Introduction To Clinical Pharmacology 8th Edition by Marilyn Winterton Edmunds – Test Bank A+

$35.00
Introduction To Clinical Pharmacology  8th Edition by Marilyn Winterton Edmunds – Test Bank A+

Introduction To Clinical Pharmacology 8th Edition by Marilyn Winterton Edmunds – Test Bank A+

$35.00
Introduction To Clinical Pharmacology 8th Edition by Marilyn Winterton Edmunds – Test Bank A+

Chapter 5: Lifespan and Cultural Modifications

Edmunds: Introduction to Clinical Pharmacology, 8th Edition

MULTIPLE CHOICE

  1. A mother asks why her 6-year-old requires a daily dose of digoxin that is twice that of an adult. The nurse explains that the larger dose is necessary because of which characteristics of children?
a.Greater resistance to medications
b.Variations in development of drug receptors
c.A slower metabolic rate than adults
d.More total body water, which dilutes the drug

ANS: B

Infants and children require a total daily digoxin dose that is approximately twice that of an adult on a basis of the ratio of weight to dose. This increased requirement for digoxin is thought to be the result of a greater binding strength of the child’s developing myocardial digoxin receptors.

DIF: Cognitive Level: Apply REF: p. 48 OBJ: 1

TOP: Excretion KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

  1. Which statement made by an older adult patient would require further teaching by the nurse?
a.“Nonprescription drugs will not interfere with my prescribed medications.”
b.“I can get non-childproof lids for my pills from the pharmacist.”
c.“Alcohol can affect drug action.”
d.“I will report any signs of drug toxicity to my doctor.”

ANS: A

You must be sure that older adult patients are taught how to take their prescription medications and about the danger of taking nonprescription drugs at the same time. Elderly patients often have age-related decline in renal and hepatic function, which can affect how their bodies handle many over-the-counter (OTC) drugs and prescription drugs. They may also have some loss in “hepatic reserve,” thereby placing them at increased risk of adverse effects when drugs are added to their existing treatment plan. The risk of adverse drug interactions is also increased if the elderly patients’ physicians don’t know all the drugs they are taking.

DIF: Cognitive Level: Apply REF: p. 51 OBJ: 1

TOP: Patient Teaching KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

  1. An older adult woman comes into the clinic complaining of “feeling bad” since yesterday. She tells the nurse her husband gave her his medication for a headache. Which represents the best response to this information?
a.“The cost of medication is high, so sharing is okay, since he has no problems.”
b.“You both have the same health problems, so sharing is all right.”
c.“Monitoring the drug effect is easier, since he also takes the medication.”
d.“When you take his medication, it makes evaluating the effects of your medication harder.”

ANS: D

Many older patients also diagnose each other’s health problems and share medications, which may make it very difficult for you to evaluate the effects of prescribed medications in a particular patient. Include the dangers of this in patient teaching.

DIF: Cognitive Level: Apply REF: p. 51 OBJ: 1

TOP: Patient Teaching Considerations KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

  1. A pregnant patient asks the nurse what “teratogenic effect” of medications means. Which is the nurse’s best response?
a.The ability to cause damage to the pregnant woman
b.A type of anaphylactic reaction in the pregnant woman
c.The ability to cause damage to the fetus
d.A term for stating the therapeutic effect of the medication for the fetus

ANS: C

All mothers want to have healthy babies, so it is important for pregnant women to avoid as many drugs as possible, especially those drugs with teratogenic potential (those likely to cause malformations or damage in the embryo or fetus).

DIF: Cognitive Level: Remember REF: p. 52 OBJ: 1

TOP: Pregnant and Breastfeeding Women

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

  1. A young woman comes into the clinic for follow-up care after a sexually transmitted infection. Which statement made by this patient alerts the nurse that further explanation is needed about her use of oral contraceptive pills (OCPs)?
a.“The OCPs will stop infections.”
b.“The OCPs will not cause infection.”
c.“I will continue the OCPs if I get an infection.”
d.“I need to use a backup means of contraception while taking an antibiotic.”

ANS: A

Oral contraceptive pills do not reduce a patient’s risk of getting a sexually transmitted disease.

DIF: Cognitive Level: Apply REF: p. 52 OBJ: 3

TOP: Women’s Health Issues KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

  1. Which action by a breastfeeding mother who takes medication would decrease the amount of the drug the baby receives in breast milk?
a.Always using sustained-release medications
b.Taking medication just before breastfeeding
c.Taking medication in the morning
d.Expressing and discarding milk when feedings are skipped

ANS: D

If a feeding is skipped, the mother needs to express and discard her breast milk, because drug levels may build up in the milk.

