Pharmacology: A Patient-Centered Nursing Process Approach, (Kee, Pharmacology) 8th Edition Test Bank

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Chapter 1: Drug Action:Pharmaceutic,Pharmacokinetic, andPharmacodynamic PhasesKee: Pharmacology, 7th EditionChapter 1: Drug Action: Pharmaceutic, Pharmacokinetic, andPharmacodynamic PhasesTest BankMULTIPLE CHOICE1. A nurse is providing an oral medication for pain relief to a client. To attain thefastest pain relief, the nurse administers the medication so that it is most rapidlyabsorbed from the gastrointestinal (GI) tract. Which mode of delivery has the fastestabsorption?a.Tabletb.Enteric-coatedpillc.Capsuled.LiquidsuspensionANS: DDrugs must be in solution to be absorbed in the gastrointestinal tract. Because liquiddrugs are already in solution, they are absorbed faster than drugs in a solid form.DIF: Cognitive Level: Application REF: p. 3TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies2. A client asks why she needs to take a medication on an empty stomach. The nurseexplains that food generally has which effect on drug dissolution and absorption?a.Enhancesb.Increasesc.Decreases

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d.DoesnothaveaneffectANS: CFood in the GI tract can interfere with the dissolution and absorption of some drugs.However, there are specific drugs that should be taken with food to enhanceabsorption.DIF: Cognitive Level: Application REF: p. 4TOP: Nursing Process: Intervention/TeachingMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies3. Biotransformation is affected by many factors. What happens to theclient’sdrugmetabolism when liver function is decreased?a.Theclientcandeveloptoxicity.b.Theclientwillhaveanenhancedtherapeuticresponse.c.Theclientmayrequirealargerthannormaldoseofthemedication.d.Theclientwillexperienceadecreasedtherapeuticresponse.ANS: AWhen the drug metabolism rate is decreased, excess drug accumulation can occur andlead to theclient’sdeveloping toxicity. The GI membrane is made up of lipids;therefore, lipid medications are most easily absorbed across the digestive membraneof the stomach. Medications that are nonionized (neither positive nor negative) alsopass through the GI membrane faster than those with a charge.DIF: Cognitive Level: Application REF: p. 6TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies4. A client asks why the oral dose of her pain medication is higher than theintravenous dose. The nurse explains that with the oral dose, only 20% to 40% of thedrug may actually enter systemic circulation. This reduces the amount of active drug.What is the term for this effect?a.Proteinbindingb.Bioavailabilityc.Hepaticfirstpass

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d.PinocytosisANS: BBioavailabilityis the percentage of the administered drug dose that reaches thesystemic circulation. Oral drugs that have a high first-pass hepatic metabolism mayhave a bioavailability of only 20% to 40% on entering systemic circulation. To obtainthe desired drug effect, the oral dose could be three to five times larger than the drugdose for IV use.DIF: Cognitive Level: Comprehension REF: p. 4TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies5. When providing a medication, which route should the nurse select to ensure themaximum amount of bioavailability?a.Oralb.Intravenousc.Intramusculard.SubcutaneousANS: BThe percentage of bioavailability for the oral route is always less than 100%, but forthe intravenous route it is usually 100%.DIF: Cognitive Level: Comprehension REF: p. 4TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies6. A client is being given two highly protein-bound drugs concurrently. What is mostlikely to be the result of this administration?a.Morefreedrugincirculationb.Lessfreedrugincirculationc.Moredrugboundtoproteind.MoredrugexcretedintheurineANS: A

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When two highly protein-bound drugs are given concurrently, they compete forprotein-binding sites, causing more free drug to be released into the circulation. Drugaccumulation and possible drug toxicity can result.DIF: Cognitive Level: Application REF: p. 5TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies7. A client is taking a drug that is moderately highly protein bound. Several days later,the client takes a second drug that is 90% protein bound. What is most likely to haveoccurred as a result of this administration?a.Thefirstdrugremainsproteinbound.b.Thefirstdrugbecomesincreasinglyinactive.c.Thefirstdrugisreleasedfromtheproteinandbecomesmorepharmacologicallyactive.d.Theseconddrugbecomesmoreactive.ANS: COnly drugs not bound to protein are active and can cause a pharmacologic response.As the free drug in the circulation decreases, more bound drug is released from theprotein to maintain the balance of free drug.DIF: Cognitive Level: Application REF: p. 5TOP: Nursing Process: ActiveMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies8. A nurse is determining whether a medication is ordered to be given at theappropriate intervals. This is done by assessing the half-life of the medication. Theserum half-life (t) of a drug is the time required:a.forhalfofadrugdosetobeabsorbed.b.afterabsorptionforhalfofthedrugtobeeliminated.c.foradrugtobeachievemaximumeffectiveness.d.forhalfofthedrugdosetobecompletelydistributed.ANS: BThe half-life (t) of a drug is the time it takes for one half of the drug concentrationto be eliminated.

