Chapter 47 My Nursing Test Banks

 

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 47

Question 1

Type: MCSA

A child has rickets, and is being treated at the clinic. In addition to taking vitamin D as prescribed, what is the best information the nurse can provide?

1. Avoid dairy products while taking vitamin D.

2. Be sure to take brand name, not generic, vitamin D.

3. Spend at least 20 minutes/day in the sunlight.

4. Take your vitamin D on an empty stomach.

Correct Answer: 3

Rationale 1: Dairy products are good sources of vitamin D and should be consumed.

Rationale 2: Generic vitamin D is fine to take.

Rationale 3: Twenty minutes/day in the sun will provide all the vitamin D that is required.

Rationale 4: Vitamin D should be taken with food, not on an empty stomach.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-1

Question 2

Type: MCMA

The client receives alendronate (Fosamax) as treatment for osteoporosis. The nurse has completed medication education and evaluates learning has occurred when the client makes which statements?

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

Standard Text: Select all that apply.

1. I cannot lie down for at least 30 minutes after taking the medication.

2. Milk will help with the absorption of this medication.

3. I should call my doctor if I experience heartburn.

4. I must take this with a full glass of water.

5. The medication can be taken with or without food.

Correct Answer: 1,3,4

Rationale 1: The client must stay upright for at least 30 minutes to prevent GI upset.

Rationale 2: Milk will interfere with the absorption of alendronate (Fosamax); it should be taken on an empty stomach.

Rationale 3: Alendronate (Fosamax) is irritating to the esophagus; the client must contact the physician if heartburn occurs.

Rationale 4: Alendronate (Fosamax) must be taken on an empty stomach with a full glass of water to ensure absorption.

Rationale 5: Food will interfere with the absorption of alendronate (Fosamax); it should be taken on an empty stomach.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 47-7

Question 3

Type: MCSA

The client has osteomalacia and the physician has ordered a treatment to restore calcium balance. What will the nurse plan to administer to the client?

1. Calcium supplements and dark green, leafy vegetables

2. Calcium supplements and milk products

3. Calcium supplements and potassium

4. Calcium supplements and vitamin D

Correct Answer: 4

Rationale 1: Dark green, leafy vegetables are not the best of the sources of calcium listed.

Rationale 2: Calcium supplements and milk products are good choices, but the client must also have vitamin D.

Rationale 3: Potassium is not necessary with this illness.

Rationale 4: Calcium supplements and vitamin D are considered the most effective treatments for osteomalacia.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 47-4

Question 4

Type: MCSA

The client receives raloxifene (Evista). Which other medication would the nurse hold and validate with the physician?

1. Lisinopril (Prinivil)

2. Paroxetine (Paxil)

3. Atorvastatin (Lipitor)

4. Diphenhydramine (Benadryl)

Correct Answer: 3

Rationale 1: There is no contraindication to the use of lisinopril (Prinivil) and raloxifene (Evista).

Rationale 2: There is no contraindication to the use of paroxetine (Paxil) and raloxifene (Evista).

Rationale 3: Antilipids and hormones are the only medications contraindicated with raloxifene (Evista).

Rationale 4: There is no contraindication to the use of diphenhydramine (Benadryl) and raloxifene (Evista).

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-7

Question 5

Type: MCSA

The client receives hydroxychloroquine sulfate (Plaquenil). Which test does the nurse tell the client should be done on a regular basis?

1. Serum potassium

2. Eye exams

3. Serum glucose

4. Blood pressure

Correct Answer: 2

Rationale 1: Serum potassium monitoring is not necessary when the client receives hydroxychloroquine sulfate (Plaquenil).

Rationale 2: Blurred vision, inability to read, and visual field disturbances can occur when receiving hydroxychloroquine sulfate (Plaquenil) so the client must have regular eye exams.

Rationale 3: Serum glucose monitoring is not necessary when the client receives hydroxychloroquine sulfate (Plaquenil).

Rationale 4: Blood pressure monitoring is not necessary when the client receives hydroxychloroquine sulfate (Plaquenil).

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-7

Question 6

Type: MCMA

The client has gout and receives allopurinol (Zyloprim). The nurse has completed medication education and evaluates that learning has occurred when the client makes which statements?

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

Standard Text: Select all that apply.

1. It may take a few days or weeks for me to get the full effect of this medication.

2. I should not drink alcohol while taking this drug.

3. If I develop a skin rash I should contact the prescriber.

4. I should not crush this medication.

5. I should take this medication with food.

Correct Answer: 1,2,3,5

Rationale 1: It may take 1-3 weeks for blood levels of uric acid to return to normal range.

