Results for Lesson 6: Pharmacological and Parenteral Therapies Questions are numbered by the order in which they appeared

in the test. Represents the correct answer.
Question 1 A parent asks the school nurse how to eliminate lice from Answers Correct D their child. What is the most appropriate response by the Student's D nurse? A) Cut the child's hair short to remove the nits B) Apply warm soaks to the head twice daily Wash the child's linen and clothing in a bleach C) solution D) Application of pediculicides Review Information: The correct answer is D: Application of pediculicides Treatment of head lice consists of application of pediculicides. Pediculicides vary, and the directions must be followed carefully. Wong, D.L., Perry, S.E., & Hockenberry, M.J. (2002). Maternal Child Nursing. (2nd edition). Mosby: St. Louis, Missouri. Potts, N.L. and Mandleco, B.L. (2002). Pediatric nursing, caring for children and their families. USA: Thompson, Delmar, Learning.

Question 2 The nurse receives an order to give a client iron by deep Answers Correct D injection. The nurse know that the reason for this route is Student's D to A) enhance absorption of the medication B) ensure that the entire dose of medication is given C) provide more even distribution of the drug D) prevent the drug from causing tissue irritation Review Information: The correct answer is D: prevent the drug from causing tissue irritation Deep injection or Z-track is a special method of giving medications via the intramuscular route. Use of this technique prevents irritating or staining medications from being tracked through tissue. Use of Z-track does not affect dose, absorption, or distribution of the drug.

Altman, G. (2004). Delmar’s Fundamental and Advanced Nursing Skills, 2nd ed. Albany, NY: Delmar. Potter P. and Perry, A. (2005). Fundamental of Nursing. (6th Edition). St. Louis, Missouri: Mosby.

Question 3 A nurse is providing care to a 63 year-old client with Answers Correct C pneumonia. Which intervention promotes the client’s Student's C comfort? A) Increase oral fluid intake B) Encourage visits from family and friends C) Keep conversations short D) Monitor vital signs frequently Review Information: The correct answer is C: Keep conversations short Keeping conversations short will promote the client’s comfort by decreasing demands on the client’s breathing and energy. Increased intake is not related to comfort. While the presence of family is supportive, demands on the client to interact with the visitors may interfere with the client’s rest. Monitoring vital signs is an important assessment but not related to promoting the client’s comfort. Daniels, R. (2003). Delmar’s manual of laboratory and diagnostic tests. USA: Thompson Delmar Learning. Altman, G. (2004). Delmar’s Fundamental and Advanced Nursing Skills, 2nd ed. Albany, NY: Delmar.

Question 4 While providing home care to a client with congestive Answers Correct C heart failure, the nurse is asked how long diuretics must be Student's C taken. What is the nurse’s best response? "As you urinate more, you will need less medication A) to control fluid." "You will have to take this medication for about a B) year." "The medication must be continued so the fluid C) problem is controlled." "Please talk to your health care provider about D) medications and treatments." Review Information: The correct answer is C: "The medication must be continued so the fluid problem is controlled." This is the most therapeutic response and gives the client accurate information. Smeltzer, S.C. and Bare, B.G. (2004). Medical surgical nursing. (10th edition).

Philadelphia, PA. Lippincott Williams & Wilkins. Key, J.L. and Hayes, E.R. (2003). Pharmacology, a nursing process approach. (4th edition). Philadelphia: Saunders.

Question 5 An antibiotic IM injection for a 2 year-old child is ordered. Answers Correct A The total volume of the injection equals 2.0 ml. The correct Student's A action is to A) administer the medication in 2 separate injections B) give the medication in the dorsal gluteal site C) call to get a smaller volume ordered check with pharmacy for a liquid form of the D) medication Review Information: The correct answer is A: administer the medication in 2 separate injections Intramuscular injections should not exceed a volume of 1 ml for small children. Medication doses exceeding this volume should be split into 2 separate injections of 1.0 ml each. In adults the maximum intramuscular injection volume is 5 ml per site Altman, G. (2004). Delmar’s Fundamental and Advanced Nursing Skills, 2nd ed. Albany, NY: Delmar. Potter P. and Perry, A. (2005). Fundamental of Nursing. (6th Edition). St. Louis, Missouri: Mosby.