DIF: Cognitive Level: Analyze REF: p. 53 OBJ: 1

TOP: Breastfeeding Women KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

  1. Hormone replacement therapy for menopausal women helps reduce the incidence of which condition?
a.Varicose veins
b.Osteoporosis
c.Hypertension
d.Depression

ANS: B

Hormone replacement therapy for menopause has been used to reduce calcium loss from bones, which leads to osteoporosis.

DIF: Cognitive Level: Remember REF: p. 52 OBJ: 3

TOP: Women’s Health Issues KEY: Nursing Process Step: N/A

MSC: NCLEX: Health Promotion and Maintenance

  1. A Hispanic patient in the hospital has been told that medication is recommended for his condition. He tells the nurse that he would like to consult the curandera before making a decision. What should the nurse do first?
a.Talk with the patient about his cultural beliefs related to health.
b.Inform the physician of the patient’s request.
c.Restrict contact between the patient and the curandera.
d.Talk with the family about the request.

ANS: A

The LPN/LVN should attempt to accept and work with the cultural practices of patients as much as possible and not force patients to accept care that conflicts with their values.

DIF: Cognitive Level: Apply REF: p. 56 OBJ: 2

TOP: Cultural Influences KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

  1. Which individual would be at the highest risk for drug noncompliance?
a.A 2-year-old in a day care center
b.A 10-year-old receiving antibiotics for an ear infection
c.A 65-year-old on a fixed income taking multiple medications
d.A 95-year-old in a long-term care facility taking multiple medications

ANS: C

The patient’s age, sex, race, education, occupation, income, and marital status usually provide clues about whether the patient will follow medication instructions or not.

DIF: Cognitive Level: Analyze REF: p. 59 OBJ: 3

TOP: Noncompliance KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

  1. Which nursing intervention would be most helpful in improving a patient’s ability to follow the drug treatment plan?
a.Obtaining a unit-dose dispensing system for home use
b.Providing instruction three times before discharge
c.Discussing the medications with a family member
d.Establishing a good nurse-patient relationship

ANS: D

Factors that have been identified as helpful in having a good relationship with the patient include being friendly with a positive, confident approach.

DIF: Cognitive Level: Analyze REF: pp. 58-59 OBJ: 3

TOP: Noncompliance KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

  1. A mother comes to the clinic with her 7-year-old son who has had a cold for 2 days. She has been giving the child an over-the-counter preparation for his cough. The mother tells the nurse the child has been very hyperactive since his illness. What would the nurse assessing this patient tell the mother?
a.“Keep him busy. He will soon get tired and fall asleep.”
b.“All children act this way when they are ill and want attention.”
c.“Over-the-counter medication may cause reactions in children.”
d.“Over-the-counter medication is not strong enough to cause a reaction.”

ANS: C

Over-the-counter preparations, particularly various cough syrups, may provoke adverse reactions in pediatric patients. Many over-the-counter cold meds now carry warnings against giving them to children.

DIF: Cognitive Level: Apply REF: p. 49 OBJ: 1

TOP: Adverse Reactions KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

  1. The nurse is counseling a young woman who is planning her pregnancy. She asks if there is anything she might do to help prevent birth defects in her unborn child. Which would be an appropriate response to the patient?
a.“There is no way you can prevent a natural condition.”
b.“Birth defects only happen occasionally to some people.”
c.“Eating a diet rich in iron may prevent or stop birth defects.”
d.“Taking multivitamins with folic acid will help prevent birth defects.”

ANS: D

There is now a great deal of scientific data that support eating foods high in folic acid or taking a multivitamin with folic acid to protect against certain birth defects.

DIF: Cognitive Level: Apply REF: pp. 51-52 OBJ: 1

TOP: Women’s Health Issues KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

  1. The nurse instructs a woman on hormone replacement therapy (HRT) and informs her of the risk for which conditions?
a.Hot flashes
b.Increased calcium deposits
c.Heart attack
d.Weight loss

ANS: C

Research has shown that HRT may lead to an increased risk for heart attack.

DIF: Cognitive Level: Apply REF: p. 52 OBJ: 1

TOP: Women’s Health Issues KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

  1. The nurse is administering naproxen to a 70-year-old patient with poor nutritional intake. What should the nurse assess prior to administering the medication?
a.Blood pressure
b.Heart rate
c.Oxygen saturation level
d.Albumin level

ANS: D

The nurse should assess the patient’s albumin level prior to administering naproxen. Older adults may have decreased serum albumin levels due to the aging process. Naproxen is a high-protein binding drug. Decreased levels of albumin places the patient potentially at risk for high serum levels of naproxen. This may lead to increased effects of the drug or drug toxicity.

