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Pharmacology: A Patient-Centered Nursing Process Approach, (Kee, Pharmacology) 8th Edition Test Bank

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    Chapter 1: Drug Action: Pharmaceutic, Pharmacokinetic, and Pharmacodynamic Phases Kee: Pharmacology, 7th Edition Chapter 1: Drug Action: Pharmaceutic, Pharmacokinetic, and Pharmacodynamic Phases Test Bank MULTIPLE CHOICE 1. A nurse is providing an oral medication for pain relief to a client. To attain the fastest pain relief, the nurse administers the medication so that it is most rapidly absorbed from the gastrointestinal (GI) tract. Which mode of delivery has the fastest absorption? a. Tablet b. Enteric - coated pill c. Capsule d. Liquid suspension ANS: D Drugs must be in solution to be absorbed in the gastrointestinal tract. Because liquid drugs are already in solution, they are absorbed faster than drugs in a solid form. DIF: Cognitive Level: Application REF: p. 3 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A client asks why she needs to take a medication on an empty stomach. The nurse explains that food generally has which effect on drug dissolution and absorption? a. Enhances b. Increases c. Decreases

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    d. Does not have an effect ANS: C Food in the GI tract can interfere with the dissolution and absorption of some drugs. However, there are specific drugs that should be taken with food to enhance absorption. DIF: Cognitive Level: Application REF: p. 4 TOP: Nursing Process: Intervention/Teaching MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 3. Biotransformation is affected by many factors. What happens to the client’s drug metabolism when liver function is decreased? a. The client can develop toxicity. b. The client will have an enhanced therapeutic response. c. The client may require a larger than normal dose of the medication. d. The client will experience a decreased therapeutic response. ANS: A When the drug metabolism rate is decreased, excess drug accumulation can occur and lead to the client’s developing toxicity. The GI membrane is made up of lipids; therefore, lipid medications are most easily absorbed across the digestive membrane of the stomach. Medications that are nonionized (neither positive nor negative) also pass through the GI membrane faster than those with a charge. DIF: Cognitive Level: Application REF: p. 6 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A client asks why the oral dose of her pain medication is higher than the intravenous dose. The nurse explains that with the oral dose, only 20% to 40% of the drug may actually enter systemic circulation. This reduces the amount of active drug. What is the term for this effect? a. Protein binding b. Bioavailability c. Hepatic first pass

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    d. Pinocytosis ANS: B Bioavailability is the percentage of the administered drug dose that reaches the systemic circulation. Oral drugs that have a high first-pass hepatic metabolism may have a bioavailability of only 20% to 40% on entering systemic circulation. To obtain the desired drug effect, the oral dose could be three to five times larger than the drug dose for IV use. DIF: Cognitive Level: Comprehension REF: p. 4 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 5. When providing a medication, which route should the nurse select to ensure the maximum amount of bioavailability? a. Oral b. Intravenous c. Intramuscular d. Subcutaneous ANS: B The percentage of bioavailability for the oral route is always less than 100%, but for the intravenous route it is usually 100%. DIF: Cognitive Level: Comprehension REF: p. 4 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 6. A client is being given two highly protein-bound drugs concurrently. What is most likely to be the result of this administration? a. More free drug in circulation b. Less free drug in circulation c. More drug bound to protein d. More drug excreted in the urine ANS: A

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    When two highly protein-bound drugs are given concurrently, they compete for protein-binding sites, causing more free drug to be released into the circulation. Drug accumulation and possible drug toxicity can result. DIF: Cognitive Level: Application REF: p. 5 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 7. A client is taking a drug that is moderately highly protein bound. Several days later, the client takes a second drug that is 90% protein bound. What is most likely to have occurred as a result of this administration? a. The first drug remains protein bound. b. The first drug becomes increasingly inactive. c. The first drug is released fro m the protein and becomes more pharmacologically active. d. The second drug becomes more active. ANS: C Only drugs not bound to protein are active and can cause a pharmacologic response. As the free drug in the circulation decreases, more bound drug is released from the protein to maintain the balance of free drug. DIF: Cognitive Level: Application REF: p. 5 TOP: Nursing Process: Active MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 8. A nurse is determining whether a medication is ordered to be given at the appropriate intervals. This is done by assessing the half-life of the medication. The serum half-life (t ) of a drug is the time required: a. for half of a drug dose to be absorbed. b. after absorption for ha lf of the drug to be eliminated. c. for a drug to be achieve maximum effectiveness. d. for half of the drug dose to be completely distributed. ANS: B The half-life (t ) of a drug is the time it takes for one half of the drug concentration to be eliminated.