Question 6 A client is receiving intravenous heparin therapy. What medication should the nurse have available in the event of an overdose of heparin? A) Protamine B) Amicar C) Imferon D) Diltiazem Review Information: The correct answer is A: Protamine Protamine binds heparin, making it ineffective.

Answers Correct A Student's A

Deglin, J.D. and Vallerand, A.H. (2001). Davis’ drug guide for nurses. (7th edition). Philadelphia: F.A. Davis Company. Wilson, B.A., Shannon, M.T., and Stang, C.L. (2004). Nurse’s drug guide. Upper Saddle River, New Jersey: Pearson Prentice Hall.

Question 7 The nurse has given discharge instructions to parents of a Answers Correct B child on phenytoin (Dilantin). Which of the following Student's B statements suggests that the teaching was effective? "We will call the health care provider if the child A) develops acne." "Our child should brush and floss carefully after B) every meal." "We will skip the next dose if vomiting or fever C) occur." "When our child is seizure-free for 6 months, we can D) stop the medication." Review Information: The correct answer is B: "Our child should brush and floss carefully after every meal." Phenytoin causes lymphoid hyperplasia that is most noticeable in the gums. Frequent gum massage and careful attention to good oral hygiene may reduce the gingival hyperplasia. Deglin, J.D. and Vallerand, A.H. (2001). Davis’ drug guide for nurses. (7th edition). Philadelphia: F.A. Davis Company. Wong, D.L., Perry, S.E., & Hockenberry, M.J. (2002). Maternal Child Nursing. (2nd edition). Mosby: St. Louis, Missouri.

Question 8 Although nonsteroidal anti-inflammatory drugs (NSAIDs) Answers Correct D such as ibuprofen (Motrin) are beneficial in managing Student's D arthritis pain, the nurse should caution clients about which of the following common side effects? A) Urinary incontinence B) Constipation C) Nystagmus D) Occult bleeding Review Information: The correct answer is D: Occult bleeding Nonsteroidal anti-inflammatory drugs (NSAIDs) taken for long periods of time may cause serious side effects, including bleeding in the gastrointestinal track. Deglin, J.D. and Vallerand, A.H. (2001). Davis’ drug guide for nurses. (7th edition). Philadelphia: F.A. Davis Company. Smeltzer, S.C. and Bare, B.G. (2004). Medical surgical nursing. (10th edition). Philadelphia, PA. Lippincott Williams & Wilkins.

Question 9

A client with heart failure has Lanoxin (digoxin) ordered. Answers Correct C What would the nurse expect to find when evaluating for Student's C the therapeutic effectiveness of this drug? A) Diaphoresis with decreased urinary output B) Increased heart rate with increased respirations Improved respiratory status and increased urinary C) output D) Decreased chest pain and decreased blood pressure Review Information: The correct answer is C: Improved respiratory status and increased urinary output Digoxin, a cardiac glycoside, is used in clients with heart failure to slow and strengthen the heartbeat. As cardiac output is improved, renal perfusion is improved and urinary output increases. Clients can become toxic on this drug, indicated by findings of bradycardia, dysrhythmia, and visual and GI disturbances. Clients being treated with digoxin should have their apical pulse evaluated for 1 full minute prior to the administration of the drug. Wilson, B.A., Shannon, M.T., and Stang, C.L. (2004). Nurse’s drug guide. Upper Saddle River, New Jersey: Pearson Prentice Hall. White, L., and Duncan, G,. (2002). Medical-Surgical Nursing An Integrated Approach (2nd ed.). Australia: Delmar.

Question 10 Why is it important for the nurse to monitor blood pressure Answers Correct A in clients receiving antipsychotic drugs? Student's A A) Orthostatic hypotension is a common side effect Most antipsychotic drugs cause elevated blood B) pressure This provides information on the amount of sodium C) allowed in the diet It will indicate the need to institute antiparkinsonian D) drugs Review Information: The correct answer is A: Orthostatic hypotension is a common side effect Clients should be made aware of the possibility of dizziness and syncope from postural hypotension for about an hour after receiving medication. They should be advised to get up slowly, especially from a supine position. Deglin, J.D. and Vallerand, A.H. (2001). Davis’ drug guide for nurses. (7th edition). Philadelphia: F.A. Davis Company. Smeltzer, S.C. and Bare, B.G. (2004). Medical surgical nursing. (10th edition). Philadelphia, PA. Lippincott Williams & Wilkins.

