Pharmacology for Nursing Care, 7th Edition by Richard A. Lehne – Test Bank
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Sample Test
Lehne: Pharmacology for Nursing Care, 7th Edition
Chapter 3: Drug Regulation, Development, Names, and Information
Test Bank
1. A
nurse educator is providing a continuing education class on pharmacology. To
evaluate the learning of the nurses in the class, the nurse educator asks,
“Which of the following is (or are) a generic drug name?”
|
a. |
Acetaminophen |
|
b. |
Tylenol |
|
c. |
Cipro |
|
d. |
Motrin |
ANS: A
Acetaminophen is the generic name.
Tylenol, Cipro, and Motrin are all trade names.
DIF: Cognitive Level:
Comprehension REF: p. 20
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity:
Pharmacological and Parenteral Therapies
2. A
researcher working for a pharmaceutical company is providing orientation to a
new nurse researcher. The researcher determines that further education is
needed when the nurse states that
|
a. |
preclinical testing takes
place in animals. |
|
b. |
clinical testing phase 1
involves normal volunteers. |
|
c. |
clinical testing phase 2
involves normal volunteers. |
|
d. |
clinical testing phase 3
involves patients. |
ANS: C
Clinical testing phase 2 involves patients, not normal
volunteers, therefore further education is required.
Preclinical testing does take place in animals, therefore no
further education is necessary.
Clinical testing phase 1 does involve normal volunteers,
therefore no further education is needed.
Clinical testing phase 3 involves patients, therefore no further
education is required.
DIF: Cognitive Level:
Comprehension REF: p. 17
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
3. A
nurse is providing discharge teaching about an opiate analgesic for a patient.
The nurse correctly tells the patient that the greatest potential for abuse
exists with drugs from which schedule?
|
a. |
I |
|
b. |
II |
|
c. |
III |
|
d. |
IV |
ANS: A
Schedule I drugs have the greatest potential for abuse.
Drugs from schedule II have less potential for abuse.
Drugs from schedule III also have less potential for abuse.
Drugs from schedule IV do not have the greatest potential for
abuse.
DIF: Cognitive Level:
Comprehension REF: p. 15
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
4. A prescriber
orders a drug that is considered “off label.” A patient asks what “off label”
means. The nurse correctly explains that “off label” means that a drug is
|
a. |
still being tested in the
FDA experimental stages. |
|
b. |
FDA approved for one use
but is being prescribed for another purpose. |
|
c. |
in the “fast-track” FDA
approval process to expedite use. |
|
d. |
a schedule I drug but may
be used as a schedule II drug. |
ANS: B
The term off
label indicates that the drug is approved for one use but may
be used for a different purpose.
A drug still being tested in the FDA experimental stages is
called an investigational drug.
The term fast
track refers to the expeditious nature in which a drug would
be channeled for approval by the FDA.
The classification of scheduled drugs has to do with abuse
potential, not labeled or unlabeled uses.
DIF: Cognitive Level:
Comprehension REF: p. 16
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
5. What
was the rationale for the 1992 changes in the Food and Drug Administration’s
regulations to permit accelerated approval of drugs for the treatment of
life-threatening or severely debilitating disease?
|
a. |
To allow for marketing
before completion of phase II of drug trials |
|
b. |
To ensure that the unknown
risks associated with early approval are balanced by the need for effective
drugs |
|
c. |
To change the rules because
existing FDA regulations were too stringent for potentially effective drugs |
|
d. |
To accelerate approval of
new drugs to give prescribers the option of using them without research
findings |
ANS: B
Accelerated drug approval was needed to ensure that effective
drugs necessary for life-threatening and/or severely debilitating diseases were
available but with a balance of benefit/effectiveness and risk.
Phase II drug trials are related to the therapeutic utility and
dosage range, not to accelerated approval of drugs.
FDA regulations were not stringent enough, but became so over
time to protect consumers.
Accelerated approval of new drugs did not give prescribers the
option to use them without research findings. Drugs are approved only after a
rigorous clinical trial and research process.
DIF: Cognitive Level:
Comprehension REF: pp.
15-17
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiological
Integrity: Reduction of Risk Potential
MULTIPLE RESPONSE
1. A
nurse is providing patient education regarding over-the-counter medications. To
evaluate the patient’s learning, the nurse asks the patient which of these
medications are considered over-the-counter medications. What is her response?
(Select all that apply.)
|
a. |
Acetaminophen (Tylenol) |
|
b. |
Diphenhydramine (Benadryl) |
|
c. |
Sildenafil (Viagra) |
|
d. |
Ciprofloxacin (Cipro) |
|
e. |
Ibuprofen (Motrin) |
ANS: A, B, E
Acetaminophen, diphenhydramine, and ibuprofen are all
over-the-counter medications. Cipro and Viagra are not.
