Chapter 4: The Nursing Process in Drug Therapy and Patient Safety

True or False: A nursing diagnosis indicates a patient's problem that requires collaborative intervention.

False (Rationale: A nursing diagnosis identifies an actual or potential problem unique to nursing intervention.)

True or False: The right route of the drug is usually determined by the drug's formulation.

True (Rationale: The formulation of the drug determines by what route it should be given. For example, insulin is destroyed by stomach acids and cannot be given orally so it must be given parenterally.)

What activity would a nurse do first? a. Determine that drug has stabilized blood glucose levels. b. Identify a priority problem. c. Ask the patient about any chronic conditions. d. Teach a patient about a drug's adverse effects.

c. Ask the patient about any chronic conditions. (Rationale: Asking about chronic conditions would be part of assessment and completed first. Teaching would occur during implementation. Problem identification occurs during the nursing diagnosis step, after assessment. Determining effectiveness of therapy is part of evaluation, the last step of the nursing process.)

A nurse is performing the following activities. Place them in their proper sequence based on the steps in the nursing process. -Instructing the patient to take the medication with meals. -Questioning the patient about the use of over-the-counter medications. -Identifying if the patient is at risk for skin breakdown. -Obtaining the patient's weight. -Analyzing the patient for changes in his condition.

1. Questioning the patient about the use of over-the-counter medications. 2. Obtaining the patient's weight. 3. Identifying if the patient is at risk for skin breakdown. 4. Instructing the patient to take the medication with meals. 5. Analyzing the patient for changes in his condition. (Rationale: When following the nursing process, the nurse first questions the patient about the use of over-the-counter medications, Then, the nurse obtains the patient's weight. The nurse then identifies if the patient is at risk for skin breakdown. Then, the nurse instructs the patient to take the medication with meals. Finally, the nurse analyzes.)

True or False: Most institutions have their own policies for reporting medication errors.

True (Rationale: Facilities have their own policy related to how medication errors are to be handled including who it should be reported to, when it should be reported, and the required paperwork to be completed.)

True or False: A nurse should teach parents to call their child's health care provider if the child seems to be getting worse even with drug therapy.

True (Rationale: One of the teaching points included with medication teaching is when to notify the health care provider. The appearance of common adverse effects, lack of improvement within a specified period of time, or signs of allergic reaction are all things the parents should be taught to report.)

A nurse is teaching parents of a child who is to receive drug therapy. What instructions will the nurse include? a. "Tell your health care provider about all the medicines that your child is taking." b. "Use a common household teaspoon or tablespoon to administer the liquid medication." c. "Use the same medication that you use for adult problems, but just adjust the dose." d. "Over-the-counter medicines are usually safe, so don't hesitate to use them together."

a. "Tell your health care provider about all the medicines that your child is taking." (Rationale: Health care providers don't always know what a child is taking if multiple providers are involved or over-the-counter medications are administered, so parents need to keep a list of all medications given to a child including prescription, over-the-counter, and herbal medicines. Liquid medications should be measured with appropriate measuring devices such as a measured dosing devise or spoon from a measuring set. A household teaspoon or tablespoon should not be used because the amounts are highly variable. Adult medications should never be used to treat a child. The body organs and systems of children are very different from those of an adult. Parents should read all labels before giving a child a drug, including over-the-counter medicines, because many of these contain similar ingredients, which could potentially lead to accidental overdose.)

The patient receives a medication for pain and says they know this drug will be very effective in making them feel better. The nurse suspects this drug will be more effective than normal because of what effect? a. Placebo effect b. Therapeutic effect c. Adverse effect d. Renal effect

a. Placebo effect (Rationale: Patients who expect a drug is going to work well are far more likely to have their expectations met according to the placebo effect. Adverse effects are negative effects that occur as a result of the medication. Therapeutic effect is the effect for which the drug is administered. Renal effect is a distractor.)

A public warning has been issued about medication errors involving sound-alike drug names. Where would the nurse expect this warning to have come from? a. U.S. Pharmacopeia b. Institute for Safe Medication Practices c. Food and Drug Administration (FDA) d. Drug manufacturer

a. U.S. Pharmacopeia (Rationale: The U.S. Pharmacopeia (USP) is responsible for coordinating national reporting programs and gathering information about errors to prevent recurrence at other health care sites and by other health care providers. These reports can lead to the issue of health care provider warnings. Medication error reports are shared with the FDA, drug manufacturer, and the Institute for Safe Medication Practices.)

When a medication error occurs, who would the nurse report to first? a. Drug manufacturer b. Employing institution c. Institute for Safe Medication Practices d. Food and Drug Administration

b. Employing institution (Rationale: If a nurse sees or participates in a medication error, the nurse first reports the error to the institution and then to the national reporting program. The report will then be shared with the FDA, the manufacturer, and Institute for Safe Medication Practices.)

