Test Bank for Lilley's Pharmacology for Canadian Health Care Practice, 4th Edition (Chapters 1-58)
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1 Chapter 01: Nursing Practice in Canada and Drug Therapy Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which is a judgement about a particular patient’s potential need or problem? a. A goal b. An assessment c. Subjective data d. A nursing diagnosis ANS: D Nursing diagnosis is the phase of the nursing process during which a clinical judgement is made about how a patient responds to heath conditions and life processes or vulnerability for that response. DIF: Cognitive Level: Knowledge 2. The patient is to receive oral furosemide (Lasix) every day; however, because the patient is unable to swallow, he cannot take medication orally, as ordered. The nurse needs to contact the physician. What type of problem is this? a. A “right time” problem b. A “right dose” problem c. A “right route” problem d. A “right medication” problem ANS: C This is a “right route” problem: the nurse cannot assume the route and must clarify the route with the prescriber. This is not a “right time” problem because the ordered frequency has not changed. This is not a “right dose” problem because the dose is not related to an inability to swallow. This is not a “right medication” problem because the medication ordered will not change, just the route. DIF: Cognitive Level: Application 3. The nurse has been monitoring the patient’s progress on his new drug regimen since the first dose and has been documenting signs of possible adverse effects. What nursing process phase is the nurse practising? a. Planning b. Evaluation c. Implementation d. Nursing diagnosis ANS: B Monitoring the patient’s progress is part of the evaluation phase. Planning, implementation, and nursing diagnosis are not illustrated by this example. DIF: Cognitive Level: Application 4. The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes mellitus. Which statement best illustrates an outcome criterion for this patient? a. The patient will follow instructions. b. The patient will not experience complications. c. The patient adheres to the new insulin treatment regimen. d. The patient demonstrates safe insulin self-administration technique. ANS: D Having the patient demonstrate safe insulin self-administration technique is a specific and measurable outcome criterion. Following instructions and avoiding complications are not specific criteria. Adherence to the new insulin treatment regimen is not objective and would be difficult to measure. DIF: Cognitive Level: Application 5. Which activity best reflects the implementation phase of the nursing process for the patient who is newly diagnosed with type 1 diabetes mellitus? a. Providing education regarding self-injection technique b. Setting goals and outcome criteria with the patient’s input c. Recording a history of over-the-counter medications used at home d. Formulating nursing diagnoses regarding knowledge deficits related to the new treatment regimen ANS: A Education is an intervention that occurs during the implementation phase. Setting goals and outcome criteria reflects the planning phase. Recording a drug history reflects the assessment phase. Formulating nursing diagnoses regarding a knowledge deficit reflects analysis of data as part of the planning phase. DIF: Cognitive Level: Analysis lOMoARcPSD|13778330
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2 6. The nurse is working during a very busy night shift, and the health care provider has just given the nurse a medication order over the telephone, but the nurse does not recall the route. What is the best way for the nurse to avoid medication errors? a. Recopy the order neatly on the order sheet, with the most common route indicated b. Consult with the pharmacist for clarification about the most common route c. Call the health care provider to clarify the route of administration d. Withhold the drug until the health care provider visits the patient ANS: C If a medication order does not include the route, the nurse must ask the health care provider to clarify it. Never assume the route of administration. DIF: Cognitive Level: Application | Cognitive Level: Analysis 7. Which constitutes the traditional Five Rights of medication administration? a. Right drug, right route, right dose, right time, and right patient b. Right drug, the right effect, the right route, the right time, and the right patient c. Right patient, right strength, right diagnosis, right drug, and right route d. Right patient, right diagnosis, right drug, right route, and right time ANS: A The traditional Five Rights of medication administration were considered to be Right drug, Right route, Right dose, Right time, and Right patient. Right effect, right strength, and right diagnosis are not part of the traditional Five Rights. DIF: Cognitive Level: Comprehension 8. What correctly describes the nursing process? a. Diagnosing, planning, assessing, implementing, and finally evaluating b. Assessing, then diagnosing, implementing, and ending with evaluating c. A linear direction that begins with assessing and continues through diagnosing, planning, and finally implementing d. An ongoing process that begins with assessing and continues with diagnosing, planning, implementing, and evaluating ANS: D The nursing process is an ongoing, flexible, adaptable, and adjustable five-step process that begins with assessing and continues through diagnosing, planning, implementing, and finally evaluating, which may then lead back to any of the other phases. DIF: Cognitive Level: Application 9. When the nurse is considering the timing of a drug dose, which is most important to assess? a. The patient’s identification b. The patient’s weight c. The patient’s last meal d. Any drug or food allergies ANS: C The pharmacokinetic and pharmacodynamic properties of the drug need to be assessed with regard to any drug–food interactions or compatibility issues. The patient’s identification, weight, and drug or food allergies are not affected by the drug’s timing. DIF: Cognitive Level: Application 10. The nurse is writing nursing diagnoses for a plan of care. Which reflects the correct format for her nursing diagnosis? a. Anxiety b. Anxiety related to new drug therapy c. Anxiety related to anxious feelings about drug therapy, as evidenced by statements such as “I’m upset about having to give myself shots” d. Anxiety related to new drug therapy, as evidenced by statements such as “I’m upset about having to give myself shots” ANS: D Formulation of nursing diagnoses is usually a three-step process. The only complete answer is “Anxiety related to new drug therapy, as evidenced by statements such as ‘I’m upset about having to give myself shots.’” The answer “Anxiety” is missing the “related to” and “as evidenced by” portions. The answer “Anxiety related to new drug therapy” is missing the “as evidenced by” portion of defining characteristics. The “related to” section in “Anxiety related to anxious feelings about drug therapy, as evidenced by statements such as ‘I’m upset about having to give myself shots’” is simply a restatement of the problem “anxiety,” not a separate factor related to the response. DIF: Cognitive Level: Analysis OTHER 1. Place the phases of the nursing process in the correct order, starting with the first phase. a. Planning b. Evaluation c. Assessment d. Implementation e. Diagnosing ANS: C, E, A, D, B DIF: Cognitive Level: Analysis lOMoARcPSD|13778330
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1 Chapter 02: Pharmacological Principles Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient is receiving two different drugs, which, at their current dose forms and dosages, are both absorbed into the circulation in identical amounts. Which term best denotes that the drugs have the same absorption rates? a. Equivalent b. Synergistic c. Compatible d. Bioequivalent ANS: D Two drugs absorbed into the circulation at the same amount (in specific dosage forms) have the same bioavailability; thus, they are bioequivalent. “Equivalent” is incorrect because the term “bioavailability” is used to express the extent of drug absorption. “Synergistic” is incorrect because this term refers to two drugs given together whose resulting effect is greater than the sum of the effects of each drug given alone. “Compatible” is incorrect because this term is a general term used to indicate that two substances do not have a chemical reaction when mixed (or given, in the case of drugs) together. DIF: Cognitive Level: Comprehension 2. A patient is receiving medication via intravenous injection. Which information should the nurse provide for patient education? a. The medication will cause fewer adverse effects when given intravenously. b. The medication will be absorbed slowly into the tissues over time. c. The medication’s action will begin faster when given intravenously. d. Most of the drug is inactivated by the liver before it reaches the target area. ANS: C Intravenous injections are the fastest route of absorption. The intravenous route does not affect the number of adverse effects, the intravenous route is not a slow route of absorption, and the intravenous route does not cause inactivation of the drug by the liver before it reaches the target area. DIF: Cognitive Level: Comprehension 3. Which is true regarding parenteral drugs? a. They bypass the first-pass effect. b. They decrease blood flow to the stomach. c. They are altered by the presence of food in the stomach. d. They exert their effects while circulating in the bloodstream. ANS: A Drugs given by the parenteral route bypass the first-pass effect, but they still must be absorbed into cells and tissues before they can exert their effects. Enteral drugs (drugs taken orally), not parenteral drugs, decrease blood flow to the stomach and are altered by the presence of food in the stomach. Parenteral drugs must be absorbed into cells and tissues from the circulation before they can exert their effects; they do not exert their effects while circulating in the bloodstream. DIF: Cognitive Level: Analysis 4. A drug’s half-life is best defined as a. The time it takes for the drug to elicit half its therapeutic response. b. The time it takes one-half of the original amount of a drug to reach the target cells. c. The time it takes one-half of the original amount of a drug to be removed from the body. d. The time it takes one-half of the original amount of a drug to be absorbed into the circulation. ANS: C A drug’s half-life is the time it takes for one-half of the original amount of a drug to be removed from the body. It is a measure of the rate at which drugs are removed from the body. Answers A, B, and D are not correct definitions of a drug’s half-life. DIF: Cognitive Level: Comprehension 5. The term “duration of action” is best defined as a. The time it takes for the drug to elicit a therapeutic response. b. The time it takes a drug to reach its maximum therapeutic response. c. The length of time it takes to remove a drug from circulation. d. The time during which drug concentration is sufficient to elicit a therapeutic response. ANS: D Duration of action is the time during which drug concentration is sufficient to elicit a therapeutic response. The time it takes for a drug to elicit a therapeutic response is the drug’s “onset of action.” The time it takes a drug to reach its maximum therapeutic response is a drug’s “peak effect.” “The length of time it takes to remove a drug from circulation” defines a drug’s elimination and does not correctly define a drug’s duration of action. DIF: Cognitive Level: Comprehension lOMoARcPSD|13778330
