Pharmacology Ch. 43

A nurse is assessing a patient's height, weight, and body mass index. The nurse classifies the patient as obese if the body mass index exceeds ______ kg/m2.

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An important function of vitamin A is to 1. promote visual pigment of the eye. 2. act as an antioxidant. 3. help with the clotting of blood. 4. help with bile excretion.

Correct Answer: 1 Rationale 1: Vitamin A is needed for the precursor retinol for normal vision. Rationale 2: Vitamin C and E are antioxidants. Rationale 3: Vitamin K is important in the clotting of blood. Rationale 4: Vitamin B can help with metabolic processes.

The client receives topical vitamin A for the treatment of psoriasis. Which laboratory test will the nurse review when assessing for an adverse effect? 1. Serum calcium level 2. Hemoglobin level 3. Thyroid profile 4. Serum potassium level

Correct Answer: 1 Rationale 1: Vitamin A may increase serum calcium. Rationale 2: There is no reason to assess the hemoglobin level. Rationale 3: There is no reason to assess the thyroid profile. Rationale 4: There is no reason to assess the serum potassium level.

A woman calls the emergency department and says, "My 2-year-old just swallowed about 20 of my magnesium tablets." What direction should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Call 911 to bring your child to the emergency room immediately." 2. "Watch your child for decreased breathing." 3. "Give your child a glass of milk." 4. "Your child may be sleepy but will not have any permanent damage." 5. "Give your child a laxative tonight and come to the emergency room in the morning."

Correct Answer: 1,2 Rationale 1: This is an emergency situation, and the child will require treatment. Rationale 2: While waiting for the ambulance, the mother should observe the client for respiratory suppression. Rationale 3: Drinking milk will not provide an antidote for magnesium overdose. Rationale 4: This overdose is an emergency situation. Rationale 5: The child needs immediate assessment and treatment.

A nurse is concerned that a client is not eating a sufficient amount. Which assessment findings would support this concern? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The client complains of weakness. 2. The client's muscles appear wasted. 3. The client doesn't remember what day it is. 4. The client's subcutaneous fat layer is thinner. 5. The client's skin is oily.

Correct Answer: 1,2,4 Rationale 1: Generalized weakness is a common assessment in the client with insufficient intake. Rationale 2: Muscle wasting is a common finding associated with insufficient intake of food. Rationale 3: Confusion is an assessment finding associated with many disease processes and is not particular to insufficient intake. Rationale 4: Loss of subcutaneous fat supports the diagnosis of insufficient intake. Rationale 5: Insufficient intake would generally result in dry, flaky skin.

A client is to receive enteral nutrition. Which information should the nurse provide to the client and family? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Nutrition can be given either intermittently or continuously." 2. "Your nutrition will be administered through your veins." 3. "Enteral feedings are chosen when you cannot swallow enough to maintain nutrition." 4. "Most enteral feeding consists of thinned pureed food." 5. "Enteral feedings are milk based."

Correct Answer: 1,3 Rationale 1: Enteral products can be given intermittently by bolus or by continuous drip. Rationale 2: Parenteral nutrition is administered through the venous system. Enteral nutrition is delivered into the gastrointestinal tract. Rationale 3: Difficulty swallowing is often the reason enteral feedings are initiated. Rationale 4: Most enteral feeding is formula based. Rationale 5: Formulas consist of various combinations of proteins, carbohydrates, and lipids and are not milk based.

A nurse is providing administration instruction to the wife of a client going home on intermittent enteral nutrition. Which information should the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Clean the equipment between each feeding administration." 2. "Once mixed, enteral feeding should hang no more than 8 hours." 3. "Refrigerate any feeding that is not needed for a feeding." 4. "You may use plain tap water for scheduled tubing flushes." 5. "Keep the area around the insertion site clean."

Correct Answer: 1,3,4,5 Rationale 1: The equipment used to provide enteral feedings should be kept clean. Rationale 2: Enteral feedings should hang no more than 4 hours. Rationale 3: Unused feeding should be refrigerated to prevent spoilage. Rationale 4: Plain water is acceptable for tubing flushes. Rationale 5: The area around the insertion site should be kept clean.

