Chapter 33: Pharmacology and Preparation for Drug Administration My Nursing Test Banks

Chapter 33: Pharmacology and Preparation for Drug Administration

Test Bank

MULTIPLE CHOICE

1. A nurse has an order to administer a schedule II drug to a patient. When working with medications of this type, the responsibility of the nurse is to:

a.

leave the medication in a cup at the bedside.

b.

ask another licensed nurse to check the dose.

c.

sign out the drug on a narcotic control inventory sheet.

d.

tell the patient to drink extra water with the pill.

ANS: C

Schedule II drugs are narcotics, which are controlled substances that are kept in a locked area on the nursing unit, and each dose must be signed out.

DIF: Cognitive Level: Application REF: p. 623 OBJ: Theory #2

TOP: Legal Control of Drugs KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

2. The nurse is aware that the physician has ordered a pain relief drug to be delivered in the manner in which postoperative pain would be relieved most rapidly. This method is:

a.

intradermally.

b.

orally.

c.

intramuscularly.

d.

intravenously.

ANS: D

Intravenously administered medications are absorbed more quickly than medications administered by other routes.

DIF: Cognitive Level: Knowledge REF: p. 624, Table 33-8

OBJ: Theory #3 TOP: Medication Absorption

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

3. A nurse is administering a medication to an elderly patient who is normally highly protein bound. The nurse would be concerned about increased drug activity and possible toxicity if the patients laboratory values show _____ levels.

a.

low albumin

b.

high glucose

c.

low sodium

d.

high potassium

ANS: A

Albumin is a type of protein, and this patient is at risk if the albumin level is low, because this larger amount of drug will circulate in unbound form, increasing risk of adverse and toxic effects.

DIF: Cognitive Level: Analysis REF: p. 624, Table 33-8

OBJ: Clinical Practice #1 TOP: Medication Absorption

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: pharmacological therapies

4. A patient with liver disease is beginning medication therapy with a drug that is metabolized in the liver. The nurse anticipates the dose of the medication to be _____ the normal dose.

a.

increased above

b.

double

c.

unchanged from

d.

lower than

ANS: D

When there is a decrease in liver function resulting from disease or aging, a smaller dose may be ordered to prevent excess drug accumulation and development of toxicity.

DIF: Cognitive Level: Analysis REF: p. 629, Elder care

OBJ: Clinical Practice #1 TOP: Factors Leading to Toxicity

KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

5. A patient is receiving antibiotic drug therapy. It is important to ensure the scheduled dose is not given late to keep the circulating drug level above the _____ concentration level.

a.

peak

b.

minimum

c.

average

d.

baseline

ANS: B

If a drug is given late, the concentration level of the drug in the circulation could drop below the minimum effective concentration level.

DIF: Cognitive Level: Comprehension REF: p. 624 OBJ: Clinical Practice #1

TOP: Pharmacodynamics KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

6. A patient is receiving an initial dose of penicillin for pneumonia. The nurse should be alert and monitor for:

a.

hives.

b.

nausea.

c.

fever.

d.

dizziness.

ANS: A

A rash or hives can indicate allergic response; nausea and dizziness are examples of adverse drug effects. With an allergic reaction the patient is cautions to never take the drug again.

DIF: Cognitive Level: Application REF: p. 625 OBJ: Clinical Practice #1

TOP: Allergic Response KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

7. A nurse is reinforcing instructions to a patient who is beginning medication therapy with a central nervous system (CNS) depressant drug. The nurse cautions the patient not to drink alcohol, because alcohol and the drug could cause a synergic effect, which means the:

a.

alcohol makes the drug have less than the desired effect.

b.

drug undergoes a rapid breakdown and is rapidly excreted.

c.

drug and alcohol increase the effect on the central nervous system.

d.

drug changes the alcohol to a toxic substance.

ANS: C

Alcohol has a synergistic effect when combined with any drug that depresses the CNS, because it is also a CNS depressant. The combination of the two makes the drug more powerful.