Rationale 2: Alcohol may inhibit the renal excretion of uric acid.

Rationale 3: Skin rash is a possible adverse reaction of allopurinol and can be serious.

Rationale 4: Allopurinol tablets may be crushed for administration.

Rationale 5: Allopurinol should be taken with or after meals.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-7

Question 7

Type: MCSA

The client takes calcium supplements. What is the best instruction by the nurse?

1. This drug may cause insomnia.

2. Take your calcium with a meal.

3. It does not matter if Vitamin D is added.

4. Take them on an empty stomach.

Correct Answer: 2

Rationale 1: Insomnia is not an adverse effect of calcium ingestion.

Rationale 2: Calcium is best absorbed if taken with a meal.

Rationale 3: Vitamin D facilitates absorption of calcium.

Rationale 4: Calcium should be taken with food for best absorption.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-7

Question 8

Type: MCSA

The nurse assesses the client might be experiencing toxicity from colchicine. Which statement by the client would most likely confirm the nurses suspicion?

1. My joints hurt more.

2. I have nausea, vomiting, and abdominal pain every day.

3. I dont see as well as I used to, and my taste has changed.

4. I wake up at night with muscle cramps.

Correct Answer: 2

Rationale 1: Joint pain is not a sign of colchicine toxicity.

Rationale 2: Nausea, vomiting, and abdominal pain are signs of colchicine toxicity.

Rationale 3: Vision and taste changes are not signs of colchicine toxicity.

Rationale 4: Muscle cramps are not a sign of colchicine toxicity.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 47-6

Question 9

Type: MCSA

The client takes a bisphosphonate for osteoporosis. Which assessment is best in determining the effectiveness of the medication?

1. Normal serum calcium levels

2. Absence of fractures

3. Bone density scan

4. Absence of bone pain

Correct Answer: 3

Rationale 1: The bone density scan, not the levels of serum calcium, is the best assessment measure to determine the effectiveness of biphosphonates.

Rationale 2: The bone density scan, not the absence of fractures, is the best assessment measure to determine the effectiveness of bisphosphonates.

Rationale 3: The bone density scan is the best assessment tool to determine the effectiveness of bisphosphonates.

Rationale 4: The bone density scan, not the absence of bone pain, is the best assessment measure to determine the effectiveness of bisphosphonates.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 47-4

Question 10

Type: MCSA

The nurse has taught the client with osteoporosis about how to manage the illness. Which statement by the client indicates that she needs additional teaching?

1. I will avoid drinking alcohol.

2. I will walk for 30 minutes every day.

3. I will take my calcium at bedtime.

4. I will drink milk regularly.

Correct Answer: 3

Rationale 1: Avoiding alcohol will help with osteoporosis.

Rationale 2: Walking will help with osteoporosis.

Rationale 3: Calcium should be taken with meals, not at bedtime.

Rationale 4: Drinking milk will help with osteoporosis.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 47-3

Question 11

Type: MCSA

The client has arthritis and has just learned that she is pregnant. What is the best instruction by the nurse?

1. An ice bath to the affected joint will help with discomfort.

2. Hydroxychloroquine (Plaquenil) is the best medication for you.

3. You could try heat applications and splinting for discomfort.

4. Glucocorticoids are considered safe during pregnancy.

Correct Answer: 3

Rationale 1: Heat will relieve arthritic pain much more effectively than ice.

Rationale 2: Hydroxychloroquine (Plaquenil) is a Pregnancy Category C drug, and should be avoided.

Rationale 3: Heat and splinting are appropriate nonpharmacological methods for arthritic pain during pregnancy.

Rationale 4: Glucocorticoids are Pregnancy Category C drugs, and should be avoided.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-5

Question 12

Type: MCSA

The nurse teaches a class for college students about osteoporosis. What is the best information to include?

1. Prevention of osteoporosis begins in early adulthood.

2. Medication is the primary treatment to prevent and halt bone loss.

3. Osteoporosis is an inevitable part of aging.

4. Men do not need to be concerned about osteoporosis.

Correct Answer: 1

Rationale 1: Prevention of osteoporosis should begin in early adulthood.

Rationale 2: Lifestyle changes such as diet, exercise, and calcium are also needed as well as medication.

Rationale 3: . Osteoporosis is not an inevitable part of aging.

