Chapter 9 My Nursing Test Banks

 

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 9

Question 1

Type: MCMA

The nurse is doing a holistic assessment on a patient prior to the initiation of antihypertensive medication. What will the best assessment include?

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

Standard Text: Select all that apply.

1. Blood pressure

2. The cause of the hypertension

3. Mood

4. Level of education

5. Belief in a higher power

Correct Answer: 1,3,4,5

Rationale 1: Holistic health care incorporates the whole patient to include the biological (blood pressure), psychological (mood), sociocultural (level of education), and spiritual (belief in a higher power) dimensions. The cause of the hypertension focuses on a specific disease, its cause and treatment; this is a medical model, not a holistic model.

Rationale 2: Holistic health care incorporates the whole patient to include the biological (blood pressure), psychological (mood), sociocultural (level of education), and spiritual (belief in a higher power) dimensions. The cause of the hypertension focuses on a specific disease, its cause and treatment; this is a medical model, not a holistic model.

Rationale 3: Holistic health care incorporates the whole patient to include the biological (blood pressure), psychological (mood), sociocultural (level of education), and spiritual (belief in a higher power) dimensions. The cause of the hypertension focuses on a specific disease, its cause and treatment; this is a medical model, not a holistic model.

Rationale 4: Holistic health care incorporates the whole patient to include the biological (blood pressure), psychological (mood), sociocultural (level of education), and spiritual (belief in a higher power) dimensions. The cause of the hypertension focuses on a specific disease, its cause and treatment; this is a medical model, not a holistic model.

Rationale 5: Holistic health care incorporates the whole patient to include the biological (blood pressure), psychological (mood), sociocultural (level of education), and spiritual (belief in a higher power) dimensions. The cause of the hypertension focuses on a specific disease, its cause and treatment; this is a medical model, not a holistic model.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9-1

Question 2

Type: MCSA

The adolescent Hispanic male has been diagnosed with attention-deficit hyperactivity disorder (ADHD), and is taking methylphenidate (Ritalin). Even though the drug helps with focus and grades, the adolescent will not go to the school office at noon for his medication. Which statement best describes the result of the nurses evaluation?

1. The adolescent has developed alternative coping mechanisms to increase his focus during classes.

2. The adolescent is fearful that this drug may be a gateway drug and he will abuse other substances.

3. The adolescent really does not need an additional dose of methylphenidate (Ritalin) at school.

4. The adolescent is embarrassed about having to take medicine at school; it is a social stigma.

Correct Answer: 4

Rationale 1: Some patients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Patients can also perceive this as a social stigma. Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the patient must receive a dose during school hours. Attention-deficit hyperactivity disorder is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes. Appropriate treatment of attention-deficit hyperactivity disorder will result in less addiction to mood-altering substances, not more addiction.

Rationale 2: Some patients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Patients can also perceive this as a social stigma. Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the patient must receive a dose during school hours. Attention-deficit hyperactivity disorder is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes. Appropriate treatment of attention-deficit hyperactivity disorder will result in less addiction to mood-altering substances, not more addiction.

Rationale 3: Some patients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Patients can also perceive this as a social stigma. Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the patient must receive a dose during school hours. Attention-deficit hyperactivity disorder is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes. Appropriate treatment of attention-deficit hyperactivity disorder will result in less addiction to mood-altering substances, not more addiction.

Rationale 4: Some patients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Patients can also perceive this as a social stigma. Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the patient must receive a dose during school hours. Attention-deficit hyperactivity disorder is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes. Appropriate treatment of attention-deficit hyperactivity disorder will result in less addiction to mood-altering substances, not more addiction.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 9-5

Question 3

Type: MCSA

The patient is from an Arab culture and is in labor and delivery. Her husband insists he must stay with her, and will not allow her to receive any analgesia during the experience. What is the best action by the nurse?

1. Inform the husband that it is his wifes choice whether or not to receive analgesia.

2. Inform the husband that he must sign a release of responsibility to avoid future litigation against the hospital.

3. Allow the request, but inform the husband that the physician will make the final decision about analgesia.

4. Allow this request, and be available in the event the request changes.

Correct Answer: 4

Rationale 1: Nurses must allow and support cultural differences. The husbands decisions must be respected as long as patient safety is not involved, and it is not involved in this situation. With some cultures, the husband makes the choices, not the wife or the physician. When cultural differences are allowed and supported, patients are not as likely to become involved in litigation.