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    DIF: Cognitive Level: Comprehension REF: pp. 5-6 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A client is to receive a drug that has a half-life of 36 hours. The drug would probably be administered on which dose schedule? a. Once a week b. Once a day c. Twice a day d. Three times a day ANS: B Since the medication requires 36 hours to be eliminated from the body, a once-daily dosing pattern would allow therapeutic drug levels to be maintained. DIF: Cognitive Level: Analysis REF: pp. 5-6 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A client is suffering from end-stage renal disease. Because of this condition, the nurse monitors drug levels to assess for which phenomenon? a. Toxicity b. Subtherapeutic levels c. Drug ineffectiveness d. Poor compliance ANS: A The primary route for drug elimination is the renal system. If kidney function is impaired, drugs may reach toxic levels. DIF: Cognitive Level: Comprehension REF: pp. 6-7 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A client’s creatinine clearance level is 105 mL/min. Based on this information, what type of change in his medication should the nurse anticipate?

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    a. Increased dosage b. Decreased dosage c. Unchanged dosage d. Dosage withheld ANS: C This is a normal creatinine clearance level (normal level is 85 to 135 mL/min); therefore the dose would be unchanged. DIF: Cognitive Level: Analysis REF: pp. 6-7 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 12. Isoproterenol (Isuprel) is an example of a medication that enhances the beta receptors in the body. What is the term for drugs that stimulate a response? a. Antagonists b. Agonists c. Depressants d. Therapeutic effect ANS: B An agonist is a drug that produces a response. DIF: Cognitive Level: Comprehension REF: p. 8 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 13. A nursing role is to teach clients to watch for adverse medication reactions. The client should be able to recognize what about adverse reactions? a. They are mild, easily treatable side effects. b. They are therapeutic, expected effects. c. They are undesired effects that may be severe. d. They are the desired therapeutic effects. ANS: C Adverse reactions are a range of untoward effects (unintended and occurring at normal doses) of drugs that cause mild-to-severe side effects, including anaphylaxis

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    (cardiovascular collapse). Adverse reactions are always undesirable and must always be reported and documented because they represent variances from planned therapy. DIF: Cognitive Level: Comprehension REF: p. 10 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 14. The nurse teaches the client that undesired effects are frequently associated with a client stopping a medication before completion of the full course. The nurse should also instruct the client that physiologic effects not related to the desired effect, which can be predicted or associated with the use of the drug, may also occur. What should the client recognize about these physiologic effects? a. They are severe adverse reactions. b. They are side effects. c. They are synergistic effects. d. They are toxic effects. ANS: B Some side effects are expected as part of drug therapy. The occurrence of these expected but undesirable side effects is not a reason to discontinue therapy. The nurse’s role includes teaching clients to report any side effects. It is important to know that the occurrence of side effects is one of the primary reasons clients stop taking the prescribed medication. DIF: Cognitive Level: Application REF: p. 10 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 15. A nurse is learning how to draw peak and trough levels of a medication. In order to draw them correctly, the nurse should know what the trough level is. The trough level is the __________ of a drug. a. minimum effective concentration b. highest plasma concentration c. lowest plasma concentration d. rate of absorption

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    ANS: C The trough drug level is the lowest plasma concentration of a drug, and it measures the rate at which the drug is eliminated. DIF: Cognitive Level: Comprehension REF: p. 9 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 16. The client is receiving frequent daily drug dosing of a drug that has a long duration of action. What should the nurse expect to be the result of this administration? a. Drug accumulation and possible drug toxicity b. Increased drug excretion c. Enhanced therapeutic response d. Increased drug half - life ANS: A When the drug level exceeds the therapeutic range, toxic effects are likely to occur from overdosing or drug accumulation. Medications with a long half-life and frequent dosing may build up in the system or accumulate and lead to toxic effects. DIF: Cognitive Level: Analysis REF: p. 10 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 17. The nurse notes that the client is rapidly developing a decreased response to a medication. This decreased response is known as: a. pharmacogenetics. b. tachyphylaxis. c. drug accumulation. d. drug toxicity. ANS: B Tachyphylaxis refers to a rapid decrease in response to the drug. DIF: Cognitive Level: Comprehension REF: p. 11 TOP: Nursing Process: Analysis

