this is not recommended." Rationale 1: The bottle may not be labeled for breastfeeding, so the patient should check with the nurse. Rationale 2: It is best to avoid as many drugs as possible during breastfeeding. Rationale 3: Herbal products are drugs. Rationale 4: There is no safety time limit established between the use of the product and breastfeeding. Global Rationale: It is best to avoid as many drugs as possible during breastfeeding. The bottle may not be labeled for breastfeeding, so the patient should check with the nurse. There is no safety time limit established between the use of the product and breastfeeding. Herbal products are drugs.

The client is receiving methadone (Dolophine), a Schedule II drug. The client says to the nurse, "A pharmacist told me the pharmacy must register with the Drug Enforcement Administration (DEA) to give me this drug; will DEA agents be snooping around my house?" What is the best response by the nurse? 1. "It is probably unlikely that Drug Enforcement Administration (DEA) agents will be bothering you." 2. "No, the Drug Enforcement Administration (DEA) restricts drugs that have a high potential for abuse." 3. "No. I think our system should be more like Europe; they have fewer controlled drugs." 4. "That's an interesting question. Are you worried about the Drug Enforcement Administration (DEA)?"

2. "No, the Drug Enforcement Administration (DEA) restricts drugs that have a high potential for abuse." Rationale 1: Telling the client that Drug Enforcement Administration (DEA) agents will "probably" not bother him can lead the client to think DEA agents might bother him. Rationale 2: The Controlled Substance Act of 1970 restricts the use of drugs that have a high potential for abuse. Hospitals and pharmacies must register with the Drug Enforcement Administration (DEA) to obtain a specific registration number that will enable them to purchase controlled drugs. Rationale 3: By saying that our system should be more like Europe's, the nurse is introducing her beliefs and this is non-therapeutic; the client may not agree. Rationale 4: Asking the client if he is worried about the Drug Enforcement Administration (DEA) puts him on the defensive and is non-therapeutic. Global Rationale: The Controlled Substance Act of 1970 restricts the use of drugs that have a high potential for abuse. Hospitals and pharmacies must register with the Drug Enforcement Administration (DEA) to obtain a specific registration number that will enable them to purchase controlled drugs. Telling the client that Drug Enforcement Administration (DEA) agents will "probably" not bother him can lead the client to think DEA agents might bother him. Asking the client if he is worried about the Drug Enforcement Administration (DEA) puts him on the defensive and is non-therapeutic. By saying that our system should be more like Europe's, the nurse is introducing her beliefs and this is non-therapeutic; the client may not agree.

Prior to administering a newly prescribed antibiotic, the nurse asks the patient if any other drugs have been taken today. The patient responds, "Why do you need to know?" Which nursing responses are indicated? Standard Text: Select all that apply. 1. "I need to be certain you are not taking another antibiotic." 2. "Some drugs block the action of others." 3. "Some drugs increase the activity of other drugs." 4. "The antibiotic I am about to give you is a prodrug." 5. "We don't want to increase first-pass effect."

2. "Some drugs block the action of others." 3. "Some drugs increase the activity of other drugs." Rationale 1: There are many instances when a patient is prescribed more than one antibiotic at a time. Rationale 2: Some drug-drug interactions are antagonistic, blocking or opposing the effects of the drugs taken. Rationale 3: Some drug-drug interactions are synergistic, resulting in a potentiated effect. Rationale 4: Prodrugs have no pharmacologic activity unless they are first metabolized to their active form by the body. This is not dependent on whether or not other drugs are present in the system. Rationale 5: This question has nothing to do with first-pass effect. Global Rationale: There are many instances when a patient is prescribed more than one antibiotic at a time. Some drug-drug interactions are antagonistic, blocking or opposing the effects of the drugs taken, and some are synergistic, resulting in a potentiated effect. Prodrugs have no pharmacologic activity unless they are first metabolized to their active form by the body. This is not dependent on whether or not other drugs are present in the system. This question has nothing to do with first-pass effect.

The nurse is conducting medication education about the difference between potency and efficacy to a group of patients. The nurse correctly determines that learning has occurred when the patients makes which response? 1. "The best drug for us is the one with the highest potency." 2. "The best drug for us is the one with the greatest efficacy." 3. "Drugs with the greatest efficacy will produce the least side effects." 4. "Low-potency drugs have efficacy and do not produce side effects."

2. "The best drug for us is the one with the greatest efficacy." Rationale 1: Potency refers to the dose of the drug; high-potency drugs do not necessarily provide the best response in the patient. Rationale 2: Efficacy means the magnitude of maximal response that can be produced from a particular drug. Rationale 3: Efficacious drugs do produce side effects. Rationale 4: Low-potency drugs do produce side effects. Global Rationale: Efficacy means the magnitude of maximal response that can be produced from a particular drug. Potency refers to the dose of the drug; high-potency drugs do not necessarily provide the best response in the patient. Efficacious drugs and low-potency drugs do produce side effects.

A patient with hypertension is taking a potent antihypertensive without results. The patient is concerned when the health care provider orders a new drug. The nurse explains, Standard Text: Select all that apply. 1. "The drug you took is very potent, and a higher dose is needed." 2. "The new drug has greater efficacy, so it will help reduce your blood pressure." 3. "The prescriber must have made an error in the orders." 4. "Efficacy in treating your hypertension is more important than potency." 5. "You are correct. I think the prescriber meant to order both drugs."

2. "The new drug has greater efficacy, so it will help reduce your blood pressure." 4. "Efficacy in treating your hypertension is more important than potency." Rationale 1: A higher dose of a potent drug may cause more serious adverse effects without greater efficacy. Rationale 2: Efficacy is more important than potency in providing blood pressure control. Rationale 3: This is not an appropriate response by the nurse. Rationale 4: Efficacy is more important than potency in pharmacologic treatment. Rationale 5: This is not an appropriate response, and the nurse cannot assume the order was supposed to be for two drugs. Global Rationale: Efficacy is more important than potency in providing blood pressure control. Efficacy is more important than potency in pharmacologic treatment. A higher dose of a potent drug may cause more serious adverse effects without greater efficacy. Statements regarding the prescriber are not appropriate.

The nurse is teaching a caregivers' support group for caretakers of older adult patients. The focus is medication compliance. The nurse determines that learning has occurred when the caregivers make which response? 1. "We should crush their medicine and put it in applesauce so they will swallow it." 2. "We should use a medication management box so they won't forget to take it." 3. "We should ask the doctor if all the medication is really necessary." 4. "We should give them more education about the medicine so they will take it."

2. "We should use a medication management box so they won't forget to take it." Rationale 1: Many older adults can swallow pills just fine, and many medications cannot be crushed. Rationale 2: Most older adults patients will be medication compliant if they have a way to remember to take the medication; a medication management box is an excellent idea. Rationale 3: Asking the physician about medications is fine, but this will not help the older adult patient to remember when to take it. Rationale 4: The problem is not the education; it is that the older adults often forget what medication to take at what time. Global Rationale: Most older adult patients will be medication compliant if they have a way to remember to take the medication; a medication management box is an excellent idea. Many older adults can swallow pills just fine, and many medications cannot be crushed. The problem is not the education; it is that older adults often forget what medication to take at what time. Asking the physician about medications is fine, but this will not help the older adult patient to remember when to take it.

A client has been chosen to participate in the clinical trial of a medication to treat chemotherapy-induced nausea. When the nurse takes the informed consent form to the bedside the client says, "I am glad there is finally a medication to cure my cancer." How should the nurse respond? Standard Text: Select all that apply. 1. "Who told you the medication would cure your cancer?" 2. "What questions do you have about this medication?" 3. "Let me explain how this medication works." 4. "Has anyone explained the research trial to you?" 5. "So am I. This research has been intense."

2. "What questions do you have about this medication?" 4. "Has anyone explained the research trial to you?" Rationale 1: It is not important to discover who specifically gave the client this information. Rationale 2: The nurse should be certain the client has no questions prior to having the consent signed. Rationale 3: It is not the nurse's responsibility to explain how the medication works. It is the responsibility of the researcher or health care provider. The nurse should refer questions to those individuals. Rationale 4: It is the nurse's responsibility to ensure that the client has been provided with facts about the medication and the clinical trial prior to having the consent signed. Rationale 5: The nurse should identify that this client does not fully understand the purpose of this medication and should collaborate with the researcher or health care provider regarding this misunderstanding. Global Rationale: The nurse should be certain the client has no questions prior to having the consent signed. It is the nurse's responsibility to ensure that the client has been provided with facts about the medication and the clinical trial prior to having the consent signed. The nurse should identify that this client does not fully understand the purpose of this medication and should collaborate with the researcher or health care provider regarding this misunderstanding. It is not the nurse's responsibility to explain how the medication works. It is the responsibility of the researcher or health care provider. It is not important to discover who specifically gave the client this information.

The client says to the nurse, "My doctor said my drug is a controlled substance; am I considered an addict?" What is the best response by the nurse? 1. "Are you concerned about becoming an addict? We can discuss this in more detail if you would like to." 2. "You are not an addict; the Drug Enforcement Administration (DEA) restricts the use of drugs with a high potential for abuse." 3. "Why do you ask about becoming an addict? Not many of our clients have asked this question." 4. "You are not an addict, but the Drug Enforcement Administration (DEA) will monitor you for this."

2. "You are not an addict; the Drug Enforcement Administration (DEA) restricts the use of drugs with a high potential for abuse." Rationale 1: It is premature at this time to ask the client if he is concerned about addiction; there is no information to support an addiction. Rationale 2: Drugs that have a high potential for addiction are considered controlled substances. Rationale 3: "Why" questions are considered non-therapeutic because they put the client on the defensive. Rationale 4: The Drug Enforcement Administration (DEA) does not monitor clients for addiction when they receive controlled substances. Global Rationale: Drugs that have a high potential for addiction are considered controlled substances. The Drug Enforcement Administration (DEA) does not monitor clients for addiction when they receive controlled substances. It is premature at this time to ask the client if he is concerned about addiction; there is no information to support an addiction. "Why" questions are considered non-therapeutic because they put the client on the defensive.

The patient is admitted to the hospital following an abortion, and she is septic. The physician orders antibiotics that the patient refuses stating, "I don't deserve them." The nurse providing care has anti-abortion beliefs. What is the best response by the nurse? 1. "I think you need to do what is best for you." 2. "You have a serious infection and really need the drug." 3. "It seems you think you should be punished because you had an abortion" 4. "I'll call your physician and let him know about your decision."

2. "You have a serious infection and really need the drug." Rationale 1: Telling the patient she needs to do what is best is inappropriate; the nurse knows she needs the drug. Rationale 2: Telling the patient she needs the drug is providing the best care possible; this must be done even though the nurse's beliefs are different from the patient's beliefs. Rationale 3: Telling the patient what she thinks is not appropriate. Rationale 4: Calling the physician is inappropriate; the nurse knows the patient needs the drug. Global Rationale: Telling the patient she needs the drug is providing the best care possible; this must be done even though the nurse's beliefs are different from the patient's beliefs. Telling the patient she needs to do what is best is inappropriate; the nurse knows she needs the drug. Calling the physician is inappropriate; the nurse knows the patient needs the drug. Telling the patient what she thinks is not appropriate.

The nurse is teaching a patient the importance of taking the medication as prescribed. Patient teaching is guided by the nurse's knowledge of which principles of pharmacokinetics? Standard Text: Select all that apply. 1. A medication taken by injection must cross the membranes of the gastrointestinal tract to get to the bloodstream before it can be distributed throughout the body. 2. A drug may be exposed to several physiological processes while en route to target cells. 3. Liver enzymes may chemically change the drug. 4. Excretion organs such as kidneys and intestines must be healthy enough to eliminate the drug. 5. Many processes to which drugs are exposed are destructive, thereby helping facilitate the drug's movement throughout the body.

2. A drug may be exposed to several physiological processes while en route to target cells. 3. Liver enzymes may chemically change the drug. 4. Excretion organs such as kidneys and intestines must be healthy enough to eliminate the drug. 5. Many processes to which drugs are exposed are destructive, thereby helping facilitate the drug's movement throughout the body. Rationale 1: Medications taken by mouth must cross the membranes of the GI tract to get to the bloodstream in order to be distributed throughout the body. This is not the case for medications administered by injection. Rationale 2: Drugs taken orally are often exposed to physiological processes such as stomach acid and digestive enzymes. Rationale 3: Enzymes in the liver may chemically change some drugs. Rationale 4: Drugs will continue to act on the body until they are either metabolized to an inactive form or are excreted. Pathologic states such as kidney disease can increase the drug's action on the body. Rationale 5: Many destructive processes, such as when stomach acid breaks down food, can break down the drug molecule before it can reach the target cells. This will facilitate the drug's movement throughout the body. Global Rationale: Medications taken by mouth must cross the membranes of the GI tract to get to the bloodstream in order to be distributed throughout the body. This is not the case for medications administered by injection. Drugs taken orally are often exposed to physiological processes such as stomach acid and digestive enzymes. Enzymes in the liver may chemically change some drugs. Drugs will continue to act on the body until they are either metabolized to an inactive form or are excreted. Pathologic states such as kidney disease can increase the drug's action on the body. Many destructive processes, such as when stomach acid breaks down food, can break down the drug molecule before it can reach the target cells. This will facilitate the drug's movement throughout the body.

A patient with hypertension is receiving medication to lower his blood pressure. Which nursing action demonstrates the evaluation process related to medication administration? 1. Asking the patient whether he is compliant in taking his medications 2. Determining that goals were not met 3 days following medication administration 3. Administration of IV antihypertensive agents 4. Determination of the patient's baseline blood pressure

2. Determining that goals were not met 3 days following medication administration Rationale 1: Asking about compliance would be the assessment step. Rationale 2: Evaluation is the final step in the nursing process where goal attainment is determined. Rationale 3: Administering medications is the intervention step. Rationale 4: Determining the patient's baseline blood pressure would be the assessment step. Global Rationale: Evaluation is the final step in the nursing process where goal attainment is determined. Administering medications is the intervention step. Determining the patient's baseline blood pressure and asking him about compliance would be the assessment step.

The African American patient has panic attacks, is suicidal, and is on an inpatient psychiatric unit. The psychiatrist orders sertraline (Zoloft) and clonazepam (Klonopin). The patient refuses the drugs; he requests to have herbs and African objects in his room to "remove the curse." What is the priority action by the nurse? 1. Allow the request without seeking further information from the patient. 2. Allow the request as long as the herbs and objects do not pose a safety risk for the patient or other patients. 3. Allow the request after the patient signs a release of responsibility to avoid litigation. 4. Allow the request after all members of the treatment team agree to it.

2. Allow the request as long as the herbs and objects do not pose a safety risk for the patient or other patients. Rationale 1: To allow an ethnic request without seeking further information about safety could jeopardize patient safety. Rationale 2: Nurses must grant ethnic requests as long as the request does not pose a safety risk to the patient or others. Rationale 3: There is no need for the patient to sign a release of responsibility to avoid litigation; if items pose a safety risk, they cannot be allowed on the unit. Rationale 4: The treatment team does not need to agree to this request; the nurse can approve it as long as the items do not pose a safety risk. Global Rationale: Nurses must grant ethnic requests as long as the request does not pose a safety risk to the patient or others. To allow an ethnic request without seeking further information about safety could jeopardize patient safety. There is no need for the patient to sign a release of responsibility to avoid litigation; if items pose a safety risk, they cannot be allowed on the unit. The treatment team does not need to agree to this request; the nurse can approve it as long as the items do not pose a safety risk.

The nurse was very busy and unfamiliar with a new medication, but administered it anyway. Later the nurse looked up the medication. How does the nurse manager evaluate this behavior? 1. This was acceptable as long as the nurse looked up the action and side effects of the drug later. 2. An error could have occurred because the nurse was unfamiliar with the medication. 3. The nurse manager was partially at fault because the nursing unit was understaffed and the nurse was too busy. 4. An error did occur because the nurse could have administered the medication via the incorrect route.

2. An error could have occurred because the nurse was unfamiliar with the medication. Rationale 1: Nurses should never administer a medication unless they are familiar with its uses and side effects; an error could have occurred because the nurse was unfamiliar with the medication. It is not acceptable for a nurse to administer an unfamiliar medication and then look up the action and side effects later; an error could occur. An error did not occur, but could have because the nurse was unfamiliar with the medication. There is no information in the stem of the question that the nursing unit was understaffed, so the nurse manager is not partially at fault. Rationale 2: Nurses should never administer a medication unless they are familiar with its uses and side effects; an error could have occurred because the nurse was unfamiliar with the medication. It is not acceptable for a nurse to administer an unfamiliar medication and then look up the action and side effects later; an error could occur. An error did not occur, but could have because the nurse was unfamiliar with the medication. There is no information in the stem of the question that the nursing unit was understaffed, so the nurse manager is not partially at fault. Rationale 3: Nurses should never administer a medication unless they are familiar with its uses and side effects; an error could have occurred because the nurse was unfamiliar with the medication. It is not acceptable for a nurse to administer an unfamiliar medication and then look up the action and side effects later; an error could occur. An error did not occur, but could have because the nurse was unfamiliar with the medication. There is no information in the stem of the question that the nursing unit was understaffed, so the nurse manager is not partially at fault. Rationale 4: Nurses should never administer a medication unless they are familiar with its uses and side effects; an error could have occurred because the nurse was unfamiliar with the medication. It is not acceptable for a nurse to administer an unfamiliar medication and then look up the action and side effects later; an error could occur. An error did not occur, but could have because the nurse was unfamiliar with the medication. There is no information in the stem of the question that the nursing unit was understaffed, so the nurse manager is not partially at fault.

The nurse uses the nursing process prior to administering any medications. Which step will ensure the best patient safety? 1. Assess the patient's developmental level. 2. Assess the patient's medical history. 3. Assess the patient's disease process. 4. Assess the patient's learning needs.

2. Assess the patient's medical history. Rationale 1: Assessing the patient's developmental level is important for medication education, but not for safely administering medications. Rationale 2: An assessment of the patient's medical history, which includes allergies, is the most important assessment prior to administering medications. Rationale 3: Assessing the patient's disease process is important in evaluating the effects of the medications, but not for safely administering medications. Rationale 4: Assessing the patient's learning needs is important for medication education, but not for safely administering medications. Global Rationale: An assessment of the patient's medical history, which includes allergies, is the most important assessment prior to administering medications. Assessing the patient's learning needs is important for medication education, but not for safely administering medications. Assessing the patient's developmental level is important for medication education, but not for safely administering medications. Assessing the patient's disease process is important in evaluating the effects of the medications, but not for safely administering medications.

The nurse is aware that it is most important to be accurate in which portion of the nursing process? 1. Evaluation 2. Assessment 3. Diagnosis 4. Planning

2. Assessment Rationale 1: While accuracy in evaluation is important, it is more important to be accurate in a different step of the nursing process. Rationale 2: Assessment is the basis for the development of the rest of the steps of the nursing process. While the nurse always strives to be accurate, inaccuracies in assessment will translate as inaccuracies in the remaining steps. Rationale 3: While accuracy in diagnosis is important, it is more important to be accurate in a different step of the nursing process. Rationale 4: While accuracy in planning is important, it is more important to be accurate in a different step of the nursing process. Global Rationale: Assessment is the basis for the development of the rest of the steps of the nursing process. While the nurse always strives to be accurate, inaccuracies in assessment will translate as inaccuracies in the remaining steps. While accuracy in evaluation, diagnosis, and planning is important, it is more important to be accurate in assessment.

A nurse is reviewing medical records for usage of drugs that are beta2 agonists. The nurse should start with the medical records of patients with which conditions? Standard Text: Select all that apply. 1. Heart failure 2. Asthma 3. COPD 4. Overactive bladder 5. Nasal congestion

2. Asthma 3. COPD Rationale 1: Beta1 agonists are most likely to be given to patients with heart failure. Rationale 2: Beta2 agonists are useful in the treatment of asthma. Rationale 3: Beta2 agonists are useful in the treatment of COPD. Rationale 4: Beta3 agonists are most likely to be given to patients with overactive bladder. Rationale 5: Alpha1 agonists are most likely to be given to patients with nasal congestion. Global Rationale: Beta2 agonists are useful in the treatment of asthma and COPD. Beta1 agonists are most likely to be given to patients with heart failure. Beta2 agonists are useful in the treatment of asthma. Alpha1 agonists are most likely to be given to patients with nasal congestion.

