Pharmacology For Canadian Health Care Practice 3rd Edition By Linda Lane Lilley – Test Bank
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Sample
Questions
Chapter 04: Patient Focused Considerations
Lilley: Pharmacology for Canadian Health Care Practice, 3rd
Canadian Edition
MULTIPLE CHOICE
1. During
the last trimester of pregnancy, drug transfer to the fetus is more likely to
occur. Which is a reason for this possibility?
|
a. |
Fetal size |
|
b. |
Decreased surface area |
|
c. |
Enhanced placental blood
flow |
|
d. |
Increased amount of bound
drug in maternal circulation |
ANS: C
Drug transfer to the fetus is more likely during the last
trimester, as a result of enhanced placental blood flow, increased fetal
surface area, and an increased amount of free drug in the mother’s circulation.
Increased, not decreased, fetal surface area affects drug transfer to the
fetus. The placenta’s surface area does not increase during this time. Drug
transfer is increased due to an increased amount of free drug, not
protein-bound drug, in the mother’s circulation. “Fetal size” is incorrect
because the first trimester of pregnancy is the period of greatest danger of
drug-induced developmental defects. During this period, the fetus undergoes
rapid cell proliferation. Gestational age is more important than fetal size.
DIF: Cognitive Level:
Comprehension REF: p. 60
2. A
22-year-old patient is in the twenty-sixth week of pregnancy and has developed
gestational diabetes and pneumonia. She is given medications that pose a possible
fetal risk, but the potential benefits may warrant the use of the medications
in her situation. Which is the Food and Drug Administration (FDA) pregnancy
safety category for this medication?
|
a. |
Category B |
|
b. |
Category C |
|
c. |
Category D |
|
d. |
Category X |
ANS: C
Category D fits the description given in the example. Category B
indicates no risk to an animal fetus; information for humans is not available.
Category C indicates adverse effects reported in animal fetuses; information
for humans is not available. Category X drugs should not be used in pregnant
women due to reports of fetal abnormalities and positive evidence of fetal risk
in humans.
DIF: Cognitive Level:
Application
REF: p. 61
3. Which
type of dosage calculation is used most commonly when calculating drug dosages
for children?
|
a. |
Fried’s rule |
|
b. |
Clark’s rule |
|
c. |
Young’s rule |
|
d. |
The mg/kg formula |
ANS: D
The body weight method, using the mg/kg formula, is the most
common and reliable method for calculating doses for young patients. Fried’s
rule, Clark’s rule, and Young’s rule are not methods used for calculating drug
dosages for young patients.
DIF: Cognitive Level:
Knowledge
REF: p. 63
4. While
assessing an 82-year-old woman, the nurse determines that the patient is
experiencing polypharmacy. What is this experience most likely to indicate?
|
a. |
The patient has a lower
risk of drug interactions. |
|
b. |
The patient takes
medications for one illness several times a day. |
|
c. |
The patient risks problems
only if she also takes over-the-counter medications. |
|
d. |
The patient takes multiple
medications for several different illnesses. |
ANS: D
Polypharmacy usually occurs when a patient has several illnesses
and takes medications for each of them, medications possibly prescribed by
different specialists who may be unaware of the patient’s other treatments.
This situation puts the patient at increased risk of drug interactions and
adverse reactions. Polypharmacy means that the patient has a higher, not lower,
risk of drug interactions, and that the patient is taking several different
medications, not just one. Polypharmacy can include prescription drugs,
over-the-counter medications, and natural health products.
DIF: Cognitive Level:
Application
REF: p. 66
5. Which
statement is true in regard to children?
|
a. |
Their levels of microsomal
enzymes are decreased compared to those of adults. |
|
b. |
Their total body water
content is much less than that of adults. |
|
c. |
Their first-pass
elimination is increased because of higher portal circulation. |
|
d. |
Gastric emptying is more
rapid than that of adults because of increased peristaltic activity. |
ANS: A
In children, the levels of microsomal enzymes are decreased. A
child’s gastric emptying is slowed because of slow or irregular peristalsis.
Total body water content is greater in children than in adults, and first-pass
elimination by the liver is reduced because of immaturity of the liver and
reduced levels of microsomal enzymes.
DIF: Cognitive Level:
Comprehension REF: p. 62
6. For
accurate medication administration to young patients, the nurse must take into
account which information?
|
a. |
Weight, height, age, and
organ maturity |
|
b. |
Age, glomerular filtration
rate, and weight |
|
c. |
Weight, height, body
temperature, and age |
|
d. |
Weight, height, and total
body water content |
ANS: A
To accurately administer medications to young patients, their
weight, height, age, physical condition, metabolism and organ maturity must be
taken into account. Glomerular filtration rate, body temperature, and total
body water content are not considerations when administering medications to
young patients.