Question 11

The nurse is teaching a client about precautions with Answers Correct A Coumadin therapy. The client should be instructed to avoid Student's A which over-the-counter medication? A) Non-steroidal anti-inflammatory drugs (NSAIDs) B) Cough medicines with guaifenesin C) Histamine blockers D) Laxatives containing magnesium salts Review Information: The correct answer is A: Non-steroidal anti-inflammatory drugs (NSAIDs) Medications with NSAIDs may increase the response to Coumadin (warfarin) and increase the risk of bleeding. Deglin, J.D. and Vallerand, A.H. (2001). Davis’ drug guide for nurses. (7th edition). Philadelphia: F.A. Davis Company. Wilson, B.A., Shannon, M.T., and Stang, C.L. (2004). Nurse’s drug guide. Upper Saddle River, New Jersey: Pearson Prentice Hall.

Question 12 The nurse is caring for a client with clinical depression Answers Correct A who is receiving a monoamine oxidase inhibitor (MAOI). Student's A When providing instructions about precautions with this medication, which action should the nurse stress to the client as important? A) Avoid chocolate and cheese B) Take frequent naps C) Take the medication with milk D) Avoid walking without assistance Review Information: The correct answer is A: Avoid chocolate and cheese Foods high in tryptophan, tyramine and caffeine, such as chocolate, wine and cheese may precipitate hypertensive crisis. Deglin, J.D. and Vallerand, A.H. (2001). Davis’ drug guide for nurses. (7th edition). Philadelphia: F.A. Davis Company. Wilson, B.A., Shannon, M.T., and Stang, C.L. (2004). Nurse’s drug guide. Upper Saddle River, New Jersey: Pearson Prentice Hall.

Question 13

A client is being discharged with a prescription for Answers Correct B chlorpromazine (Thorazine). Before leaving for home, Student's B which of these findings should the nurse teach the client to report? A) Change in libido, breast enlargement B) Sore throat, fever C) Abdominal pain, nausea, diarrhea D) Dyspnea, nasal congestion Review Information: The correct answer is B: Sore throat, fever A sore throat and fever may be findings of agranulocytosis, a serious side effect of chlorpromazine (Thorazine). Deglin, J.D. and Vallerand, A.H. (2001). Davis’ drug guide for nurses. (7th edition). Philadelphia: F.A. Davis Company. Wilson, B.A., Shannon, M.T., and Stang, C.L. (2004). Nurse’s drug guide. Upper Saddle River, New Jersey: Pearson Prentice Hall.

Question 14 A client diagnosed with cirrhosis of the liver and ascites is Answers Correct B receiving spironolactone (Aldactone). The nurse Student's B understands that this medication spares elimination of which element? A) Sodium B) Potassium C) Phosphate D) Albumin Review Information: The correct answer is B: Potassium If ascites is present in the client with cirrhosis of the liver, potassium-sparing diuretics such as Aldactone should be administered because it inhibits the action of aldosterone on the kidneys. Deglin, J.D. and Vallerand, A.H. (2001). Davis’ drug guide for nurses. (7th edition). Philadelphia: F.A. Davis Company. Wilson, B.A., Shannon, M.T., and Stang, C.L. (2004). Nurse’s drug guide. Upper Saddle River, New Jersey: Pearson Prentice Hall.

Question 15

The nurse has been teaching a client with Insulin Answers Correct D Dependent Diabetes Mellitus. Which statement by the Student's D client indicates a need for further teaching? "I use a sliding scale to adjust regular insulin to my A) sugar level." "Since my eyesight is so bad, I ask the nurse to fill B) several syringes." C) "I keep my regular insulin bottle in the refrigerator." "I always make sure to shake the NPH bottle hard to D) mix it well." Review Information: The correct answer is D: "I always make sure to shake the NPH bottle hard to mix it well." The bottle should by rolled gently, not shaken. Deglin, J.D. and Vallerand, A.H. (2001). Davis’ drug guide for nurses. (7th edition). Philadelphia: F.A. Davis Company. Wilson, B.A., Shannon, M.T., and Stang, C.L. (2004). Nurse’s drug guide. Upper Saddle River, New Jersey: Pearson Prentice Hall.