A drug for which research has shown an adverse effect in animals but not in pregnant women would be categorized as Category 1. A. 2. B. 3. D. 4. C.

2. B. Rationale 1: Category A drugs have shown no adverse effects in women. Rationale 2: A drug that has adverse effects in animals but not in pregnant women is a Category B drug. Rationale 3: Category D drugs have demonstrated risk to pregnant women. Rationale 4: Category C drugs have had either no animal studies or adverse effects in animal studies with no adequate studies in women. Global Rationale: A drug that has adverse effects in animals but not in pregnant women is a Category B drug. Category A drugs have shown no adverse effects in women. Category D drugs have demonstrated risk to pregnant women. Category C drugs have had either no animal studies or adverse effects in animal studies with no adequate studies in women.

A patient has been prescribed scopolamine (Transderm-Scop) for the prevention of motion sickness. The nurse should teach the patient to immediately report which adverse effects? Standard Text: Select all that apply. 1. Slow heart rate 2. Cardiac palpitations 3. Decreased urinary output 4. Development of tremors 5. Diarrhea

2. Cardiac palpitations 3. Decreased urinary output 4. Development of tremors Rationale 1: Tachycardia is the adverse effect associated with scopolamine (Transderm-Scop). Rationale 2: Dysrhythmia is an adverse effect of this drug. Rationale 3: Decreased urinary output is an adverse effect of this drug. Rationale 4: Tremors are an adverse effect of this drug. Rationale 5: Diarrhea is not an expected adverse effect of this drug. Global Rationale: Dysrhythmia, decreased urinary output, and tremors are adverse effects of scopolamine (Transderm-Scop). Tachycardia is the adverse effect associated with scopolamine (Transderm-Scop). Diarrhea is not an expected adverse effect of this drug.

A patient who is strictly vegetarian due to religious beliefs has been prescribed a medication contained in a gelatin capsule. Which nursing actions are indicated? Standard Text: Select all that apply. 1. Do not tell the patient the capsule contains gelatin. 2. Collaborate with the prescriber to find an alternative medication. 3. Check to see if the capsule can be opened for administration. 4. Work to convince the patient that this application does not violate vegetarian beliefs. 5. Tell the patient that the gelatin is an inactive ingredient in the medication.

2. Collaborate with the prescriber to find an alternative medication. 3. Check to see if the capsule can be opened for administration. Rationale 1: Withholding information regarding the medication is not ethical. Rationale 2: An alternative dosage form that does not require use of a gelatin capsule may be available. Rationale 3: Many capsules can be opened and the contents placed in fluid or on soft food for administration. Rationale 4: If the patient is strictly vegetarian the use of a gelatin capsule is a violation of belief. The nurse should not try to influence the patient otherwise. Rationale 5: Whether the gelatin is an active ingredient or an inactive ingredient is not relevant. Global Rationale: An alternative dosage form that does not require use of a gelatin capsule may be available. Many capsules can be opened and the contents placed in fluid or on soft food for administration. Withholding information regarding the medication is not ethical. If the patient is strictly vegetarian the use of a gelatin capsule is a violation of belief. The nurse should not try to influence the patient otherwise. Whether the gelatin is an active ingredient or an inactive ingredient is not relevant.

During assessment a patient says, "I took my blood pressure at home and it was high. I have been taking my husband's propranolol (Inderal) for the last week." The nurse is especially concerned about this action when it is noted that the patient has which preexisting conditions? Standard Text: Select all that apply. 1. Obesity 2. Diabetes mellitus 3. COPD 4. Asthma 5. Rheumatoid arthritis

2. Diabetes mellitus 3. COPD 4. Asthma Rationale 1: While obesity may be contributing to the patient's hypertension, use of propranolol (Inderal) is not contraindicated. Rationale 2: Beta blockers may cause hyperglycemia or hypoglycemia and may mask the symptoms of hypoglycemia in patients with diabetes. Rationale 3: Beta blockers may cause significant bronchial constriction. Rationale 4: Beta blockers may cause significant bronchial constriction. Rationale 5: Beta blockers are not contraindicated for use in patients with rheumatoid arthritis. Global Rationale: Beta blockers may cause hyperglycemia or hypoglycemia and may mask the symptoms of hypoglycemia in patients with diabetes. Beta blockers may cause significant bronchial constriction. While obesity may be contributing to the patient's hypertension, use of propranolol (Inderal) is not contraindicated. Beta blockers are not contraindicated for use in patients with rheumatoid arthritis.

The nurse is preparing to administer an adrenergic drug intravenously. What nursing actions should be planned? Standard Text: Select all that apply. 1. Give the drug as rapidly as possible by intravenous push. 2. Dilute the drug before administration. 3. Use an infusion pump to control rate of administration. 4. Monitor for blanching at the infusion site. 5. Advise the patient that a sweet taste may occur as the drug is being given.

2. Dilute the drug before administration. 3. Use an infusion pump to control rate of administration. 4. Monitor for blanching at the infusion site. Rationale 1: These drugs should be administered slowly. Rationale 2: These drugs should be diluted prior to administration. Rationale 3: Infusion of these drugs should be controlled via an infusion pump. Rationale 4: Blanching at the infusion site indicates probable extravasation. The drip should be stopped. Rationale 5: There is no evidence that a sweet taste will occur. Global Rationale: These drugs should be diluted prior to administration. Infusion of these drugs should be controlled via an infusion pump. Blanching at the infusion site indicates probable extravasation. The drip should be stopped. These drugs should be administered slowly. There is no evidence that a sweet taste will occur.

A nurse is reviewing medication records of older adults living in extended care. Which concepts about the pharmacotherapy of older adults should be considered? Standard Text: Select all that apply. 1. Plasma-binding of drugs is greater in those over age 65. 2. Drug distribution is slowed in the older adult. 3. The half-life of many drugs is lessened in older adults. 4. First-pass metabolism is reduced in the older adult. 5. Changes in the kidney may result in decreased drug excretion.

2. Drug distribution is slowed in the older adult. 4. First-pass metabolism is reduced in the older adult. 5. Changes in the kidney may result in decreased drug excretion. Rationale 1: The aging liver produces less albumin, resulting in decreased plasma protein-binding ability and increased levels of free drug in the bloodstream. Rationale 2: The aging cardiovascular system has decreased cardiac output and less efficient blood circulation, which slow drug distribution. Rationale 3: Enzyme production in the liver is decreased and the visceral blood flow is diminished, resulting in reduced hepatic drug metabolism and increased drug half-life. Rationale 4: The decline in hepatic function reduces first-pass metabolism. Rationale 5: Changes in the kidney result in decreased drug excretion. Global Rationale: The aging cardiovascular system has decreased cardiac output and less efficient blood circulation, which slow drug distribution. The decline in hepatic function reduces first-pass metabolism. Changes in the kidney result in decreased drug excretion. The aging cardiovascular system has decreased cardiac output and less efficient blood circulation, which slow drug distribution. Enzyme production in the liver is decreased and the visceral blood flow is diminished, resulting in reduced hepatic drug metabolism and increased drug half-life.

The nurse reads that a newly discovered drug is a functional antagonist for some commonly administered medications. The nurse interprets this information as indicating the new drug could have which actions? Standard Text: Select all that apply. 1. Blocks alpha receptors 2. Enhances drug excretion 3. Blocks beta receptors 4. Speeds drug metabolism 5. Inhibits protein synthesis

2. Enhances drug excretion 4. Speeds drug metabolism Rationale 1: Functional antagonists do not block alpha receptors. Rationale 2: Functional antagonists change pharmacokinetic factors such as excretion. Rationale 3: Functional antagonists do not block beta receptors. Rationale 4: Functional antagonists change pharmacokinetic factors such as metabolism. Rationale 5: Drugs that bind with DNA may inhibit protein synthesis. Global Rationale: Functional antagonists change pharmacokinetic factors such as excretion and metabolism. They do not block alpha or beta receptors. Drugs that bind with DNA may inhibit protein synthesis.

The nursing instructor teaches student nurses about the Food and Drug Administration (FDA) Pregnancy Categories. What is the best information to include? Standard Text: Select all that apply. 1. Food and Drug Administration (FDA) Pregnancy Category C is safe to use during pregnancy. 2. Food and Drug Administration (FDA) Pregnancy categories provide a framework for safe use of drugs in pregnant women. 3. Food and Drug Administration (FDA) Pregnancy categories for individual drugs seldom change once they are established. 4. Food and Drug Administration (FDA) Pregnancy categories are based on studies using clinical human research trials. 5. Food and Drug Administration (FDA) Pregnancy Category X has been associated with teratogenic effects.

2. Food and Drug Administration (FDA) Pregnancy categories provide a framework for safe use of drugs in pregnant women. 5. Food and Drug Administration (FDA) Pregnancy Category X has been associated with teratogenic effects. Rationale 1: Pregnancy Category C is not necessarily safe, it just means that animal studies have shown an adverse effect, but well-controlled studies in pregnant women have not been done. Rationale 2: Food and Drug Administration (FDA) Pregnancy Categories provide a framework for safe use of drugs in pregnant women. Rationale 3: Food and Drug Administration (FDA) Pregnancy categories for individual drugs do change based on reported effects on fetuses. Rationale 4: Food and Drug Administration (FDA) Pregnancy Categories are based on animal studies. Rationale 5: Food and Drug Administration (FDA) Pregnancy Category X has been associated with teratogenic effects. Global Rationale: Food and Drug Administration (FDA) Pregnancy Categories provide a framework for safe use of drugs in pregnant women. Food and Drug Administration (FDA) Pregnancy Category X has been associated with teratogenic effects. Food and Drug Administration (FDA) Pregnancy Categories are based on animal studies. Pregnancy Category C is not necessarily safe, it just means that animal studies have shown an adverse effect, but well-controlled studies in pregnant women have not been done. Food and Drug Administration (FDA) Pregnancy categories for individual drugs do change based on reported effects on fetuses.

While in the hospital, the pediatric patient has been receiving amoxicillin 10 mL orally bid, pc. The child will be going home on this medication. What is the best instruction by the nurse for the parents? 1. Give 2 teaspoons by mouth, 3 times a day, on an empty stomach. 2. Give 2 teaspoons by mouth, twice a day, after meals. 3. Give 2 teaspoons by mouth, 3 times a day, after meals. 4. Give 2 teaspoons by mouth, twice a day, with meals.

2. Give 2 teaspoons by mouth, twice a day, after meals. Rationale 1: Giving 2 teaspoons by mouth, 3 times a day, on an empty stomach is incorrect. Rationale 2: Giving 2 teaspoons by mouth, twice a day, after meals is correct. Rationale 3: Giving 2 teaspoons by mouth, 3 times a day, after meals is incorrect. Rationale 4: Giving 2 teaspoons by mouth, twice a day, with meals is incorrect. Global Rationale: Giving 2 teaspoons by mouth, twice a day, after meals is correct. Giving 2 teaspoons by mouth, 3 times a day, after meals is incorrect. Giving 2 teaspoons by mouth, twice a day, with meals is incorrect. Giving 2 teaspoons by mouth, 3 times a day, on an empty stomach is incorrect.

Which statement is accurate regarding medication administration via the intradermal route? 1. Injections should be limited to 1-2 milliliters. 2. Hairy sites should be avoided. 3. Usual administration sites include the upper and lower abdomen. 4. Medications should be injected into the epidermis skin layer.

2. Hairy sites should be avoided. Rationale 1: Intradermal injection involves administering small amounts (0.1-0.2 milliliters) of medication. Rationale 2: Usual sites of intradermal administration include nonhairy surfaces. Rationale 3: Usual sites of intradermal administration include the forearm, upper chest, and scapulae. Rationale 4: Intradermal injection involves administering small amounts of medication into the dermis layer of skin. Global Rationale: Usual sites of intradermal administration include nonhairy surfaces, including the forearm, upper chest, and scapulae. Intradermal injection involves administering small amounts (0.1-0.2 milliliters) of medication into the dermis layer of skin.

The patient is quadriplegic and receives oxybutynin (Ditropan), an anticholinergic drug, to increase his bladder capacity. What is an important assessment of this patient by the nurse? 1. Is he irritable? 2. Is he constipated? 3. Is he gaining weight? 4. Is he lethargic?

2. Is he constipated? Rationale 1: Anticholinergic drugs do not cause irritability. Rationale 2: Anticholinergics slow gastrointestinal (GI) motility and can increase the risk for constipation. Rationale 3: Anticholinergic drugs do not cause weight gain. Rationale 4: Anticholinergic drugs do not cause lethargy. Global Rationale: Anticholinergics slow gastrointestinal (GI) motility and can increase the risk for constipation. Anticholinergic drugs do not cause lethargy. Anticholinergic drugs do not cause weight gain. Anticholinergic drugs do not cause irritability.

The physician orders dicyclomine (Bentyl), an anticholinergic drug, for a patient. What is the nurse's priority assessment prior to administering this drug? 1. Does the patient have light sensitivity? 2. Is the patient able to urinate? 3. Does the patient have a history of alcoholism? 4. Is the patient dizzy upon standing?

2. Is the patient able to urinate? Rationale 1: Anticholinergic drugs are not contraindicated in a patient with light sensitivity. Rationale 2: Anticholinergic drugs can cause or increase urinary hesitancy or retention. Rationale 3: Anticholinergic drugs are not contraindicated in a patient with a history of alcoholism. Rationale 4: Anticholinergic drugs are not contraindicated in a patient who is dizzy. Global Rationale: Anticholinergic drugs can cause or increase urinary hesitancy or retention. Anticholinergic drugs are not contraindicated in a patient with light sensitivity. Anticholinergic drugs are not contraindicated in a patient with a history of alcoholism. Anticholinergic drugs are not contraindicated in a patient who is dizzy.

The nurse plans to teach a safety class to parents of toddlers about household exposure to medications. What will the best plan of the nurse include? Standard Text: Select all that apply. 1. Keep the toddler awake and observe for side effects of the medication. 2. Keep all medications locked up and stored out of reach of the toddler. 3. Use syrup of ipecac immediately if the toddler has ingested medication. 4. Call the Poison Control Center for guidance with any medication ingested. 5. Teach the toddler that medications are for adult use only.

2. Keep all medications locked up and stored out of reach of the toddler. 4. Call the Poison Control Center for guidance with any medication ingested. Rationale 1: The Poison Control Center should be contacted, and they will advise if the child is to be kept awake. Rationale 2: Locking up medications is the safest way to childproof the home. Rationale 3: Syrup of ipecac should only be used if recommended by the Poison Control Center. Rationale 4: The Poison Control Center should be contacted for any type of medication the toddler has ingested. Rationale 5: It is unrealistic to expect a toddler to understand that medications are for adult use only. Global Rationale: Locking up medications is the safest way to childproof the home. The Poison Control Center should be contacted for any type of medication the toddler has ingested. Syrup of ipecac should only be used if recommended by the Poison Control Center. The Poison Control Center should be contacted, and they will advise if the child is to be kept awake. It is unrealistic to expect a toddler to understand that medications are for adult use only.

The nurse is administering medications to an older adult. Which laboratory tests are most important for the nurse to assess prior to the administration of medication? 1. Complete blood count (CBC) and electrolytes 2. Kidney and liver function tests 3. Arterial blood gases (ABGs) and basic metabolic panel 4. Lipid panel and thyroid function tests

2. Kidney and liver function tests Rationale 1: Complete blood count (CBC) and electrolytes are not likely to help in determining the proper drug dosage. Rationale 2: Renal and hepatic function tests are essential for many patients, particularly older patients and those who are critically ill, as these will be used to determine the proper drug dosage. Rationale 3: Arterial blood gases (ABGs) and a basic metabolic panel are not likely to help in determining the proper drug dosage. Rationale 4: Lipid panel and thyroid function tests are not likely to help in determining the proper drug dosage. Global Rationale: Renal and hepatic function tests are essential for many patients, particularly older patients and those who are critically ill, as these will be used to determine the proper drug dosage. Complete blood count (CBC) and electrolytes, lipid panel and thyroid function tests; and ABGs and a basic metabolic panel are not likely to help in determining the proper drug dosage.

The physician has ordered several medications for the patient. What does the nurse recognize as responsibilities regarding administration of medications? Standard Text: Select all that apply. 1. Knowing whether or not the medication is on the hospital formulary 2. Knowing the reason the medication was prescribed for this patient 3. Knowing how the medication is to be administered 4. Knowing how the medication is supplied by the pharmacy 5. Knowing the name of the medication

2. Knowing the reason the medication was prescribed for this patient 3. Knowing how the medication is to be administered 4. Knowing how the medication is supplied by the pharmacy 5. Knowing the name of the medication Rationale 1: Whether or not a drug is on a hospital formulary list is not a primary responsibility of the nurse. Rationale 2: Knowing the reason the medication was prescribed for the patient is the responsibility of the nurse regarding medication administration. Rationale 3: Knowing how the medication is to be administered is the responsibility of the nurse regarding medication administration. Rationale 4: Knowing how the medication is to be administered is the responsibility of the nurse regarding medication administration. Rationale 5: Knowing how the medication is supplied by the pharmacy is the responsibility of the nurse regarding medication administration. Global Rationale: How the medication is supplied by the pharmacy, how the medication is to be administered, the name of the medication, and the reason the medication was prescribed for the patient are the responsibilities of the nurse regarding medication administration. Whether or not a drug is on a hospital formulary list is not a primary responsibility of the nurse.

Which nursing intervention would take priority following administration of a new medication? 1. Monitoring lab values 2. Monitoring the patient's respiratory status 3. Prescribing additional medications if side effects occur 4. Measuring patient weight

2. Monitoring the patient's respiratory status Rationale 1: Monitoring lab values might be appropriate nursing interventions with some medications but would not be the priority. Rationale 2: Any time a new medication is provided to the patient, it is important to monitor for an allergic reaction. Anaphylaxis, a life-threatening allergic reaction, can impair breathing. Rationale 3: Nurses do not prescribe medications. Rationale 4: Measuring weight might be appropriate nursing interventions with some medications but would not be the priority. Global Rationale: Any time a new medication is provided to the patient, it is important to monitor for an allergic reaction. Anaphylaxis, a life-threatening allergic reaction, can impair breathing. Monitoring lab values and measuring weight might be appropriate nursing interventions with some medications but would not be the priority. Nurses do not prescribe medications.

The nurse administers narcotics to surgical patients. Which statement represents the nurse's best understanding as it relates to the potency of different narcotics? 1. Codeine is less potent than morphine; it will not produce an allergic reaction. 2. Morphine is more potent than codeine; a lesser dose will be required. 3. Morphine is more potent than codeine; it will produce more adverse effects. 4. Codeine is less potent than morphine; it will not relieve pain as well.

2. Morphine is more potent than codeine; a lesser dose will be required. Rationale 1: The potency of a drug is not related to its ability to cause an allergic reaction. Rationale 2: A drug that is more potent will produce a therapeutic effect at a lower dose. Rationale 3: Potency does not mean the drug will produce more adverse effects. Rationale 4: Less potent narcotics can be very effective with pain relief. Global Rationale: A drug that is more potent will produce a therapeutic effect at a lower dose. Potency does not mean the drug will produce more adverse effects. Less potent narcotics can be very effective with pain relief. The potency of a drug is not related to its ability to cause an allergic reaction.

The nurse administers an evening medication to the patient in the morning. The medication did go to the correct patient. What is the nurse's best course of action at this time? 1. Change the medication administration time to the morning. 2. Notify the physician about the error and complete an incident report. 3. Tell the evening nurse to hold the evening dose just for tonight. 4. Notify the physician and ask if any further action needs to be taken.

2. Notify the physician about the error and complete an incident report. Rationale 1: Even though the medication went to the correct patient, this is still considered a medication error. The time of the medication cannot be changed without an order from the physician. Telling the evening nurse to hold the evening dose is unethical; an error has been committed. There is no need to ask the physician if any further action needs to be taken; an incident report needs to be completed. Rationale 2: Even though the medication went to the correct patient, this is still considered a medication error. The time of the medication cannot be changed without an order from the physician. Telling the evening nurse to hold the evening dose is unethical; an error has been committed. There is no need to ask the physician if any further action needs to be taken; an incident report needs to be completed. Rationale 3: Even though the medication went to the correct patient, this is still considered a medication error. The time of the medication cannot be changed without an order from the physician. Telling the evening nurse to hold the evening dose is unethical; an error has been committed. There is no need to ask the physician if any further action needs to be taken; an incident report needs to be completed. Rationale 4: Even though the medication went to the correct patient, this is still considered a medication error. The time of the medication cannot be changed without an order from the physician. Telling the evening nurse to hold the evening dose is unethical; an error has been committed. There is no need to ask the physician if any further action needs to be taken; an incident report needs to be completed.