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2 6. A drug interacts with enzymes by a. altering cell membrane permeability. b. “fooling” a receptor on the cell wall. c. enhancing the drug’s effectiveness within the cells. d. “fooling” the enzyme into binding with it instead of its normal target cell. ANS: D When drugs interact with enzymes, they inhibit the action of a specific enzyme by “fooling” the enzyme into binding to it instead of to its normal target cell. Thus, the target cells are protected from the action of the enzymes to result in a drug effect. The alteration of cell membrane permeability, the “fooling” of a receptor on the cell wall, and the enhancement of the effectiveness of drugs within cells do not occur with selective enzyme interactions. DIF: Cognitive Level: Comprehension 7. When administering a new medication to a patient, the nurse reads that it is highly protein bound. Which consequence will result from this protein binding? a. Renal excretion will take longer. b. The drug will be metabolized quickly. c. The duration of action of the medication will be longer. d. The duration of action of the medication will be shorter. ANS: C Drugs that are bound to plasma proteins are characterized by a longer duration of action. Protein binding does not make renal excretion longer and does not increase metabolism of the drug. Protein binding of a drug means that the duration of action is longer, not shorter. DIF: Cognitive Level: Application 8. When monitoring a patient on an insulin drip to reduce blood glucose levels, the nurse notes that the patient’s glucose level is extremely low, and the patient is lethargic and difficult to awaken. Which adverse drug reaction is the nurse observing? a. An adverse effect b. An allergic reaction c. An idiosyncratic reaction d. A pharmacological reaction ANS: D A pharmacological reaction is an extension of the drug’s normal effects in the body. In this case, the insulin lowered the patient’s blood glucose levels too much. An adverse effect is a predictable, well-known adverse drug reaction that results in minor or no changes in patient management. An allergic reaction (also known as a hypersensitivity reaction ) involves the patient’s immune system. An idiosyncratic reaction is unexpected and is defined as a genetically determined abnormal response to normal dosages of a drug. DIF: Cognitive Level: Comprehension 9. A patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where should the nurse tell the patient to place the tablet? a. Under the tongue b. In the space between the cheek and gum c. At the back of the throat, for easy swallowing d. On a non-hairy area on the chest ANS: A Drugs taken by the sublingual route are placed under the tongue. Placing the tablet in the space between the cheek and gum is done for the buccal route; placing the tablet at the back of the throat (for easy swallowing) is done in the oral route; and placing the tablet on a non-hairy area on the chest is done in the topical or transdermal route. DIF: Cognitive Level: Comprehension 10. The nurse is administering medications to a patient who is in liver failure due to end-stage cirrhosis. The nurse is aware that patients with liver failure are most likely to have problems with which pharmacokinetic phase? a. Absorption b. Distribution c. Metabolism d. Excretion ANS: C The liver is the organ that is most responsible for drug metabolism. Decreased liver function will most affect a drug’s metabolism. The absorption of a drug is not affected by liver function, and distribution is not affected by liver function. Excretion is affected only because decreased liver function may not transform drugs into water-soluble substances for elimination via the kidneys, but this is not the best answer to this question. DIF: Cognitive Level: Application lOMoARcPSD|13778330
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1 Chapter 03: Legal and Ethical Considerations Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. In the development of a new drug by a pharmaceutical company, the researcher must ensure that the participants in experimental drug studies do not have unrealistic expectations of the new drug’s usefulness. What will the researcher include in the design of the study to prevent bias that may occur? a. A placebo b. Health Canada approval c. Informed consent d. Efficacy information ANS: A To prevent bias that may occur as a result of unrealistic expectations of an investigational new drug, a placebo will be incorporated into the study. Health Canada approval, if given, does not be obtained until after phase III of the study. Informed consent is required in all drug studies. Efficacy information is not determined until the study is under way. DIF: Cognitive Level: Comprehension 2. A member of an investigational drug study team is working with healthy volunteers whose participation will help determine the optimal dosage range and pharmacokinetics of the drug. In what type of study is the team member participating? a. Phase I b. Phase II c. Phase III d. Phase IV ANS: A Phase I studies involve small numbers of healthy volunteers to determine the optimal dosage range and the pharmacokinetics of the drug. Phases II, III, and IV involve progressively larger numbers of volunteers who have the disease or ailment that the drug is designed to diagnose or treat. DIF: Cognitive Level: Application 3. A patient has a prescription for a drug classified as Schedule F. What important information should the nurse give this patient about obtaining refills for this medication? a. No prescription refills are permitted. b. Refills may be obtained via telephone order. c. Refills are indicated by the prescriber. d. The patient may have no more than six refills in a 12-month period. ANS: C Schedule F contains a list of drugs that can be sold and refilled only on prescription; prescriptions can be refilled as often as indicated by the prescriber. DIF: Cognitive Level: Analysis 4. A patient has been chosen to be a recipient of an investigational drug for heart failure and has given informed consent. Which is indicated by the patient’s informed consent? a. The patient has been informed of the possible benefits of the new therapy. b. The patient will be informed of the details of the study as the research continues. c. The patient will not be assured of receiving the actual drug during the experiment. d. The patient has received an explanation of the study’s purpose, procedures, and the benefits and risks involved. ANS: D Informed consent involves the careful explanation of the purpose of the study, procedures to be used, and the possible benefits and risks involved. Being informed of the possible benefits of the new therapy, being informed of the study details as research continues, and being assured of receiving the actual drug during the experiment do not describe informed consent. DIF: Cognitive Level: Comprehension 5. Which is the most significant part of legislation in regard to professional nursing practice? a. Canada Health Act b. Nursing Practice Act c. Controlled Drugs and Substances Act d. Personal Information Protection and Electronic Documents Act ANS: B Nurse practice acts (NPAs) are regulatory laws that are instrumental in defining the scope of nursing practice and that protect public health, safety, and welfare. Nursing practice in Canada is regulated by separate acts in each of the 10 provinces and 3 territories. These acts grant self-governance to the nursing profession, direct entry into nursing practice, define the scopes of practice, and identify disciplinary actions. NPAs are the most significant part of legislation in regard to professional nursing practice. DIF: Cognitive Level: Comprehension lOMoARcPSD|13778330
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2 6. What potential failure is identified when a patient with a documented penicillin allergy receives 1.2 g of benzylpenicillin IV? a. Failure to assess b. Failure to evaluate c. Failure to ensure safety d. Failure to identify the patient ANS: C Failure to ensure safety includes lack of adequate monitoring, failure to identify patient allergies and other risk factors related to medication therapy, inappropriate drug administration technique, and failure to implement appropriate nursing actions because of improper assessment of the patient’s condition. Whereas failure to assess or evaluate includes failure to see significant changes in the patient’s condition after taking a medication, failure to report these changes, failure to take a complete medication history and nursing assessment/history, and failure to monitor the patient after medication administration. Failure to identify the patient’s identity is a medication error. DIF: Cognitive Level: Application 7. Which statement correctly describes drugs in Part G, Part II of the Food and Drugs Act ? a. They are drugs with high potential for misuse that have an accepted medical use. b. They are drugs with high potential for misuse that do not have an accepted medical use. c. They are medically accepted drugs that may cause mild physical or psychological dependence. d. They are medically accepted drugs with very limited potential for causing mild physical or psychological dependence. ANS: A Part G, Part II drugs are those with high potential for misuse that have an accepted medical use (e.g., barbiturates). DIF: Cognitive Level: Comprehension 8. Miss Knox, a 26-year-old, has returned to the surgical unit post appendectomy. The physician has prescribed intravenous (IV) morphine for pain. According to the Controlled Drugs and Substances ACT (CDSA), morphine is classified under which schedule? a. Schedule I b. Schedule IV c. Schedule V d. Schedule III ANS: A The CDSA is based on eight schedules that list controlled drugs and substances based on potential for misuse or harm or how easy they are to manufacture into illicit substances. A summary of Schedule I contains the most dangerous drugs, including opiates (opium, heroin, morphine, cocaine), fentanyls, and methamphetamine. DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. Which are elements of ethical principles in nursing and health care according to the Canadian Nurses Association (CNA) Code of Ethics? ( Select all that apply. ) a. Promoting justice b. Maintaining anonymity c. Demonstrating responsibility d. Preserving dignity e. Promoting health and well-being ANS: A, D, E Elements of ethical principles in nursing and health care according to the CNA Code of Ethics include providing safe, compassionate, competent, and ethical nursing care; maintaining privacy and confidentiality; promoting justice, being accountable, preserving dignity, and promoting and respecting informed decision making; and promoting health and well-being. DIF: Cognitive Level: Critical Thinking 2. The personal Information Protection and Electronic Documents Act (PIPEDA) is a federal law governing the collection, use and disclosure of personal health details. Protected health information includes? ( Select all that apply. ) a. Patients’ health conditions b. Payment information c. Prescription numbers d. Dietary restrictions e. Medications ANS: A, B, C, E The personal Information Protection and Electronic Documents Act (PIPEDA) requires all health care providers, health insurance and life insurance companies, public health authorities, employers, and schools to maintain patient privacy regarding protected health information. Protected health information includes any individually identifying information such as patients’ health conditions, account numbers, prescription numbers, medications, and payment information. A postal code on its own covers a wide geographical area. DIF: Cognitive Level: Comprehension lOMoARcPSD|13778330