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DIF: Cognitive Level: Comprehension REF: pp. 5-6TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies9. A client is to receive a drug that has a half-life of 36 hours. The drug wouldprobably be administered on which dose schedule?a.Onceaweekb.Onceadayc.Twiceadayd.ThreetimesadayANS: BSince the medication requires 36 hours to be eliminated from the body, a once-dailydosing pattern would allow therapeutic drug levels to be maintained.DIF: Cognitive Level: Analysis REF: pp. 5-6TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies10. A client is suffering from end-stage renal disease. Because of this condition, thenurse monitors drug levels to assess for which phenomenon?a.Toxicityb.Subtherapeuticlevelsc.Drugineffectivenessd.PoorcomplianceANS: AThe primary route for drug elimination is the renal system. If kidney function isimpaired, drugs may reach toxic levels.DIF: Cognitive Level: Comprehension REF: pp. 6-7TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies11. Aclient’screatinine clearance level is 105 mL/min. Based on this information,what type of change in his medication should the nurse anticipate?

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a.Increaseddosageb.Decreaseddosagec.Unchangeddosaged.DosagewithheldANS: CThis is a normal creatinine clearance level (normal level is 85 to 135 mL/min);therefore the dose would be unchanged.DIF: Cognitive Level: Analysis REF: pp. 6-7TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies12. Isoproterenol (Isuprel) is an example of a medication that enhances the betareceptors in the body. What is the term for drugs that stimulate a response?a.Antagonistsb.Agonistsc.Depressantsd.TherapeuticeffectANS: BAn agonist is a drug that produces a response.DIF: Cognitive Level: Comprehension REF: p. 8TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies13. A nursing role is to teach clients to watch for adverse medication reactions. Theclient should be able to recognize what about adverse reactions?a.Theyaremild,easilytreatablesideeffects.b.Theyaretherapeutic,expectedeffects.c.Theyareundesiredeffectsthatmaybesevere.d.Theyarethedesiredtherapeuticeffects.ANS: CAdverse reactions are a range of untoward effects (unintended and occurring atnormal doses) of drugs that cause mild-to-severe side effects, including anaphylaxis

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(cardiovascular collapse). Adverse reactions are always undesirable and must alwaysbe reported and documented because they represent variances from planned therapy.DIF: Cognitive Level: Comprehension REF: p. 10TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies14. The nurse teaches the client that undesired effects are frequently associated with aclient stopping a medication before completion of the full course. The nurse shouldalso instruct the client that physiologic effects not related to the desired effect, whichcan be predicted or associated with the use of the drug, may also occur. What shouldthe client recognize about these physiologic effects?a.Theyaresevereadversereactions.b.Theyaresideeffects.c.Theyaresynergisticeffects.d.Theyaretoxiceffects.ANS: BSome side effects are expected as part of drug therapy. The occurrence of theseexpected but undesirable side effects is not a reason to discontinue therapy. Thenurse’srole includes teaching clients to report any side effects. It is important to knowthat the occurrence of side effects is one of the primary reasons clients stop taking theprescribed medication.DIF: Cognitive Level: Application REF: p. 10TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies15. A nurse is learning how to draw peak and trough levels of a medication. In orderto draw them correctly, the nurse should know what the trough level is. The troughlevel is the __________ of a drug.a.minimumeffectiveconcentrationb.highestplasmaconcentrationc.lowestplasmaconcentrationd.rateofabsorption

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ANS: CThe trough drug levelis the lowest plasma concentration of a drug, and it measuresthe rate at which the drug is eliminated.DIF: Cognitive Level: Comprehension REF: p. 9TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies16. The client is receiving frequent daily drug dosing of a drug that has a longduration of action. What should the nurse expect to be the result of thisadministration?a.Drugaccumulationandpossibledrugtoxicityb.Increaseddrugexcretionc.Enhancedtherapeuticresponsed.Increaseddrughalf-lifeANS: AWhen the drug level exceeds the therapeutic range, toxic effects are likely to occurfrom overdosing or drug accumulation. Medications with a long half-life and frequentdosing may build up in the system or accumulate and lead to toxic effects.DIF: Cognitive Level: Analysis REF: p. 10TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies17. The nurse notes that the client is rapidly developing a decreased response to amedication. This decreased response is known as:a.pharmacogenetics.b.tachyphylaxis.c.drugaccumulation.d.drugtoxicity.ANS: BTachyphylaxis refers to a rapid decrease in response to the drug.DIF: Cognitive Level: Comprehension REF: p. 11TOP: Nursing Process: Analysis

