Pharmacology Connections To Nursing Practice 3rd Edition By Adams – Test Bank
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Sample Questions
Adams and Urban, Pharmacology:
Connections to Nursing Practice, 3e Test Bank
Chapter 4
Question 1
Type: MCSA
The client and his wife receive the same medication for
hypertension. The wife asks the nurse why she is receiving a higher dose of the
medication. Which response by the nurse is the most appropriate?
1. “You
have a greater percentage of body fat, so you need more medication.”
2. “Females
have a higher metabolism, so you need more medication.”
3. “Your
hormones are different from your husband’s, so you need more medication.”
4. “Everyone
is unique and responds differently to medication.”
Correct Answer: 4
Rationale 1: The percentage of body fat
is only one of the variables involved in a client’s response to medication.
Rationale 2: Females do not necessarily
have higher metabolic rates than males.
Rationale 3: Hormones are only one of
the variables involved in a client’s response to medication.
Rationale 4: Many variables influence
how clients respond to medications; each client must be evaluated for response.
Global Rationale: Many variables
influence how clients respond to medications; each client must be evaluated for
response. The percentage of body fat is only one of the variables involved in a
client’s response to medication. Females do not necessarily have higher
metabolic rates than males. Hormones are only one of the variables involved in
a client’s response to medication.
Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: III.5.
Participate in the process of retrieval, appraisal and synthesis of evidence in
collaboration with other members of the healthcare team to improve patient
outcomes
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-1 Apply frequency distribution curves to
explain interpatient variability in medication response.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 2
Type: MCSA
A client asks the nurse why his dose of an antihypertensive
medication is different from his neighbor’s dose, stating, “We both take the
exact same drug, but I take 60 mg and he takes only 25 mg.” Which response by
the nurse is the most appropriate?
1. “If
your neighbor is a lot younger than you, his dose might be a lot lower.”
2. “Individuals
often have widely different responses to the same medications and need
different doses of the same medication.”
3. “If
your neighbor takes a lot of other medications, he might need to take a lower
dose of the medication than you.”
4. “If
you are taking a generic brand of the medication, you will need a higher dose
than you would of a brand name of the same medication.”
Correct Answer: 2
Rationale 1: Age can be a factor in
dosing of medications, but this is not the best explanation of why different
doses are needed to for two different people.
Rationale 2: Genetic makeup and
metabolism vary widely and account for the differences in response to drugs and
the need for individualized doses.
Rationale 3: Taking other medications
could be part of the reason why the dose is different, but this is not the best
explanation.
Rationale 4: Generic and brand name
drugs usually have the same dose equivalency.
Global Rationale: Genetic makeup and
metabolism vary widely and account for the differences in response to drugs and
the need for individualized doses. Age can be a factor in dosing of
medications, but this is not the best explanation of why different doses are
needed to for two different people. Taking other medications could be part of
the reason why the dose is different, but this is not the best explanation.
Generic and brand name drugs usually have the same dose equivalency.
Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: III.5.
Participate in the process of retrieval, appraisal and synthesis of evidence in
collaboration with other members of the healthcare team to improve patient
outcomes
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-1 Apply frequency
distribution curves to explain interpatient variability in medication response.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 3
Type: MCSA
The nursing instructor is teaching student nurses about how the
median effective dose of a medication is related to clinical practice. Which
statement reflects the correct understanding by the student?
1. “About
50% of clients will experience severe side effects from the drug.”
2. “About
50% of clients will not experience any effect from the drug.”
3. “Some
clients will respond differently, depending on their ethnic background.”
4. “Some
clients will require more or less than the average dose of the drug.”
Correct Answer: 4
Rationale 1: The median effective dose
does not predict how many clients will experience severe side effects from the
drug.
Rationale 2: The median effective dose
does not predict that 50% of clients will not experience an effect of the drug.
Rationale 3: The median effective dose
is not related to ethnicity.
Rationale 4: The median effective dose
is the dose required to produce a specific therapeutic response in 50% of a
group of clients.
Global Rationale: The median effective
dose is the dose required to produce a specific therapeutic response in 50% of
a group of clients. The median effective dose does not predict how many clients
will experience severe side effects from the drug. The median effective dose is
not related to ethnicity.
Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: III.2.
