Pharmacology A Patient Centered Nursing Process Approach 9th Edition By Linda E-Test Bank
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Sample
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Chapter 03: Cultural Considerations
McCuistion: Pharmacology: A Patient-Centered Nursing Process
Approach, 9th Edition
MULTIPLE CHOICE
1. The
nurse is performing a pain assessment on a patient of Asian descent. The
patient does not describe the pain when asked to do so and looks away from the
nurse. What will the nurse do next?
|
a. |
Ask the patient’s family
member to evaluate the patient’s pain. |
|
b. |
Conclude that the patient’s
pain is minimal. |
|
c. |
Evaluate the patient’s
nonverbal pain cues. |
|
d. |
Suspect that the patient is
experiencing severe pain. |
ANS: C
Patients of Asian descent might speak in soft tones and avoid
direct eye contact while being comfortable with long silences. It is not
correct to ask family members to evaluate pain. Without assessment of nonverbal
cues, the nurse cannot determine whether the pain is minimal or severe.
DIF: Cognitive Level: Applying
(Application)
REF: p. 32
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity: Cultural
Diversity
2. The
nurse is preparing to discuss long-term care needs with a patient newly diagnosed
with a chronic disease. The patient is of Latin American descent. The nurse
will plan to take which action when teaching this patient?
|
a. |
Discussing long-term
outcomes associated with compliance of the prescribed regimen |
|
b. |
Highlighting various traditional
healing practices that will not be effective for this patient’s care |
|
c. |
Providing factual
information and answering all questions as they arise |
|
d. |
Providing teaching in
increments, allowing periods of silence to allow assimilation of information |
ANS: C
The nurse should provide factual information and answer
questions. Persons of Latin American descent have less dependence on time
schedules and do not tend to have a future orientation. They are not
comfortable with periods of silence. Nurses should be receptive to traditional
healing practices and seek ways to include those in care when they do not
hinder safe and effective care; highlighting practices that won’t work may
convey a lack of respect for these traditions.
DIF: Cognitive Level: Applying
(Application)
REF: p. 33
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity: Cultural
Diversity
3. A
Native American patient has just been diagnosed with diabetes mellitus. The nurse
preparing a teaching plan for this patient understands that which aspect of the
disease and disease management may be most difficult for this patient?
|
a. |
Body image changes |
|
b. |
Management of meal and
medication schedules |
|
c. |
Perception of the disease
as punishment from God |
|
d. |
The sense of dependence on
others |
ANS: B
Non-European cultural groups such as those of Native American
descent have less dependence on time schedules. Disease management will likely
focus more on present concerns about alleviating current discomfort and less on
measures to promote long-term wellness or treat a chronic illness.
DIF: Cognitive Level: Applying
(Application)
REF: p. 33
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity: Cultural
Diversity
4. A
patient who is of Filipino descent is admitted to the hospital. The nurse goes
to the room to start intravenous fluids and to perform an admission assessment
and finds several family members in the room. Which action by the nurse is
appropriate?
|
a. |
Ask the family to wait in
the hallway until the admission tasks are completed. |
|
b. |
Determine which family
member is the family patriarch and address questions to him. |
|
c. |
Invite family members to
assist with appropriate tasks during the admission process. |
|
d. |
Provide chairs for family
members and ask them to stay seated during the admission. |
ANS: C
In general, the Filipino culture expects that family members
will stay at a patient’s bedside and participate in his or her care. The nurse
should include the family in appropriate tasks. It is not correct to ask the
family to wait in the hall or to sit in chairs and not participate. Filipino
families do not necessarily depend on family patriarchs.
DIF: Cognitive Level: Applying
(Application)
REF: p. 32
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Psychosocial Integrity: Cultural
Diversity
5. The
nurse is caring for a patient who is a member of the local Native American
community. The patient is refusing medications and treatments in spite of
repeated attempts to explain the importance of these interventions. Which is an
appropriate nursing action?
|
a. |
Ask a family member about
traditional healing practices that might be better accepted. |
|
b. |
Enlist the help of a family
member to explain the need for the medications and treatments. |
|
c. |
Find a hospital staff
member who is a Native American to help provide teaching for this patient. |
|
d. |
Suggest a Social Worker
consult to the patient’s provider. |
ANS: A
Members of some cultures may use traditional healers, and this
should be accommodated whenever possible. Showing respect for this patient’s
culture will help to establish trust and thus greater cooperation. It is
important for the nurse not to make generalizations within and among cultural
groups, so asking a family member to describe what this particular patient
needs is the better choice. Finding a hospital staff member who is a Native
American assumes that all Native Americans have the same practices. Deferring
to a Social Worker is not necessary. Enlisting a family member to explain the
need for the medications is just another way of imposing treatments on this
person without respecting their cultural needs.