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1 Chapter 04: Patient-Focused Considerations Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. During the last trimester of pregnancy, drug transfer to the fetus is more likely to occur. Which is a reason for this possibility? a. Fetal size b. Decreased surface area c. Enhanced placental blood flow d. Increased amount of bound drug in maternal circulation ANS: C Drug transfer to the fetus is more likely during the last trimester, as a result of enhanced placental blood flow, increased fetal surface area, and an increased amount of free drug in the mother’s circulation. Increased, not decreased, fetal surface area affects drug transfer to the fetus. The placenta’s surface area does not increase during this time. Drug transfer is increased due to an increased amount of free drug, not protein-bound drug, in the mother’s circulation. “Fetal size” is incorrect because the first trimester of pregnancy is the period of greatest danger of drug-induced developmental defects. During this period, the fetus undergoes rapid cell proliferation. Gestational age is more important than fetal size. DIF: Cognitive Level: Comprehension 2. Which type of dosage calculation is used most commonly when calculating drug dosages for children? a. Fried’s rule b. Clark’s rule c. Young’s rule d. The mg/kg formula ANS: D The body weight method, using the mg/kg formula, is the most common and reliable method for calculating doses for young patients. Fried’s rule, Clark’s rule, and Young’s rule are not methods used for calculating drug dosages for young patients. DIF: Cognitive Level: Knowledge 3. While assessing an 82-year-old woman, the nurse determines that the patient is experiencing polypharmacy. What is this experience most likely to indicate? a. The patient has a lower risk of drug interactions. b. The patient takes medications for one illness several times a day. c. The patient risks problems only if she also takes over-the-counter medications. d. The patient takes multiple medications for several different illnesses. ANS: D Polypharmacy usually occurs when a patient has several illnesses and takes medications for each of them, medications possibly prescribed by different specialists who may be unaware of the patient’s other treatments. This situation puts the patient at increased risk of drug interactions and adverse reactions. Polypharmacy means that the patient has a higher, not lower, risk of drug interactions, and that the patient is taking several different medications, not just one. Polypharmacy can include prescription drugs, over-the-counter medications, and natural health products. DIF: Cognitive Level: Application 4. Which statement is true in regard to children? a. Their levels of microsomal enzymes are decreased compared to those of adults. b. Their total body water content is much less than that of adults. c. Their first-pass elimination is increased because of higher portal circulation. d. Gastric emptying is more rapid than that of adults because of increased peristaltic activity. ANS: A In children, the levels of microsomal enzymes are decreased. A child’s gastric emptying is slowed because of slow or irregular peristalsis. Total body water content is greater in children than in adults, and first-pass elimination by the liver is reduced because of immaturity of the liver and reduced levels of microsomal enzymes. DIF: Cognitive Level: Comprehension 5. For accurate medication administration to young patients, the nurse must take into account which information? a. Weight, height, age, and organ maturity b. Age, glomerular filtration rate, and weight c. Weight, height, body temperature, and age d. Weight, height, and total body water content ANS: A To accurately administer medications to young patients, their weight, height, age, physical condition, metabolism and organ maturity must be taken into account. Glomerular filtration rate, body temperature, and total body water content are not considerations when administering medications to young patients. DIF: Cognitive Level: Comprehension lOMoARcPSD|13778330
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2 6. An older adult patient will often experience a reduction in the stomach’s ability to produce hydrochloric acid. This change will result in which alteration? a. Delayed gastric emptying b. Increased gastric acidity c. Decreased intestinal absorption of medications d. Altered absorption of select drugs ANS: D This aging-related change results in a decrease in gastric acidity and may alter the absorption of some drugs. Delayed gastric emptying, increased gastric acidity, and decreased intestinal absorption of medications are not results of reduced hydrochloric acid production. DIF: Cognitive Level: Application 7. Which is the reason drug toxicity is more likely to occur in the neonate? a. The lungs are immature. b. The kidneys are smaller. c. The liver is not fully developed. d. Renal excretion of the drug is faster. ANS: C A neonate’s liver is not fully developed and cannot detoxify many drugs; thus, drug toxicity is more likely to occur in the neonate. The lungs and kidneys do not play major roles in drug metabolism. Renal excretion of the drug is slower, not faster, due to organ immaturity. DIF: Cognitive Level: Comprehension 8. An 83-year-old female patient has been given a thiazide diuretic to treat mild heart failure. She and her daughter should be taught to watch for which complications? a. Dizziness and constipation b. Fatigue and dehydration c. Daytime sedation and lethargy d. Edema and blurred vision ANS: B Electrolyte imbalance, fatigue, and dehydration are common complications of thiazide diuretics in older adult patients. Dizziness and constipation, daytime sedation and lethargy, and edema and blurred vision are not complications that occur when these drugs are given to older adults. DIF: Cognitive Level: Comprehension 9. Which complication is common with an older adult patient who is taking digoxin? a. Hallucinations b. Edema c. Dry mouth d. Constipation ANS: A Common complications for older adults taking digoxin include visual disorders, nausea, diarrhea, dysrhythmias, hallucinations, decreased appetite, and weight loss. Nonsteroidal anti-inflammatory drugs may cause edema, anticholinergics and antihistamines may cause dry mouth, and opioids may cause constipation. DIF: Cognitive Level: Comprehension 10. The nurse is aware that confusion, ataxia, and increased risk for falls are older adult patients’ common responses to which medication? a. Laxatives b. Anticoagulants c. Sedatives d. Diuretics ANS: C In older adults, sedatives and hypnotics often cause confusion, daytime sedation, ataxia, lethargy, and increased risk for falls. Laxatives, anticoagulants, and diuretics may cause adverse effects in older adults, but not the adverse effects specified in the question. DIF: Cognitive Level: Application lOMoARcPSD|13778330
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3 11. The nurse is trying to give a liquid medication to a 2-year-old child and notes that the medication has a strong taste. The best way for the nurse to give this medication to a child is to a. Give the medication with spoonfuls of sherbet. b. Add the medication to the child’s bottle. c. Tell the child you have candy. d. Add the medication to a cup of milk. ANS: A Using sherbet or another non-essential food that makes the medication taste better is the best way to give a strong-tasting medication to a child. Adding the medication to the child’s bottle is not correct because the child may not drink the entire contents of the bottle, thus wasting the medication. Telling the child that the medication is candy is not correct because using the word “ candy” with drugs may lead to the child’s thinking that drugs are actually candy. Adding the medication to a cup of milk is not correct because the child may not drink the entire cup of milk, and the distasteful drug may cause the child to refuse milk in the future. DIF: Cognitive Level: Application 12. For which cultural group must the nurse respect the value placed on natural health products, the use of heat, and a concern for the balance of opposing forces that lead to illness or health? a. Hispanic Canadians b. Asian Canadians c. Indigenous peoples d. Black people of African descent ANS: B Some Asian Canadians believe in yin and yang, which are opposing forces leading to illness or health, depending on which force is in balance. Other health practices for this cultural group include belief in the use of heat and in the value of herbal remedies. Hispanic Canadians, Indigenous peoples, and Black people of African descent do not typically engage in these practices. DIF: Cognitive Level: Comprehension 13. A nurse is assessing an older adult Indigenous woman who is being treated for hypertension. During the assessment, what important information should the nurse remember or expect in regard to culture? a. The patient should be discouraged from using traditional remedies and rituals. b. The nurse should expect the patient to value protective bracelets and herbal teas. c. The nurse should remember that the balance between body, mind, and environment is important to this patient’s health beliefs. d. The assessment should include information about cultural practices and beliefs regarding medication, treatment, and healing. ANS: D All beliefs need to be strongly considered to prevent a conflict between the goals of nursing and health care and the dictates of a patient’s cultural background. Assessing cultural practices and beliefs is part of a thorough assessment. The nurse should not ignore a patient’s cultural practices. Protective bracelets, use of herbal teas, and balance between body, mind, and environment do not describe beliefs and practices that usually apply to this patient’s cultural group. DIF: Cognitive Level: Application 14. Which ethnocultural group believes in harmony with nature and views ill spirits as causing disease? a. Black people of African descent b. South Asian Canadians c. Filipino Canadians d. Indigenous peoples ANS: D Indigenous peoples believe in harmony with nature and view ill spirits as causing disease. DIF: Cognitive Level: Comprehension 15. Which contributes to drug polymorphism? a. The number of drugs ordered by the physician b. The patient’s drug history c. The patient’s age, sex, and body composition d. Different dosage forms of the same drug ANS: C A patient’s age, sex, size, and body composition are some of the factors that contribute to drug polymorphism, which is the effect of such variables on how an individual absorbs or metabolizes specific drugs. The number of drugs ordered by the physician, the patient’s drug history, and different dosage forms of the same drug are not factors that contribute to drug polymorphism. DIF: Cognitive Level: Comprehension 16. Which best describes drug polymorphism? a. Cultural and genetic effects on drug metabolism and excretion b. Gender and cultural effects on drug absorption and distribution c. Age or body composition effects on drug absorption or metabolism d. Multidrug use resulting in impaired excretion ANS: C Drug polymorphism is the variation in response to a drug because of a patient’s age, sex, size, and body composition. DIF: Cognitive Level: Comprehension lOMoARcPSD|13778330
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4 MULTIPLE RESPONSE 1. Which is true regarding young patients? ( Select all that apply. ) a. The levels of microsomal enzymes are decreased. b. Perfusion to the kidneys may be decreased, which may result in reduced renal function. c. First-pass elimination is increased because of higher portal circulation. d. First-pass elimination is reduced because of the immaturity of the liver. e. Total body water content is much less than in adults. f. Gastric emptying is slowed because of slow or irregular peristalsis. g. Gastric emptying is more rapid because of increased peristaltic activity. ANS: A, B, D, F In children, microsomal enzymes are decreased and first-pass elimination by the liver is reduced because of the immaturity of the liver. In addition, gastric emptying is reduced because of slow or irregular peristalsis. Perfusion to the kidneys may be decreased, resulting in reduced renal function. “First-pass elimination is increased because of higher portal circulation” and “Gastric emptying is more rapid because of increased peristaltic activity” are not correct statements. Total body water content is greater in children than in adults. DIF: Cognitive Level: Application 2. Which is true regarding older adults? ( Select all that apply. ) a. The levels of microsomal enzymes are decreased. b. Fat content is increased because of decreased lean body mass. c. Fat content is decreased because of increased lean body mass. d. The number of intact nephrons is increased. e. The number of intact nephrons is decreased. f. Gastric pH is less acidic. g. Gastric pH is more acidic. ANS: A, B, E, F In older adults, levels of microsomal enzymes are decreased because the aging liver is less able to produce them; fat content is increased because of decreased lean body mass; the number of intact nephrons is decreased due to aging; and gastric pH is less acidic due to a gradual reduction of the production of hydrochloric acid. “Fat content is decreased because of increased lean body mass,” “The number of intact nephrons is increased,” and “Gastric pH is more acidic” are incorrect statements. DIF: Cognitive Level: Application lOMoARcPSD|13778330
