Pharm Ch. 8
The nurse is developing a plan of care for a patient who has chronic lung disease and hypoxia. The patient has been admitted for increased oxygen needs above a baseline of 2 L/min. The nurse develops a goal stating,The patient will have oxygen saturations of > 95% on room air at the time of discharge from the hospital. What is wrong with this goal? a. It cannot be evaluated. b. It is not measurable. c. It is not patient-centered. d. It is not realistic.
ANS: D This goal is not realistic because the patient is not usually on room air and should not be expected to attain that goal by discharge from this hospitalization.
The nurse is developing a teaching plan for an elderly patient who will begin taking an antihypertensive drug that causes dizziness and orthostatic hypotension. Which nursing diagnosis is appropriate for this patient? a. Deficient knowledge related to drug side effects b. Ineffective health maintenance related to age c. Readiness for enhanced knowledge related to medication side effects d. Risk for injury related to side effects of the medication
ANS: D This patient has an increased risk for injury because of drug side effects, so this is an appropriate nursing diagnosis.
An adolescent patient who has acne is given a regimen of topical medications and an oral antibiotic that generally clears up lesions to fewer than 10 within 6 to 8 weeks. At a 2-month follow-up, the patient continues to have more than 25 lesions. The child's parent affirms that the child is using the medications as prescribed.Which evaluation statement is correct for this patient? a. Goal of fewer than 10 lesions in 6 to 8 weeks is not met. b. Goal that the medication will be effective is not met. c. Goal that the patient will take medications as prescribed is not met. d. Goal that the patient understands the medication regimen is not met.
ANS: A All indications are that this patient is taking the medications and they are not effective. The first statement is correct because it identifies a measurable goal and a specific time frame.
The nurse is performing an admission assessment on an 80-year-old patient who has frequent hospital admissions. The patient appears more disoriented and confused than usual. Which action by the nurse is correct? a. Asking about medication doses b. Asking for a neurologist consult c. Requesting orders for liver function tests d. Suspecting impaired renal function
ANS: A An initial sign of drug toxicity in elderly patients may be confusion or changes in behavior. The nurse should ask about drug doses and notify the provider of the behaviors. The provider may order further evaluation based on examination of the patient. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 95 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
The nurse is preparing to administer a medication and reviews the patients chart for drug allergies, serum creatinine, and blood urea nitrogen (BUN) levels. The nurses actions are reflective of which phase of the nursing process? a. Assessment b. Evaluation c. Implementation d. Planning
ANS: A Assessment involves gathering information about the patient and the drug, including any previous use of the drug
The nurse learns that a patient cannot afford a prescribed medication and enlists the assistance of the social worker and an outside agency to provide medications at a lower cost. Which QSEN competency do the nurses actions best demonstrate? a. Collaboration and teamwork b. Evidence-based practice c. Patient-centered care d. Quality improvement
ANS: A Collaboration and teamwork involve interprofessional communication and shared decision-making to provide patient care.
A 5-year-old child with type 1 diabetes mellitus has repeated hospitalizations for episodes of hyperglycemia related to poor control. The parents tell the nurse that they cant keep track of everything that has to be done to care for their child. The nurse reviews medications, diet, and symptom management with the parents and draw up a daily checklist for the family to use. This is an example of the principles outlined in... a. Guiding Principles of Patient Engagement. b. National Alliance for Quality Care. c. Nursing Process. d. Quality and Safety Education for Nurses.
ANS: A Guiding Principles of Patient Engagement address the dynamic partnership among patients, families, and health care providers.
An older patient who reports a 2- to 3-year history of upper gastrointestinal symptoms will begin taking ranitidine (Zantac) to treat this disorder. The patient has completed a health history form. The nurse notes that the patient answered "no" when asked if any medications were being taken. Which action will the nurse take next? a. Ask whether the patient uses over-the-counter (OTC) medications. b. Obtain a careful dietary history for the past two weeks. c. Recommend that the patient take antacid tablets. d. Suggest that the patient add high-potassium foods to the diet.