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    MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 18. Because of hereditary influence, drug action may vary from a predicted drug response. This variance is known as: a. biotransformation. b. tachyphylaxis. c. pharmacoge netics. d. transcription factors. ANS: C Pharmacogenetics is the effect of a drug action that varies from a predicted drug response because of genetic factors or hereditary influence. DIF: Cognitive Level: Comprehension REF: p. 11 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 19. The nurse is monitoring a patient prescribed an aminoglycoside antibiotic for toxicity. Which nursing intervention is indicated when administering this medication? a. Ensure that the client voids before administration. b. Have emergency airway equipment at the bedside. c. Monitor blood levels of the medication. d. Determine liver function before each dose. ANS: C For those drugs with a narrow therapeutic index, such as aminoglycoside antibiotics and anticonvulsants, the therapeutic ranges are closely monitored. DIF: Cognitive Level: Analysis REF: p. 10 TOP: Nursing Process: Planning MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 20. The nurse sees that the client has been prescribed a loading dose of medication. What effect should the nurse expect to result from the client receiving a loading dose? a. A rapid maximum effective concentration b. Maintenance dose the lowest plasma concentration of the drug

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    c. Therapeutic dose the highest plasma concentration of the drug d. A rapid minimum effective concentration ANS: D When immediate drug response is desired, a large initial dose, known as the loading dose, of drug is given to achieve a rapid minimum effective concentration in the plasma. After a large initial dose, a prescribed dosage per day is ordered. DIF: Cognitive Level: Analysis REF: pp. 9-1 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 21. The nurse receives the results of laboratory testing and sees that the level of valproic acid in the client’s blood is 78 mcg/mL. What is the nurse’s most appropriate response? a. The nurse must call the physician immediately; this is a toxic level of medication. b. He or she must do nothing; this is a therapeutic level of medication. c. He or she must call the physician; this is a dangerously high level of medication. d. The nurse must do nothing; this is a subnormal level of medication. ANS: B The therapeutic range for valproic acid is 50 to 100 mcg/mL. DIF: Cognitive Level: Analysis REF: p. 10 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 22. The nurse is caring for a client who needs to have a peak drug level drawn. He was given the oral medication 30 minutes ago. What is the best action on the part of the nurse? a. Call the lab to have the medicatio n level drawn immediately. b. Arrange for the level to be drawn tomorrow since the peak time has passed. c. Wait for at least another 30 minutes before calling to have the level drawn. d. Schedule the level to be drawn in 8 hours. ANS: C The peak drug level for an oral drug can be 1 to 3 hours after drug administration.

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    DIF: Cognitive Level: Application REF: p. 9 TOP: Nursing Process: Planning MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 23. The client has been prescribed digoxin. Before administering the drug on a routine basis to the client, the nurse should recognize that the client should receive a _____ dose. a. therapeutic b. peak c. trough d. loading ANS: D Digoxin requires a loading dose when first prescribed. DIF: Cognitive Level: Application REF: pp. 9-10 TOP: Nursing Process: Planning MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 24. The client has been placed on an enteric-coated medication. An appropriate action on the part of the nurse is to instruct the client to __________ the medication. a. weigh herself at the same time every day while on b. drink at least eight glasses of water daily while on c. adhere to a low - sodium diet while on d. a void eating fatty food before taking ANS: D Fatty foods decrease the absorption rate of enteric-coated tablets. DIF: Cognitive Level: Application REF: pp. 11-12 TOP: Nursing Process: Planning MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 2: Nursing Process and Client Teaching

