Chapter 39 My Nursing Test Banks

 

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 39

Question 1

Type: MCSA

The client receives albuterol (Proventil) via inhaler. He asks the nurse why he cant just take a pill. What is the best response by the nurse?

1. When you inhale the drug the blood supply in your lungs picks it up rapidly, resulting in quicker effects.

2. Because pills cannot help your illness; you must have inhaled medications for relief of symptoms.

3. Because pills would produce too many side effects; you will have very few side effects with inhaled medications.

4. Because this medication cannot be absorbed from your GI tract; the acid in your stomach would destroy it.

Correct Answer: 1

Rationale 1: The respiratory system offers a rapid and efficient mechanism for delivering drugs. The enormous surface area of the bronchioles and alveoli, and the rich blood supply to these areas, results in an almost instantaneous onset of action for inhaled substances.

Rationale 2: Albuterol (Proventil) can be given orally (PO), but has a faster onset of action if inhaled.

Rationale 3: Inhaled medications also produce side effects.

Rationale 4: Oral medications are effective with some symptoms of respiratory disorders, but inhaled medications work faster.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39-3

Question 2

Type: MCSA

The nurse teaches a medication class on bronchodilators for clients with asthma. The nurse evaluates that learning has occurred when the clients make which statement?

1. The medication widens the airways because it decreases the production of mucous that narrows them.

2. The medication widens the airways because it decreases the production of histamine that narrows them.

3. The medication widens the airways because it acts on the parasympathetic nervous system.

4. The medication widens the airways because it stimulates the fight-or-flight response of the nervous system.

Correct Answer: 4

Rationale 1: Bronchodilators do not decrease the production of mucous.

Rationale 2: Bronchodilators do not decrease the production of histamine.

Rationale 3: Bronchodilators act on the sympathetic nervous system, not the parasympathetic nervous system.

Rationale 4: During the fight-or-flight response, beta2-adrenergic receptors of the sympathetic nervous system are stimulated, the bronchiolar smooth muscle relaxes, and bronchodilation occurs.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 39-2

Question 3

Type: MCSA

The client asks the nurse why she must continue taking her asthma medication even though she has not had an asthma attack in several months. What is the best response by the nurse?

1. The medication needs to be taken indefinitely according to your doctor, so you should discuss this with him.

2. The medication is still needed to decrease inflammation in your airways and help prevent an attack.

3. The medication needs to be taken or your lungs will be severely damaged and we will not be able to stop an acute attack.

4. The medication needs to be taken for at least a year; then, if you have not had an acute attack, you can stop it.

Correct Answer: 2

Rationale 1: The nurse is able to answer the clients question; it does not need to be referred to the physician.

Rationale 2: Effective treatment of asthma includes long-term treatment to prevent attacks and decrease inflammation, as well as short-term treatment when an attack occurs.

Rationale 3: Telling a client that his or her lungs will be severely damaged is nontherapeutic; the inability to prevent an acute attack in this client is not true.

Rationale 4: Long-term treatment of asthma continues indefinitely, not for just one year.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39-5

Question 4

Type: MCSA

The nurse plans to teach an adolescent about inhalation therapy as part of the treatment plan for the clients asthma. What does the best plan by the nurse include?

1. Inhalation therapy is effective because it provides around-the-clock therapy, as opposed to oral medications.

2. Inhalation therapy is the preferred treatment for adolescents because it is easier for them to manage.

3. Inhalation therapy is effective because it provides systemic relief of symptoms as well as local relief.

4. Inhalation therapy is effective because it goes to the direct site of action in the respiratory tract.

Correct Answer: 4

Rationale 1: Inhalation therapy does not provide around-the-clock therapy.

Rationale 2: Inhalation therapy is used for adolescents because it is effective, not because it is easier for them to manage.

Rationale 3: Inhalation therapy does not provide systemic relief of symptoms.

Rationale 4: The major advantage of aerosol therapy is that it delivers the drugs to their direct site of action. Inhalation therapy does not provide around-the-clock therapy. Inhalation therapy does not provide systemic relief of symptoms. Inhalation therapy is used for adolescents because it is effective, not because it is easier for them to manage.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39-3

Question 5

Type: MCSA

A client receives theophylline (Theo-Dur) and calls the clinic to say he has had nausea and vomiting for two days. What is the best action by the nurse?