DIF: Cognitive Level: Apply REF: p. 50 OBJ: 1

TOP: Geriatric Special Considerations KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

  1. A patient with HIV has been diagnosed with Candida albicans. The nurses can anticipate the physician will order medication to be taken over how many days?
a.10 days
b.7 days
c.14 days
d.2 days

ANS: D

Candida infection is being treated by newer antifungal medications that have cut the treatment time from 7 to 2 days. These products are commonly prescribed for women with vaginal infections and AIDS patients with reduced immunity.

DIF: Cognitive Level: Understand REF: p. 51 OBJ: 2

TOP: Health Issues KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

MULTIPLE RESPONSE

  1. Which people, as a condition of their work, are required to maintain current immunizations? (Select all that apply.)
a.People in the military
b.Chefs
c.Health care providers
d.Cosmetologists
e.Teachers

ANS: A, B

People who travel outside the United States, are in the military, or work in handling food are required to have immunizations against many diseases. People at high risk, such as health care workers, older adults, and those who are immunocompromised, are encouraged to obtain yearly injections to help protect them against current strains of influenza.

DIF: Cognitive Level: Analyze REF: p. 55 OBJ: 2

TOP: Immunizations KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

  1. In aging patients, distribution of drugs may be lessened because of a decline in total body water and lean body mass, warranting the use of decreased dosing. Which drugs are distributed into body water or lean muscle mass and may lead to increased effects and possible toxicity for the aging patient? (Select all that apply.)
a.Digoxin (Lanoxin)
b.Gentamicin (Garamycin)
c.Meperidine (Demerol)
d.Acetaminophen (Tylenol)
e.Ibuprofen (Motrin)

ANS: A, B, C

Drugs that are distributed into body water or lean body mass include digoxin, cimetidine, lithium, gentamicin, meperidine, phenytoin, and theophylline.

DIF: Cognitive Level: Apply REF: pp. 49-50 OBJ: 1

TOP: Distribution of Drugs KEY: Nursing Process Step: N/A

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

  1. What may the nurse question the patient about when performing a cultural assessment? (Select all that apply.)
a.Differences in values
b.Religious practices
c.Health practices
d.Tolerance practices
e.Political values and beliefs

ANS: A, B, C

Cultural assessment involves talking with a patient about differences in values, religion, dietary practices, family lines of authority, family life patterns, and beliefs and practices related to health and illness.

DIF: Cognitive Level: Understand REF: p. 56 OBJ: 2

TOP: Cultural Inferences KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

  1. Nurses working with older adult patients must remember which factors about their kidney function and administration of their medications? (Select all that apply.)
a.Older adult patients are all alike with regard to kidney function and medications.
b.Drugs excreted by the kidney must be assessed individually in older adults.
c.The nurse should remember factors about liver function only and not kidney function in older adults.
d.Longer dosage intervals and lower doses are generally appropriate for older adults with kidney damage.
e.With older adults, creatinine clearance values help measure kidney function.

ANS: B, D, E

The important factors to remember when caring for older adult patients taking drugs that will be excreted from the kidney are to monitor these patients individually, follow creatinine clearance as prescribed by the health care provider, and expect that lower doses or longer intervals between doses may be ordered for patients with possible kidney damage.

DIF: Cognitive Level: Understand REF: p. 50 OBJ: 1

TOP: Excretion KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

Chapter 7: Preparing and Administering Medications

Edmunds: Introduction to Clinical Pharmacology, 8th Edition

MULTIPLE CHOICE

  1. Which represents the proper way for a nurse to administer an oral capsule?
a.Tell the patient to swallow it whole.
b.Pierce it with a needle and squeeze into the mouth.
c.Crush and dilute it in warm water.
d.Tell the patient to chew it completely.

ANS: A

Remain at the patient’s bedside until the medication is swallowed. Do not crush tablets or break capsules without checking with the pharmacist. Many medications have special coatings that are essential for proper absorption.

DIF: Cognitive Level: Understand REF: p. 79 OBJ: 6

TOP: Oral Medications KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

  1. The nurse instructs a clinic patient on using an inhaler for his asthma attacks. Which is correct about the use of an inhaler?
a.The medication must go into the back of the nose.
b.The medication must go directly into the throat.
c.The medication must get to the ears.
d.The medication must go into the lungs.