Demonstrate an understanding of the basic elements of the research process and
models for applying evidence to clinical practice
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 4-2 Explain the
importance of the median effective dose (ED50) to clinical practice.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 4
Type: MCSA
A client looks up the drug he is taking in a drug guide and asks
the nurse why the health care provider prescribed a medication that has a
lethal dose measure. Which response by the nurse is the most appropriate?
1. “Lethal dose just
refers to what is done in research; it is not used by doctors to prescribe
drugs.”
2. “The
lethal dose is a value determined in research that helps to establish the safe
dose.”
3. “All
that means is that the drug could be lethal, but I will closely monitor you for
side effects.”
4. “Don’t
worry about that. I will have your doctor explain it to you.”
Correct Answer: 2
Rationale 1: The lethal dose is
considered by health care providers when prescribing medications.
Rationale 2: The difference between the
median effective dose and the median lethal dose is measured to determine the
drug’s safety margin as well as the safe effective dose.
Rationale 3: All drugs have the
potential to be lethal, but telling this to the client might be frightening.
Rationale 4: Telling the client not to
worry is condescending and does not answer his question.
Global Rationale: The difference between
the median effective dose and the median lethal dose is measured to determine
the drug’s safety margin as well as the safe effective dose. The lethal dose is
considered by health care providers when prescribing medications. All drugs
have the potential to be lethal, but telling this to the client might be
frightening. Telling the client not to worry is condescending and does not
answer his question.
Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: II.7.
Promote factors that create a culture of safety and caring
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-3 Compare and
contrast median lethal dose (LD50) and median toxicity dose (TD50).
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 5
Type: MCMA
The nurse explains to a student nurse that the median lethal
dose of drugs is often determined in laboratory preclinical trials. Which
rationales best support why this is done?
Note: Credit will be given only if all correct choices and no
incorrect choices are selected.
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.
Correct Answer: 1,2
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.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: II.7.
Promote factors that create a culture of safety and caring
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-3 Compare and
contrast median lethal dose (LD50) and median toxicity dose (TD50).
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 6
Type: FIB
The nurse is educating a client who is participating in a drug
study and describes the median toxicity dose as the dose that will produce
toxicity in ____ % of a group of clients.
Standard Text: Record your answer rounding to
the nearest whole number.
Correct Answer: 50
Rationale: The median toxicity dose
(TD50) is the dose that will produce a given toxicity in 50% of a
group of clients.
Global Rationale: The median toxicity
dose (TD50) is the dose that will produce a given toxicity in 50% of a
group of clients.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: II.7.
Promote factors that create a culture of safety and caring
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-3 Compare and
contrast median lethal dose (LD50) and median toxicity dose (TD50).
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 7
Type: MCSA
The nurse is researching a drug recently released on the market
to determine what the median lethal dose (LD50) was
in preclinical trials. The nurse recognizes that this number reflects which
fact?
1. The
dose at which 50% of the research animals died
2. A
measurement of the potency of the drug
3. The
value of relative safety of the drug
4. The
dose that produced signs of toxicity in 50% of lab animals
Correct Answer: 1
Rationale 1: The dose at which 50% of
animals in the preclinical trials are killed is the median LD50 dose.
Rationale 2: A comparison of two drugs
is done when defining the potency of a drug.
Rationale 3: Relative safety of dose is
reflected in the therapeutic index.
Rationale 4: The dose at which signs of
toxicity are seen in 50% of laboratory subjects is the median toxicity dose.
Global Rationale: The dose at which 50%
of animals in the preclinical trials are killed is the median LD50 dose.
A comparison of two drugs is done when defining the potency of a drug. Relative
safety of dose is reflected in the therapeutic index. The dose at which signs
of toxicity are seen in 50% of laboratory subjects is the median toxicity dose.
Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate knowledge of basic
scientific methods and processes
AACN Essential Competencies: II.7.
Promote factors that create a culture of safety and caring
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 4-3 Compare and
contrast median lethal dose (LD50) and median toxicity dose (TD50).
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 8
Type: MCSA
Prior to administering medications, the nurse reviews the
therapeutic index. What is the therapeutic index used to identify?
1. Whether
the health are provider has prescribed the best drug for the client
2. When
a client will begin to experience toxic drug effects
3. Interactions
among the drugs the client is receiving
4. Clients
who will need to have serum blood levels monitored
Correct Answer: 4
Rationale 1: The therapeutic index does
not help to determine whether the best drug has been prescribed for the client.