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MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies18. Because of hereditary influence, drug action may vary from a predicted drugresponse. This variance is known as:a.biotransformation.b.tachyphylaxis.c.pharmacogenetics.d.transcriptionfactors.ANS: CPharmacogenetics is the effect of a drug action that varies from a predicted drugresponse because of genetic factors or hereditary influence.DIF: Cognitive Level: Comprehension REF: p. 11TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies19. The nurse is monitoring a patient prescribed an aminoglycoside antibiotic fortoxicity. Which nursing intervention is indicated when administering this medication?a.Ensurethattheclientvoidsbeforeadministration.b.Haveemergencyairwayequipmentatthebedside.c.Monitorbloodlevelsofthemedication.d.Determineliverfunctionbeforeeachdose.ANS: CFor those drugs with a narrow therapeutic index, such as aminoglycoside antibioticsand anticonvulsants, the therapeutic ranges are closely monitored.DIF: Cognitive Level: Analysis REF: p. 10TOP: Nursing Process: PlanningMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies20. The nurse sees that the client has been prescribed a loading dose of medication.What effect should the nurse expect to result from the client receiving a loading dose?a.Arapidmaximumeffectiveconcentrationb.Maintenancedosethelowestplasmaconcentrationofthedrug

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c.Therapeuticdosethehighestplasmaconcentrationofthedrugd.ArapidminimumeffectiveconcentrationANS: DWhen immediate drug response is desired, a large initial dose, known as the loadingdose, of drug is given to achieve a rapid minimum effective concentration in theplasma. After a large initial dose, a prescribed dosage per day is ordered.DIF: Cognitive Level: Analysis REF: pp. 9-1TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies21. The nurse receives the results of laboratory testing and sees that the level ofvalproic acid in theclient’sblood is 78 mcg/mL. What is thenurse’smost appropriateresponse?a.Thenursemustcallthephysicianimmediately;thisisatoxiclevelofmedication.b.Heorshemustdonothing;thisisatherapeuticlevelofmedication.c.Heorshemustcallthephysician;thisisadangerouslyhighlevelofmedication.d.Thenursemustdonothing;thisisasubnormallevelofmedication.ANS: BThe therapeutic range for valproic acid is 50 to 100 mcg/mL.DIF: Cognitive Level: Analysis REF: p. 10TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies22. The nurse is caring for a client who needs to have a peak drug level drawn. Hewas given the oral medication 30 minutes ago. What is the best action on the part ofthe nurse?a.Callthelabtohavethemedicationleveldrawnimmediately.b.Arrangefortheleveltobedrawntomorrowsincethepeaktimehaspassed.c.Waitforatleastanother30minutesbeforecallingtohavetheleveldrawn.d.Scheduletheleveltobedrawnin8hours.ANS: CThe peak drug level for an oral drug can be 1 to 3 hours after drug administration.

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DIF: Cognitive Level: Application REF: p. 9TOP: Nursing Process: PlanningMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies23. The client has been prescribed digoxin. Before administering the drug on a routinebasis to the client, the nurse should recognize that the client should receive a _____dose.a.therapeuticb.peakc.troughd.loadingANS: DDigoxin requires a loading dose when first prescribed.DIF: Cognitive Level: Application REF: pp. 9-10TOP: Nursing Process: PlanningMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies24. The client has been placed on an enteric-coated medication. An appropriate actionon the part of the nurse is to instruct the client to __________ the medication.a.weighherselfatthesametimeeverydaywhileonb.drinkatleasteightglassesofwaterdailywhileonc.adheretoalow-sodiumdietwhileond.avoideatingfattyfoodbeforetakingANS: DFatty foods decrease the absorption rate of enteric-coated tablets.DIF: Cognitive Level: Application REF: pp. 11-12TOP: Nursing Process: PlanningMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral TherapiesChapter 2: Nursing Process andClient Teaching

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Kee: Pharmacology, 7th EditionChapter 2: Nursing Process and Client TeachingTest BankMULTIPLE CHOICE1. Which is the sequence of steps in the nursing process?a.Implementation,evaluation,planning,assessmentb.Planning,assessment,implementation,evaluationc.Assessment,planning,implementation,evaluationd.Evaluation,implementation,assessment,planningANS: CThe four phases of the nursing process are assessment, planning, implementation, andevaluation.DIF: Cognitive Level: Comprehension REF: pp. 14-15TOP: Nursing Process: AllMSC: CONTENT CATEGORY: Management of Care2. Theclient’sknowledge base about the drugs used is part of the:a.plan.b.analysis.c.subjectivedatabase.d.objectivedatabase.ANS: CTheclient’sknowledge about a drug and its side effects would be part of thesubjective database.DIF: Cognitive Level: Comprehension REF: p. 15TOP: Nursing Process: AssessmentMSC: CONTENT CATEGORY: Health Promotion and Maintenance3. Attainment of goals is associated with which phase of the nursing process?a.Implementationb.Planningc.Assessmentd.EvaluationANS: D