DIF: Cognitive Level: Comprehension
REF: p. 74
7. An
older adult patient will often experience a reduction in the stomach’s ability
to produce hydrochloric acid. This change will result in which alteration?
|
a. |
Delayed gastric emptying |
|
b. |
Increased gastric acidity |
|
c. |
Decreased intestinal
absorption of medications |
|
d. |
Altered absorption of
select drugs |
ANS: D
This aging-related change results in a decrease in gastric
acidity and may alter the absorption of some drugs. Delayed gastric emptying,
increased gastric acidity, and decreased intestinal absorption of medications
are not results of reduced hydrochloric acid production.
DIF: Cognitive Level:
Application
REF: p. 67
8. Which
is the reason drug toxicity is more likely to occur in the neonate?
|
a. |
The lungs are immature. |
|
b. |
The kidneys are smaller. |
|
c. |
The liver is not fully
developed. |
|
d. |
Renal excretion of the drug
is faster. |
ANS: C
A neonate’s liver is not fully developed and cannot detoxify
many drugs; thus, drug toxicity is more likely to occur in the neonate. The
lungs and kidneys do not play major roles in drug metabolism. Renal excretion
of the drug is slower, not faster, due to organ immaturity.
DIF: Cognitive Level:
Comprehension REF: p. 63
9. An
83-year-old female patient has been given a thiazide diuretic to treat mild
heart failure. She and her daughter should be taught to watch for which
complications?
|
a. |
Dizziness and constipation |
|
b. |
Fatigue and dehydration |
|
c. |
Daytime sedation and lethargy |
|
d. |
Edema and blurred vision |
ANS: B
Electrolyte imbalance, fatigue, and dehydration are common
complications of thiazide diuretics in older adult patients. Dizziness and
constipation, daytime sedation and lethargy, and edema and blurred vision are
not complications that occur when these drugs are given to older adults.
DIF: Cognitive Level:
Comprehension REF: p. 69
10. Which
complication is common with an older adult patient who is taking digoxin?
|
a. |
Hallucinations |
|
b. |
Edema |
|
c. |
Dry mouth |
|
d. |
Constipation |
ANS: A
Common complications for older adults taking digoxin include
visual disorders, nausea, diarrhea, dysrhythmias, hallucinations, decreased
appetite, and weight loss. Nonsteroidal anti-inflammatory drugs may cause edema,
anticholinergics and antihistamines may cause dry mouth, and opioids may cause
constipation.
DIF: Cognitive Level:
Comprehension REF: p. 68
11. The
nurse is aware that confusion, ataxia, and increased risk for falls are older
adult patients’ common responses to which medication?
|
a. |
Laxatives |
|
b. |
Anticoagulants |
|
c. |
Sedatives |
|
d. |
Diuretics |
ANS: C
In older adults, sedatives and hypnotics often cause confusion,
daytime sedation, ataxia, lethargy, and increased risk for falls. Laxatives,
anticoagulants, and diuretics may cause adverse effects in older adults, but
not the adverse effects specified in the question.
DIF: Cognitive Level:
Application
REF: p. 69
12. The
nurse is trying to give a liquid medication to a 2-year-old child and notes
that the medication has a strong taste. The best way for the nurse to give this
medication to a child is to
|
a. |
give the medication with
spoonfuls of sherbet. |
|
b. |
add the medication to the
child’s bottle. |
|
c. |
tell the child you have
candy. |
|
d. |
add the medication to a cup
of milk. |
ANS: A
Using sherbet or another non-essential food that makes the
medication taste better is the best way to give a strong-tasting medication to
a child. Adding the medication to the child’s bottle is not correct because the
child may not drink the entire contents of the bottle, thus wasting the
medication. Telling the child that the medication is candy is not correct
because using the word “candy” with
drugs may lead to the child’s thinking that drugs are actually candy. Adding
the medication to a cup of milk is not correct because the child may not drink
the entire cup of milk, and the distasteful drug may cause the child to refuse
milk in the future.
DIF: Cognitive Level:
Application
REF: p. 76
13. For
which cultural group must the nurse respect the value placed on natural health
products, the use of heat, and a concern for the balance of opposing forces
that lead to illness or health?
|
a. |
Hispanic Canadians |
|
b. |
Asian Canadians |
|
c. |
Indigenous peoples |
|
d. |
Black people of African
descent |
ANS: B
Some Asian Canadians believe in yin and yang, which are opposing
forces leading to illness or health, depending on which force is in balance.
Other health practices for this cultural group include belief in the use of
heat and in the value of herbal remedies. Hispanic Canadians, Indigenous
peoples, and Black people of African descent do not typically engage in these
practices.