Rationale 2: The therapeutic index does
not determine toxic doses of a drug, and clients differ in their response to
drugs.
Rationale 3: The therapeutic index does
not help to identify interactions among drugs.
Rationale 4: Drugs with a narrow
therapeutic index have low margins of safety and need to be monitored through
serum drug levels.
Global Rationale: Drugs with a narrow
therapeutic index have low margins of safety and need to be monitored through
serum drug levels. The therapeutic index does not help to determine whether the
best drug has been prescribed for the client. The therapeutic index does not
determine toxic doses of a drug, and clients differ in their response to drugs.
The therapeutic index does not help to identify interactions among drugs.
Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: II.7.
Promote factors that create a culture of safety and caring
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-4 Relate a drug’s
therapeutic index to its margin of safety.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology; 1.1.2 Apply key principles
related to safe drug administration.
Page Number:
Question 9
Type: FIB
The nurse checks the margin of safety (MOS) for a drug that will
be administered to a client, knowing that the MOS is the amount of drug that is
lethal to ____ % of animals divided by the amount that produces a therapeutic
effect in ____ % of animals.
Standard Text: Record your answer rounding
to the nearest whole number.
Correct Answers: 1, 99
Rationale: The MOS is calculated as
the amount of drug that is lethal to 1% of animals (LD1)
divided by the amount of drug that produces a therapeutic effect in 99% of the
animals (ED99).
Global Rationale: The MOS is calculated
as the amount of drug that is lethal to 1% of animals (LD1)
divided by the amount of drug that produces a therapeutic effect in 99% of the
animals (ED99).
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: II.7.
Promote factors that create a culture of safety and caring
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-4 Relate a drug’s
therapeutic index to its margin of safety.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology; 1.1.2 Apply key principles
related to safe drug administration.
Page Number:
Question 10
Type: MCSA
The nurse is researching a drug that has a median effective dose
(ED50) of 5 mg and a median lethal dose (LD50) of
20 mg. Which therapeutic index (TI) calculated by the nurse is correct?
1. 5
2. 4
3. 1
4. 10
Correct Answer: 2
Rationale 1: The TI is calculated by
dividing the median LD by the median ED. Twenty divided by 5 does not equal 5.
Rationale 2: The TI is calculated by
dividing the median LD by the median ED. Twenty divided by 5 equals 4.
Rationale 3: The TI is calculated by
dividing the median LD by the median ED. Twenty divided by 5 does not equal 1.
Rationale 4: The TI is calculated by
dividing the median LD by the median ED. Twenty divided by 5 does not equal 10.
Global Rationale: The TI is calculated
by dividing the median LD by the median ED. Twenty divided by 5 equals 4.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: V.B.1 Demonstrate
effective use of technology and standardized practices that support safety and
quality
AACN Essential Competencies: III.2.
Demonstrate an understanding of the basic elements of the research process and
models for applying evidence to clinical practice
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 4-5 Identify the
significance of the dose–response relationship to clinical practice.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 11
Type: FIB
The nurse is preparing to administer a medication to a client 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 _____.
Standard Text:
Correct 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).
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: II.7.
Promote factors that create a culture of safety and caring
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-4 Relate a drug’s
therapeutic index to its margin of safety.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology; 1.1.2 Apply key principles
related to safe drug administration.
Page Number:
Question 12
Type: MCSA
A client receiving antibiotics for a serious infection asks the
nurse, “Why don’t you just give me more of that drug to cure the infection
faster?” Which response by the nurse is the most appropriate?
1. “I
will check with the doctor to see if it is time to increase the medication.”
2. “You
are at maximum dose; taking more will not help.”
3. “You
are at a maximum dose; taking more will cause interactions with other
medications.”
4. “You
must stay on this drug for two more weeks before the dosage can be increased.”
Correct Answer: 2
Rationale 1: The drug plateau has been
reached; the nurse can provide this explanation to the client.
Rationale 2: When the plateau of a drug
has been reached, administering more of the drug will not produce additional benefit.
Rationale 3: An increase in dosage could
cause interactions with other medications, but this is not the best answer.
Rationale 4: Once the plateau of a drug
has been reached, there is no time frame for an increase in dosage because an increase
will not produce a greater effect.