ANS: D

If using inhalers, patients must be carefully instructed so the medication goes all the way into the lungs, not just to the back of the nose or throat. Take a deep breath first, exhale, and then inhale the medication.

DIF: Cognitive Level: Apply REF: p. 117 OBJ: 6

TOP: Medication to Mucous Membranes

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

  1. When giving a medicine through a nasogastric (NG) tube, which will the nurse do first?
a.Flush the tube with 30 mL of water.
b.Check placement of the tube.
c.Take the vital signs.
d.Ask the patient if the tube is painful.

ANS: B

Make certain that the NG tube is in the stomach. Aspirate (take out) stomach contents with a syringe, or inject (put in) 5 to 10 mL of air into the tube and listen for a gurgling sound in the abdominal area. This may be heard by placing a stethoscope over the stomach.

DIF: Cognitive Level: Understand REF: p. 82 OBJ: 6

TOP: Nasogastric Medications KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

  1. Which is done after giving medication through a nasogastric tube that is connected to suction?
a.The tube is reconnected to the suction.
b.The tube is clamped for 10 minutes and then reconnected to suction.
c.The tube is clamped for 30 minutes and then reconnected to suction.
d.The tube is left off for 4 hours and then reconnected to suction.

ANS: C

When the medication has passed through the tube, reclamp the tube for 30 minutes before the suction is reattached.

DIF: Cognitive Level: Understand REF: p. 82 OBJ: 6

TOP: Administering Nasogastric Medications

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

  1. Standard precautions to prevent transmission of HIV and other bloodborne pathogens should be used when the nurse is likely to come into contact with blood, semen, vaginal secretions, and possibly breast milk. Only these four fluids have been shown to transmit HIV. Although the risk is unknown, universal precautions for prevention of HIV have also been suggested for which bodily fluids?
a.Tears
b.Sweat
c.Pleural fluid
d.Nasal secretions

ANS: C

The Centers for Disease Control (CDC) recommend that health care workers use gloves, gowns, masks, and protective eyewear when they are likely to be exposed to patients’ blood or body fluids; they consider that all patients might be infected. Universal precautions also apply to tissues, cerebrospinal fluid, synovial fluid, and amniotic fluid.

DIF: Cognitive Level: Remember REF: p. 86| Box 7-2

OBJ: 7 TOP: Standard Precautions

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

  1. Which way can a nurse prevent injury from a needlestick?
a.Recap the needle before disposal.
b.Remove the needle from the syringe.
c.Immediately discard the needle and syringe in a puncture-proof container.
d.Stick it into the patient’s mattress until it can be disposed of.

ANS: C

Standard precautions recommend the use of puncture-resistant containers for disposal of all needles and sharps. Never recap a needle; most sticks happen this way.

DIF: Cognitive Level: Understand REF: pp. 86-87| Box 7-2

OBJ: 6 TOP: Standard Precautions

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

  1. When a patient is experiencing a life-threatening emergency, the nurse may be given an order to administer medication via which route?
a.IV
b.IM
c.Subcutaneous
d.Rectal

ANS: A

IV injections or infusions may be needed when medication must go directly into the bloodstream, because the action of this method is rapid.

DIF: Cognitive Level: Understand REF: p. 87 OBJ: 6

TOP: Parenteral Administration KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

  1. Which is the correct needle for an intramuscular (IM) injection?
a.18 G, 1-inch
b.20 G, -inch
c.25 G, 2-inch
d.21 G, 1-inch

ANS: D

An IM injection is usually given with a 1- to 2-inch, 20- to 22-gauge needle.

DIF: Cognitive Level: Understand REF: p. 98 | Table 7-1

OBJ: 6 TOP: Intramuscular Medications KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

  1. Which principles of medication administration will be taught to a patient who will be administering his own subcutaneous injections?
a.Use a 22-gauge, 5/8-inch needle.
b.Rotate sites among the upper arm, abdomen, and anterior thigh.
c.Avoid injecting within 3 inches of a previous injection site.
d.Insert the needle at a 30-degree angle to the skin.

ANS: B

The patient should agree on a rotation plan for injection sites and this should be posted with the patient’s medications or by the patient’s bedside.

DIF: Cognitive Level: Apply REF: p. 96 OBJ: 8

TOP: Sites for Injection KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

  1. If an IV has become infiltrated, the nurse will observe which assessment findings?
a.Pallor, pain
b.Erythema, warmth
c.Erythema, swelling
d.Warmth, swelling

ANS: C

Infiltration produces pain, swelling of the area, and redness (erythema).