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The effectiveness of health teaching about drug therapy and the attainment of goalsare associated with evaluation.DIF: Cognitive Level: Comprehension REF: pp. 19-20TOP: Nursing Process: EvaluationMSC: CONTENT CATEGORY: Management of Care4. During which phase of the nursing process would the nurse identify clientperceptions and expectations of thedrug’seffectiveness?a.Planningb.Assessmentc.Evaluationd.ImplementationANS: BThis information consists of subjective data.DIF: Cognitive Level: Comprehension REF: p. 15TOP: Nursing Process: AssessmentMSC: CONTENT CATEGORY: Management of Care5. The nurse is establishing goals for a client related to medication administration.Which of the phases of the nursing process is characterized by goal setting?a.Planningb.Evaluationc.Implementationd.AssessmentANS: AThe planning phase of the nursing process is characterized by goal setting or expectedoutcomes.DIF: Cognitive Level: Comprehension REF: p. 16TOP: Nursing Process: PlanningMSC: CONTENT CATEGORY: Management of Care6. During which phase of the nursing process will the nurse include nursing actions orinterventions necessary to accomplish expected outcomes?a.Assessmentb.Planning

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c.Implementationd.EvaluationANS: CThe implementation phase of the nursing process includes the nursingactions/interventions necessary to accomplish the established goals or expectedoutcomes.DIF: Cognitive Level: Comprehension REF: pp. 16-19TOP: Nursing Process: ImplementationMSC: CONTENT CATEGORY: Management of Care7. Which is a correctly written goal?a.Theclientwillindependentlyadministeraprescribeddoseofantibioticbytheendofthefirteachingsession.b.Theclientwilllearntotakeanantibioticcorrectly.c.Theclientwilladministeraprescribeddose.d.Theclientwillknowhowtoadministerantibiotics.ANS: AThe goal should be client centered, have a realistic deadline, be measurable, andcontain components for evaluation.DIF: Cognitive Level: Application REF: p. 16TOP: Nursing Process: PlanningMSC: CONTENT CATEGORY: Management of Care8. Upon physical assessment, a nurse notes that a client has visual impairment. Thenurse is concerned that theclient’svisual changes may affect her ability to self-administer medications. Which nursing diagnosis best describes this situation?a.Riskforineffectivetherapeuticregimenmanagementrelatedtomedicationsecondarytoviimpairmentb.Deficientknowledgerelatedtomedicationadministrationc.Ineffectivefamilytherapeuticregimenmanagementrelatedtovisualimpairmentd.Ineffectivecopingrelatedtolackofabilitytoself-administermedicationsANS: AThe nurse would need more information to determine whether an actual nursingdiagnosis exists. This diagnosis would best represent this problem.DIF: Cognitive Level: Analysis REF: p. 16

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TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Management of Care9. During assessment, a client reports a reaction to a medication. What is the nextnursing intervention?a.Letthephysicianknowthattheclientcannotreceivethemedication.b.Asktheclientthetypeofreactionexperienced.c.Reassuretheclientthatthereactionwillnotoccuragain.d.Notethecommentintheclient’schartandgivethemedication.ANS: BIt is important for the nurse to know what type of reaction occurred in order to planaction.DIF: Cognitive Level: Application REF: p. 15TOP: Nursing Process: AssessmentMSC: CONTENT CATEGORY: Management of Care10. A nurse is caring for a client who takes a chewable medication. The client doesnot take the medication because his teeth and gums have pain when chewing. Thenurse establishes the following nursing diagnosis for the client: impaired dentitionrelated to chronic gum inflammation secondary to poor dental hygiene. Which nursinggoal is most appropriate for the client?a.Theclientwillverbalizethepathophysiologyofgumdisease.b.Theclientwilldemonstratetheprocedureforbrushingteeth.c.Theclientwillunderstandtheneedfordentalhygiene.d.Theclientwilldiscussthereasonsdentalhygieneisimportant.ANS: BAn important intervention would be to teach the client how to take care of his teeth,which would alleviate the pain and allow for greater adherence to the medicationregimen.DIF: Cognitive Level: Application REF: p. 16TOP: Nursing Process: PlanningMSC: CONTENT CATEGORY: Management of Care

