Pharmacology Connections To Nursing Practice 3rd Edition By Adams – Test Bank

Chapter 11

Question 1

Type: MCMA

The nurse is performing a holistic assessment on a client prior to administering antihypertensive medication. Which factors would be included in the holistic assessment?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Blood pressure
2. Belief in a higher power
3. Level of education
4. The symptoms of the hypertension only
5. Mood

Correct Answer: 1,2,3,5

Rationale 1: Holistic health care incorporates the whole client to include the biological dimension.

Rationale 2: Holistic health care incorporates the whole client to include the spiritual dimension.

Rationale 3: Holistic health care incorporates the whole client to include the sociocultural dimension.

Rationale 4: A focus solely on the symptoms of a disorder is not characteristic of the holistic model.

Rationale 5: Holistic health care incorporates the whole client to include the psychological dimension.

Global Rationale: Holistic health care incorporates the whole client to include the biological dimension, spiritual dimension, sociocultural dimension, and the psychological dimension. A focus solely on the symptoms of a disorder is not characteristic of the holistic model.

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-1 Describe the fundamental concepts underlying a holistic approach to patient care and their importance to pharmacotherapy.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number:

 

Question 2

Type: MCMA

The nurse is conducting a holistic assessment of a client diagnosed with alcoholism. Which priority questions should the nurse include in the assessment?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “Did you see your parents drink alcohol when you were growing up?”
2. “How old were you when you started drinking?”
3. “Have you ever attended Alcoholic Anonymous meetings?”
4. “Have you been treated with any medications that are designed to discourage consumption of alcohol?”
5. “Have any of your blood relatives been addicted to alcohol?”

Correct Answer: 1,2,3,5

Rationale 1: Environmental questions are valid questions to ask during a holistic assessment.

Rationale 2: This question helps to determine the length of time alcohol has been a problem for this client.

Rationale 3: Participation in Alcoholic Anonymous assesses nonpharmacologic measures the client may have pursued and is relevant to a holistic assessment.

Rationale 4: This question is asking about medical treatment, which is not holistic in nature.

Rationale 5: Biologic questions are valid questions to ask during a holistic assessment.

Global Rationale: Environmental questions are valid questions to ask during a holistic assessment. Asking the age when drinking began helps to determine the length of time alcohol has been a problem for this client. Participation in Alcoholic Anonymous assesses nonpharmacologic measures the client may have pursued and is relevant to a holistic assessment. Biologic questions are valid questions to ask during a holistic assessment. Asking about medical treatment is not holistic in nature.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-1 Describe the fundamental concepts underlying a holistic approach to patient care and their importance to pharmacotherapy.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number:

 

 

Question 3

Type: MCSA

An African-American adult client is prescribed a sulfonamide drug to treat an infection. Why would the nurse question this prescribed medication order?

1. The client has a history of a penicillin allergy.
2. The client may exhibit slow acetylation which can impact the effect of the medication.
3. The client has a history of hypertension.
4. The client may not metabolize the medication due to CYP2D6.

Correct Answer: 2

Rationale 1: A penicillin allergy would not cause the nurse question this medication order.

Rationale 2: African-American clients may not be able to metabolize this mediation effectively because of the slow acetylation that is can occur when taking sulfa based medications. This can increase the risk of toxicity. The nurse should question this medication order.

Rationale 3: A history of hypertension would not cause the nurse to question this medication order.

Rationale 4: CYP2D6 does not impact sulfa medications and would not cause the nurse to question this medication order.

Global Rationale: African-American clients may not be able to metabolize this mediation effectively because of the slow acetylation that is can occur when taking sulfa based medications. This can increase the risk of toxicity. The nurse should question this medication order. A penicillin allergy would not cause the nurse question this medication order. A history of hypertension would not cause the nurse to question this medication order. CYP2D6 does not impact sulfa medications and would not cause the nurse to question this medication order.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-6 Explain how pharmacogenomics may lead to customized drug therapy.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.

Page Number:

 

 

Question 4

Type: MCSA

A health care provider recommends chemotherapy for a client diagnosed with cancer. The client tells the nurse, “This is a punishment from God for the sins I have committed. Some of the women at my church say so.” Which intervention will best meet the client’s spiritual needs?

1. Plan to involve a hospital minister to discuss the client’s perspective about cancer.
2. Plan to meet with family members to discuss their feeling about the cancer and prognosis.
3. Plan to contact the client’s minister to make a visit.
4. Plan to bring the case before the hospital’s board of ethics.

Correct Answer: 3

Rationale 1: Involving the hospital minister might be an option, but it is best to work through the client’s minister initially.

Rationale 2: Meeting with the client’s family might help; however, this does not address the client’s spiritual needs.

Rationale 3: Strong religious beliefs can affect the outcome of illness. The nurse should involve the client’s religious leader when possible.

Rationale 4: Bringing the case before the hospital board of ethics will not meet the client’s spiritual needs.