DIF: Cognitive Level: Applying
(Application)
REF: p. 33
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Psychosocial Integrity: Cultural
Diversity
6. The
nurse is caring for an African-American patient who appears to understand
instructions for self-care but does not carry out basic self-care tasks. The
nurse understands that the patient may
|
a. |
be poorly educated and lack
basic comprehension skills. |
|
b. |
need more time and personal
space to assimilate what is taught. |
|
c. |
require the use of
culturally appropriate words and phrases when teaching. |
|
d. |
view illness as punishment
and lack desire to change the outcome. |
ANS: C
African Americans may use a common style of speaking. This
vernacular English may be quite different in some cases from standard English,
so if things are misunderstood, it is possible that vernacular terminology may
need to be used. This vernacular English does not mean that patients are poorly
educated or uncommunicative. African Americans do not tend to need more space
and do not necessarily view illness as punishment.
DIF: Cognitive Level: Applying
(Application)
REF: p. 31
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity: Cultural
Diversity
7. The
nurse notes that a patient of African-American descent who is taking an oral
antihypertensive medication continues to have elevated blood pressure 3 months
after beginning the medication regimen. The nurse suspects that the patient may
be
|
a. |
consuming ethnic foods that
interfere with absorption of the drug. |
|
b. |
discarding the medication. |
|
c. |
experiencing allergic
reactions to the medication. |
|
d. |
metabolizing the drug
differently than expected. |
ANS: D
Certain classifications of medications have different effects in
individuals whose genetic markers are predominantly characteristic of a certain
biologic group. African Americans respond poorly to several classes of
antihypertensive agents.
DIF: Cognitive Level: Applying
(Application)
REF: p. 33
TOP: Nursing Process: Evaluation
MSC: NCLEX: Psychosocial Integrity: Cultural
Diversity
8. The
nurse is caring for a postoperative patient who is of Asian descent. The
patient reports little relief from pain even while taking an opioid analgesic
containing codeine and acetaminophen. What does the nurse suspect that this
patient is exhibiting?
|
a. |
Drug-seeking behavior |
|
b. |
Heightened pain perception |
|
c. |
Poor understanding of
expected drug effects |
|
d. |
Rapid metabolism of one of
the drug’s components |
ANS: D
Certain classifications of medications have different effects in
individuals whose genetic markers are predominantly characteristic of a certain
biologic group. Persons of Asian descent may have a decreased response to some
drugs because they are more likely to have higher levels of CYP2D6 enzymes.
DIF: Cognitive Level: Applying
(Application)
REF: p. 33
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity: Cultural
Diversity
9. The
nurse is caring for an African-American patient who is taking warfarin
(Coumadin) to prevent blood clots. The nurse will monitor this patient
carefully for which effect?
|
a. |
Decreased therapeutic
effects |
|
b. |
Heightened risk for
hemorrhage |
|
c. |
Increased risk of
hypersensitivity |
|
d. |
Potential risk of
paradoxical effects |
ANS: A
Certain classifications of medications have different effects in
individuals whose genetic markers are predominantly characteristic of a certain
biologic group. African-American patients will tend to have a decreased
therapeutic effect from warfarin (Coumadin).
DIF: Cognitive Level: Applying
(Application)
REF: p. 34
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity: Cultural
Diversity
10. The
home health nurse learns that an immigrant family relies on folk healers when
treating illnesses among family members. The nurse will perform which action?
|
a. |
Acknowledge the family’s
beliefs while pointing out how these are not effective. |
|
b. |
Ask the family elder to
explain how a prescribed regimen will be more effective. |
|
c. |
Give the family a list of
dangerous practices to avoid using. |
|
d. |
Incorporate any safe,
non-conflicting practices into the plan of care. |
ANS: D
The nurse should communicate respect for families and cultures
at all times. Respect for cultural diversity may be demonstrated by including
traditional practices into plans as long as they are safe and do not conflict
with evidence-based care.