DIF: Cognitive Level:
Comprehension REF: p. 72
14. A
nurse is assessing an older adult Indigenous woman who is being treated for
hypertension. During the assessment, what important information should the
nurse remember or expect in regard to culture?
|
a. |
The patient should be
discouraged from using traditional remedies and rituals. |
|
b. |
The nurse should expect the
patient to value protective bracelets and herbal teas. |
|
c. |
The nurse should remember
that the balance between body, mind, and environment is important to this
patient’s health beliefs. |
|
d. |
The assessment should
include information about cultural practices and beliefs regarding
medication, treatment, and healing. |
ANS: D
All beliefs need to be strongly considered to prevent a conflict
between the goals of nursing and health care and the dictates of a patient’s
cultural background. Assessing cultural practices and beliefs is part of a
thorough assessment. The nurse should not ignore a patient’s cultural
practices. Protective bracelets, use of herbal teas, and balance between body,
mind, and environment do not describe beliefs and practices that usually apply
to this patient’s cultural group.
DIF: Cognitive Level:
Application
REF: p. 72
15. Which
ethnocultural group believes in harmony with nature and views ill spirits as
causing disease?
|
a. |
Black people of African
descent |
|
b. |
South Asian Canadians |
|
c. |
Filipino Canadians |
|
d. |
Indigenous peoples |
ANS: D
Indigenous peoples believe in harmony with nature and view ill
spirits as causing disease.
DIF: Cognitive Level:
Comprehension REF: p. 71
MULTIPLE RESPONSE
1. Which
is true regarding young patients? (Select
all that apply.)
|
a. |
The levels of microsomal
enzymes are decreased. |
|
b. |
Perfusion to the kidneys
may be decreased, which may result in reduced renal function. |
|
c. |
First-pass elimination is
increased because of higher portal circulation. |
|
d. |
First-pass elimination is
reduced because of the immaturity of the liver. |
|
e. |
Total body water content is
much less than in adults. |
|
f. |
Gastric emptying is slowed
because of slow or irregular peristalsis. |
|
g. |
Gastric emptying is more
rapid because of increased peristaltic activity. |
ANS: A, B, D, F
In children, microsomal enzymes are decreased and first-pass
elimination by the liver is reduced because of the immaturity of the liver. In
addition, gastric emptying is reduced because of slow or irregular peristalsis.
Perfusion to the kidneys may be decreased, resulting in reduced renal function.
“First-pass elimination is increased because of higher portal circulation” and
“Gastric emptying is more rapid because of increased peristaltic activity” are
not correct statements. Total body water content is greater in children than in
adults.
DIF: Cognitive Level:
Application
REF: p. 62
2. Which
is true regarding older adults? (Select
all that apply.)
|
a. |
The levels of microsomal
enzymes are decreased. |
|
b. |
Fat content is increased
because of decreased lean body mass. |
|
c. |
Fat content is decreased
because of increased lean body mass. |
|
d. |
The number of intact
nephrons is increased. |
|
e. |
The number of intact
nephrons is decreased. |
|
f. |
Gastric pH is less acidic. |
|
g. |
Gastric pH is more acidic. |
ANS: A, B, E, F
In older adults, levels of microsomal enzymes are decreased
because the aging liver is less able to produce them; fat content is increased
because of decreased lean body mass; the number of intact nephrons is decreased
due to aging; and gastric pH is less acidic due to a gradual reduction of the
production of hydrochloric acid. “Fat content is decreased because of increased
lean body mass,” “The number of intact nephrons is increased,” and “Gastric pH
is more acidic” are incorrect statements.
DIF: Cognitive Level:
Application
REF: p. 67
Chapter 07: Patient Education and Drug Therapy
Lilley: Pharmacology for Canadian Health Care Practice, 3rd
Canadian Edition
MULTIPLE CHOICE
1. Which
diagnosis is appropriate for the patient who has just received a prescription
for a new medication?
|
a. |
Nonadherence related to a
new drug therapy |
|
b. |
High risk for nonadherence
related to new drug therapy |
|
c. |
Knowledge deficit related
to newly prescribed drug therapy |
|
d. |
Deficient knowledge related
to newly prescribed drug therapy |
ANS: D
The patient who has a limited understanding of newly prescribed
drug therapy may have the nursing diagnosis of deficient knowledge.
“Nonadherence” implies that the patient does not follow a recommended regimen,
which is not the case with a newly prescribed drug. “High risk for nonadherence
related to new drug therapy” is not a North American Nursing Diagnosis
Association nursing diagnosis, and “Deficient knowledge related to newly
prescribed drug therapy” is an outdated nursing diagnosis.
