Test Bank For Basic Pharmacology For Nurses, 16e, 16th Edition

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Chapter 1: Drug Definitions, Standards, andInformation SourcesChapter 1: Drug Definitions, Standards, and Information SourcesTest BankMULTIPLE CHOICE1.What is the name under which a drug is listed by the U.S. Food and DrugAdministration (FDA)?a.Brandb.Nonproprietaryc.Officiald.TrademarkANS: CThe official name is the name under which a drug is listed by the FDA. The brandname, or trademark, is the name given to a drug by its manufacturer. Thenonproprietary, or generic, name is provided by the U.S. Adopted Names Council.DIF: Cognitive Level: Knowledge REF: p. 1 OBJ: 2TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Safe, Effective Care Environment2.Which source contains information specific to nutritional supplements?a.USPDictionaryofUSAN&InternationalDrugNamesb.NaturalMedicinesComprehensiveDatabasec.UnitedStatesPharmacopoeia/NationalFormulary(USPNF)d.DrugInteractionFactsANS: CUnited States Pharmacopoeia/National Formularycontainsinformation specific tonutritional supplements.USP Dictionary of USAN & International Drug Namesis acompilation of drug names, pronunciation guide, and possible future FDA approveddrugs; it does not include nutritional supplements.Natural Medicines ComprehensiveDatabasecontains evidence based information on herbal medicines and herbalcombination products; it does not include information specific to nutritionalsupplements.Drug Interaction Factscontains comprehensive information on druginteraction facts; it does not include nutritional supplements.

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DIF: Cognitive Level: Knowledge REF: p. 2 OBJ: 4TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity3.What is the most comprehensive reference available to research a drug interaction?a.DrugFactsandComparisonsb.DrugInteractionFactsc.HandbookonInjectableDrugsd.Martindale—TheCompleteDrugReferenceANS: BFirst published in 1983,Drug Interaction Factsis the most comprehensive bookavailable on drug interactions. In addition to monographs listing various aspects ofdrug interactions, this information is reviewed and updated by an internationallyrenowned group of physicians and pharmacists with clinical and scientific expertise.DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 3TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity4.The physician has written an order for a drug with which the nurse is unfamiliar.Which section of thePhysicians’Desk Reference (PDR)is most helpful to getinformation about this drug?a.Manufacturer’ssectionb.BrandandGenericNamesectionc.ProductCategorysectiond.ProductInformationsectionANS: BAphysician’sorder would include the brand and/or generic name of the drug. Thealphabetic index in thePDRwould make this section the most user friendly. Based onaphysician’sorder,manufacturer’sinformation and classification information wouldnot be known. TheManufacturer’ssection is a roster of manufacturers. The ProductCategory section lists products subdivided by therapeutic classes, such as analgesics,laxatives, oxytocics, and antibiotics. The Product Information section contains reprintsof the package inserts for the major products of manufacturers.DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 4

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TOP: Nursing Process Step: PlanningMSC: NCLEX Client Needs Category: Physiological Integrity5.Which online drug reference makes available to health care providers and the publica standard, comprehensive, up to date look up and downloadable resource aboutmedicines?a.AmericanDrugIndexb.AmericanHospitalFormularyc.DailyMedd.Physicians’DeskReference(PDR)ANS: CDailyMed makes available to health care providers and the public a standard,comprehensive, up to date look up and downloadable resource about medicines.TheAmerican Drug Indexis not appropriate for patient use. TheAmerican HospitalFormularyis not appropriate for patient use. ThePDRis not appropriate for patientuse.DIF: Cognitive Level: Knowledge REF: p. 4 OBJ: 5TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Physiological Integrity6.Which legislation authorizes the FDA to determine the safety of a drug before itsmarketing?a.FederalFood,Drug,andCosmeticAct(1938)b.DurhamHumphreyAmendment(1952)c.ControlledSubstancesAct(1970)d.KefauverHarrisDrugAmendment(1962)ANS: AThe Federal Food, Drug, and Cosmetic Act of 1938 authorized the FDA to determinethe safety of all drugs before marketing. Later amendments and acts helped tightenFDA control and ensure drug safety. The Durham Humphrey Amendment defines thekinds of drugs that cannot be used safely without medical supervision and restrictstheir sale to prescription by a licensed practitioner. The Controlled Substances Actaddresses only controlled substances and their categorization. The Kefauver HarrisDrug Amendment ensures drug efficacy and greater drug safety. Drug manufacturers

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are required to prove to the FDA the effectiveness of their products before marketingthem.DIF: Cognitive Level: Knowledge REF: p. 4 OBJ: 8TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity7.Meperidine (Demerol) is a narcotic with a high potential for physical andpsychological dependency. Under which classification does this drug fall?a.Ib.IIc.IIId.IVANS: BMeperidine (Demerol) is a Schedule II drug; it has a high potential for abuse and maylead to severe psychological and physical dependence. Schedule I drugs have highpotential for abuse and no recognized medical use. Schedule III drugs have somepotential for abuse. Use may lead to low to moderate physical dependence or highpsychological dependence. Schedule IV drugs have low potential for abuse. Use maylead to limited physical or psychological dependence.DIF: Cognitive Level: Comprehension REF: p. 4 | p. 5 OBJ: 7TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Safe, Effective Care Environment8.What would the FDA do to expedite drug development and approval for anoutbreak of smallpox, for which there is no known treatment?a.Listsmallpoxasahealthorphandisease.b.Omitthepreclinicalresearchphase.c.Extendtheclinicalresearchphase.d.Fasttracktheinvestigationaldrug.ANS: DOnce the Investigational New Drug Application has been approved, the drug canreceive highest priority within the agency, which is called fast tracking. A smallpoxoutbreak would become a priority concern in the world. Orphan diseases are notresearched in a priority manner. Preclinical research is not omitted. Extending any