ANS: A Many patients do not think of OTC products as medications and often do not list them when asked about medication use. A patient who takes ranitidine along with an OTC antacid could be duplicating medications. A dietary history is important as well but would not be the most important action in this case. The nurse should not recommend antacid tablets or high-potassium foods. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 89 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
An 80-year-old patient is being treated for an infection. An order for which type of antibiotic would cause concern for the nurse caring for this patient? a. Aminoglycoside b. Cephalosporin c. Penicillin d. Sulfonamide
ANS: A Penicillins, cephalosporins, tetracyclines, and sulfonamides are normally considered safe for the older adult. Aminoglycosides are excreted in the urine and are not usually prescribed for patients older than 75 years. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 92 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Which drug properties are problematic for older patients? (Select all that apply.) a. Drugs with anticholinergic effects b. Drugs that are highly protein-bound c. Drugs with a short half-life d. Drugs that undergo hepatic conjugation e. Drugs with a narrow therapeutic range
ANS: A, B, E Older patients are more susceptible to drug side effects, especially those that cause anticholinergic effects. Older patients have a loss of protein-binder sites for drugs, so those that are highly protein-bound will have higher than usual serum levels and can cause toxicity. Drugs with a narrow therapeutic range require closer monitoring in all patients, but especially in older patients. Drugs with a short half-life are preferred because older patients have a decreased ability to metabolize and excrete drugs. Hepatic conjugation is usually not influenced by older age, liver diseases, or drug interaction. DIF: COGNITIVE LEVEL: Applying (Application) REF: Pages 89, 93 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
The nurse is preparing an 80-year-old patient for discharge home from the hospital. The patient will receive several new medications. The patient lives alone but has several family members who stop by every day. Which suggestions will the nurse make for this family? (Select all that apply.) a. Ask the pharmacy for non-childproof medication bottles. b. Ask the patient to record all medications and the times they are taken. c. Place the pills in an organizer container. d. Provide the patient with the drug manufacturer information sheets. e. Put water bottles near pills for convenience.
ANS: A, C, E To help older patients with compliance, medications should be convenient and easy to open. Asking the pharmacist for non-childproof containers will help make medications easier to get. Using an organizer container helps patients remember which drugs should be taken at what time. Placing water bottles nearby eliminates a step in the process and increases the likelihood that a medication will be taken on time. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 94 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
The nurse is caring for an 82-year-old patient who takes digoxin to treat chronic atrial fibrillation. When caring for this patient, to monitor for drug side effects, what will the nurse will carefully assess? a. Blood pressure b. Heart rate c. Oxygen saturation d. Respiratory rate
ANS: B Most of digoxin is eliminated by the kidneys, so a decline in kidney function can cause digoxin accumulation, which can cause bradycardia. Digoxin should not be given to any patient with a pulse less than 60 beats per minute. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 95 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Which assessment is categorized as objective data? a. A list of herbal supplements regularly used b. Lab values associated with drugs the patient is taking c. The ages and relationship to the patient of all household members d. Usual dietary patterns and intake
ANS: B Objective data are measured and detected by another person and would include lab values. The other examples are subjective data.
The nurse is caring for an 80-year-old patient who is taking warfarin (Coumadin). Which action does the nurse understand is important when caring for this patient? a. Encouraging the patient to rise slowly from a sitting position b. Initiating a fall-risk protocol c. Maintaining strict intake and output measures d. Monitoring blood pressure frequently
ANS: B Patients who take anticoagulants have an increased risk of hemorrhage. Older patients have an increased risk of falls that can lead to bleeding complications. Initiating a fall-risk protocol is important. Warfarin does not affect blood pressure and would not cause orthostatic hypotension. Warfarin does not alter urine output. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 92 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
To assist an older, confused patient to adhere to a multidrug regimen, the nurse will provide which recommendation? a. Avoid the use of over-the-counter medications. b. Bring all medications to each clinic visit. c. Review the manufacturer's information insert about each medication. d. Save money by getting each drug at the pharmacy with the lowest price.