DIF: Cognitive Level: Analyze REF: p. 110 OBJ: 6

TOP: Infiltration KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

  1. Which should the nurse do when applying a topical nitroglycerin ointment?
a.Massage it thoroughly into the skin.
b.Squeeze it onto the applicator paper and place it on the skin.
c.Apply it to the medial aspect of the thigh.
d.Shave the skin prior to application.

ANS: B

The correct number of inches of medication is squeezed onto the applicator paper as a small ribbon. The applicator paper is then laid on top of the skin where the medication is to be applied. A nonhairy area on the chest, upper arm, or flank area should be selected for application. Apply it to the paper because the nurse can receive some of the medication if it comes in contact with his or her fingers and is absorbed into the skin.

DIF: Cognitive Level: Understand REF: pp. 112-114 OBJ: 6

TOP: Nitroglycerin Ointment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

  1. When using the mucous membrane for percutaneous medication administration, the nurse should use an oily base for medication absorption when which is true?
a.The mucous membrane is too dry, and skin will flake off.
b.The patient is allergic to oil-based preparations.
c.The medication needs a slow absorption.
d.The medication needs a rapid absorption.

ANS: C

Medication given in an oily base will slow its absorption and help when administering antibiotics.

DIF: Cognitive Level: Understand REF: p. 114 OBJ: 6

TOP: Mucous Membrane Medications KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

  1. As part of an antismoking program, nicotine can be administered by which delivery system?
a.Intravenously
b.Enterally
c.Sublingually
d.Transdermally

ANS: D

Various antismoking programs use nicotine patches in the form of a disc or transdermal patch.

DIF: Cognitive Level: Remember REF: p. 114 OBJ: 6

TOP: Transdermal Delivery Systems KEY: Nursing Process Step: Implementation

MSC: NCLEX: N/A

  1. An elderly patient is scheduled to take six medications each morning. What should the nurse know to do when administering these medications?
a.Allow extra time to administer all of the medications.
b.Allow the patient to take only the medications she can swallow.
c.Crush all of the medications before giving them.
d.Leave the medication at the bedside so the patient can take them slowly.

ANS: A

Allow extra time to administer medication to the elderly. These individuals often are slower at swallowing medications and water. The nurse must be present for the administration of every medication.

DIF: Cognitive Level: Apply REF: p. 82 OBJ: 6

TOP: Older Adults/Administering Medications

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

  1. Metered-dose inhalers are used to deliver specific amounts of medication. The nurse gives the patient which instructions?
a.Never shake the inhaler medication before use.
b.Exhale while squeezing the canister to deliver the medication.
c.Sit upright, exhale, then activate the inhaler as the next inhalation begins.
d.Hold the head back while inhaling the medication.

ANS: C

The patient should exhale, and then activate the inhaler as the next inspiration begins. This will carry medication down into the lungs.

DIF: Cognitive Level: Apply REF: p. 117 OBJ: 6

TOP: Metered-Dose Inhalers KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

  1. Injectable iron should be administered by which injection method?
a.Subcutaneous
b.Intradermal
c.Z-track intramuscular injection
d.IV piggyback

ANS: C

For medications that are irritating or may stain the skin (e.g., iron), the “Z-track technique” of IM injection is employed. The Z-track uses the skin itself as a “door” to seal in the drug and prevent it from leaking back out from muscle tissue.

DIF: Cognitive Level: Apply REF: p. 98 OBJ: 6

TOP: Intramuscular Injections KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

  1. A nurse is observing another nurse prepare insulin for administration to a diabetic patient. Which observation is considered unsafe?
a.The nurse draws up the Regular insulin first, then the NPH insulin.
b.The nurse draws up both the Regular and NPH insulin in the same syringe.
c.The nurse draws up the insulin in a syringe calibrated in milligrams (mg).
d.The nurse draws up 30 units of NPH insulin as ordered by the physician.

ANS: C

Insulin should be drawn up in a special insulin syringe that is marked or calibrated in units. Accuracy is very important when calculating insulin dosages because a small error makes a big change. Use the correct syringe, the correct insulin, and the correct dose.