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phase of the research would mean a longer time to develop a vaccine. The FDA mustensure that all phases of the preclinical and clinical research phase have beencompleted in a safe manner.DIF: Cognitive Level: Knowledge REF: p. 7 OBJ: 8TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Safe, Effective Care Environment9.Which statement is true about over the counter (OTC) drugs?a.TheyarenotlistedintheUSPNF.b.Aprescriptionfromahealthcareproviderisneeded.c.Theyaresoldwithoutaprescription.d.Theyareknownonlybytheirbrandnames.ANS: COTC medications do not require a prescription. A variety of names, both generic andtrade, can be used for individual drugs sold OTC. OTC drugs are listed in theUSPNF. Prescription drugs require an order by a health professional who is licensed toprescribe, such as a physician, nurse practitioner, physician assistant, or dentist.DIF: Cognitive Level: Comprehension REF: p. 2 OBJ: 2TOP: Nursing Process Step: PlanningMSC: NCLEX Client Needs Category: Physiological Integrity10.Which is the most authoritative reference for medications that are injected?a.Physician’sDeskReferenceb.HandbookonInjectableDrugsc.DailyMedd.HandbookofNonprescriptionDrugsANS: BTheHandbook on Injectable Drugsis the most comprehensive reference available onthe topic of compatibility of injectable drugs. It is a collection of monographs formore than300 injectable drugs that are listed alphabetically by generic name.DIF: Cognitive Level: Comprehension REF: p. 3 OBJ: 4TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity

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11.The nurse is administering Lomotil, a Schedule V drug. Which statement is trueabout thisdrug’sclassification?a.Abusepotentialforthisdrugislow.b.Psychologicaldependencyislikely.c.Thereisahighpotentialforabuse.d.Thisdrugisnotacontrolledsubstance.ANS: ALomotil, a Schedule V drug, has an abuse potential of limited physical orpsychological dependence liability compared with drugs in Schedule IV. Becauseabuse potential is low with a Schedule V drug, a prescription may not be required.Psychological dependency is not likely with a Schedule V drug. Schedule V drugs areclassified as controlled substances.DIF: Cognitive Level: Knowledge REF: p. 5 OBJ: 7TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity12.The nurse is transcribing new orders written for a patient with a substance abusehistory. Choose the medication ordered that has the greatest risk for abuse.a.Lomotilb.Diazepamc.Phenobarbitald.LortabANS: DLortab is a Schedule III drug with a high potential for abuse but less so than drugs inSchedules I and II. Lomotil is a Schedule V drug with a low potential for abusecompared with those in Schedule V. Diazepam is a Schedule IV drug with a lowpotential for abuse compared with those in schedule III. Phenobarbital is a ScheduleIV drug with a low potential for abuse compared with those in Schedule III.DIF: Cognitive Level: Application REF: pp. 4-5 OBJ: 7TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological IntegrityMULTIPLE RESPONSE

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13.The nurse is caring for a patient newly diagnosed with type 1 diabetes mellitus.Which approach(es) to therapeutic methods would be considered in thispatient’streatment?(Select all that apply.)a.Therapeuticdrugsb.Concentratedcarbohydratedietc.Familycenteredcared.Regulardailyexerciseandactivitye.DailybathsANS: A, B, DTherapeutic methods include drug therapy, diet therapy, physiotherapy, andpsychological therapy. Therapeutic methods do not include family centered care ordaily baths.DIF: Cognitive Level: Application REF: p. 1 OBJ: 1TOP: Nursing Process Step: PlanningMSC: NCLEX Client Needs Category: Physiological Integrity14.An older adult experiencing shortness of breath is brought to the hospital by herdaughter. While obtaining the medication history from the patient and her daughter,the nurse discovers that neither has a list of thepatient’scurrent medications orprescriptions. All the patient has is a weekly pill dispenser that contains four differentpills. The prescriptions are filled through the local pharmacy. Which resource(s)would be appropriate to use in determining the medication names and doses?(Selectall that apply.)a.Martindale—TheCompleteDrugReferenceb.Physicians’DeskReference,Section4c.Seniorcitizens’centerd.Patient’shomepharmacyANS: B, DThePhysicians’Desk Reference,Section 4, has full color images of commonlydispensed tablets and capsules. Thepatient’spharmacy would have an accurateaccount of all the medications the client is currently taking.Martindale—TheComplete Drug Referencehas written information on medications and would not be

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an appropriate resource. The seniorcitizens’center is not likely to have specificpatient medication information.DIF: Cognitive Level: Application REF: p. 3 OBJ: 3 | 4TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity15.The nurse planning patient teaching regarding drug names would include whichstatement(s)?(Select all that apply.)a.Mostdrugcompaniesplacetheirproductsonthemarketundergenericnames.b.TheofficialnameisthenameunderwhichthedrugislistedbytheU.S.FoodandDrugAdministration(FDA).c.Brandnamesareeasiertopronounce,spell,andremember.d.Thefirstletterofthegenericnameisnotcapitalized.e.Thechemicalnameismostmeaningfultothepatient.ANS: B, C, DThe official name is the name under which the drug is listed by the FDA. Brandnames are easier to pronounce, spell, and remember. The first letter of the genericname is not capitalized. Most drug companies place their products on the marketunder brand names instead of generic names. The chemical name is most meaningfulto the chemist.DIF: Cognitive Level: Application REF: p. 1 OBJ: 2TOP: Nursing Process Step: PlanningMSC: NCLEX Client Needs Category: Physiological Integrity16.When categorizing, the nurse is aware that which drug(s) would be consideredSchedule II?(Select all that apply.)a.Marijuanab.Percodanc.Amphetaminesd.Fiorinale.FlurazepamANS: B, CSchedule II drugs have a high potential for abuse, they are currently accepted in theUnited States, and use may lead to severe psychological or physical dependence.