ANS: B Patients who take multiple medications should be advised to bring medications to each clinic visit. Patients may take OTC medications as long as those are included in the list of medications reviewed by the provider. Manufacturers' inserts provide an overwhelming amount of information. Patients should be advised to use only one pharmacy. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 94 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
The nurse is caring for a 78-year-old patient who lives independently. The patient will begin a new drug regimen that requires taking multiple drugs at various times per day. Which intervention is appropriate for the nurse to implement with this patient? a. Ask the patient's family members to monitor the patient's drug regimen. b. Develop a log to record the times each drug will be taken. c. Reinforce the need to take the drugs as scheduled. d. Write the medication administration times on each prescription label.
ANS: B The patient should be advised to keep a medication record of drugs and when they will be taken. The patient is independent, and this helps maintain independence. Family member support is essential when older patients are confused. Reinforcing information without providing a means to keep track of the medications does not necessarily improve compliance. Writing medication times on prescription labels does not help to organize the medication schedule. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 96 TOP: NURSING PROCESS: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A 75-year-old patient is readmitted to the hospital to treat recurrent pneumonia. The patient had been discharged home with a prescription for antibiotics 5 days prior. The nurse admitting this patient will take which initial action? a. Ask the patient about over-the-counter drug use. b. Ask the patient how many doses of the antibiotic have been taken. c. Discuss increasing the antibiotic dose with the provider. d. Obtain an order for a creatinine clearance test.
ANS: B There are many reasons for non-adherence to a drug regimen in an older patient, so if a patient is readmitted, the nurse should first ascertain whether or not the medications have been used. Asking the patient how many doses have been taken will help to assess this. If it is determined that the patient is taking the drug as ordered, the other steps may be taken. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 94 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A school-age child will begin taking a medication to be administered 5 mL three times daily. The child's parent tells the nurse that, with a previous use of the drug, the child repeatedly forgot to bring the medication home from school, resulting in missed evening doses. What will the nurse recommend? a. Asking the provider if the medication may be taken before school, after school, and at bedtime b. Putting a note on the child's locker to encourage the child to take responsibility for medication administration c. Asking the provider if 7.5 mL may be taken in the morning and 7.5 mL may be taken in the evening so that the correct amount is given daily d. Taking the noon dose to school every day and giving it to the school nurse to administer
ANS: C For busy families with school-age children, it may be necessary to adjust the medication schedule to one that fits their schedule. The nurse should ask the provider if a revised schedule is possible. In this case, the revised schedule would involve not taking the medication while at school. Putting a note on the locker is not likely to be effective. It is not correct to adjust the dose.
A high-school student regularly forgets to use a twice-daily inhaled corticosteroid to prevent asthma flares and is repeatedly admitted to the hospital. The child's parent tells the nurse that the child has been told that forgetting to take the medication causes frequent hospitalizations. The nurse will... a. encourage the child to take responsibility for taking the medication. b. reinforce the need to take prescribed medications to avoid hospitalizations. c. suggest putting the inhaler with the child's toothbrush to use before brushing teeth. d. suggest that the child's parents administer the medication to increase compliance.
ANS: C It is important to empower patients to take responsibility for managing medications. Putting the medication with the toothbrush can help this child remember to use it. Telling the child to take medications and reminding the child that failure to do so results in hospitalization is not working. Asking the child's parents to administer the medication does not empower the adolescent to take responsibility.
The nurse provides teaching about the sedative side effects of a medication ordered to be given at 8:00 PM daily. The patient works a 7:00 PM to 7:00 AM shift. The nurse explores options including taking the medication at 8:00 AM instead of in the evening. Which QSEN competency do the nurses actions best demonstrate? a. Collaboration and teamwork b. Evidence-based practice c. Patient-centered care d. Patient safety
ANS: C Patient-centered care recognizes the patient as the source of control and provides care based on respect for the patients preferences, values, and needs.