DIF: Cognitive Level: Analyze REF: p. 75 OBJ: 6

TOP: Insulin KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

MULTIPLE RESPONSE

  1. When giving an IM injection to an HIV-positive patient, the nurse recognizes that the HIV infection is spread in which body fluids? (Select all that apply.)
a.Sputum
b.Vaginal fluid
c.Breast milk
d.Blood
e.Semen

ANS: B, C, D, E

Evidence has suggested that only blood, semen, vaginal fluid, and possibly breast milk can carry HIV.

DIF: Cognitive Level: Understand REF: pp. 83-85 | Box 7-2

OBJ: 7 TOP: Standard Precautions

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

  1. A nurse discovers that an infusion is failing to infuse properly. Which items should be checked? (Select all that apply.)
a.IV pole height
b.IV site for infiltration
c.Whether tubing is bent
d.Position of needle
e.IV solution type

ANS: A, B, C, D

Failure of an IV to infuse properly warrants the following nursing actions: check for bent tubing, needle against vein wall, or small clot at needle end; the IV pole may be too low, or the needle may be out of the vein and infiltrated.

DIF: Cognitive Level: Apply REF: p. 110 OBJ: 6

TOP: Intravenous Infusions KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

  1. Which are examples of medications that are given by enteral routes? (Select all that apply.)
a.Total parenteral nutrition (TPN) solutions
b.Oral tablets
c.Oral capsules
d.Rectal suppositories
e.Liquid medications

ANS: B, C, D, E

Enteral medications are given directly into the gastrointestinal (GI) tract through oral, nasogastric, or rectal routes. TPN solutions are administered intravenously, which is a parenteral route.

DIF: Cognitive Level: Understand REF: p. 78 OBJ: 6

TOP: Enteral Medications KEY: Nursing Process Step: Implementation

MSC: NCLEX: N/A

OTHER

  1. List the nursing actions in the correct sequence for a patient with an infiltrated IV. Separate letters by a comma and space as follows: A, B, C, D.
  2. Contact the physician.
  3. Inspect for signs of injury.
  4. Apply warm, moist compresses.
  5. Discontinue the infusion.

ANS:

B, D, A, C

Whenever an IV infiltration is discovered, the infusion site must be carefully inspected for signs of injury. The infusion is discontinued and the physician contacted, especially if necrosis, sloughing, blistering, or unusual swelling is seen. Warm, moist compresses should be applied to the area.

DIF: Cognitive Level: Analyze REF: p. 110 OBJ: 6

TOP: Infiltration KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

Chapter 11: Antineoplastic Medications

Edmunds: Introduction to Clinical Pharmacology, 8th Edition

MULTIPLE CHOICE

  1. Which term refers to a medication that interferes with metabolic functions in cells?
a.Antibiotic
b.Alkylating agent
c.Antimetabolite
d.Mitotic inhibitor

ANS: C

Antimetabolites disrupt normal cell function by interfering with various metabolic functions of the cells.

DIF: Cognitive Level: Remember REF: p. 191 OBJ: 1

TOP: Antimetabolites KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

  1. In observing a chemotherapy patient, an LPN/LVN must be aware of adverse effects from other products. The patient tells the nurse that he has found an herbal preparation to help control his nausea. Which represents the nurse’s best response?
a.“That sounds wonderful, and it’s inexpensive.”
b.“Stop taking this product; it is toxic.”
c.“Tell me the name of the herbal preparation you are taking.”
d.“Follow the instructions on how to take that preparation.”

ANS: C

Some herbal preparations may be helpful in dealing with nausea and vomiting due to chemotherapy. The nurse should find out what herbal preparation the patient is taking to ensure it does not react negatively with the other medications the patient is prescribed.

DIF: Cognitive Level: Apply REF: p. 192 OBJ: 2

TOP: Drug Interactions KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

  1. What is the effect of chemotherapeutic agents on cells?
a.Slows cell growth
b.Kills malignant cells
c.Breaks down the bacterial cell wall
d.Increase helper T-cell production

ANS: A

Chemotherapeutic agents slow cell growth or delay the spread of malignant cells into other parts of the body.

DIF: Cognitive Level: Remember REF: p. 190 OBJ: 1

TOP: Chemotherapeutic Agents KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

  1. Which common adverse reaction is associated with antineoplastic drugs?
a.Alopecia and bone marrow depression
b.Bone marrow stimulation and nausea
c.Diarrhea and blurred vision
d.Anorexia and rhinorrhea

ANS: A

The action of antineoplastic agents on normal cells causes many adverse reactions, which include alopecia and bone marrow depression.