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    Kee: Pharmacology, 7th Edition Chapter 2: Nursing Process and Client Teaching Test Bank MULTIPLE CHOICE 1. Which is the sequence of steps in the nursing process? a. Implementation, evaluation, planning, assessment b. Planning, assessment, implementation, evaluation c. Assessment, planning, implementation, evaluation d. Evaluation, implementation, assessment, planning ANS: C The four phases of the nursing process are assessment, planning, implementation, and evaluation. DIF: Cognitive Level: Comprehension REF: pp. 14-15 TOP: Nursing Process: All MSC: CONTENT CATEGORY: Management of Care 2. The client’s knowledge base about the drugs used is part of the: a. plan. b. analysis. c. subjective database. d. objective database. ANS: C The client’s knowledge about a drug and its side effects would be part of the subjective database. DIF: Cognitive Level: Comprehension REF: p. 15 TOP: Nursing Process: Assessment MSC: CONTENT CATEGORY: Health Promotion and Maintenance 3. Attainment of goals is associated with which phase of the nursing process? a. Implementation b. Planning c. Assessment d. Evaluation ANS: D

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    The effectiveness of health teaching about drug therapy and the attainment of goals are associated with evaluation. DIF: Cognitive Level: Comprehension REF: pp. 19-20 TOP: Nursing Process: Evaluation MSC: CONTENT CATEGORY: Management of Care 4. During which phase of the nursing process would the nurse identify client perceptions and expectations of the drug’s effectiveness? a. Planning b. Assessment c. Evaluation d. Implementation ANS: B This information consists of subjective data. DIF: Cognitive Level: Comprehension REF: p. 15 TOP: Nursing Process: Assessment MSC: CONTENT CATEGORY: Management of Care 5. The nurse is establishing goals for a client related to medication administration. Which of the phases of the nursing process is characterized by goal setting? a. Planning b. Evaluation c. Implementation d. Assessment ANS: A The planning phase of the nursing process is characterized by goal setting or expected outcomes. DIF: Cognitive Level: Comprehension REF: p. 16 TOP: Nursing Process: Planning MSC: CONTENT CATEGORY: Management of Care 6. During which phase of the nursing process will the nurse include nursing actions or interventions necessary to accomplish expected outcomes? a. Assessment b. Planning

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    c. Implementation d. Evaluation ANS: C The implementation phase of the nursing process includes the nursing actions/interventions necessary to accomplish the established goals or expected outcomes. DIF: Cognitive Level: Comprehension REF: pp. 16-19 TOP: Nursing Process: Implementation MSC: CONTENT CATEGORY: Management of Care 7. Which is a correctly written goal? a. The client will independently administer a prescribed dose of antibiotic by the end of the fir teaching session. b. The client will learn to take an antibiotic correctly. c. The client will administer a prescribed dose. d. The client will know how to administer antibiotics. ANS: A The goal should be client centered, have a realistic deadline, be measurable, and contain components for evaluation. DIF: Cognitive Level: Application REF: p. 16 TOP: Nursing Process: Planning MSC: CONTENT CATEGORY: Management of Care 8. Upon physical assessment, a nurse notes that a client has visual impairment. The nurse is concerned that the client’s visual changes may affect her ability to self- administer medications. Which nursing diagnosis best describes this situation? a. Risk for ineffective therapeutic regimen management related to medication secondary to vi impairment b. Deficient knowledge related to medication administration c. Ineffective family therapeutic regimen management related to visual impairment d. Ineffective coping related to lack of ability to self - administer medications ANS: A The nurse would need more information to determine whether an actual nursing diagnosis exists. This diagnosis would best represent this problem. DIF: Cognitive Level: Analysis REF: p. 16

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    TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Management of Care 9. During assessment, a client reports a reaction to a medication. What is the next nursing intervention? a. Let the physician know that the client cannot receive the medication. b. Ask the client the type of reaction experienced. c. Reassure the client that the reaction will not occur again. d. Note the comment in the client’s chart and give the medication. ANS: B It is important for the nurse to know what type of reaction occurred in order to plan action. DIF: Cognitive Level: Application REF: p. 15 TOP: Nursing Process: Assessment MSC: CONTENT CATEGORY: Management of Care 10. A nurse is caring for a client who takes a chewable medication. The client does not take the medication because his teeth and gums have pain when chewing. The nurse establishes the following nursing diagnosis for the client: impaired dentition related to chronic gum inflammation secondary to poor dental hygiene. Which nursing goal is most appropriate for the client? a. The client will verbalize the pathophysiology of gum disease. b. The client will demonstrate the procedure for brushing teeth. c. The client will understand the need for dental hygiene. d. The client will discuss the reasons dental hygiene is important. ANS: B An important intervention would be to teach the client how to take care of his teeth, which would alleviate the pain and allow for greater adherence to the medication regimen. DIF: Cognitive Level: Application REF: p. 16 TOP: Nursing Process: Planning MSC: CONTENT CATEGORY: Management of Care