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Percodan and amphetamines are considered Schedule II drugs. Marijuana is aSchedule I drug. Fiorinal is a Schedule III drug. Flurazepam is a Schedule IV drug.DIF: Cognitive Level: Analysis REF: pp. 4-5 OBJ: 7TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological IntegrityChapter 2: Basic Principles of Drug Action andDrug InteractionsChapter 2: Basic Principles of Drug Action and Drug InteractionsTest BankMULTIPLE CHOICE1.The nurse assesses hives in a patient started on a new medication. What is thenurse’spriority action?a.Notifyphysicianofallergicreaction.b.Notifyphysicianofidiosyncraticreaction.c.Notifyphysicianofpotentialteratogenicity.d.Notifyphysicianofpotentialtolerance.ANS: AAn allergic reaction is indicative of hypersensitivity and manifests with hives and/orurticaria, which are easily identified. An idiosyncratic reaction occurs whensomething unusual or abnormal happens when a drug is first administered. Ateratogenic reaction refers to the occurrence of birth defects related to administrationof the drug. Tolerance refers to thebody’srequirement for increasing dosages toachieve the same effects that a lower dose once did.DIF: Cognitive Level: Application REF: p. 17 OBJ: 7TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity2.The nurse administers an initial dose of a steroid to a patient with asthma. Thirtyminutes after administration, the nurse finds the patient agitated and stating that“everyoneis out to getme.”What is the term for this unusual reaction?a.Desiredactionb.Adverseeffectc.Idiosyncraticreaction

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d.AllergicreactionANS: CIdiosyncratic reactions are unusual, abnormal reactions that occur when a drug is firstadministered. Patients typically exhibit an overresponsiveness to a medication relatedto diminished metabolism. These reactions are believed to be related to geneticenzyme deficiencies. Desired actions are expected responses to a medication. Adverseeffects are reactions that occur in another system of the body; they are usuallypredictable. Allergic reactions appear after repeated medication dosages.DIF: Cognitive Level: Comprehension REF: p. 17 OBJ: 7TOP: Nursing Process Step: EvaluationMSC: NCLEX Client Needs Category: Physiological Integrity3.Which is the best description of when drug interactions occur?a.Onadministrationoftoxicdosagesofadrugb.Onanincreaseinthepharmacodynamicsofbounddrugsc.Onthealterationoftheeffectofonedrugbyanotherdrugd.OnincreaseofdrugexcretionANS: CDrug interactions may be characterized by an increase or decrease in the effectivenessof one or both of the drugs. Toxicity of one drug may or may not affect themetabolism of another one. Drug interactions may result from either increased ordecreased pharmacodynamics. Drug interactions may result from either increased ordecreased excretion.DIF: Cognitive Level: Comprehension REF: p. 17 OBJ: 8TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity4.What occurs when two drugs compete for the same receptor site, resulting inincreased activity of the first drug?a.Desiredactionb.Synergisticeffectc.Carcinogenicityd.DisplacementANS: D

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The displacement of the first drug from receptor sites by a second drug increases theamount of the first drug because more unbound drug is available. An expectedresponse of a drug is the desired action. A synergistic effect is the effect of two drugsbeing greater than the effect of each chemical individually, or the sum of theindividual effects. Carcinogenicity is the ability of a drug to cause cells to mutate andbecome cancerous.DIF: Cognitive Level: Comprehension REF: p. 17 OBJ: 9TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Physiological Integrity5.What do drug blood levels indicate?a.Theyconfirmifthepatientistakingagenericformofadrug.b.Theydetermineifthepatienthassufficientbodyfattometabolizethedrug.c.Theyverifyifthepatientistakingsomeoneelse’smedications.d.Theydetermineiftheamountofdruginthebodyisinatherapeuticrange.ANS: DThe amount of drug present may vary over time and the blood level must remain in atherapeutic range in order to obtain the desired result. Generic drugs do notnecessarily produce a different drug blood level than proprietary medications. Bodyfat is not measured by drug blood levels. Drug blood levels only measure the amountof drug in the body; they do not determine the source of the medication.DIF: Cognitive Level: Comprehension REF: p. 16 OBJ: 7TOP: Nursing Process Step: EvaluationMSC: NCLEX Client Needs Category: Physiological Integrity6.What is the process by which a drug is transported by circulating body fluids toreceptor sites?a.Osmosisb.Distributionc.Absorptiond.BiotransformationANS: BDistribution refers to the ways in which drugs are transported by the circulating bodyfluids to the sites of action (receptors), metabolism, and excretion. Osmosis is the