DIF: Cognitive Level: Knowledge REF: p. 625 OBJ: Clinical Practice #2

TOP: Drug Interactions KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

8. A patient who is to receive a daily medication by the oral route has had nausea and vomiting for the last 24 hours. The best action to ensure that the patient receives the scheduled dose is to:

a.

have the patient take the pill with sips of water.

b.

have the patient take the pill with crackers.

c.

acquire an order to administer by the rectal or parenteral route.

d.

withhold the dose for 1 hour and see whether the nausea subsides.

ANS: C

When a patient is experiencing nausea and vomiting, the nurse can consult with the physician to get an order for the drug to be changed to the rectal or parenteral route, as long as the drug is also supplied in that form.

DIF: Cognitive Level: Analysis REF: p. 616 OBJ: Clinical Practice #4

TOP: Safe Drug Administration KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

9. A hospitalized 3-year-old toddler is to receive an oral medication. For the most effective approach, the nurse should tell the child:

a.

firmly that the drug is important to take as soon possible.

b.

in a confident manner what the medication is for and how it will be given.

c.

that the medication is candy and tastes good.

d.

that it will make him feel better right away.

ANS: B

The best approach is to confidently explain to the child what the drug is for and how it will be given using simple language and short sentences.

DIF: Cognitive Level: Application REF: p. 629 OBJ: Theory #4

TOP: Drug Administration for Children KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

10. An elderly patient with arthritis who has been taking anti-inflammatory drugs for the last 5 years should be monitored for:

a.

dizziness and fever.

b.

abdominal cramps and bloating.

c.

restlessness and dyspnea.

d.

gastrointestinal (GI) bleeding and anemia.

ANS: D

Older patients who are on long-term anti-inflammatory therapy for arthritis should be monitored for GI bleeding and anemia.

DIF: Cognitive Level: Application REF: p. 629, Elder care

OBJ: Clinical Practice #1

TOP: Medication Administration and Safety for the Elderly

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

11. An elderly patient who lives in a skilled nursing facility and who likes to walk is taking a medication that lowers blood pressure by dilating blood vessels. The best nursing action for this patient is to:

a.

suggest total bed rest.

b.

monitor intake and output.

c.

assist the patient when ambulating in the hall.

d.

instruct the resident to rise slowly when getting out of bed or a chair.

ANS: D

Elderly patients are likely to have greater blood pressure fluctuations with position changes and are more susceptible to falls when taking drugs that cause orthostatic hypotension. Assistance with ambulation may offer safety, but if the patient has already fallen when getting out of bed or a chair, assisted ambulation is pointless.

DIF: Cognitive Level: Application REF: p. 629, Elder care

OBJ: Theory #4 TOP: Medication Administration and Safety for the Elderly

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: reduction of risk

12. The nurse explains that a drug may have several names. The trade name is the only name that can be:

a.

used in an order.

b.

trademarked.

c.

recognized as its chemical makeup.

d.

used by retailers to sell the drug.

ANS: B

The trade name of a drug is patented or trademarked. Generic names cannot be trademarked and are frequently cheaper to purchase under that name. The chemical name is one that identifies the compounds in the drug. Retailers can sell the drug by either name.

DIF: Cognitive Level: Knowledge REF: p. 620 OBJ: Theory #1

TOP: Trademarked Drugs KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

13. The nurse is aware that for a drug to be effectively eliminated from the body, the patient must have a fluid intake of 50 mL/kg/day. The nurse would provide for a patient who weighs 125 pounds ______ mL of water per day.

a.

1560

b.

899.2

c.

2840.9

d.

3039.1

ANS: C

Divide the patients weight by 2.2 to convert to kilograms. Then multiply the total by 50 mL to get the total mL per day. (125lbs/2.2) x 50 mL = 2840.9 mL.

DIF: Cognitive Level: Analysis REF: p. 624 OBJ: Theory #3

TOP: Distribution of Drugs KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

14. Before administering a medication to a newly assigned patient, the nurse should determine why the patient is receiving it by checking the:

a.

medication administration record (MAR).

b.

medical history.

c.

laboratory test results.

d.

intake and output record.

ANS: B

The medical history contains information about the medical problems a patient has, so the nurse can correlate the reason a drug is being administered.