The physician prescribes multivitamins for the client. The client asks the nurse why she needs vitamins. What will the best teaching plan by the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Small amounts of vitamins are needed for health. 2. Vitamins will heal many illnesses. 3. Vitamins are inorganic compounds that are not stored in the body. 4. Your body cannot synthesize most vitamins. 5. Vitamins are needed for growth and maintenance of normal metabolic processes.

Correct Answer: 1,4,5 Rationale 1: Vitamins are organic compounds. They are needed for health. Rationale 2: Vitamins are great nutritional support, but there are very few illnesses that vitamins will heal. Rationale 3: Vitamins are organic compounds, but many are stored in the body. Rationale 4: Only vitamin D can be synthesized. Rationale 5: Vitamins are needed for growth and maintenance of normal metabolic processes.

The client is a vegetarian. What information would the nurse give the client as it relates to the avoidance of vitamin deficiencies? 1. A vegetarian diet is adequate to meet all of your needs, so there should be no vitamin deficiencies. 2. Look at the types of foods eaten on the vegetarian diet and evaluate for possible vitamin B12 sources. 3. Increasing fluids and fiber with the vegetarian diet will help prevent vitamin deficiencies. 4. You are at risk for vitamin C deficiencies by following a vegetarian diet.

Correct Answer: 2 Rationale 1: A vegetarian diet may not be adequate; it depends on the type of vegetarian diet the client is following. Rationale 2: Vitamin B12 is found only in animal sources, but this does include eggs and dairy products. Some vegetarian diets allow eggs and/or dairy products. Rationale 3: Increasing fluids and fiber will not help correct any vitamin deficiencies. Rationale 4: A vegetarian diet is almost never deficient in vitamin C as this vitamin is plentiful in fruits and vegetables.

A pregnant client asks the nurse if she can take vitamin supplements in addition to her prenatal vitamins. What is the best response by the nurse? 1. "As long as you meet the recommended daily allowance (RDA) requirements, there will be no problem." 2. "The prenatal vitamins supply all the vitamins you need during your pregnancy." 3. "This is dangerous; we need to do an ultrasound of your baby." 4. "Bring in your vitamins on the next visit so we can include them in your chart."

Correct Answer: 2 Rationale 1: Additional vitamins could lead to toxicity; the client should not take additional vitamin supplements as the RDA requirements are met by the prenatal vitamins. Rationale 2: Prenatal vitamins supply all the vitamins a client needs during a pregnancy; there is no need for additional supplementation. Rationale 3: An ultrasound of the baby is premature, and this comment would unnecessarily alarm the client. Rationale 4: Additional vitamins could lead to toxicity and be dangerous for the fetus; the nurse should not tell the client the vitamins will be included in the chart.

A patient who is obese says, "I have been taking orlistat (alli) that I buy over-the-counter at my drugstore. The nurse would review the patient's medical record for use of which medication? 1. Aspirin 2. Warfarin (Coumadin) 3. Vitamin C 4. Ibuprofen

Correct Answer: 2 Rationale 1: Aspirin is not contraindicated with orlistat (alli). Rationale 2: Warfarin (Coumadin) absorption is affected by orlistat (alli). Rationale 3: Vitamin C is not contraindicated with orlistat (alli). Rationale 4: Ibuprofen is not contraindicated with orlistat (alli).

The nurse assesses which client as being at greatest risk for developing vitamin deficiencies? 1. The young male client who takes phenytoin (Dilantin) for new-onset epilepsy 2. The young female client who uses oral contraceptives for birth control 3. The young male client who eats a well-balanced diet and does not take vitamins 4. The young pregnant female client who is taking prenatal vitamins

Correct Answer: 2 Rationale 1: Certain anticonvulsants can be associated with B complex deficiencies, but the client is just starting therapy so he is not at great risk. Rationale 2: The use of oral contraceptives is associated with deficiencies of B complex vitamins. Rationale 3: Most nutritional demands can be met with a well-balanced diet. Rationale 4: The prenatal vitamins will meet all the vitamin requirements of the pregnant female.