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    11. A nurse is teaching a client about a medication that is scheduled to be administered q.i.d. The client states that she does not use a watch or clock and lives without a daily routine. Which teaching would be most helpful for the client? a. Instruct the client to take the medication each morning and evening when brushing her teeth b. Teach the client to take the medication at lunch every day. c. Provide the client with a watch to ensure she takes the medication at correct times. d. Instruct the client to take the medication with meals and at bedtime each day. ANS: D For a client who is not time oriented and needs to take the medication 4 times a day, this is the only answer that is feasible. DIF: Cognitive Level: Application REF: pp. 17-19 TOP: Nursing Process: Intervention/Teaching MSC: CONTENT CATEGORY: Health Promotion and Maintenance 12. A nurse is teaching a client about his medications. In his care plan, a previous nurse indicated that the client was a visual learner. Which teaching strategy would be indicated for this client? a. Pamphlets or videos about the medication b. Opportunities for practicing the administration of medication c. A discussion about the medication d. An audiotape describing the medication and its actions ANS: A A visual learner would respond best to teaching strategies that can be seen (e.g., pamphlets, videos). DIF: Cognitive Level: Application REF: pp. 17-19 TOP: Nursing Process: Planning MSC: CONTENT CATEGORY: Health Promotion and Maintenance 13. A nurse is establishing a plan of care for a client who has been ordered to receive antibiotic therapy. The client does not read English but is able to understand spoken English. She is of a lower-income socioeconomic group. Which strategy would be most appropriate for teaching this client? a. Provide a video going over the information. b. Give the client several pamphlets and asking her to go over them with her family.

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    c. Provi de a teaching sheet with simple words and pictures. d. Arrange a quiet time to discuss the medication regimen with the client. ANS: D This strategy takes both the client’s strengths and cultural factors into account. DIF: Cognitive Level: Application REF: pp. 17-19 TOP: Nursing Process: Planning MSC: CONTENT CATEGORY: Management of Care 14. A client with AIDS-defined disease is ordered to receive two different medications. The primary care nurse notes that he has not been taking his medications as ordered. The client says, “I don’t like the side effects of the drugs.” Which is an appropriate nursing diagnosis? a. Knowledge deficit related to progression of the AIDS disease b. Grieving related to diagnosis of terminal disease c. Risk for infection related to impaired immune function d. Noncompliance related to medication side effects and lack of knowledge ANS: D This nursing diagnosis reflects analysis of the client subjective data. DIF: Cognitive Level: Analysis REF: p. 15 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Management of Care 15. The nurse is working with an Asian client to provide instruction regarding his medication regimen. The nurse is planning to provide the client with pamphlets to take with him as part of the follow-up to his instructional sessions. What is the most appropriate action on the part of the nurse? a. Make prolonged eye contact with the client. b. Use both hands as a show of respect. c. Show flexibility in making follow - up appointments. d. Speak clearly in a loud voice. ANS: B Use both hands to show respect when offering a prescription, instructions, or pamphlets to Asians and Pacific Islanders. DIF: Cognitive Level: Application REF: p. 18

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    TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Management of Care 16. The nurse has decided to add a nursing diagnosis to the client’s drug therapy plan of care that represents wellness/health promotion. What is the most appropriate diagnosis to add to promote these areas? a. Ineffective health maintenance related t o not having recommended preventive care b. Risk for injury related to side effect if drugs c. Therapeutic regimen management, readiness for enhanced d. Ineffective therapeutic regimen management related to lack of finances ANS: C This is the only diagnosis that would be classified as promoting wellness/health. DIF: Cognitive Level: Comprehension REF: p. 16 TOP: Nursing Process: Assessment MSC: CONTENT CATEGORY: Health Promotion and Maintenance Chapter 3: Medication Safety Kee: Pharmacology, 7th Edition Chapter 3: Medication Safety Test Bank MULTIPLE CHOICE 1. What is the importance of the nurse practicing the “5 -plus-5 rights” of drug administration? a. They ensure correct mixing of the drug. b. They ensure safe drug administration. c. They ensure time - saving administration. d. They ensure adequate knowledge about the drug. ANS: B The “5 -plus- 5” rights ensure that the nurse has considered all of the details of safe medication administration. DIF: Cognitive Level: Comprehension REF: pp. 23-27 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