1. Tell the client to come to the clinic for an assessment.

2. Ask the client if he has eaten at any unclean restaurants.

3. Ask the client if he has been exposed to anyone with the flu.

4. Recommend that the client begin a clear liquid diet.

Correct Answer: 1

Rationale 1: Nausea and vomiting are symptoms of theophylline toxicity; the client needs to come to the clinic for an assessment.

Rationale 2: Food poisoning could be the cause of the clients symptoms, but he needs to be assessed for theophylline toxicity.

Rationale 3: Flu could be the cause of the clients symptoms, but he needs to be assessed for theophylline toxicity.

Rationale 4: A clear-liquid diet might help, but the client needs to be assessed for theophylline toxicity.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39-7

Question 6

Type: MCSA

The nurse teaches the client about the use of a metered-dose inhaler (MDI) and spacer. The nurse evaluates that additional teaching is required when the client makes which statement?

1. I need to follow the instructions about using the metered-dose inhaler (MDI).

2. I need to rinse my mouth each time after using the metered-dose inhaler (MDI).

3. I need to drink a lot of fluids while I am using the metered-dose inhaler (MDI).

4. I should keep the spacer moist between uses by storing it in a plastic zipbag.

Correct Answer: 4

Rationale 1: Following instructions indicates compliance with use of the metered-dose inhaler (MDI).

Rationale 2: Rinsing the mouth after using the metered-dose inhaler (MDI) is correct; it will help reduce oral absorption of the drug.

Rationale 3: Fluids are encouraged to liquefy pulmonary secretions when using the metered-dose inhaler (MDI).

Rationale 4: The spacer and inhaler should be rinsed with water and allowed to air-dry.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 39-

Question 7

Type: MCMA

The client receives beclomethasone (Beconase). What will the best assessment by the nurse include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Assess the clients mouth for any sign of fungal infection.

2. Assess the clients blood glucose prior to administration of nasal spray.

3. Assess if the client has blown his nose prior to administration of nasal spray.

4. Assess if the client has had a change in taste.

5. Assess the client for any hoarseness or change in voice.

Correct Answer: 1,3,4,5

Rationale 1: Clients may develop candidiasis so the mouth should be assessed.

Rationale 2: There is no need to assess the clients blood glucose.

Rationale 3: The client should gently blow the nose prior to use to clear the nasal passages.

Rationale 4: Clients may experience a change in taste.

Rationale 5: Clients may experience a change in voice as a local effect.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39-7

Question 8

Type: MCMA

The client receives ipratropium (Atrovent) via inhalation for the treatment of chronic asthma. The nurse plans to do medication education with the client. What will the best plan by the nurse include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Wait 15 minutes before using any other inhaled medications.

2. The medication may also be used for acute asthma attacks.

3. Report any increased dyspnea.

4. Report any changes in urinary pattern.

5. Use the medication consistently, not occasionally.

Correct Answer: 3,4,5

Rationale 1: It is only necessary to wait 23 minutes, not 15 minutes, between inhaled medications.

Rationale 2: Anticholinergic drugs will not terminate an acute asthma attack, as peak effects may take 1 to 2 hours.

Rationale 3: The client should be advised to report any symptoms of deteriorating respiratory status such as increased dyspnea.

Rationale 4: Anticholinergic drugs can result in urinary retention, and the client should report any changes in urinary patterns.

Rationale 5: To get the most benefit from ipratropium (Atrovent), it must be used consistently.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39-8

Question 9

Type: MCSA

The client receives isoproterenol (Isuprel) via inhalation. The nurse determines that the client is experiencing a side effect of this medication when reviewing which laboratory test?

1. AST of 20 units/L

2. Sodium of 160

3. Glucose of 145

4. Creatinine of 1.0 mg/dl

Correct Answer: 3

Rationale 1: A side effect of isoproterenol (Isuprel) is hyperglycemia. A creatinine of 1.0 mg/dl is a normal creatinine level, and isoproterenol (Isuprel) is not nephrotoxic. A sodium of 160 is an elevated sodium level, but isoproterenol (Isuprel) does not cause hypernatremia. An AST of 20 units/L is a normal AST, and isoproterenol (Isuprel) is not hepatotoxic.