Rationale 4: Men are also at risk for osteoporosis.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-4

Question 13

Type: MCSA

The clients calcium level is low. What will be the nurses primary concern?

1. Seizures

2. Bone fractures

3. Hypoglycemia

4. Depression

Correct Answer: 1

Rationale 1: A low calcium level puts the client at risk for seizures.

Rationale 2: A consistently low calcium level will result in bone fractures, but this is not the immediate concern.

Rationale 3: A low calcium level will not result in hypoglycemia.

Rationale 4: A low calcium level will not result in depression.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 47-3

Question 14

Type: MCSA

The nurse administers calcium intravenously (IV) to the client. What will a key assessment by the nurse include?

1. Assess the serum glucose levels.

2. Assess the intravenous (IV) site.

3. Assess the serum potassium levels.

4. Assess for peripheral edema.

Correct Answer: 2

Rationale 1: The clients glucose levels will not be affected when receiving intravenous (IV) calcium.

Rationale 2: The intravenous (IV) site must be assessed, as extravasation may lead to necrosis of tissue at the insertion site.

Rationale 3: The clients serum potassium levels should not be affected when receiving intravenous (IV) calcium.

Rationale 4: The client should not develop peripheral edema when receiving intravenous (IV) calcium.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 47-7

Question 15

Type: MCSA

The client receives alendronate (Fosamax) as treatment for osteoporosis. Which symptoms, caused by an adverse effect of the medication, does the nurse teach should be reported to the physician?

1. Ringing of the ears

2. Hot and dry skin

3. Vision changes and photophobia

4. Muscle spasms and facial twitching

Correct Answer: 4

Rationale 1: Ringing of the ears is not associated with alendronate (Fosamax.)

Rationale 2: Hot and dry skin is not an adverse effect of alendronate (Fosamax).

Rationale 3: Vision changes and photophobia are not adverse effects of alendronate (Fosamax).

Rationale 4: Muscle spasms and facial twitching indicate a low calcium level, which can be caused by alendronate (Fosamax), and should be reported immediately before the client has seizures.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-7

Question 16

Type: MCSA

An important function of calcium is to

1. regulate acidbase balance.

2. improve glucose absorption.

3. increase energy.

4. regulate nerve transmission.

Correct Answer: 4

Rationale 1: Calcium does not regulate acidbase balance.

Rationale 2: Calcium does not improve glucose absorption.

Rationale 3: Calcium does not increase energy level as do carbohydrates.

Rationale 4: Adequate calcium levels help to transmit nerve impulses.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 47-1

Question 17

Type: MCSA

Which of the following signs are common with hypocalcemia?

1. Bruising

2. Hypertension

3. Muscle wasting

4. Muscle spasms

Correct Answer: 4

Rationale 1: Bruising is not a sign of hypocalcemia.

Rationale 2: Hypertension is not a sign of hypocalcemia.

Rationale 3: Muscle wasting is not a sign of hypocalcemia.

Rationale 4: Signs and symptoms of hypocalcemia are nerve and muscle excitability. Muscle spasms, tremors, or cramping can be evident. Numbness and tingling of the extremities can occur, and convulsions are possible.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 47-3

Question 18

Type: MCSA

The symptoms of gout are due to

1. an increase in the excretion of uric acid.

2. buildup of uric acid in the blood.

3. cartilage loss in the joints.

4. a decrease in uric acid in the blood.

Correct Answer: 2

Rationale 1: An increase in excretion would not cause gout.

Rationale 2: Gout is due to buildup of uric acid in blood or joints.

Rationale 3: Cartilage loss is characterized by osteoarthritis.

Rationale 4: A decrease in uric acid would not cause gout.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 47-5

Question 19

Type: MCSA

A client takes calcium three times a day in the form of supplements. The nurse will advise the client to take the drug

1. with tea or coffee.

2. on an empty stomach.

3. with zinc supplements.

4. with food.

Correct Answer: 4

Rationale 1: Caffeine may slow absorption.

Rationale 2: Taking the calcium on an empty stomach can increase gastric upset.

Rationale 3: Zinc can interact with calcium and decrease effectiveness.

Rationale 4: Food helps to absorb the calcium.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47-6

Question 20

Type: MCSA

The mechanism of action of selective estrogen receptor modulators (SERMs), such as raloxifene (Evista), is to

1. increase calcium levels in the bone.

2. slow bone resorption.

3. inhibit synthesis of microtubules.

4. increase bone mass and density.

Correct Answer: 4

Rationale 1: Calcium supplements increase calcium levels.

