Pharmacology For Nurses A Pathophysiologic Approach 5th Edition by Michael Patrick Adams – Test bank
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Sample Test
Adams, Pharmacology for Nurses: A
Pathophysiologic Approach, 5/E
Chapter 3
Question 1
Type: MCMA
The physician has ordered several medications for the patient.
What does the nurse recognize as responsibilities regarding administration of
medications?
Note: Credit will be given only if all correct choices and no
incorrect choices are selected.
Standard Text: Select all that apply.
1. Knowing
whether or not the medication is on the hospital formulary
2. Knowing
the reason the medication was prescribed for this patient
3. Knowing
how the medication is to be administered
4. Knowing
how the medication is supplied by the pharmacy
5. Knowing
the name of the medication
Correct Answer: 2,3,4,5
Rationale 1: Whether or not a drug is on
a hospital formulary list is not a primary responsibility of the nurse.
Rationale 2: Knowing the reason the
medication was prescribed for the patient is the responsibility of the nurse
regarding medication administration.
Rationale 3: Knowing how the medication
is to be administered is the responsibility of the nurse regarding medication
administration.
Rationale 4: Knowing how the medication
is to be administered is the responsibility of the nurse regarding medication
administration.
Rationale 5: Knowing how the medication
is supplied by the pharmacy is the responsibility of the nurse regarding
medication administration.
Global Rationale: How the medication is
supplied by the pharmacy, how the medication is to be administered, the name of
the medication, and the reason the medication was prescribed for the patient
are the responsibilities of the nurse regarding medication administration.
Whether or not a drug is on a hospital formulary list is not a primary
responsibility of the nurse.
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 3-2 Describe the roles
and responsibilities of nurses regarding safe drug administration.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 21
Question 2
Type: MCMA
The nurse is preparing medications prior to administration. To
promote patient safety, the nurse uses “rights” of drug administration. What do
these “rights” include?
Note: Credit will be given only if all correct choices and no
incorrect choices are selected.
Standard Text: Select all that apply.
1. The
right medication
2. The
right time of delivery
3. The
right dose
4. The
right route of administration
5. The
right nurse
Correct Answer: 1,2,3,4
Rationale 1: The right medication is an
essential consideration of medication administration and is considered one of
the five rights.
Rationale 2: The right time of delivery
is an essential consideration of medication administration and is considered
one of the five rights.
Rationale 3: The right dose is an
essential consideration of medication administration and is considered one of
the five rights.
Rationale 4: The right route of delivery
is an essential consideration of medication administration and is considered
one of the five rights.
Rationale 5: The right nurse is not one
of the listed rights of medication delivery.
Global Rationale: The five rights of
drug administration are the right patient, the right medication, the right
dose, the right route of administration, and the right time of delivery. The
right nurse is not one of the listed rights.
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: IX.12
Create a safe environment that results in high quality patient outcomes.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 3-3 Explain how the
five rights of drug administration affect patient safety.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 22
Question 3
Type: MCSA
The nurse suspects that the patient has not been taking his
prescribed antihypertensive medication because the patient’s blood pressure
remains elevated. What is the best therapeutic question the nurse can ask that
will assess noncompliance?
1. “Taking
medication is difficult for many people. What are some of your concerns about
the medication?”
2. “Your
blood pressure is really high; do you realize the serious consequences of not
taking your medication?”
3. “I
really doubt that you are taking your medication. What would you think about
talking to the doctor?”
4. “You
are one of my favorite patients and I want you to be safe. Are you really
taking your medication?”
Correct Answer: 1
Rationale 1: The most therapeutic
question informs the patient that compliance is difficult for many people, and
does not directly challenge the patient about not taking the medication.
Rationale 2: Telling the patient his
blood pressure is high and there are serious consequences is using the “scare
tactic,” and is non-therapeutic; the patient most likely is aware of the
consequences.
Rationale 3: Telling the patient that
the nurse doubts he is taking the medication directly challenges him, and
recommending that he see the physician is threatening.