The nurse is planning care for a client who receives total parenteral nutrition. What will the best plan by the nurse include? 1. Check the feeding tube for residual prior to initiating feedings. 2. Remove the solution from the refrigerator 30 minutes prior to hanging. 3. Withhold oral medications while the total parenteral nutrition (TPN) is hanging. 4. Maintain a dedicated percutaneous endoscopic gastrostomy (PEG) tube for the solution.

Correct Answer: 2 Rationale 1: Checking the tube for residual is done with enteral feedings, not parenteral feedings. Rationale 2: A cold infusion could cause irritation to the intravenous (IV) site. Rationale 3: The client can continue to receive oral medications while total parenteral nutrition (TPN) is infusing. Rationale 4: Parenteral infusions are done through an intravenous (IV) line, not a percutaneous endoscopic gastrostomy (PEG) tube.

The client has preeclampsia and might require magnesium sulfate therapy. Which assessment is a critical assessment parameter by the nurse? Which assessment does the nurse prioritize? 1. Fetal heart sounds 2. Deep tendon reflexes 3. Peripheral edema 4. Breath sounds

Correct Answer: 2 Rationale 1: Fetal heart sounds, although always important, are not the critical assessment in this situation. Rationale 2: A decrease in deep tendon reflexes indicates that the client has a low magnesium level. This puts the client at risk for seizures related to preeclampsia. Rationale 3: Peripheral edema is not a critical assessment in this situation. Rationale 4: Breath sounds, although always important, are not the critical assessment in this situation.

The client is receiving enteral nutrition. He reads on the bag hanging at his bedside that the liquid is a polymeric formulation. He asks the nurse what this means. What is the best response by the nurse? 1. "It means that your formulation requires little or no digestion." 2. "It means that your formulation is meant for patients who are generally undernourished but whose gastrointestinal tract is still working." 3. "It means that your formulation is lactose free and low fat." 4. "It means that your formulation contains a single nutrient, protein, lipid, or carbohydrate."

Correct Answer: 2 Rationale 1: Oligomeric formulations are agents containing varying slightly larger molecules such as free amino acids and peptide combinations that require little or no digestion. Rationale 2: Polymeric formulations are the most common enteral preparations. These products contain various mixtures of proteins, carbohydrates, and lipids and are used in patients who are generally undernourished but have a fully functioning GI tract. Rationale 3: Elemental or monomeric formulas include products that are usually lactose free and contain a small percentage of calories from fats. Rationale 4: Modular formulations contain a single nutrient, protein, lipid, or carbohydrate.

Deficiencies in cyanocobalamin (B12) can result in 1. pellagra. 2. pernicious anemia. 3. rickets. 4. scurvy.

Correct Answer: 2 Rationale 1: Pellagra is a deficiency of niacin. Rationale 2: Cyanocobalamin (B12) deficiency can result in pernicious or megaloblastic anemia, and can require pharmacotherapy. Rationale 3: Rickets is vitamin D deficiency. Rationale 4: Scurvy is a deficiency of vitamin C.

The client is receiving total parenteral nutrition (TPN). What does the best plan by the nurse include to prevent complications from total parenteral nutrition? 1. Assess the client's potassium levels. 2. Assess the client's blood glucose levels. 3. Assess the client's mental status. 4. Assess the client's blood pressure.

Correct Answer: 2 Rationale 1: The client's potassium levels are not as likely to be affected by total parenteral nutrition (TPN). Rationale 2: Hyperglycemia may occur, as total parenteral nutrition (TPN) solutions contain concentrated amounts of glucose. Rationale 3: The client's mental status should not be affected by total parenteral nutrition (TPN). Rationale 4: Blood pressure is not an essential assessment because of total parenteral nutrition (TPN).

A patient who has been prescribed orlistat (Alli) for control of obesity has ordered dry toast, jelly, and orange juice for breakfast. What adjustment should the nurse make, if any, in the dose of orlistat? 1. Reduce the dose by half 2. Hold the pre-breakfast dose 3. Double the pre-breakfast dose 4. Give the normal dose

Correct Answer: 2 Rationale 1: The dose will not be reduced by half. Rationale 2: Orlistat should be held if the meal does not contain fat. Rationale 3: The dose should not be doubled. Rationale 4: An adjustment of dose is necessary.