Rationale 2: Bisphosphonates slow bone resorption.

Rationale 3: Selective estrogen receptor modulators do not inhibit synthesis of microtubules.

Rationale 4: Selective estrogen receptor modulators increase bone mass and density through the estrogen receptor.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 47-7

Question 21

Type: MCMA

During a medication history, the client states, I take the calcium supplement called calcitriol. 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. Calcitriol is a vitamin D supplement.

2. What other medications do you take?

3. You dont understand the medications you are taking.

4. Do you also take a vitamin D supplement?

5. Do you take the prescription strength or over-the-counter?

Correct Answer: 1,2

Rationale 1: Calcitriol is a vitamin D supplement.

Rationale 2: Calcitriol is often taken with calcium supplementation and the client may have medication names confused.

Rationale 3: This may be the truth, but this is not a therapeutic statement.

Rationale 4: Calcitriol is a vitamin D supplement.

Rationale 5: The nurse should correct the clients mistake.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47.2

Question 22

Type: MCMA

A client who has osteoporosis says, I am exercising more. I go to the gym once a week. How should the nurse respond?

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

Standard Text: Select all that apply.

1. What kind of exercises are you doing

2. You should try to exercise three to five times a week.

3. That is not enough.

4. Is there somewhere that you can walk on the days you dont go to the gym?

5. Exercise will not improve your osteoporosis.

Correct Answer: 1,2,4

Rationale 1: In order to affect osteoporosis, exercise must be weight-bearing.

Rationale 2: To affect osteoporosis, exercise should be done three to five times weekly.

Rationale 3: This is a true statement, but is not therapeutic. The nurse should encourage this clients efforts at exercise.

Rationale 4: This client should exercise more frequently and walking is a good form of exercise for those with osteoporosis.

Rationale 5: Weight-bearing exercise has been shown to slow or improve effects of osteoporosis.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47.8

Question 23

Type: MCMA

A client states, I stopped taking my medications for osteoporosis. I couldnt see how they were helping me any. How should the nurse respond?

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

Standard Text: Select all that apply.

1. The results from these medications are hard for you to see.

2. It takes about 6 months to see any results.

3. When did you stop taking the medications?

4. Were there any other reasons that you decided to discontinue the medications?

5. You are not helping us help you when you dont follow directions.

Correct Answer: 1,3,4

Rationale 1: The changes from taking medications for osteoporosis are difficult for the client to measure.

Rationale 2: Therapeutic response may take 1 to 3 months.

Rationale 3: The nurse should determine how long it has been since therapy was discontinued.

Rationale 4: The nurse should determine if other reasons, such as adverse side effects or cost of medication, were factors in the clients decision.

Rationale 5: This is not a therapeutic approach to this clients statement.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47.8

Question 24

Type: MCMA

A client has been prescribed denosumab (Prolia). What medication education should the nurse provide?

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

Standard Text: Select all that apply.

1. I will give your medication in the form of an injection.

2. You may feel more fatigued than usual when taking this drug.

3. Be certain to keep your appointments for follow-up.

4. Do not take any kind of calcium supplement or vitamin D supplement while taking this drug.

5. We must monitor your cholesterol while you are taking this drug.

Correct Answer: 1,2,3,5

Rationale 1: Denosumab is given subcutaneously.

Rationale 2: An adverse reaction of this drug is fatigue.

Rationale 3: This drug can cause severe hypocalcemia, so it is important to monitor lab values.

Rationale 4: Calcium and vitamin D supplementation may be necessary to keep serum calcium at normal level.

Rationale 5: This drug may result in hypercholesterolemia.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47.8

Question 25

Type: MCMA

A client is receiving therapy for gout. Which information should the nurse provide?

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

Standard Text: Select all that apply.

1. You should not drink alcohol.

2. You should increase intake of fatty fish like salmon and sardines.

3. Take a vitamin C supplement while on your medication for gout.

4. Increase your fluid intake to 2 to 4 liters each day.

5. If your joint pain does not improve, let us know.

Correct Answer: 1,4,5

Rationale 1: Limiting or eliminating alcohol consumption is standard treatment for gout.

Rationale 2: Salmon and sardines should be eliminated from the diet.

Rationale 3: Vitamin C may acidify the urine and lead to formation of uric acid stones.

Rationale 4: Increasing fluid intake increases uric acid excretion.

Rationale 5: The client should be taught to report worsening or continued inflammation or pain.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 47.8

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

Copyright 2014 by Pearson Education, Inc.

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