Rationale 4: Telling the patient that he
is a favorite is manipulating.
Global Rationale: The most therapeutic
question informs the patient that compliance is difficult for many people, and
does not directly challenge the patient about not taking the medication.
Telling the patient that the nurse doubts he is taking the medication directly
challenges him, and recommending that he see the physician is threatening.
Telling the patient his blood pressure is high and there are serious consequences
is using the “scare tactic,” and is non-therapeutic; the patient most likely is
aware of the consequences. Telling the patient that he is a favorite is
manipulating.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: I.B.1 Elicit patient
values, preferences, and expressed needs as part of clinical interview,
implementation of care plan, and evaluation of care.
AACN Essential Competencies: IX.5
Deliver compassionate, patient-centered, evidence-based care that respects
patient and family preferences.
NLN Competencies: Relationship centered
care: Respect the patient’s dignity, uniqueness, integrity, and
self-determination, and his or her own power and self-healing process.
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 3-4 Give specific
examples of how nurses can increase patient compliance in taking medications.
MNL Learning Outcome: 1.3.3
Implement the nursing process in the administration of medications.
Page Number: 23
Question 4
Type: MCSA
The patient is having chest pain. The physician orders
sublingual nitroglycerine STAT. The nurse obtains the medication from the
pharmacy and administers it to the patient 30 minutes later. Which statement
best describes the nurse’s action?
1. The
medication should have been administered immediately.
2. The
physician should have specified the time frame for the medication.
3. The
medication should have been administered within a 5-minute time frame.
4. The
nursing action was correct because the medication was not on the unit.
Correct Answer: 3
Rationale 1: Although the drug does not
need to be administered immediately, there is a time limit in which it should
be administered.
Rationale 2: For a STAT order, the time
frame between writing the order and administering the drug should be 5 minutes
or less. Not having a drug on the unit is not an excuse, as commonly ordered
STAT medications should be kept in stock. Although the drug does not need to be
administered immediately, it should be done within 5 minutes. By using the
abbreviation STAT, the physician has specified the time frame for the
medication.
Rationale 3: For a STAT order, the time
frame between writing the order and administering the drug should be 5 minutes
or less.
Rationale 4: Not having a drug on the
unit is not an excuse, as commonly ordered STAT medications should be kept in
stock.
Global Rationale: For a STAT order, the
time frame between writing the order and administering the drug should be 5
minutes or less. Although the drug does not need to be administered
immediately, there is a time limit in which it should be administered. By using
the abbreviation STAT, the physician has specified the time frame for the
medication. Not having a drug on the unit is not an excuse, as commonly ordered
STAT medications should be kept in stock.
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 3-5 Interpret drug
orders that contain abbreviations.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 24
Question 5
Type: MCSA
The nurse uses the nursing process prior to administering any
medications. Which step will ensure the best patient safety?
1. Assess
the patient’s developmental level.
2. Assess
the patient’s medical history.
3. Assess
the patient’s disease process.
4. Assess
the patient’s learning needs.
Correct Answer: 2
Rationale 1: Assessing the patient’s
developmental level is important for medication education, but not for safely
administering medications.
Rationale 2: An assessment of the
patient’s medical history, which includes allergies, is the most important
assessment prior to administering medications.
Rationale 3: Assessing the patient’s
disease process is important in evaluating the effects of the medications, but
not for safely administering medications.
Rationale 4: Assessing the patient’s
learning needs is important for medication education, but not for safely
administering medications.
Global Rationale: An assessment of the
patient’s medical history, which includes allergies, is the most important
assessment prior to administering medications. Assessing the patient’s learning
needs is important for medication education, but not for safely administering
medications. Assessing the patient’s developmental level is important for
medication education, but not for safely administering medications. Assessing
the patient’s disease process is important in evaluating the effects of the
medications, but not for safely administering medications.
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 3-1 Discuss drug
administration as a component of safe, effective nursing care, using the
nursing process.
