Pharmacology For Nurses A Pathophysiologic Approach 5th Edition By Michael Patrick Adams – Test bank

Chapter 11
Question 1
Type: MCMA
The nurse is teaching the importance of drugs for emergency preparedness to local firemen. The nurse determines that learning has occurred when the firemen make which statements?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. “The vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours.”
2. “Our local hospital is supposed to be stockpiling antibiotics.”
3. “The push package can reach any community within 12 hours of an attack.”
4. “The Strategic National Stockpile is located at the Centers for Disease Control and Prevention (CDC) in Atlanta.”
5. “Our country’s drug stockpile is managed by the Centers for Disease Control and Prevention (CDC).”
Correct Answer: 1,3,5
Rationale 1: The vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours.
Rationale 2: Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics.
Rationale 3: The push package can reach any community within 12 hours of an attack.
Rationale 4: The Strategic National Stockpile is located at various sites throughout the country.
Rationale 5: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC).
Global Rationale: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country.

Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacologic and Parenteral Therapies
QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.
AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.
NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 11-3 Identify the purpose and components of the Strategic National Stockpile (SNS).
MNL Learning Outcome:
Page Number: 116

Question 2
Type: MCMA
The nurse works for the Centers for Disease Control and Prevention (CDC). In planning for a bioterrorist attack, what will the best plan of the nurse include?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Learn the signs and symptoms of chemical and biological agents.
2. Obtain a listing of health and law enforcement contacts.
3. Assist in the stockpiling of medications.
4. Obtain current knowledge of emergency management.
5. Assist in triage at local hospitals.
Correct Answer: 1,2,4
Rationale 1: The key roles of nurses in meeting the challenge of a potential bioterrorist event include diagnosis and treatment (signs and symptoms of chemical and biological agents).
Rationale 2: The key roles of nurses in meeting the challenge of a potential bioterrorist event include resources (health and law enforcement contacts).
Rationale 3: Stockpiling of medications is discouraged.
Rationale 4: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge).
Rationale 5: In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage.
Global Rationale: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage.

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacologic and Parenteral Therapies
QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.
AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.
NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 11-2 Discuss the role of the nurse in preparing for and responding to worldwide epidemics and bioterrorist activity.
MNL Learning Outcome:
Page Number: 116

Question 3
Type: MCSA
The patient comes to the emergency department with an anxiety attack. He tells the nurse he heard that there was another anthrax attack in the capitol and is concerned about running out of medications. What is the best response by the nurse?
1. “You don’t need to worry about another attack at all; I think our government can take care of us.”
2. “Your health is in danger due to the anxiety; we really need to focus on reducing your anxiety now.”
3. “The Centers for Disease Control and Prevention (CDC) maintains a large stockpile of medications for us in case that occurs.”
4. “I’m sure the Centers for Disease Control and Prevention (CDC) has contingency plans in the event of an anthrax attack.”
Correct Answer: 3
Rationale 1: Telling the patient not to worry is a nonspecific and patronizing response.
Rationale 2: Reducing anxiety is important, but this response does not answer the patient’s concern.
Rationale 3: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack.
Rationale 4: Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific.
Global Rationale: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack. Telling the patient not to worry is a nonspecific and patronizing response. Reducing anxiety is important, but this response does not answer the patient’s concern. Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific.

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacologic and Parenteral Therapies
QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.
AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.
NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 11-2 Discuss the role of the nurse in preparing for and responding to worldwide epidemics and bioterrorist activity.
MNL Learning Outcome:
Page Number: 115

Question 4
Type: MCSA
The nurse is teaching a class on anthrax to a group of emergency response workers. What is the best instruction to include?
1. Anthrax is a deadly bacterium; the most common and deadly form is gastrointestinal anthrax.
2. Cutaneous anthrax is the most common form, but inhaled anthrax is the most lethal form.
3. Anthrax most commonly affects wild rodents such as mice, rats, squirrels, and chipmunks.
4. Cutaneous anthrax is serious because it quickly spreads by person-to-person contact.
Correct Answer: 2
Rationale 1: Gastrointestinal anthrax is a rare form of anthrax.
Rationale 2: Cutaneous anthrax is the most common, but inhalation anthrax is the most dangerous form of anthrax.
Rationale 3: Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses.
Rationale 4: Cutaneous anthrax cannot be spread by person-to-person contact.
Global Rationale: Cutaneous anthrax is the most common, but least complicated, form of anthrax. Inhalation anthrax is the least common, but most dangerous, form of anthrax. Gastrointestinal anthrax is a rare form of anthrax. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses. Cutaneous anthrax cannot be spread by person-to-person contact.

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacologic and Parenteral Therapies
QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.
AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.
NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 11-4 Identify specific agents that would likely be used in a bioterrorist attack.
MNL Learning Outcome:
Page Number: 117

Question 5
Type: MCSA
The patient has been exposed to anthrax. What treatment will the nurse plan to administer?
1. Penicillin (Bicillin LA) and vancomycin (Vancocin).
2. Tetracycline (Sumycin) and erythromycin (Erythrocin).
3. Ampicillin (Principen) and cefepime (Maxipime).
4. Ciprofloxacin (Cipro) and doxycycline (Vibramycin).
Correct Answer: 4
Rationale 1: Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax.
Rationale 2: Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax.
Rationale 3: Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax.
Rationale 4: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax.
Global Rationale: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax.

