Pharmacology And the Nursing Process, 8th Edition by Linda Lane Lilley – Test Bank
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Sample
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Chapter 03: Lifespan Considerations
Lilley: Pharmacology and the Nursing Process, 8th Edition
MULTIPLE CHOICE
1. Drug
transfer to the fetus is more likely during the last trimester of pregnancy for
which reason?
|
a. |
Decreased fetal surface
area |
|
b. |
Increased placental surface
area |
|
c. |
Enhanced blood flow to the
fetus |
|
d. |
Increased amount of
protein-bound drug in maternal circulation |
ANS: C
Drug transfer to the fetus is more likely during the last
trimester as a result of enhanced blood flow to the fetus. The other options
are incorrect. Increased fetal surface area, not decreased, is a factor that
affects drug transfer to the fetus. The placenta’s surface area does not
increase during this time. Drug transfer is increased because of an increased
amount of free drug, not protein-bound drug, in the mother’s circulation.
DIF: COGNITIVE LEVEL: Understanding (Comprehension)
REF: p. 37
TOP: NURSING PROCESS:
General MSC: NCLEX: Health Promotion
and Maintenance
2. The
nurse is monitoring a patient who is in the 26th week of pregnancy and has
developed gestational diabetes and pneumonia. She is given medications that
pose a possible fetal risk, but the potential benefits may warrant the use of
the medications in her situation. The nurse recognizes that these medications
are in which U.S. Food and Drug Administration pregnancy safety category?
|
a. |
Category X |
|
b. |
Category B |
|
c. |
Category C |
|
d. |
Category D |
ANS: D
Pregnancy category D fits the description given. Category B
indicates no risk to animal fetus; information for humans is not available.
Category C indicates adverse effects reported in animal fetus; information for
humans is not available. Category X consists of drugs that should not be used
in pregnant women because of reports of fetal abnormalities and positive
evidence of fetal risk in humans.
DIF: COGNITIVE LEVEL: Understanding (Comprehension)
REF: p. 37
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Safe and Effective Care Environment: Safety
and Infection Control
3. When
discussing dosage calculation for pediatric patients with a clinical
pharmacist, the nurse notes that which type of dosage calculation is used most commonly
in pediatric calculations?
|
a. |
West nomogram |
|
b. |
Clark rule |
|
c. |
Height-to-weight ratio |
|
d. |
Milligram per kilogram of
body weight formula |
ANS: D
The milligram per kilogram formula, based on body weight, is the
most common method of calculating doses for pediatric patients. The other
options are available methods but are not the most commonly used.
Height-to-weight ratio is not used.
DIF: COGNITIVE LEVEL: Remembering (Knowledge)
REF: p. 39
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Health Promotion and Maintenance
4. The
nurse is assessing a newly admitted 83-year-old patient and determines that the
patient is experiencing polypharmacy. Which statement most accurately
illustrates polypharmacy?
|
a. |
The patient is experiencing
multiple illnesses. |
|
b. |
The patient uses one
medication for an illness several times per day. |
|
c. |
The patient uses
over-the-counter drugs for an illness. |
|
d. |
The patient uses multiple
medications simultaneously. |
ANS: D
Polypharmacy usually occurs when a patient has several illnesses
and takes medications for each of them, possibly prescribed by different
specialists who may be unaware of other treatments the patient is undergoing.
The other options are incorrect. Polypharmacy addresses the medications taken,
not just the illnesses. Polypharmacy means the patient is taking several
different medications, not just one, and can include prescription drugs,
over-the-counter medications, and herbal products.
DIF: COGNITIVE LEVEL: Understanding
(Comprehension) REF: p. 40
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and
Parenteral Therapies
5. The
nurse is aware that confusion, forgetfulness, and increased risk for falls are
common responses in an elderly patient who is taking which type of drug?
|
a. |
Laxatives |
|
b. |
Anticoagulants |
|
c. |
Sedatives |
|
d. |
Antidepressants |
ANS: C
Sedatives and hypnotics often cause confusion, daytime sedation,
ataxia, lethargy, forgetfulness, and increased risk for falls in the elderly.