MNL Learning Outcome: 1.3.3 Implement
the nursing process in the administration of medications.
Page Number: 21
Question 6
Type: MCSA
The physician prescribes an oral medication for the patient.
What is the primary nursing assessment of the patient prior to receiving this
medication?
1. The
patient’s understanding of the medication
2. The
patient’s ability to swallow
3. The
patient’s allergies
4. The
patient’s eyesight
Correct Answer: 2
Rationale 1: The patient’s understanding
is important, but not a priority.
Rationale 2: The ability of the patient
to swallow is a safety issue to prevent aspiration of the medication.
Rationale 3: The patient’s allergies are
important, but if the patient cannot swallow the medication, then the allergies
are not significant.
Rationale 4: The patient’s eyesight is
not significant.
Global Rationale: The ability of the
patient to swallow is a safety issue to prevent aspiration of the medication.
The patient’s understanding is important, but not a priority. The patient’s
eyesight is not significant. The patient’s allergies are important, but if the
patient cannot swallow the medication, then the allergies are not significant.
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 3-7 Explain the proper
methods of administering enteral, topical, and parenteral drugs.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 26
Question 7
Type: MCSA
The physician ordered an oral medication. The nurse incorrectly
administered the medication intravenously. What does the best analysis of the
nurse’s action reveal?
1. An
antidote cannot be given.
2. The
nurse will be terminated from her job.
3. The
medication cannot be retrieved.
4. A
lawsuit by the patient will be impending.
Correct Answer: 3
Rationale 1: Antidotes may be given, but
this must be done very quickly.
Rationale 2: The nurse may be
terminated, but patient safety is the main concern.
Rationale 3: When a medication is given
intravenously, its effects cannot be reversed because it is already in the
bloodstream.
Rationale 4: A lawsuit may occur, but
this is not the primary concern; patient safety is the primary concern.
Global Rationale: When a medication is
given intravenously, its effects cannot be reversed because it is already in
the bloodstream. A lawsuit may occur, but this is not the primary concern;
patient safety is the primary concern. The nurse may be terminated, but patient
safety is the main concern, and the effect of the medication cannot be
reversed. Antidotes may be given, but this must be done very quickly.
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: V.A.4 Delineate
general categories of errors and hazards in care.
AACN Essential Competencies: VIII.12
Act to prevent unsafe, illegal, or unethical care practices.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 3-7 Explain the proper
methods of administering enteral, topical, and parenteral drugs.
MNL Learning Outcome: 1.3.2
Apply the correct principles and procedures for safe administration of
medications to clients.
Page Number: 35
Question 8
Type: MCSA
What is the best plan as the nurse prepares to administer a
topical medication?
1. Check
the medication for interactions with other medications.
2. Take
the patient’s vital signs.
3. Educate
the patient to not disturb the patch.
4. Assess
the patient’s skin where the medication will be applied.
Correct Answer: 4
Rationale 1: Checking for drug
interactions is important, but it is not the priority.
Rationale 2: Vital signs are not always
indicated; it depends on the medication.
Rationale 3: Patient education is
important, but is not the priority.
Rationale 4: Planning to assess the
patient’s skin is imperative; if it is cracked, dry, or irritated, the
medication may not be properly absorbed.
Global Rationale: Planning to assess the
patient’s skin is imperative; if it is cracked, dry, or irritated, the
medication may not be properly absorbed. Patient education is important, but is
not the priority. Vital signs are not always indicated; it depends on the
medication. Checking for drug interactions is important, but it is not the
priority.
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 3-7 Explain the proper
methods of administering enteral, topical, and parenteral drugs.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 29
Question 9
Type: MCSA
The physician ordered an intravenous medication for a patient
with nausea. The patient asks the nurse how it will help his nausea. What is
the best response by the nurse?
1. “We
have more intravenous drugs for nausea than we do oral drugs.”
2. “If
you take an oral medication, you will just vomit it up.”