DIF: Cognitive Level: Applying
(Application)
REF: p. 31
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
Chapter 04: Complementary and Alternative Therapies
McCuistion: Pharmacology: A Patient-Centered Nursing Process
Approach, 9th Edition
MULTIPLE CHOICE
1. A
family member expresses concern that a patient is taking several herbal
remedies and worries that they may be unsafe. The nurse will respond by saying
that herbs
|
a. |
are classified as
medications by the Dietary Supplement Health and Education Act of 1994. |
|
b. |
are regulated by the
government and are determined to be safe. |
|
c. |
aren’t usually effective
but are generally harmless. |
|
d. |
should be discussed with
the patient’s provider in conjunction with other medications. |
ANS: D
Herbs are sometimes useful but can also be useless or dangerous.
There are two types of monographs under development to compile information
about these substances, but there are no agencies that regulate safety and
efficacy. Patients should always tell providers if they are taking any herbal
remedies since there are known drug–herbal interactions and side effects.
DIF: Cognitive Level: Applying
(Application)
REF: p. 41
TOP: Nursing Process: Nursing Intervention:
Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
2. A
pregnant woman tells the nurse that she is taking ginger to reduce morning
sickness. What will the nurse tell this patient?
|
a. |
“Ginger can cause fetal
birth defects.” |
|
b. |
“Ginger is not safe during
pregnancy.” |
|
c. |
“Ginger can cause abortion
in low doses.” |
|
d. |
“Ginger may be taken in low
doses for up to 4 days.” |
ANS: D
Ginger may be taken during pregnancy for morning sickness, but
only on a short-term, low-dose basis. There is no indication that it causes
fetal birth defects. Ginger is an abortifacient in large amounts.
DIF: Cognitive Level: Applying
(Application)
REF: p. 39
TOP: Nursing Process: Nursing Intervention:
Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
3. A
patient asks the nurse about a herbal supplement and reports that it has a
United States Pharmacopeia (USP) seal of approval. The nurse explains that this
indicates
|
a. |
identity, potency, purity,
and labeling accuracy. |
|
b. |
premarket testing for
safety and efficacy. |
|
c. |
structure and function
claims may be made. |
|
d. |
the supplement’s ability to
prevent and treat disease. |
ANS: A
The USP “seal of approval” is a fee-based test and reports on
identity, potency, purity, and labeling accuracy. It does not indicate
premarket research on safety and accuracy, does not allow manufacturers to make
claims about the function of the products, and does not indicate the
substance’s ability to prevent and treat disease.
DIF: Cognitive Level: Applying
(Application)
REF: p. 38
TOP: Nursing Process: Nursing Intervention:
Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
4. A
woman reports using ginseng to treat menopausal symptoms. Which response by the
nurse is correct?
|
a. |
“Ginseng will inhibit your
immune system.” |
|
b. |
“Please tell me if you are taking
diabetic medications.” |
|
c. |
“Side effects of ginseng
are common.” |
|
d. |
“You may experience a
decrease in blood pressure while taking ginseng.” |
ANS: B
Diabetic patients taking ginseng should consult with their
provider if used in conjunction with other herbs or drugs, because hypoglycemia
may result. It may boost the immune system. Side effects are rare except with
long-term use or in large doses. Ginseng can increase blood pressure.
DIF: Cognitive Level: Applying (Application)
REF: p. 40
TOP: Nursing Process: Assessment/Nursing
Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
5. A
woman who is experiencing symptoms of heart failure asks the nurse about using
hawthorn. Which response by the nurse is correct?
|
a. |
“Hawthorn may be used long
term in conjunction with nitrates.” |
|
b. |
“Hawthorn may contribute to
hypertension.” |
|
c. |
“Hawthorn may interact with
antihypertensive drugs.” |
|
d. |
“Hawthorn treats heart
failure by lowering potassium levels.” |
ANS: C
Hawthorn may increase the action of antihypertensive
medications. Its efficacy is not conclusive and it may interact with nitrates.
It may decrease blood pressure. There is no evidence that hawthorn lowers
potassium levels.