Acetaminophen, diphenhydramine, and ibuprofen are all
over-the-counter medications and therefore do not require a prescription from a
licensed physician or nurse practitioner. Cipro and Viagra do require a
prescription from a licensed physician or nurse practitioner, therefore they
are not over-the-counter medications.
DIF: Cognitive Level:
Comprehension REF: pp.
22-23
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
Lehne: Pharmacology for Nursing Care, 7th Edition
Chapter 4: Pharmacokinetics
Test Bank
1. The
nurse has just administered diphenhydramine (Benadryl) and morphine sulfate to
a patient. An hour has passed, and the nurse is checking on the patient. The
patient asks the nurse why he feels so drowsy. The nurse’s best response would
be
|
a. |
“Both of these drugs pass
the blood-brain barrier, resulting in sedation.” |
|
b. |
“Both of these drugs cause
toxicity, leading to sedation.” |
|
c. |
“Your drowsiness is a
result of an adverse drug reaction (ADR).” |
|
d. |
“Both of these drugs act as
competitive antagonists and lead to sedation.” |
ANS: A
Both diphenhydramine and morphine sulfate act by depressing the
central nervous system, leading to sedation.
These drugs do not lead to toxicity unless given in excessive
doses.
Sedation is an expected side effect of these medications, not an
adverse reaction.
These drugs are not competitive antagonists, but they do act on
the central nervous system.
DIF: Cognitive Level: Analysis
REF: pp. 35-36
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
2. Two
nurses are discussing drugs that are affected by the first-pass effect. The
nurses understand that a prime example of a drug affected by the first-pass
effect is _____ given _____.
|
a. |
morphine; intravenously |
|
b. |
nitroglycerin; sublingually |
|
c. |
insulin; sublingually |
|
d. |
nitroglycerin; orally |
ANS: D
Nitroglycerin given orally is subject to the first-pass effect
because most of it is destroyed by the liver; therefore, this medication should
not be given orally.
An intravenous medication cannot be subject to the first-pass
effect.
Nitroglycerin given sublingually is not subject to the
first-pass effect, therefore the most effective route for administration of
nitroglycerin is the sublingual route.
A drug given sublingually is not subject to the first-pass
effect.
DIF: Cognitive Level:
Application
REF: p. 39
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
3. A
nurse administers warfarin (Coumadin) to a patient who is concurrently taking
drug X, which also is highly protein bound. The nurse would anticipate that
drug X will act at the receptor site as a
|
a. |
competitive agonist. |
|
b. |
sympathomimetic. |
|
c. |
competitive antagonist. |
|
d. |
parasympathomimetic. |
ANS: C
Because both drugs are highly protein bound, they will be
competing for the same receptor site; they therefore are competitive
antagonists, which increases the risk of toxicity.
Competitive agonists are drugs that compete for the same
receptor site but do not potentiate the effects of the drugs.
A sympathomimetic effect mimics the effects of the sympathetic
nervous system.
A parasympathomimetic effect mimics the effects of the PNS.
DIF: Cognitive Level:
Analysis
REF: p. 37
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
4. The
nurse is caring for a patient with a cold who presents to the emergency
department after having taken diphenhydramine (Benadryl), a glass of wine, and
four shots of whiskey to “kill” the cold. The nurse should observe the patient
for apparent signs of
|
a. |
vomiting and
gastrointestinal upset. |
|
b. |
central nervous system
depression. |
|
c. |
dryness in the oral mucosa. |
|
d. |
mydriasis. |
ANS: B
CNS depression is a resultant drug-to-drug interaction for a
patient taking diphenhydramine and alcohol, because both are central nervous
system depressants.
Mixing diphenhydramine, wine, and whiskey may or may not cause
vomiting and gastrointestinal upset.
Dryness of the oral mucosa is not significant when a patient has
mixed diphenhydramine, wine, and whiskey.
Miosis (constricted pupils) rather than mydriasis (dilated
pupils) could possibly be expected when diphenhydramine, wine, and whiskey are
mixed.
DIF: Cognitive Level:
Analysis
REF: pp. 35-36
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiological
Integrity: Reduction of Risk Potential
5. A
patient is being discharged home on enteric-coated aspirin (Ecotrin). A nurse
is providing patient education regarding the rationale for the enteric coating.
Which statement made by the patient indicates understanding of the purpose of
the enteric coating on the aspirin?
|
a. |
“Enteric coating will allow
the aspirin to be released a little at a time throughout the day.” |
|
b. |
“Enteric coating means that
the aspirin will not be broken down by the liver.” |
|
c. |
“Enteric coating means that
the aspirin can be broken down easier and eliminated by the kidney.” |
|
d. |
“Enteric coating means that
the acids of the gut will not destroy the aspirin.” |
ANS: D
The purpose of enteric coating is to prevent the acids of the
stomach from destroying the medication before it is effectively utilized by the
body.
Sustained-release formulations allow medications to be released
a little at a time throughout the day.
The first-pass effect is a process whereby a medication is
broken down by the liver.