3. “This
will work much faster for your nausea.”
4. “You
can’t have anything by mouth, so you will receive the medication
intravenously.”
Correct Answer: 3
Rationale 1: Telling the patient that
the nurse has more intravenous drugs than oral drugs does not answer the
patient’s question.
Rationale 2: Telling the patient that he
will vomit the medication is non-therapeutic.
Rationale 3: The intravenous route
provides the quickest route of medication absorption.
Rationale 4: There is no evidence that
the patient cannot have anything by mouth.
Global Rationale: The intravenous route
provides the quickest route of medication absorption. Telling the patient that
he will vomit the medication is non-therapeutic. Telling the patient that the
nurse has more intravenous drugs than oral drugs does not answer the patient’s
question. There is no evidence that the patient cannot have anything by mouth.
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care.
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 3-8 Compare and
contrast the advantages and disadvantages of each route of drug administration.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 34
Question 10
Type: MCSA
The physician orders enteric-coated aspirin, 300 mg every day,
for the patient with a nasogastric tube. What is the priority action by the
nurse?
1. Crush
the tablet, dissolve it in 30 mL of water, and administer through the tube.
2. Put
the tablet in the tube, “milk” it down the tube, and then flush the tube with
60 mL of water.
3. Withhold
the medication and contact the physician.
4. Substitute
plain aspirin, dissolve it in 30 mL of water, and administer through the tube.
Correct Answer: 3
Rationale 1: Crushing the tablet
destroys the enteric coating.
Rationale 2: Putting the tablet in the
tube will result in clogging of the tube.
Rationale 3: The only option is to
withhold the medication and contact the physician.
Rationale 4: The nurse cannot substitute
plain aspirin; this requires a physician’s order.
Global Rationale: The only option is to
withhold the medication and contact the physician. Crushing the tablet destroys
the enteric coating. Putting the tablet in the tube will result in clogging of
the tube. The nurse cannot substitute plain aspirin; this requires a
physician’s order.
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 3-7 Explain the proper
methods of administering enteral, topical, and parenteral drugs.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 26
Question 11
Type: MCSA
The patient is receiving a sustained-release capsule for his
cardiac condition. The patient tells the nurse there is no way he can swallow
such a large pill. What is the best response by the nurse?
1. “Let
me contact your physician to see if a change can be made.”
2. “Place
the capsule on the back of your tongue, and drink a full glass of water.”
3. “I
will open the capsule and sprinkle the contents over some applesauce for you to
eat.”
4. “It
may be difficult, but try to swallow the capsule as it is the best medicine for
your heart condition.”
Correct Answer: 1
Rationale 1: The only option is to
contact the physician.
Rationale 2: Placing the capsule on the
back of the patient’s tongue and having him drink a full glass of water may
cause the patient to aspirate the capsule and/or the water.
Rationale 3: Sustained-release
medications cannot be opened and sprinkled on food.
Rationale 4: Encouraging the patient to
try to swallow the capsule is coercive and may result in the patient choking on
the medication.
Global Rationale: The only option is to
contact the physician. Sustained-release medications cannot be opened and
sprinkled on food. Placing the capsule on the back of the patient’s tongue and
having him drink a full glass of water may cause the patient to aspirate the
capsule and/or the water. Encouraging the patient to try to swallow the capsule
is coercive and may result in the patient choking on the medication.
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 3-7 Explain the proper
methods of administering enteral, topical, and parenteral drugs.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 27
Question 12
Type: MCSA
While in the hospital, the pediatric patient has been receiving
amoxicillin 10 mL orally bid, pc. The child will be going home on this
medication. What is the best instruction by the nurse for the parents?
1. Give
2 teaspoons by mouth, 3 times a day, on an empty stomach.
2. Give
2 teaspoons by mouth, twice a day, after meals.
3. Give
2 teaspoons by mouth, 3 times a day, after meals.
4. Give
2 teaspoons by mouth, twice a day, with meals.