DIF: Cognitive Level: Applying
(Application)
REF: p. 40
TOP: Nursing Process: Nursing Intervention:
Patient Teaching
MSC: NCLEX: Physiological Integrity: Reduction of
Risk Potential
6. A
patient who has HIV asks the nurse about taking Echinacea to improve immune
function. What will the nurse tell this patient?
|
a. |
“The root extract is useful
for treating upper respiratory and urinary tract infections.” |
|
b. |
“Research regarding the
benefits of Echinacea is inconclusive.” |
|
c. |
“Use it as needed when
antibiotics fail to treat your infections.” |
|
d. |
“You may use it safely up
to 8 weeks at a time as a preventive medication.” |
ANS: B
Research regarding the benefits of Echinacea as
treatment for cold and flu symptoms is inconclusive. The use of Echinacea to
stimulate the immune system of patients with HIV is being investigated, but its
use is currently not recommended.
DIF: Cognitive Level: Applying
(Application)
REF: p. 39
TOP: Nursing Process: Nursing Intervention:
Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
7. The
nurse is counseling a female patient who reports taking ginger to treat
postoperative nausea. Which statement by the patient indicates understanding of
the teaching?
|
a. |
“I should experience
immediate effects with this herb.” |
|
b. |
“The benefits of taking
ginger for postoperative nausea have not been proven.” |
|
c. |
“I should take ginger with
nonsteroidal antiinflammatory drugs (NSAIDs) to enhance its effects.” |
|
d. |
“If I develop
gastrointestinal (GI) upset, I should stop taking ginger immediately.” |
ANS: B
The benefits of taking ginger for postoperative nausea have not
been proven, as they have been used short-term for the treatment of nausea
associated with pregnancy. Patients may not experience immediate effects.
Patients should not take ginger with NSAIDs without consulting the provider. GI
upset (gas, bloating, heartburn) are common side effects of the herb.
DIF: Cognitive Level: Applying
(Application)
REF: p. 39
TOP: Nursing Process: Nursing Intervention:
Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
8. The
nurse is providing preoperative education to a patient who will have surgery in
several weeks. The patient denies taking anticoagulant medications but reports
using herbal supplements. Which herb would cause the nurse to be concerned?
|
a. |
Echinacea |
|
b. |
Ginkgo biloba |
|
c. |
Kava |
|
d. |
Sage |
ANS: B
Ginkgo can prolong bleeding time and therefore should be
discontinued 2 weeks prior to surgery.
DIF: Cognitive Level: Applying (Application)
REF: p. 40
TOP: Nursing Process: Nursing Intervention:
Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
9. The
nurse provides counseling to a patient who reports taking licorice root to
treat a stomach ulcer. Which statement by the patient indicates understanding
of the teaching?
|
a. |
“I may take licorice root
with prednisone.” |
|
b. |
“I may develop hypotension
while taking licorice root.” |
|
c. |
“I should avoid licorice
root when pregnant.” |
|
d. |
“I should try licorice
instead of coming back to see the provider.” |
ANS: C
In large amounts, licorice root has been associated with preterm
labor and should be avoided in women who are pregnant. Licorice root when taken
with corticosteroids can lead to life-threatening hypokalemia. In large
amounts, it can elevate blood pressure. The benefits of licorice in the
treatment of any condition have not been proven, and the client should see the
provider rather than turn to the herbal medication.
DIF: Cognitive Level: Applying
(Application)
REF: p. 40
TOP: Nursing Process: Nursing Intervention:
Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
10. The
spouse of a patient who is an alcoholic asks the nurse about dietary
supplements that may help prevent liver disease. Which herb will the nurse
suggest the patient discuss with a provider who has prescriptive authority?
|
a. |
Ginkgo biloba |
|
b. |
Kava |
|
c. |
Milk thistle |
|
d. |
Sage |
ANS: C
Milk thistle can prevent damage to liver cells and stimulates
regeneration of liver cells.
DIF: Cognitive Level: Understanding
(Comprehension)
REF: p. 40
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
11. A
patient reports taking St. John’s wort to treat symptoms of depression and asks
the nurse how to use this product safely and effectively. Which response by the
nurse is correct?
|
a. |
“Apply sunscreen while
taking St. John’s wort.” |
|
b. |
“It is safe to take St.
John’s wort with prescription antidepressants.” |
|
c. |
“St. John’s wort does not
affect nutrition.” |
|
d. |
“You should take St. John’s
wort as needed when symptoms occur.” |
ANS: A
St. John’s wort can cause photosensitivity, so patients should
be counseled to use sunscreen. It should not be taken with prescription
antidepressants because it increases the risk of suicidal ideation. It
interferes with the absorption of iron and other minerals. Effects do not occur
for 4 to 8 weeks, so it cannot be taken as needed.