The nurse teaches older adults at a community center about the effectiveness of vitamin C in preventing the common cold. The nurse evaluates that learning has occurred when an older adult makes which statement? 1. "Vitamin C, in the form of orange juice, is the most effective aid in preventing the common cold." 2. "There is no proof that vitamin C prevents the common cold." 3. "Vitamin C is only effective in preventing the common cold if 2 grams/day are taken." 4. "Vitamin C must be taken prior to the onset of the cold to be most effective."

Correct Answer: 2 Rationale 1: There is no clinical evidence to support that orange juice is the most effective form of vitamin C in preventing the common cold. Rationale 2: The ability of vitamin C to prevent the common cold has not been definitely proved. Rationale 3: The efficacy of vitamin C against the common cold has not been proven. Rationale 4: There is no evidence to support that vitamin C must be taken before a cold in order to be effective.

The nurse works in an obesity clinic and is screening patients for use of anorexiant medications. The nurse would evaluate that which patients could potentially be prescribed one of these drugs? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A patient who has a BMI of 26. 2. A patient who has a BMI of 30. 3. A patient who has a BMI of 28 and has hypertension. 4. A patient who has a BMI of 27 and has osteoarthritis.

Correct Answer: 2,3 Rationale 1: The criterion for BMI is 30. Rationale 2: The criterion for BMI is 30. Rationale 3: Patients with a BMI of 27 or over who has hypertension meets the criterion. Rationale 4: Osteoarthritis is not an inclusion factor. Rationale 5: The lowest BMI of 27 is the lowest inclusion criterion.

Which clinical conditions would the nurse most likely associate with a client who has a documented history of alcoholism? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Carbohydrate deficiency 2. Thiamine deficiency 3. Scurvy 4. Vitamin A deficiency 5. Pellagra

Correct Answer: 2,3,4,5 Rationale 1: Alcohol is high in carbohydrates. Rationale 2: Thiamine deficiency is commonly seen in alcoholic clients. Rationale 3: Alcoholics are among those at highest risk for vitamin C deficiency or scurvy. Rationale 4: Vitamin A deficiency is caused by prolonged dietary deprivation that may occur in alcoholism. Rationale 5: Pellagra is a niacin deficiency that is commonly seen in alcoholic clients

A client who weighs 245 pounds and has a BMI of 32 kg/m2 has been prescribed diethylpropion (Tenuate). The nurse states the drug will be discontinued if the client weighs more than ____ pounds at the end of the first month of treatment.

Correct Answer: 241 Rationale: Diethylpropion (Tenuate) is one of the oldest medications for weight loss. Given orally, its use is limited to 12 weeks of therapy. If the patient has not lost at least four pounds after the first month of therapy, treatment will be discontinued

Vitamins are organic substances needed in 1. large amounts to decrease cell size. 2. large amounts to promote health. 3. small amounts to promote growth. 4. small amounts to increase cell size.

Correct Answer: 3 Rationale 1: Cells do not supply vitamins; they are needed in the diet. Rationale 2: Vitamins are not needed in large amounts. Rationale 3: Vitamins are needed in small amounts to promote growth and maintain health. Rationale 4: Cells do not supply vitamins; they are needed in the diet.

Which vitamin can be toxic if consumed in large amounts? 1. Niacin 2. Vitamin C 3. Vitamin A 4. Folic acid

Correct Answer: 3 Rationale 1: Niacin is vitamin B and therefore water soluble. Rationale 2: Vitamin C is a water-soluble vitamin and cannot be toxic. Rationale 3: Vitamin A is lipid-soluble and can be toxic in large amounts. Rationale 4: Folic acid is a B vitamin and is water soluble.

Vitamin C is necessary for the 1. maintenance of vision. 2. regulation of digestion. 3. development of bones and teeth. 4. manufacture of platelets.