Global Rationale: When the plateau of a
drug has been reached, administering more of the drug will not produce
additional benefit. The drug plateau has been reached; the nurse can provide
this explanation to the client. An increase in dosage could cause interactions
with other medications, but this is not the best answer. Once the plateau of a
drug has been reached, there is no time frame for an increase in dosage because
an increase will not produce a greater effect.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: V.B.1 Demonstrate
effective use of technology and standardized practices that support safety and
quality
AACN Essential Competencies: III.2.
Demonstrate an understanding of the basic elements of the research process and
models for applying evidence to clinical practice
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-5 Identify the
significance of the dose–response relationship to clinical practice.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 13
Type: MCSA
The nurse is administering narcotics to surgical clients and
understands that which characteristic is true?
1. Codeine
is less potent than morphine; it will not produce an allergic reaction.
2. Codeine
is less potent than morphine; it will not relieve pain as well.
3. Morphine
is more potent than codeine; it will produce more adverse effects.
4. Morphine
is more potent than codeine; a lesser dose will be required.
Correct Answer: 4
Rationale 1: The potency of a drug is
not related to its ability to cause an allergic reaction.
Rationale 2: Although codeine is less
potent than morphine, less potent narcotics can be very effective with pain
relief.
Rationale 3: Morphine is more potent
than codeine, but greater potency does not imply the drug will produce more
adverse effects.
Rationale 4: A drug that is more potent
will produce a therapeutic effect at a lower dose.
Global Rationale: A drug that is more
potent will produce a therapeutic effect at a lower dose. The potency of a drug
is not related to its ability to cause an allergic reaction. Although codeine
is less potent than morphine, less potent narcotics can be very effective with
pain relief. Morphine is more potent than codeine, but greater potency does not
imply the drug will produce more adverse effects.
Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: III.1.
Explain the interrelationships among theory, practice and research
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-6 Compare and
contrast the terms potency and efficacy.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 14
Type: MCSA
The nurse is discussing the difference between potency and
efficacy with a client who has just received a prescription to treat congestive
heart failure. Which statement by the client indicates that learning has
occurred?
1. “The
best drug for me is the one with the greatest efficacy.”
2. “A
drug with the greatest efficacy will produce the least side effects.”
3. “Low-potency
drugs have efficacy and do not produce side effects.”
4. “The
best drug for me is the one with the highest potency.”
Correct Answer: 1
Rationale 1: Efficacy refers to the
magnitude of maximal response that can be produced by a particular drug.
Rationale 2: Even though a drug is
efficacious for a condition, it can still have side effects.
Rationale 3: Low potency does not
guarantee a drug will not produce side effects.
Rationale 4: High-potency drugs do not
necessarily provide the best response in the patient.
Global Rationale: Efficacy refers to the
magnitude of maximal response that can be produced by a particular drug. Even
though a drug is efficacious for a condition, it can still have side effects.
Low potency does not guarantee a drug will not produce side effects.
High-potency drugs do not necessarily provide the best response in the patient.
Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: III.1.
Explain the interrelationships among theory, practice and research
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-6 Compare and
contrast the terms potency and efficacy.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 15
Type: MCMA
A client with hypertension is prescribed a potent
antihypertensive without results. The client is concerned when the health care
provider orders a new drug. Which explanation by the nurse is the most
appropriate?
Note: Credit will be given only if all correct choices and no
incorrect choices are selected.
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.”
Correct Answer: 2,4
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. Telling
the client that the prescriber made an error is not an appropriate response by
the nurse. The nurse cannot assume the order was supposed to be for two drugs.
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: III.1.
Explain the interrelationships among theory, practice and research
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 4-6 Compare and
contrast the terms potency and efficacy.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 16
Type: MCSA
The nurse administers a medication that binds to a beta receptor
on the cardiac muscle, resulting in stimulation of the receptor. Which effect
does the nurse anticipate when assessing the client?
1. A
decrease in chest pain
2. An
increase in heart rate
3. An
increase in blood pressure
4. A
decrease in electrical conduction
Correct Answer: 2
Rationale 1: Since stimulation of the
beta receptors increases heart rate and workload, an increase in chest pain
could occur.
Rationale 2: Stimulation of the beta
receptors will cause an increase of sympathetic nervous system activity,
resulting in an increased heart rate.
Rationale 3: Stimulation of the beta
receptors is more likely to cause a decrease in blood pressure.
Rationale 4: Electrical conduction will
be increased by beta stimulation.