Correct Answer: 2
Rationale 1: Giving 2 teaspoons by
mouth, 3 times a day, on an empty stomach is incorrect.
Rationale 2: Giving 2 teaspoons by
mouth, twice a day, after meals is correct.
Rationale 3: Giving 2 teaspoons by
mouth, 3 times a day, after meals is incorrect.
Rationale 4: Giving 2 teaspoons by
mouth, twice a day, with meals is incorrect.
Global Rationale: Giving 2 teaspoons by
mouth, twice a day, after meals is correct. Giving 2 teaspoons by mouth, 3
times a day, after meals is incorrect. Giving 2 teaspoons by mouth, twice a
day, with meals is incorrect. Giving 2 teaspoons by mouth, 3 times a day, on an
empty stomach is incorrect.
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 3-5 Interpret drug
orders that contain abbreviations.
MNL Learning Outcome: 1.3.2
Apply the correct principles and procedures for safe administration of
medications to clients.
Page Number: 24
Question 13
Type: MCSA
The patient is 3 days postop, and the physician orders an oral
pain medication. The patient asks the nurse if it wouldn’t be better to get the
medication in the intravenous (IV) line. What is the best response by the nurse?
1. “No,
because you could not medicate yourself intravenously (IV) at home.”
2. “No,
because pills are more effective than intravenous (IV) medications.”
3. “No,
because pills are safer than intravenous (IV) medications.”
4. “No,
because we are going to take your intravenous (IV) line out.”
Correct Answer: 3
Rationale 1: There is no evidence that
the patient will be going home with an intravenous line, so this answer is
incorrect.
Rationale 2: Oral medications are not
more effective than IV medications.
Rationale 3: Oral medications are safer
than intravenous (IV) medications.
Rationale 4: Telling the patient that
she cannot have the medication intravenously because the intravenous line is to
be removed does not answer the patient’s question.
Global Rationale: Oral medications are
safer than intravenous (IV) medications. Telling the patient that she cannot
have the medication intravenously because the intravenous line is to be removed
does not answer the patient’s question. There is no evidence that the patient
will be going home with an intravenous line, so this answer is incorrect. Oral
medications are not more effective than IV medications.
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Knowledge and Science:
Relationships between knowledge/science and quality and safe patient care.
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 3-8 Compare and
contrast the advantages and disadvantages of each route of drug administration.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 26
Question 14
Type: MCSA
The nurse plans to administer heparin by drawing the heparin up
in an appropriate syringe, donning gloves, prepping the patient’s abdominal
area, inserting the needle, aspirating for blood, and injecting the medication.
Which statement best describes the nurse’s plan?
1. The
nurse does not need to wear gloves.
2. The
nurse should not aspirate for blood.
3. The
nurse does not need to prep the skin.
4. The
nurse performed the injection correctly.
Correct Answer: 2
Rationale 1: Gloves must always be worn
for invasive techniques.
Rationale 2: When performing heparin
injections, the nurse should not aspirate for blood as this may cause bruising
or bleeding.
Rationale 3: The skin should be prepped
with alcohol prior to administering an injection.
Rationale 4: The nurse did not perform
the correct technique.
Global Rationale: When performing
heparin injections, the nurse should not aspirate for blood as this may cause
bruising or bleeding. Gloves must always be worn for invasive techniques. The
nurse did not perform the correct technique. The skin should be prepped with
alcohol prior to administering an injection.
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of human
growth and development, pathophysiology, pharmacology, medical management and
nursing management across the health-illness continuum, across lifespan, and in
all healthcare settings.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 3-7 Explain the proper
methods of administering enteral, topical, and parenteral drugs.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 33
Question 15
Type: MCSA
The order is for a pain medication to be given prn. Which
statement, by the nurse, correctly teaches the client about this medication
order?
1. “I
can give you this medication anytime you need it, so I will be asking you about
your pain level frequently.”