Excretion refers to the elimination of a medication’s metabolic byproducts
by the kidneys.
DIF: Cognitive Level:
Analysis
REF: p. 35
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
6. The
nurse is preparing to administer a medication via the parenteral route. Which
medication order best demonstrates this route of administration?
|
a. |
Acetaminophen (Tylenol) 325
mg 1 tab orally |
|
b. |
Acetaminophen (Tylenol)
suspension 2 tablespoons |
|
c. |
Insulin NPH 30 units subcutaneously |
|
d. |
Enteric-coated aspirin
(Ecotrin) 81 mg orally |
ANS: C
Parenteral routes include the intravenous, intramuscular, and
subcutaneous routes.
Enteral routes include oral administration, including pills and
liquid suspensions.
DIF: Cognitive Level:
Comprehension REF: pp.
30-31
TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
7. A
patient has been taking warfarin (Coumadin) daily and is also taking aspirin
(acetylsalicylic acid) for rheumatoid arthritis. A nurse is aware of the
actions of these medications and should be most concerned if the patient were
to report complaints of
|
a. |
a loose tooth. |
|
b. |
a urinary tract infection. |
|
c. |
stiffness in the joints. |
|
d. |
easy bruising. |
ANS: D
Complaints of easy bruising should concern the nurse because of
the drug-to-drug interaction of two competing antagonist anticoagulant agents.
A loose tooth does not indicate any adverse effects from the combination
of warfarin and acetylsalicylic acid.
Complaints of a UTI do not indicate any adverse effects from the
combination of warfarin and acetylsalicylic acid.
Complaints of stiffness in the joints would not be the greatest
concern in a patient taking both warfarin and acetylsalicylic acid.
DIF: Cognitive Level:
Analysis
REF: pp. 36-37
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiological
Integrity: Reduction of Risk Potential
8. The
nurse is listening to a drug representative discuss receptorless drugs. Which
drug choice made by the nurse as representing a receptorless drug would
indicate a need for further teaching?
|
a. |
Antacids |
|
b. |
Antiseptics |
|
c. |
Saline laxatives |
|
d. |
Topical agents |
ANS: D
Topical agents are absorbed through the skin and bind to
receptor sites; they therefore are not receptorless drugs. This drug choice by
the nurse indicates a need for further teaching.
Antacids are receptorless drugs, therefore no further teaching
is required.
Antiseptics are receptorless drugs, therefore no further
teaching is required.
Saline laxatives are receptorless drugs, therefore no further
teaching is required.
DIF: Cognitive Level:
Comprehension REF: p. 54
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
9. A
patient is receiving morphine sulfate 4 mg intravenously every 3 hours for
pain. The nurse understands that the half-life for morphine sulfate is
approximately 3 hours. Which statement made by the nurse best demonstrates
understanding of the meaning of half-life?
|
a. |
The half-life of a
medication does not determine dosing intervals. |
|
b. |
The half-life for morphine
sulfate would be 2 mg. |
|
c. |
The patient will require
more morphine sulfate in 6 hours to keep the minimum effective concentration. |
|
d. |
The half-life of a
medication refers to the time required for the amount of drug in the body to
decrease by 50%. |
ANS: D
The half-life of a medication refers to the time required for
the amount of drug to be decreased by the body by 50%.
The half-life of a medication does determine dosing intervals.
The half-life of a medication may be any amount of a drug,
depending on what is in the patient’s system at any given time.
The morphine sulfate should be dosed at shorter intervals due to
the short half-life.
DIF: Cognitive Level:
Comprehension REF: p. 42
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
10. A
nurse is having a discussion with another nurse regarding the narrow
therapeutic range of a particular drug. A patient has been taking this drug for
1 week. What is the most significant implication for the nurse who is caring
for this patient?
|
a. |
The drug will be
ineffective, because it will have difficulty reaching the minimum effective
concentration. |
|
b. |
The patient’s body will
maintain therapeutic levels easily. |
|
c. |
The patient’s kidney
function may be compromised. |
|
d. |
The patient should be
monitored carefully for toxicity. |
ANS: D
Toxicity is the most significant implication for the nurse to
consider in a medication with a narrow therapeutic range, and the patient
should be monitored closely for signs of toxicity.
How effective the medication will be is not necessarily
determined by the narrowness of the therapeutic range.
The drug may maintain therapeutic levels easily, but that is not
the most significant implication of a narrow therapeutic range.
The therapeutic range of a medication is not related to the
patient’s kidney function.
DIF: Cognitive Level:
Analysis
REF: pp. 41-42
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiological
Integrity: Reduction of Risk Potential
11. A
nurse is caring for a patient with a history of advanced liver disease. What
should be the primary concern of the nurse when administering multiple
medications to this patient?
|
a. |
The medications will be
subject to the first-pass effect. |
|
b. |
The medications are not in
a bioavailable form to be used by the body. |
|
c. |
The medications may cause
toxicity to the patient. |
|
d. |
The medications will not be
absorbed and will not have a therapeutic effect. |
ANS: C
Medications administered to a patient with liver disease may
cause toxicity, because metabolism of the drugs may be altered, depending on
the amount of liver damage.