The nurse reviews a patients database and learns that the patient lives alone, is forgetful, and does not have an established routine. The patient will be sent home with three new medications to be taken at different times of day. The nurse develops a daily medication chart and enlists a family member to put the patients pills in a pill organizer. This is an example of which phase of the nursing process? a. Assessment b. Evaluation c. Implementation d. Planning
ANS: C The implementation phase involves education and patient care in order to assist the patient to accomplish the goals of treatment.
The nurse is caring for an older adult patient who is receiving multiple medications. When monitoring this patient for potential drug toxicity, the nurse should review which lab values closely? a. Complete blood count and serum glucose levels b. Pancreatic enzymes and urinalysis c. Serum creatinine and liver function tests (LFTs) d. Serum lipids and electrolytes
ANS: C With liver and kidney dysfunction, the efficacy of drugs is generally increased and may cause toxicity. The nurse should review serum creatinine levels to monitor renal function and LFTs to monitor hepatic function. The other lab tests may be ordered for specific drugs if they affect those body systems. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Pages 90-91 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
An older patient must learn to administer a medication using a device that requires manual dexterity. The patient becomes frustrated and expresses lack of self-confidence in performing this task. Which action will the nurse perform next? a. Ask the patient to keep trying until the skill is learned. b. Provide written instructions with illustrations showing each step of the skill. c. Schedule multiple sessions and practice each step separately. d. Teach the procedure to family members who can administer the medication for the patient.
ANS: C Nurses should be sensitive to patients level of frustration when teaching skills. In this case, breaking the steps down into individual parts will help with this patients frustration level
A patient will be sent home with a metered-dose inhaler, and the nurse is providing teaching. Which is a correctly written goal for this process? a. The nurse will demonstrate correct use of a metered-dose inhaler to the patient. b. The nurse will teach the patient how to administer medication with a metered-dose inhaler. c. The patient will know how to self-administer the medication using the metered-dose inhaler. d. The patient will independently administer the medication using the metered-dose inhaler at the end of the session.
ANS: D Goals must be patient-centered and clearly state the outcome with a reasonable deadline and should identify components for evaluation.
An older patient takes ibuprofen for arthritis pain. The patient tells the nurse that the ibuprofen causes gastrointestinal (GI) upset. Which action will the nurse take with this patient? a. Ask the provider about having the patient take a different medication. b. Instruct the patient to cut the ibuprofen dose in half to avoid GI upset. c. Explain that all drugs have adverse effects. d. Explore options to help decrease the drug side effects.
ANS: D Older adults are more likely to experience drug side effects, and nurses should be aware of measures that may decrease these side effects and thus improve adherence. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 94 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
The nurse is caring for an older patient who is taking 25 mg per day of hydrochlorothiazide. The nurse will closely monitor which lab value in this patient? a. Coagulation studies b. White blood count c. Liver function tests d. Serum potassium
ANS: D Older patients who take doses of hydrochlorothiazide between 25 to 50 mg/day have increased risk of electrolyte imbalances, so potassium should be monitored closely. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 95 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A 75-year-old patient will be discharged home with a prescription for an opioid analgesic. To help the patient minimize adverse effects, what will the nurse recommend for this patient? a. Sucking on lozenges to moisten oral mucosa b. Taking an antacid with each dose c. Taking the medication on an empty stomach d. Using a stool softener
ANS: D Opioid analgesics can cause constipation. Stool softeners can help minimize this effect. Opioids do not cause dry mouth. Drug absorption may be decreased with an antacid. Opioid analgesics should be taken with food or milk to decrease gastrointestinal irritation. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 93 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient who is hospitalized for chronic obstructive pulmonary disease wants to go home. The nurse and the patient discuss the patients situation and decide that the patient may go home when able to perform self-care without dyspnea and hypoxia. This is an example of which phase of the nursing process? a. Assessment b. Evaluation c. Implementation d. Planning
ANS: D Planning involves goal-setting which, for this patient, means being able to perform self-care activities without dyspnea and hypoxia.