The nurse provides care for elders in an assisted living facility. What does the nurse assess as a primary contributing factor for drug toxicity in the elderly? 1. Older adults often abuse alcohol. 2. Older adults are frequently dehydrated. 3. Older adults are frequently constipated. 4. Older adults have increased stomach acid.

2. Older adults are frequently dehydrated. Rationale 1: Alcohol abuse could be a factor in medication complications with older adults but is not as critical as another physiologic change. Rationale 2: Fluid deficit is a critical factor in the older adult that can contribute to medication toxicity. Rationale 3: Frequent constipation is not a critical factor with medication complications in older adults. Rationale 4: Older adults have a tendency to decreased stomach acid, which may interfere with medication absorption. Global Rationale: Fluid deficit is a critical factor in the older adult that can contribute to medication complications. Older adults have a tendency to decreased stomach acid which may interfere with medication absorption. Frequent constipation is not a critical factor with medication complications in older adults. Alcohol abuse could be a factor in medication complications with older adults but is not as critical as fluid volume deficit.

The nurse administers medications by various routes of delivery. The nurse recognizes which route of administration as requiring higher dosages of drugs to achieve a therapeutic effect? 1. Intravenous route 2. Oral route 3. Rectal route 4. Sublingual route

2. Oral route Rationale 1: Intravenously administered drugs are not affected by the "first-pass effect." Rationale 2: Oral medications pass into the hepatoportal circulation and may be completely metabolized before reaching the general circulation. This so-called "first pass effect" may necessitate the use of higher dosages of oral medications to achieve a therapeutic effect. Rationale 3: Rectally administered drugs are not affected by the "first-pass effect." Rationale 4: Sublingually administered drugs are not affected by the "first-pass effect." Global Rationale: Oral medications pass into the hepatoportal circulation and may be completely metabolized before reaching the general circulation. This so-called "first pass effect" may necessitate the use of higher dosages of oral medications to achieve a therapeutic effect. None of the other routes, sublingual, rectal, or intravenous, are affected by the "first-pass effect."

The nurse is preparing for medication administration to a group of patients. What is the best overall outcome for the patients? 1. Patients will take the medications after receiving medication instruction. 2. Patients will receive the best therapeutic outcome from the medications. 3. Patients will state the reason they are receiving the medications. 4. Patients will experience minimal side effects after taking the medications.

2. Patients will receive the best therapeutic outcome from the medications. Rationale 1: The fact that the patient takes the medication is not the best overall outcome for the patients. Rationale 2: Outcomes should focus first on the therapeutic outcome of the medications. Rationale 3: Having the patients state the reason they are receiving the medications is the best overall outcome for the patients. Rationale 4: The treatment of side effects is not the best overall outcome for the patients. Global Rationale: Outcomes should focus first on the therapeutic outcome of the medications. The fact that the patient takes the medication is not the best overall outcome for the patients. The treatment of side effects is not the best overall outcome for the patients. Having the patients state the reason they are receiving the medications is the best overall outcome for the patients.

A patient's genetic testing reveals a change in CYP2A6. The nurse would plan which interventions based on this discovery? Standard Text: Select all that apply. 1. Teaching the patient to avoid caffeine-containing drugs. 2. Planning additional time and interventions to help the patient stop smoking. 3. Use of an alternative to the drug warfarin. 4. Increased surveillance for the development of lung cancer. 5. Frequent monitoring of blood pressure.

2. Planning additional time and interventions to help the patient stop smoking. 4. Increased surveillance for the development of lung cancer. Rationale 1: CYP2A6 is not associated with caffeine. Rationale 2: CYP2A6 reduction may make smoking cessation more difficult. Rationale 3:.CYP2C9 is associated with reduced metabolism of warfarin. Rationale 4: CYP2A6 reduction may increase risk of lung cancer. Rationale 5: CYP2A6 is not associated with blood pressure level. Global Rationale: CYP2A6 reduction may make smoking cessation more difficult and increases risk of lung cancer. It is not associated with caffeine or blood pressure level. CYP2C9 is associated with reduced metabolism of warfarin.

A drug manufacturer that is performing the effects of a drug on laboratory animals would be in which phase of the new drug development timeline? 1. Clinical Investigation 2. Preclinical Investigation 3. New Drug Application Review 4. Post-marketing Studies

2. Preclinical Investigation Rationale 1: Clinical investigation involves testing the drug on human subjects. Rationale 2: Preclinical investigation involves laboratory research on nonhuman subjects. Rationale 3: New Drug Application review occurs during human clinical trials. Rationale 4: Post-marketing Studies occur after the drug is being used by the general population. Global Rationale: Clinical investigation involves testing the drug on human subjects. Preclinical investigation involves laboratory research on nonhuman subjects. New Drug Application review occurs during human clinical trials. Post-marketing Studies occur after the drug is being used by the general population.

Which statement is accurate regarding medications that end up being secreted in bile? 1. All medications secreted in bile are excreted in the feces. 2. Some medications are excreted in the feces while others can be recirculated to the liver many times. 3. Most medications secreted in bile are metabolized in the gallbladder. 4. Generally, medications are not secreted in the bile.

2. Some medications are excreted in the feces while others can be recirculated to the liver many times. Rationale 1: Some bile (and medications within) is excreted in the feces. Rationale 2: Most bile is circulated back to the liver by enterohepatic circulation, where medications are metabolized in the liver. Rationale 3: Medications are not metabolized in the gallbladder. Rationale 4: Some medications are secreted in bile. Global Rationale: Most bile is circulated back to the liver by enterohepatic circulation, where medications are metabolized in the liver. Some bile (and medications within) is excreted in the feces. Medications are not metabolized in the gallbladder.

A patient at a community health center has been prescribed oral medications and tells the nurse that medications were administered intravenously when the patient was in the hospital. The nurse discusses the benefits and disadvantages of oral medications, including which facts? Standard Text: Select all that apply. 1. The oral route is considered the second safest route, after the intradermal route. 2. Tablets that are scored may be crushed for easier swallowing. 3. Enteric-coated drugs are designed to dissolve in the stomach, not the small intestine. 4. A major disadvantage of oral medications is that the patient must be conscious and able to swallow. 5. Enteric-coated drugs should be crushed to help facilitate dissolving by the stomach acid.

2. Tablets that are scored may be crushed for easier swallowing. 4. A major disadvantage of oral medications is that the patient must be conscious and able to swallow. Rationale 1: The oral route is considered the safest because the skin barrier is not compromised; if an overdose occurs, drugs remaining in the stomach can be evacuated with stomach contents. Rationale 2: The purpose of scoring a tablet is the greater ease of cutting the tablet in half or quarters. These same tablets may be crushed, if needed. Rationale 3: Some drugs irritate the stomach lining and are coated to prevent being dissolved in the stomach. These drugs go on to the small intestine and are dissolved in the alkaline environment. Rationale 4: The fact that the patient must be conscious and able to swallow is a major disadvantage of oral medications. Rationale 5: Enteric-coated drugs are designed specifically to bypass the stomach's acidic environment and continue to the alkaline environment of the small intestine. Global Rationale: The purpose of scoring a tablet is the greater ease of cutting the tablet in half or quarters. These same tablets may be crushed, if needed. The fact that the patient must be conscious and able to swallow is a major disadvantage of oral medications. The oral route is considered the safest because the skin barrier is not compromised; if an overdose occurs, drugs remaining in the stomach can be evacuated with stomach contents. Enteric-coated drugs are designed specifically to bypass the stomach's acidic environment and continue to the alkaline environment of the small intestine.

The patient has meningitis. The physician initially prescribed a water-soluble drug. Another physician changed the order to a lipid-soluble drug. The patient is confused about this. Which plan best resolves the patient's concern? 1. Teach the patient that lipid-soluble drugs are better because of protein binding. 2. Teach the patient that lipid-soluble drugs are more effective in treating his illness. 3. Teach the patient that lipid-soluble drugs are better because they have fewer side effects. 4. Teach the patient that lipid-soluble drugs are more effective because they are excreted at a slower rate.

2. Teach the patient that lipid-soluble drugs are more effective in treating his illness. Rationale 1: Not all lipid-soluble drugs are protein bound. Rationale 2: Drug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. Rationale 3: Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs are protein bound. Rationale 4: Lipid solubility does not affect drug excretion. Global Rationale: Drug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs are protein bound. Lipid solubility does not affect drug excretion.

What is the most significant role for nurses as defined by state nurse practice acts and by regulating bodies such as The Joint Commission? 1. Planning care 2. Teaching 3. Assessment 4. Evaluating care

2. Teaching Rationale 1: Planning is important but not the most significant role of the nurse according to state nurse practice acts and Joint Commission. Rationale 2: State nurse practice acts and regulating bodies such as the Joint Commission consider teaching to be a primary role for nurses, giving it the weight of law and key important accreditation standards. Rationale 3: State nurse practice acts and regulating bodies such as the Joint Commission consider teaching to be a primary role for nurses. Assessment is important but not the most significant role of the nurse according to state nurse practice acts and Joint Commission. Rationale 4: Evaluation is important but not the most significant role of the nurse according to state nurse practice acts and Joint Commission. Global Rationale: State nurse practice acts and regulating bodies such as the Joint Commission consider teaching to be a primary role for nurses, giving it the weight of law and key important accreditation standards. Assessment, planning, and evaluation are important but not the most significant roles of the nurse according to state nurse practice acts and Joint Commission.

A client who is terminally ill reports hearing about a drug that is in preclinical investigation. The client asks the nurse if the drug will be available to the public soon. What should the nurse consider when formulating an answer to this question? 1. After preclinical investigation the drug has one more step before being released for public use. 2. The average length of preclinical investigation is 18 months. 3. When the drug reaches the clinical investigation stage it is usually released within 2 years. 4. The drug will not be available until after the post-marketing studies are done.

2. The average length of preclinical investigation is 18 months. Rationale 1: Preclinical investigation is the first of three stages the drug must go through before being released for use. Rationale 2: Preclinical investigation may last 1 to 3 years with 18 months being the average. Rationale 3: Clinical investigation may last 2 to 10 years with 5 years being the average. Rationale 4: Post-marketing studies are started as soon as the NDA review is completed and may continue for years after drug release. Global Rationale: Preclinical investigation is the first of three stages the drug must go through before being released for use. Preclinical investigation may last 1 to 3 years with 18 months being the average. Clinical investigation may last 2 to 10 years with 5 years being the average. Post-marketing studies are started as soon as the NDA review is completed and may continue for years after drug release.

The patient receives metaproterenol (Alupent), an adrenergic drug. A consulting physician orders carteolol (Cartrol), a beta blocker. What best describes the nurse's assessment? 1. The patient is at risk for a hypertensive crisis. 2. The effects of metaproterenol (Alupent) will be decreased. 3. The drugs are compatible; there will not be any adverse effects. 4. The effects of metaproterenol (Alupent) will be increased.

2. The effects of metaproterenol (Alupent) will be decreased. Rationale 1: A hypertensive crisis is unlikely. Rationale 2: Beta-adrenergic blockers block the receptors that are stimulated by adrenergic drugs; the effects of metaproterenol (Alupent) would be decreased. Rationale 3: The drugs are not compatible. Rationale 4: The effects of metaproterenol (Alupent) would not be increased. Global Rationale: Beta-adrenergic blockers block the receptors that are stimulated by adrenergic drugs; the effects of metaproterenol (Alupent) would be decreased, not increased. The drugs are not compatible; the effects of metaproterenol (Alupent) would be decreased. A hypertensive crisis is unlikely.

Which finding would most accurately indicate that a therapeutic range for a medication had been reached? 1. No serious adverse effects are experienced following administration. 2. The indication for administration was achieved without serious side effects. 3. A pre-specified amount (in milligrams) was administered. 4. The medication was effective, but the patient experienced a lethal dysrhythmia.

2. The indication for administration was achieved without serious side effects. Rationale 1: Lack of serious adverse effects does not indication therapeutic range has been reached. Rationale 2: The therapeutic range of a drug is between the minimum effective concentration and the toxic concentration. Rationale 3: Standard doses of medications are determined by expected therapeutic range, not vice versa. Rationale 4: Effective medication is desired, but not at the expense of a lethal dysrhythmia. Global Rationale: The therapeutic range of a drug is between the minimum effective concentration and the toxic concentration. Lack of serious adverse effects does not indicate therapeutic range has been reached. Standard doses of medications are determined by expected therapeutic range, not vice versa. Effective medication is desired, but not at the expense of a lethal dysrhythmia.

The nurse in the emergency department administers an adult dose of an antibiotic to a 3-month-old baby. As a result, the baby suffers permanent brain damage. What best describes the effect of this error on the health care facility? 1. The professional license of the nurse will be lost. 2. The morale of the staff involved will be depleted. 3. The reputation of the health care facility will suffer. 4. The health care facility will pay a very large settlement.

2. The morale of the staff involved will be depleted. Rationale 1: Medication errors that result in permanent damage increase self-doubt and destroy the morale of all staff involved; some may choose to leave the nursing profession. Payment of a large settlement is not the primary concern; staff morale is the concern. The professional license of the nurse may or may not be lost depending on the circumstances of the case. The reputation of the facility will probably suffer, but this is not as important as the staff morale. Rationale 2: Medication errors that result in permanent damage increase self-doubt and destroy the morale of all staff involved; some may choose to leave the nursing profession. Payment of a large settlement is not the primary concern; staff morale is the concern. The professional license of the nurse may or may not be lost depending on the circumstances of the case. The reputation of the facility will probably suffer, but this is not as important as the staff morale. Rationale 3: Medication errors that result in permanent damage increase self-doubt and destroy the morale of all staff involved; some may choose to leave the nursing profession. Payment of a large settlement is not the primary concern; staff morale is the concern. The professional license of the nurse may or may not be lost depending on the circumstances of the case. The reputation of the facility will probably suffer, but this is not as important as the staff morale. Rationale 4: Medication errors that result in permanent damage increase self-doubt and destroy the morale of all staff involved; some may choose to leave the nursing profession. Payment of a large settlement is not the primary concern; staff morale is the concern. The professional license of the nurse may or may not be lost depending on the circumstances of the case. The reputation of the facility will probably suffer, but this is not as important as the staff morale.

The nurse is assessing a newly admitted patient's current medications. What does the best objective data include? 1. The patient's wife tells the nurse what medications the patient has been receiving. 2. The nurse checks the prescription bottles the patient has brought to the hospital. 3. The nurse asks the physician what medications the patient was currently taking. 4. The patient lists the medications that have been prescribed.

2. The nurse checks the prescription bottles the patient has brought to the hospital. Rationale 1: A list of medications provided by the patient's wife is subjective, not objective, data. Rationale 2: Objective data includes information gathered through assessment, and not necessarily what the patient says or perceives. The most reliable and objective assessment by the nurse is to check the patient's prescription medication bottles. Rationale 3: Asking the physician what medication the patient was receiving is subjective data, and the physician may not remember all the medication the patient was receiving. Rationale 4: A list of medications provided by the patient is subjective, not objective, data. Asking the physician what medication the patient was receiving is subjective data, and the physician may not remember all the medication the patient was receiving. Global Rationale: Objective data includes information gathered through assessment, and not necessarily what the patient says or perceives. The most reliable and objective assessment by the nurse is to check the patient's prescription medication bottles. A list of medications provided by the patient and the patient's wife is subjective, not objective data. Asking the physician what medication the patient was receiving is subjective data, and the physician may not remember all the medication the patient was receiving.

Twenty minutes after receiving a dose of antibiotic, the patient develops a red, itchy rash. What nursing actions are indicated? Standard Text: Select all that apply. 1. The nurse should plan to watch for a rash after the next dose is administered. 2. The nurse should contact the prescriber and relay this assessment information. 3. The nurse should contact the pharmacy. 4. The nurse should place an allergy bracelet on the patient. 5. The nurse should document the presence of the rash in the medical record.

2. The nurse should contact the prescriber and relay this assessment information. 3. The nurse should contact the pharmacy. 4. The nurse should place an allergy bracelet on the patient. 5. The nurse should document the presence of the rash in the medical record. Rationale 1: Giving another dose of the antibiotic is not indicated and could have a serious outcome. Rationale 2: The nurse should discuss this finding with the prescriber as an allergy likely exists. Rationale 3: Because there is a strong possibility of an allergy, the nurse should contact the pharmacy. Rationale 4: The nurse should place an allergy bracelet on the patient. If it is determined that the rash is from some other etiology, the bracelet can be removed. Rationale 5: The nurse should always document the presence of an unexpected finding. Global Rationale: The nurse should discuss this finding with the prescriber as an allergy likely exists. Because there is a strong possibility of an allergy, the nurse should contact the pharmacy. The nurse should place an allergy bracelet on the patient. If it is determined that the rash is from some other etiology, the bracelet can be removed. The nurse should always document the presence of an unexpected finding. Giving another dose of the antibiotic is not indicated and could have a serious outcome.

The nurse plans to administer heparin by drawing the heparin up in an appropriate syringe, donning gloves, prepping the patient's abdominal area, inserting the needle, aspirating for blood, and injecting the medication. Which statement best describes the nurse's plan? 1. The nurse does not need to wear gloves. 2. The nurse should not aspirate for blood. 3. The nurse does not need to prep the skin. 4. The nurse performed the injection correctly.

2. The nurse should not aspirate for blood. Rationale 1: Gloves must always be worn for invasive techniques. Rationale 2: When performing heparin injections, the nurse should not aspirate for blood as this may cause bruising or bleeding. Rationale 3: The skin should be prepped with alcohol prior to administering an injection. Rationale 4: The nurse did not perform the correct technique. Global Rationale: When performing heparin injections, the nurse should not aspirate for blood as this may cause bruising or bleeding. Gloves must always be worn for invasive techniques. The nurse did not perform the correct technique. The skin should be prepped with alcohol prior to administering an injection.

A patient's heart rate is found to be 72 beats per minute and regular. The nurse evaluates which situation in the patient's peripheral nervous system? Standard Text: Select all that apply. 1. The sympathetic system is in control. 2. The parasympathetic system is dominating. 3. Both parasympathetic and sympathetic systems are influencing cardiac status. 4. The autonomic nervous system is affecting cardiac status. 5. The somatic nervous system is affecting cardiac status.

2. The parasympathetic system is dominating. 3. Both parasympathetic and sympathetic systems are influencing cardiac status. 4. The autonomic nervous system is affecting cardiac status. Rationale 1: If the sympathetic system was in control, the heart rate would be accelerated. Rationale 2: Restful cardiac response indicates that the primary input is from the parasympathetic system. Rationale 3: These two systems work in tandem to regulate the cardiac response. Rationale 4: Both the sympathetic and parasympathetic systems are part of the autonomic system. Rationale 5: The somatic system is separate from the autonomic system. Global Rationale: Restful cardiac response indicates that the primary input is from the parasympathetic system. These two systems work in tandem to regulate the cardiac response. Both the sympathetic and parasympathetic systems are part of the autonomic system. If the sympathetic system was in control, the heart rate would be accelerated. The somatic system is separate from the autonomic system.

A patient presents with hypotension and bradycardia. The patient indicates that one of her physicians recently prescribed three new medications to her current list of 10 medications per day. Based on this information, which statement would be the most accurate? 1. The patient is having an allergic reaction to one of the new medications. 2. The patient is experiencing adverse reactions as a result of polypharmacy. 3. The patient is not in compliance with her prescribed medications. 4. The patient is experiencing an adverse effect that will go away in time.

2. The patient is experiencing adverse reactions as a result of polypharmacy. Rationale 1: Bradycardia and hypotension do not necessarily indicate an allergic reaction. Rationale 2: Polypharmacy increases the risk of drug interactions and side effects. Rationale 3: The information provided does not reveal anything about patient compliance. Rationale 4: It is not appropriate to assume the side effects will go away. Global Rationale: Polypharmacy increases the risk of drug interactions and side effects. It is not appropriate to assume the side effects will go away. The information provided does not reveal anything about patient compliance. Bradycardia and hypotension do not necessarily indicate an allergic reaction.

The physician has prescribed quetiapine (Seroquel) for the patient with chronic auditory hallucinations. The patient has stopped taking the medication. The nurse incorrectly uses the diagnosis of "noncompliance." In which situation would this diagnosis be appropriate? 1. The patient reported a physical change as the reason for stopping the medication. 2. The patient made an informed decision not to take the medication. 3. The patient was unsure about how to order a refill for the prescription. 4. The patient did not understand why the medication was prescribed.