2. ”This
medication will be given to you at a set time every day, probably just before
your bath.”
3. “You
will be given this medication at bedtime each night so that you can rest.”
4. “This
medication may upset your stomach, so always take it with food or milk.”
Correct Answer: 1
Rationale 1: The abbreviation PRN is
used to designate as needed.
Rationale 2: PRN does not mean every
day.
Rationale 3: PRN does not mean at
bedtime.
Rationale 4: PRN does not mean with
food.
Global Rationale: PRN does not mean
every day, at bedtime, or with food.
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 3-5 Interpret drug
orders that contain abbreviations.
MNL Learning Outcome: 1.3.2
Apply the correct principles and procedures for safe administration of
medications to clients.
Page Number: 24
Question 16
Type: MCSA
A patient has an increased reaction to a drug following a change
in her dietary habits. Which change would most likely be the cause?
1. Increased
intake of grapefruit juice
2. Reduced
intake of alcohol
3. Increased
fiber intake
4. Reduced
intake of citrus fruit
Correct Answer: 1
Rationale 1: Grapefruit juice lowers the
activity of enzymes in the GI system that break down medications. This in turn
results in higher medication absorption into the bloodstream.
Rationale 2: A reduced intake of alcohol
would not likely produce an increased reaction to a drug.
Rationale 3: A reduced intake of fiber
would not likely produce an increased reaction to a drug.
Rationale 4: A reduction in citrus fruit
intake would likely cause a lowered drug reaction.
Global Rationale: Grapefruit juice
lowers the activity of enzymes in the GI system that break down medications.
This in turn results in higher medication absorption into the bloodstream. A
reduction in citrus fruit intake would likely cause a lowered drug reaction. A
reduced intake of alcohol or fiber would not likely produce an increased
reaction to a drug.
Cognitive Level: Understanding
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 3-1 Discuss drug
administration as a component of safe, effective nursing care, using the
nursing process.
MNL Learning Outcome: 1.3.3 Implement
the nursing process in the administration of medications.
Page Number: 24
Question 17
Type: MCSA
The nurse administers an oral preparation of liquid Tylenol 650
mg as ordered. Afterward, the patient indicates he had been receiving Tylenol
650 mg in pill form. Which statement is accurate in regards to the five rights?
1. The
nurse failed to deliver the correct dose.
2. The
nurse failed to administer the right medication.
3. The
nurse did not violate the five rights.
4. The
nurse failed to give the medication via the correct route.
Correct Answer: 3
Rationale 1: The correct dose was
administered.
Rationale 2: The correct medication was
administered.
Rationale 3: Nothing in the question
depicts a violation of the five rights. Both forms of the medication are oral
preparations.
Rationale 4: The correct route was used.
Global Rationale: Nothing in the
question depicts a violation of the five rights. Both forms of the medication
are oral preparations. The correct dose, medication, and route were used.
Cognitive Level: Analyzing
Client Need: Safe Effective Care
Environment
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: IX.12
Create a safe environment that results in high quality patient outcomes.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Evaluation
Learning Outcome: 3-3 Explain how the
five rights of drug administration affect patient safety.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 26
Question 18
Type: MCSA
A young patient has been receiving five milliliters of liquid
antibiotic three times each day. The nurse providing discharge instructions
would teach the parents to use a standard measuring spoon to administer which
amount for each dose?
1. 2
tablespoons
2. 1
fluid ounce
3. 15
drops
4. 1
teaspoon
Correct Answer: 4
Rationale 1: Five milliliters is not
equivalent to two tablespoons.
Rationale 2: A fluid ounce is equal to
30–32 milliliters.
Rationale 3: Five milliliters is equal
to about 60 drops.
Rationale 4: One standard teaspoon is
equal to 4 or 5 milliliters, so this is the best answer.
Global Rationale: Liquid medications
should be measured using a standardized instrument. One standard teaspoon is
equal to 4 or 5 milliliters. The other measurements are not accurate and would
result in large overdoses or underdoses.