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    2. “Give Tylenol 650 mg q3-4h as needed for headache” is an example of which category of drug order? a. Standing drug order b. One - time drug order c. PRN d. STAT ANS: C PRN means to administer the drug on an as-needed basis. DIF: Cognitive Level: Comprehension REF: p. 25 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 3. A nurse is administering a medication to a client. The nurse tells the client the rationale for the medication. This nurse is observing which client right? a. The right to informed consent b. The righ t to permission c. The right to ethics d. The right to autonomy ANS: A To observe a client’s right to informed consent, the nurse must give the client the knowledge necessary to make an appropriate decision. DIF: Cognitive Level: Comprehension REF: p. 26 TOP: Nursing Process: Intervention/Teaching MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A nurse is ordered to administer a medication via the sublingual route. The nurse correctly places the medication: a. in the buccal mucosa. b. under the tongue. c. between the teeth and gums. d. in a cup of water to dissolve. ANS: B

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    Sublingual means under the tongue. DIF: Cognitive Level: Comprehension REF: p. 26 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is calculating the dosage of a drug to administer. Once the dosage has been calculated, what is the most important action on the part of the nurse? a. Contact the pharmacist for dosage confirmation. b. Check the identity of the patient three times. c. Recalculate the drug dose and check with another nurse. d. Check the American Hospital Formulary for drug doses. ANS: C After calculating the drug dose, when in doubt, recalculate the drug dose and check with another nurse. DIF: Cognitive Level: Analysis REF: p. 24 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is preparing to administer tetracycline to the client. What is the most appropriate time for the client to receive this medication? a. One hour before dinner in the evening b. With breakfast in the morning c. With a late - afternoon snack d. Directly after lunch in the mid - afternoon ANS: A Tetracycline is a drug that is affected by food; therefore, it should be given before meals. DIF: Cognitive Level: Analysis REF: p. 25 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

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    7. The nurse checks the expiration date on the medication to be administered and finds that the drug expired 2 days ago. What is the most appropriate action on the part of the nurse? a. Hold one dose of the medication. b. Return the medication to the pharmacy. c. Contact the physician for orders. d. Administer the drug but monitor the client. ANS: B When a medication is found to have expired, discard it or return it to the pharmacy. DIF: Cognitive Level: Analysis REF: p. 25 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse notes that the client is scheduled to receive a dose of potassium. What is the most appropriate time for the client to receive this medication? a. Directly after dinner in the evening b. One hour before lunch in late morning c. With water only in the late afternoon d. First thing after rising in the morning ANS: A Potassium is a drug that can irritate the stomach. Therefore it should be given after meals. DIF: Cognitive Level: Analysis REF: p. 25 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The nurse verifies that he is using only standardized abbreviations in documenting medication information. He recognizes that this fulfills which of the National Patient Safety Goals? a. Improve the accuracy of patient identification. b. Improve the effectiveness of communication among caregivers. c. Improve the safety of using medications.

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    d. Accurately and completely reconcile medications across the continuum of care. ANS: B The use of standardized abbreviations fulfills the goal of improving the effectiveness of communication among caregivers. DIF: Cognitive Level: Analysis REF: pp. 27-29 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse ensures that she provides the next nurse taking over the care of her client with a complete list of his medications since the next nurse is newly admitted to that unit. She recognizes that this fulfills which of the National Patient Safety Goals? a. Improve the accuracy of patient identification b. Improve the effectiveness of communication among caregivers c. Improve the safety of using medications d. Accurately and completely reconcile medications across the continuum of care ANS: D Communicating a complete list of the client’s medications to the next provider ensures that the goal of accurately and completely reconciling the medications across the continuum of care. DIF: Cognitive Level: Analysis REF: pp. 27-29 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The client is scheduled to receive Protonix as part of his medication regimen. The most important teaching intervention to be implemented by the nurse is to instruct the client: a. on the proper way to split the tablet. b. to crush the tablet before swallowing. c. to avoid crushing the tablet. d. to swallow the tablet with a minimum of water. ANS: C Protonix is a medication that should never be crushed.