DIF: Cognitive Level: Application REF: p. 631 OBJ: Clinical Practice #4

TOP: Assessment Before Medication Administration

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

15. The nurse is going to administer a medication that must be crushed for the patient to take it. This medication is best given to the patient by:

a.

adding it to water.

b.

dissolving it in juice.

c.

mixing it in applesauce or soft food.

d.

sprinkling it on meat or vegetables.

ANS: C

A drug that is crushed needs to be mixed in something else, such as applesauce.

DIF: Cognitive Level: Application REF: p. 633 OBJ: Clinical Practice #4

TOP: Medication Preparation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

16. When the nurse is administering a medication to a patient, the patient states that the tablet looks different from the one usually taken. The most prudent action by the nurse would be to:

a.

reassure the patient that the medication is the same as the one ordered.

b.

determine why the patient is refusing to take the medication and call the physician.

c.

assess for possible causes of this patients confusion.

d.

withhold the dose and verify the drug order.

ANS: D

If a patient questions the dose given, the nurse should stop and verify the order.

DIF: Cognitive Level: Application REF: p. 638, Box 33-1

OBJ: Clinical Practice #4 TOP: Safe Drug Administration

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

17. A patient is due for a 40-mg dose of furosemide (Lasix), at 9:00 AM on May 5, 2013. The drug label reads 20 mg per tablet. The tablets in the bottle appear firm and unbroken. The expiration date on the bottle reads April 2, 2013. The best nursing action is to:

a.

administer two tablets.

b.

administer one-half tablet.

c.

call the pharmacy to see if 40-mg tablets are available.

d.

call the pharmacy for a new bottle of the medication.

ANS: D

The pharmacy should be called, because the medication is past the expiration date and should not be given to the patient.

DIF: Cognitive Level: Analysis REF: p. 638, Box 33-3

OBJ: Clinical Practice #4 TOP: Patients Five Rights

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

18. A nurse is administering medications to a group of patients. The safest way to identify each patient is to:

a.

call each patient by his given name, ask for his birthday, and compare with the MAR.

b.

check the patients name on the wristband and compare it with the MAR.

c.

check the name and hospital number on the wristband and compare them to the MAR.

d.

check the patients identification number on the wristband.

ANS: C

The best method is to check both the name and identification number on the wristband and compare them to the MAR.

DIF: Cognitive Level: Application REF: p. 638, Box 33-3

OBJ: Clinical Practice #4 TOP: Patients Five Rights

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

19. When preparing medications for delivery to an assigned patient, the nurse should check each medication for accuracy of drug and dose _____ time(s).

a.

five

b.

three

c.

two

d.

one

ANS: B

Medications should be checked three times to prevent medication errors.

DIF: Cognitive Level: Application REF: p. 638, Box 33-3

OBJ: Clinical Practice #4 TOP: Three Medication Checks

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

20. A nurse is administering a dose of insulin to a patient. To practice nursing safely and effectively, the nurse should:

a.

confirm with the patient the site of the last injection.

b.

give the drug before a meal.

c.

inject the insulin in the deltoid muscle.

d.

have another licensed nurse double-check the dose.

ANS: D

The prudent nurse asks another nurse to check the prepared dose of drugs such as insulin, anticoagulants, and injectable digoxin.

DIF: Cognitive Level: Application REF: p. 636 OBJ: Clinical Practice #4

TOP: Prevention of Medication Errors KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

21. A patient will be started on furosemide (Lasix). The physician has also ordered potassium chloride (KCl) 40 mEq. There is a bottle of KCl labeled 45 mEq per 15 mL. How many milliliters should the patient receive?

a.

10.8 mL

b.

12.6 mL

c.

13.3 mL

d.

14 mL

ANS: C

Using the drug problem formula desired over on hand (D/H), divide 40 by 45 and multiply by 15, which equals 13.3 mL (i.e., 40/45 = 0.88 15 = 13.33).

DIF: Cognitive Level: Application REF: p. 636 OBJ: Clinical Practice #3

TOP: Drug Calculations KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

22. When categorizing medications, drug classifications may be defined by the effects of the drug and:

a.

the symptoms the drug relieves.

b.

patient tolerance.

c.

the nursing implications.

d.

the dosage amounts.