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process of moving solution across a semipermeable membrane to equalize the dilutionon each side. Absorption is the process by which a drug is transferred from its site ofentry into the body to the circulating fluids for distribution. Biotransformation, alsocalled metabolism, is the process by which the body inactivates drugs.DIF: Cognitive Level: Comprehension REF: p. 13 OBJ: 4TOP: Nursing Process Step: PlanningMSC: NCLEX Client Needs Category: Physiological Integrity7.The nurse assesses which blood level to determine the amount of circulatingmedication in a patient?a.Peakb.Troughc.Drugd.TherapeuticANS: CWhen a drug is circulating in the blood, a blood sample may be drawn and assayed todetermine the amount of drug present; this is known as the drug blood level. Peaklevels are only those drug blood levels that are at their maximum before metabolismstarts to decrease the amount of circulating drug. Trough levels are only those drugblood levels that are at their minimum when metabolism has decreased the amount ofcirculating drug and before an increase caused by a subsequent dose of themedication. Therapeutic levels are only those within a prescribed range of bloodlevels determined to bring about effective action of the medication.DIF: Cognitive Level: Comprehension REF: p. 16 OBJ: 7TOP: Nursing Process Step: EvaluationMSC: NCLEX Client Needs Category: Physiological Integrity8.The nurse administers 50 mg of a drug at 6:00 AM that has a half life of 8 hours.What time will it be when 25 mg of the drug has been eliminated from the body?a.8:00AMb.11:00AMc.2:00PMd.6:00PMANS: C

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Fifty percent of the medication, or 25 mg, will be eliminated in 8 hours, or at 2:00PM.8:00 AM is 2 hours after administration; the half life is 8 hours. 11:00 AM is 4 hoursafter administration; the half life is 8 hours. 6:00PMis 12 hours after administration;the half life is 8 hours.DIF: Cognitive Level: Analysis REF: p. 14 OBJ: 6TOP: Nursing Process Step: EvaluationMSC: NCLEX Client Needs Category: Physiological Integrity9.What will the nurse need to determine first in order to mix two drugs in the samesyringe?a.Absorptionrateofthedrugsb.Compatibilityofthedrugsc.Drugbloodlevelofeachdrugd.MedicationadverseeffectsANS: BKnowledge of absorption is important but not in order to mix drugs. In order to mixtwo drugs, compatibility is determined so there is no deterioration when the drugs aremixed in the same syringe. Drug level does not indicate if it is acceptable to mixmedications in the same syringe. Adverse effects are important for the nurse to know,but not in order to mix drugs.DIF: Cognitive Level: Application REF: p. 18 OBJ: 9TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Physiological Integrity10.A patient developed hives and itching after receiving a drug for the first time.Which instruction by the nurse is accurate?a.Stopthemedicationandencouragethepatienttowearamedicalalertbraceletthatexplainsallergy.b.Explaintothepatientthatthesearesignsandsymptomsofananaphylacticreaction.c.Emphasizetothepatienttheimportancetoinformmedicalpersonnelthatinthefuturealowdosageofthisdrugisnecessary.d.Instructthepatientthatitwouldbesafetotakethedrugagainbecausethisinstancewasamreaction.ANS: A

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This initial allergic reaction is mild, and the patient is more likely to have ananaphylactic reaction at the next exposure; a medical alert bracelet is necessary toexplain the reaction. Signs and symptoms of an anaphylactic reaction are respiratorydistress and cardiovascular collapse. A more severe reaction will occur at the nextexposure, and the patient should not receive the drug again.DIF: Cognitive Level: Application REF: p. 17 OBJ: 7TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Physiological Integrity11.When obtaining apatient’shealth history, which assessment data would the nurseidentify as having the most effect on drug metabolism?a.Historyofliverdiseaseb.Intakeofavegetariandietc.Sedentarylifestyled.TeacherasanoccupationANS: ALiver enzyme systems are the primary site for metabolism of drugs. Intake of avegetarian diet may affect absorption but not metabolism. Sedentary lifestyle andoccupations could affect metabolism (exposure to environmental pollutants), but thesedo not have the most significant effect on metabolism.DIF: Cognitive Level: Application REF: p. 14 OBJ: 5TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity12.Aphysician’sorder indicates to administer a medication to the patient via thepercutaneous route. The nurse can anticipate that the patient will receive thismedication:a.intramuscularly.b.subcutaneously.c.topically.d.rectally.ANS: CThe percutaneous route refers to drugs that are absorbed through the skin and mucousmembranes. Methods of the percutaneous route include inhalation, sublingual (under

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the tongue), or topical (on the skin) administration. The parenteral route bypasses thegastrointestinal (GI) tract by using subcutaneous (subcut), intramuscular (IM), orintravenous (IV) injection. The parenteral route bypasses the GI tract by using subcut,IM, or IV injection. In the enteral route, the drug is administered directly into the GItract by the oral, rectal, or nasogastric route.DIF: Cognitive Level: Application REF: p. 12 OBJ: 1TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Physiological Integrity13.A nurse is preparing to administer tetracycline to a patient diagnosed with aninfection. Which medication should not be administered with tetracycline?a.Ativanb.Tylenolc.Colaced.MylantaANS: DAdministering tetracycline with Mylanta can provide an antagonistic effect that willresult in decreased absorption of the tetracycline. Ativan, Tylenol, and Colace are notcontraindicated to administer with tetracycline.DIF: Cognitive Level: Application REF: p. 18 OBJ: 9TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Physiological IntegrityMULTIPLE RESPONSE14.Which statement(s) about liberation of drugs is/are true?(Select all that apply.)a.Adrugmustbedissolvedinbodyfluidsbeforeitcanbeabsorbedintobodytissues.b.AsoliddrugtakenorallymustdisintegrateanddissolveinGIfluidstoallowforabsorptionthebloodstreamfortransporttothesiteofaction.c.Theprocessofconvertingthedrugintoasolubleformcanbecontrolledtoacertaindegreedosageform.d.Convertingthedrugtoasolubleformcanbeinfluencedbyadministeringthedrugwithorwfoodinthepatient’sstomach.e.Elixirstakelongertobeliberatedfromthedosageform.ANS: A, B, C, D