DIF: Cognitive Level: Applying
(Application)
REF: p. 40
TOP: Nursing Process: Nursing Intervention:
Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
12. A
patient is taking valerian, or “herbal valium,” to induce sleep. What will the
nurse teach this patient about this herb?
|
a. |
Habituation and addiction
are likely. |
|
b. |
Hangover effects are common
with usual doses. |
|
c. |
Liver function tests must
be monitored with long-term use. |
|
d. |
Valerian has a high risk
for overdose. |
ANS: C
Liver function tests must be monitored with long-term use, and
valerian should be discontinued if these are elevated. Habituation and
addiction are rare. Hangover effects occur with high doses. There is no
increased risk for overdose.
DIF: Cognitive Level: Applying
(Application)
REF: p. 40
TOP: Nursing Process: Nursing Intervention:
Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
13. A
patient asks the nurse about the safety of herbal products in general. Which
response by the nurse is correct?
|
a. |
“Consumers should research
products and their manufacturers before taking.” |
|
b. |
“Manufacturers are required
to list interactions of herbs with drugs and food.” |
|
c. |
“Products manufactured for
drug and grocery store chains are safe.” |
|
d. |
“Toxicological analysis is
required of all commercial herbal products.” |
ANS: A
There are no comprehensive regulations of herbal supplements
regarding safety and efficacy, so consumers should research herbs and product manufacturers.
Companies manufacturing for drug and grocery stores are suspect and do not
always list all ingredients on their labels.
DIF: Cognitive Level: Applying
(Application)
REF: p. 38
TOP: Nursing Process: Nursing Intervention:
Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
14. Which
information can consumers expect to be included in labeling of herbal products?
|
a. |
Actions and uses |
|
b. |
Interactions and precautions |
|
c. |
Scientific name of the
product |
|
d. |
Safety and efficacy study
results |
ANS: C
Manufacturers should list the scientific name of the product and
the parts of the plant used in preparation. They are not required to list
actions, uses, interactions, precautions, and any results of safety or efficacy
studies.
DIF: Cognitive Level: Understanding
(Comprehension)
REF: p. 38
TOP: Nursing Process: N/A
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
MULTIPLE RESPONSE
1. Which
herbal remedies are often used for GI disorders? (Select all that apply.)
|
a. |
Chamomile |
|
b. |
Cinnamon |
|
c. |
Echinacea |
|
d. |
Ginger |
|
e. |
Ginkgo Biloba |
|
f. |
Peppermint |
ANS: A, B, D, F
Chamomile, cinnamon, ginger, and peppermint are often used to
treat GI disorders.
DIF: Cognitive Level: Remembering
(Knowledge)
REF: pp. 39-40
TOP: Nursing Process: N/A
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
Chapter 55: Adult and Pediatric Emergency Drugs
McCuistion: Pharmacology: A Patient-Centered Nursing Process
Approach, 9th Edition
MULTIPLE CHOICE
1. A
patient who is experiencing chest pain and shortness of breath is brought to
the emergency department. The nurse assesses a heart rate of 98 beats per
minute, bilateral lung crackles, and an oxygen saturation of 93%. What drug
will the nurse expect to administer initially to this patient?
|
a. |
Albuterol |
|
b. |
Aspirin |
|
c. |
Nitroglycerin |
|
d. |
Oxygen |
ANS: D
The patient has signs of pulmonary edema, which can cause chest
pain, crackles, and shortness of breath along with compensatory tachycardia and
low oxygen saturations. The initial drug of choice is oxygen, which can
minimize chest pain and open up the alveoli. The other drugs are given for
specific underlying causes and may be necessary after the patient is evaluated
further.
DIF: Cognitive Level: Applying
(Application)
REF: p. 814
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
2. A
patient with suspected myocardial infarction is seen in the emergency
department. The nurse is preparing to administer 325 mg of aspirin. The nurse
will perform which action?
|
a. |
Administer an
enteric-coated tablet. |
|
b. |
Ask the patient to chew the
tablet. |
|
c. |
Give the tablet with a
small sip of water. |
|
d. |
Place the tablet under the
patient’s tongue. |
ANS: B
To speed the absorption of aspirin, in a cardiac emergency, the
patient should chew the tablet when given. An enteric-coated tablet will slow
the absorption. Giving the aspirin with water or sublingually will slow the
absorption rate.
DIF: Cognitive Level: Applying
(Application)
REF: p. 815
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological
and Parenteral Therapies
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