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1 Chapter 05: Gene Therapy and Pharmacogenomics Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which is the most important compound that transfers genes from parents to offspring? a. Chromatin b. Deoxyribonucleic acid (DNA) c. Alleles d. Ribonucleic acid ANS: B It is now recognized that DNA is the most important body compound that serves to transfer genes from parents to offspring. DIF: Cognitive Level: Knowledge 2. Which is manufactured as a result of indirect gene therapy? a. Vitamin K b. epoetin (Eprex) c. Human insulin d. Heparin ANS: C A recombinant form of human insulin is one of the most widespread uses of indirect gene therapy. DIF: Cognitive Level: Comprehension 3. Eugenics is defined as a. the use of gene therapy to prevent disease. b. the development of new drugs based on gene therapy. c. the intentional selection, before birth, of genotypes that are considered more desirable than others. d. the determination of genetic factors that influence a person’s response to medications. ANS: C Eugenics is the intentional selection, before birth, of genotypes that are considered more desirable than others. Eugenics is a major ethical issue related to gene therapy. DIF: Cognitive Level: Knowledge 4. What is the main purpose of the Human Genome Project? a. To study genetic diseases b. To study genetic traits in humans c. To discover new genetic diseases d. To describe the entire genome of a human being ANS: D The Human Genome Project was undertaken to describe in detail the entire genome of a human being. DIF: Cognitive Level: Knowledge 5. Genotyping for the presence of cytochrome P-450 2D6 (CYP2D6) enzymes and alleles will be helpful in which area of medicine? a. Cardiology b. Psychiatry c. Respirology d. Oncology ANS: B Psychiatry and general medicine will benefit. Genotyping for the presence of CYP2D6 will determine whether patients are poor, intermediate, extensive, or ultrarapid metabolizers with these enzymes, which will help guide the prescribing of specific medications. DIF: Cognitive Level: Comprehension SHORT ANSWER 1. Name one clinical application of pharmacogenomics. ANS: Several possible clinical applications are listed in Table 5-1: Clinical Applications of Pharmacogenomics. DIF: Cognitive Level: Application lOMoARcPSD|13778330
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1 Chapter 06: Medication Errors: Preventing and Responding Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which situation is an example of a medication error? a. A patient refuses her morning medications. b. A patient receives a double dose of a medication because the nurse did not cut the pill in half. c. A patient develops hives after starting an intravenous antibiotic 24 hours earlier. d. A patient reports severe pain still present 60 minutes after a pain medication was given. ANS: B A medication error is defined as a preventable adverse drug event that involves inappropriate medication use by a patient or health care provider. Refusing morning medications and reporting severe pain after having been given medication are examples of patient behaviours. The development of hives is a possible allergic reaction. None of these situations is preventable. DIF: Cognitive Level: Application 2. Which is the proper notation for the dose of the drug ordered? a. digoxin .125 mg b. digoxin .1250 mg c. digoxin 0.125 mg d. digoxin 0.1250 mg ANS: C Always use a leading zero for decimal dosages (e.g., digoxin 0.125 mg) with medication orders or their transcription. Omitting the leading zero may cause the order to be misread, resulting in a large drug overdose. Never use trailing zeros. DIF: Cognitive Level: Application 3. When the nurse is giving a scheduled morning medication, the patient states, “I haven’t seen that pill before. Are you sure it’s correct?” The nurse checks the medication administration record and sees that medication is listed. Which is the nurse’s best response to the patient? a. “It’s listed here on the medication sheet, so you should take it.” b. “Go ahead and take it, and then I’ll check with your doctor about it.” c. “It wouldn’t be listed here if it wasn’t ordered for you!” d. “I’ll check on the order first, before you take it.” ANS: D When giving medications, the nurse must always listen to and honour any concerns or doubts expressed by the patient. If the patient doubts an order, the nurse should check the written order, check with the prescriber, or both. The other options included with this example illustrate the nurse’s not listening to the patient’s concerns. DIF: Cognitive Level: Application 4. The physician has written admission orders, and the nurse is transcribing them. The nurse is having difficulty transcribing one order because of the physician’s handwriting. The best action for the nurse to take is to a. ask a colleague what the order says. b. contact the physician to clarify the order. c. contact the pharmacy to clarify the order. d. ask the patient what medications are being taken at home. ANS: B If a prescriber writes an order that is illegible, the nurse should contact the prescriber for clarification. The nurse should not ask a colleague what the order says because the colleague did not write the order. The nurse should not contact the pharmacy to clarify the order because this action would delay implementation of the order. Asking the patient what medications are taken at home is incorrect because this question will not clarify the current order. DIF: Cognitive Level: Comprehension 5. Health care providers should report actual and potential medication errors to which organization? a. Institute for Safe Medications Practices (ISMP) Canada b. Accreditation Canada c. Canadian Patient Safety Institute (CPSI) d. Health Canada ANS: A Actual and potential medication errors should be reported to ISMP Canada; confidentiality of the reporter is respected. Accreditation Canada, CPSI, and Health Canada all offer information pertaining to medication safety. DIF: Cognitive Level: Knowledge lOMoARcPSD|13778330
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2 MULTIPLE RESPONSE 1. Which statements are true regarding an adverse drug reactions (ADRs)? ( Select all that apply. ) a. Adverse effects are ADRs that are usually predictable. b. ADRs always result in harm to patients. c. All ADRs are preventable if proper precautions are taken. d. ADRs can be unexpected and unintended responses to medications. ANS: A, D An ADR is defined as any unexpected, undesired, or excessive response to a medication. Adverse effects are ADRs that are usually not severe enough to warrant stopping the medication. Not all ADRs result in harm to the patient. Some ADRs, such as allergic or idiosyncratic reactions, may not be preventable or predicted. DIF: Cognitive Level: Knowledge lOMoARcPSD|13778330
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1 Chapter 07: Patient Education and Drug Therapy Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which diagnosis is appropriate for the patient who has just received a prescription for a new medication? a. Nonadherence related to a new drug therapy b. High risk for nonadherence related to new drug therapy c. Knowledge deficit related to newly prescribed drug therapy d. Deficient knowledge related to newly prescribed drug therapy ANS: D The patient who has a limited understanding of newly prescribed drug therapy may have the nursing diagnosis of deficient knowledge. “Nonadherence” implies that the patient does not follow a recommended regimen, which is not the case with a newly prescribed drug. “High risk for nonadherence related to new drug therapy” is not a North American Nursing Diagnosis Association nursing diagnosis, and “Deficient knowledge related to newly prescribed drug therapy” is an outdated nursing diagnosis. DIF: Cognitive Level: Analysis 2. Which statement reflects a measurable goal? a. The patient will know about insulin injections. b. The patient will understand the principles of insulin preparation. c. The patient will demonstrate the proper technique of mixing insulin. d. The patient will comprehend the proper technique of preparing insulin. ANS: C The word “demonstrate” is a measurable verb, and measurable terms should be used when developing goals and outcome criteria statements. The terms “know,” “understand” and “comprehend” are not measurable terms. DIF: Cognitive Level: Analysis 3. During an assessment, which question allows the nurse to clarify and open up discussion with the patient? a. “Are you allergic to penicillin?” b. “What medications do you take?” c. “Have you had a reaction to this drug?” d. “Are you taking this medication with meals?” ANS: B “What medications do you take?” is an open-ended question that will encourage more clarification and discussion from the patient. “Are you allergic to penicillin?” is a closed-ended question, as are “Have you had a reaction to this drug?” and “Are you taking this medication with meals?” Closed-ended questions prompt only a “yes” or “no” answer and provide limited information. DIF: Cognitive Level: Application 4. The nurse is setting up a teaching–learning session with an 85-year-old patient who will be going home on anticoagulant therapy. Which strategy will reflect consideration of aging changes that may occur? a. Showing a colourful video about anticoagulation therapy b. Presenting all the information in one session just before discharge c. Giving the patient pamphlets about the medications to read at home d. Developing large-print handouts that reflect the verbal information presented ANS: D Developing large-print handouts that reflect the verbal information presented will address altered perception in two ways. First, using visual aids reinforces the verbal instructions by addressing the patient’s possibly decreased ability to hear high-frequency sounds. Second, developing the handouts in large print addresses the possibility of decreased visual acuity. Showing a colourful video about anticoagulation therapy does not allow for discussion of the information; furthermore, the text and print may be small and difficult to read and understand. Presenting all the information in one session just before discharge also does not allow for discussion, and the patient may not be able to hear or see the information sufficiently. Because of the possibility of decreased short-term memory and slowed cognitive function, giving the patient pamphlets about the medications to read at home is not appropriate. DIF: Cognitive Level: Application 5. When the nurse is teaching a manual skill, such as self-injection of insulin, the best way to set up the teaching-learning session is to a. provide written pamphlets for instruction. b. show a video and allow the patients to practice as needed on their own. c. verbally explain the procedure and provide written handouts for reinforcement. d. allow the patients to do several “return” demonstrations after the nurse has demonstrated the procedure. ANS: D Return demonstrations allow the nurse to evaluate the patient’s newly learned skills. Providing written pamphlets for instruction, showing a video and then allowing patients to practice as needed on their own, and verbally explaining the procedure and providing written handouts for reinforcement do not allow for evaluation of the patient’s technique. DIF: Cognitive Level: Analysis lOMoARcPSD|13778330