Global Rationale: Strong religious beliefs can affect the outcome of illness. The nurse should involve the client’s religious leader when possible. Involving the hospital minister might be an option, but it is best to work through the client’s minister initially. Meeting with the client’s family might help; however, this does not address the client’s spiritual needs. Bringing the case before the hospital board of ethics will not meet the client’s spiritual needs.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes

AACN Essential Competencies: IX.18 Develop an awareness of patients as well as healthcare professionals’ spiritual beliefs and values and how those beliefs and values impact health care

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-2 Identify psychosocial and spiritual factors that can affect pharmacotherapeutics.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number:

 

Question 5

Type: MCSA

A Native American client is admitted to receive chemotherapy. At any given time, five family members are in the client’s private room. The nurse tells the client that according to hospital policy, only two visitors at a time are allowed. What is the nurse manager’s analysis of the situation?

1. The nurse should allow the client to have as many family members visiting as desired.
2. The nurse followed protocol by informing the client about hospital policy.
3. The nurse should have called the health care provider and obtained an order allowing additional family members to be present.
4. The nurse should have assessed the client’s preference about the number of family members present.

Correct Answer: 4

Rationale 1: The nurse must be realistic with regard to the number of family members the client wants present. Five family members is acceptable; 20 would be too many.

Rationale 2: The nurse should have assessed the client’s preference concerning visitors before interpreting the hospital rules so strictly.

Rationale 3: This situation can be resolved by the nurse; there is no need for a health care provider’s order at this point.

Rationale 4: Many hospital rules, such as how many visitors are allowed, are flexible, and do not have to be strictly interpreted; this client is in a private room.

Global Rationale: Many hospital rules, such as how many visitors are allowed, are flexible, and do not have to be strictly interpreted; this client is in a private room. The nurse must be realistic with regard to the number of family members the client wants present. Five family members is acceptable; 20 would be too many. The nurse should have assessed the client’s preference concerning visitors before interpreting the hospital rules so strictly. This situation can be resolved by the nurse; there is no need for a health care provider’s order at this point.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes

AACN Essential Competencies: IX.18 Develop an awareness of patients as well as healthcare professionals’ spiritual beliefs and values and how those beliefs and values impact health care

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11-2 Identify psychosocial and spiritual factors that can affect pharmacotherapeutics.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy

Page Number:

 

Question 6

Type: MCSA

A Caucasian nurse is caring for an African American client who has a history of myocardial infarction and is receiving atorvastatin (Lipitor). The nurse assesses the client’s diet to be very high in fat. Which teaching plan would be most effective at improving the client’s diet and possibly reducing the need for additional medications?

1. Plan to ask an African American nurse to speak to the client about low-fat diets.
2. Discuss the client’s diet with whoever prepares meals for the family.
3. Give the client a printout about low-fat diets specific to African Americans.
4. Ask the health care provider for a consult by dietary services so a dietician can teach the client about low-fat diets.

Correct Answer: 2

Rationale 1: This is racist and implies that a Caucasian nurse cannot understand the dietary needs of an African American client.

Rationale 2: Every culture has culture-specific diets; the nurse must include the person in the family who prepares meals if a different diet is to be successful.

Rationale 3: Providing printouts can be helpful, but the nurse must work more closely with the client to make adjustments in the diet.

Rationale 4: At this point, a consult by dietary services is premature.

Global Rationale: Every culture has culture-specific diets; the nurse must include the person in the family who prepares meals if a different diet is to be successful. Asking an African-American nurse to speak to the client implies that a Caucasian nurse cannot understand the dietary needs of an African American client. Providing printouts can be helpful, but the nurse must work more closely with the client to make adjustments in the diet. At this point, a consult by dietary services is premature.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values

AACN Essential Competencies: II.8. Promote achievement of safe and quality outcomes of care for diverse populations

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-3 Explain how ethnicity can affect pharmacotherapeutic outcomes.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy

Page Number:

 

Question 7

Type: MCSA

The nurse is caring for an Asian American client diagnosed with terminal cancer. Which factor should the nurse consider to achieve adequate pain control for the client?

1. All ethnic groups respond to medications in the same manner.
2. The only variation in drug metabolism occurs among African Americans.
3. Asians respond differently to antidepressants only.
4. Opioids are metabolized differently in individuals of Asian and Native American descent.

Correct Answer: 4

Rationale 1: Research demonstrates a biologic basis for variations or differences in metabolism response to agents among various ethnic groups.

Rationale 2: Drugs are metabolized differently by various ethnic groups.

Rationale 3: Asians respond differently to antidepressants, antidysrhythmics, and opioids.

Rationale 4: Opioids are also metabolized differently by clients of Asian descent. The nurse must understand how the drug is metabolized to ensure that the correct dose is being given.