What decision-making, problem-solving process do nurses use to provide efficient and effective care? a. Scientific method b. Nursing process c. Think tanks d. Critical thinking

b. Nursing process (Rationale: The nursing process is used by nurses as the decision-making, problem-solving process to provide efficient and effective care. Part of using the nursing process effectively is the need for critical thinking. The nursing process is based on and adapted from the scientific method. Think tanks are not usually used in nursing.)

What types of nursing intervention are involved in drug therapy? (Select all that apply.) a. Identification of a problem b. Provision of comfort c. Patient education d. Drug administration e. Collection of data

b. Provision of comfort c. Patient education d. Drug administration (Rationale: Nursing interventions related to drug therapy include provision of comfort, patient education, drug administration, and documentation of administration. Identification of a problem occurs in the nursing diagnosis phase and collection of data occurs during assessment and evaluation.)

What nursing diagnosis would be most appropriate for a patient who is experiencing drowsiness and fatigue related to adverse effects of drug therapy? a. Bathing self-care deficit b. Risk for injury c. Impaired physical mobility d. Risk for imbalanced fluid volume

b. Risk for injury (Rationale: Drowsiness and fatigue can interfere with the patient's ability to function, placing the patient at risk for injury. Risk for imbalanced fluid volume would be appropriate if the patient was experiencing increased loss or fluid retention due to drug therapy. Ability to function may be affected by the drowsiness and fatigue but safety would be the priority. Mobility may be affected by the patient's complaints, but safety would be the priority.)

Pediatric dosages are determined based on what assessment data collected by the nurse? a. Age b. Weight c. Ethnicity d. Family history

b. Weight (Rationale: Weight is the primary means of determining the best dosage of medication for the pediatric patient. Age can be an indicator of weight in some children, but the obese child, the child born prematurely, or the child born to short parents often has a weight that is not in keeping with others of the same age.)

The nurse admits a patient suspected of using street drugs. The nurse asks the patient, "Do you take any medication?" The patient says "No." The nurse asks, "When I ask if you take medication, I mean street drugs, over-the-counter drugs, prescription medications, vitamins, minerals, or alternative therapy." The patient says, "No, I don't take any medications at all." How would the nurse explain the need to know? a. "I suspect you are taking medications that you aren't telling me about and that could be very dangerous." b. "I can't help you withdraw safely from illegal street drugs if I don't know what you are taking." c. "Drugs often have an effect on other drugs so it is important to know what you take before I give you any additional medications." d. "Giving you the wrong medication if you are using street drugs could be fatal for you so you must tell me what you are taking."

c. "Drugs often have an effect on other drugs so it is important to know what you take before I give you any additional medications." (Rationale: It is important to the safety of the patient to know about any drug the patient may be taking because there is a potential for a drug-drug or drug-alternative therapy interaction. Administering the needed medication to treat his condition would not be safe if not all medications are known. However, the nurse only suspects street drug usage, so the best approach is to explain why you need the information without confronting him, sharing your suspicions, or frightening him. When the nurse explains why the information is needed, the patient can make an informed decision about whether or not to share his personal information with the nurse.)

The nurse is teaching a patient about his drug therapy regimen before being discharged. The nurse is emphasizing safety in the home setting. Which statement by the patient indicates a need for additional teaching? a. "The drugs that the doctor prescribed are used to control my blood pressure." b. "I need to take the medicines like the doctor said, before each meal and at bedtime." c. "I will make sure to store the medications in the bathroom medicine chest." d. "I'll keep a written record of all medicines, prescription or otherwise, that I take."

c. "I will make sure to store the medications in the bathroom medicine chest." (Rationale: Storage in the bathroom, which is hot and humid, may cause drugs to break down faster. Drugs should be stored in a cool, dry place. The patient should keep a list of all drugs taken, including prescription, over-the-counter, and herbal preparations. The patient should know and follow the directions for taking the drug to ensure the maximum effectiveness. The patient should understand what each drug is being used to treat to ensure a better understanding of what to report, what to watch for, and when to report signs.)

A patient receiving drug therapy that increases urinary elimination comes to the clinic complaining of waking up numerous times during the night to urinate. What question would be a priority for the nurse to ask? a. "What is the dosage of your medication?" b. "Have you had any other complaints?" c. "When are you taking your medication?" d. "Are you taking any herbal medicines?"

c. "When are you taking your medication?" (Rationale: The patient's complaints suggest that the drug's peak effect is occurring during sleep, which would lead the nurse to suspect that the patient is taking the medication before bedtime. The nurse would need to confirm that this is true before questioning the patient further about the dosage or other complaints. Asking about herbal medicines is appropriate with any drug therapy but is not the priority in this situation.)