The likelihood of the first-pass effect cannot be determined by
the information provided in this question.
Bioavailability has to do with the formulation of the drug, and
because the medication names are not given, this would not be relevant.
The liver does not absorb the drugs, therefore this answer is
incorrect.
DIF: Cognitive Level:
Analysis
REF: p. 38
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiological
Integrity: Reduction of Risk Potential
12. A
prescriber has written an order for a pain medication: Drug X 50 mg PO every 6
hours. The patient has had right arm pain since surgery, rated as a 7 on a
scale of 0 to 10, with 10 being the greatest pain. The half-life for the drug
is approximately 12 hours. The nurse should first take which action?
|
a. |
The nurse should question
the dose. |
|
b. |
The nurse should question
the need for the drug. |
|
c. |
The nurse should question
the frequency of the medication. |
|
d. |
The nurse should administer
the medication as ordered. |
ANS: C
The nurse should ask the prescriber about the frequency of the
medication, because the half-life is long, therefore fewer doses would be
required.
The drug being administered is not specified, therefore the
nurse can’t question the dose as it relates to drug half-life.
The nurse already knows that the patient is having postoperative
pain, therefore the medication is appropriate.
The order should be questioned and the medication withheld until
clarification is obtained regarding the frequency of the medication.
DIF: Cognitive Level:
Application
REF: p. 42
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Reduction of Risk Potential
13. An
adult male patient is 1 day postoperative from a total hip replacement. The
patient is rocking back and forth with a facial grimace. On a pain scale of 0
to 10, with 10 being the greatest pain, the patient reports a pain level of 10.
Which medications would be most appropriate for the nurse to administer to this
patient?
|
a. |
60 mg morphine sulfate PO |
|
b. |
75 mg meperidine (Demerol)
intramuscularly |
|
c. |
6 mg morphine sulfate
intravenously |
|
d. |
Duragesic (Fentanyl) patch
50 mcg transdermally |
ANS: C
The intravenous route is the fastest route of absorption and the
one most appropriate for a patient in extreme pain who is being given morphine
sulfate.
With the oral route, the medication would take at least 45
minutes to be effective, too long for a patient in extreme pain.
With the intramuscular route, the medication would take at least
15 minutes to be effective; although faster than the oral route, this is not as
fast as the intravenous route.
A duragesic patch would be the most inappropriate route because
of the long drug half-life. This is a more appropriate route for long-term use.
DIF: Cognitive Level:
Application
REF: p. 31
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
14. A
patient with a history of cardiac problems is admitted to a telemetry unit. The
prescriber orders digoxin (Lanoxin) at a high dose for 2 days, followed by a
lower dose thereafter. What is the nurse’s best action?
|
a. |
Delay administration of the
drug in order to discuss the prescription with the pharmacist. |
|
b. |
Question the prescriber
about the two doses, recognizing that a potentially hazardous situation
exists. |
|
c. |
Administer the drug per the
prescription, recognizing that a loading dose, followed by a maintenance
dose, is being given. |
|
d. |
In the interest of patient
advocacy, seek a second prescriber’s opinion before carrying out the
prescription. |
ANS: C
The nurse should recognize that digoxin may be given using a
loading dose to achieve a therapeutic level quickly, followed by maintenance
doses.
Delaying administration of the drug would prolong the patient’s
need for it.
Questioning the prescriber would not be the best action.
The nurse should consult with the prescriber first before going
over her head; the nurse should follow the chain of command.
DIF: Cognitive Level:
Application
REF: p. 43
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
Lehne: Pharmacology for Nursing Care, 7th Edition
Chapter 38: Drug Abuse II: Alcohol
Test Bank
1. A
nurse is teaching a patient who drinks alcohol in excess. When the patient asks
the nurse about the effect of chronic alcohol use on the heart, the nurse’s
best response would be which of the following statements?
|
a. |
“Alcohol has little effect
on the heart. You should be more concerned about your liver.” |
|
b. |
“Heart failure is a major
problem that develops in patients who use excessive alcohol.” |
|
c. |
“Excessive alcohol use can
lower your blood pressure.” |
|
d. |
“Drinking more than two
drinks a day has been shown to protect the heart from atherosclerosis.” |
ANS: B
Chronic abuse of alcohol results in direct damage to the
myocardium, increasing the risk of heart failure.
Chronic alcohol abuse has a significant effect on the heart and
also affects the liver.
Excessive alcohol does not predispose a patient to hypotension.
Drinking fewer than two alcoholic beverages a day has been shown
to potentially protect the heart from atherosclerosis.