2. The patient made an informed decision not to take the medication. Rationale 1: If the patient reports a physical change as the reason for stopping the medication, the nursing diagnosis should be related to that change. For example, if the patient reports being fatigued, the nursing diagnosis would relate to that finding. Rationale 2: Noncompliance assumes that the patient has been properly educated about the medication and has made an informed decision not to take it. Rationale 3: Being unsure of the way to obtain a refill on the medication is related to a knowledge deficit, not noncompliance. Rationale 4: Not knowing why the medication was prescribed related to a knowledge deficit, not noncompliance. Global Rationale: Noncompliance assumes that the patient has been properly educated about the medication and has made an informed decision not to take it. A lack of understanding of the reason the medication was prescribed or being unsure of how to obtain an prescription refill are related to a knowledge deficit, not noncompliance. Reports of a physical change since taking the medication would be diagnosed as pertaining to the change.

The patient is admitted to the hospital in chronic renal failure and is on several medications. What best describes the nurse's assessment of this patient? 1. The patient's liver may compensate for renal failure; the drugs may be effective. 2. The patient may have drug toxicity from all the drugs. 3. The patient may have drug toxicity only if the drugs are excreted by the kidneys. 4. The patient may have decreased effectiveness of the drugs.

2. The patient may have drug toxicity from all the drugs. Rationale 1: The liver cannot compensate for renal failure; the patient is at risk for drug toxicity. Rationale 2: Since the kidneys are the primary route of excretion for many drugs, chronic renal failure puts the patient at risk for drug toxicity. Rationale 3: The patient in chronic renal failure will more likely have drug toxicity than decreased effectiveness of the drugs. Rationale 4: Since the majority of drugs are excreted by the kidneys, the patient will most likely have drug toxicity. Global Rationale: Since the kidneys are the primary route of excretion for many drugs, chronic renal failure puts the patient at risk for drug toxicity. The patient in chronic renal failure will more likely have drug toxicity than decreased effectiveness of the drugs. The liver cannot compensate for renal failure; the patient is at risk for drug toxicity. Since the majority of drugs are excreted by the kidneys, the patient will most likely have drug toxicity.

The patient is malnourished and has a low serum albumin. The physician has ordered aspirin, a highly protein-bound drug, for the patient. Which evaluation by the nurse best describes the effect this will have on the patient? 1. The patient will be at risk to experience a decreased effectiveness of the drug. 2. The patient will be at risk to experience toxic effects of the drug. 3. The patient's kidneys will excrete the drug at a faster rate. 4. The patient's serum globulin is more important than serum albumin.

2. The patient will be at risk to experience toxic effects of the drug. Rationale 1: Effects from the drug will not be decreased because there is less protein for aspirin to bind with and more free drug available. Rationale 2: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic effects from the drug because there is less protein for aspirin to bind with and more free drug available. Rationale 3: The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Rationale 4: Serum albumin plays a major role, more than serum globulin. Global Rationale: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic, not decreased, effects from the drug because there is less protein for aspirin to bind with and more free drug available. The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Serum albumin plays a major role, more than serum globulin.

The nurse is preparing to administer medications to a group of patients. One of the medications is benztropine (Cogentin), an anticholinergic drug. This drug is contraindicated in which patient? 1. The patient with a fractured femur 2. The patient with tachycardia 3. The patient with an irritable colon 4. The patient with diarrhea

2. The patient with tachycardia Rationale 1: There is no contraindication with a fractured femur and anticholinergic drugs. Rationale 2: Anticholinergic drugs increase the heart rate; a patient with tachycardia should not receive benztropine (Cogentin). Rationale 3: Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with an irritable colon. Rationale 4: Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with diarrhea. Global Rationale: Anticholinergic drugs increase the heart rate; a patient with tachycardia should not receive benztropine (Cogentin). Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with an irritable colon. Anticholinergic drugs slow gastrointestinal (GI) motility; this would help with diarrhea. There is no contraindication with a fractured femur and anticholinergic drugs.

The physician prescribes an oral medication for the patient. What is the primary nursing assessment of the patient prior to receiving this medication? 1. The patient's understanding of the medication 2. The patient's ability to swallow 3. The patient's allergies 4. The patient's eyesight

2. The patient's ability to swallow Rationale 1: The patient's understanding is important, but not a priority. Rationale 2: The ability of the patient to swallow is a safety issue to prevent aspiration of the medication. Rationale 3: The patient's allergies are important, but if the patient cannot swallow the medication, then the allergies are not significant. Rationale 4: The patient's eyesight is not significant. Global Rationale: The ability of the patient to swallow is a safety issue to prevent aspiration of the medication. The patient's understanding is important, but not a priority. The patient's eyesight is not significant. The patient's allergies are important, but if the patient cannot swallow the medication, then the allergies are not significant.

A nurse suspects a client has had an allergic reaction to a recently prescribed antibiotic. The nurse is responsible for providing emergency treatment and for reporting this suspected reaction to which persons? Standard Text: Select all that apply. 1. FDA 2. The prescriber 3. Hospital pharmacist 4. Medicare 5. Hospital risk management

2. The prescriber 3. Hospital pharmacist 5. Hospital risk management Rationale 1: While it may be necessary to report this reaction to the FDA, it is not the bedside nurse's responsibility to do so. Rationale 2: The prescriber should be notified as this is an unexpected event. A change in therapy is likely to be required. Rationale 3: The hospital pharmacist should be advised of this possible reaction. Rationale 4: There is no reason for the bedside nurse to notify Medicare. Rationale 5: Hospital risk management should be notified of this event. A variance report may be required. Global Rationale: While it may be necessary to report this reaction to the FDA, it is not the bedside nurse's responsibility to do so. The prescriber should be notified as this is an unexpected event. A change in therapy is likely to be required. The hospital pharmacist should be advised of this possible reaction. There is no reason for the bedside nurse to notify Medicare. Hospital risk management should be notified of this event. A variance report may be required.

The nurse is managing care for several patients at a diabetic treatment center. What is the primary intervention for the nurse? 1. To administer the correct medicine to the correct patient at the correct dose and the correct time via the correct route 2. To return the patient to an optimum level of wellness while limiting adverse effects related to the patient's medical diagnosis 3. To include any cultural or ethnic preferences in the administration of the medication 4. To answer any questions the patient may have about the medicine, or any possible side effect of the medication

2. To return the patient to an optimum level of wellness while limiting adverse effects related to the patient's medical diagnosis Rationale 1: The correct patient, dose, and time refer to the five "rights" of medication administration and, while important, is not the best, overall nursing intervention. Rationale 2: Interventions are aimed at returning the patient to an optimum level of wellness and limiting adverse effects related to the patient's medical diagnosis or condition. Rationale 3: Answering questions the patient may have is an appropriate intervention but is not the best overall intervention. While important to include cultural and ethnic preferences, this is not the best overall intervention. Rationale 4: Answering questions the patient may have is an appropriate intervention but is not the best overall intervention. Global Rationale: Interventions are aimed at returning the patient to an optimum level of wellness and limiting adverse effects related to the patient's medical diagnosis or condition. The correct patient, dose, and time refer to the five "rights" of medication administration and, while important, is not the best, overall nursing intervention. Answering questions the patient may have is an appropriate intervention but is not the best overall intervention. While important to include cultural and ethnic preferences, this is not the best overall intervention.

The African American patient had a myocardial infarction and is receiving atorvastatin (Lipitor). The nurse caring for the patient is Caucasian. The nurse assesses the patient's diet to be very high in fat. What is the best plan by the nurse to improve the patient's diet and reduce the risk for additional medications? 1. With the patient's permission, plan to ask an African American nurse to speak to him about a low-fat diet. 2. With the patient's permission, plan to discuss his diet with whomever prepares meals for his family. 3. Plan to give the patient information specific to African Americans about low-fat diets. 4. Plan to ask the physician for a consult by dietary services so a dietician can teach the patient about low-fat diets.

2. With the patient's permission, plan to discuss his diet with whomever prepares meals for his family. Rationale 1: Asking the patient about having an African American nurse speak to him is racist and implies that a Caucasian nurse cannot understand the dietary needs of an African American patient. Rationale 2: Every culture has culture-specific diets; the nurse must include the person in the family who does the meal preparation if a different diet is to be successful. Rationale 3: Providing information is a good idea, but the nurse must also teach the patient. Rationale 4: At this point, a consult by dietary services is premature. Global Rationale: Every culture has culture-specific diets; the nurse must include the person in the family who does the meal preparation if a different diet is to be successful. Asking the patient about having an African American nurse speak to him is racist and implies that a Caucasian nurse cannot understand the dietary needs of an African American patient. At this point, a consult by dietary services is premature. Providing information is a good idea, but the nurse must also teach the patient.

Patients who are discharged from the hospital on new medications should 1. be advised that their local pharmacy will provide them with the drug information and instructions they need. 2. be provided with oral and written drug information and instructions. 3. be provided oral drug information and instructions as opposed to written. 4. be provided with written drug information and instructions only.

2. be provided with oral and written drug information and instructions. Rationale 1: Patients should be provided with oral and written drug information and instructions prior to discharge. Patients may receive these oral and written materials from their pharmacy, but should be supplied initially by the hospital.

A prototype drug is a single drug in a class and can be compared with all other medications in the class. The benefit of studying the prototype drug is that the nurse would be able to predict characteristics of other drugs in the same class, including Standard Text: Select all that apply. 1. which drugs have the most favorable safety profile. 2. their therapeutic indications. 3. their actions. 4. their adverse effects. 5. duration of action of drugs in the group.

2. their therapeutic indications. 3. their actions. 4. their adverse effects. Rationale 1: The prototype drug does not provide a safety profile of other drugs in the same class. Rationale 2: The prototype drug has the same therapeutic indications, or clinical use, of other drugs in the same class. Rationale 3: Studying the therapeutic indications of a prototype drug may allow the nurse to predict actions and adverse effects of other drugs in the same group. Rationale 4: Studying the prototype drug may allow the nurse to predict the adverse effects of another drug in the same class. Rationale 5: Drugs in the same class may have different duration of action. Global Rationale: The prototype drug does not provide a safety profile of other drugs in the same class. Studying the therapeutic indications of a prototype drug may allow the nurse to predict actions and adverse effects of other drugs in the same group. The prototype drug has the same therapeutic indications, or clinical use, of other drugs in the same class. By studying the prototype, the nurse can predict the actions and adverse effects of other drugs in the same class. Drugs in the same class may have different duration of action.

The nurse developing a time line of drug regulations and standards would list the following events in which chronological order? 1. Passage of the Sherley Amendment 2. Passage of the Childhood Vaccine Act 3. Development of the U.S. Pharmacopoeia 4. Passage of the Prescription Drug User Fee Act 5. Passage of the Biologics Control Act

3, 5, 1, 2, 4 Rationale: The U.S. Pharmacopoeia was established in 1820 and served as the first comprehensive publication of drug standards. The Biologics Control Act was passed in 1902 and controlled the quality of serums and other blood-related products. Passed in 1912, the Sherley Amendment made medicines safer by prohibiting the sale of drugs labeled with false therapeutic claims. The Childhood Vaccine Act was passed in 1986 and allowed the FDA to acquire information about clients taking vaccines, to recall biologics, and to recommend civil penalties if guidelines regarding biologic use were not followed. Lastly, in 1992 the Prescription Drug User Fee Act was passed requiring that nongeneric drug and biologic manufacturers pay fees to be used for improvements in the drug review process.

The patient is receiving a beta-blocker medication. The nurse has done medication education and provided the patient with printed information to take home. During the next appointment, the nurse notes that the patient is not taking the medication properly. What is a therapeutic assessment question to ask this patient? 1. "Do I have to inform your physician about your noncompliance?" 2. "Why didn't you take your medicine as we talked about?" 3. "Are you able to read and comprehend the printed information?" 4. "Don't you understand how important it is to take the medicine?"

3. "Are you able to read and comprehend the printed information?" Rationale 1: It is inappropriate to involve the physician before the nurse assesses the reason for noncompliance, and this question is threatening. Rationale 2: Asking "why" questions put the patient on the defensive, and the nurse might not receive the most accurate answer. Rationale 3: Many English-speaking patients do not have functional literacy, a basic ability to read, understand, and act on health information. The nurse should ask the patient about the ability to read and understand printed information. Rationale 4: Being confrontational with a "don't you understand" question is as demeaning as asking a "why" question. Global Rationale: Many English-speaking patients do not have functional literacy, a basic ability to read, understand, and act on health information. The nurse should ask the patient about the ability to read and understand printed information. Asking "why" questions put the patient on the defensive, and the nurse might not receive the most accurate answer. Being confrontational with a "don't you understand" question is as demeaning as asking a "why" question. It is inappropriate to involve the physician before the nurse assesses the reason for noncompliance, and this question is threatening.

The public health nurse notices that several patients in the hypertension clinic have poorly controlled hypertension, even though they have been prescribed appropriate antihypertensive drugs. Which question will best enable the nurse to assess these patients? 1. "Does your religion allow the use of high blood pressure medication?" 2. "Do you think your high blood pressure is a problem?" 3. "Can you afford the high blood pressure medication?" 4. "Does your culture use herbs to treat high blood pressure?"

3. "Can you afford the high blood pressure medication?" Rationale 1: Religious beliefs could result in the patient not taking the medication, but the cost of the medication is more likely the problem. Rationale 2: To ask a patient if they think hypertension is a problem should not be necessary; the nurse could eliminate this by appropriate medication education when the medication is prescribed for the patient. Rationale 3: Once treatment is rendered, the cost of prescription drugs may be far too high for patients on limited incomes. Rationale 4: The use of herbs may be important in the patient's culture, but the cost of the medication is more likely the problem. Global Rationale: Once treatment is rendered, the cost of prescription drugs may be far too high for patients on limited incomes. The use of herbs may be important in the patient's culture, but the cost of the medication is more likely the problem. To ask a patient if they think hypertension is a problem should not be necessary; the nurse could eliminate this by appropriate medication education when the medication is prescribed for the patient. Religious beliefs could result in the patient not taking the medication, but the cost of the medication is more likely the problem.

The patient receives methyldopa (Aldomet), an adrenergic drug. The nurse determines that the patient is having side effects when the patient makes which statement? 1. "Will you check my pupils? I can't see very well at all." 2. "I am so thirsty; will you please bring me another pitcher of water?" 3. "I am so anxious; I really need to walk around the room." 4. "I feel so sleepy that I don't think I can eat my dinner."

3. "I am so anxious; I really need to walk around the room." Rationale 1: Adrenergic drugs dilate the pupils, so vision should not be affected. Rationale 2: Anticholinergic, not adrenergic, drugs dry secretions, therefore the patient would not be thirsty. Rationale 3: Adrenergic drugs mimic the effect of the sympathetic nervous system (SNS). This can result in anxiety and restlessness. Rationale 4: Adrenergic drugs increase alertness, so the patient would not be sleepy. Global Rationale: Adrenergic drugs mimic the effect of the sympathetic nervous system (SNS). This can result in anxiety and restlessness. Adrenergic drugs increase alertness, so the patient would not be sleepy. Anticholinergic, not adrenergic, drugs dry secretions, therefore the patient would not be thirsty. Adrenergic drugs dilate the pupils, so vision should not be affected.

The patient is receiving an oral antibiotic as treatment for cellulitis of the lower extremity. The patient's outcome is "Patient will state a key point about antibiotic treatment for cellulitis." Which statement would the nurse evaluate as best indicating this outcome has been met? 1. "If the pain gets too bad, I can take my prescribed pain medication." 2. "If the swelling continues, I can apply an ice pack." 3. "I need to take all the pills even if my leg looks better." 4. "I must keep my leg elevated until the swelling goes down."

3. "I need to take all the pills even if my leg looks better." Rationale 1: Taking pain medication does not address the outcome for antibiotic treatment. Rationale 2: Applying an ice pack does not address the outcome for antibiotic treatment. Rationale 3: Taking all the medication even if the leg looks better is a key point about antibiotic therapy and meets the patient's outcome. Rationale 4: Keeping the leg elevated does not address the outcome for antibiotic treatment. Global Rationale: Taking all the medication even if the leg looks better is a key point about antibiotic therapy and meets the patient's outcome. Keeping the leg elevated does not address the outcome for antibiotic treatment. Applying an ice pack does not address the outcome for antibiotic treatment. Taking pain medication does not address the outcome for antibiotic treatment.

The patient is 3 days postop, and the physician orders an oral pain medication. The patient asks the nurse if it wouldn't be better to get the medication in the intravenous (IV) line. What is the best response by the nurse? 1. "No, because you could not medicate yourself intravenously (IV) at home." 2. "No, because pills are more effective than intravenous (IV) medications." 3. "No, because pills are safer than intravenous (IV) medications." 4. "No, because we are going to take your intravenous (IV) line out."

3. "No, because pills are safer than intravenous (IV) medications." Rationale 1: There is no evidence that the patient will be going home with an intravenous line, so this answer is incorrect. Rationale 2: Oral medications are not more effective than IV medications. Rationale 3: Oral medications are safer than intravenous (IV) medications. Rationale 4: Telling the patient that she cannot have the medication intravenously because the intravenous line is to be removed does not answer the patient's question. Global Rationale: Oral medications are safer than intravenous (IV) medications. Telling the patient that she cannot have the medication intravenously because the intravenous line is to be removed does not answer the patient's question. There is no evidence that the patient will be going home with an intravenous line, so this answer is incorrect. Oral medications are not more effective than IV medications.

The nursing mother asks the nurse if it is all right to take St. John's wort for mild depression. What is the best response by the nurse? 1. "No, it will probably cause your baby to have more allergies." 2. "No, because it might decrease the amount of milk you produce." 3. "No, it could be excreted in your milk and affect the baby." 4. "No, it will affect the taste of your milk, and your baby might reject nursing."

3. "No, it could be excreted in your milk and affect the baby." Rationale 1: Taking St. John's wort is not likely to cause the baby to have more allergies. Rationale 2: Taking St. John's wort is not likely to decrease the amount of milk the mother produces. Rationale 3: Many drugs are excreted in breast milk and can affect the nursing infant. Rationale 4: Taking St. John's wort may affect the taste of the mother's milk, but this is not the most important response. Global Rationale: Many drugs are excreted in breast milk and can affect the nursing infant. Taking St. John's wort is not likely to cause the baby to have more allergies. Taking St. John's wort is not likely to decrease the amount of milk the mother produces. Taking St. John's wort may affect the taste of the mother's milk, but this is not the most important response.

The nurse is teaching a medication class for parents of children with attention-deficit hyperactivity disorder who are receiving stimulant medications. The nurse has reviewed reasons why the medications are restricted. The nurse determines that learning has occurred when the parents make which responses? Standard Text: Select all that apply. 1. "The use of these medications is restricted so that the pharmacies can track the rate of drug abuse in our city." 2. "The use of these medications is restricted because the physician needs to evaluate our child more often." 3. "The use of these medications is restricted because they have the potential for abuse." 4. "The use of these medications is restricted so that the drug companies can make a bigger profit." 5. "The use of these medications is restricted because this is the current law."

3. "The use of these medications is restricted because they have the potential for abuse." 5. "The use of these medications is restricted because this is the current law." Rationale 1: Pharmacies do not track the rate of drug abuse in cities. Rationale 2: More frequent evaluations is a good plan, but this is not the reason for restricted use of stimulant medications. Rationale 3: Medications with abuse potential are restricted. Rationale 4: Drug companies do not make a bigger profit when medications are listed as restricted. Rationale 5: The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances. Global Rationale: The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances. More frequent evaluations is a good plan, but this is not the reason for restricted use of stimulant medications. Drug companies do not make a bigger profit when medications are listed as restricted. Pharmacies do not track the rate of drug abuse in cities.

Which of the following are the four categories of pharmacokinetics? 1. Diffusion, active transport, interspersing, and storage 2. Ingestion, metabolism, interspersing, and excretion 3. Absorption, distribution, metabolism, and excretion 4. Ingestion, settling, movement, and storage

3. Absorption, distribution, metabolism, and excretion Rationale 1: Diffusion, active transport, interspersing, and storage are not the four categories of pharmacokinetics. Rationale 2: Ingestion, metabolism, interspersing, and excretion are not the four categories of pharmacokinetics. Rationale 3: The four categories of pharmacokinetics are absorption, distribution, metabolism, and excretion. Rationale 4: Ingestion, settling, movement, and storage are not the four categories of pharmacokinetics. Global Rationale: The four categories of pharmacokinetics are absorption, distribution, metabolism, and excretion.