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Regardless of the route of administration, a drug must be dissolved in body fluidsbefore it can be absorbed into body tissues. Before a solid drug taken orally can beabsorbed into the bloodstream for transport to the site of action, it must disintegrateand dissolve in the GI fluids and be transported across the stomach or intestinal lininginto the blood. The process of converting a drug into a soluble form can be partiallycontrolled by the pharmaceutical dosage form used (e.g., solution, suspension,capsules, and tablets with various coatings). The conversion process can also beinfluenced by administering the drug with or without food in thepatient’sstomach.Elixirs are already drugs dissolved in a liquid and do not need to be liberated from thedosage form.DIF: Cognitive Level: Comprehension REF: p. 13 OBJ: 3TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Physiological Integrity15.Which are routes of drug excretion?(Select all that apply.)a.GItract;fecesb.Genitourinary(GU)tract;urinec.Lymphaticsystemd.Circulatorysystem;blood/plasmae.Respiratorysystem;exhalationANS: A, B, EThe GI system is a primary route for drug excretion. The GU and the respiratorysystems do function in the excretion of drugs. The lymphatic and circulatory systemsare involved with drug distribution, not drug excretion.DIF: Cognitive Level: Knowledge REF: p. 14 OBJ: 5TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity16.Which route(s) enable(s) drug absorption more rapidly than the subcutroute?(Select all that apply.)a.IVrouteb.IMroutec.Inhalation/sublinguald.Intradermalroute

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e.EnteralrouteANS: A, B, CIV route of administration enables drug absorption more rapidly than the subcut route.IM route of administration enables drug absorption more rapidly because of greaterblood flow per unit weight of muscle. Inhalation/sublingual route of administrationenables drug absorption more rapidly than the subcut route. Intradermallyadministered drugs are absorbed more slowly because of the limited available bloodsupply in the dermis. Enterally administered drugs are absorbed more slowly becauseof the biotransformation process.DIF: Cognitive Level: Comprehension REF: p. 13 OBJ: 1TOP: Nursing Process Step: EvaluationMSC: NCLEX Client Needs Category: Physiological Integrity17.The nurse recognizes that which factor(s) would contribute to digoxin toxicity in a92-year-old patient?(Select all that apply.)a.Takingthemedicationwithmealsb.Prolongedhalflifeofthedrugdigoxinc.Impairedrenalfunctiond.DiminishedmentalcapacityANS: B, CImpaired renal and hepatic function in older adults impairs metabolism and excretionof drugs, thus prolonging the half life of a medication. Food would decrease theabsorption of the drug. Diminished mental capacity does not contribute to drugtoxicity unless it is due to administration errors.DIF: Cognitive Level: Application REF: p. 14 OBJ: 5 | 6TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Health Promotion and Maintenance18.Which statement(s) about variables that influence drug action is/are true?(Selectall that apply.)a.Anolderadultwillrequireincreaseddosageofadrugtoachievethesametherapeuticeffecseeninayoungerperson.b.Bodyweightcanaffectthetherapeuticresponseofamedication.c.Chronicsmokersmaymetabolizedrugsmorerapidlythannonsmokers.d.Apatient’sattitudeandexpectationsaffecttheresponsetomedication.

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e.Reducedcirculationcausesdrugstoabsorbmorerapidly.ANS: B, C, DBody weight can affect response to medications; typically, obese patients require anincrease in dosage and underweight patients a decrease in dosage. Chronic smokingenhances metabolism of drugs. Attitudes and expectations play a major role in anindividual’sresponse to drugs. Older adults require decreased dosages of drugs toachieve a therapeutic effect. Decreased circulation causes drugs to absorb moreslowly.DIF: Cognitive Level: Comprehension REF: p. 13 OBJ: N/ATOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Physiological Integrity19.Which factor(s) affect(s) drug actions?(Select all that apply.)a.Teratogenicityb.Agec.Bodyweightd.Metabolicratee.IllnessANS: B, C, D, EAge, body weight, metabolic rate, and illness may contribute to a variable response toa medication. Teratogenicity does not contribute to a variable response to amedication.DIF: Cognitive Level: Comprehension REF: p. 14 OBJ: N/ATOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological IntegrityOTHER20.A patient receives 200 mg of a medication that has a half life of 12 hours. Howmany mg of the drug would remain in thepatient’safter 24 hours?ANS:50The half life is defined as the amount of time required for 50% of the drug to beeliminated from the body. If a patient is given 200 mg of a drug that has a half life of12 hours, then 50 mg of the drug would remain in the body after 24 hours.DIF: Cognitive Level: Analysis REF: p. 14 OBJ: 6

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TOP: Nursing Process Step: EvaluationMSC: NCLEX Client Needs Category: Physiological IntegrityChapter 3: Drug Action Across the Life SpanChapter 3: Drug Action Across the Life SpanTest BankMULTIPLE CHOICE1.What time will the trough blood level need to be drawn if the nurse administers theintravenous medication dose at 9:00 AM?a.6:30AMb.8:30AMc.9:30AMd.11:30AMANS: BTrough blood levels measure the lowest blood level of medicine and are obtained justbefore the dose is administered. In this case, 6:30 AM is too early to obtain the bloodlevel. The other two times occur after the medication is administered.DIF: Cognitive Level: Application REF: p. 26 OBJ: 3TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Physiological Integrity2.What will the nurse expect the health careprovider’sorder to be when starting anolder adult patient on thyroid hormone replacement therapy?a.Administeringaloadingdoseofthedrugb.Directionsonhowtotaperthedrugc.Adosagethatisonethirdtoonehalfoftheregulardosaged.AdosagethatisdoubletheregulardosageANS: CTo prevent toxicity, dosages for new medications in older adults should be one thirdto one half the amount of a standard adult dosage. Loading doses of drugs could causesevere toxicity. Tapering off is characteristic of discontinuation of medications and isnot appropriate for this situation. Older adults generally need a lower medicationdosage than younger patients.DIF: Cognitive Level: Application REF: p. 29 OBJ: 3