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 3-6 Compare and
contrast the three systems of measurement used in pharmacology.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 25
Question 19
Type: MCSA
Placement of a tablet between the cheek and gum would be which
route?
1. Buccal
2. Oral
3. Transdermal
4. Sublingual
Correct Answer: 1
Rationale 1: Buccal is the term used to
describe a medication placed between the cheek and gum.
Rationale 2: An oral medication is
swallowed.
Rationale 3: A transdermal medication is
applied to the skin.
Rationale 4: A sublingual medication is
placed under the tongue.
Global Rationale: Buccal is the term
used to describe a medication placed between the cheek and gum. An oral
medication is swallowed. A transdermal medication is applied to the skin. A
sublingual medication is placed under the tongue.
Cognitive Level: Remembering
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 3-7 Explain the proper
methods of administering enteral, topical, and parenteral drugs.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 27
Question 20
Type: FIB
A client will receive a liter of fluid intravenously to treat
dehydration. The client says, “I don’t understand the metric system, how much
is that?” The nurse responds, “It is about ______ cups of fluid.”
Standard Text: Record your answer
rounding to the nearest whole number.
Correct Answer: 4
Rationale: The household
measurement most nearly equivalent to 1 liter is 4 cups or 1 quart.
Global Rationale: The household
measurement most nearly equivalent to 1 liter is 4 cups or 1 quart.
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Quality and Safety:
Best Practices.
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 3.6 Compare and
contrast the three systems of measurement used in pharmacology.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page number: 25
Question 21
Type: MCSA
Which statement is accurate regarding medication administration
via the intradermal route?
1. Injections
should be limited to 1–2 milliliters.
2. Hairy
sites should be avoided.
3. Usual
administration sites include the upper and lower abdomen.
4. Medications
should be injected into the epidermis skin layer.
Correct Answer: 2
Rationale 1: Intradermal injection
involves administering small amounts (0.1–0.2 milliliters) of medication.
Rationale 2: Usual sites of intradermal
administration include nonhairy surfaces.
Rationale 3: Usual sites of intradermal
administration include the forearm, upper chest, and scapulae.
Rationale 4: Intradermal injection
involves administering small amounts of medication into the dermis layer of
skin.
Global Rationale: Usual sites of
intradermal administration include nonhairy surfaces, including the forearm,
upper chest, and scapulae. Intradermal injection involves administering small
amounts (0.1–0.2 milliliters) of medication into the dermis layer of skin.
Cognitive Level: Remembering
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: IX.3
Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management
and nursing management across the health-illness continuum, across lifespan,
and in all healthcare settings.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Planning
Learning Outcome: 3-7 Explain the proper
methods of administering enteral, topical, and parenteral drugs.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 29
Question 22
Type: MCMA
Which patients should the nurse be concerned about regarding
nonadherence to prescribed medication regimens?
Note: Credit will be given only if all correct choices and no
incorrect choices are selected.
Standard Text: Select all that apply.
1. A
70-year-old male patient with hypertension who has a prescription for a
diuretic and is complaining that his medication is keeping him up all night
2. A
30-year-old college student who has a prescription for birth control pills and
tells the nurse she has had breakthrough bleeding this past cycle
3. A
45-year-old patient with diabetes who has a prescription for insulin and whose
blood sugar is within the normal range
4. A
57-year-old day laborer who has a prescription for Lipitor for high cholesterol
and a prescription card for a free health clinic
5. An
18-year-old male with a prescription for an acne medication that must be taken
4 times a day
Correct Answer: 1,5
Rationale 1: This patient has been
taking his diuretic in the evening instead of in the morning and is most likely
experiencing increased urination at night that is disrupting his sleep. Adverse
side effects are common causes for nonadherence.
Rationale 2: Birth control pills often
cause midcycle bleeding. This does not raise any red flags for nonadherence.
Rationale 3: The fact that this
patient’s blood sugar is within the normal range may be evidence that the
patient is taking insulin as directed.