Question 16 The nurse is caring for a client receiving a blood Answers Correct A transfusion who develops urticaria one-half hour after the Student's A transfusion has begun. What is the first action the nurse should take? A) Stop the infusion B) Slow the rate of infusion C) Take vital signs and observe for further deterioration D) Administer Benadryl and continue the infusion Review Information: The correct answer is A: Stop the infusion This is an indication of an allergy to the plasma protein. The priority action of the nurse is to stop the transfusion. Smeltzer, S.C. and Bare, B.G. (2004). Medical surgical nursing. (10th edition). Philadelphia, PA. Lippincott Williams & Wilkins. Delaune, S & Lander, P. (2002). Fundamentals in Nursing: Standards and Practice. (2nd ed). Clinton Park, New York: Delmar.

Question 17

A client is recovering from a hip replacement and is taking Answers Correct D Tylenol #3 every 3 hours for pain. In checking the client, Student's B which finding suggests a side effect of the analgesic? A) Bruising at the operative site B) Elevated heart rate C) Decreased platelet count D) No bowel movement for 3 days Review Information: The correct answer is D: No bowel movement for 3 days With opioid analgesics, observe for respiratory depression, sedation, and constipation. Bruising is not related to the analgesic, but could be the result of corticosteroids or previously used anticoagulants. Elevated heart rate could be the result of bronchodilators. Some antibiotics can lower platelet count. Wilson, B.A., Shannon, M.T., and Stang, C.L. (2004). Nurse’s drug guide. Upper Saddle River, New Jersey: Pearson Prentice Hall. Key, J.L. and Hayes, E.R. (2003). Pharmacology, a nursing process approach. (4th edition). Philadelphia: Saunders.

Question 18 A client with amyotrophic lateral sclerosis has a Answers Correct D percutaneous endoscopic gastrostomy (PEG) tube for the Student's D administration of feedings and medications. Which nursing action is appropriate? A) Pulverize all medications to a powdery condition Squeeze the tube before using it to break up stagnant B) liquids Cleanse the skin around the tube daily with hydrogen C) peroxide Flush adequately with water before and after using D) the tube Review Information: The correct answer is D: Flush adequately with water before and after using the tube Flushing the tube before and after use not only provides for good flow and keeps the tube patent, it also provides water to maintain hydration. While medications should be crushed to pass through the tube, it is flushing that moves them through. Not all medications should be crushed, for example sustained release preparations should not be cut or pulverized. Stagnant liquids are reduced by flushing after tube use. Cleansing is important, but soap and water are sufficient without the added irritation of hydrogen peroxide. Smeltzer, S.C. and Bare, B.G. (2004). Medical surgical nursing. (10th edition). Philadelphia, PA. Lippincott Williams & Wilkins. Altman, G. (2004). Delmar’s Fundamental and Advanced Nursing Skills, 2nd ed. Albany, NY: Delmar.

Question 19 A client has received 2 units of whole blood today Answers Correct B following an episode of GI bleeding. Which of the Student's B following laboratory reports would the nurse monitor most closely? A) Bleeding time B) Hemoglobin and hematocrit C) White blood cells D) Platelets Review Information: The correct answer is B: Hemoglobin and hematocrit The post-transfusion hematocrit provides immediate information about red cell replacement and about continued blood loss. Smeltzer, S.C. and Bare, B.G. (2004). Medical surgical nursing. (10th edition). Philadelphia, PA. Lippincott Williams & Wilkins. Delaune, S & Lander, P. (2002). Fundamentals in Nursing: Standards and Practice. (2nd ed). Clinton Park, New York: Delmar.

Question 20 Discharge instructions for a client taking alprazolam Answers Correct B (Xanax) should include which of the following? Student's B A) Sedative hypnotics are effective analgesics Sudden cessation of alprazolam (Xanax) can cause B) rebound insomnia and nightmares Caffeine beverages can increase the effect of sedative C) hypnotics Avoidance of excessive exercise and high D) temperature is recommended Review Information: The correct answer is B: Sudden cessation of alprazolam (Xanax) can cause rebound insomnia and nightmares Sudden cessation of any medication, unless medically necessary, is ill-advised. Deglin, J.D. and Vallerand, A.H. (2001). Davis’ drug guide for nurses. (7th edition). Philadelphia: F.A. Davis Company. Wilson, B.A., Shannon, M.T., and Stang, C.L. (2004). Nurse’s drug guide. Upper Saddle River, New Jersey: Pearson Prentice Hall.

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