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2 6. A patient and the dietitian have just reviewed the patient’s new diet, which is low protein and low potassium. This reviewing constitutes learning in which domain? a. Physical b. Affective c. Cognitive d. Psychomotor ANS: C The cognitive domain refers to problem-solving abilities and may involve recall and knowledge of facts. The physical domain is not one of the learning domains. The affective domain refers to values and beliefs. The psychomotor domain may involve actions such as learning how to perform a procedure. DIF: Cognitive Level: Comprehension 7. The nurse needs to teach a 16-year-old patient, newly diagnosed with diabetes, about blood glucose monitoring and the importance of regulating glucose intake. When the nurse is developing the teaching plan, which of Erickson’s stages of development should be considered? a. Trust versus mistrust b. Intimacy versus isolation c. Industry versus inferiority d. Identity versus role confusion ANS: D According to Erickson, the adolescent, 12 to 18 years of age, is in the “identity versus role confusion” stage of development. According to Erikson, “trust versus mistrust” reflects the infancy stage; “intimacy versus isolation” reflects the young adulthood stage; and “industry versus inferiority” reflects the school-age stage of development. DIF: Cognitive Level: Comprehension 8. A 60-year-old patient is on several new medications and expresses worry that she will forget to take her pills. For a patient in this situation, the most helpful response from the nurse is to do what? a. Teach effective coping strategies. b. Reduce the number of drugs prescribed. c. Assure the patient that she won’t forget once she is accustomed to the routine. d. Help the patient obtain and learn to use a calendar or a pill container. ANS: D Calendars, pill containers, or diaries may be helpful to patients who may forget to take prescribed drugs as scheduled. The nurse must ensure that the patient knows how to use these reminder tools. Teaching the patient effective coping strategies is a helpful suggestion but will not help the patient to remember to take medications. Reducing the number of drugs prescribed is not an appropriate action by the nurse. Assuring the patient that she won’t forget once she is accustomed to the routine is false reassurance by the nurse and inappropriate when education is needed. DIF: Cognitive Level: Application MULTIPLE RESPONSE 1. Which are appropriate considerations when the nurse is assessing the learning needs of a patient? ( Select all that apply. ) a. Cultural background b. Social support c. Level of education d. Readiness to learn e. Health beliefs ANS: A, B, C, D, E All options are appropriate to consider when the nurse is assessing learning needs. DIF: Cognitive Level: Comprehension lOMoARcPSD|13778330
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1 Chapter 08: Over-the-Counter Drugs and Natural Health Products Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go “natural” with her pregnancy. She shows the nurse a list of natural health products that she wishes to take so she can “avoid taking any drugs.” Which statement represents the nurse’s best response? a. Most natural health products are nontoxic and safe for use during pregnancy. b. Please read the labels carefully before use, to check for cautionary warnings. c. Products from different manufacturers are required to contain consistent amounts of herbal constituents. d. Natural health products are actually drugs of unproven safety and should not be taken during pregnancy without medical supervision. ANS: D Natural health products are actually drugs of mostly unproven safety, especially for pregnant women; many have not been tested for safety during pregnancy. Manufacturers are not required to provide cautionary statements or guarantee the reliability of the contents. The labels on natural health products may not provide enough information for use during pregnancy. Manufacturers of natural health products are not required to guarantee the reliability of the contents. DIF: Cognitive Level: Analysis 2. The role of the Natural and Non-prescription Health Products Directorate (NNHPD) is to see that a. natural health products are regulated for safety and quality. b. natural health products are held to the same standards as drugs. c. producers of natural health products prove the therapeutic efficacy of their products. d. natural health products are protected by patent laws. ANS: A The NNHPD ensures access to safe, effective, and quality natural health products. DIF: Cognitive Level: Analysis 3. Which is a concern regarding the use of the natural health product kava? a. Cancer risk b. Liver toxicity c. Cardiovascular incidents d. Intestinal disorders ANS: B The herb kava is found in herbal and homeopathic preparations and sometimes in food. Kava is promoted for the treatment of anxiety, nervousness, insomnia, pain, and muscle tension. Health Canada has issued warnings about possible liver toxicity with the use of kava root. In 2012, after a 10-year ban, Health Canada regulated kava root as a new drug. DIF: Cognitive Level: Knowledge 4. A patient tells the nurse that she wants to begin taking St. John’s wort for treatment of depression. The nurse should warn her about which substance that may cause an interaction with St. John’s wort? a. digoxin b. All caffeine-containing products c. Alcoholic beverages d. Selective serotonin reuptake inhibitors ANS: D Drug interactions may occur with the ingestion of other serotonergic drugs, such as selective serotonin reuptake inhibitors; the drug interaction may lead to serotonin syndrome. DIF: Cognitive Level: Comprehension 5. A patient says that he eats large amounts of garlic for its cardiovascular benefits. Which drug, if taken, could have a potential interaction with the garlic? a. acetaminophen b. warfarin c. digoxin d. phenytoin ANS: B When taking garlic, taking any drugs that may interfere with platelet and clotting functions should be avoided. These drugs include antiplatelet drugs, anticoagulants (e.g., warfarin), nonsteroidal anti-inflammatory drugs (NSAIDs), and acetylsalicylic acid (Aspirin). Acetaminophen, digoxin, and phenytoin do not have interactions with garlic. DIF: Cognitive Level: Analysis lOMoARcPSD|13778330
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2 6. When teaching patients about over-the-counter (OTC) and natural health products, the nurse should teach the patients that a. histamine-blocking agents should be taken with antacids to prevent gastrointestinal upset. b. drug interactions are rare with OTC products because OTC drugs are safer than prescription drugs. c. manufacturers of natural health products are required to provide evidence of safety and effectiveness; therefore, check the labels carefully. d. natural health products and OTC drugs cannot be safely administered to infants, children, and pregnant or lactating women without first checking with the health care provider. ANS: D Natural health products and OTC drugs are not necessarily safe for infants, children, and pregnant or lactating women; the health care provider should be contacted before use. “Histamine-blocking agents should be taken with antacids to prevent gastrointestinal upset,” “Drug interactions are rare with OTC products because OTC drugs are safer than prescription drugs,” and “Manufacturers of natural health products are required to provide evidence of safety and effectiveness; therefore, check the labels carefully” are all false statements. DIF: Cognitive Level: Comprehension 7. Patients from which culture will not report gastrointestinal symptoms caused by OTC drugs or natural health products? a. Chinese b. Japanese c. Hispanic d. European ANS: B Japanese patients experiencing nausea, vomiting, or bowel changes as a result of OTC drugs or natural health products often do not mention these symptoms. Because the Japanese culture considers complaining about gastrointestinal symptoms to be unacceptable, these symptoms may go unreported. The nurse needs to be aware of this implication for this ethnocultural group. DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. Which statement is true regarding the use of OTC drugs? ( Select all that apply. ) a. Use of OTC drugs may delay treatment of more serious ailments. b. Drug interactions with OTC medications are rare. c. OTC drugs may relieve symptoms without addressing the cause of the problem. d. OTC drugs are indicated for long-term treatment of conditions. e. Patients may misunderstand product labels and misuse the drugs. ANS: A, C, E “Use of OTC drugs may delay treatment of more serious ailments,” “OTC drugs may relieve symptoms without addressing the cause of the problem,” and “Patients may misunderstand product labels and misuse the drugs” are all true statements about the use of OTC drugs and should be included when patients are being taught about their use. Drug interactions may indeed occur with prescription medications and other OTC drugs. Normally, OTC drugs are intended for short-term treatment of minor ailments. DIF: Cognitive Level: Analysis lOMoARcPSD|13778330
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1 Chapter 09: Vitamins and Minerals Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Conditions such as infantile rickets, tetany, and osteomalacia are caused by a deficiency in which vitamin or mineral? a. Vitamin D b. Vitamin K c. Magnesium d. Cyanocobalamin ANS: A Conditions such as infantile rickets, tetany, and osteomalacia are all results of long-term vitamin D deficiency. DIF: Cognitive Level: Comprehension 2. Which nursing diagnosis is appropriate for the patient undergoing therapy with vitamin A? a. Risk for impaired skin integrity due to vitamin deficiency b. Disturbed sensory perception (visual) due to night blindness c. Impaired physical mobility (muscle weakness) due to vitamin deficiency d. Disturbed thought processes (confusion and psychosis) due to vitamin deficiency ANS: B Vitamin A deficiency causes night blindness. DIF: Cognitive Level: Analysis 3. Which symptom may indicate toxicity during vitamin D therapy? a. Urticaria b. Anorexia c. Diarrhea d. Tinnitus ANS: B Anorexia may indicate vitamin D toxicity. DIF: Cognitive Level: Comprehension 4. Which dietary information is important for the patient taking calcium supplements? a. Oral calcium supplements should be taken before meals. b. Calcium products bind with tetracyclines, making the antibiotic inactive. c. Foods high in calcium include whole grain cereals, egg yolks, and liver. d. Foods high in oxalate and zinc, such as spinach and legumes, increase the absorption of oral calcium supplementation. ANS: B Calcium products chelate or bind with tetracyclines, resulting in decreased effects of tetracyclines. Foods high in calcium include milk and other dairy products, shellfish, and dark green leafy vegetables. Oral calcium supplements should be taken with meals. DIF: Cognitive Level: Analysis 5. What adverse effect may occur from calcium salt infusion? a. Ototoxicity b. Metabolic acidosis c. Nephrotoxicity d. Respiratory arrest ANS: B Adverse effects from calcium salts include metabolic acidosis, as well as hemorrhage, hypertension, constipation, obstruction, nausea, vomiting, flatulence, kidney dysfunction, and hypercalcemia. DIF: Cognitive Level: Application 6. Which vitamin is given to newborns shortly after delivery? a. Vitamin B 3 b. Vitamin D c. Vitamin A d. Vitamin K ANS: D Vitamin K deficiency in newborns is a result of malabsorption attributable to inadequate amounts of bile. Thus, vitamin K is given in a single intramuscular dose to infants shortly after delivery. DIF: Cognitive Level: Application lOMoARcPSD|13778330
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2 7. A patient with a history of alcohol abuse has been admitted to hospital for severe weakness and malnutrition. Which preparation will he receive to prevent Wernicke’s encephalopathy? a. Vitamin B 3 b. Vitamin B 1 c. Vitamin B 2 d. Vitamin B 6 ANS: B Vitamin B 1 (thiamine) is useful in the treatment of a variety of thiamine deficiencies, including Wernicke’s encephalopathy. DIF: Cognitive Level: Comprehension 8. People who live in Canada’s North often have a lack of which vitamin? a. Vitamin A b. Vitamin B c. Vitamin C d. Vitamin D ANS: D Vitamin D, the “sunshine vitamin,” is naturally produced by the sun. People who live in Canada’s North, which lacks sunlight for much of the year, dress for intense cold, which reduces their opportunity for taking in vitamin D. DIF: Cognitive Level: Knowledge MULTIPLE RESPONSE 1. Which statement is true in regard to vitamin C? ( Select all that apply. ) a. Vitamin C is important in the maintenance of bones, teeth, and capillaries. b. Vitamin C is important for erythropoiesis. c. Glycogenolysis relies on the presence of vitamin C. d. Vitamin C is important for tissue repair. e. Vitamin C is essential for the synthesis of blood coagulation factors. f. Vitamin C is found in animal sources, such as dairy products and meat. g. Vitamin C is found in citrus fruits, tomatoes, cabbage, and strawberries. h. Vitamin C is essential for night vision. ANS: A, B, D, G Vitamin C is important in the maintenance of bones, teeth, and capillaries; for erythropoiesis; and for tissue repair. Vitamin C is found in citrus fruits, tomatoes, cabbage, and strawberries. Vitamin C deficiency is known as scurvy. DIF: Cognitive Level: Comprehension lOMoARcPSD|13778330