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacologic and Parenteral Therapies
QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.
AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.
NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 11-6 Discuss the clinical manifestations and treatment of anthrax exposure.
MNL Learning Outcome:
Page Number: 118

Question 6
Type: MCSA
The patient was exposed to cutaneous anthrax 2 weeks ago. What will the nurse see when assessing the patient’s skin?
1. Large pustules, and later, reddish scabs
2. Small, fluid-filled vesicles, and later, small skin erosions
3. Ulcerated areas, and later, keloids
4. Small skin lesions, and later, black scabs
Correct Answer: 4
Rationale 1: Large pustules, and later, reddish scabs are not seen with cutaneous anthrax.
Rationale 2: Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax.
Rationale 3: Ulcerated areas, and later, keloids are not seen with cutaneous anthrax.
Rationale 4: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs.
Global Rationale: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs. Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax. Large pustules, and later, reddish scabs are not seen with cutaneous anthrax. Ulcerated areas, and later, keloids are not seen with cutaneous anthrax.

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacologic and Parenteral Therapies
QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.
AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.
NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 11-6 Discuss the clinical manifestations and treatment of anthrax exposure.
MNL Learning Outcome:
Page Number: 117

Question 7
Type: MCSA
The nursing instructor is teaching student nurses about the use of viruses in a bioterrorism attack. The nurse determines that learning has occurred when the students make which statement?
1. “The Centers for Disease Control and Prevention (CDC) has a plan to vaccinate Americans against most viruses.”
2. “Actually, a bigger concern is a nuclear weapon exploding in a city.”
3. “Most Americans have already been vaccinated against the lethal viruses.”
4. “A bioterrorist attack with viruses is a real threat to Americans.”
Correct Answer: 4
Rationale 1: The CDC does not have a plan to vaccinate Americans against most viruses.
Rationale 2: At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack.
Rationale 3: Most Americans have not been vaccinated against viruses.
Rationale 4: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack.
Global Rationale: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack. Mass vaccination is not appropriate until safer vaccines can be produced. The CDC does not have a plan to vaccinate Americans against most viruses. Most Americans have not been vaccinated against viruses. At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack.

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacologic and Parenteral Therapies
QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.
AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.
NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 11-4 Identify specific agents that would likely be used in a bioterrorist attack.
MNL Learning Outcome:
Page Number: 119

Question 8
Type: MCSA
The patient tells the nurse that she is concerned about terrorist activity and questions if everyone should be immunized against smallpox. What is the best response by the nurse?
1. “The vaccine has side effects, which are serious and could kill many people.”
2. “I really do not think our country has enough vaccine to do this.”
3. “Don’t be so concerned; if an attack comes, we will immunize people then.”
4. “The vaccine has some serious side effects, but this is probably a good idea.”
Correct Answer: 1
Rationale 1: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox.
Rationale 2: There is enough vaccine for all Americans to be vaccinated against smallpox.
Rationale 3: Telling a patient not to be concerned is a condescending and non-therapeutic response.
Rationale 4: Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox.
Global Rationale: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox. There is enough vaccine for all Americans to be vaccinated against smallpox. Telling a patient not to be concerned is a condescending and non-therapeutic response. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox.

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacologic and Parenteral Therapies
QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.
AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.
NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 11-8 Explain the advantages and disadvantages of vaccination as a means of preventing illness due to bioterrorist threats.
MNL Learning Outcome:
Page Number: 119

Question 9
Type: MCMA

A nurse who is presenting community education states, “Drugs are among our most powerful weapons for emergency preparedness.” What additional statements, made by the nurse, would support this statement?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. “Drugs help us treat the diseases that could be caused by bioterrorism.”
2. “We can use drugs to neutralize our enemies.”
3. “If we control the manufacture and distribution of drugs, we will control global politics.”
4. “Without drugs, we might be quickly overwhelmed by a bioterrorist attack.”
5. “Drugs can be used in chemical or nuclear attacks.”
Correct Answer: 1,4,5
Rationale 1: Drugs are a major treatment option for the types of diseases used in bioterrorism.
Rationale 2: The nurse would not have knowledge of this level of emergency planning.
Rationale 3: The nurse has no part in manufacture and distribution.
Rationale 4: If there were no drugs to treat a bioterrorist-released organism, the medical systems would soon become overwhelmed.
Rationale 5: Drugs can be used to treat the results of chemical or nuclear warfare as well as bioterrorism.

Global Rationale: Drugs are a major treatment option for the types of diseases used in bioterrorism. If there were no drugs to treat a bioterrorist-released organism, the medical systems would soon become overwhelmed. Drugs can be used to treat the results of chemical or nuclear warfare as well as bioterrorism. The nurse would have no input into how to neutralize enemies or control drug manufacture and distribution.

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacologic and Parenteral Therapies
QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.
AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.
NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 11-1 Explain why drugs are important in the context of emergency preparedness.
MNL Learning Outcome:
Page Number: 114

Question 10
Type: MCSA
The patient has been exposed to a nerve agent. For which symptoms will the nurse most likely assess?
1. Salivation, involuntary urination, and convulsions
2. Dilated pupils and increased blood pressure and heart rate
3. Pinpoint pupils, decreased blood pressure, and increased heart rate
4. Rapid breathing and cold, clammy skin
Correct Answer: 1
Rationale 1: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase.
Rationale 2: Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation.
Rationale 3: Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine.
Rationale 4: Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine.
Global Rationale: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase. Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine.

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacologic and Parenteral Therapies
QSEN Competencies: V.B.2 Demonstrate effective use of strategies to reduce risk of harm to self or others.
AACN Essentials Competencies: VII.9 Use clinical judgement and decision-making skills in appropriate, timely nursing care during disaster, mass casualty and other emergency situation.
NLN Competencies: Context and Environment: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty.
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 11-10 List top substances that represent human poison exposures.
MNL Learning Outcome:
Page Number: 119