Laxatives, anticoagulants, and antidepressants may cause adverse effects in the
elderly, but not the ones specified in the question.
DIF: COGNITIVE LEVEL: Understanding
(Comprehension) REF: p. 43
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Safety
and Infection Control
6. For
accurate medication administration to pediatric patients, the nurse must take into
account which criteria?
|
a. |
Organ maturity |
|
b. |
Renal output |
|
c. |
Body temperature |
|
d. |
Height |
ANS: A
To administer medications to pediatric patients accurately, one
must take into account organ maturity, body surface area, age, and weight. The other
options are incorrect; renal output and body temperature are not
considerations, and height alone is not sufficient.
DIF: COGNITIVE LEVEL: Understanding
(Comprehension) REF: p. 39
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Health Promotion and Maintenance
7. The
nurse recognizes that it is not uncommon for an elderly patient to experience a
reduction in the stomach’s ability to produce hydrochloric acid. This change
may result in which effect?
|
a. |
Delayed gastric emptying |
|
b. |
Increased gastric acidity |
|
c. |
Decreased intestinal
absorption of medications |
|
d. |
Altered absorption of
weakly acidic drugs |
ANS: D
Reduction in the stomach’s ability to produce hydrochloric acid
is an aging-related change that results in a decrease in gastric acidity and
may alter the absorption of weakly acidic drugs. The other options are not
results of reduced hydrochloric acid production.
DIF: COGNITIVE LEVEL: Applying
(Application)
REF: p. 42
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Health Promotion and Maintenance
8. The
nurse is administering drugs to neonates and will consider which factor may
contribute the most to
drug toxicity?
|
a. |
The lungs are immature. |
|
b. |
The kidneys are small. |
|
c. |
The liver is not fully
developed. |
|
d. |
Excretion of the drug
occurs quickly. |
ANS: C
A neonate’s liver is not fully developed and cannot detoxify
many drugs. The other options are incorrect. The lungs and kidneys do not play
major roles in drug metabolism. Renal excretion is slow, not fast, because of
organ immaturity, but this is not the factor that contributes the most to drug
toxicity.
DIF: COGNITIVE LEVEL: Understanding
(Comprehension) REF: p. 38
TOP: NURSING PROCESS:
Planning MSC: NCLEX: Health Promotion and
Maintenance
9. An
83-year-old woman has been given a thiazide diuretic to treat mild heart
failure. She and her daughter should be told to watch for which problems?
|
a. |
Constipation and anorexia |
|
b. |
Fatigue, leg cramps, and
dehydration |
|
c. |
Daytime sedation and
lethargy |
|
d. |
Edema, nausea, and blurred
vision |
ANS: B
Electrolyte imbalance, leg cramps, fatigue, and dehydration are
common complications when thiazide diuretics are given to elderly patients. The
other options do not describe complications that occur when these drugs are
given to the elderly.
DIF: COGNITIVE LEVEL: Understanding
(Comprehension) REF: p. 43
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and
Parenteral Therapies
10. An
elderly patient with a new diagnosis of hypertension will be receiving a new
prescription for an antihypertensive drug. The nurse expects which type of
dosing to occur with this drug therapy?
|
a. |
Drug therapy will be based
on the patient’s weight. |
|
b. |
Drug therapy will be based
on the patient’s age. |
|
c. |
The patient will receive
the maximum dose that is expected to reduce the blood pressure. |
|
d. |
The patient will receive
the lowest possible dose at first, and then the dose will be increased as
needed. |
ANS: D
As a general rule, dosing for elderly patients should follow the
admonition, “Start low, and go slow,” which means to start with the lowest
possible dose (often less than an average adult dose) and increase the dose
slowly, if needed, based on patient response. The other responses are
incorrect.