Global Rationale: Opioids are also metabolized differently by clients of Asian descent. The nurse must understand how the drug is metabolized to ensure that the correct dose is being given. Research demonstrates a biologic basis for variations or differences in metabolism response to agents among various ethnic groups. Drugs are metabolized differently by various ethnic groups. Asians respond differently to antidepressants, antidysrhythmics, and opioids.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values

AACN Essential Competencies: II.8. Promote achievement of safe and quality outcomes of care for diverse populations

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-3 Explain how ethnicity can affect pharmacotherapeutic outcomes.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy

Page Number:

 

Question 8

Type: MCSA

An adolescent Hispanic male with attention deficit hyperactivity disorder (ADHD) is taking methylphenidate (Ritalin). The adolescent will not go to the school nurse at noon for his medication. Which statement best describes the likely result of the nurse’s assessment?

1. The adolescent really does not need an additional dose of methylphenidate (Ritalin) at school.
2. The adolescent is embarrassed about having to take medicine at school; it is a social stigma.
3. The adolescent is fearful that this drug might be a “gateway drug” and he will abuse other substances.
4. The adolescent has developed alternative coping mechanisms to increase his focus during classes.

Correct Answer: 2

Rationale 1: Methylphenidate (Ritalin) is a short-acting drug, and doses must be administered about 4 hours apart, so the client must receive a dose during school hours.

Rationale 2: Some clients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Clients can also perceive this as a social stigma.

Rationale 3: Appropriate treatment of ADHD will result in less addiction, not more addiction, to mood-altering substances.

Rationale 4: ADHD is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms do not usually help to increase focus.

Global Rationale: Some clients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Clients can also perceive this as a social stigma. Methylphenidate (Ritalin) is a short-acting drug, and doses must be administered about 4 hours apart, so the client must receive a dose during school hours. Appropriate treatment of ADHD will result in less addiction, not more addiction, to mood-altering substances. ADHD is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms do not usually help to increase focus.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values

AACN Essential Competencies: II.8. Promote achievement of safe and quality outcomes of care for diverse populations

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-4 Identify examples of how cultural values and beliefs can influence pharmacotherapeutic outcomes.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy

Page Number:

 

 

Question 9

Type: MCSA

A woman from an Arab culture is in labor and delivery. Her husband insists he must stay with her and will not allow her to receive any analgesia. Which action by the nurse is the most appropriate?

1. Inform the husband that he must sign a release of responsibility to avoid future litigation against the hospital.
2. Allow this request, and be available in the event the request changes.
3. Inform the husband that it is his wife’s choice whether to receive analgesia.
4. Allow the request, but inform the husband that the primary health care provider will make the final decision regarding analgesia.

Correct Answer: 2

Rationale 1: When cultural differences are allowed and supported, clients are not as likely to initiate litigation.

Rationale 2: Nurses must allow and support cultural differences. The husband’s decisions must be respected as long as the client’s safety is not jeopardized.

Rationale 3: In some cultures, the husband, not the wife, makes the choices for health care.

Rationale 4: In some cultures, the husband, not the primary health care provider, makes the health care decisions.

Global Rationale: Nurses must allow and support cultural differences. The husband’s decisions must be respected as long as the client’s safety is not jeopardized. When cultural differences are allowed and supported, clients are not as likely to initiate litigation. In some cultures, the husband, not the wife, makes the choices for health care. In some cultures, the husband, not the primary health care provider, makes the health care decisions.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values

AACN Essential Competencies: II.8. Promote achievement of safe and quality outcomes of care for diverse populations

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-4 Identify examples of how cultural values and beliefs can influence pharmacotherapeutic outcomes.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy

Page Number:

 

 

 

Question 10

Type: MCSA

The nurse is providing education about warfarin (Coumadin) to a group of Asian American and African American clients who have experienced strokes. The nurse determines that learning has occurred when the clients make which statement?

1. “We might need to have more frequent blood tests.”
2. “We might need less medication than other ethnic groups.”
3. “We might need to have less frequent blood tests.”
4. “We might need more medication than other ethnic groups.”

Correct Answer: 2

Rationale 1: There is no need for Asian American and African American clients to have more frequent blood tests if their dosage is regulated based on their reduced metabolism of the drug.

Rationale 2: Asian Americans and African Americans have reduced metabolism rates of warfarin (Coumadin), so they often require lower doses to prevent toxicity.

Rationale 3: As they have a reduced metabolism rate of warfarin, reduced blood tests would not be appropriate.

Rationale 4: They would need less medication, not more, related to their reduced metabolism rate of the drug.

Global Rationale: Asian Americans and African Americans have reduced metabolism rates of warfarin (Coumadin), so they often require lower doses to prevent toxicity. There is no need for Asian American and African American clients to have more frequent blood tests if their dosage is regulated based on their reduced metabolism of the drug. As they have a reduced metabolism rate of warfarin, reduced blood tests would not be appropriate. They would need less medication, not more, related to their reduced metabolism rate of the drug.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11-5 Convey how genetic polymorphisms can influence pharmacotherapy.

MNL Learning Outcome: 1.1.1 Apply basic concepts related to pharmacology.