DIF: Cognitive Level: Understand REF: p. 190 OBJ: 2

TOP: Antineoplastics KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

  1. The nurse may include which diagnosis for a patient taking an antineoplastic medication?
a.Decreased cardiac output
b.Deficient fluid volume
c.Social isolation
d.Imbalanced nutrition: more than body requirements

ANS: B

Nausea, vomiting, anorexia, and diarrhea are seen with almost all of the antineoplastic agents.

DIF: Cognitive Level: Apply REF: p. 192 OBJ: 2

TOP: Adverse Reactions KEY: Nursing Process Step: Diagnosis

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

  1. For which condition should the nurse take special care in an older patient who is receiving chemotherapy?
a.Anorexia and diarrhea
b.Dry eyes
c.Edema in the joints
d.Pain at injection site

ANS: A

The nurse must take special care to hydrate the patient because nausea, anorexia, and diarrhea all work to dehydrate patients who are undergoing chemotherapy.

DIF: Cognitive Level: Apply REF: p. 191 OBJ: 2

TOP: Geriatric Considerations with Chemotherapy

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

  1. Which person is qualified to prepare and administer antineoplastic drugs?
a.Any trained drug representative
b.Any medical assistant
c.An advanced practice nurse
d.An oncology nurse

ANS: D

Some preparations should be given only by a physician or other health care provider such as a specially trained chemotherapy nurse.

DIF: Cognitive Level: Understand REF: p. 193 OBJ: 1

TOP: Antineoplastics KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

  1. Which precautions should nurses administering antineoplastic preparations use?
a.Standard precautions as always
b.Proper hand hygiene after use
c.Preparation of medication in special areas
d.Preparation in direct light under a hood

ANS: C

Administration of these toxic products may pose a safety hazard to the nurse and patient. There should be a special area designated for mixing these preparations.

DIF: Cognitive Level: Apply REF: p. 193 OBJ: 1

TOP: Antineoplastics KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

  1. For which organ may a patient with cancer be prescribed hormones?
a.Bone
b.Prostate
c.Brain
d.Liver

ANS: B

Some tumors, such as cancer of the prostate, may depend on male or female hormones, the chemicals produced by the sex glands.

DIF: Cognitive Level: Understand REF: p. 192 OBJ: 1

TOP: Hormones KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

  1. A patient taking Mustargen is suffering from alopecia. The nurse should include which intervention in the care plan?
a.Provide ice chips.
b.Maintain IV hydration.
c.Use emollients on the affected area.
d.Offer the use of a scarf.

ANS: D

Hair loss secondary to chemotherapy is usually of great concern to the patient.

DIF: Cognitive Level: Apply REF: p. 195 OBJ: 2

TOP: Adverse Reactions KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

  1. A patient in treatment for multiple myeloma is on Mesnex (ifosfamide). She reports to the nurse that she is having bouts of nausea and has been unable to eat. Which would be the best advice to give her?
a.Take nothing by mouth until this passes.
b.Replace fluid losses right away.
c.Only eat nonsalty foods.
d.Hold ice chips in your mouth.

ANS: D

The patient may not be able to eat anything at times but may find holding ice chips in the mouth to be helpful.

DIF: Cognitive Level: Apply REF: p. 195 OBJ: 3

TOP: Antineoplastics KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

  1. Which healthy cells in the body are commonly affected by antineoplastic agents?
a.Myocardial
b.Gastrointestinal
c.Vascular
d.Cerebral

ANS: B

The cells in the gastrointestinal tract are rapidly dividing and growing. Antineoplastic drugs affect rapidly growing normal cells.

DIF: Cognitive Level: Remember REF: p. 190 OBJ: 2

TOP: Antineoplastics KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity

  1. The effectiveness of antineoplastic agents can be best evaluated by which means?
a.Physical exam
b.Laboratory studies
c.Return of appetite
d.Subjective report of increased strength

ANS: B

Follow-up laboratory work and x-ray studies are used to determine the response to medication.

DIF: Cognitive Level: Understand REF: p. 193 OBJ: 2

TOP: Antineoplastics KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity

  1. Which over-the-counter medications might a patient on chemotherapy use to control nausea?
a.Zinc and honey
b.Vitamin C and honey
c.Herbal preparations
d.Vanilla extract

ANS: C

Patients who are undergoing chemotherapy might explore herbal preparations.

DIF: Cognitive Level: Understand REF: p. 196| Table 11-2

OBJ: 1 TOP: Chemotherapy

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

  1. Antioxidants are viewed as helpful in the prevention and treatment of cancer because they have which effects?
a.They stimulate platelet production.
b.They minimize the toxic effects of other antineoplastics.
c.They eliminate free radicals.
d.They alleviate nausea.