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TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Physiological Integrity3.Which drugs cause birth defects?a.Teratogensb.Carcinogensc.Metabolitesd.PlacebosANS: ATeratogens are drugs that cause birth defects. Carcinogens cause cancer. Metabolitesare the end product of metabolism. Placebos are drugs that have no pharmacologicactivity.DIF: Cognitive Level: Knowledge REF: p. 30 OBJ: 6TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity4.Which life threatening illness may occur as a result of aspirin (salicylate)administration during viral illness to patients younger than 20 years of age?a.Anaphylacticshockb.Reye’ssyndromec.Chickenpoxd.InfluenzaAANS: BChildren are susceptible toReye’ssyndrome if they ingest aspirin at the time of orshortly after a viral infection of chickenpox or influenza. Anaphylactic shock iscaused by a hypersensitivity reaction. Chickenpox is the result of being infected witha virus. Influenza A is caused by a pathogen.DIF: Cognitive Level: Knowledge REF: pp. 27-28 OBJ: 3TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Physiological Integrity5.Which classification of medications commonly causes allergic reactions inchildren?a.Antacidsb.Analgesics

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c.Antibioticsd.AnticonvulsantsANS: CAntibiotics, especially penicillins, commonly cause allergic reactions in children.Intravenous antibiotics can cause rapid reactions; therefore, the pediatricpatient’sresponse to a medication should be assessed and monitored closely. Antacids rarelycause allergic reactions. Children are not particularly allergic to analgesics oranticonvulsants.DIF: Cognitive Level: Knowledge REF: p. 28 OBJ: 3TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity6.After giving instructions to an expectant mother about taking medications duringpregnancy, which patient statement indicates the need for further teaching?a.“Iwillnottakeherbalmedicinesduringpregnancy.”b.“Formorningsickness,Iwilltrycrackersinsteadoftakingadrug.”c.“IfIgetacold,IwillavoidtakingnonprescriptionmedicationsuntilIcheckwithmyphysicd.“Iwilllimitmyalcoholintaketoonlyoneglassofwineweekly.”ANS: DAlcohol needs to be eliminated during pregnancy and for 2 to 3 months prior toconception. Limited studies are available regarding the use of herbal medications ingeneral, and thus they should be avoided during pregnancy. Alternativenonpharmacologic treatments are appropriate to use during morning sickness. Thepregnant woman should also avoid using nonprescription drugs because few data areavailable about safe use in pregnancy. Because few medicines can be consideredcompletely safe for use in pregnancy, the physician needs to approve and recommendthe use of nonprescription drugs.DIF: Cognitive Level: Application REF: p. 30 OBJ: 6TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Health Promotion and Maintenance7.When is the ideal time for a nursing mother to take her own medications?a.Beforetheinfantlatchesontobegintobreastfeedb.Assoonasthemotherwakesupinthemorning

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c.Rightbeforethemothergoestosleepatnightd.AssoonastheinfantfinishesbreastfeedingANS: DTaking medications after breastfeeding reduces the amount of the medication that willreach the baby. Medications taken directly before breastfeeding may have a highconcentration in the milk and possibly pass on to the baby. The mother must take intoconsideration when her medications are ordered to be taken, and schedule themaround breastfeeding.DIF: Cognitive Level: Comprehension REF: p. 31 OBJ: 6TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Health Promotion and Maintenance8.Which age-related change would affect transdermal drug absorption in geriatricpatients the most?a.Difficultyswallowingb.Diminishedkidneyfunctionc.Changesinpigmentationd.AlteredcirculatorystatusANS: DThe decreased circulation that occurs with aging will affect transdermal drugabsorption. Difficulty swallowing would not affect transdermal drugs being absorbed.Kidney function affects drug excretion. Changes in pigmentation would not affecttransdermal drug absorption.DIF: Cognitive Level: Application REF: p. 22 OBJ: 3TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity9.Which intervention would be considered to reduce accumulation of a drug in apatient who has decreased liver function?a.Decreasingthetimeintervalbetweendosagesb.Reducingthedosagec.Administeringthemedicationintravenouslyd.ChangingthedrugtoonethathasalongerhalflifeANS: B

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Dosages must be reduced to prevent accumulation. Decreasing the time intervalbetween dosages would increase the accumulation of the drug. The intravenous routehas the fastest absorption and with liver dysfunction would increase the accumulationof the drug. A similar drug with a longer half life would stay in the system longer;with impaired liver function, the result would be increased accumulation.DIF: Cognitive Level: Comprehension REF: p. 24 OBJ: 3TOP: Nursing Process Step: PlanningMSC: NCLEX Client Needs Category: Physiological Integrity10.The nurse is teaching an elderly patient with difficulty swallowing about hismedications. Which explanation by the nurse is most helpful?a.“Entericcoatedtabletscanbecrushedandtakenwithapplesauce.”b.“Tabletsthatarescoredcanbebrokeninhalf.”c.“Medicationslabeled‘SR’canbecrushed.”d.“Avoidtakingmedicationsinliquidform.”ANS: BIt is acceptable to break scored tablets in half to facilitate swallowing of themedication. Enteric coated tables should never be crushed because of the effect on theabsorption rate and potential for toxicity. Medications labeled“SR”indicate“sustainedrelease”and should not be crushed because of the effect on the absorptionrate. Medication in liquid form may be easier to swallow.DIF: Cognitive Level: Application REF: p. 29 OBJ: 3TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Health Promotion and Maintenance11.The nurse is administering an antibiotic intravenously. Which blood leveldetermines the lowest amount of medication present in the patient?a.Peakb.Serumc.Therapeuticd.TroughANS: D