The physician ordered an intravenous medication for a patient with nausea. The patient asks the nurse how it will help his nausea. What is the best response by the nurse? 1. "We have more intravenous drugs for nausea than we do oral drugs." 2. "If you take an oral medication, you will just vomit it up." 3. "This will work much faster for your nausea." 4. "You can't have anything by mouth, so you will receive the medication intravenously."

3. "This will work much faster for your nausea." Rationale 1: Telling the patient that the nurse has more intravenous drugs than oral drugs does not answer the patient's question. Rationale 2: Telling the patient that he will vomit the medication is non-therapeutic. Rationale 3: The intravenous route provides the quickest route of medication absorption. Rationale 4: There is no evidence that the patient cannot have anything by mouth. Global Rationale: The intravenous route provides the quickest route of medication absorption. Telling the patient that he will vomit the medication is non-therapeutic. Telling the patient that the nurse has more intravenous drugs than oral drugs does not answer the patient's question. There is no evidence that the patient cannot have anything by mouth.

A patient who has used an adrenergic nasal spray for 2 weeks complains that, "I am more stuffed up now than I was when I was sick." What advise should the nurse provide? Standard Text: Select all that apply. 1. "You are having an allergic reaction to the nasal spray. Stop using it immediately." 2. "You probably have developed a secondary infection." 3. "Try increasing the amount of fluids you are drinking." 4. "Switch to a saline-based nasal spray." 5. "Continue to use your current nasal spray until the congestion goes away."

3. "Try increasing the amount of fluids you are drinking." 4. "Switch to a saline-based nasal spray." Rationale 1: There is no evidence that an allergic reaction has occurred. Rationale 2: There is no evidence that a secondary infection has occurred. Rationale 3: Increased oral fluids may help to thin secretions, making them easier to remove. Rationale 4: The patient is probably experiencing rebound congestion. Switching from the adrenergic spray to a saline spray will keep the mucosa moist and more comfortable until the effects of the adrenergic spray abate. Rationale 5: The patient is probably experience rebound congestion. Continuing to use this spray is contraindicated. Global Rationale: The patient is probably experiencing rebound congestion. Switching from the adrenergic spray to a saline spray will keep the mucosa moist and more comfortable until the effects of the adrenergic spray abate. Increased oral fluids may help to thin secretions, making them easier to remove. There is no evidence that an allergic reaction or secondary infection has occurred. Continuing to use this spray is contraindicated.

The physician has prescribed a chemotherapeutic drug for the patient with cancer. This drug commonly causes loss of hair. The patient asks the nurse, "Will all of my hair fall out?" What is the most therapeutic response by the nurse? 1. "We are not really sure; applying an ice bag to your head may help." 2. "Don't worry, we can recommend an excellent wig company if need be." 3. "Yes, that is one of the expected side effects of this medication." 4. "It might. Have you discussed this with your physician?"

3. "Yes, that is one of the expected side effects of this medication." Rationale 1: Ice bags can minimize hair loss with some patients, but the nurse is not honestly answering the patient's question. Rationale 2: Telling a patient not to worry is one of the most non-therapeutic responses a nurse can make. Rationale 3: The nurse must always be forthright in explaining drug actions and potential side effects; minimizing potential adverse effects can result in a distrust of the nurse. Rationale 4: In this case, the nurse, not the physician, is responsible for answering the patient's questions. Global Rationale: The nurse must always be forthright in explaining drug actions and potential side effects; minimizing potential adverse effects can result in a distrust of the nurse. Ice bags can minimize hair loss with some patients, but the nurse is not honestly answering the patient's question. Telling a patient not to worry is one of the most non-therapeutic responses a nurse can make. In this case, the nurse, not the physician, is responsible for answering the patient's questions.

The physician ordered a loading dose of medication for the patient; it is to be followed by a lower dose. When the patient receives the lower dose, she says to the nurse, "I think my doctor made a mistake; my medication dose is too low." What is the best response by the nurse? 1. "The initial dose shortened the half-life, so the medication would work more quickly." 2. "We always give medications this way; the doctor did not make a mistake." 3. "You had a larger dose initially so that the medication would work more quickly." 4. "Giving a larger dose initially will reduce the chance of side effects."

3. "You had a larger dose initially so that the medication would work more quickly." Rationale 1: Loading doses do not shorten the half-life of a drug. Rationale 2: Not all medications are initiated with a loading dose. Rationale 3: Loading doses of medications are used to quickly induce a therapeutic response. Rationale 4: Loading doses do not reduce the occurrence of side effects. Global Rationale: Loading doses of medications are used to quickly induce a therapeutic response. Loading doses do not shorten the half-life of a drug. Not all medications are initiated with a loading dose. Loading doses do not reduce the occurrence of side effects.

The patient comes to the emergency department following an overdose of aspirin, an acidic drug. What will the best plan of the nurse include? 1. Administration of intravenous fluids to flush the kidneys 2. Administration of ammonium chloride to the patient 3. Administration of sodium bicarbonate to the patient 4. Administration of intravenous proteins to bind the aspirin

3. Administration of sodium bicarbonate to the patient Rationale 1: Administering intravenous (IV) fluids will not increase the excretion of aspirin from the body. Rationale 2: Ammonium chloride will acidify the urine and cause reabsorption of the aspirin. Rationale 3: Sodium bicarbonate will alkalinize the urine and increase the excretion of aspirin from the body. Rationale 4: Administering proteins will not help with the excretion of aspirin from the body. Global Rationale: : Sodium bicarbonate will alkalinize the urine and increase the excretion of aspirin from the body. Administering intravenous (IV) fluids will not increase the excretion of aspirin from the body. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin. Administering proteins will not help with the excretion of aspirin from the body.

A drug has been prescribed to decrease the effects of an endogenous chemical. The nurse would place this drug in which category? 1. An agonist 2. A partial agonist 3. An antagonist 4. An agonist-antagonist

3. An antagonist Rationale 1: An agonist drug produces the same type of response as the endogenous substance. Rationale 2: A partial agonist produces a weaker, or less efficacious, response than an agonist. Rationale 3: An antagonist occupies receptor sites, preventing them from being activated by the medication. This prevents the endogenous chemical from acting. Rationale 4: An agonist-antagonist produces a weaker, or less efficacious, response than an agonist. Global Rationale: An antagonist occupies receptor sites, preventing them from being activated by the medication. This prevents the endogenous chemical from acting. An agonist drug produces the same type of response as the endogenous substance. A partial agonist produces a weaker, or less efficacious, response than an agonist. An agonist-antagonist produces a weaker, or less efficacious, response than an agonist.

The nurse has several educational pamphlets for the patient about medications the patient is receiving. Prior to giving the patient these pamphlets, what is a primary assessment for the nurse? 1. Assess the patient's readiness to learn new information. 2. Assess the patient's religious attitudes toward medicine. 3. Assess the patient's reading level. 4. Assess the patient's cultural bias toward taking medicine.

3. Assess the patient's reading level. Rationale 1: Assessing the patient's readiness to learn is important but not the primary assessment. Rationale 2: Educational pamphlets are ineffective if the reading level is above what the patient can understand. Assessing the patient's religious attitudes is important but not the primary assessment. Rationale 3: Educational pamphlets are ineffective if the reading level is above what the patient can understand. Rationale 4: Assessing the patient's cultural bias is important but not the primary assessment. Global Rationale: Educational pamphlets are ineffective if the reading level is above what the patient can understand. Assessing the patient's readiness to learn, cultural bias, and religious attitudes are important but not as important as the patient's reading level.

Which list correctly identifies and orders the primary steps of the nursing process? 1. Establish nursing diagnosis, assessment, intervene, collaborate, evaluation 2. Establish goals, assessment, intervention, planning, communication 3. Assessment, establish nursing diagnosis, planning, interventions, evaluation 4. Assessment, planning, establish objectives, communication, evaluation

3. Assessment, establish nursing diagnosis, planning, interventions, evaluation Rationale 1: Nursing diagnoses cannot be established until assessment is done. Rationale 2: Goals cannot be established until assessment is done. Rationale 3: The primary steps (in order) include assessment, establish nursing diagnosis, planning, interventions, evaluation. Rationale 4: Communication is important but is not a primary step of the nursing process. Global Rationale: The primary steps (in order) include assessment, establish nursing diagnosis, planning, interventions, evaluation. Although some steps might not be in this precise order, assessment is done first. Communication is important but is not a primary step of the nursing process.

A patient has been prescribed isoproterenol (Isuprel). The nurse plans care based on the drug's stimulation of which receptors? Standard Text: Select all that apply. 1. Alpha1 2. Alpha2 3. Beta1 4. Beta2 5. Beta3

3. Beta1 4. Beta2 Rationale 1: This drug does not affect alpha1 receptors. Rationale 2: This drug does not affect alpha2 receptors. Rationale 3: Isoproterenol (Isuprel) is a nonselective drug that stimulates beta1 receptors. Rationale 4: Isoproterenol (Isuprel) is a nonselective drug that stimulates beta2 receptors. Rationale 5: This drug does not affect beta3 receptors. Global Rationale: Isoproterenol (Isuprel) is a nonselective drug that stimulates beta1 and beta2 receptors. This drug does not affect alpha1, alpha2, or beta3 receptors.

Which drug has the highest dependency potential? 1. Acetaminophen 2. Codeine 3. Heroin 4. Diazepam

3. Heroin Rationale 1: Acetaminophen does not have a high abuse potential. Rationale 2: Codeine is a Schedule III drug. Rationale 3: Heroin is a Schedule I drug and has the highest potential for abuse, physical dependence, and psychological dependence of the drugs listed. Rationale 4: Diazepam is a Schedule IV drug. Global Rationale: Heroin is a Schedule I drug and has the highest potential for abuse, physical dependence, and psychological dependence of the drugs listed. Acetaminophen does not have a high abuse potential. Codeine is a Schedule III drug. Diazepam is a Schedule IV drug.

The Joint Commission documented that patient education was deficient on several medical-surgical units of a local hospital. A nursing committee was formed to address this problem and focused on what likely nursing intervention? 1. Providing educational pamphlets about medications to the patients. 2. Asking the physicians to provide medication education to the patients. 3. Discussing medications each time they are administered to patients. 4. Requesting more frequent pharmacy consults for the patients.

3. Discussing medications each time they are administered to patients. Rationale 1: Educational pamphlets can be effective but are not as effective as the nurse providing education to the patient. Rationale 2: Medication education is considered to be a responsibility of the nurse, not the physician. Rationale 3: Discussing medications each time they are administered is an effective way to increase the amount of education provided. Rationale 4: Medication education is considered to be a responsibility of the nurse, not the pharmacist. Global Rationale: Discussing medications each time they are administered is an effective way to increase the amount of education provided. Medication education is considered to be a responsibility of the nurse, not the physician or pharmacist. Educational pamphlets can be effective but are not as effective as the nurse providing education to the patient.

Drug X has a median lethal dose of 30 mg and a median effective dose of 10. Drug Y has a therapeutic index of 4, while drug Z has a therapeutic index of 3. Which statement is accurate based on this information? 1. Drugs X and Y are safer than drug Z. 2. The therapeutic index of drug X is 20. 3. Drug Y is the safest of the three. 4. Drug Z is the safest of the three.

3. Drug Y is the safest of the three. Rationale 1: Drugs X and Z have the same therapeutic index and are more dangerous than drug Y. Rationale 2: The therapeutic index of drug X is 30/10 or 3. Rationale 3: Since drug Y has the highest therapeutic index, it is the safest drug. Rationale 4: Drugs X and Z have the same therapeutic index and are more dangerous than drug Y. Global Rationale: Since drug Y has the highest therapeutic index, it is the safest drug. Drugs X and Z have the same therapeutic index and are more dangerous than drug Y. The therapeutic index of drug X is 30/10 or 3.

The student nurse is taking a pharmacology course and studying about the Food and Drug Administration (FDA). What has the student learned about how the FDA has decreased the amount of time involved in bringing a new drug to the market? 1. The Food and Drug Administration (FDA) is not as strict as it once was with regard to drug approval. 2. Since consumers have demanded more drugs, the Food and Drug Administration (FDA) has streamlined the review/approval process. 3. Drug manufacturers are required to pay yearly user fees, which allow the Food and Drug Administration (FDA) to hire more employees to increase its efficiency. 4. Drug manufacturers are required by the Food and Drug Administration (FDA) to test more drugs on an annual basis.

3. Drug manufacturers are required to pay yearly user fees, which allow the Food and Drug Administration (FDA) to hire more employees to increase its efficiency. Rationale 1: The Food and Drug Administration (FDA) is just as strict now as it always was with regard to drug approval. Rationale 2: The Food and Drug Administration (FDA) has not streamlined the review/approval process. Rationale 3: In 1992, the Prescription Drug User Fee Act was passed. This required drug manufacturers to provide yearly product user fees so the Food and Drug Administration (FDA) could restructure, hire more employees, and operate more efficiently. Rationale 4: The Food and Drug Administration (FDA) does not require drug manufacturers to test more drugs on an annual basis. Global Rationale: In 1992, the Prescription Drug User Fee Act was passed. This required drug manufacturers to provide yearly product user fees so the Food and Drug Administration (FDA) could restructure, hire more employees, and operate more efficiently. The Food and Drug Administration (FDA) is just as strict now as it always was with regard to drug approval. The Food and Drug Administration (FDA) has not streamlined the review/approval process. The Food and Drug Administration (FDA) does not require drug manufacturers to test more drugs on an annual basis.

Which of the following statements regarding medication error rates is ethically accurate? 1. Error rates are acceptable when well below the national average. 2. Error rates are acceptable when associated costs exceed the costs necessary for preventative actions. 3. Error rates are never acceptable. 4. Error rates are only acceptable when associated costs are less than 5% of the facility's yearly profit.

3. Error rates are never acceptable. Rationale 1: The incidence of medication errors is never acceptable.

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

3. Even though human genetic differences are small, significant differences can be seen with drug metabolism. Rationale 1: Human DNA differences of only 0.2% can produce significant differences in the way drugs are handled within the body. Rationale 2: Asian Americans are less likely to metabolize codeine to morphine. Rationale 3: Human DNA differences of only 0.2% can produce significant differences in the way drugs are handled within the body. Rationale 4: Caucasians are known to be slow acetylators. Global Rationale: Human DNA differences of only 0.2% can produce significant differences in the way drugs are handled within the body. Asian Americans are less likely to metabolize codeine to morphine, and Caucasians are known to be slow acetylators.

Which of the following statements correctly identifies factors that contribute to medication errors? 1. A nurse who observes the five rights will prevent all medication errors from occurring. 2. Nurses are always liable when a medication error occurs. 3. Handwritten orders are more frequently associated with medication errors than are typed orders. 4. An incorrect dose (based on weight) is ordered, dispensed, and administered to a patient. The administering nurse and ordering clinician would be the only parties held accountable.

3. Handwritten orders are more frequently associated with medication errors than are typed orders. Rationale 1: Handwritten orders can be illegible, leading to higher medication error rates. Although the nurse is a major player in medication safety, there are instances when medication errors occur that do not involve the nurse, such as when patients take medications at home. Observing the five rights is essential to avoiding medication errors, but will not prevent all medication errors from occurring. The clinician ordering the medication, the nurse administering the medication, and the pharmacist dispensing the medication would be held accountable.

The patient is scheduled to receive a medication that is an enzyme inducer of the P450 system. What best describes the effect of this medication on the patient? 1. In time, the patient will experience no effect from other medications. 2. In time, the patient will experience increased effects from other medications. 3. In time, the patient will experience a reduced effect from this medication. 4. In time, the patient will experience an increased effect from this medication.

3. In time, the patient will experience a reduced effect from this medication. Rationale 1: The patient will experience a reduced effect from other medications, not an absence of effect. Rationale 2: An enzyme inhibitor will result in an increased effect from other medications. Rationale 3: An enzyme inducer will increase the rate of its own metabolism, thereby reducing its effectiveness. Rationale 4: An enzyme inhibitor will result in an increased effect of this medication. Global Rationale: An enzyme inducer will increase the rate of its own metabolism, thereby reducing its effectiveness. An enzyme inhibitor will result in an increased effect of this medication. An enzyme inhibitor will result in an increased effect from other medications. The patient will experience a reduced effect from other medications, not an absence of effect.

Which concepts should the nurse use when formulating a nursing diagnosis? Standard Text: Select all that apply. 1. Base the nursing diagnosis on the medical diagnosis 2. Focus on what the nurse needs to help the patient return to health 3. Include the patient in the identification of needs 4. Consider the patient's response to the current health problem 5. Be certain the diagnosis is measureable

3. Include the patient in the identification of needs 4. Consider the patient's response to the current health problem Rationale 1: The nursing diagnosis is not dependent on the medical diagnosis. Rationale 2: The focus should be on the patient's needs. Rationale 3: Including the patient in the formulation of nursing diagnoses encourages more active involvement in working toward meeting identified goals. Rationale 4: A nursing diagnosis is a clinical judgment concerning human response to health conditions. Rationale 5: Goals and outcomes need to be measureable, not nursing diagnosis. Global Rationale: A nursing diagnosis is a clinical judgment concerning human response to health conditions and should be patient focused. Including the patient in the formulation of nursing diagnoses encourages more active involvement in working toward meeting identified goals. It is not dependent on the medical diagnosis. Goals and outcomes need to be measureable, not nursing diagnosis.

Which substance has the lowest rate of crossing renal tubular membranes and would therefore be excreted in the urine? 1. Lipid-soluble drugs 2. Volatile drugs 3. Ionized drugs 4. Non-ionized drugs

3. Ionized drugs Rationale 1: Lipid-soluble drugs cross renal tubular membranes easily and return to the circulation. Rationale 2: Volatile drugs are eliminated through respiration. Rationale 3: Ionized and water-soluble drugs are less likely to cross renal tubular walls and will therefore be excreted. Rationale 4: Non-ionized drugs cross the renal tubular membranes easily and return to circulation. Global Rationale: Ionized and water-soluble drugs are less likely to cross renal tubular walls and will therefore be excreted. Non-ionized and lipid-soluble drugs cross renal tubular membranes easily and return to the circulation. Volatile drugs are eliminated through respiration.

When administering a standard or median effective dose to a patient, the nurse explains that this amount of drug will have which effect? 1. It will produce an effect without the presence of adverse effects. 2. It will be metabolized within 24 hours. 3. It will be effective in half of the population. 4. It will be effective in the majority of patients.

3. It will be effective in half of the population. Rationale 1: The median effective dose may result in toxicity in some patients. Rationale 2: Rate of metabolism is not a specific factor in determining median effective dose. Rationale 3: The median effective dose is the amount of a drug that produces an effect in 50% of a group of patients. Rationale 4: Median does not refer to a value in excess of 50%. Global Rationale: The median effective dose is the amount of a drug that produces an effect in 50% of a group of patients. The median effective dose may result in toxicity in some patients. Rate of metabolism is not a specific factor in determining median effective dose. Median does not refer to a value in excess of 50%.

Which organ is the most responsible for the first-pass effect? 1. Bladder 2. Kidneys 3. Liver 4. Stomach

3. Liver Rationale 1: The bladder is not the organ most responsible for the first-pass effect. Rationale 2: The kidneys are not the organs most responsible for the first-pass effect. Rationale 3: The first pass effect occurs in the liver. Rationale 4: The stomach is not the organ most responsible for the first-pass effect. Global Rationale: The first pass effect occurs in the liver.

Which statement regarding medication distribution within the body is accurate? 1. The blood-brain barrier inhibits rapid crossing of all medications. 2. Body organs with high levels of blood flow are more difficult organs to which to deliver drugs. 3. Medications that are lipid-soluble are more completely distributed. 4. Drug-protein complexes must form prior to crossing capillary membranes.

3. Medications that are lipid-soluble are more completely distributed. Rationale 1: Some medications (sedatives) are able to rapidly cross the blood-brain barrier. Rationale 2: Body organs with low levels of blood flow are more difficult organs to which to deliver drugs. Rationale 3: Lipid-soluble medications are absorbed and distributed quicker and more quickly than those that are not. Rationale 4: When medications bind to proteins, their size increases, preventing them from passing through capillary membranes. Global Rationale: Lipid-soluble medications are absorbed and distributed quicker and more quickly than those that are not. Body organs with low levels of blood flow are more difficult organs to which to deliver drugs. When medications bind to proteins, their size increases, preventing them from passing through capillary membranes. Some medications (sedatives) are able to rapidly cross the blood-brain barrier.