DIF: Cognitive Level:
Application
REF: p. 411
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Reduction of Risk Potential
2. A
patient presents to the clinic at 0900 with an unsteady gait and slurred
speech. During the health history, the patient admits to consuming a case of
beer every day for 7 years but denies being an alcoholic. Which of the
following medications that the patient is taking would concern the nurse the
most?
|
a. |
Antacids daily |
|
b. |
Antihistamines daily |
|
c. |
Acetaminophen daily |
|
d. |
Stool softener daily |
ANS: C
Chronic use of alcohol may lead to cirrhosis; concurrent use of
acetaminophen is contraindicated, because taking more than 4 g a day may lead
to hepatotoxicity, and the liver may already be compromised.
Antacids, antihistamines, and stool softeners are not
contraindicated with chronic alcohol use.
DIF: Cognitive Level:
Application
REF: p. 414
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Reduction of Risk Potential
3. A
nurse is teaching a community education class about the difference between
alcohol dependence and alcohol abuse. Which of the following statements best
confirms that a participant understands the difference?
|
a. |
“The major difference
between alcohol dependence and alcohol abuse is the amount of alcohol
consumed.” |
|
b. |
“The major difference
between alcohol dependence and alcohol abuse is the presence of craving.” |
|
c. |
“The major difference
between alcohol dependence and alcohol abuse is that in abuse, alcohol is
consumed in excess.” |
|
d. |
“The major difference
between alcohol dependence and alcohol abuse is tolerance and withdrawal.” |
ANS: D
Alcohol dependence is chronic use of alcohol that produces
physical dependence, for which a withdrawal syndrome occurs if alcohol is
discontinued abruptly.
Chronic consumption of alcohol produces tolerance. The amount of
alcohol consumed determines the extent of abuse, not the difference between
dependence and abuse.
The presence of craving has to do with psychological abuse.
Consumption of alcohol in excess involves both alcohol
dependence and alcohol abuse.
DIF: Cognitive Level: Analysis
REF: pp. 414-415
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Reduction of Risk Potential
4. A
patient is admitted to the hospital with a history of chronic alcohol abuse and
is showing signs and symptoms of acute alcohol withdrawal. The nurse would
expect to administer which class of drugs?
|
a. |
Antianxiety medications |
|
b. |
Antidepressants |
|
c. |
Benzodiazepines |
|
d. |
Antipsychotics |
ANS: C
In actual practice, the drug of choice for acute alcohol
withdrawal is benzodiazepines. They can stabilize vital signs, reduce symptom
intensity, and reduce the risk of seizures and delirium tremens.
Antianxiety medications are not the drug of choice for acute
alcohol withdrawal.
Antidepressants would not be indicated for acute alcohol
withdrawal.
Antipsychotics are not indicated for acute alcohol withdrawal.
DIF: Cognitive Level:
Application
REF: pp. 416-417
TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
5. A
nurse has provided patient education about the dangers of chronic alcohol
abuse. Which of the following statements made by the patient about chronic
alcohol abuse indicates a need for further teaching?
|
a. |
“Excessive alcohol use
results in the promotion of heat loss.” |
|
b. |
“Excessive alcohol use
results in erosive gastritis.” |
|
c. |
“Excessive alcohol use
results in a decreased risk of MI and stroke.” |
|
d. |
“Excessive alcohol use
results in an increased risk of colorectal cancer.” |
ANS: C
Chronic and excessive alcohol consumption is clearly harmful,
resulting in direct damage to the myocardium, which increases the risk
of MI and stroke. This is caused by the vasoconstriction in vascular beds of
the skeletal muscle that is brought on by increased activity of the sympathetic
nervous system, also resulting in hypertension. This statement clearly
indicates a need for further teaching.
Excessive alcohol abuse promotes heat loss through the
vasodilation of cutaneous vessels; no further teaching is required.
Erosive gastritis is also a result of excessive alcohol abuse
because of the increased stimulation of gastric acid secretions; no further
teaching is required.
Alcohol is associated with an increased risk of breast and
colorectal cancer; no further teaching is required.
DIF: Cognitive Level:
Application
REF: pp. 411-412
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Physiological Adaptation
6. A
chronic alcoholic patient is brought to the emergency department. Which of the
following areas of the body is responsible for most alcohol absorption?
|
a. |
Stomach |
|
b. |
Liver |
|
c. |
Kidneys |
|
d. |
Small intestines |
ANS: D
Approximately 80% of ingested alcohol is absorbed from the small
intestines.
Approximately 20% of ingested alcohol is absorbed from the
stomach.
Absorption of alcohol does not take place in the liver, the
location of metabolism, or the kidneys.
DIF: Cognitive Level:
Comprehension REF: pp.