DIF: COGNITIVE LEVEL: Understanding
(Comprehension) REF: p. 40
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and
Parenteral Therapies
11. The nurse
is trying to give a liquid medication to a -year-old child and notes that the
medication has a strong taste. Which technique is the best way for the nurse to
give the medication to this child?
|
a. |
Give the medication with a
spoonful of ice cream. |
|
b. |
Add the medication to the
child’s bottle. |
|
c. |
Tell the child you have
candy for him. |
|
d. |
Add the medication to a cup
of milk. |
ANS: A
Ice cream or another nonessential food disguises the taste of
the medication. The other options are incorrect. If the child does not drink
the entire contents of the bottle, medication is wasted and the full dose is
not administered. Using the word candy with
drugs may lead to the child thinking that drugs are actually candy. If the
medication is mixed with a cup of milk, the child may not drink the entire cup
of milk, and the distasteful drug may cause the child to refuse milk in the
future.
DIF: COGNITIVE LEVEL: Applying
(Application)
REF: p. 45
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and
Parenteral Therapies
12. The
nurse is preparing to give an injection to a 4-year-old child. Which
intervention is age appropriate for this child?
|
a. |
Give the injection without
any advanced preparation. |
|
b. |
Give the injection, and
then explain the reason for the procedure afterward. |
|
c. |
Offer a brief, concrete
explanation of the procedure at the patient’s level and with the parent or
caregiver present. |
|
d. |
Prepare the child in
advance with details about the procedure without the parent or caregiver
present. |
ANS: C
For a 4-year-old child, offering a brief, concrete explanation
about a procedure just beforehand, with the parent or caregiver present, is
appropriate. The other options are incorrect for any age group.
DIF: COGNITIVE LEVEL: Applying
(Application)
REF: p. 39
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Psychosocial Integrity
MULTIPLE RESPONSE
1. Which
statements are true regarding pediatric patients and pharmacokinetics? (Select all that apply.)
|
a. |
The levels of microsomal
enzymes are decreased. |
|
b. |
Perfusion to the kidneys
may be decreased and may result in reduced renal function. |
|
c. |
First-pass elimination is
increased because of higher portal circulation. |
|
d. |
First-pass elimination is
reduced because of the immaturity of the liver. |
|
e. |
Total body water content is
much less than in adults. |
|
f. |
Gastric emptying is slowed
because of slow or irregular peristalsis. |
|
g. |
Gastric emptying is more
rapid because of increased peristaltic activity. |
ANS: A, B, D, F
In children, first-pass elimination by the liver is reduced
because of the immaturity of the liver, and microsomal enzymes are decreased.
In addition, gastric emptying is reduced because of slow or irregular
peristalsis. Perfusion to the kidneys may be decreased, resulting in reduced
renal function. The other options are incorrect. In addition, remember that
total body water content is greater in children than in adults.
DIF: COGNITIVE LEVEL: Applying
(Application)
REF: p. 38
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Health Promotion and Maintenance
2. Which
statements are true regarding the elderly and pharmacokinetics? (Select all that apply.)
|
a. |
The levels of microsomal
enzymes are decreased. |
|
b. |
Fat content is increased
because of decreased lean body mass. |
|
c. |
Fat content is decreased
because of increased lean body mass. |
|
d. |
The number of intact
nephrons is increased. |
|
e. |
The number of intact
nephrons is decreased. |
|
f. |
Gastric pH is less acidic. |
|
g. |
Gastric pH is more acidic. |
ANS: A, B, E, F
In the elderly, levels of microsomal enzymes are decreased
because the aging liver is less able to produce them; fat content is increased
because of decreased lean body mass; the number of intact nephrons is decreased
as the result of aging; and gastric pH is less acidic because of a gradual
reduction of the production of hydrochloric acid. The other options are
incorrect statements.