The clinic nurse will immediately alert the health care provider when which category X drugs are identified on the medication record of a recently diagnosed pregnant patient? Standard Text: Select all that apply. 1. Tetracycline 2. ACE inhibitor antihypertensive medication 3. Methotrexate 4. Isotretinoin (Accutane) 5. Oral contraceptives

3. Methotrexate 4. Isotretinoin (Accutane) 5. Oral contraceptives Rationale 1: Tetracycline is in category D, not category X. It should be avoided during pregnancy, and the nurse should alert the health care provider. Rationale 2: ACE inhibitor antihypertensive drugs are in category C and are considered safe during pregnancy. Rationale 3: Methotrexate is in category X and should be avoided during pregnancy. Rationale 4: Isotretinoin is in category X and should be avoided during pregnancy. Rationale 5: Oral contraceptives are in category X and should be avoided during pregnancy. Global Rationale: Methotrexate, isotretinoin, and oral contraceptives are in category X and should be avoided during pregnancy. Tetracycline is in category D, not category X. It should be avoided during pregnancy, and the nurse should alert the health care provider. ACE inhibitor antihypertensive drugs are in category C and are considered safe during pregnancy.

Which cholinergic receptor type is found at the ganglionic synapse of both the sympathetic and parasympathetic nervous systems? 1. Alpha receptors 2. Muscarinic 3. Nicotinic 4. Beta receptors

3. Nicotinic Rationale 1: The term alpha is not used for these receptors. Rationale 2: Muscarinic receptors are found at the ganglionic synapse of the parasympathetic nervous system. Rationale 3: Nicotinic receptors are found at the ganglionic synapse of both sympathetic and parasympathetic nervous systems. Rationale 4: The term beta is not used for these receptors. Global Rationale: Nicotinic receptors are found at the ganglionic synapse of both sympathetic and parasympathetic nervous systems. Muscarinic receptors are found at the ganglionic synapse of the parasympathetic nervous system. The terms alpha and beta are not used for these receptors.

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

3. Obtaining the outcomes is essential for goal attainment. Rationale 1: Outcomes are generally more measurable than goals as they are more specific. Rationale 2: Goals are more general than specific. Rationale 3: Outcomes are specific, measurable criteria that are used to measure goal attainment. Rationale 4: The planning phase (including outcomes and goals) follows nursing diagnosis. Global Rationale: Outcomes are specific, measurable criteria that are used to measure goal attainment. The planning phase (including outcomes and goals) follows nursing diagnosis. Outcomes are generally more measurable than goals as they are more specific. Goals are more general than specific.

The nurse will administer medication to a school-age child. What is the preferred action by the nurse? 1. Teach the child the action and expected side effects of the medication. 2. Tell the child he will not be allowed to go to recess if the medication is not taken. 3. Offer the child a choice of beverage with which to take the medication. 4. Offer to play with the child prior to medication administration.

3. Offer the child a choice of beverage with which to take the medication. Rationale 1: Teaching the child the action and expected side effects of the medication is too advanced for the school-age child. Rationale 2: Threatening a school-age child is antagonistic; the child will most likely not take the medication. Rationale 3: Offering the child a choice fosters cooperation and compliance. Rationale 4: Playing with the child is a preschool child activity. Global Rationale: Offering the child a choice fosters cooperation and compliance. Playing with the child is a preschool child activity. Teaching the child the action and expected side effects of the medication is too advanced for the school-age child. Threatening a school-age child will antagonize him; he will most likely not take the medication.

The physician ordered an oral medication. The nurse incorrectly administered the medication intravenously. What does the best analysis of the nurse's action reveal? 1. An antidote cannot be given. 2. The nurse will be terminated from her job. 3. The medication cannot be retrieved. 4. A lawsuit by the patient will be impending.

3. The medication cannot be retrieved. Rationale 1: Antidotes may be given, but this must be done very quickly. Rationale 2: The nurse may be terminated, but patient safety is the main concern. Rationale 3: When a medication is given intravenously, its effects cannot be reversed because it is already in the bloodstream. Rationale 4: A lawsuit may occur, but this is not the primary concern; patient safety is the primary concern. Global Rationale: When a medication is given intravenously, its effects cannot be reversed because it is already in the bloodstream. A lawsuit may occur, but this is not the primary concern; patient safety is the primary concern. The nurse may be terminated, but patient safety is the main concern, and the effect of the medication cannot be reversed. Antidotes may be given, but this must be done very quickly.

The patient is having chest pain. The physician orders sublingual nitroglycerine STAT. The nurse obtains the medication from the pharmacy and administers it to the patient 30 minutes later. Which statement best describes the nurse's action? 1. The medication should have been administered immediately. 2. The physician should have specified the time frame for the medication. 3. The medication should have been administered within a 5-minute time frame. 4. The nursing action was correct because the medication was not on the unit.

3. The medication should have been administered within a 5-minute time frame. Rationale 1: Although the drug does not need to be administered immediately, there is a time limit in which it should be administered. Rationale 2: For a STAT order, the time frame between writing the order and administering the drug should be 5 minutes or less. Not having a drug on the unit is not an excuse, as commonly ordered STAT medications should be kept in stock. Although the drug does not need to be administered immediately, it should be done within 5 minutes. By using the abbreviation STAT, the physician has specified the time frame for the medication. Rationale 3: For a STAT order, the time frame between writing the order and administering the drug should be 5 minutes or less. Rationale 4: Not having a drug on the unit is not an excuse, as commonly ordered STAT medications should be kept in stock. Global Rationale: For a STAT order, the time frame between writing the order and administering the drug should be 5 minutes or less. Although the drug does not need to be administered immediately, there is a time limit in which it should be administered. By using the abbreviation STAT, the physician has specified the time frame for the medication. Not having a drug on the unit is not an excuse, as commonly ordered STAT medications should be kept in stock.

The nurse administers an oral preparation of liquid Tylenol 650 mg as ordered. Afterward, the patient indicates he had been receiving Tylenol 650 mg in pill form. Which statement is accurate in regards to the five rights? 1. The nurse failed to deliver the correct dose. 2. The nurse failed to administer the right medication. 3. The nurse did not violate the five rights. 4. The nurse failed to give the medication via the correct route.

3. The nurse did not violate the five rights. Rationale 1: The correct dose was administered. Rationale 2: The correct medication was administered. Rationale 3: Nothing in the question depicts a violation of the five rights. Both forms of the medication are oral preparations. Rationale 4: The correct route was used. Global Rationale: Nothing in the question depicts a violation of the five rights. Both forms of the medication are oral preparations. The correct dose, medication, and route were used.

Which assessment identifies the collection of objective data? 1. The patient rates her pain a 5 on a 0-10 pain scale. 2. The patient states she is anxious. 3. The patient has a wound measured at 5 centimeters in length. 4. The patient informs the nurse that she weighs 150 pounds.

3. The patient has a wound measured at 5 centimeters in length. Rationale 1: Subjective data consist of what the patient says or perceives. Rationale 2: Subjective data consist of what the patient says or perceives. Rationale 3: Objective data are gathered through physical assessment, laboratory tests, and other diagnostic sources. Rationale 4: Subjective data consist of what the patient says or perceives. Global Rationale: Objective data are gathered through physical assessment, laboratory tests, and other diagnostic sources. Subjective data consist of what the patient says or perceives.

When reading about a drug, the nurse learns it has a median toxic dose of 50 mg. The patient has been receiving 60 mg of the drug. What analysis does the nurse make? 1. It is likely the drug will not produce the desired effect. 2. The efficacy and potency of this drug have not been well defined. 3. The patient will be at greater risk of adverse effects. 4. This amount of drug would have been lethal to half the population.

3. The patient will be at greater risk of adverse effects. Rationale 1: This information is insufficient to predict if the drug will produce the desired effect. Rationale 2: The median toxicity dose is not a measure of efficacy and potency. Rationale 3: Since the dose exceeds the median toxicity for this drug, the patient is at greater risk of developing adverse effects. Rationale 4: Median toxicity dose has to do with development of toxicity, not lethality. Global Rationale: Since the dose exceeds the median toxicity for this drug, the patient is at greater risk of developing adverse effects. This information is insufficient to predict if the drug will produce the desired effect. The median toxicity dose is not a measure of efficacy and potency. Median toxicity dose has to do with development of toxicity, not lethality.

Which patient outcome statements are correctly formatted? Standard Text: Select all that apply. 1. The patient will understand the effects of the medication administered prior to discharge. 2. The nurse will administer all medications with ten minutes of their scheduled time. 3. The patient will identify two adverse effects of enoxaprarin (Lovenox) prior to self-administering the drug. 4. The patient will verbalize the storage requirements for NPH insulin prior to discharge. 5. The physician will discuss the desired effects of discharge medications with the patient the evening before discharge.

3. The patient will identify two adverse effects of enoxaprarin (Lovenox) prior to self-administering the drug. 4. The patient will verbalize the storage requirements for NPH insulin prior to discharge. Rationale 1: "Understand" is not a measureable verb. Rationale 2: Patient outcome statements are focused on what the patient will do, not on what the nurse will do. Rationale 3: "Identify" is a measurable verb, there is a specific measure to be evaluated and a time line is present. Rationale 4: "Verbalize" is a measurable verb, there is a specific measure to be evaluated, and a time line is present. Rationale 5: Patient outcome statements are focused on what the patient will do, not on what the physician will do. Global Rationale: In order to be complete, the patient outcome measure must be patient (not nurse or physician) focused, must contain a measurable verb, must have the specific circumstances to be evaluated, and must have a time line.

The nurse recognizes that agency system checks are in place to decrease medication errors. Who commonly collaborates with the nurse on checking the accuracy of the medication prior to administration? 1. The nursing supervisor 2. The nursing unit manager 3. The pharmacist 4. The physician

3. The pharmacist Rationale 1: Pharmacists and nurses must collaborate on checking the accuracy and appropriateness of drug orders prior to patient administration. The physician does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. The nursing unit manager does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. The nursing supervisor does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. Rationale 2: Pharmacists and nurses must collaborate on checking the accuracy and appropriateness of drug orders prior to patient administration. The physician does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. The nursing unit manager does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. The nursing supervisor does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. Rationale 3: Pharmacists and nurses must collaborate on checking the accuracy and appropriateness of drug orders prior to patient administration. The physician does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. The nursing unit manager does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. The nursing supervisor does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. Rationale 4: Pharmacists and nurses must collaborate on checking the accuracy and appropriateness of drug orders prior to patient administration. The physician does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. The nursing unit manager does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. The nursing supervisor does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration.

Which statement is accurate concerning drugs classified as adrenergic antagonists? 1. They are also known as anticholinergics. 2. Their actions will block the neurotransmitter acetylcholine. 3. Their actions are the opposite of those of sympathomimetics. 4. They will stimulate the sympathetic nervous system.

3. Their actions are the opposite of those of sympathomimetics. Rationale 1: They are also known as sympatholytics. Rationale 2: They block adrenergic receptors, not cholinergic receptors. Rationale 3: Adrenergic antagonists inhibit the actions of the sympathetic nervous system. Rationale 4: Adrenergic antagonists inhibit the actions of the sympathetic nervous system. Global Rationale: Adrenergic antagonists inhibit the actions of the sympathetic nervous system. They are also known as sympatholytics. They block adrenergic receptors, not cholinergic receptors.

The nurse is on a committee to reduce medication errors in a large health care facility. What is a recommendation the nurse proposes that will most likely help to reduce medication errors? 1. Train medication technicians to administer medications. 2. Use robots to prepare all medications for administration by the nurse. 3. Use automated, computerized cabinets on all nursing units. 4. Designate nurses whose only function is to administer medication.

3. Use automated, computerized cabinets on all nursing units. Rationale 1: To help reduce medication errors, many health care agencies are using automated, computerized, locked cabinets for medication storage on patient-care units. Health care agencies are not planning to designate nurses who just do medication administration. Health care agencies are not planning to have medication technicians administer medications. Health care agencies are not planning to have robots prepare all medications for administration by the nurse.

A patient is diagnosed with cancer. The physician has recommended chemotherapy, which would likely save the patient's life. The patient tells the nurse, "This is punishment from God for sins I have committed; some women at my church say so." What will the best plan of the nurse include? 1. With the patient's permission, plan to involve a hospital minister to discuss the patient's perspective about cancer. 2. With the patient's permission, plan to bring the case before the hospital's board of ethics. 3. With the patient's permission, plan to contact the patient's minister to discuss the patient's perspective about cancer. 4. With the patient's permission, plan to meet with family members to discuss the patient's perspective about cancer.

3. With the patient's permission, plan to contact the patient's minister to discuss the patient's perspective about cancer. Rationale 1: Involving a hospital minister may be an option, but it is best to work through the patient's minister initially. Rationale 2: Bringing the case before the hospital's board of ethics is premature at this point. Rationale 3: When patients have strong religious beliefs, these can affect the outcome of the illness. The nurse should involve the patient's religious leader when possible. Rationale 4: Meeting with family might help; however, they may have the same perspective as the patient. Global Rationale: When patients have strong religious beliefs, these can affect the outcome of the illness. The nurse should involve the patient's religious leader when possible. Meeting with family might help; however, they may have the same perspective as the patient. Bringing the case before the hospital's board of ethics is premature at this point. Involving a hospital minister may be an option, but it is best to work through the patient's minister initially.

The physician orders enteric-coated aspirin, 300 mg every day, for the patient with a nasogastric tube. What is the priority action by the nurse? 1. Crush the tablet, dissolve it in 30 mL of water, and administer through the tube. 2. Put the tablet in the tube, "milk" it down the tube, and then flush the tube with 60 mL of water. 3. Withhold the medication and contact the physician. 4. Substitute plain aspirin, dissolve it in 30 mL of water, and administer through the tube.

3. Withhold the medication and contact the physician. Rationale 1: Crushing the tablet destroys the enteric coating. Rationale 2: Putting the tablet in the tube will result in clogging of the tube. Rationale 3: The only option is to withhold the medication and contact the physician. Rationale 4: The nurse cannot substitute plain aspirin; this requires a physician's order. Global Rationale: The only option is to withhold the medication and contact the physician. Crushing the tablet destroys the enteric coating. Putting the tablet in the tube will result in clogging of the tube. The nurse cannot substitute plain aspirin; this requires a physician's order.

Following ingestion, a drug crosses a membrane from an area of higher concentration to an area of lower concentration. This is an example of 1. active transport. 2. osmosis. 3. diffusion. 4. metabolism.

3. diffusion. Rationale 1: Active transport is the movement of a chemical against concentration or gradient. Rationale 2: Osmosis involves the movement of water. Rationale 3: Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Rationale 4: Metabolism involves chemical conversion. Global Rationale: Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. Osmosis involves the movement of water, and metabolism involves chemical conversion.

Enzymatic activity that changes a medication into a less active form is an example of 1. pharmacodynamics. 2. active transport. 3. pharmacokinetics. 4. diffusion.

3. pharmacokinetics. Rationale 1: Pharmacodynamics involves how drugs change the body. Rationale 2: Active transport is the movement of a chemical against concentration or gradient. Rationale 3: Pharmacokinetics describes how drugs are handled within the body. Rationale 4: Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Global Rationale: Pharmacokinetics describes how drugs are handled within the body. Pharmacodynamics involves how drugs change the body. Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient.

The nurse follows the nursing process when conducting medication education about insulin. The step of evaluation is best demonstrated by which question? 1. "Is your abdomen the best place to inject insulin?" 2. "What questions do you have about insulin?" 3. "Can you recognize when you are experiencing hypoglycemia?" 4. "Can you tell me four points you remember about how to take your insulin?"

4. "Can you tell me four points you remember about how to take your insulin?" Rationale 1: Asking the patient what questions she has about insulin is an assessment question. Rationale 2: Asking the patient what questions she has about insulin is an assessment question. Rationale 3: Asking the patient if she can recognize when she is experiencing hypoglycemia is an assessment question. Rationale 4: The nurse is evaluating the effectiveness of medication education by asking the patient for feedback from the education provided. Global Rationale: The nurse is evaluating the effectiveness of medication education by asking the patient for feedback from the education provided. Asking the patient what questions she has about insulin is an assessment question. Asking the patient if her abdomen is the best place to inject insulin is an assessment question. Asking the patient if she can recognize when she is experiencing hypoglycemia is an assessment question.

The nurse makes a medication error and a patient dies. In court, the attorney for the family of the deceased patient asks the nurse if she followed standards of care in administering the medication. How would the attorney phrase this question? 1. "Did you follow agency guidelines as in previous circumstances?" 2. "Did you follow the physician's orders and double-check them before administration?" 3. "Did you do the three checks and follow the five rights as taught in school?" 4. "Did you do what another nurse would have done under similar circumstances?"

4. "Did you do what another nurse would have done under similar circumstances?" Rationale 1: Standards of care refer to the actions that a reasonable and prudent nurse with equivalent preparation would do under similar circumstances. Standards of care do not refer to following physician orders. Standards of care do not refer to following agency guidelines. Standards of care do not refer to doing three checks or five rights. Rationale 2: Standards of care refer to the actions that a reasonable and prudent nurse with equivalent preparation would do under similar circumstances. Standards of care do not refer to following physician orders. Standards of care do not refer to following agency guidelines. Standards of care do not refer to doing three checks or five rights. Rationale 3: Standards of care refer to the actions that a reasonable and prudent nurse with equivalent preparation would do under similar circumstances. Standards of care do not refer to following physician orders. Standards of care do not refer to following agency guidelines. Standards of care do not refer to doing three checks or five rights. Rationale 4: Standards of care refer to the actions that a reasonable and prudent nurse with equivalent preparation would do under similar circumstances. Standards of care do not refer to following physician orders. Standards of care do not refer to following agency guidelines. Standards of care do not refer to doing three checks or five rights.

During the admission assessment, the client tells the nurse "Sure I smoke a little weed (marijuana) to manage my stress. Doesn't everyone?" What is the best assessment question for the nurse to ask? 1. "What other ways do you think you might use to help you to manage your stress?" 2. "That is a Schedule I drug; aren't you afraid of going to jail for a long time?" 3. "Do you really believe that everyone smokes marijuana to manage stress?" 4. "How often do you smoke marijuana, and how much each time?"

4. "How often do you smoke marijuana, and how much each time?" Rationale 1: Stress management is not the main concern during the admission assessment. Rationale 2: Asking the client if he is afraid of going to jail is not an assessment question and is not the issue during the admission assessment. Rationale 3: Asking the client if he really believes something is not an assessment question and can lead to an argument with the client. Rationale 4: The nurse must assess the amount and frequency of any drug the client uses, including illegal drugs. Global Rationale: The nurse must assess the amount and frequency of any drug the client uses, including illegal drugs. Asking the client if he really believes something is not an assessment question and can lead to an argument with the client. Stress management is not the main concern during the admission assessment. Asking the client if he is afraid of going to jail is not an assessment question and is not the issue during the admission assessment.

The nurse is providing education about warfarin (Coumadin) to a patient of Asian ancestry. The nurse determines that learning has occurred when the patient makes which statement? 1. "I may need to have more frequent blood tests." 2. "I may need to have less frequent blood tests." 3. "I may need more medication than someone from a different ethnic group." 4. "I may need less medication than someone from a different ethnic group."

4. "I may need less medication than someone from a different ethnic group." Rationale 1: There is no need for patients of Asian ancestry to have more frequent blood tests than other patients.. Rationale 2: There is no need for patients of Asian ancestry to have less frequent blood tests. Rationale 3: A patient of Asian ancestry may be a poor metabolizer of warfarin (Coumadin), so they will not require a higher dose. Rationale 4: A patient of Asian ancestry may be a poor metabolizer of warfarin (Coumadin), so they will often require lower dosages. Global Rationale: A patient of Asian ancestry may be a poor metabolizer of warfarin (Coumadin), so they will often require lower dosages. There is no need for patients of Asian ancestry to have more or less frequent blood tests than other patients.

The nurse provides medication education to a client with terminal cancer. The physician has ordered morphine (MS Contin), a Schedule II drug, for the client. The nurse determines that learning has occurred when the client makes which statement? 1. "I need to call the office for a refill before my medication runs out." 2. "This drug is addictive so I should only take it when my pain becomes severe." 3. "Maybe my doctor could change me to a Schedule IV drug." 4. "I need to see my doctor before my prescription runs out so I can get a refill."