411-412
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiological
Integrity: Physiological Adaptation
7. A
nurse is providing patient education about the benefits of moderate versus
excessive drinking. Which of the following statements made by the patient
indicates a need for further teaching?
|
a. |
“Moderate drinking is
defined as two drinks a day for men.” |
|
b. |
“Chronic drinking leads to erosive
gastritis.” |
|
c. |
“Moderate drinking raises
low-density lipoprotein cholesterol.” |
|
d. |
“Chronic use of alcohol
damages the myocardium.” |
ANS: C
Available data suggest that alcohol protects against heart
disease largely by raising levels of high-density lipoprotein (HDL) cholesterol
and protects low-density lipoprotein (LDL) from oxidation (LDL must first be
oxidized before it can promote atherosclerosis). This statement indicates a
need for further teaching.
Clear evidence indicates that people who drink moderately (two
drinks a day or fewer for men, 1 drink a day or fewer for women) experience
less coronary artery disease; no further teaching is required.
Erosive gastritis is a result of excessive alcohol abuse caused
by increased stimulation of gastric acid secretions; no further teaching is
required.
Chronic and excessive consumption is clearly harmful, resulting
in direct damage to the myocardium, which increases the risk of MI and stroke;
no further teaching is required.
DIF: Cognitive Level:
Analysis
REF: pp. 411-412
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Health Promotion
and Maintenance
8. A
27-year-old male patient is brought unresponsive to the emergency department by
friends, who say that their friend drank more than half of a large bottle of
whiskey 3 hours ago. Assessment reveals a blood alcohol level of 0.32%; V/S
are: BP–88/32, R–6/minute, T–96.8° F, P–76/minute, weak and thready. The nurse
should prepare the patient for which of the following interventions?
|
a. |
IV fluids and stimulants |
|
b. |
Charcoal administration |
|
c. |
Gastric lavage and dialysis |
|
d. |
Naloxone (Narcan)
administration |
ANS: C
The average rate at which a person can metabolize alcohol is
about 15 mL (0.5 ounces) per hour. The patient in this scenario has consumed
more than half of a large bottle of whiskey within 3 hours. Alcohol can be
removed from the body by gastric lavage and dialysis. Gastric lavage “washes
out” most of the alcohol if any is left in the gut, and dialysis is implemented
to reduce the chance of renal failure and cardiovascular shock.
Although intravenous fluids may be appropriate, stimulants are
contraindicated for this patient.
Charcoal is not indicated in this situation.
Naloxone is indicated in opiate overdoses, not alcohol
overdoses.
DIF: Cognitive Level:
Application
REF: p. 414
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Reduction of Risk Potential
9. A
nurse is providing education on alcohol and would be correct to state that
which of the following individuals should avoid alcohol? (Select all that
apply.)
|
a. |
Women trying to conceive |
|
b. |
People performing
activities that require muscular coordination |
|
c. |
Those 21 years of age |
|
d. |
Individuals taking
antihistamines and/or sedatives |
|
e. |
A man who consumes two
alcoholic beverages a day |
ANS: A, B, D
Women trying to conceive should avoid alcoholic beverages,
because the woman may be pregnant and not know it, risking harm to the fetus.
Any activities that require muscular coordination and focus should be avoided
when consuming alcohol. Individuals taking antihistamines or sedatives should
avoid alcohol, because it may enhance the effects of the medications,
increasing the risk to the patient.
People 21 years of age can legally consume alcohol; if they
choose to do so, they drink in moderation.
A man who drinks two alcoholic beverages a day is considered a
moderate drinker.
DIF: Cognitive Level:
Application
REF: pp. 412-414
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Health Promotion
and Maintenance
10. A
nurse is working with a patient who indicates that he wants to stop drinking alcohol.
The patient asks, “What medications are available to reduce my cravings for
alcohol?” The nurse understands that which of the following medications reduce
the craving for alcohol?
|
a. |
Naltrexone (ReVia) |
|
b. |
Diazepam (Valium) |
|
c. |
Disulfiram (Antabuse) |
|
d. |
Acamprosate (Campral) |
ANS: A
Naltrexone (ReVia) reduces the craving for alcohol and block
alcohol’s reinforcing pleasurable effects.
Diazepam reduces alcohol withdrawal symptoms.
Disulfiram is taken by alcoholics to help them refrain from drinking,
because unpleasant effects result if alcohol is ingested.
Acamprosate is indicated for maintaining abstinence in patients
with alcohol dependence after detoxification.
DIF: Cognitive Level:
Application
REF: p. 418
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
11. A
35-year-old is admitted to the emergency department with a blood alcohol level
of 0.25%. The nurse would anticipate the patient to exhibit which of the
following clinical manifestations?
|
a. |
Respiratory depression |
|
b. |
Double vision |
|
c. |
Stupor |
|
d. |
Altered perception |
ANS: D
Altered perception would be expected with a 0.25% blood alcohol
level.
Respiratory depression occurs most frequently with an alcohol
level of 0.45%.
Double vision occurs in patients with an alcohol level of 0.30%.
Stupor occurs when a patient’s alcohol level is 0.40%.