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    DIF: Cognitive Level: Analysis REF: p. 30 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The client has been on an oral dose of a medication. The nurse recognizes that the client is experiencing difficulty swallowing. What is the most important action on the nurse’s part? a. Crush the medication and mix it with water. b. Split the medication in half and mix it in jelly. c. Call the physician for a liquid version of the medication. d. Tell the pharmacy to hold the medication until further notice. ANS: C A major part of assessing the client is assessing his ability to swallow when he is scheduled to receive oral medications. DIF: Cognitive Level: Analysis REF: pp. 30-31 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is caring for an older adult client who is scheduled to receive a dose of barbiturates. Based on the nurse’s knowledge of how the older adult client responds to these medications, the nurse should expect the dosage to be: a. lower than normal. b. higher than normal. c. divided in half. d. unchanged. ANS: A Infants as well as older adults are more sensitive to drugs, with the elderly being hypersensitive to barbiturates. DIF: Cognitive Level: Analysis REF: p. 32 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

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    14. The nurse is calculating a dosage of medication for an infant. The nurse recognizes that the dosage is based on the infant’s: a. biological age. b. weight in pounds. c. gestational age. d. weight in kilograms. ANS: D Infant doses are calculated on the basis of weight in kilograms. DIF: Cognitive Level: Application REF: p. 32 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 15. The nurse is caring for a thin-framed adult who is scheduled to receive multiple doses of antineoplastic medication. The nurse should expect the dosage for this person to be: a. lower than normal. b. higher than normal. c. divided in half. d. unchanged. ANS: A Drug doses of antineoplastic medications are usually ordered according to body weight. DIF: Cognitive Level: Application REF: p. 32 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 4: Medication Administration Kee: Pharmacology, 7th Edition Chapter 4: Medication Administration Test Bank

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    MULTIPLE CHOICE 1. The nurse is preparing to administer an intramuscular injection to an infant. What is the most accurate site for the nurse to select for this administration? a. Ventrogluteal b. Vastus lateralis c. Dorsogluteal d. Deltoid ANS: B The vastus lateralis is the most appropriate site to utilize for an IM injection in an infant. DIF: Cognitive Level: Comprehension REF: p. 44 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 2. What is an appropriate nursing intervention to use to meet the psychiatric needs of a hospitalized infant? a. Move slowly while conducting care. b. Explain procedures carefully. c. Use the oral route for medications. d. Allow the child to express feelings. ANS: A The nurse should move slowly and maintain a nonthreatening attitude in order to prevent stranger anxiety from developing in the infant. DIF: Cognitive Level: Application REF: p. 45 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 3. During administration of eye drops, the nurse should teach the client to prevent systemic absorption of the drug by performing which action? a. Use the ointment form of the drug. b. Apply the drug directly on th e cornea. c. Have the client look straight ahead.

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    d. Gently press on the lacrimal duct. ANS: D By applying pressure on the inner canthus of the eye, the medication is less likely to be systemically absorbed. DIF: Cognitive Level: Application REF: p. 37 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A nurse is preparing to administer a deep IM injection to a client. Which site is suited for a deep IM injection? a. Abdomen b. Dorsogluteal c. Deltoid d. Vastus lateralis ANS: B The dorsogluteal site is suited for deep IM or Z-track injections. DIF: Cognitive Level: Comprehension REF: p. 44 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 5. A nurse administers an injection using the Z-track method. The nurse instructs the patient that the Z-track technique is designed to accomplish what? a. Allow the client to accept at leas t 5 mL of medication. b. Prevent medication from leaking into subcutaneous tissue. c. Decrease the possibility of “self - sticks.” d. Take less time to administer. ANS: B The Z-track method displaces the tissue during medication injection and replaces the tissue when withdrawn. This prevents leaking. DIF: Cognitive Level: Comprehension REF: p. 44 TOP: Nursing Process: Intervention/Implementation

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    MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 6. A nurse is applying nitroglycerin ointment to a client. When applying medication topically, what is the highest priority nursing intervention? a. Apply medication liberally. b. Avoid contact of the medication with the nurse’s skin. c. Massage the area. d. Have cli ent apply medication. ANS: B Because this medication is topically absorbed, contact with the nurse’s skin may cause the nurse to feel the effects of the medication. DIF: Cognitive Level: Application REF: p. 37 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 7. A nurse prepares to administer an ear medication to a 2-year-old child. What is the correct action by the nurse? a. Position the child w ith the ear down on the bed. b. Pull the ear upward and backward. c. Put the child in high - Fowler’s position. d. Pull the ear downward and backward. ANS: D This is the correct method for a child younger than 3 years. For a child older than 3 years, the ear is pulled up and back. DIF: Cognitive Level: Application REF: p. 38 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is teaching the client how to administer a sublingual tablet in the home setting. What is the highest priority instruction? a. Take nothing by mouth for one hour before taking the medication. b. Avoid taking fluid with the medication.