4. "I need to see my doctor before my prescription runs out so I can get a refill." Rationale 1: Schedule II drugs cannot be refilled by phone order. Rationale 2: Not taking pain medication until the pain becomes severe is an inappropriate use of pain medication for a client with terminal cancer. Rationale 3: A Schedule IV drug may not effectively relieve the client's pain. Rationale 4: The client must see the physician for a refill. Global Rationale: Schedule II drugs cannot be refilled by phone order. Not taking pain medication until the pain becomes severe is an inappropriate use of pain medication for a client with terminal cancer. The client must see the physician for a refill. A Schedule IV drug may not effectively relieve the client's pain.

The nurse has completed medication education about pyridostigmine (Mestinon), an indirect cholinergic drug, for the patient with myasthenia gravis. The nurse determines that learning has occurred when the patient makes which statement? 1. "My heart may beat slower while I am on this drug." 2. "I will need to increase my fluid intake with this medication." 3. "I must take this medication immediately before eating a full meal." 4. "It is really important to take my medication on time."

4. "It is really important to take my medication on time." Rationale 1: Heart rate is typically increased by anticholinergic drugs. Rationale 2: There is no reason to increase fluid intake with this drug. Rationale 3: There is no reason this drug should be taken immediately prior to eating a full meal. Rationale 4: Maintaining an optimum blood level of the drug is crucial in promoting muscle functioning, so it is important for the patient to take his medication on time and as directed. Global Rationale: Maintaining an optimum blood level of the drug is crucial in promoting muscle functioning, so it is important for the patient to take his medication on time and as directed. Heart rate is typically increased by anticholinergic drugs. There is no reason to increase fluid intake with this drug. There is no reason this drug should be taken immediately prior to eating a full meal.

The student nurse has been reading about the Human Genome Project and asks the nursing instructor how this will impact future pharmacological therapies. What is the best response by the instructor? 1. "We will be able to alter genes so we will not need drugs." 2. "We will be able to standardize drug doses to make prescribing easier." 3. "It will help prevent disease through gene manipulation but will not impact drugs." 4. "It will help to individualize drug therapy for people in a more effective way."

4. "It will help to individualize drug therapy for people in a more effective way." Rationale 1: Altering genes to prevent illness is a possibility, but we will always need medications. Rationale 2: Individuals will still respond differently to medications; not all drugs will have standardized doses. Rationale 3: Medications will be very much impacted by this research. Rationale 4: The goal of pharmacogenetics is to help individualize drug therapy for people in a more effective way. Global Rationale: The goal of pharmacogenetics is to help individualize drug therapy for people in a more effective way. Altering genes to prevent illness is a possibility, but we will always need medications. Individuals will still respond differently to medications; not all drugs will have standardized doses. Medications will be very much impacted by this research.

The student nurse asks the nursing instructor, "Do the medications we are studying actually make more neurotransmitters?" What is the best response by the nursing instructor? 1. "No, but medications can heal diseases of the autonomic nervous system." 2. "Yes, some of the newer medications are very good at doing this." 3. "Yes, but the newer drugs that do this have some serious side effects." 4. "No, medications can only increase or decrease the action of neurotransmitters."

4. "No, medications can only increase or decrease the action of neurotransmitters." Rationale 1: There are virtually no diseases of the autonomic nervous system to heal. Rationale 2: Even the newest medications cannot manufacture new neurotransmitters. Rationale 3: Medications cannot manufacture new neurotransmitters, even if they have serious side effects. Rationale 4: Medications cannot manufacture new neurotransmitters; they can only increase or decrease their action. Global Rationale: Medications cannot manufacture new neurotransmitters; they can only increase or decrease their action. There are virtually no diseases of the autonomic nervous system to heal. Even the newest medications cannot manufacture new neurotransmitters. Medications cannot manufacture new neurotransmitters, even if they have serious side effects.

The mother of an adolescent receiving methylphenidate (Concerta) for attention-deficit hyperactivity disorder tells the nurse that her son is better and asks why she can't just get refills on the prescription. What is the best response by the nurse? 1. "Just drop by and I will get a prescription for you without seeing your son." 2. "We can't do that; maybe you can find another doctor's office that will do it." 3. "The law does not allow us to give you refills on this medication." 4. "The medication can be addictive so your son needs a monthly medical evaluation."

4. "The medication can be addictive so your son needs a monthly medical evaluation." Rationale 1: Schedule II medications cannot be refilled without the client being seen by the physician. Rationale 2: Referring the mother to another office is non-therapeutic and implies that other medical offices violate the law. Rationale 3: Telling the mother about the law is accurate, but it is a non-therapeutic response; the mother needs an explanation. Rationale 4: Telling the mother the reason for monthly evaluations is a therapeutic response that is correct and answers the mother's question. Global Rationale: Telling the mother the reason for monthly evaluations is a therapeutic response that is correct and answers the mother's question. Schedule II medications cannot be refilled without the client being seen by the physician. Telling the mother about the law is accurate, but it is a non-therapeutic response; the mother needs an explanation. Referring the mother to another office is non-therapeutic and implies that other medical offices violate the law.

The patient is receiving lithium (Eskalith) and asks the nurse why he has to have blood drawn so often. What is the best response by the nurse? 1. "To detect side effects before they become a problem." 2. "To be sure the medication is working properly." 3. "To determine if your body is responding as it should." 4. "To be sure you have the correct amount of medication in your system."

4. "To be sure you have the correct amount of medication in your system." Rationale 1: Side effects are best determined by patient assessment. Rationale 2: A lab test will not confirm that the medication is working properly; assessment of the patient confirms this. Rationale 3: Body response to the medication is best determined by patient assessment. Rationale 4: Medications, such as lithium (Eskalith), with a narrow therapeutic range must be monitored with lab tests; this is how the correct dosage is determined. Global Rationale: Medications, such as lithium (Eskalith), with a narrow therapeutic range must be monitored with lab tests; this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly; assessment of the patient confirms this. Body response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment.

The nurse is conducting medication education for patients with hypertension. The focus of the education is on enhancing the absorption of their medications. The nurse determines that learning has occurred when the patients make which statement? 1. "We can safely take the drug for at least 6 months beyond the expiration date." 2. "We don't need to worry about storage of the drug, it won't lose potency." 3. "We should not take our medications with milk or dairy products." 4. "We need to be careful about taking the medication with certain foods."

4. "We need to be careful about taking the medication with certain foods." Rationale 1: Patients should be taught to avoid taking medications beyond the expiration date. Rationale 2: Storage can affect the medication's strength and may affect how it responds in the body. Rationale 3: There are many more foods that will alter the absorption of medications other than milk and dairy products. Rationale 4: Food can alter the absorption of many medications. Global Rationale: Food can alter the absorption of many medications. Storage can affect the medication's strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. Patients should be taught to avoid taking medications beyond the expiration date.

The patient receives antibiotics for a serious infection. The patient asks the nurse, "Why don't you just give me more of that drug to cure this infection faster?" What is the best response by the nurse? 1. "I will check with the doctor to see if it is time to increase the medication." 2. "You are at a maximum dose; taking more will cause interactions with other medications." 3. "You must stay on this drug for 2 more weeks before it can be increased." 4. "You are at a maximum dose; taking more will not help."

4. "You are at a maximum dose; taking more will not help." Rationale 1: Telling the patient the nurse will check with the physician is inappropriate because the plateau of the drug has been reached; the physician will not change the dosage. Rationale 2: An increase in dosage may cause interactions with other medications, but this is not the best answer. Rationale 3: Once the plateau of a drug has been reached, there is no time frame for an increase in dosage because an increase in dosage will not produce a greater effect. Rationale 4: When the plateau of a drug has been reached, administering more of the drug will not produce additional benefit. Once the plateau of a drug has been reached, there is no time frame for an increase in dosage because an increase in dosage will not produce a greater effect. Telling the patient the nurse will check with the physician is inappropriate because the plateau of the drug has been reached; the physician will not change the dosage. An increase in dosage may cause interactions with other medications, but this is not the best answer. Global Rationale: When the plateau of a drug has been reached, administering more of the drug will not produce additional benefit. Once the plateau of a drug has been reached, there is no time frame for an increase in dosage because an increase in dosage will not produce a greater effect. Telling the patient the nurse will check with the physician is inappropriate because the plateau of the drug has been reached; the physician will not change the dosage. An increase in dosage may cause interactions with other medications, but this is not the best answer.

At a dose of 10 mg, drug X lowers total cholesterol by 50 mg/dL, while a maximum drop in cholesterol of 65 mg/dL is achieved at 40 mg. At a dose of 5 mg, drug Y lowers cholesterol by 50 mg/dL, while a maximum drop in cholesterol of 55 mg/dL is achieved at 10 mg. What can be concluded about the efficacy and potency of these two drugs? 1. Drug X is more potent, and drug Y has a higher efficacy. 2. Drug X is more potent and has higher efficacy. 3. Drug Y is more potent and has higher efficacy. 4. Drug Y is more potent, and drug X has a higher efficacy.

4. Drug Y is more potent, and drug X has a higher efficacy. Rationale 1: Drug X is not more potent. Drug Y does not have higher efficacy. Rationale 2: Drug X is not more potent. Rationale 3: Drug Y does not have higher efficacy. Rationale 4: Drug Y causes a greater drop in cholesterol at lower doses (higher potency), whereas drug X causes the highest drop in total cholesterol (efficacy). Global Rationale: Drug Y causes a greater drop in cholesterol at lower doses (higher potency), whereas drug X causes the highest drop in total cholesterol (efficacy).

A young patient has been receiving five milliliters of liquid antibiotic three times each day. The nurse providing discharge instructions would teach the parents to use a standard measuring spoon to administer which amount for each dose? 1. 2 tablespoons 2. 1 fluid ounce 3. 15 drops 4. 1 teaspoon

4. 1 teaspoon Rationale 1: Five milliliters is not equivalent to two tablespoons. Rationale 2: A fluid ounce is equal to 30-32 milliliters. Rationale 3: Five milliliters is equal to about 60 drops. Rationale 4: One standard teaspoon is equal to 4 or 5 milliliters, so this is the best answer. Global Rationale: Liquid medications should be measured using a standardized instrument. One standard teaspoon is equal to 4 or 5 milliliters. The other measurements are not accurate and would result in large overdoses or underdoses.

Which statement is accurate regarding pharmacotherapy in the older adult? 1. Increased body water can lead to a higher risk of drug toxicity. 2. Plasma levels are increased, leading to a heightened drug response. 3. Generally, drug doses should be increased due to prolonged drug metabolism. 4. Drug absorption is slower due to increased gastric pH.

4. Drug absorption is slower due to increased gastric pH. Rationale 1: Body water is reduced, leading to a higher risk of drug toxicity. Rationale 2: Plasma levels are lower, causing a diminished drug response. Rationale 3: Generally, drug doses are reduced because of prolonged drug metabolism. Rationale 4: Older adults have an increase in gastric pH, which slows absorption. Global Rationale: Older adults have an increase in gastric pH, which slows absorption. Plasma levels are lower, causing a diminished drug response. Body water is reduced, leading to a higher risk of drug toxicity. Generally, drug doses are reduced because of prolonged drug metabolism.

The patient is complaining of a severe headache. The physician orders aspirin. Which action by the nurse will result in the fastest relief of the patient's headache? 1. Administer the aspirin with an alkaline food, like cottage cheese. 2. Administer the aspirin in an enteric-coated formulation. 3. Administer the aspirin with a high-fat food, like peanut butter. 4. Administer the aspirin on an empty stomach.

4. Administer the aspirin on an empty stomach. Rationale 1: Cottage cheese will slow absorption and increase the time for the drug's effect. Rationale 2: Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal irritation, but will increase the time for the drug's effect. Rationale 3: Peanut butter will slow absorption and increase the time for the drug's effect. Rationale 4: Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the aspirin should be administered on an empty stomach. Global Rationale: Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal irritation, but will increase the time for the drug's effect. Peanut butter and cottage cheese will slow absorption and increase the time for the drug's effect.

The patient is from an Arab culture and is in labor and delivery. Her husband insists he must stay with her and will not allow her to receive any analgesia during the experience. What is the best action by the nurse? 1. Inform the husband that it is his wife's choice whether or not to receive analgesia. 2. Inform the husband that he must sign a release of responsibility to avoid future litigation against the hospital. 3. Allow the request but inform the husband that the physician will make the final decision about analgesia. 4. Allow this request and be available in the event the request changes.

4. Allow this request and be available in the event the request changes. Rationale 1: With some cultures, the husband makes the choices, not the wife. Rationale 2: When cultural differences are allowed and supported, patients are not as likely to become involved in litigation. Rationale 3: With some cultures, the husband makes the choices, not the physician. Rationale 4: Nurses must allow and support cultural differences. The husband's decisions must be respected as long as patient safety is not involved, and it is not involved in this situation. Global Rationale: Nurses must allow and support cultural differences. The husband's decisions must be respected as long as patient safety is not involved, and it is not involved in this situation. With some cultures, the husband makes the choices, not the wife or the physician. When cultural differences are allowed and supported, patients are not as likely to become involved in litigation.

The nurse reviewing prescription refill request messages would collaborate with the physician regarding a request for which drug? 1. Morphine 2. Cannabis 3. Meperidine 4. An anabolic steroid

4. An anabolic steroid Rationale 1: Morphine is a Schedule II drug. Telephone prescription requests are not allowed. The client must be examined by a physician prior to a new prescription being written. Rationale 2: Cannabis is a Schedule I drug. Telephone prescriptions requests are not allowed. Rationale 3: Meperidine is a Schedule II drug. Telephone prescription requests are not allowed. Rationale 4: Anabolic steroids are Schedule III drugs. Telephone prescription refills are allowed. Global Rationale: Schedule I and II drugs cannot be ordered via the telephone. The client must been examined by a physician prior to a new prescription being written. Morphine and meperidine are Schedule II drugs. Cannabis is a Schedule I drug. Anabolic steroids are Schedule III drugs. Telephone prescription refills are allowed.

A drug is withdrawn from a client who has been taking it routinely for many years. The client has developed muscle tremors. How would the nurse characterize this event? 1. As an adverse effect 2. As evidence that the client had psychological dependence on the drug 3. As an expected therapeutic effect of no longer taking the drug 4. As an assessment finding associated with physical dependence on a drug

4. As an assessment finding associated with physical dependence on a drug Rationale 1: Adverse effects are seen while the drug is being taken, not after it is withdrawn. Rationale 2: With psychological dependence, few physical signs are seen. Rationale 3: Therapeutic effects are seen while drugs are being used, not after they have been removed. Rationale 4: The presence of physical withdrawal symptoms (muscle tremors) is seen when a person is physically dependent on a drug and the drug is removed. Global Rationale: The presence of physical withdrawal symptoms (muscle tremors) is seen when a person is physically dependent on a drug and the drug is removed. With psychological dependence, few physical signs are seen. Therapeutic effects are seen while drugs are being used, not after they have been removed. Adverse effects are the seen while the drug is being taken, not after it is withdrawn.

What is the best plan as the nurse prepares to administer a topical medication? 1. Check the medication for interactions with other medications. 2. Take the patient's vital signs. 3. Educate the patient to not disturb the patch. 4. Assess the patient's skin where the medication will be applied.

4. Assess the patient's skin where the medication will be applied. Rationale 1: Checking for drug interactions is important, but it is not the priority. Rationale 2: Vital signs are not always indicated; it depends on the medication. Rationale 3: Patient education is important, but is not the priority. Rationale 4: Planning to assess the patient's skin is imperative; if it is cracked, dry, or irritated, the medication may not be properly absorbed. Global Rationale: Planning to assess the patient's skin is imperative; if it is cracked, dry, or irritated, the medication may not be properly absorbed. Patient education is important, but is not the priority. Vital signs are not always indicated; it depends on the medication. Checking for drug interactions is important, but it is not the priority.

The nurse explains that atropine (Atropair) increases heart rate in which manner? 1. Blocking the beta receptors of the parasympathetic nervous system. 2. Directly stimulating the sympathetic nervous system. 3. Potentiating the effects of acetylcholine on nicotinic receptors. 4. Blocking the effects of acetylcholine by occupying muscarinic receptors.

4. Blocking the effects of acetylcholine by occupying muscarinic receptors. Rationale 1: Atropine occupies muscarinic receptors. Rationale 2: Atropine blocks parasympathetic actions of acetylcholine. Rationale 3: Atropine does not potentiate acetylcholine effects on nicotinic receptors. Rationale 4: Atropine is a cholinergic-blocking agent that occupies muscarinic receptors. Global Rationale: Atropine is a cholinergic-blocking agent that occupies muscarinic receptors. It is classified as an anticholinergic agent because it inhibits the effects of the parasympathetic nervous system, which induces the fight-or-flight responses of the sympathetic nervous system.

Which substance would inhibit the function of the autonomic nervous system? 1. Drugs that bind and then stimulate the postsynaptic neuron 2. Drugs that prohibit neurotransmitter reuptake 3. Drugs that increase neurotransmitter synthesis 4. Drugs that prevent the storage of neurotransmitter in vesicles

4. Drugs that prevent the storage of neurotransmitter in vesicles Rationale 1: Stimulation of the postsynaptic neuron would enhance function. Rationale 2: Prohibiting neurotransmitter intake would lower the amount available. Rationale 3: Increasing neurotransmitter synthesis would decrease the amount available. Rationale 4: The more neurotransmitter available, the greater the function/stimulation of the autonomic nervous system. Global Rationale: The more neurotransmitter available, the greater the function/stimulation of the autonomic nervous system. Stimulation of the postsynaptic neuron would enhance function. Prohibiting neurotransmitter intake would lower the amount available. Increasing neurotransmitter synthesis would decrease the amount available.

A patient who has myasthenia gravis (MG) presents to the emergency department with abrupt onset of increased muscle weakness and difficulty swallowing. An attempt to distinguish worsening of the MG symptoms from overdose of the patient's prescribed anticholinergic is planned. What medications should the nurse obtain for use in this procedure? Standard Text: Select all that apply. 1. Donepezil (Aricept) 2. Pyridostigmine (Mestinon) 3. Neostigmine (Prostigmin) 4. Edrophonium (Edrophonium Injectable) 5. Atropine (Atropine Injectable)

4. Edrophonium (Edrophonium Injectable) 5. Atropine (Atropine Injectable) Rationale 1: Donepezil (Aricept) is prescribed for the treatment of Alzheimer's disease and would not be used in this situation. Rationale 2: Pyridostigmine (Mestinon) is prescribed for the treatment of MG but would not be used to determine if this patient is having increased symptoms or excessive medication. Rationale 3: Neostigmine (Prostigmin) is prescribed for the treatment of MG but would not be used to determine if this patient is having increased symptoms or excessive medication. Rationale 4: Edrophonium (Edrophonium Injectable) is given as a test dose. If muscular symptoms improve, the patient is having a myasthenic crisis. Rationale 5: Atropine (Atropine Injectable) is given if the test results in a cholinergic crisis. Global Rationale: Edrophonium (Edrophonium Injectable) is given as a test dose. If muscular symptoms improve, the patient is having a myasthenic crisis. Atropine (Atropine Injectable) is given if the test results in a cholinergic crisis. Donepezil (Aricept) is prescribed for the treatment of Alzheimer's disease and would not be used in this situation. Pyridostigmine (Mestinon) is prescribed for the treatment of MG but would not be used to determine if this patient is having increased symptoms or excessive medication. Neostigmine (Prostigmin) is prescribed for the treatment of MG but would not be used to determine if this patient is having increased symptoms or excessive medication.

The nurse teaching a pre-conception class would tell participants that they should be most careful about exposure to drugs during which stage of pregnancy? 1. Each stage is equal in risk. 2. Pre-implantation period 3. Third trimester 4. Embryonic

4. Embryonic Rationale 1: The goal should be to minimize exposure to all drugs for the length of pregnancy, but exposure during some time periods is more critical than exposure at other times. Rationale 2: During the pre-implantation phase there is no direct link to the mother so exposure to a teratogen either causes death or has no effect. Rationale 3: The third trimester falls in the fetal period when teratogen exposure is more likely to impair organ function or delay growth than to cause gross structural malformation. Rationale 4: The embryonic phase poses the greatest risk to fetal development as this is a time of rapid development of internal structures. Global Rationale: The embryonic phase poses the greatest risk to fetal development as this is a time of rapid development of internal structures. During the pre-implantation phase there is no direct link to the mother so exposure to a teratogen either causes death or has no effect. The goal should be to minimize exposure to all drugs for the length of pregnancy, but exposure during some time periods is more critical than exposure at other times.