A patient is experiencing difficulty swallowing a large oral tablet. What action by the nurse would be most appropriate? a. Have the patient drink a large glass of water to aid in swallowing. b. Ask the prescriber to change the medication to parenteral form. c. Check to see if the drug can be crushed or mixed with food. d. Contact the pharmacy to order the drug in liquid form.

c. Check to see if the drug can be crushed or mixed with food. (Rationale: Not all drugs can be crushed, chewed, or cut. The nurse needs to consult a reputable reference to see if this is possible. Parenteral administration is invasive and should be avoided if there are other options. Some drugs are not available in parenteral form. Patients with physical problems making swallowing difficult would not be aided by drinking more water. Even healthy patients who have trouble swallowing are often not helped by drinking more water. The nurse cannot change the form of the medication without a prescriber's order because this is outside the scope of practice of the nurse.)

Who most often serves as the final check in the drug regimen process? a. Physician b. Medical assistant c. Nurse d. Pharmacist

c. Nurse (Rationale: The nurse serves as the final check in the drug regimen process because the nurse is the one who administers the drug and is responsible for educating the patient.)

An instructor is teaching a group of students about patient education and drug therapy. The instructor determines a need for additional instruction when the students identify what as an important area to include in a patient teaching plan? a. Administration scheduling b. Alternative therapies to avoid c. Steps to report a drug error d. Drug toxicity warning signs

c. Steps to report a drug error (Rationale: Patients are not responsible for reporting medication errors and that would be inappropriate to include in patient teaching plan. Warning signs would be an important aspect to include in a patient education plan. Information about possible interactions with alternative therapies and those to avoid would be an important aspect of a patient teaching plan. Information about the administration schedule would be an important aspect of a patient teaching plan.)

A student asks a nurse why it is important to determine the patient's education level before administering medications. Which response by the nurse would be most appropriate? a. "Most of the patient education material is written at a high school level." b. "We need to know if additional help will be necessary for teaching the patient." c. "The patient may not be able to read the pamphlets that we give to him." d. "It helps ensure that we develop a teaching plan that is appropriate for the patient."

d. "It helps ensure that we develop a teaching plan that is appropriate for the patient." (Rationale: Gathering information about the patient's level of understanding about his or her condition, illness, or drug therapy helps the nurse determine where the patient is in terms of his or her status and the level of explanation that will be required. It also provides additional baseline information for developing a patient education program.)

When describing the nursing process to a group of new students, what would the instructor likely include? a. "It allows information gathering about a patient's current status." b. "It is a method for determining a patient's priority needs." c. "It is a continuous linear approach to problem solving." d. "It involves a set of sequential yet dynamic and cyclical steps."

d. "It involves a set of sequential yet dynamic and cyclical steps." (Rationale: The nursing process is a continuous, dynamic, cyclical method of problem solving that follows a set of sequential steps to ensure that the patient receives the best, safest, most efficient, scientifically based, and holistic care. The nursing process is continuous, but it is not a static or strictly linear approach because the steps overlap and are interrelated. Priority needs are determined from assessment and are just one aspect of the nursing process. Information is primarily gathered during assessment and it is just one aspect of the nursing process.)

What is most likely to occur during the implementation step of the nursing process? a. Determining the patient's level of understanding b. Questioning the patient about his financial resources c. Obtaining information about the patient's chronic condition d. Documenting medications that were administered

d. Documenting medications that were administered (Rationale: Administration of medication and documentation occurs during the implementation phase. Information about the patient's chronic condition would be obtained during assessment. Information about the patient's level of understanding would be obtained during the evaluation phase of the nursing process. Information about the patient's financial resources would be obtained during assessment.)

A nurse identifies the following: Risk for injury to central nervous system effects of the prescribed drug therapy. The nurse engaged in which step of the nursing process? a. Implementation b. Assessment c. Evaluation d. Nursing diagnosis

d. Nursing diagnosis (Rationale: In the nursing diagnosis step, the nurse identifies actual and potential problems, such as risk for injury. Assessment is the first step of the nursing process that involves information gathering via a history and physical examination. Implementation involves setting goals and desired patient outcomes and interventions to achieve these goals. Evaluation involves determining the effectiveness of therapy, including the therapeutic response, occurrence of adverse effects, and interactions.)

A nurse is completing the first step of the nursing process. What activity would the nurse be performing? a. Determining the therapeutic response to the drug b. Administering the prescribed drug c. Identifying actual patient problems d. Obtaining a medication history

d. Obtaining a medication history (Rationale: History and physical examination are completed during assessment, the first step of the nursing process. Problem identification is completed during the nursing diagnosis step, the second step of the nursing process. Drug administration is performed during the implementation step, the third step of the nursing process. Determining the response to drug therapy is completed during evaluation, the last step of the nursing process.)