Global Rationale: Stimulation of the
beta receptors will cause an increase of sympathetic nervous system activity,
resulting in an increased heart rate. Since stimulation of the beta receptors
increases heart rate and workload, an increase in chest pain could occur.
Stimulation of the beta receptors is more likely to cause a decrease in blood
pressure. Electrical conduction will be increased by beta stimulation.
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: III.1.
Explain the interrelationships among theory, practice and research
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 4-7 Describe the
relationship between receptors and drug action.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 17
Type: MCSA
The nurse is administering a medication that will bind to histamine-2
receptors in the stomach and block their action. The nurse explains to the
client that this drug will cause which action?
1. A
reduction in abdominal cramping
2. A
decrease in stomach acidity
3. A
reduction in nausea
4. An
increase in stomach motility
Correct Answer: 2
Rationale 1: Histamine-2 stimulates the
production of gastric acid; it will not affect abdominal cramping.
Rationale 2: Blocking the histamine-2
receptors will help to reduce the stimulation of gastric acid.
Rationale 3: Histamine-2 stimulates the
production of gastric acid; it will not reduce nausea.
Rationale 4: Histamine-2 stimulates the
production of gastric acid; it does not affect stomach motility.
Global Rationale: Blocking the
histamine-2 receptors will help to reduce the stimulation of gastric acid.
Histamine-2 stimulates the production of gastric acid; it will not affect
abdominal cramping. Histamine-2 stimulates the production of gastric acid; it
will not reduce nausea. Histamine-2 stimulates the production of gastric acid;
it does not affect stomach motility.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: III.1.
Explain the interrelationships among theory, practice and research
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-7 Describe the
relationship between receptors and drug action.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 18
Type: MCMA
The nurse is reviewing the medication administration record for
a group of clients and recognizes that which agents have nonspecific cellular
responses?
Note: Credit will be given only if all correct choices and no
incorrect choices are selected.
Standard Text: Select all that apply.
1. Ethyl
alcohol
2. General
anesthetics
3. Osmotic
diuretics
4. Calcium
channel blockers
5. Alpha-adrenergic
antihypertensives
Correct Answer: 1,2,3
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.
Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: III.1.
Explain the interrelationships among theory, practice and research
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 4-7 Describe the
relationship between receptors and drug action.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 19
Type: MCSA
The nurse has taught a group of clients how their medications
work in their bodies. Which comment by a client reflects correct understanding
of the teaching?
1. “The
normal function of a cell is enhanced or blocked by medications.”
2. “Medications
help the body produce new enzymes.”
3. “Body
tissue functions are changed by medications.”
4. “Medications
change the function of cells in the body.”
Correct Answer: 1
Rationale 1: Many medications work by
stimulating or enhancing the normal function of a cell or by blocking the
normal function.
Rationale 2: Medications can stimulate
enzyme reactions or even provide enzymes that are missing, but they do not help
the body produce new ones.
Rationale 3: Body tissue functions are
not changed.
Rationale 4: Functions of the cell can
be enhanced or blocked, but they are not changed.
Global Rationale: Many medications work
by stimulating or enhancing the normal function of a cell or by blocking the
normal function. Medications can stimulate enzyme reactions or even provide
enzymes that are missing, but they do not help the body produce new ones. Body
tissue functions are not changed. Functions of the cell can be enhanced or
blocked, but they are not changed.
Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: III.1.
Explain the interrelationships among theory, practice and research
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 4-7 Describe the
relationship between receptors and drug action.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 20
Type: MCSA
The health care provider has ordered naltrexone (ReVia), a
narcotic antagonist, for a client in rehabilitation who is recovering from
heroin addiction. The nurse explains that if heroin is used while taking the
naltrexone, the client could experience which effect?
1. Severe
nausea and vomiting
2. Lack
of euphoria
3. Anger
and rage
4. A
severe craving for more heroin
Correct Answer: 2
Rationale 1: Severe nausea and vomiting
will not occur.
Rationale 2: Euphoria will not occur.
Rationale 3: Anger and rage would not be
effects.
Rationale 4: A severe craving for more
heroin is not likely to occur.
Global Rationale: Euphoria will not
occur. Severe nausea and vomiting will not occur. Anger and rage would not be
effects. A severe craving for more heroin is not likely to occur.
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: III.1.