DIF: COGNITIVE LEVEL: Applying
(Application)
REF: p. 41
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Health Promotion and Maintenance
COMPLETION
1. A
7-year-old child will be receiving amoxicillin (Amoxil) 80 mg/kg/day in two divided
doses. The child weighs 55 pounds. The medication, once reconstituted, is
available as an oral suspension of 50 mg/mL. Identify how many milliliters will
the child receive per dose. _______
ANS:
20 mL
Convert pounds to kilograms: 55 pounds = 25 kg.
To get the amount per dose, divide 2000 by 2, which equals 1000
mg/dose.
To calculate the milliliters:
DIF: COGNITIVE LEVEL: Applying
(Application)
REF: N/A
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and
Parenteral Therapies
Chapter 04: Cultural, Legal, and Ethical Considerations
Lilley: Pharmacology and the Nursing Process, 8th Edition
MULTIPLE CHOICE
1. During
the development of a new drug, which would be included in the study by the
researcher to prevent any bias or unrealistic expectations of the new drug’s
usefulness?
|
a. |
A placebo |
|
b. |
FDA approval |
|
c. |
Informed consent |
|
d. |
Safety information |
ANS: A
To prevent bias that may occur as a result of unrealistic
expectations of an investigational new drug, a placebo is incorporated into the
study. The other options are incorrect. FDA approval, if given, does not occur
until after phase III. Informed consent is required in all drug studies. Safety
information is not determined until the study is under way.
DIF: COGNITIVE LEVEL: Understanding
(Comprehension) REF: p. 55
TOP: NURSING PROCESS: General
MSC: NCLEX: Safe and Effective Care Environment: Safety
and Infection Control
2. A
member of an investigational drug study team is working with healthy volunteers
whose participation will help to determine the optimal dosage range and
pharmacokinetics of the drug. The team member is participating in what type of
study?
|
a. |
Phase I |
|
b. |
Phase II |
|
c. |
Phase III |
|
d. |
Phase IV |
ANS: A
Phase I studies involve small numbers of healthy volunteers to
determine optimal dosage range and the pharmacokinetics of the drug. The other
phases progressively involve volunteers who have the disease or ailment that the
drug is designed to diagnose or treat.
DIF: COGNITIVE LEVEL: Applying
(Application)
REF: p. 55
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and
Parenteral Therapies
3. During
discharge patient teaching, the nurse reviews prescriptions with a patient.
Which statement is correct about refills for an analgesic that is classified as
Schedule C-III?
|
a. |
No prescription refills are
permitted. |
|
b. |
Refills are allowed only by
written prescription. |
|
c. |
The patient may have no
more than five refills in a 6-month period. |
|
d. |
Written prescriptions
expire in 12 months. |
ANS: C
Schedule C-III medications may be refilled no more than five
times in a 6-month period. The patient should be informed of this regulation.
No prescription refills are permitted for Schedule C-II drugs. Requiring
refills by written prescription only applies to Schedule C-II drugs. Schedule
C-III prescriptions (written or oral) expire in 6 months.
DIF: COGNITIVE LEVEL: Remembering
(Knowledge) REF: p.
54
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and
Parenteral Therapies
4. A
patient has been selected as a potential recipient of an experimental drug for
heart failure. The nurse knows that when informed consent has been obtained, it
indicates which of these?
|
a. |
The patient has been
informed of the possible benefits of the new therapy. |
|
b. |
The patient will be
informed of the details of the study as the research continues. |
|
c. |
The patient will receive
the actual drug during the experiment. |
|
d. |
The patient has had the
study’s purpose, procedures, and the risks involved explained to him. |
ANS: D
Informed consent involves the careful explanation of the purpose
of the study, the procedures to be used, and the risks involved. The other
options do not describe informed consent.