DIF: Cognitive Level:
Application
REF: p. 410
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
12. A
patient is admitted to the emergency department with a blood alcohol level of
0.45%. The nurse should immediately prepare to administer which intervention?
|
a. |
CPR |
|
b. |
Intravenous fluids |
|
c. |
Respiratory support |
|
d. |
Naloxone (Narcan) |
ANS: C
Respiratory support should be implemented for the respiratory
depression, which most frequently is exhibited in a patient with a blood
alcohol level of 0.45%.
The patient displays no symptoms that require CPR.
Intravenous fluids would not address the respiratory depression
that occurs with a 0.45% blood alcohol level.
Naloxone is indicated for opiate overdose, not alcohol abuse.
DIF: Cognitive Level:
Application
REF: pp. 405-406 | p. 410
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Reduction of Risk Potential
Lehne: Pharmacology for Nursing Care, 7th Edition
Chapter 64: Androgens
Test Bank
1. Parents
of a pubescent teen are concerned that he has not “developed” at the rate of
other boys. The prescriber diagnoses the teen with hypogonadism. The nurse
provides patient education about treatment with testosterone injections. Which
statement by the parents best indicates understanding of testosterone therapy?
“Our son will have to take the injections
|
a. |
until he grows at least 4
inches.” |
|
b. |
for 6 to 12 months.” |
|
c. |
for 3 to 4 years.” |
|
d. |
monthly until the age of
16.” |
ANS: C
The patient will have to take the injections for at least 3 to 4
years; no further teaching is required.
Testosterone injections are given every 2 to 4 weeks for 3 to 4
years; further teaching is required.
DIF: Cognitive Level:
Application
REF: p. 771
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
2. The
nurse is caring for a male teen patient who has been receiving androgen
therapy. What diagnostic testing would be needed approximately every 6 months
to monitor this patient?
|
a. |
X-ray films of the hands
and wrists |
|
b. |
Complete blood count (CBC)
for anemia |
|
c. |
Urinalysis for ketones |
|
d. |
Male pattern baldness |
ANS: A
X-ray films of the hands and wrists would be necessary for this
patient, because androgen therapy accelerates epiphyseal closure.
Anemia is not an expected adverse effect of androgen therapy.
Ketones in the urine are not an expected effect of this
medication.
Male pattern baldness is not a typical finding associated with
androgen therapy in a young teen patient.
DIF: Cognitive Level:
Analysis
REF: p. 773
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
3. A
nurse working in a private pediatric practice is caring for a patient who has
been receiving 17–alpha-alkylated androgen (Fluoxymesterone). Which clinical manifestation
would cause the nurse to be concerned, and what intervention would the nurse
anticipate?
|
a. |
Gynecomastia;
discontinuation of the drug |
|
b. |
Yellowish tint to the skin
and sclera; discontinuation of the drug |
|
c. |
Decrease in high-density
lipoprotein (HDL); titration of the medication |
|
d. |
Erratic blood glucose
levels; adjustment of the dose |
ANS: B
A yellowish tint to the skin and sclera would most concern the
nurse, because 17–alpha-alkylated androgen (Fluoxymesterone) is known to cause
hepatotoxicity.
Gynecomastia is expected in males.
A decrease in HDL would require monitoring of those levels but
not titration of the medication.
Fluoxymesterone is not associated with erratic blood glucose
levels.
DIF: Cognitive Level:
Analysis
REF: p. 773
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
4. The
nurse is discussing testosterone therapy with a male patient. The nurse
provides education about the different formulations of the medication. Which
statement by the patient best demonstrates misunderstanding of the differences
between testosterone patches and testosterone transdermal gel?
|
a. |
“The testosterone in the
patch is less likely to be transferred to another person by skin-to-skin
contact.” |
|
b. |
“The patch is less
effective.” |
|
c. |
“The patch produces more
consistent blood levels of the hormone.” |
|
d. |
“The patch causes less
local irritation.” |
ANS: C
Compared with testosterone patches, testosterone transdermal gel
produces more consistent blood levels of the hormone.
The testosterone in the patch is less likely to be transferred
to another person by skin-to-skin contact.
The patch is less effective than the gel.
The patch causes less local irritation than the gel does.
DIF: Cognitive Level:
Application
REF: p. 771 | p. 774
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
5. The
nurse is providing education to a patient who is beginning therapy with
testosterone gel. What statement made by the patient demonstrates a need for
further teaching?
|
a. |
“I should not shower or
swim for at least 5 to 6 hours after application.” |
|
b. |
“I should avoid direct
skin-to-skin contact with my spouse where the medication was applied.” |
|
c. |
“I should have my blood
drawn for laboratory tests in 14 days.” |
|
d. |
“I should apply the entire
contents of the packet to my genitals.” |
ANS: D
The medication should be applied to the arms and upper torso,
not to the genitalia; this statement indicates a need for further teaching.
The patient should be instructed not to shower, bathe, or swim
for 5 to 6 hours after administration of the medication; no further teaching is
necessary.