Explain the interrelationships among theory, practice and research
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-8 Distinguish
between an agonist, partial agonist, and antagonist.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 21
Type: MCSA
A client has been receiving haloperidol (Haldol), a dopamine
antagonist. When the psychiatrist changes the order to aripiprazole (Abilify),
a partial dopamine antagonist, the nurse anticipates the client will experience
which effect?
1. A
greater reduction in symptoms
2. Fewer
side effects
3. Greater
adherence in taking the drug
4. Greater
efficacy from the new drug
Correct Answer: 2
Rationale 1: A reduction in symptoms
might occur, but is not certain to occur, with the new medication.
Rationale 2: Partial blocking of
dopamine results in fewer side effects than does complete blocking.
Rationale 3: If the client experiences
fewer side effects from the drug, adherence might be improved, but that is not
guaranteed.
Rationale 4: The client will not
necessarily experience greater efficacy; each client responds differently to a
drug.
Global Rationale: Partial blocking of dopamine
results in fewer side effects than does complete blocking. A reduction in
symptoms might occur, but is not certain to occur, with the new medication. If
the client experiences fewer side effects from the drug, adherence might be
improved, but that is not guaranteed. The client will not necessarily
experience greater efficacy; each client responds differently to a drug.
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: III.1.
Explain the interrelationships among theory, practice and research
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 4-8 Distinguish
between an agonist, partial agonist, and antagonist.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 22
Type: MCSA
The student nurse has been reading about the Human Genome
Project, and asks the nursing instructor how it will affect future
pharmacological therapies. Which response by the nurse is the most appropriate?
1. “It
will help prevent disease through gene manipulation, but will not impact
drugs.”
2. “We
will be able to alter genes, so we will not need drugs,”
3. “We
will be able to standardize drug doses to make prescribing easier.”
4. “It
will help to individualize drug therapy for people in a more effective way.”
Correct Answer: 4
Rationale 1: Medications will be
impacted greatly by this research.
Rationale 2: Altering genes to prevent
illness is a possibility, but we will always need medications.
Rationale 3: Individuals will still
respond differently to medications; not all drugs will have standardized doses.
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.
Medications will be impacted greatly by this research. 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.
Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: III.2.
Demonstrate an understanding of the basic elements of the research process and
models for applying evidence to clinical practice
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 4-9 Explain possible
future developments in the field of pharmacogenetics.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 23
Type: MCSA
A male client of African descent has been prescribed
sulfamethoxazole with trimethoprim (Bactrim), a sulfonamide anti-infective, for
a bacterial infection. When the client arrives in the emergency department, the
nurse should place priority on which assessment?
1. Urinary
output
2. Level
of red blood cells (RBCs)
3. Liver
function tests
4. Renal
function tests
Correct Answer: 2
Rationale 1: Urinary output is not the
priority assessment based on the information provided.
Rationale 2: Males of African descent
are more likely to be deficient in the enzyme G6PD, an enzyme that is essential
in carbohydrate metabolism. The use of sulfonamides in this group of clients
can cause an acute hemolysis of red blood cells due to the breaking chemical
bonds in the hemoglobin molecule.
Rationale 3: Liver function tests are
not the priority assessment based on the information provided.
Rationale 4: Renal function tests are
not the priority assessment based on the information provided.
Global Rationale: Males of African
descent are more likely to be deficient in the enzyme G6PD, an enzyme that is
essential in carbohydrate metabolism. The use of sulfonamides in this group of
clients can cause an acute hemolysis of red blood cells due to the breaking
chemical bonds in the hemoglobin molecule. Urinary output is not the priority
assessment based on the information provided. Liver function tests are not the
priority assessment based on the information provided. Renal function tests are
not the priority assessment based on the information provided.
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate knowledge
of basic scientific methods and processes
AACN Essential Competencies: III.2.
Demonstrate an understanding of the basic elements of the research process and
models for applying evidence to clinical practice
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 4-9 Explain possible
future developments in the field of pharmacogenetics.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Question 24
Type: MCMA
The nurse on a medical–surgical unit identifies several clients
as being at risk for hemolytic symptoms after the administration of oxidative
medications. Which clients does the nurse correctly identify as being at risk?
Note: Credit will be given only if all correct choices and no
incorrect choices are selected.
Standard Text: Select all that apply.