Correct Answer: 3 Rationale 1: Vision is maintained by vitamin A. Rationale 2: Vitamin B helps with metabolic processes, such as digestion. Rationale 3: Vitamin C is necessary for development of bones, teeth, and blood vessels. Rationale 4: Vitamin C is not essential in the manufacturing of platelets

The nurse teaches new mothers about the reason their infants receive vitamin K. The nurse evaluates instruction as being effective when the mother makes which statement? 1. "Babies do not need an injection of vitamin K unless bleeding is observed." 2. "Babies will be able to get enough vitamin K through breast milk." 3. "Babies do not have enough intestinal bacteria to synthesize vitamin K." 4. "Babies could receive vitamin K through a liquid or an injection."

Correct Answer: 3 Rationale 1: Vitamin K injection must be used before bleeding is observed in the infant. Rationale 2: Vitamin K is not present in high enough amounts in breast milk to protect the infant from bleeding. Rationale 3: The infant's gut is sterile, so there are inadequate bacteria to synthesize vitamin K, which is essential to promote blood clotting. Rationale 4: The stimulus for vitamin K rests with an injection, not a liquid form, to promote blood clotting and stimulate intestinal synthesis of the vitamin.

A client is prescribed total parenteral nutrition (TPN). Which education should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "You will not be able to return home until the TPN is discontinued." 2. "Once you go home, you will come in twice a week for TPN." 3. "Since this is going to be a long-term treatment, your TPN will be given through a central line." 4. "Your TPN will be infused via an infusion pump." 5. "All of your nutrition can be supplied by TPN."

Correct Answer: 3,4,5 Rationale 1: TPN can be managed at home. Rationale 2: TPN is administered continuously. Rationale 3: Long-term therapy is provided through a central line. Rationale 4: TPN must be monitored closely, so an infusion pump is necessary. Rationale 5: TPN supplies all of a client's nutrition.

The nurse is aware that efficient absorption of calcium is assisted by 1. intrinsic factor. 2. coenzymes. 3. phosphorus. 4. vitamin D.

Correct Answer: 4 Rationale 1: Efficient absorption of calcium is not associated with intrinsic factor. Rationale 2: Efficient absorption of calcium is not associated with coenzymes. Rationale 3: Efficient absorption of calcium is not associated with phosphorus. Rationale 4: Efficient absorption of calcium is assisted by vitamin D.

The nurse teaches young females in college about the importance of vitamins for anyone planning on becoming pregnant. Which vitamin does the nurse include as being most essential in the prevention of neural tube defects in a fetus? 1. Thiamine 2. Niacin 3. Riboflavin 4. Folic acid

Correct Answer: 4 Rationale 1: Folic acid, not thiamine, is the vitamin that is essential for the prevention of neural tube defects in a fetus. Rationale 2: Folic acid, not niacin, is the vitamin that is essential for the prevention of neural tube defects in a fetus. Rationale 3: Folic acid, not riboflavin, is the vitamin that is essential for the prevention of neural tube defects in a fetus. Rationale 4: Folic acid is the vitamin that is essential for the prevention of neural tube defects in a fetus.

The client has been consuming very high amounts of vitamin A. He asks the nurse why this is a problem since it is just a vitamin. What is the best response by the nurse? 1. "Water-soluble vitamins like vitamin A are readily excreted in your urine." 2. "It really isn't a problem; your body will just get rid of the excess vitamins." 3. "It's okay to take what you want; just cut back if you experience side effects." 4. "Fat-soluble vitamins like vitamin A are stored in your body and too much can be toxic."

Correct Answer: 4 Rationale 1: Vitamin A is a fat-soluble vitamin and is not readily excreted in the urine; only the water-soluble vitamins like B and C will be excreted in the urine. Rationale 2: Fat-soluble vitamins can be stored in large quantities in the liver and adipose tissue. This storage may lead to dangerously high levels if taken in excessive amounts. Rationale 3: By the time the client experiences side effects, toxicity has occurred, so this is bad advice. Rationale 4: Fat-soluble vitamins can be stored in large quantities in the liver and adipose tissue. This storage may lead to dangerously high levels if taken in excessive amounts.