ANS: C

Antioxidants are viewed as helpful because of their ability to eliminate free radicals. These are substances that remain after normal metabolism of a chemical; the residue may damage the cell.

DIF: Cognitive Level: Remember REF: p. 192 OBJ: 1

TOP: Natural Products KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

  1. For which reason must a patient keep his or her chemotherapy medications in a locked cabinet?
a.These medications are very costly.
b.These medications are very toxic.
c.These medications have narcotic effects.
d.These medications are hard to replace monthly.

ANS: B

These medications are toxic, and chemotherapy patients should keep any medication, when taken home, in a locked cabinet away from children and pets.

DIF: Cognitive Level: Understand REF: p. 191 | Table 11-1

OBJ: 3 TOP: Patient Education

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

  1. Onxol (paclitaxel) is used to treat testicular cancer. This drug directly interferes with or stops cell division. The nurse knows that this medication is which preparation?
a.Mitotic agent
b.Chemotherapy agent
c.Hormone
d.Neoplasm

ANS: A

Mitotic inhibitors are a special group of medications that directly interfere with or stop cell division.

DIF: Cognitive Level: Remember REF: p. 192 | Table 11-1

OBJ: 1 TOP: Action of Mitotic Agents

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

  1. The nurse is completing education for a patient receiving Novantrone (mitoxantrone) for treatment of leukemia. The nurse teaches the patient that he or she may experience which signs or symptoms?
a.Low blood pressure
b.Stomatitis
c.Numbness
d.Increased appetite

ANS: B

Novantrone (mitoxantrone) may cause petechiae, nausea, vomiting, diarrhea, stomatitis, sepsis, fungal infections, dyspnea, fever, and alopecia.

DIF: Cognitive Level: Understand REF: Table 11-1 OBJ: 3

TOP: Patient Education KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

  1. The nurse is caring for a patient receiving an antineoplastic medication IV. While the medication is infusing, the IV needle becomes dislodged and goes in to the tissue. What is the highest priority for this patient at this time?
a.Call the physician on call to report the occurrence.
b.Inject medication immediately into the skin to counter the effect of the medication.
c.Elevate the affected IV site and apply ice.
d.Place the affected site into a dependent position.

ANS: B

Some medications given intravenously will damage and destroy the tissues of the skin if the IV needle becomes dislodged and medication goes into the tissue and not the veins. This is called extravasation. Medication must be available that can be immediately injected directly into the skin to counter the effect of the antitumor medicine. Failure to act quickly may result in huge areas of tissue damage, sometimes destroying the ability of the hand or arm to function.

DIF: Cognitive Level: Analyze REF: p. 193 OBJ: 2

TOP: Extravasation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

MULTIPLE RESPONSE

  1. A chemotherapy patient should be instructed to report which signs or symptoms to his or her health care provider? (Select all that apply.)
a.Sleeping 10 hours at night
b.Uncontrollable nausea
c.Constipation
d.Oral temperature of 98° F
e.Blood pressure 120/80

ANS: B, C

In patients on chemotherapy, dehydration must be avoided, and bowel regularity must be maintained.

DIF: Cognitive Level: Understand REF: p. 195 OBJ: 3

TOP: Patient Education KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

  1. Dactinomycin (Cosmegen) is an antibiotic used in the treatment of which types of cancer? (Select all that apply.)
a.Pancreatic carcinoma
b.Testicular carcinoma
c.Uterine carcinoma
d.Wilms tumor
e.Multiple myeloma

ANS: B, C, D

Dactinomycin (Cosmegen) is used in the treatment of testicular carcinoma, uterine carcinoma, and Wilms tumor.

DIF: Cognitive Level: Remember REF: Table 11-1 OBJ: 1

TOP: Antineoplastics KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

  1. A patient is being treated for ovarian carcinoma with carboplatin, an alkylating agent. Which are actions of this medication? (Select all that apply.)
a.It interferes with normal cell division.
b.Malignant cells convert to normal cells.
c.Its effects occur in both normal and malignant cells.
d.Cell division is totally controlled with this medication.
e.It attaches to DNA.

ANS: A, C, E

Alkylating agents are used to interfere with the normal process of cell division by attaching physically to DNA in the tumor cells. This effect occurs in both malignant and normal cells, although malignant cells seem to be affected much more by the medications.

DIF: Cognitive Level: Apply REF: p. 191| Table 11-1

OBJ: 1 TOP: Alkylating Agents

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

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