Rationale 2: A side effect of isoproterenol (Isuprel) is hyperglycemia. A creatinine of 1.0 mg/dl is a normal creatinine level, and isoproterenol (Isuprel) is not nephrotoxic. A sodium of 160 is an elevated sodium level, but isoproterenol (Isuprel) does not cause hypernatremia. An AST of 20 units/L is a normal AST, and isoproterenol (Isuprel) is not hepatotoxic.

Rationale 3: A side effect of isoproterenol (Isuprel) is hyperglycemia. A creatinine of 1.0 mg/dl is a normal creatinine level, and isoproterenol (Isuprel) is not nephrotoxic. A sodium of 160 is an elevated sodium level, but isoproterenol (Isuprel) does not cause hypernatremia. An AST of 20 units/L is a normal AST, and isoproterenol (Isuprel) is not hepatotoxic.

Rationale 4: A side effect of isoproterenol (Isuprel) is hyperglycemia. A creatinine of 1.0 mg/dl is a normal creatinine level, and isoproterenol (Isuprel) is not nephrotoxic. A sodium of 160 is an elevated sodium level, but isoproterenol (Isuprel) does not cause hypernatremia. An AST of 20 units/L is a normal AST, and isoproterenol (Isuprel) is not hepatotoxic.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:

Question 10

Type: MCSA

The physician has ordered ipratropium (Atrovent) for the client. What is a priority assessment question for the nurse to ask prior to administering this medication?

1. Do you have glaucoma?

2. Do you have diabetes mellitus?

3. Do you have seizures?

4. Do you have gout?

Correct Answer: 1

Rationale 1: Anticholinergic drugs can worsen narrow angle glaucoma.

Rationale 2: Anticholinergic drugs do not impact glucose levels, so having diabetes mellitus is not a concern.

Rationale 3: Anticholinergic drugs do not affect seizure disorders; this is not a concern.

Rationale 4: Anticholinergic drugs are not contraindicated in clients with gout.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39-8

Question 11

Type: MCSA

The client receives zafirlukast (Accolate) as treatment for asthma. The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement?

1. This medication activates my fight-or-flight response.

2. This medication is good when I have an acute attack of asthma.

3. This medication dilates my airways so I can breathe better.

4. This medication decreases the inflammation in my lungs.

Correct Answer: 4

Rationale 1: Zafirlukast (Accolate) does not stimulate the sympathetic nervous system.

Rationale 2: Zafirlukast (Accolate) is ineffective for acute asthma attacks.

Rationale 3: Zafirlukast (Accolate) is not a bronchodilator.

Rationale 4: Zafirlukast (Accolate) prevents airway edema and inflammation by blocking leukotriene receptors in the airways.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 39-7

Question 12

Type: MCSA

The physician has prescribed cromolyn (Intal) for the client with asthma. The nurse plans to do medication education. What will the best plan by the nurse include?

1. This medication is indicated for acute asthma attacks.

2. This medication can affect blood glucose levels.

3. This medication will help prevent asthma attacks.

4. This medication can result in hypertension.

Correct Answer: 3

Rationale 1: Cromolyn (Intal) is ineffective for acute asthma attacks.

Rationale 2: Cromolyn (Intal) does not affect blood glucose levels.

Rationale 3: By reducing inflammation, cromolyn (Intal) is able to prevent asthma attacks.

Rationale 4: Cromolyn (Intal) does not cause hypertension.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39-7

Question 13

Type: MCSA

The nurse is preparing to administer beclomethasone (Beconase) to several clients. For which client would the nurse hold the drug and contact the physician?

1. The client who has had a myocardial infarction (MI)

2. The client who has methicillin resistant Staphylococcus aureus (MRSA)

3. The client who has diabetes mellitus

4. The client who has terminal cancer

Correct Answer: 2

Rationale 1: Beclomethasone (Beconase) is not contraindicated in clients who have had a myocardial infarction.

Rationale 2: Glucocorticoids can mask the signs of infection, and are contraindicated if active infection is present.

Rationale 3: Beclomethasone (Beconase) is not contraindicated in clients who have diabetes mellitus.

Rationale 4: Beclomethasone (Beconase) is not contraindicated in clients who have terminal cancer.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39-7

Question 14

Type: MCSA

The client receives ipratropium (Atrovent). She tells the nurse she is going to stop it because of the bitter taste in her mouth after using the medication. What is the best response by the nurse?