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1 Chapter 10: Principles of Drug Administration Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Before administering any medication, which action by the nurse is most important? a. Verifying orders with another nurse b. Documenting the medications given c. Counting medications in the medication cart drawers d. Checking the patient’s identification and allergy bracelets ANS: D Checking the patient’s identification and allergy bracelets are important for the patient’s safety and reflects some of the six (or more) Rights of medication administration. Verifying orders with another nurse is not required; only some medications require double-checking with another nurse. Documenting the medications given or counting medications in the medication cart drawers do not affect safety. DIF: Cognitive Level: Comprehension 2. What is the proper syringe size for an intradermal (ID) injection? a. 3-mL syringe b. 1-mL tuberculin c. 2-mL tuberculin d. 2-mL syringe ANS: B The proper syringe size for ID injection is a 1-mL tuberculin, or a 1-mL syringe with a 26- or 27-gauge needle that is 10 mm to 16 mm long. DIF: Cognitive Level: Knowledge 3. A patient is to receive an intramuscular (IM) injection of penicillin in the ventrogluteal site. What is the proper angle for needle insertion in an adult who is not emaciated? a. 15 degrees b. 45 degrees c. 60 degrees d. 90 degrees ANS: D The proper angle for IM injections is 90 degrees. DIF: Cognitive Level: Comprehension 4. When the nurse is administering medication by intravenous (IV) bolus (push), which is the correct procedure? a. Occluding the IV line by folding the tubing just above the injection port b. Clamping the tubing just above the insertion site c. Pinching the tubing just above the injection port d. Pinching the tubing at least 5 cm above the injection port ANS: C Before injecting an IV push medication, occlude the IV line by pinching the tubing just above the injection port. DIF: Cognitive Level: Comprehension 5. The nurse is preparing to administer IM immunization to a 2-month-old infant. Which site is acceptable for this injection? a. Deltoid b. Dorsogluteal c. Ventrogluteal d. Vastus lateralis ANS: D The vastus lateralis is the acceptable IM site for infants. DIF: Cognitive Level: Comprehension 6. The nurse is administering insulin subcutaneously to a patient who is obese. Proper technique for this injection requires the nurse to do which? a. Use the Z-track method b. Insert the needle at a 5- to 15-degree angle until resistance is felt c. Pinch the skin at the injection site and inject the needle below the skin fold d. Spread the skin tightly over the injection site, insert the needle, then release the skin ANS: C The proper technique for administering a subcutaneous injection to a patient who is obese is to pinch the skin at the site and inject the needle below the skin fold at a 90-degree angle. DIF: Cognitive Level: Comprehension lOMoARcPSD|13778330
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2 7. When should the nurse administer IM medication with the Z-track method? a. When the medication is known to be irritating to tissues b. When the patient is emaciated and has very little muscle mass c. When the medication must be absorbed quickly into the tissues d. When the patient is obese and has a deep fat layer below the muscle mass ANS: A The Z-track method should be used for medications known to irritate tissues. This method prevents the deposit of medication through sensitive tissues and reduces pain, irritation, and staining at the injection site. DIF: Cognitive Level: Application 8. After administering an ID injection for a skin test, the nurse notices a small bleb at the injection site. What is the proper action for the nurse to take? a. Apply heat b. Massage the area c. Report the bleb to the physician d. Do nothing ANS: D The formation of a small bleb is expected after an ID injection for skin testing. It is normal to feel resistance, and a bleb that resembles a mosquito bite (about 6 mm in diameter) will form at the site if accurate technique is used. DIF: Cognitive Level: Comprehension 9. What important action should the nurse take after administering an IV push medication through an IV lock? a. Flush the lock. b. Regulate the IV flow. c. Clamp the tubing for 10 minutes. d. Hold the patient’s arm up to improve blood flow. ANS: A IV locks are to be flushed before and after each use. Either a heparin or saline flush is used, depending on the particular institution’s policy. Regulating the IV flow, clamping the tubing for 10 minutes, or holding the patient’s arm up to improve blood flow are not appropriate actions. DIF: Cognitive Level: Comprehension 10. Which is the proper method of mixing IV solutions and medications? a. Shaking the bag or bottle vigorously b. Holding the bag or bottle and gently turning it end to end c. Inverting the bag or bottle just once after injecting the medication d. Allowing the IV solution to stand for 10 minutes to enhance even distribution of medication ANS: B When adding medications to IV fluid containers, mix the medication and the IV solution by holding the bag or bottle and gently turning it end to end. DIF: Cognitive Level: Comprehension 11. To measure 4 mL of a liquid cough elixir properly for a child, what should the nurse do? a. Use a teaspoon to measure and administer the elixir. b. Hold the medication cup at eye level and fill it to the desired level. c. Withdraw the elixir from the container with a syringe with a needle attached. d. Withdraw the elixir from the container with a syringe without a needle attached. ANS: D Liquid medication volumes of less than 5 mL should be withdrawn in a syringe without a needle. To prevent accidental ingestion of the needle during administration of the liquid, never use a needle to draw up oral medication; never withdraw the elixir from the container with a syringe with a needle attached. Using a teaspoon to measure and administer liquid medication or holding the medication cup at eye level and filling it to the desired level are not accurate methods for measuring small volumes. DIF: Cognitive Level: Comprehension 12. The nurse is helping a patient to take his medications; however, the medication cup falls to the floor, spilling the contents. The appropriate action for the nurse to take is to a. discard the medications and repeat the preparation. b. document the client’s refusal of the medications. c. wait until the next dosage time, then give the medications. d. retrieve the medications and administer them to avoid waste. ANS: A Medications that fall onto the floor need to be discarded, and the procedure must be repeated with new medications. DIF: Cognitive Level: Application lOMoARcPSD|13778330
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3 13. The patient is to receive a buccal medication. Which action is appropriate for the nurse to take? a. Encourage the patient to swallow if necessary. b. Administer water after the medication has been given. c. Place the medication between the upper molar teeth and cheek. d. Place the tablet under the client’s tongue, and allow the tablet to dissolve completely. ANS: C Buccal medications are properly placed between the upper or lower molar teeth and the cheek. Caution the patient against swallowing, and do not administer with water. Medications given under the tongue are said to be sublingually administered. DIF: Cognitive Level: Comprehension 14. How should the nurse administer medication through a nasogastric (NG) tube? a. Administer the medication with a small medication syringe. b. Apply gentle pressure on the syringe’s piston to infuse the medication. c. Flush the tubing with 30 mL of saline after the medication has been given. d. Using the barrel of the syringe, allow the fluid to flow via gravity into the NG tube. ANS: D For NG tubes, medications are poured into the barrel of the syringe with the piston removed, and fluid is allowed to flow via gravity into the tube. Never force any fluid into the tube. Flush the tubing with 30 mL of tap water to ensure that the medication is cleared from the tube. DIF: Cognitive Level: Comprehension 15. Which technique should the nurse use to facilitate the administration of a rectal suppository? a. Having the patient lie on the right side of the body, unless contraindicated b. Having the patient hold the breath during insertion of the medication c. Lubricating the suppository with a small amount of petroleum-based lubricant d. Encouraging the patient to lie on the left side of the body for 15 to 20 minutes after insertion ANS: D For rectal suppository insertion, the patient should be positioned on the left side of the body. Lubricate the suppository with a small amount of water-soluble lubricant, have the patient take a deep breath and exhale through the mouth during insertion, and then have the patient remain lying on the left side for 15 to 20 minutes to allow absorption of the drug. DIF: Cognitive Level: Application 16. What is the best action for the nurse to take to reduce systemic effects after administering eye drops? a. Wiping off excess liquid immediately after instilling drops. b. Having the patient close the eye tightly after instilling drops. c. Having the patient close the eye, then moving the eye around to help distribute the medication. d. Applying gentle pressure to the patient’s nasolacrimal duct for 30 to 60 seconds after instilling drops. ANS: D When administering drugs that cause systemic effects, protect your finger with a clean tissue, then apply gentle pressure to the patient’s nasolacrimal duct for 30 to 60 seconds. DIF: Cognitive Level: Comprehension 17. What is the proper technique for administering ear drops to a 2-year-old child? a. Administering the drops without altering the ear canal direction. b. Straightening the ear canal by pulling the lobe upward and back. c. Straightening the ear canal by pulling the pinna down and back. d. Straightening the ear canal by pulling the pinna upward and outward. ANS: C For an infant or a child younger than 3 years, straighten the ear canal by pulling the pinna down and back. For adults, pull the pinna up and outward. DIF: Cognitive Level: Comprehension 18. A patient with asthma is to begin medication therapy with a metered-dose inhaler. What important reminder should the nurse include during teaching sessions with the patient? a. Repeat subsequent puffs, if ordered, after 5 minutes. b. Inhale slowly while pressing down to release the medication. c. Inhale quickly while pressing down to release the medication. d. Administer the inhaler while holding it 7.5 to 10 cm away from the mouth. ANS: B The patient should position the inhaler at the open mouth with the inhaler 3 to 5 cm away from the mouth, attach a spacer to the mouthpiece of the inhaler, or place the mouthpiece in the mouth. To administer, the patient presses down on the inhaler to release the medication while inhaling slowly, waiting 1 to 2 minutes between puffs. DIF: Cognitive Level: Application lOMoARcPSD|13778330