1. A
male of Egyptian descent with no allergies
2. A
male immigrant from Morocco with hypertension
3. An
adolescent female from India with anemia
4. A
Latina female with an allergy to fava beans
5. An
older Native American male with diabetes
Correct Answer: 1,2
Rationale 1: Males of Mediterranean and
African descent are known to have a deficiency of the enzyme G6PD, which can
lead to hemolysis of red blood cells after administration of oxidative
medications.
Rationale 2: Males of Mediterranean and
African descent are known to have a deficiency of the enzyme G6PD, which can
lead to hemolysis of red blood cells after administration of oxidative
medications.
Rationale 3: Females are not known to
have a deficiency of the enzyme G6PD, which can lead to hemolysis of red blood
cells after administration of oxidative medications.
Rationale 4: Females are not known to
have a deficiency of the enzyme G6PD, which can lead to hemolysis of red blood
cells after administration of oxidative medications.
Rationale 5: Males of Native American
descent are not known to have a deficiency of the enzyme G6PD, which can lead
to hemolysis of red blood cells after administration of oxidative medications.
Global Rationale: Males of Mediterranean
and African descent are known to have a deficiency of the enzyme G6PD, which
can lead to hemolysis of red blood cells after administration of oxidative
medications. Females are not known to have a deficiency of the enzyme G6PD,
which can lead to hemolysis of red blood cells after administration of
oxidative medications. Males of Native American descent are not known to have a
deficiency of the enzyme G6PD, which can lead to hemolysis of red blood cells
after administration of oxidative medications.
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: III.A.1 Demonstrate
knowledge of basic scientific methods and processes
AACN Essential Competencies: III.2.
Demonstrate an understanding of the basic elements of the research process and
models for applying evidence to clinical practice
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care
Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 4-9 Explain possible
future developments in the field of pharmacogenetics.
MNL Learning Outcome: 1.1.1
Apply basic concepts related to pharmacology.
Page Number:
Adams and Urban, Pharmacology:
Connections to Nursing Practice, 3e Test Bank
Chapter 7
Question 1
Type: MCSA
Which activity would support the client’s use of mind–body
interventions and require privacy?
1. Reading
2. Praying
3. Practicing
aromatherapy
4. Meditation
Correct Answer: 4
Rationale 1: Reading might be considered
a diversional activity or pleasure.
Rationale 2: Prayer is a spiritual
intervention.
Rationale 3: Aromatherapy can usually be
done without privacy.
Rationale 4: Meditation is considered a
mind–body intervention, as are massage, yoga, and biofeedback.
Global Rationale: Meditation is
considered a mind–body intervention, as are massage, yoga, and biofeedback.
Reading might be considered a diversional activity or pleasure. Prayer is a
spiritual intervention. Aromatherapy can usually be done without privacy.
Cognitive Level: Applying
Client Need: Health Promotion and
Maintenance
Client Need Sub:
QSEN Competencies: I.A.1 Integrate
understanding of multiple dimensions of patient centered care:
·
patient/family/community preferences, values
·
coordination and integration of care
·
information, communication, and education
·
physical comfort and emotional support
·
involvement of family and friends
·
transition and continuity
AACN Essential Competencies: IX.17.
Develop a beginning understanding of complementary and alternative modalities
and their role in health care
NLN Competencies: Knowledge and
Practice: Relationships between knowledge/science and quality and safe patient
care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 7-1 Identify specific
types of complementary and alternative therapies that are used by patients to
promote wellness.
MNL Learning Outcome: 1.2.4
Explore the nurse’s role as it applies to client use of complementary and
alternative supplements.
Page Number:
Question 2
Type: MCSA
Which is an advantage to the use of complementary and
alternative medicine (CAM) for clients?
1. They
can reduce the need for medications.
2. They
are less expensive.
3. They
are as effective as allopathic drugs.
4. They
have fewer side effects.
Correct Answer: 1
Rationale 1: From a pharmacologic
perspective, an advantage of CAM therapy is its ability to reduce the need for
medications. Reduction of drug dosages leads to fewer adverse effects.
Rationale 2: CAM therapies are not
necessarily less expensive than mainstream health care.
Rationale 3: Few CAM therapies have been
subjected to controlled clinical studies to prove their effectiveness.
Rationale 4: Not all CAM therapies have
fewer side effects.