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The lowest amount of a medication in the blood is the trough. The peak is the highestamount of medication in the blood. Serum level identifies the amount of medicationpresent. Therapeutic levels identify the range in which a medication is effective.DIF: Cognitive Level: Knowledge REF: p. 26 OBJ: noneTOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity12.Which patient would the nurse identify as having the lowest rate of absorption ofenteral medications?a.A5-year-oldboyb.An18-year-oldwomanc.A55-year-oldmand.An85-year-oldwomanANS: AMales’stomachs empty more rapidly; children have increased motility, resulting indecreased absorption time. As one gets older, gastrointestinal (GI) motility isdecreased, allowing for increased absorption time; women have slower gastricemptying, resulting in more time for absorption.Males’stomachs empty morerapidly; however, as one gets older, GI motility is decreased, resulting in an increasein absorption time. As one gets older, GI motility is decreased, allowing for increasedabsorption time; women have slower gastric emptying, resulting in more time forabsorption.DIF: Cognitive Level: Application REF: pp. 20-21 OBJ: 3 | 4TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity13.What is the definition of cumulative effect of a drug?a.Drugtoxicityrelatedtoovermedicationb.Drugbuilduprelatedtodecreasedmetabolismc.Theinabilitytocontroltheingestionofdrugsd.TheneedforhigherdosagetoproducethesameeffectaspreviouslowerdosagesANS: BCumulative effects are related to diminished metabolism or excretion of a drug thatcauses it to accumulate. Cumulative effects can lead to drug toxicity. Toxicity occurs

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when adverse effects are severe. Inability to control the ingestion of drugs is drugdependence. The need for higher dosage to produce the same effect as previous lowerdosages is the definition of tolerance.DIF: Cognitive Level: Knowledge REF: p. 22 OBJ: 2TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity14.Which patient, when compared with the general population, would require a largerdose or more frequent administration of a drug to attain a therapeutic response?a.A29yearoldwhohasbeendiagnosedwithkidneyfailureb.A35yearoldobesemalewhoisbeingevaluatedforanexerciseprogramc.A52yearolddiagnosedwithhypothyroidismanddecreasedmetabolicrated.A72yearoldwithdecreasedcirculatorystatusANS: BAn obese individual would require a larger dose of a drug to attain a therapeuticresponse. An individual with kidney failure would require less medication because ofdecreased excretory ability. Individuals with decreased metabolic rate wouldmetabolize drugs more slowly and require smaller doses or less frequentadministration. Individuals with decreased circulation would require less medication.DIF: Cognitive Level: Application REF: p. 20 OBJ: 3TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity15.A resident in a long term care facility reports difficulty swallowing enteric coatedaspirin and asks the nurse to crush it prior to administration. The most appropriateaction for the nurse to take is to:a.crushthetabletandmixwithapplesauce.b.encouragetheresidenttoswallowthetabletwithafullglassofwater.c.holdthemedicationandnotifythephysician.d.substitutearegularaspirinfortheentericcoatedtablet.ANS: CThe medication should be held and the physician notified. The physician has theauthority to determine how to proceed in this situation. Enteric coated tablets shouldnot be crushed because this will increase the absorption rate and the potential for

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toxicity. Geriatric patients may have difficulty swallowing and are at risk for chokingand aspiration. They should not be encouraged to swallow medications if they reportdifficulty swallowing. The physician must determine if a substitution can be ordered.Prescribing is not in thenurse’sscope of practice.DIF: Cognitive Level: Analysis REF: p. 22 OBJ: 3TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Physiological IntegrityMULTIPLE RESPONSE16.One of the prescribed medications for a 36 week gestational age baby girl is atopical water soluble medication to be applied to the perineum daily to treat aninflammatory rash. What considerations is the nurse aware of before medicationadministration?(Select all that apply.)a.Ageoftheclientb.Locationoftopicalapplicationc.Increasedintestinaltransitrated.Conditionoftheskine.GastricpHof8ANS: A, B, DThe prematureinfant’souter layer of skin is not fully developed, although it is morehydrated, which will enhance the absorption of the topical water soluble medication.Neonates often wear diapers, which will act as an occlusive dressing, therebyincreasing absorption. Theclient’sinflammatory condition will increase theabsorption of medication. The intestinal transit rate increases as the newborn matures.This is irrelevant when a medication is applied topically. Gastric pH would not factorinto metabolism of a medication that is applied topically.DIF: Cognitive Level: Application REF: p. 20 | p. 22 OBJ: 3TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Physiological Integrity17.The nurse is caring for a 4 month old child who is on a water soluble medicationfor seizures. Thechild’smother voices concern that the dosage seems“toomuch”forthechild’sage and would like the dosage verified. What actions will the nursetake?(Select all that apply.)a.VerifydosagerequirementsinthePhysicians’DeskReference(PDR)inmg/kg.