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    c. Gently place the tablet between the teeth and gums. d. Take the medication with food so as to avoid gastrointestinal irritation. ANS: B Food and fluids should be avoided when taking a sublingual tablet to avoid moving the tablet from under the sublingual region. DIF: Cognitive Level: Application REF: p. 36 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A client has been using his inhaler at home. He tells the nurse that “the medication doesn’t seem to work as well as it did.” What should the nurse assess for first? a. Tolerance to the medication b. Unhealthy drug - seeking behaviors c. Physical addiction d. Poor tolerance of pain ANS: A Overuse of the medication can lead to the development of tolerance. DIF: Cognitive Level: Analysis REF: p. 40 TOP: Nursing Process: Assessment MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A client with chronic angina is ordered to receive nitroglycerin via patch. What is the highest priority nursing action regarding this method of administration? a. Cut the patch to provide the correct dose of medication. b. Use sterile technique when applying the patch. c. Remove the old patch before applying the new patch. d. Cover the pa tch with an airtight dressing after application. ANS: C The old patch must be removed before the new patch is applied in order to prevent overdosing the client and also to prevent irritation to the skin. DIF: Cognitive Level: Application REF: pp. 36-37 TOP: Nursing Process: Intervention/Implementation

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    MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A nurse is administering an intradermal PPD to test for client exposure to the tuberculosis bacterium. Which method is the correct one for administering this injection? a. Use a 5 - degree angle to insert a 20 - gauge needle. b. Use a 10 - degree angle to insert a 25 - gauge needle. c. Use a 45 - degree angle to insert a 26 - gauge needle. d. Use a 90 - degree angle to insert an 18 - gauge needle. ANS: B This is the correct procedure for an intradermal injection. DIF: Cognitive Level: Analysis REF: p. 41 TOP: Nursing Process: Intervention/Implementation MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A client returns to the nursing unit from conscious sedation after having a fracture set and placed in a cast. The client expresses pain 3 hours after the procedure. The choice of medication and route will be based on which information? a. The client should not receive pain medication because of his previous sedation. b. The client will need to void before receiving any pain medication in order to avoid urinary retention. c. The client should receive intravenous medication only for pain because of the operative pro d. The client’s ability to swallow should be evaluated before he or she receives oral medicatio ANS: D Before providing oral medication, it is essential for the nurse to evaluate the client’s level of consciousness and ability to swallow. DIF: Cognitive Level: Analysis REF: p. 36 TOP: Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is preparing to administer a subcutaneous injection of morphine sulfate (MSO4) to a client. The client’s height, weight, and muscle mass are within normal limits. What are the appropriate needle size and angle for this injection?

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    a. 27 - gauge needle, 10 - degree angle b. 20 - gauge needle, 90 - degree a ngle c. 23 - gauge needle, 20 - degree angle d. 25 - gauge needle, 45 - degree angle ANS: D This is the correct angle and size for a subcutaneous injection. DIF: Cognitive Level: Application REF: pp. 41-42 TOP: Nursing Process: Intervention MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. The nurse is preparing to administer an ointment to the client’s eye and is gathering the needed supplies. What supplies are needed to complete this task? (Select all that apply.) a. Clean gloves b. Medication ointment c. Sterile gauze d. Sterile gloves e. 30 - mL syringe f. 5 - mL syringe g. Tissues ANS: A, B, C, G Although the eyes are considered sterile, clean gloves are all that are needed, and care should be taken to keep the medication sterile. The syringes are not needed. The sterile gauze is needed in case the eye must be touched. The tissues allow for removal of excess medication. DIF: Cognitive Level: Application REF: p. 38 TOP: Nursing Process: Intervention MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

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