Global Rationale: From a pharmacologic
perspective, an advantage of CAM therapy is its ability to reduce the need for
medications. Reduction of drug dosages leads to fewer adverse effects. CAM
therapies are not necessarily less expensive than mainstream health care. Few
CAM therapies have been subjected to controlled clinical studies to prove their
effectiveness. Not all CAM therapies have fewer side effects.
Cognitive Level: Understanding
Client Need: Physiological Integrity
Client Need Sub: Basic Care and Comfort
QSEN Competencies: I.A.1 Integrate
understanding of multiple dimensions of patient centered care:
·
patient/family/community preferences, values
·
coordination and integration of care
·
information, communication, and education
·
physical comfort and emotional support
·
involvement of family and friends
·
transition and continuity
AACN Essential Competencies: IX.17.
Develop a beginning understanding of complementary and alternative modalities
and their role in health care
NLN Competencies: Knowledge and
Practice: Relationships between knowledge/science and quality and safe patient
care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 7-1 Identify specific
types of complementary and alternative therapies that are used by patients to
promote wellness.
MNL Learning Outcome: 1.2.4
Explore the nurse’s role as it applies to client use of complementary and
alternative supplements.
Page Number:
Question 3
Type: MCSA
The nurse in a long-term care facility begins giving clients
evening massages. Using complementary and alternative medicine (CAM) in this
manner would have which pharmacologic benefit for the clients?
1. A
possible decreased need for antianxiety medication
2. Fewer
drug interactions
3. Improved
nurse–client communication
4. Consistent
time for client to go to sleep
Correct Answer: 1
Rationale 1: From the perspective of
pharmacology, the value of CAM therapies is the ability to reduce the need for
medications. CAM has been shown to assist with a variety of client symptoms,
including anxiety.
Rationale 2: Massage does not have an
impact on drug interactions.
Rationale 3: Although massage can
contribute to an improved nurse–client relationship, this is not a
pharmacologic benefit.
Rationale 4: Massage does not guarantee
a consistent time at which the client will fall asleep.
Global Rationale: From the perspective
of pharmacology, the value of CAM therapies is the ability to reduce the need
for medications. CAM has been shown to assist with a variety of client
symptoms, including anxiety. Massage does not have an impact on drug
interactions. Although massage can contribute to an improved nurse–client
relationship, this is not a pharmacologic benefit. Massage does not guarantee a
consistent time at which the client will fall asleep.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Basic Care and Comfort
QSEN Competencies: I.A.1 Integrate understanding
of multiple dimensions of patient centered care:
·
patient/family/community preferences, values
·
coordination and integration of care
·
information, communication, and education
·
physical comfort and emotional support
·
involvement of family and friends
·
transition and continuity
AACN Essential Competencies: IX.17.
Develop a beginning understanding of complementary and alternative modalities
and their role in health care
NLN Competencies: Knowledge and
Practice: Relationships between knowledge/science and quality and safe patient
care
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 7-1 Identify specific
types of complementary and alternative therapies that are used by patients to
promote wellness.
MNL Learning Outcome: 1.2.4
Explore the nurse’s role as it applies to client use of complementary and
alternative supplements.
Page Number:
Question 4
Type: MCSA
The nurse has noticed that more clients are asking about the use
of herbal supplements to treat their symptoms. The nurse is aware that this
could be related to which factor?
1. Aggressive
marketing by the herbal industry
2. The
greater safety of herbal remedies over prescription medications
3. An
increase in acute illnesses
4. The
lower cost of herbal remedies
Correct Answer: 1
Rationale 1: Factors contributing to the
increasing popularity of herbal products include the increased availability of
herbal products, aggressive marketing by the herbal industry, and renewed
interest in preventive medicine and natural alternatives.
Rationale 2: Herbal remedies are not
necessarily safer than other therapies.
Rationale 3: There has been an increase
in use of herbal and supplemental therapies for treatment of chronic, not
acute, conditions.
Rationale 4: Herbal remedies are not
necessarily lower in cost.
Global Rationale: Factors contributing
to the increasing popularity of herbal products include the increased
availability of herbal products, aggressive marketing by the herbal industry,
and renewed interest in preventive medicine and natural alternatives. Herbal
remedies are not necessarily safer than other therapies. There has been an
increase in use of herbal and supplemental therapies for treatment of chronic,
not acute, conditions. Herbal remedies are not necessarily lower in cost.
Cognitive Level: Applying
Client Need: Health Promotion and
Maintenance
Client Need Sub:
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