DIF: COGNITIVE LEVEL: Understanding
(Comprehension) REF: p. 55
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment:
Management of Care
5. For
which cultural group must the health care provider respect the value placed on
preserving harmony with nature and the belief that disease is a result of ill
spirits?
|
a. |
Hispanics |
|
b. |
Asian Americans |
|
c. |
Native Americans |
|
d. |
African Americans |
ANS: C
Some Native Americans believe in preserving harmony with nature
and that disease is a result of ill spirits. The groups listed in the other
options do not typically reflect these practices.
DIF: COGNITIVE LEVEL: Remembering
(Knowledge) REF: p.
51
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Psychosocial Integrity
6. The
nurse is assessing an elderly Hispanic woman who is being treated for hypertension.
During the assessment, what is important for the nurse to remember about
cultural aspects?
|
a. |
The patient should be
discouraged from using folk remedies and rituals. |
|
b. |
The nurse will expect the
patient to value protective bracelets and “root workers” as healers. |
|
c. |
The nurse will remember
that the balance among body, mind, and environment is important for this
patient’s health beliefs. |
|
d. |
The nurse’s assessment
needs to include gathering information regarding religious practices and beliefs
regarding medication, treatment, and healing. |
ANS: D
All beliefs need to be considered clearly so as to prevent a
conflict from arising between the goals of nursing and health care and the
dictates of a patient’s cultural background. Assessing religious practices and
beliefs is part of a thorough cultural assessment. The other options are
incorrect. The nurse should not ignore a patient’s cultural practices. The
concept of balance among body, mind, and environment and the valuing of
protective bracelets and root workers reflect beliefs or practices that usually
do not apply to the Hispanic cultural group.
DIF: COGNITIVE LEVEL: Applying
(Application)
REF: p. 52
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Psychosocial Integrity
7. When
reviewing the various schedules of controlled drugs, the nurse knows that which
description correctly describes Schedule II drugs?
|
a. |
Drugs with high potential
for abuse that have accepted medical use |
|
b. |
Drugs with high potential
for abuse that do not have accepted medical use |
|
c. |
Medically accepted drugs
that may cause moderate physical or psychologic dependence |
|
d. |
Medically accepted drugs
with limited potential for causing physical or psychologic dependence |
ANS: A
Schedule II drugs are those with high potential for abuse but
that have accepted medical use. Drugs that have high potential for abuse but do
not have accepted medical use are Schedule I drugs. Medically accepted drugs
that may cause moderate physical or psychologic dependence are Schedule III
drugs. Medically accepted drugs with limited potential for causing physical or
psychologic dependence are Schedule IV and V drugs.
DIF: COGNITIVE LEVEL: Remembering
(Knowledge) REF: p.
54
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and
Parenteral Therapies
8. The
nurse is reviewing facts about pharmacology for a review course. The term legend drug refers
to which item?
|
a. |
Over-the-counter drugs |
|
b. |
Prescription drugs |
|
c. |
Orphan drugs |
|
d. |
Older drugs |
ANS: B
The term legend
drug refers to prescription drugs, which were differentiated
from over-the-counter drugs by the 1951 Durham-Humphrey Amendment. Orphan drugs
are drugs that are developed for rare diseases. The other options are not
examples of legend drugs.
DIF: COGNITIVE LEVEL: Understanding
(Comprehension) REF: p. 53
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral
Therapies
9. Nurses
have the ethical responsibility to tell the truth to their patients. What is
this principle known as?
|
a. |
Justice |
|
b. |
Veracity |
|
c. |
Beneficence |
|
d. |
Autonomy |
ANS: B
Veracity is defined as the duty to tell the
truth. Justice is
the ethical principle of being fair or equal in one’s actions. Beneficence is the
ethical principle of doing or actively promoting good. Autonomy is
self-determination, or the ability to make one’s own decisions.
DIF: COGNITIVE LEVEL: Remembering
(Knowledge) REF: p.