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b.Comparethewatercompositionrequirementsofadultsandchildren.c.Evaluateleanbodymassandtotalfatcontentinadultsandinfants.d.Chart“refusedpermother”ontheMARanddonotadminister.e.ComparetransportationinthecirculationofplasmaboundproteinsbetweenadultsandchilANS: A, BThePDRlists the recommended dosages for all age groups. Because dilution mayvary among age groups, the water concentration should be verified prior toadministration. As we age, lean body mass and total body water decrease while totalfat content increases; however, this drug is not fat soluble. The nurse is responsible foradministering the medication as ordered after verifying that it is correct; the mother isasking for verification, not refusal of administration. Drugs that are relativelyinsoluble are transported in the circulation by being bound to plasma proteins;however, this drug is water soluble.DIF: Cognitive Level: Application REF: p. 27 OBJ: 3TOP: Nursing Process Step: ImplementationMSC: NCLEX Client Needs Category: Physiological Integrity18.For which reason(s) is/are elderly patients at increased risk for drug interactionsand toxicity?(Select all that apply.)a.Theyhaveahigherincidenceofmalnourishment.b.Theirrenalfunctionisenhanced.c.Theyhaveincreaseduseofmultiplemedications.d.Hepaticfunctionisreduced.e.Thereareoftenissueswithswallowing.ANS: A, C, DOlder adult patients have an increased incidence of malnourishment, are often onmultiple medications, and have reduced hepatic function, all of which puts them atincreased risk for drug interactions and toxicity. Renal function diminishes in theelderly as a result of decreased renal blood flow, reduced cardiac output, loss ofglomeruli, and diminished tubular function and concentrating ability. Older adultshave swallowing difficulties, leading to compliance issues, but taking drugs less oftenwould not result in toxicity.DIF: Cognitive Level: Comprehension REF: p. 28 OBJ: 3

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TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity19.Which patient(s) require(s) special considerations for medicationadministration?(Select all that apply.)a.A29-year-oldpregnantwomanb.A2-month-oldbabyc.An18-year-oldcollegestudentd.A45-year-oldfarmere.An82-year-oldretirednurseANS: A, B, EDrug therapy during pregnancy should be avoided. Recommendations by the providerare necessary during any stage of pregnancy. Pediatric and elderly patients areaffected by differences in muscle mass and blood flow to muscles, as well as otherphysiological systems. Teenagers and adult patients do not typically require specialconsiderations for medication administration.DIF: Cognitive Level: Application REF: pp. 20-21 OBJ: 3 | 4 | 5 | 6TOP: Nursing Process Step: PlanningMSC: NCLEX Client Needs Category: Physiological Integrity20.Which factor(s) in a patient would influence GI absorption of medications?(Selectall that apply.)a.StomachpHb.Levelofconsciousnessc.Feverd.Bloodflowtogastricmucosae.Weightf.BodysurfaceareaANS: A, DAbsorption by passive diffusion across the membranes depends on the pH of theenvironment. Increased blood flow to gastric mucosa increases absorption ofmedication and decreases time of absorption. Drug absorption does not depend on themental status of the patient. Fever does not affect drug absorption. Thepatient’sabsolute weight and body surface area do not affect drug absorption, although

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problems associated with weight greater than or less than normal may be a factor inthe process.DIF: Cognitive Level: Application REF: p. 22 OBJ: 3TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity21.When receiving a report on a new admission from the emergency room, the nurselearns that the patient is newly diagnosed with renal failure. Which medication(s) inthepatient’smedication history will require dosage adjustment by thephysician?(Select all that apply.)a.Lithiumb.Tobramycinc.Atenolold.Quinidinee.AmpicillinANS: A, B, C, D, ELithium, tobramycin, atenolol, quinidine, and ampicillin are all select medications thatrequire dosage adjustment in renal failure.DIF: Cognitive Level: Application REF: p. 26 OBJ: 3TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Physiological Integrity22.Prenatal education is being provided by the nurse at a maternal family child clinic.What information should be relayed?(Select all that apply.)a.Herbalmedicinesareconsideredsafe.b.Limittobaccoconsumptiontolessthantwocigarettesperday.c.Encourageafolicacidsupplement.d.Onealcoholicbeverageperdayisacceptableinthelasttrimester.e.Encouragenonpharmacologictreatmentsforsymptomssuchasnausea.ANS: C, EGood nutrition with appropriate ingestion of vitamins (especially folic acid) isparticularly important during pregnancy to prevent birth defects. Before usingmedicines, pregnant women should be encouraged to try nonpharmacologictreatments. Herbal medicines that have not been scientifically tested in women during

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pregnancy should be avoided. Advise against the use of tobacco. Mothers who smokehave a higher frequency of miscarriage, stillbirths, premature births, and low birthweight infants. Consumption of alcohol should be eliminated 2 to 3 months beforeplanned conception, as well as during pregnancy.DIF: Cognitive Level: Application REF: pp. 30-31 OBJ: 6TOP: Nursing Process Step: PlanningMSC: NCLEX Client Needs Category: Health Promotion and MaintenanceChapter 4: The Nursing Process andPharmacologyChapter 4: The Nursing Process and PharmacologyTest BankMULTIPLE CHOICE1.What is the primary purpose of the nursing assessment?a.Identifyingunderlyingpathologicconditionsb.Assistingthephysicianinidentifyingmedicalconditionsc.Determiningthepatient’smentalstatusd.ExploringpatientresponsestohealthproblemsANS: DA nursing assessment is done to identify thepatient’sresponse to health problems.During the nursing assessment phase, a comprehensive information base is developedthrough a physical examination, nursing history, medication history, and professionalobservation. Identifying underlying pathologic conditions and assisting the physicianin identifying medical conditions is not part of the nursing process. Determining thepatient’smental status is one part of the nursing assessment, but it is not the primarypurpose.DIF: Cognitive Level: Comprehension REF: p. 36 OBJ: 1 | 3TOP: Nursing Process Step: AssessmentMSC: NCLEX Client Needs Category: Health Promotion and Maintenance2.What is the basis of the NANDA I taxonomy?a.Functionalhealthpatternsb.Humanresponsepatternsc.Basichumanneeds

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