The physician has ordered bethanechol (Urecholine), a cholinergic drug, for the patient with urinary retention. The patient also has an enlarged prostate gland. What is the priority action by the nurse? 1. Hold the drug and prepare to catheterize the patient. 2. Administer the drug and measure urinary output. 3. Administer the drug and push fluids. 4. Hold the drug and contact the physician.

4. Hold the drug and contact the physician. Rationale 1: There should be no need for catheterization. Rationale 2: Measuring urinary output is not the best answer. Rationale 3: Pushing fluids would exacerbate the problem. Rationale 4: Bethanechol (Urecholine) relaxes the urinary sphincter and increases voiding pressure. It is contraindicated with any physical obstruction of the urinary tract, such as an enlarged prostate gland. Global Rationale: Bethanechol (Urecholine) relaxes the urinary sphincter and increases voiding pressure. It is contraindicated with any physical obstruction of the urinary tract, such as an enlarged prostate gland. Measuring urinary output is inappropriate; the patient should not receive the drug. There should be no need for catheterization as long as the drug is not given. The drug should not be given; pushing fluids would exacerbate the problem.

The physician has prescribed a nitroglycerine (Nitrodur) patch for the patient. What is the best outcome for this patient as it relates to use of the medication? 1. Patient will be able to identify the expiration date of the medication prior to discharge. 2. Patient will verbalize three side effects of the medication prior to discharge. 3. Patient will state the reason for receiving the medication prior to discharge. 4. Patient will demonstrate correct application of the patch prior to discharge.

4. Patient will demonstrate correct application of the patch prior to discharge. Rationale 1: The patient does not need to identify the expiration date of the medication in order to correctly apply the patch. Rationale 2: The patient does not need to identify side effects of the medication in order to correctly apply the patch. The patient does not need to state the reason for the medication in order to correctly apply the patch. The patient does not need to identify the expiration date of the medication in order to correctly apply the patch. Rationale 3: The patient does not need to state the reason for the medication in order to correctly apply the patch. Rationale 4: The overall goal of nursing care related to pharmacotherapy is the safe and effective administration of medication. In this instance, the most important aspect of patient teaching is that the patient be able to correctly apply the patch. If the patch is not correctly applied, the other issues are irrelevant. The patient does not need to identify side effects of the medication in order to correctly apply the patch. The patient does not need to state the reason for the medication in order to correctly apply the patch. The patient does not need to identify the expiration date of the medication in order to correctly apply the patch. Global Rationale: The overall goal of nursing care related to pharmacotherapy is the safe and effective administration of medication. In this instance, the most important aspect of patient teaching is that the patient be able to correctly apply the patch. If the patch is not correctly applied, the other issues are irrelevant. The patient does not need to identify side effects of the medication in order to correctly apply the patch. The patient does not need to state the reason for the medication in order to correctly apply the patch. The patient does not need to identify the expiration date of the medication in order to correctly apply the patch.

Which of the following responses are regulated by the sympathetic nervous system? 1. Increased heart rate, bronchial constriction 2. Peripheral artery dilation, reduced peristalsis 3. Increased secretions, sex organ stimulation 4. Relaxation of bladder, pupil dilation

4. Relaxation of bladder, pupil dilation Rationale 1: The sympathetic nervous system increases heart rate, but the parasympathetic system constricts bronchioles. Rationale 2: Parasympathetic innervation dilates peripheral arteries and stimulates digestion. Rationale 3: The sympathetic system inhibits salivation and stimulates sex organs. Rationale 4: Relaxation of the bladder and pupil dilation is regulated by the sympathetic nervous system. Global Rationale: Relaxation of the bladder and pupil dilation are regulated by the sympathetic nervous system. Parasympathetic innervation dilates peripheral arteries and stimulates digestion. The sympathetic nervous system increases heart rate, but the parasympathetic system constricts bronchioles. The sympathetic system inhibits salivation and stimulates sex organs.

The nursing instructor prepares to teach student nurses about how mean effective doses of medications are related to clinical practice. As a result of the instruction, what is the best understanding of the student nurses? 1. About 50% of patients will experience severe side effects from the drug. 2. Some patients will respond differently depending on their ethnic background. 3. About 50% of patients will not experience any effect from the drug. 4. Some patients will require more or less than the average dose of the drug.

4. Some patients will require more or less than the average dose of the drug. Rationale 1: The mean effective dose does not predict how many patients will experience severe side effects from the drug. Rationale 2: The mean effective dose is not related to ethnicity. Rationale 3: The mean effective dose does not predict that 50% of patients will not experience any effect of the drug. Rationale 4: The mean effective dose predicts how 50% of the population will respond to the average dose of the drug. Some patients will require more or less of the drug. Global Rationale: The mean effective dose predicts how 50% of the population will respond to the average dose of the drug. Some patients will require more or less of the drug. The mean effective dose is not related to ethnicity. The mean effective dose does not predict how many patients will experience severe side effects from the drug. The mean effective dose does not predict that 50% of patients will not experience any effect of the drug.

The nurse is preparing medications for a group of patients. Another nurse begins telling the nurse about her recent engagement. What is the best action by the first nurse? 1. Ask the second nurse to help with administering medications so they can have more time to talk. 2. Continue to prepare the medications for administration and pretend to listen to the first nurse. 3. Stop preparing medications until the first nurse has finished talking about her engagement. 4. Tell the second nurse that the conversation is distracting and must cease while medications are being prepared.

4. Tell the second nurse that the conversation is distracting and must cease while medications are being prepared. Rationale 1: When preparing medications, the nurse must focus entirely on the task at hand and instruct others who are talking to stop. It is inappropriate to ask another nurse to assist with medications so there is more time for the nurses to talk. The nurse cannot stop preparing medications; the patients must receive them on time. Pretending to listen to the second nurse's conversation will also be distracting. Rationale 2: When preparing medications, the nurse must focus entirely on the task at hand and instruct others who are talking to stop. It is inappropriate to ask another nurse to assist with medications so there is more time for the nurses to talk. The nurse cannot stop preparing medications; the patients must receive them on time. Pretending to listen to the second nurse's conversation will also be distracting. Rationale 3: When preparing medications, the nurse must focus entirely on the task at hand and instruct others who are talking to stop. It is inappropriate to ask another nurse to assist with medications so there is more time for the nurses to talk. The nurse cannot stop preparing medications; the patients must receive them on time. Pretending to listen to the second nurse's conversation will also be distracting. Rationale 4: When preparing medications, the nurse must focus entirely on the task at hand and instruct others who are talking to stop. It is inappropriate to ask another nurse to assist with medications so there is more time for the nurses to talk. The nurse cannot stop preparing medications; the patients must receive them on time. Pretending to listen to the second nurse's conversation will also be distracting.

The adolescent Hispanic male has been diagnosed with attention-deficit hyperactivity disorder (ADHD), and is taking methylphenidate (Ritalin). Even though the drug helps with focus and grades, the adolescent will not go to the school office at noon for his medication. Which statement best describes the result of the nurse's evaluation? 1. The adolescent has developed alternative coping mechanisms to increase his focus during classes. 2. The adolescent is fearful that this drug may be a "gateway drug" and he will abuse other substances. 3. The adolescent really does not need an additional dose of methylphenidate (Ritalin) at school. 4. The adolescent is embarrassed about having to take medicine at school; it is a social stigma.

4. The adolescent is embarrassed about having to take medicine at school; it is a social stigma. Rationale 1: Attention-deficit hyperactivity disorder is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes. Rationale 2: Appropriate treatment of attention-deficit hyperactivity disorder will result in less addiction to mood-altering substances, not more addiction. Rationale 3: Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the patient must receive a dose during school hours. Rationale 4: Some patients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Patients can also perceive this as a social stigma. Global Rationale: Some patients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Patients can also perceive this as a social stigma. Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the patient must receive a dose during school hours. Attention-deficit hyperactivity disorder is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes. Appropriate treatment of attention-deficit hyperactivity disorder will result in less addiction to mood-altering substances, not more addiction.

Which of the following demonstrates ethical reporting of a medication error? 1. The nurse does not report the error, because the error was caught and corrected prior to drug administration. 2. The nurse does not report or document the error, since the error did not result in any harm to the patient. 3. The nurse reports the error to the physician and the charge nurse but does not document the error due to possible legal action. 4. The nurse informs the patient, documents the error as per hospital policy, and notifies the physician.

4. The nurse informs the patient, documents the error as per hospital policy, and notifies the physician. Rationale 1: The nurse should report and document all medication errors whether the patient was harmed or not. It is essential to report and document medication errors to identify possible system failures, even when the error is caught prior to administration or has potential for legal action.

The patient was receiving haloperidol (Haldol), a dopamine antagonist. The psychiatrist changed the order to aripiprazole (Abilify), a partial dopamine antagonist. Which statement best describes the effect of the change of medication on the patient? 1. The patient is more compliant in taking his medication. 2. The patient experiences greater efficacy. 3. The patient experiences a greater reduction in symptoms. 4. The patient experiences fewer side effects.

4. The patient experiences fewer side effects. Rationale 1: The patient will not necessarily be more compliant in taking the medicine. Rationale 2: The patient will not necessarily experience greater efficacy. Rationale 3: Experiencing a greater reduction in symptoms is the same as greater efficacy. Rationale 4: Partial blocking of dopamine results in fewer side effects than complete blocking of dopamine. Global Rationale: Partial blocking of dopamine results in fewer side effects than complete blocking of dopamine. The patient will not necessarily experience greater efficacy or be more compliant in taking the medicine. Experiencing a greater reduction in symptoms is the same as greater efficacy.

The home health nurse notes that the elderly patient doubled up on his pain medication, even though the prescribed dose was at a therapeutic level. The patient says, "If one pill is good, two pills are better." Which statement best describes the result of the patient's action? 1. The patient develops tolerance and does not experience any difference. 2. The patient experiences more pain relief from the additional dose. 3. The patient develops tolerance and will need increased doses of the drug. 4. The patient is more likely to exhibit side effects from the additional dose.

4. The patient is more likely to exhibit side effects from the additional dose. Rationale 1: Tolerance may occur but is not the primary issue here. Rationale 2: Once the plateau of a drug has been reached, increased doses will not provide added therapeutic benefit, such as more pain relief. Rationale 3: Tolerance may occur but is not the primary issue here. Rationale 4: Once the plateau of a drug has been reached, increasing the dose may produce adverse effects. Global Rationale: Once the plateau of a drug has been reached, increasing the dose may produce adverse effects. Once the plateau of a drug has been reached, increased doses will not provide added therapeutic benefit, such as more pain relief. Tolerance may occur but is not the primary issue here.

Prior to administering medications, the student nurse reviews the therapeutic index. Which statement best describes the student's understanding of therapeutic index? 1. The student is able to determine if the physician prescribed the best drug for the patient. 2. The student is able to determine if the patients are receiving safe doses of the medications. 3. The student is able to identify interactions among the drugs each patient is receiving. 4. The student is able to identify the patients who will need to have serum blood levels monitored.

4. The student is able to identify the patients who will need to have serum blood levels monitored. Rationale 1: The therapeutic index will not help to determine if the physician prescribed the best drug for the patient. Rationale 2: The therapeutic index will give some information about safe doses, but this is not the most complete response. Rationale 3: The therapeutic index will not help to identify interactions among the drugs the patients receive. Rationale 4: Drugs with a narrow therapeutic index have a low safety margin and the concentration of the drug should be monitored by regular serum tests. Global Rationale: Drugs with a narrow therapeutic index have a low safety margin and the concentration of the drug should be monitored by regular serum tests. The therapeutic index will give some information about safe doses, but this is not the most complete response. The therapeutic index will not help to determine if the physician prescribed the best drug for the patient. The therapeutic index will not help to identify interactions among the drugs the patients receive.

The nurse is employed by the Food and Drug Administration (FDA) and is involved in clinical investigation. What is the primary role of the nurse in this phase of the review and approval process by the FDA? 1. To perform tests on the population-at-large 2. To perform tests on various species of animals 3. To perform tests on human cells cultured in the laboratory 4. To perform tests on human clients

4. To perform tests on human clients Rationale 1: Performing tests on the population-at-large is the stage of post-marketing surveillance. Rationale 2: Performing tests on various species of animals is the preclinical investigation stage. Rationale 3: Performing tests on human cells cultured in the laboratory is the preclinical investigation stage. Rationale 4: Clinical investigation includes performing tests on healthy volunteers, and later, on selected clients with a particular disease. Global Rationale: Clinical investigation includes performing tests on healthy volunteers, and later, on selected clients with a particular disease. Performing tests on human cells cultured in the laboratory is the preclinical investigation stage. Performing tests on the population-at-large is the stage of post-marketing surveillance. Performing tests on various species of animals is the preclinical investigation stage.

The nurse plans to administer medication to the preschool child. Which approach indicates the nurse has an understanding of growth and development? 1. The child is often more cooperative if the parent is not in the room. 2. The child does better with verbal instruction than with play instruction. 3. There should be no need to restrain a child of this age. 4. Use a brief rationale, followed by quick administration of the medication.

4. Use a brief rationale, followed by quick administration of the medication. Rationale 1: Having a parent in the room usually promotes more cooperation from the preschool child. Rationale 2: Preschool children do better with play instruction. Rationale 3: It may be necessary to restrain a preschool child for medication administration. Rationale 4: A brief rationale, followed by quick administration, decreases the child's anxiety and promotes cooperation with the medication process. Global Rationale: A brief rationale, followed by quick administration, decreases the child's anxiety and promotes cooperation with the medication process. It may be necessary to restrain a preschool child for medication administration. Having a parent in the room usually promotes more cooperation from the preschool child. Preschool children do better with play instruction.

Which classification of drugs would the nurse refuse to administer to a pregnant patient? 1. category A 2. category B 3. cautionary 4. teratogenic

4. teratogenic Rationale 1: Category A drugs are not known to cause birth defects. Rationale 2: Category B drugs are not known to cause birth defects. Rationale 3: Cautionary is not a term used to describe a drug that causes birth defects. Rationale 4: Drugs that are known to cause birth defects are called teratogenic or classified as category D or category X. Global Rationale: Drugs that are known to cause birth defects are called teratogenic or classified as category D or category X. Category A and B drugs are not known to cause birth defects. Cautionary is not a term used to describe a drug that causes birth defects.

While the nurse is completing a medication history the older adult client says, "My medication costs so much. I am in the doughnut hole right now. Can't the government do something to help?" The nurse replies, "I understand how difficult this can be. There are plans under way to close the doughnut hole completely by ________."

Answer: 2020 Rationale: The U.S. Affordable Care Act of 2010 includes benefits to reduce this gap in coverage for seniors with the goal of closing it completely by 2020. Global Rationale: The U.S. Affordable Care Act of 2010 includes benefits to reduce this gap in coverage for seniors with the goal of closing it completely by 2020.

The nurse preparing to transfer to a pediatric hospital would expect to administer medications to children from birth to age _____ years.

Answer: 16 Rationale: For the purposes of medication administration, the pediatric patient is defined as being any age from birth to 16 years and weighing less than 50 kg. Global Rationale: For the purposes of medication administration, the pediatric patient is defined as being any age from birth to 16 years and weighing less than 50 kg.

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

Answer: 2 Rationale: Even though the barcode identification system has improved safety, it is not foolproof. The nurse should use two other means of identifying the patient such as verifying name and birth date. Global Rationale: Even though the barcode identification system has improved safety, it is not foolproof. The nurse should use two other means of identifying the patient such as verifying name and birth date.

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

Answer: 2 Rationale: Since risk diagnoses do not have evidence to support the chosen statement, they are written in two parts. Global Rationale: Since risk diagnoses do not have evidence to support the chosen statement, they are written in two parts.

Literature review reveals that a new drug has a median lethal dose of 10 and a median effective dose of 5. The nurse determines that an error in which _____ times the correct dose is given could be lethal.

Answer: 2 Rationale: x = 10/5; solving for x, the therapeutic index would be 2. This means it would only take an error in magnitude of approximately 2 times the average dose to be lethal. Global Rationale: x = 10/5; solving for x, the therapeutic index would be 2. This means it would only take an error in magnitude of approximately 2 times the average dose to be lethal.

Place these methods of communicating with a non-English speaking patient in order of their desirability and usefulness. 1. Adult family member interprets 2. Health care agency interpreter is present 3. The nurse uses drawings and body language to communicate 4. Child relative interprets 5. No interpretation is attempted

Answer: 2,1,4,3,5 Global Rationale: In the ideal situation the nurse will contact an interpreter employed or provided by the health care agency. The next best solution is for an adult family member to interpret with the third best being a child in the family who has been assessed to be able to handle the translation. In the absence of these options, the fourth best plan is for the nurse to use drawings, body language, pictures, and nonverbal clues to communicate. Not using any kind of interpretation is not desirable and leaves the nurse in the situation of doing something "to" a patient with no explanation.

Place these substances in the correct order of synthesis of catecholamines. 1. Norepinephrine 2. Tyrosine 3. Dopamine 4. Epinephrine 5. L-dopa

Answer: 2,5,3,1,4 Global Rationale: The synthesis begins with tyrosine then moves to L-dopa, dopamine, norepinephrine, and ends with the synthesis of epinephrine.

From a transcription error, a patient received an overdose of a prescribed medication. If the therapeutic index of the medication is 10 and the median effective dose is 2, the nurse would calculate as the median lethal dose for the medication as _____.

Answer: 20 Rationale: 10 = x/2; solving for x, the median lethal dose would be 20. Global Rationale: 10 = x/2; solving for x, the median lethal dose would be 20.

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

Answer: 3,1,4,2,5 Global Rationale: The order of the steps of the nursing process is assessment, diagnosis, planning, implementing, and evaluating. Weighing the patient is assessment, analyzing data occurs in the diagnosis step, writing interventions occurs in the planning step, documentation occurs in the implementation step, and revising interventions occurs in the evaluation step.

The nurse educator is reviewing the process of synaptic transmission following the sympathetic pathway. In which order will the nurse explain the steps of synaptic transmission? 1. Action potential encounters adrenergic receptors 2. Action potential encounters cholinergic receptors 3. Action potential travels across the preganglionic neuron 4. Action potential travels across the postganglionic neuron 5. Target tissue is reached.

Answer: 3,2,4,1,5 Global Rationale: In the sympathetic pathway, the action potential travels down the preganglionic neuron, encounters cholinergic receptors where is crosses the first ganglionic synapse, travels down the postganglionic neuron, encounters adrenergic receptors, and the reaches target tissues.

A client will receive a liter of fluid intravenously to treat dehydration. The client says, "I don't understand the metric system, how much is that?" The nurse responds, "It is about ______ cups of fluid."

Answer: 4 Global Rationale: The household measurement most nearly equivalent to 1 liter is 4 cups or 1 quart.

The nurse is preparing to administer a medication to a patient on a medical-surgical unit. The median lethal dose of the drug is 40 mg, and the median effective dose is 10 mg. The nurse calculates the therapeutic index to be _____.

Answer: 4 Rationale: The therapeutic index is calculated by dividing the median lethal dose (LD50) by the median effective dose (ED50). Global Rationale: The therapeutic index is calculated by dividing the median lethal dose (LD50) by the median effective dose (ED50).

The nurse is preparing to administer a subcutaneous injection. The needle should be inserted at an angle of ______ degrees.

Answer: 45 Rationale: The correct angle for injection of a subcutaneous medication is 45 degrees. Global Rationale: The correct angle for injection of a subcutaneous medication is 45 degrees.

A client says, "This morning's nurse told me that my pain medication is a scheduled drug. Aren't all drugs given on a schedule?" The nurse explains that in the United States controlled substances such as some common pain medications are classified into one of _______ categories or schedules.

Answer: 5 Rationale: Drugs with a significant potential for abuse are classified into five schedules or categories. These drugs are called "scheduled drugs." Global Rationale: Drugs with a significant potential for abuse are classified into five schedules or categories. These drugs are called "scheduled drugs."

At the end of the shift, the patient reports drinking 4 cups of water during the day. The nurse would include this ______ mL of fluid with the patient's oral intake amount.

Answer: 960 Rationale : Each cup the patient drank should be counted as 240 mL, making 4 cups equivalent to 960 mL. Global Rationale: Each cup the patient drank should be counted as 240 mL, making 4 cups equivalent to 960 mL.