DIF: Cognitive Level:
Analysis
REF: p. 109
2. Which
statement reflects a measurable goal?
|
a. |
The patient will know about
insulin injections. |
|
b. |
The patient will understand
the principles of insulin preparation. |
|
c. |
The patient will
demonstrate the proper technique of mixing insulin. |
|
d. |
The patient will comprehend
the proper technique of preparing insulin. |
ANS: C
The word “demonstrate” is a measurable verb, and measurable
terms should be used when developing goals and outcome criteria statements. The
terms “know,” “understand” and “comprehend” are not measurable terms.
DIF: Cognitive Level:
Analysis
REF: p. 109
3. During
an assessment, which question allows the nurse to clarify and open up discussion
with the patient?
|
a. |
“Are you allergic to
penicillin?” |
|
b. |
“What medications do you
take?” |
|
c. |
“Have you had a reaction to
this drug?” |
|
d. |
“Are you taking this
medication with meals?” |
ANS: B
“What medications do you take?” is an open-ended question that
will encourage more clarification and discussion from the patient. “Are you
allergic to penicillin?” is a closed-ended question, as are “Have you had a
reaction to this drug?” and “Are you taking this medication with meals?” Closed-ended
questions prompt only a “yes” or “no” answer and provide limited information.
DIF: Cognitive Level:
Application
REF: pp. 108-109
4. The
nurse is setting up a teaching–learning session with an 85-year-old patient who
will be going home on anticoagulant therapy. Which strategy will reflect
consideration of aging changes that may occur?
|
a. |
Showing a colourful video
about anticoagulation therapy |
|
b. |
Presenting all the
information in one session just before discharge |
|
c. |
Giving the patient
pamphlets about the medications to read at home |
|
d. |
Developing large-print
handouts that reflect the verbal information presented |
ANS: D
Developing large-print handouts that reflect the verbal
information presented will address altered perception in two ways. First, using
visual aids reinforces the verbal instructions by addressing the patient’s
possibly decreased ability to hear high-frequency sounds. Second, developing
the handouts in large print addresses the possibility of decreased visual
acuity. Showing a colourful video about anticoagulation therapy does not allow
for discussion of the information; furthermore, the text and print may be small
and difficult to read and understand. Presenting all the information in one
session just before discharge also does not allow for discussion, and the
patient may not be able to hear or see the information sufficiently. Because of
the possibility of decreased short-term memory and slowed cognitive function,
giving the patient pamphlets about the medications to read at home is not
appropriate.
DIF: Cognitive Level:
Application
REF: p. 111
5. When
the nurse is teaching a manual skill, such as self-injection of insulin, the
best way to set up the teaching-learning session is to
|
a. |
provide written pamphlets
for instruction. |
|
b. |
show a video and allow the
patients to practice as needed on their own. |
|
c. |
verbally explain the
procedure and provide written handouts for reinforcement. |
|
d. |
allow the patients to do
several “return” demonstrations after the nurse has demonstrated the
procedure. |
ANS: D
Return demonstrations allow the nurse to evaluate the patient’s
newly learned skills. Providing written pamphlets for instruction, showing a
video and then allowing patients to practice as needed on their own, and
verbally explaining the procedure and providing written handouts for
reinforcement do not allow for evaluation of the patient’s technique.
DIF: Cognitive Level:
Analysis
REF: p. 112
6. A
patient and the dietitian have just reviewed the patient’s new diet, which is
low protein and low potassium. This reviewing constitutes learning in which
domain?
|
a. |
Physical |
|
b. |
Affective |
|
c. |
Cognitive |
|
d. |
Psychomotor |
ANS: C
The cognitive domain refers to problem-solving abilities and may
involve recall and knowledge of facts. The physical domain is not one of the
learning domains. The affective domain refers to values and beliefs. The
psychomotor domain may involve actions such as learning how to perform a
procedure.
DIF: Cognitive Level:
Comprehension REF: p. 106
7. The
nurse needs to teach a 16-year-old patient, newly diagnosed with diabetes,
about blood glucose monitoring and the importance of regulating glucose intake.
When the nurse is developing the teaching plan, which of Erickson’s stages of
development should be considered?
|
a. |
Trust versus mistrust |
|
b. |
Intimacy versus isolation |
|
c. |
Industry versus inferiority |
|
d. |
Identity versus role
confusion |
ANS: D
According to Erickson, the adolescent, 12 to 18 years of age, is
in the “identity versus role confusion” stage of development. According to
Erikson, “trust versus mistrust” reflects the infancy stage; “intimacy versus
isolation” reflects the young adulthood stage; and “industry versus
inferiority” reflects the school-age stage of development.
DIF: Cognitive Level:
Comprehension REF: p. 108, Box 7-3
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