ANS: A

Drug classifications may be defined by the effects of the drug, the symptoms the drug relieves, or the drugs desired effect.

DIF: Cognitive Level: Comprehension REF: p. 620 OBJ: Theory #1

TOP: Classification of Medications KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

23. An arthritic patient will be discharged home with a variety of medications. The best way for the home health nurse to assist the patient who lives alone in taking his medications is to:

a.

ensure the medications are secured with childproof caps.

b.

arrange the medication in a user-friendly pill organizer.

c.

verbally tell the patient about what to report to the doctor.

d.

leave outdated medications in the medicine cabinet for future use.

ANS: B

To ensure that medications are taken on schedule, a pill organizer should be set up for the patient.

DIF: Cognitive Level: Application REF: p. 629, Elder care

OBJ: Theory #5 TOP: Medications and Home Care

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: safety and infection control

24. An elderly patient visits an outpatient clinic for the third time this month to be seen for hypertension. The nurse finds that the patient has not taken his blood pressure medication for 10 days. The most therapeutic response from the nurse would be:

a.

You really need to take your blood pressure medicine.

b.

Your medicine will keep your blood pressure down in a safe range.

c.

Why havent you taken your blood pressure medicine?

d.

Did you stop adding salt on your food like we asked you to?

ANS: B

Being reminded of the drugs benefits and the need to keep a consistent blood level frequently supports better compliance. Why questions and calling for justification are not therapeutic.

DIF: Cognitive Level: Application REF: p. 630 OBJ: Theory #7

TOP: Noncompliance with Medications KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity: basic care and comfort

25. The nurse is administering an enteric-coated oral medication to a patient who is unable to swallow tablets. The best nurse action is to:

a.

give the patient extra water to take with the pill.

b.

crush the tablet for easier swallowing.

c.

discontinue the medication and document why.

d.

ask the physician to consider a liquid form.

ANS: D

Enteric-coated tablets should not be crushed for easier swallowing because the coating is meant to delay absorption. If a liquid form of the drug is available, the nurse should ask the physician to change the order.

DIF: Cognitive Level: Application REF: p. 636 OBJ: Clinical Practice #1

TOP: Enteric-Coated Tablets KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

COMPLETION

26. A patient is being prepared for surgery. There is an on-call order for meperidine hydrochloride (Demerol) 75 mg, with 50 mg/mL available. The patient should receive ____ mL.

ANS:

1.5

Calculate by using the desired over on hand (D/H) method for Demerol:

Desired = (1) 75 mg / On Hand = 50 mg; (2) 75 / 50 = 1.5.

DIF: Cognitive Level: Analysis REF: p. 636 OBJ: Clinical Practice #3

TOP: Calculation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

27. The nurse must be aware of how drugs enter the body and how they are metabolized and excreted. The name of this information is _____________.

ANS:

pharmacokinetics

Pharmacokinetics is the study of how drugs enter the body, how they reach their site of action, and how they are metabolized and excreted.

DIF: Cognitive Level: Knowledge REF: p. 624 OBJ: Theory #3

TOP: Pharmacokinetics KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: pharmacological therapies

MULTIPLE RESPONSE

28. What are the concepts considered to be rights of medication administration? (Select all that apply.)

a.

The right patient

b.

The right time

c.

The right route

d.

The right dose

e.

The right room

f.

The right drug

ANS: A, B, C, D, F

Before administering a drug, check the six rights of medication administration: the right drug, the right dose, the right route, the right time, and the right patient.

DIF: Cognitive Level: Comprehension REF: p. 633 OBJ: Clinical Practice #4

TOP: Medication Administration KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

29. The nurse explains that the common aspirin can be classified as an: (Select all that apply.)

a.

antipyretic.

b.

analgesic.

c.

anti-inflammatory.

d.

antibiotic.

e.

anti-clotting.

ANS: A, B, C, E

Aspirin is classified as an antipyretic, analgesic, anti-inflammatory, and anti-clotting drug.

DIF: Cognitive Level: Comprehension REF: p. 620 OBJ: Theory #1

TOP: Drug Classification KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

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