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11. A nurse is teaching a client about a medication that is scheduled to beadministered q.i.d. The client states that she does not use a watch or clock and liveswithout a daily routine. Which teaching would be most helpful for the client?a.Instructtheclienttotakethemedicationeachmorningandeveningwhenbrushingherteethb.Teachtheclienttotakethemedicationatluncheveryday.c.Providetheclientwithawatchtoensureshetakesthemedicationatcorrecttimes.d.Instructtheclienttotakethemedicationwithmealsandatbedtimeeachday.ANS: DFor a client who is not time oriented and needs to take the medication 4 times a day,this is the only answer that is feasible.DIF: Cognitive Level: Application REF: pp. 17-19TOP: Nursing Process: Intervention/TeachingMSC: CONTENT CATEGORY: Health Promotion and Maintenance12. A nurse is teaching a client about his medications. In his care plan, a previousnurse indicated that the client was a visual learner. Which teaching strategy would beindicated for this client?a.Pamphletsorvideosaboutthemedicationb.Opportunitiesforpracticingtheadministrationofmedicationc.Adiscussionaboutthemedicationd.AnaudiotapedescribingthemedicationanditsactionsANS: AA visual learner would respond best to teaching strategies that can be seen (e.g.,pamphlets, videos).DIF: Cognitive Level: Application REF: pp. 17-19TOP: Nursing Process: PlanningMSC: CONTENT CATEGORY: Health Promotion and Maintenance13. A nurse is establishing a plan of care for a client who has been ordered to receiveantibiotic therapy. The client does not read English but is able to understand spokenEnglish. She is of a lower-income socioeconomic group. Which strategy would bemost appropriate for teaching this client?a.Provideavideogoingovertheinformation.b.Givetheclientseveralpamphletsandaskinghertogooverthemwithherfamily.

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c.Provideateachingsheetwithsimplewordsandpictures.d.Arrangeaquiettimetodiscussthemedicationregimenwiththeclient.ANS: DThis strategy takes both theclient’sstrengths and cultural factors into account.DIF: Cognitive Level: Application REF: pp. 17-19TOP: Nursing Process: PlanningMSC: CONTENT CATEGORY: Management of Care14. A client with AIDS-defined disease is ordered to receive two differentmedications. The primary care nurse notes that he has not been taking his medicationsas ordered. The client says,“Idon’tlike the side effects of thedrugs.”Which is anappropriate nursing diagnosis?a.KnowledgedeficitrelatedtoprogressionoftheAIDSdiseaseb.Grievingrelatedtodiagnosisofterminaldiseasec.Riskforinfectionrelatedtoimpairedimmunefunctiond.NoncompliancerelatedtomedicationsideeffectsandlackofknowledgeANS: DThis nursing diagnosis reflects analysis of the client subjective data.DIF: Cognitive Level: Analysis REF: p. 15TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Management of Care15. The nurse is working with an Asian client to provide instruction regarding hismedication regimen. The nurse is planning to provide the client with pamphlets totake with him as part of the follow-up to his instructional sessions. What is the mostappropriate action on the part of the nurse?a.Makeprolongedeyecontactwiththeclient.b.Usebothhandsasashowofrespect.c.Showflexibilityinmakingfollow-upappointments.d.Speakclearlyinaloudvoice.ANS: BUse both hands to show respect when offering a prescription, instructions, orpamphlets to Asians and Pacific Islanders.DIF: Cognitive Level: Application REF: p. 18

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TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Management of Care16. The nurse has decided to add a nursing diagnosis to theclient’sdrug therapy planof care that represents wellness/health promotion. What is the most appropriatediagnosis to add to promote these areas?a.Ineffectivehealthmaintenancerelatedtonothavingrecommendedpreventivecareb.Riskforinjuryrelatedtosideeffectifdrugsc.Therapeuticregimenmanagement,readinessforenhancedd.IneffectivetherapeuticregimenmanagementrelatedtolackoffinancesANS: CThis is the only diagnosis that would be classified as promoting wellness/health.DIF: Cognitive Level: Comprehension REF: p. 16TOP: Nursing Process: AssessmentMSC: CONTENT CATEGORY: Health Promotion and MaintenanceChapter 3: Medication SafetyKee: Pharmacology, 7th EditionChapter 3: Medication SafetyTest BankMULTIPLE CHOICE1. What is the importance of the nurse practicing the“5-plus-5rights”of drugadministration?a.Theyensurecorrectmixingofthedrug.b.Theyensuresafedrugadministration.c.Theyensuretime-savingadministration.d.Theyensureadequateknowledgeaboutthedrug.ANS: BThe“5-plus-5”rights ensure that the nurse has considered all of the details of safemedication administration.DIF: Cognitive Level: Comprehension REF: pp. 23-27TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies

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2.“GiveTylenol 650 mg q3-4h as needed forheadache”is an example of whichcategory of drug order?a.Standingdrugorderb.One-timedrugorderc.PRNd.STATANS: CPRN means to administer the drug on an as-needed basis.DIF: Cognitive Level: Comprehension REF: p. 25TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies3. A nurse is administering a medication to a client. The nurse tells the client therationale for the medication. This nurse is observing which client right?a.Therighttoinformedconsentb.Therighttopermissionc.Therighttoethicsd.TherighttoautonomyANS: ATo observe aclient’sright to informed consent, the nurse must give the client theknowledge necessary to make an appropriate decision.DIF: Cognitive Level: Comprehension REF: p. 26TOP: Nursing Process: Intervention/TeachingMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies4. A nurse is ordered to administer a medication via the sublingual route. The nursecorrectly places the medication:a.inthebuccalmucosa.b.underthetongue.c.betweentheteethandgums.d.inacupofwatertodissolve.ANS: B

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Sublingual means under the tongue.DIF: Cognitive Level: Comprehension REF: p. 26TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies5. The nurse is calculating the dosage of a drug to administer. Once the dosage hasbeen calculated, what is the most important action on the part of the nurse?a.Contactthepharmacistfordosageconfirmation.b.Checktheidentityofthepatientthreetimes.c.Recalculatethedrugdoseandcheckwithanothernurse.d.ChecktheAmericanHospitalFormularyfordrugdoses.ANS: CAfter calculating the drug dose, when in doubt, recalculate the drug dose and checkwith another nurse.DIF: Cognitive Level: Analysis REF: p. 24TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies6. The nurse is preparing to administer tetracycline to the client. What is the mostappropriate time for the client to receive this medication?a.Onehourbeforedinnerintheeveningb.Withbreakfastinthemorningc.Withalate-afternoonsnackd.Directlyafterlunchinthemid-afternoonANS: ATetracycline is a drug that is affected by food; therefore, it should be given beforemeals.DIF: Cognitive Level: Analysis REF: p. 25TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies

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7. The nurse checks the expiration date on the medication to be administered and findsthat the drug expired 2 days ago. What is the most appropriate action on the part of thenurse?a.Holdonedoseofthemedication.b.Returnthemedicationtothepharmacy.c.Contactthephysicianfororders.d.Administerthedrugbutmonitortheclient.ANS: BWhen a medication is found to have expired, discard it or return it to the pharmacy.DIF: Cognitive Level: Analysis REF: p. 25TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies8. The nurse notes that the client is scheduled to receive a dose of potassium. What isthe most appropriate time for the client to receive this medication?a.Directlyafterdinnerintheeveningb.Onehourbeforelunchinlatemorningc.Withwateronlyinthelateafternoond.FirstthingafterrisinginthemorningANS: APotassium is a drug that can irritate the stomach. Therefore it should be given aftermeals.DIF: Cognitive Level: Analysis REF: p. 25TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies9. The nurse verifies that he is using only standardized abbreviations in documentingmedication information. He recognizes that this fulfills which of the National PatientSafety Goals?a.Improvetheaccuracyofpatientidentification.b.Improvetheeffectivenessofcommunicationamongcaregivers.c.Improvethesafetyofusingmedications.

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d.Accuratelyandcompletelyreconcilemedicationsacrossthecontinuumofcare.ANS: BThe use of standardized abbreviations fulfills the goal of improving the effectivenessof communication among caregivers.DIF: Cognitive Level: Analysis REF: pp. 27-29TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies10. The nurse ensures that she provides the next nurse taking over the care of herclient with a complete list of his medications since the next nurse is newly admitted tothat unit. She recognizes that this fulfills which of the National Patient Safety Goals?a.Improvetheaccuracyofpatientidentificationb.Improvetheeffectivenessofcommunicationamongcaregiversc.Improvethesafetyofusingmedicationsd.AccuratelyandcompletelyreconcilemedicationsacrossthecontinuumofcareANS: DCommunicating a complete list of theclient’smedications to the next providerensures that the goal of accurately and completely reconciling the medications acrossthe continuum of care.DIF: Cognitive Level: Analysis REF: pp. 27-29TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies11. The client is scheduled to receive Protonix as part of his medication regimen. Themost important teaching intervention to be implemented by the nurse is to instruct theclient:a.ontheproperwaytosplitthetablet.b.tocrushthetabletbeforeswallowing.c.toavoidcrushingthetablet.d.toswallowthetabletwithaminimumofwater.ANS: CProtonix is a medication that should never be crushed.