Rationale 4: The means to pay for
medication (free clinic prescription card) decreases the patient’s risk for
nonadherence.
Rationale 5: One of the most common
reasons for nonadherence is forgetting a dose, particularly with drugs that
must be taken more than twice a day.
Global Rationale: This patient has been
taking his diuretic in the evening instead of in the morning and is most likely
experiencing increased urination at night that is disrupting his sleep. Adverse
side effects are common causes for nonadherence. One of the most common reasons
for nonadherence is forgetting a dose, particularly with drugs that must be
taken more than twice a day. Birth control pills often cause midcycle bleeding.
This does not raise any red flags for nonadherence. The fact that this patient’s
blood sugar is within the normal range may be evidence that the patient is
taking insulin as directed. The means to pay for medication (free clinic
prescription card) decreases the patient’s risk for nonadherence.
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and
Parenteral Therapies
QSEN Competencies: I.B.1 Elicit patient
values, preferences, and expressed needs as part of clinical interview,
implementation of care plan, and evaluation of care.
AACN Essential Competencies: IX.5
Deliver compassionate, patient-centered, evidence-based care that respects
patient and family preferences.
NLN Competencies: Relationship Centered
Care: Respect the patient’s dignity, uniqueness, integrity, and self-determination,
and his or her own power and self-healing process.
Nursing/Integrated Concepts: Nursing
Process: Assessment
Learning Outcome: 3.4 Give specific
examples of how nurses can increase patient compliance in taking medications.
MNL Learning Outcome: 1.3.3
Implement the nursing process in the administration of medications.
Page Number: 23
Question 23
Type: MCMA
A patient admitted to the hospital tells the nurse she is very
nervous about getting all her medications while she is in the hospital because
her health care provider has her on a very “strict” schedule. Which principles
describe how medication dosing schedules are determined?
Note: Credit will be given only if all correct choices and no
incorrect choices are selected.
Standard Text: Select all that apply.
1. The
physical and biologic characteristics of a drug may determine dosing schedule.
2. Specific
times may improve effectiveness and decrease risk of adverse effects.
3. Some
drugs must be taken a certain time prior to an event or immediately after an event.
4. Dosing
may be set for the convenience of patient and nurse.
5. Hospitals
have routine dosing intervals so that all patients receive medications at the
same time each day.
Correct Answer: 1,2,3,4
Rationale 1: The properties of a
medication will determine how often it must be given to keep the drug at a
therapeutic level in the body.
Rationale 2: Some medications are
administered at certain times of day to improve effectiveness or decrease
adverse effects.
Rationale 3: Some medications are taken
to prevent or to cause an effect. For example, insulin should be given 30
minutes prior to eating to promote glucose usage.
Rationale 4: If the drug does not have a
characteristic that relies on a certain event to take place, then the drug can
be given at the convenience of patient and/or nurse.
Rationale 5: While most hospitals do
have specific times of day (agency protocol) when medications are administered,
this is not a principle that determines any specific dosing schedule.
Global Rationale: The properties of a
medication will determine how often it must be given to keep the drug at a
therapeutic level in the body. Some medications are administered at certain
times of day to improve effectiveness or decrease adverse effects. Some
medications are taken to prevent or to cause an effect. For example, insulin
should be given 30 minutes prior to eating to promote glucose usage. If the
drug does not have a characteristic that relies on a certain event to take
place, then the drug can be given at the convenience of patient and/or nurse.
While most hospitals do have specific times of day (agency protocol) when
medications are administered, this is not a principle that determines any
specific dosing schedule.
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: IX.12
Create a safe environment that results in high quality patient outcomes.
NLN Competencies: Quality and Safety:
Current best practices.
Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 3-3 Explain how the
five rights of drug administration affect patient safety.
MNL Learning Outcome: 1.3.2 Apply the
correct principles and procedures for safe administration of medications to
clients.
Page Number: 24
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