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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