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DIF: Cognitive Level: Analysis REF: p. 30TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies12. The client has been on an oral dose of a medication. The nurse recognizes that theclient is experiencing difficulty swallowing. What is the most important action on thenurse’spart?a.Crushthemedicationandmixitwithwater.b.Splitthemedicationinhalfandmixitinjelly.c.Callthephysicianforaliquidversionofthemedication.d.Tellthepharmacytoholdthemedicationuntilfurthernotice.ANS: CA major part of assessing the client is assessing his ability to swallow when he isscheduled to receive oral medications.DIF: Cognitive Level: Analysis REF: pp. 30-31TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies13. The nurse is caring for an older adult client who is scheduled to receive a dose ofbarbiturates. Based on thenurse’sknowledge of how the older adult client responds tothese medications, the nurse should expect the dosage to be:a.lowerthannormal.b.higherthannormal.c.dividedinhalf.d.unchanged.ANS: AInfants as well as older adults are more sensitive to drugs, with the elderly beinghypersensitive to barbiturates.DIF: Cognitive Level: Analysis REF: p. 32TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies

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14. The nurse is calculating a dosage of medication for an infant. The nurserecognizes that the dosage is based on theinfant’s:a.biologicalage.b.weightinpounds.c.gestationalage.d.weightinkilograms.ANS: DInfant doses are calculated on the basis of weight in kilograms.DIF: Cognitive Level: Application REF: p. 32TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies15. The nurse is caring for a thin-framed adult who is scheduled to receive multipledoses of antineoplastic medication. The nurse should expect the dosage for this personto be:a.lowerthannormal.b.higherthannormal.c.dividedinhalf.d.unchanged.ANS: ADrug doses of antineoplastic medications are usually ordered according to bodyweight.DIF: Cognitive Level: Application REF: p. 32TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral TherapiesChapter 4: MedicationAdministrationKee: Pharmacology, 7th EditionChapter 4: Medication AdministrationTest Bank

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MULTIPLE CHOICE1. The nurse is preparing to administer an intramuscular injection to an infant. What isthe most accurate site for the nurse to select for this administration?a.Ventroglutealb.Vastuslateralisc.Dorsogluteald.DeltoidANS: BThe vastus lateralis is the most appropriate site to utilize for an IM injection in aninfant.DIF: Cognitive Level: Comprehension REF: p. 44TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies2. What is an appropriate nursing intervention to use to meet the psychiatric needs of ahospitalized infant?a.Moveslowlywhileconductingcare.b.Explainprocedurescarefully.c.Usetheoralrouteformedications.d.Allowthechildtoexpressfeelings.ANS: AThe nurse should move slowly and maintain a nonthreatening attitude in order toprevent stranger anxiety from developing in the infant.DIF: Cognitive Level: Application REF: p. 45TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies3. During administration of eye drops, the nurse should teach the client to preventsystemic absorption of the drug by performing which action?a.Usetheointmentformofthedrug.b.Applythedrugdirectlyonthecornea.c.Havetheclientlookstraightahead.

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d.Gentlypressonthelacrimalduct.ANS: DBy applying pressure on the inner canthus of the eye, the medication is less likely tobe systemically absorbed.DIF: Cognitive Level: Application REF: p. 37TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies4. A nurse is preparing to administer a deep IM injection to a client. Which site issuited for a deep IM injection?a.Abdomenb.Dorsoglutealc.Deltoidd.VastuslateralisANS: BThe dorsogluteal site is suited for deep IM or Z-track injections.DIF: Cognitive Level: Comprehension REF: p. 44TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies5. A nurse administers an injection using the Z-track method. The nurse instructs thepatient that the Z-track technique is designed to accomplish what?a.Allowtheclienttoacceptatleast5mLofmedication.b.Preventmedicationfromleakingintosubcutaneoustissue.c.Decreasethepossibilityof“self-sticks.”d.Takelesstimetoadminister.ANS: BThe Z-track method displaces the tissue during medication injection and replaces thetissue when withdrawn. This prevents leaking.DIF: Cognitive Level: Comprehension REF: p. 44TOP: Nursing Process: Intervention/Implementation

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MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies6. A nurse is applying nitroglycerin ointment to a client. When applying medicationtopically, what is the highest priority nursing intervention?a.Applymedicationliberally.b.Avoidcontactofthemedicationwiththenurse’sskin.c.Massagethearea.d.Haveclientapplymedication.ANS: BBecause this medication is topically absorbed, contact with thenurse’sskin may causethe nurse to feel the effects of the medication.DIF: Cognitive Level: Application REF: p. 37TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies7. A nurse prepares to administer an ear medication to a 2-year-old child. What is thecorrect action by the nurse?a.Positionthechildwiththeeardownonthebed.b.Pulltheearupwardandbackward.c.Putthechildinhigh-Fowler’sposition.d.Pulltheeardownwardandbackward.ANS: DThis is the correct method for a child younger than 3 years. For a child older than 3years, the ear is pulled up and back.DIF: Cognitive Level: Application REF: p. 38TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies8. The nurse is teaching the client how to administer a sublingual tablet in the homesetting. What is the highest priority instruction?a.Takenothingbymouthforonehourbeforetakingthemedication.b.Avoidtakingfluidwiththemedication.