57
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Reduction of Risk
Potential
10. A
patient is undergoing major surgery and asks the nurse about a living will. He
states, “I don’t want anybody else making decisions for me. And I don’t want to
prolong my life.” The patient is demonstrating which ethical term?
|
a. |
Autonomy |
|
b. |
Beneficence |
|
c. |
Justice |
|
d. |
Veracity |
ANS: A
Autonomy includes self-determination, or the
ability to act on one’s own, including making one’s own decisions about health
care. Veracity is
defined as the duty to tell the truth. Justice is
the ethical principle of being fair or equal in one’s actions. Beneficence is the
ethical principle of doing or actively promoting good.
DIF: COGNITIVE LEVEL: Understanding
(Comprehension) REF: p. 57
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Reduction of Risk
Potential
11. The
nurse is reviewing a list of scheduled drugs and notes that Schedule C-I drugs are
not on the list. Which is a characteristic of Schedule C-I drugs?
|
a. |
No refills are permitted. |
|
b. |
They may be obtained
over-the-counter with a signature. |
|
c. |
They are available only by
written prescription. |
|
d. |
They are used only with
approved protocols. |
ANS: D
Schedule C-I drugs are used only with approved protocols.
Schedule C-II drugs are available only by written prescription, and refills are
not permitted. Being available over-the-counter with a signature may be true of
Schedule C-V drugs in certain states.
DIF: COGNITIVE LEVEL: Understanding
(Comprehension) REF: p. 54
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and
Parenteral Therapies
12. During
a busy night shift, a new nurse administered an unfamiliar medication without
checking it in a drug handbook. Later that day, the patient had a severe
reaction because he has renal problems, which was a contraindication to that
drug. The nurse may be liable for which of these?
|
a. |
Medical negligence |
|
b. |
Nursing negligence |
|
c. |
Nonmaleficence |
|
d. |
Autonomy |
ANS: B
Negligence is the failure to act in a
reasonable and prudent manner or failure of the nurse to give the care that a
reasonably prudent (cautious) nurse would render or use under similar
circumstances. In this case, nursing negligence applies to nurses, not medical
negligence. Nonmaleficence is
defined as the duty to do no harm; autonomy is
defined as the right to make one’s own decisions, or self-determination.
DIF: COGNITIVE LEVEL: Applying
(Application)
REF: p. 57
TOP: NURSING PROCESS: General
MSC: NCLEX: Safe and Effective Care Environment: Safety
and Infection Control
MULTIPLE RESPONSE
1. The
nurse is reviewing the concept of drug polymorphism. Which factors contribute
to drug polymorphism? (Select
all that apply.)
|
a. |
The number of drugs ordered
by the physician |
|
b. |
Inherited factors |
|
c. |
The patient’s diet and
nutritional status |
|
d. |
Different dosage forms of
the same drug |
|
e. |
The patient’s health
beliefs and practices |
|
f. |
The patient’s drug history |
|
g. |
The various available forms
of a drug |
ANS: B, C, E
Inherited factors, diet and nutritional status, and health
beliefs and practices are some of the factors that contribute to drug
polymorphism. The other options are not factors that contribute to drug
polymorphism.
DIF: COGNITIVE LEVEL: Understanding
(Comprehension) REF: p. 51
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and
Parenteral Therapies
2. The
nurse is performing an admission assessment. Which findings reflect components
of a cultural assessment? (Select
all that apply.)
|
a. |
The patient uses aspirin as
needed for pain. |
|
b. |
The patient has a history
of hypertension. |
|
c. |
The patient uses herbal tea
to relax in the evenings. |
|
d. |
The patient does not speak
English. |
|
e. |
The patient is allergic to
shellfish. |
|
f. |
The patient does not eat
pork products for religious reasons. |
ANS: A, C, D, F
The past use of medicines, use of herbal treatments, languages
spoken, and religious practices and beliefs are components of a cultural
assessment. The other options reflect components of a general medication
assessment or health history.
DIF: COGNITIVE LEVEL: Applying
(Application)
REF: p. 52
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Psychosocial Integrity
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