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4 19. Which action is considered a standard precaution for medication administration? a. Bending the syringe to prevent reuse b. Recapping needles to prevent needlestick injury c. Discarding all syringes and needles in a wastebasket d. Discarding all syringes and needles in a puncture-resistant container ANS: D Standard precautions include wearing clean gloves when there is potential exposure to a patient’s blood or other body fluids. Discard all disposable syringes and needles in an appropriate puncture-resistant container. Never bend needles or syringes, never recap needles, and never discard syringes and needles in wastebaskets. DIF: Cognitive Level: Application 20. The patient states that he prefers chewing rather than swallowing pills. The label on the container of one prescribed pill has the abbreviation “SR” after the name of the medication. Which instruction should be followed when giving this medication? a. Break the tablet into halves or quarters. b. Dissolve the tablet in a small amount of water before giving it. c. Do not crush or break the tablet before administration. d. Use a mortar and pestle to crush the tablet if crushing it is needed to ease administration. ANS: C In order to protect the gastrointestinal lining and the medication itself, sustained-release (SR) pills, enteric-coated tablets, and capsules should not be crushed before administration. DIF: Cognitive Level: Application 21. When preparing to administer nasal spray, what should the nurse tell the patient? a. “You will need to blow your nose before I give you this medication.” b. “You will need to blow your nose after I give you this medication.” c. “When I give you this medication, you will need to hold your breath.” d. “You should sit up for 5 minutes after you receive the nasal spray.” ANS: A The patient will need to blow the nose before the medication is administered, because the nasal passages should be cleared before receiving nasal spray. Blowing the nose after receiving the medication will remove the medication from the nasal passages. The patient should receive the spray while inhaling through the open nostril. Afterwards, the patient should remain in a supine position for 5 minutes. DIF: Cognitive Level: Application MULTIPLE RESPONSE 1. The nurse is preparing to give an IM injection to an average-sized adult male. Which statement applies to an IM injection? ( Select all that apply. ) a. A 6- to 13-mm ( 1 4 - to 1 2 -inch) 26- or 27-gauge needle should be chosen. b. A 13- to 16-mm ( 1 2 - to 5 8 -inch) 25-gauge needle should be chosen. c. A 38-mm ( 1 1 2 -inch) 21- to 25-gauge needle should be chosen. d. A site at least 5 cm away from the umbilicus should be selected. e. The dorsogluteal site is the preferred site for IM injections. f. The ventrogluteal site is the preferred site for IM injections. g. The needle should be inserted at a 45-degree angle. h. The needle should be inserted at a 90-degree angle. ANS: C, F, H Choose a 38-mm 21- to 25-gauge needle for an IM injection. The ventrogluteal site is preferred for IM injections; insert the needle at a 90-degree angle. Some agencies recommend that all IM injections be given by the Z-track method. Before administering the injection, pull back on the plunger and check for blood return. DIF: Cognitive Level: Analysis lOMoARcPSD|13778330
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1 Chapter 11: Analgesic Drugs Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. A patient diagnosed with migraine headache is experiencing what type of pain? a. Acute pain b. Persistent pain c. Vascular pain d. Phantom pain ANS: C Vascular pain is thought to account for a large percentage of migraine headaches. It is believed to originate from vascular or perivascular tissues. It is characterized by persistent and recurring pain lasting 3 to 6 months. Acute pain is sudden and usually subsides when treated. Phantom pain occurs in the area of a body part that has been removed—surgically or traumatically—and is often described as burning, itching, tingling, or stabbing. It can also occur in paralyzed limbs following spinal cord injury. DIF: Cognitive Level: Comprehension 2. An 18-year-old basketball player fell and twisted his ankle during a game. Which type of analgesic is he likely to be given? a. A synthetic opioid, such as meperidine hydrochloride b. An opium alkaloid, such as morphine sulphate c. An opioid antagonist, such as naloxone hydrochloride (Suboxone ® ) d. A non-opioid analgesic, such as tramadol ANS: D Pain originating from skeletal muscles, ligaments, and joints usually responds to non-opioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs). All drugs in the NSAID class are especially useful for pain associated with inflammatory conditions because these drugs have analgesic and anti-inflammatory effects. DIF: Cognitive Level: Application 3. A patient is in the recovery room following abdominal surgery. He is groggy but reports severe pain around his incision. What is the most important factor for the nurse to consider during her patient assessment before administering a dose of morphine sulphate? a. Temperature b. Respiration rate c. Appearance of the incision d. Time of last bowel movement ANS: B One of the most serious side effects of opioids is respiratory depression, so respiration must be assessed prior to administering a dose of morphine. DIF: Cognitive Level: Analysis 4. A 78-year-old patient is in the recovery room after lengthy hip surgery. While gradually awakening, the patient requests pain medication. Within 10 minutes after receiving a dose of morphine sulphate, the patient is very lethargic; respiration is shallow, at a rate of nine respirations per minute. What necessary action may the nurse need to perform? a. Close observation for signs of opioid tolerance b. Immediate intubation and artificial ventilation c. Administration of naloxone, an opioid reversal agent d. Administration of an agonist opioid, such as fentanyl (Duragesic Mat) ANS: C Naloxone, an opioid reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. DIF: Cognitive Level: Application 5. A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after his abdominal surgery. What should the nurse teach this patient in regard to this drug? a. How to manage diarrhea b. How to access drug addiction programs c. How to prevent constipation d. How to avoid dehydration due to polyuria ANS: C Gastrointestinal occurrences such as nausea, vomiting, and constipation are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. DIF: Cognitive Level: Application lOMoARcPSD|13778330
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2 6. A patient who has been treated for lung cancer for 3 years has noticed that over the past few months the opioid analgesic that is being used is not helping as much, and says that taking more medication is needed for the same pain relief. What is this patient experiencing? a. Opioid toxicity b. Addiction c. Opioid tolerance d. Abstinence syndrome ANS: C Opioid tolerance is a common physiological result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia. DIF: Cognitive Level: Comprehension 7. A 38-year-old male has arrived at the urgent care centre with severe hip pain after falling from a ladder at work. He has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol ® ). What is the most serious toxic effect of acute acetaminophen overdose? a. Tachycardia b. Central nervous system (CNS) depression c. Hepatic necrosis d. Nephrotic necrosis ANS: C Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. Tachycardia and CNS depression are not side effects of acute acetaminophen overdose. Long-term, not short-term, ingestion of large doses is more likely to result in nephropathy. DIF: Cognitive Level: Comprehension 8. The drug pentazocine (Talwin ® ) is a narcotic agonist–antagonist. Which statement describes a characteristic of this type of medication? a. It has minimal analgesic effects. b. It works to reverse the effects of opiates. c. Its adverse effects differ from those of the opiate narcotics. d. It has a lower addiction potential than opiate narcotics. ANS: D Opioid agonist–antagonist drugs generally have lower addiction potentials than opiate narcotics. DIF: Cognitive Level: Comprehension 9. A 57-year-old patient has been on a transdermal narcotic analgesic as part of the management of pain for end-stage breast cancer. Lately, she has experienced “breakthrough” pain. How should this pain be addressed? a. She should be given NSAIDs. b. Her current therapy should not be changed. c. The baseline dose of the narcotic may need to be increased in increments. d. The narcotic route should be changed to the rectal route, to increase absorption. ANS: C If a patient is requiring larger doses for breakthrough pain, the baseline dose of the narcotic may need to be titrated upward. DIF: Cognitive Level: Analysis 10. For which situation is the herb feverfew commonly used? a. Muscle aches b. Headaches c. Leg cramps d. Incisional pain after surgery ANS: B Feverfew is commonly used to treat migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain. DIF: Cognitive Level: Comprehension 11. A patient is to receive acetylcysteine as part of treatment for an acetaminophen overdose. Which action by the nurse is appropriate when administering this medication? a. Giving the medication undiluted for full effect b. Avoiding the use of a straw when giving the medication c. Disguising the flavour with a soft drink or flavoured water d. Preparing to give the medication via a nebulizer ANS: C Acetylcysteine has the flavour of rotten eggs. It is better tolerated when the taste is disguised by mixing it with a soft drink or flavoured water to increase its palatability. Giving this medication undiluted is not recommended. The use of a straw will help minimize contact with mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not acetaminophen overdose. DIF: Cognitive Level: Application lOMoARcPSD|13778330
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3 12. A patient is receiving an anticonvulsant but has no history of seizures. What is the most likely reason the patient is receiving this drug? a. Pain associated with peripheral neuropathy b. Inflammation pain c. Depression associated with chronic pain d. Prevention of possible seizures ANS: A Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance analgesic efficacy. Pain from inflammation is best treated with NSAIDs. This patient is not receiving this anticonvulsant drug for depression associated with chronic pain or to prevent possible seizures. DIF: Cognitive Level: Comprehension 13. A patient has been diagnosed with shingles and is experiencing postherpetic neuralgia. What would the nurse expect to administer for pain relief? a. Transdermal lidocaine (EMLA ® ) b. Tramadol hydrochloride (Ultram ® ) c. Naloxone hydrochloride d. Fentanyl (Duragesic MAT ® ) ANS: A Transdermal lidocaine is indicated for the treatment of postherpetic neuralgia, a painful skin condition that remains after a skin outbreak of shingles. Tramadol hydrochloride, naloxone hydrochloride, and fentanyl are not indicated for postherpetic neuralgia. DIF: Cognitive Level: Application MULTIPLE RESPONSE 1. Nalbuphine (Nubain ® ) is a partial opioid agonist. What characterizes this type of medication? ( Select all that apply. ) a. Used for mild pain b. Used for moderate to severe pain c. Drug of choice for reversing the effects of opioids in cases of overdose d. Usually used for long-term conditions e. Usually used for short-term conditions f. Sometimes used in those who have a history of opioid addiction ANS: B, E, F Partial opioid agonists are used for moderate to severe pain in conditions requiring short-term pain control, such as after surgery and for obstetric procedures. They are sometimes chosen for patients who have a history of opioid addiction. DIF: Cognitive Level: Comprehension lOMoARcPSD|13778330
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1 Chapter 12: General and Local Anaesthetics Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. After piercing a finger with a fish hook during a fishing trip, a patient is now at an emergency department to have the hook removed. What type of anaesthesia will be used for this procedure? a. Topical benzocaine spray to the area b. Spinal anaesthesia with mepivacaine hydrochloride c. Topical prilocaine cream (EMLA ® ) around the site d. Infiltration of the area with tetracaine hydrochloride ANS: D Infiltration anaesthesia is commonly used for minor surgical procedures. It involves injecting the local anaesthetic solution intradermally, subcutaneously, or submucosally across the path of nerves supplying the area to be anaesthetized. The local anaesthetic may be administered in a circular pattern around the operative field. DIF: Cognitive Level: Application 2. A patient is to receive local anaesthesia for removal of a lymph node from the groin. Why does the physician add epinephrine to the local anaesthetic during the preparation? a. Epinephrine prevents an anaphylactic reaction from occurring. b. The anaesthetic enhances the effect of the epinephrine. c. Epinephrine contributes to a balanced anaesthetic state. d. Vasoconstrictive effects keep the anaesthetic at its local site of action. ANS: D Vasoconstrictors such as epinephrine are coadministered with local anaesthetics to keep the anaesthetic at its local sit e of action and to prevent systemic absorption. DIF: Cognitive Level: Application 3. During the postoperative recovery period, what should be the nurse’s immediate main concern? a. Pupil responses b. Return to sensation c. Level of consciousness d. Airway, breathing, and circulation ANS: D After surgery and the termination of general anaesthesia, the nurse’s main concern should be assessing the patient’s airway, breathing, and circulation status. DIF: Cognitive Level: Application 4. While monitoring a patient who had surgery under general anaesthesia 2 hours earlier, the nurse notes a sudden elevation in body temperature. What does this sudden elevation in body temperature indicate? a. Tachyphylaxis b. Postoperative infection c. Malignant hypothermia d. Malignant hyperthermia ANS: D A sudden elevation in body temperature during the postoperative period may indicate the occurrence of malignant hyperthermia, a life-threatening emergency. DIF: Cognitive Level: Application 5. Which individual is at high risk for an altered response to anaesthesia? a. A 30-year-old male who has never had surgery before b. A 45-year-old female who stopped smoking 10 years ago c. A 20-year-old male who is to have a lymph node removed d. A 78-year-old female who is to have her gallbladder removed ANS: D The older adult patient is more affected by anaesthesia because of the effects of aging on the hepatic, cardiac, respiratory, and renal systems. Young or middle-aged adult patients are not at high risk for an altered response to anaesthesia. DIF: Cognitive Level: Analysis lOMoARcPSD|13778330