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c.Gentlyplacethetabletbetweentheteethandgums.d.Takethemedicationwithfoodsoastoavoidgastrointestinalirritation.ANS: BFood and fluids should be avoided when taking a sublingual tablet to avoid movingthe tablet from under the sublingual region.DIF: Cognitive Level: Application REF: p. 36TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies9. A client has been using his inhaler at home. He tells the nurse that“themedicationdoesn’tseem to work as well as itdid.”What should the nurse assess for first?a.Tolerancetothemedicationb.Unhealthydrug-seekingbehaviorsc.Physicaladdictiond.PoortoleranceofpainANS: AOveruse of the medication can lead to the development of tolerance.DIF: Cognitive Level: Analysis REF: p. 40TOP: Nursing Process: AssessmentMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies10. A client with chronic angina is ordered to receive nitroglycerin via patch. What isthe highest priority nursing action regarding this method of administration?a.Cutthepatchtoprovidethecorrectdoseofmedication.b.Usesteriletechniquewhenapplyingthepatch.c.Removetheoldpatchbeforeapplyingthenewpatch.d.Coverthepatchwithanairtightdressingafterapplication.ANS: CThe old patch must be removed before the new patch is applied in order to preventoverdosing the client and also to prevent irritation to the skin.DIF: Cognitive Level: Application REF: pp. 36-37TOP: Nursing Process: Intervention/Implementation

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MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies11. A nurse is administering an intradermal PPD to test for client exposure to thetuberculosis bacterium. Which method is the correct one for administering thisinjection?a.Usea5-degreeangletoinserta20-gaugeneedle.b.Usea10-degreeangletoinserta25-gaugeneedle.c.Usea45-degreeangletoinserta26-gaugeneedle.d.Usea90-degreeangletoinsertan18-gaugeneedle.ANS: BThis is the correct procedure for an intradermal injection.DIF: Cognitive Level: Analysis REF: p. 41TOP: Nursing Process: Intervention/ImplementationMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies12. A client returns to the nursing unit from conscious sedation after having a fractureset and placed in a cast. The client expresses pain 3 hours after the procedure. Thechoice of medication and route will be based on which information?a.Theclientshouldnotreceivepainmedicationbecauseofhisprevioussedation.b.Theclientwillneedtovoidbeforereceivinganypainmedicationinordertoavoidurinaryretention.c.Theclientshouldreceiveintravenousmedicationonlyforpainbecauseoftheoperativeprod.Theclient’sabilitytoswallowshouldbeevaluatedbeforeheorshereceivesoralmedicatioANS: DBefore providing oral medication, it is essential for the nurse to evaluate theclient’slevel of consciousness and ability to swallow.DIF: Cognitive Level: Analysis REF: p. 36TOP: Nursing Process: AnalysisMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies13. The nurse is preparing to administer a subcutaneous injection of morphine sulfate(MSO4) to a client. Theclient’sheight, weight, and muscle mass are within normallimits. What are the appropriate needle size and angle for this injection?

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a.27-gaugeneedle,10-degreeangleb.20-gaugeneedle,90-degreeanglec.23-gaugeneedle,20-degreeangled.25-gaugeneedle,45-degreeangleANS: DThis is the correct angle and size for a subcutaneous injection.DIF: Cognitive Level: Application REF: pp. 41-42TOP: Nursing Process: InterventionMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral TherapiesMULTIPLE RESPONSE1. The nurse is preparing to administer an ointment to theclient’seye and is gatheringthe needed supplies. What supplies are needed to complete this task? (Select all thatapply.)a.Cleanglovesb.Medicationointmentc.Sterilegauzed.Sterileglovese.30-mLsyringef.5-mLsyringeg.TissuesANS: A, B, C, GAlthough the eyes are considered sterile, clean gloves are all that are needed, and careshould be taken to keep the medication sterile. The syringes are not needed. Thesterile gauze is needed in case the eye must be touched. The tissues allow for removalof excess medication.DIF: Cognitive Level: Application REF: p. 38TOP: Nursing Process: InterventionMSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological andParenteral Therapies

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