1. That is a good idea; you are experiencing a serious side effect.

2. That is a common side effect; it will go away in time.

3. You can decrease that side effect by rinsing your mouth after use.

4. Are you sure you are using the medication properly?

Correct Answer: 3

Rationale 1: The client is not experiencing a serious side effect; there is no need to stop the medication.

Rationale 2: The bitter taste will not go away in time; the client must rinse her mouth.

Rationale 3: Ipratropium (Atrovent) produces a bitter taste, which may be relieved by rinsing the mouth after use.

Rationale 4: Asking how the client uses the medication may be a good option, but not with the common side effect of bitter taste.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39-7

Question 15

Type: MCSA

Bronchoconstriction in the airways is stimulated by

1. perfusion.

2. ventilation.

3. the sympathetic nervous system.

4. parasympathetic nervous system.

Correct Answer: 4

Rationale 1: Perfusion is the flow of blood in the lungs.

Rationale 2: Ventilation moves air in and out.

Rationale 3: The sympathetic nervous system stimulates dilation.

Rationale 4: The parasympathetic nervous system stimulates bronchoconstriction.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39-2

Question 16

Type: MCSA

The nurse understands that one advantage of inhaled pulmonary drugs over oral drugs is that inhaled drugs

1. increase adverse effects.

2. allow for convenience to the client.

3. are delivered to systemic locations.

4. allow for quick absorption.

Correct Answer: 4

Rationale 1: Inhaled drugs decrease adverse effects.

Rationale 2: Inhaled drugs are not as convenient as oral.

Rationale 3: Inhaled drugs are delivered to local sites.

Rationale 4: Inhalation is the most common route of administration; it is rapid, and allows for quick absorption to direct airway.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 39-3

Question 17

Type: MCSA

Which of the following is true regarding dry powder inhalers (DPI)?

1. The medication is delivered by tablet orally.

2. The medication is delivered by fine mist.

3. The device is activated by inhalation.

4. The medication is applied topically.

Correct Answer: 3

Rationale 1: Inhalers are not oral tablets.

Rationale 2: Nebulizers deliver medications in fine mist.

Rationale 3: The client activates the device by inhaling.

Rationale 4: Inhalers are not applied topically.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39-4

Question 18

Type: MCSA

Leukotriene modifiers are primarily used for

1. status asthmaticus.

2. infection.

3. bronchodilation in asthma.

4. prophylaxis of asthma symptoms.

Correct Answer: 4

Rationale 1: Leukotrienes are not used for treatment of status asthmaticus.

Rationale 2: Leukotrienes do not reduce infection.

Rationale 3: Anticholinergics are bronchodilators.

Rationale 4: Leukotriene modifiers are used primarily for prophylaxis and reducing inflammatory components.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39-5

Question 19

Type: MCSA

Which of the following statements is true regarding asthma?

1. It has both inflammatory and bronchoconstriction components.

2. Asthma is caused by a virus.

3. Asthma cannot be treated.

4. Symptoms most often occur with rest.

Correct Answer: 1

Rationale 1: Asthma has an inflammatory and a bronchoconstriction component.

Rationale 2: Asthma is not caused by a virus, although a virus can be a trigger.

Rationale 3: Asthma can be treated by several drug classes.

Rationale 4: Symptoms occur with exposure to triggers or exertion.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39-5

Question 20

Type: MCSA

The nurse would observe for fungal infection of the throat with which class of medications?

1. Methylxanthines

2. Beta-adrenergic agonists

3. Mast cell inhibitors

4. Glucocorticoids

Correct Answer: 4

Rationale 1: Methylxanthines do not cause fungal infection.

Rationale 2: Beta-adrenergic agonists can cause throat irritation, but not infection.

Rationale 3: Mast cell inhibitors do not cause fungal infection.

Rationale 4: Glucocorticoids weaken the immune system and cause candidiasis of the throat.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39-8

Question 21

Type: MCSA

Which of the following is an adverse effect of a beta-adrenergic agonist?

1. Bradycardia

2. Constipation

3. Tachycardia

4. Runny nose

Correct Answer: 3

Rationale 1: Beta-adrenergic agonists cause tachycardia, not bradycardia.

Rationale 2: Diarrhea can occur with some leukotrienes.

Rationale 3: Tachycardia is common, along with restlessness.

Rationale 4: Dry mucous membranes can occur.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39-7

Question 22

Type: MCMA

A nurse is explaining the process of respiration to a client. Which information should be given?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Moving air in and out of the lungs is really called ventilation.