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2 6. A patient is undergoing abdominal surgery and has been anaesthetized for 3 hours. Which nursing diagnosis is appropriate for him? a. Anxiety related to the use of an anaesthetic b. Risk for injury related to increased sensorium from general anaesthesia c. Decreased cardiac output related to systemic effects of local anaesthesia d. Impaired gas exchange related to central nervous system (CNS) depression produced by general anaesthesia ANS: D Impaired gas exchange related to CNS depression produced by general anaesthesia is the appropriate nursing diagnosis for this patient. Because the patient is under anaesthesia, the nurse is unable to assess the patient for anxiety. Risk for injury is related to decreased sensorium, not increased sensorium from general anaesthesia. “Decreased cardiac output related to systemic effects of local anaesthesia” is incorrect because local anaesthesia should have very little systemic effect. DIF: Cognitive Level: Application 7. When administering a neuromuscular drug such as pancuronium, what does the nurse need to remember? a. It can be used instead of general anaesthesia during surgery. b. Only skeletal muscles are paralyzed; respiratory muscles remain functional. c. It causes sedation and pain relief while allowing for lower doses of anaesthetics. d. Patients will require artificial mechanical ventilation because of paralyzed respiratory muscles. ANS: D Patients receiving neuromuscular blocking agents (NMBAs) will require artificial mechanical ventilation because of the resultant paralysis of the respiratory muscles. NMBAs do not cause sedation or pain relief and cannot be used in place of general anaesthesia during surgery. Respiratory muscles are paralyzed by this drug. DIF: Cognitive Level: Application 8. A patient has been given succinylcholine (Quelicin ® ) after a severe injury that necessitated controlled ventilation. The physician now wants to reverse the paralysis. The nurse would expect to use which drug to reverse the succinylcholine? a. diazepam (Valium ® ) b. caffeine c. neostigmine methylsulphate d. vecuronium bromide (Norcuron ® ) ANS: C The antidote for NMBAs such as succinylcholine is neostigmine methylsulphate. It reverses the effects of the NMBAs. DIF: Cognitive Level: Application 9. A patient is being prepared for an oral endoscopy, and the nurse reminds him that he will be awake during the procedure but probably will not remember it. What type of anaesthetic technique is used in this situation? a. Twilight sleep b. Procedural sedation c. Adjunctive anaesthesia d. Spinal anaesthesia ANS: B Procedural sedation effectively reduces patient anxiety, sensitivity to pain, and recall of the medical procedure, yet it preserves the patient’s ability to maintain his or her own airway and to respond to verbal commands. DIF: Cognitive Level: Comprehension 10. Which symptom may occur if a patient is taking ginger and requires an anaesthetic? a. Decreased blood pressure b. Increased risk of bleeding c. Increased risk of stroke d. Migraine headaches ANS: B A patient who has been taking the natural health product ginger and requires anaesthesia is at an increased risk of bleeding, especially if acetylsalicylic acid (Aspirin) or ginkgo is also being taken. Decreased blood pressure, increased risk of stroke, and migraine headaches are risks associated with the combination of anaesthesia with some natural health products, but not with ginger. DIF: Cognitive Level: Comprehension OTHER 1. When a neuromuscular blocking drug is given, the effects occur in a certain order. Put the following drug effects in the proper order of occurrence, using the choices A through C listed below. a. Cessation of respirations due to paralysis of diaphragm and intercostal muscles b. Total flaccid paralysis c. Weakness ANS: C, B, A The first sensation typically experienced is muscle weakness. This is usually followed by a total flaccid paralysis. Small, rapidly moving muscles such as those of the fingers and eyes are typically the first to be paralyzed. The next are those of the limbs, neck, and trunk. Finally, the intercostal muscles and the diaphragm are paralyzed. The patient can no longer breathe independently. DIF: Cognitive Level: Application lOMoARcPSD|13778330
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1 Chapter 13: Central Nervous System Depressants and Muscle Relaxants Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition MULTIPLE CHOICE 1. Which is a true statement about sedatives and hypnotics? a. The two terms mean the same thing. b. A hypnotic causes sleep. c. Low doses of sedatives will cause sleep. d. Compared with sedatives, hypnotics have a less potent effect on the central nervous system. ANS: B A sedative reduces nervousness, excitability, and irritability without causing sleep, whereas a hypnotic causes sleep. DIF: Cognitive Level: Knowledge 2. A patient who has been taking phenobarbital for 2 weeks as part of therapy for epilepsy reports feeling tense and that the “least little thing” is a bother now. What is the nurse’s best explanation to the patient? a. These adverse effects will often subside after a few weeks. b. The drug should be stopped immediately because of possible adverse effects. c. This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness. d. This drug causes deprivation of REM sleep and may cause the patient’s inability to deal with normal stress. ANS: D Barbiturates deprive people of REM sleep, which can result in agitation and an inability to deal with normal stress. A rebound phenomenon occurs when the drug is stopped, and the proportion of REM sleep increases, sometimes resulting in nightmares. DIF: Cognitive Level: Application 3. A 50-year-old male who has been taking a benzodiazepine for 1 week is found unresponsive. His wife states that he takes no other prescription drugs and that he did not take an overdose—the correct number of pills is in the bottle. What might have happened? a. He took a multivitamin. b. He drank a glass of wine. c. He took a dose of Aspirin. d. He developed an allergy to the drug. ANS: B Potential drug interactions with the benzodiazepines are significant because of their intensity, particularly when they involve other central nervous system (CNS) depressants (e.g., alcohol, opioids, muscle relaxants). DIF: Cognitive Level: Analysis 4. A patient has been taking temazepam (Restoril ® ) for intermittent insomnia. She tells the nurse that when she takes it, she sleeps well, but the next day she feels “so tired.” What is the nurse’s best explanation to the patient? a. Long-term use results in a sedative effect. b. She should take the drug every night to reduce this hangover effect. c. Benzodiazepines affect the sleep cycle, thus causing a hangover effect. d. Benzodiazepines increase CNS activity, thus causing tiredness the next day. ANS: C Benzodiazepines suppress rapid eye movement REM sleep to a degree (though not as much as barbiturates) and thus result in a hangover effect. DIF: Cognitive Level: Application 5. A patient who is recovering from a minor automobile accident that occurred 1 week ago is taking cyclobenzaprine (Novo-Cycloprine ® ) for muscular pain and goes to physical therapy three times a week. Which nursing diagnosis would be appropriate for him? a. Risk for falls related to decreased sensorium b. Risk for addiction related to psychological dependency c. Excess fluid volume related to potential adverse effects d. Disturbed sleep pattern related to the drug’s interference with REM sleep ANS: A Musculoskeletal relaxants have a depressant effect on the CNS; lightheadedness, dizziness, drowsiness, and fatigue can occur, thus putting the patient at risk for falls. The patient should be taught the importance of taking measures to minimize self-injury and falls related to decreased sensorium. DIF: Cognitive Level: Analysis lOMoARcPSD|13778330
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2 6. A patient is taking flurazepam (Apo-Flurazepam ® ) 3 to 4 nights a week for sleeplessness. She is concerned that she cannot get to sleep without taking the medication. What measures are appropriate for this patient? a. Trying to establish set sleep patterns b. Exercising before bedtime to become tired c. Consuming heavy meals in the evening to promote sleepiness d. Drinking warm beverages, such as tea or coffee, just before bedtime ANS: A Nonpharmacological approaches to induce sleep include establishing set sleep patterns. The patient should avoid heavy exercise before bedtime, avoid heavy meals late in the evening, and should drink warm decaffeinated drinks, such as warm milk, before bedtime. DIF: Cognitive Level: Application 7. Which is the best treatment of an acute overdose of diazepam? a. Infusion with diluted bicarbonate solution b. Administration of medications to decrease blood pressure c. Administration of flumazenil d. Administration of nalbuphine as an antagonist ANS: C Flumazenil, a benzodiazepine antidote, can be used to acutely reverse the sedative effects of benzodiazepines. Flumazenil antagonizes the action of benzodiazepines on the CNS by directly competing with them for binding at the receptors. Flumazenil is used in cases of oral overdose or excessive intravenous sedation. Infusion with diluted bicarbonate solution and the administration of medications to decrease blood pressure are not appropriate treatments. There are no antagonists for barbiturates. DIF: Cognitive Level: Analysis 8. A 45-year-old female has been taking dantrolene as part of the treatment for multiple sclerosis. Which laboratory value should the nurse monitor while the patient receives dantrolene? a. Creatinine b. Sedimentation rate c. Liver function studies d. Hemoglobin and hematocrit ANS: C Dantrolene can cause liver damage; therefore, liver function studies should be performed during therapy. DIF: Cognitive Level: Comprehension 9. What is an adverse effect of barbiturate administration? a. Vasoconstriction b. Thrombocytopenia c. Hypertension d. Excitement ANS: B An adverse effect of barbiturate use is thrombocytopenia. Some other effects include hypotension, vasodilation, and drowsiness and lethargy. DIF: Cognitive Level: Comprehension 10. Which natural health product is used by some people to promote sleep and to relieve anxiety and restlessness? a. Kava b. Garlic c. Ginger d. Ginkgo ANS: A Kava may be used to promote sleep and for relief of anxiety and restlessness. DIF: Cognitive Level: Comprehension MULTIPLE RESPONSE 1. The nurse is preparing to administer a barbiturate. Which condition(s) or disorder(s) are contraindications to the use of these drugs? ( Select all that apply. ) a. Gout b. Pregnancy c. Epilepsy d. Severe chronic obstructive pulmonary disease e. Peripheral vascular disease f. Advanced liver disease g. Current use of an opioid analgesic ANS: B, D, F, G Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and severe liver disease. In addition, coadministration of barbiturates with alcohol, opioids, benzodiazepines, and some medications from other drug groups can result in additive CNS depression. DIF: Cognitive Level: Analysis lOMoARcPSD|13778330
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