The patient should be instructed to keep areas covered where the
medication was applied to avoid direct skin-to-skin contact with others; no
further teaching is necessary.
The patient should be advised to return to the clinic within 2
weeks for blood tests; no further teaching is necessary.
DIF: Cognitive Level:
Application
REF: p. 771 | p. 774
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
6. The
nurse is providing patient education to a high school girls’ athletic class.
Which statement by a member of the class best demonstrates understanding of anabolic
steroid use in females? “Steroid use may lead to
|
a. |
menstrual irregularities.” |
|
b. |
enlarged breasts.” |
|
c. |
uterine enlargement.” |
|
d. |
a change in hair texture.” |
ANS: A
Anabolic steroid use in females may lead to menstrual irregularities.
Steroid use in females also causes a decrease in breast size,
clitoral enlargement, and hair loss.
DIF: Cognitive Level:
Application
REF: p. 775
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
7. The
nurse is providing education to a female patient who is a body builder and who
has been taking anabolic steroids to improve her athletic performance. During
the physical assessment and review of laboratory results, which clinical
finding would most concern the nurse?
|
a. |
Hypertension |
|
b. |
Mild cough |
|
c. |
Facial hair |
|
d. |
Increased creatinine |
ANS: A
The nurse would be most concerned about hypertension, because
steroids cause salt and water retention.
A mild cough does not indicate any significant finding
associated with steroid use.
Facial hair may be anticipated, and an increase in creatinine
would be consistent with increased muscle mass.
DIF: Cognitive Level: Application
REF: p. 775
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiological
Integrity: Reduction of Risk Potential
8. The
nurse is caring for a patient on an oncology unit who has been receiving
androgen therapy for palliation for breast cancer. Which co-morbid condition in
this patient would most concern the nurse?
|
a. |
Diabetes |
|
b. |
Heart failure (HF) |
|
c. |
Osteoporosis |
|
d. |
Anemia |
ANS: B
Heart failure would most concern the nurse, because edema can result
from androgen-induced retention of salt and water. This complication is a
concern for patients with HF and others at risk for water retention.
Androgen therapy is not contraindicated with either diabetes or
osteoporosis.
Androgen therapy actually may be used to treat anemia.
DIF: Cognitive Level:
Analysis
REF: p. 774
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
9. The
nurse is teaching a group of parents about the role of testosterone in puberty
for boys. To evaluate the group’s understanding, the nurse asks, “What
physiologic effects related to testosterone can you expect to see in your
sons?” Which of the following responses indicates an understanding of the role
of testosterone in male puberty? (Select all that apply.)
|
a. |
“It promotes skeletal
muscle growth.” |
|
b. |
“It increases height and
weight.” |
|
c. |
“It delays epiphyseal
closure.” |
|
d. |
“It causes a high-pitched
voice.” |
|
e. |
“It causes acne.” |
ANS: A, B, E
The physiologic effects associated with androgen therapy are
promotion of skeletal muscle growth, an increase in height and weight,
acceleration of epiphyseal closure, deepening of the voice, oily skin, and
acne.
Androgen therapy accelerates, not delays, epiphyseal closure.
Androgen therapy deepens the voice rather than raising the
pitch.
DIF: Cognitive Level:
Application
REF: p. 773
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
10. A
female patient is beginning androgen therapy. The nurse is providing patient
education about the adverse effects associated with androgen therapy. Which
symptoms described by the patient best demonstrate understanding? (Select all
that apply.)
|
a. |
Deeper voice |
|
b. |
Breast enlargement |
|
c. |
Menstrual cramps |
|
d. |
Decreased libido |
|
e. |
Facial hair |
ANS: A, E
Androgen therapy in female patients deepens the voice and causes
the growth of facial hair. It can cause virilization in women, which is
manifested by acne, deepening of the voice, proliferation of facial and body
hair, male pattern baldness, increased libido, clitoral enlargement, and
menstrual irregularities.
Androgen therapy reduces the size of the breasts.
Androgen therapy causes menstrual irregularities.
Androgen therapy increases the libido.
DIF: Cognitive Level:
Application
REF: p. 773
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological
Integrity: Pharmacological and Parenteral Therapies
11. The
nurse is caring for a patient on long-term androgen therapy. The nurse might
anticipate which change or changes in cholesterol? (Select all that apply)
|
a. |
Increased high-density
lipoproteins (HDL) 64 mg/dL |
|
b. |
Increased low-density
lipoproteins (LDL) 140 mg/dL |
|
c. |
Decreased low-density
lipoproteins (LDL) 90 mg/dL |
|
d. |
Decreased high-density
lipoproteins (HDL) 40 mg/dL |
|
e. |
Cholesterol <200 mg/dL |
ANS: B, D
The nurse would anticipate an increased LDL and a decreased HDL.
Androgen therapy decreases HDL.
Androgen therapy increases LDL.
Long-term androgen therapy increases, rather than decreases,
total cholesterol.
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