2. The smooth muscle in the alveoli helps to pull air into the lungs.

3. Exchange of oxygen and carbon dioxide occurs across a thin capillary membrane.

4. Respiration is not effective without perfusion.

5. Your basic respiratory drive is determined by your brain.

Correct Answer: 1,3,4,5

Rationale 1: Ventilation is the process of moving air into and out of the lungs.

Rationale 2: There is no smooth muscle in the alveoli.

Rationale 3: The blood stays in capillaries. A thin membrane separates airway from capillary.

Rationale 4: Perfusion is the blood flow through the lungs. Without this blood flow, the oxygencarbon dioxide exchange does not take place.

Rationale 5: The rate is determined by neurons in the brainstem and can be affected by a number of factors.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39.1

Question 23

Type: MCMA

A client says, My doctor told me that I have COPD and might develop emphysema. I always thought I had chronic bronchitis. How should the nurse respond to this statement?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Are you certain he didnt say you have asthma?

2. Chronic bronchitis doesnt have anything to do with COPD.

3. COPD is either asthma, chronic bronchitis, or emphysema, or a combination of those disorders.

4. As COPD progresses it becomes emphysema.

5. Both diagnoses are correct.

Correct Answer: 3,4,5

Rationale 1: There would be no reason to ask this question. It is logical that a client with chronic bronchitis would have a COPD diagnosis.

Rationale 2: The three specific COPD conditions are asthma, chronic bronchitis, and emphysema.

Rationale 3: The three specific COPD conditions are asthma, chronic bronchitis, and emphysema.

Rationale 4: COPD is progressive, with the terminal stage being emphysema.

Rationale 5: Chronic bronchitis is a form of COPD, so both diagnoses are plausible.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39.8

Question 24

Type: MCMA

A client diagnosed with COPD says, I dont see why I need to stop smoking. The damage to my lungs is already done. How should the nurse respond to this statement?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. If you stop smoking now your COPD may not get worse as fast.

2. If you stop smoking, your lungs will get better pretty quickly.

3. Your symptoms might not be as bad if you arent smoking.

4. You are probably correct, but you should at least try.

5. If I were you, I would enjoy what time I have left.

Correct Answer: 1,3

Rationale 1: Smoking cessation has been shown to slow the progression of COPD.

Rationale 2: Depending upon the extent of damage, the clients lungs may not get better at all, but may just stop getting worse.

Rationale 3: Smoking cessation has been shown to result in fewer respiratory symptoms.

Rationale 4: It is not therapeutic to tell the client that he is correct with this statement.

Rationale 5: The nurse should encourage the client to stop smoking.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39.6

Question 25

Type: MCMA

A client has been prescribed a leukotriene modifier. Which assessment finding would cause the nurse to question this prescription?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The client is 54 years old.

2. The client reports frequent foot cramps.

3. The client reports drinking two or three mixed alcohol drinks each day.

4. The client has chronic hepatitis C.

5. The client has a history of a CVA two years ago.

Correct Answer: 3,4

Rationale 1: The concern would be for persons over age 65 who may experience increased frequency of infections.

Rationale 2: There is no reason to avoid giving this medication to a client who has foot cramps.

Rationale 3: Chronic alcohol users may not tolerate these medications as they are extensively metabolized by the liver.

Rationale 4: Significant hepatic dysfunction is a contraindication to this medication as it is extensively metabolized by the liver.

Rationale 5: There is no contraindication for the use of this medication in a client with history of CVA.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 39.6

Question 26

Type: MCMA

An 8-year-old child was just diagnosed with asthma. Which assessment questions should the nurse ask the child and parents?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Have you eaten any new foods?

2. Are you exposed to anyone who smokes?

3. Have you had your carpet cleaned lately?

4. Have you grown taller since last year?

5. Has there been a change in laundry products recently?

Correct Answer: 1,2,3,5

Rationale 1: Recent diet changes should be investigated as a potential source of asthma.

Rationale 2: Cigarette smoke can trigger asthma.

Rationale 3: Recent carpet cleaning may release substances that trigger asthma.

Rationale 4: Growth rate would not likely be affected in the last year for a client with newly diagnosed asthma. Weight would be more likely to be affected than height.

Rationale 5: Changes in household chemicals may be related to the onset of asthma.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39.6

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E

Copyright 2014 by Pearson Education, Inc.

Leave a Reply