Rationale 2: Nurses must allow and support cultural differences. The husbands decisions must be respected as long as patient safety is not involved, and it is not involved in this situation. With some cultures, the husband makes the choices, not the wife or the physician. When cultural differences are allowed and supported, patients are not as likely to become involved in litigation.

Rationale 3: Nurses must allow and support cultural differences. The husbands decisions must be respected as long as patient safety is not involved, and it is not involved in this situation. With some cultures, the husband makes the choices, not the wife or the physician. When cultural differences are allowed and supported, patients are not as likely to become involved in litigation.

Rationale 4: Nurses must allow and support cultural differences. The husbands decisions must be respected as long as patient safety is not involved, and it is not involved in this situation. With some cultures, the husband makes the choices, not the wife or the physician. When cultural differences are allowed and supported, patients are not as likely to become involved in litigation.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-5

Question 4

Type: MCSA

A patient is diagnosed with cancer. The physician has recommended chemotherapy, which would likely save the patients life. The patient tells the nurse, This is punishment from God for sins I have committed; some women at my church say so. What will the best plan of the nurse include?

1. With the patients permission, plan to involve a hospital minister to discuss the patients perspective about cancer.

2. With the patients permission, plan to bring the case before the hospitals board of ethics.

3. With the patients permission, plan to contact the patients minister to discuss the patients perspective about cancer.

4. With the patients permission, plan to meet with family members to discuss the patients perspective about cancer.

Correct Answer: 3

Rationale 1: When patients have strong religious beliefs, these can affect the outcome of the illness. The nurse should involve the patients religious leader when possible. Meeting with family might help; however, they may have the same perspective as the patient. Bringing the case before the hospitals board of ethics is premature at this point. Involving a hospital minister may be an option, but it is best to work through the patients minister initially.

Rationale 2: When patients have strong religious beliefs, these can affect the outcome of the illness. The nurse should involve the patients religious leader when possible. Meeting with family might help; however, they may have the same perspective as the patient. Bringing the case before the hospitals board of ethics is premature at this point. Involving a hospital minister may be an option, but it is best to work through the patients minister initially.

Rationale 3: When patients have strong religious beliefs, these can affect the outcome of the illness. The nurse should involve the patients religious leader when possible. Meeting with family might help; however, they may have the same perspective as the patient. Bringing the case before the hospitals board of ethics is premature at this point. Involving a hospital minister may be an option, but it is best to work through the patients minister initially.

Rationale 4: When patients have strong religious beliefs, these can affect the outcome of the illness. The nurse should involve the patients religious leader when possible. Meeting with family might help; however, they may have the same perspective as the patient. Bringing the case before the hospitals board of ethics is premature at this point. Involving a hospital minister may be an option, but it is best to work through the patients minister initially.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 9-3

Question 5

Type: MCSA

The African American patient has panic attacks, is suicidal, and is on an inpatient psychiatric unit. The psychiatrist orders sertraline (Zoloft) and clonazepam (Klonopin). The patient refuses the drugs; he requests to have herbs and African objects in his room to remove the curse. What is the priority action by the nurse?

1. Allow the request without seeking further information from the patient.

2. Allow the request as long as the herbs and objects do not pose a safety risk for the patient or other patients.

3. Allow the request after the patient signs a release of responsibility to avoid litigation.

4. Allow the request after all members of the treatment team agree to it.

Correct Answer: 2

Rationale 1: Nurses must grant ethnic requests as long as the request does not pose a safety risk to the patient or others. To allow an ethnic request without seeking further information about safety could jeopardize patient safety. There is no need for the patient to sign a release of responsibility to avoid litigation; if items pose a safety risk, they cannot be allowed on the unit. The treatment team does not need to agree to this request; the nurse can approve it as long as the items do not pose a safety risk.

Rationale 2: Nurses must grant ethnic requests as long as the request does not pose a safety risk to the patient or others. To allow an ethnic request without seeking further information about safety could jeopardize patient safety. There is no need for the patient to sign a release of responsibility to avoid litigation; if items pose a safety risk, they cannot be allowed on the unit. The treatment team does not need to agree to this request; the nurse can approve it as long as the items do not pose a safety risk.

Rationale 3: Nurses must grant ethnic requests as long as the request does not pose a safety risk to the patient or others. To allow an ethnic request without seeking further information about safety could jeopardize patient safety. There is no need for the patient to sign a release of responsibility to avoid litigation; if items pose a safety risk, they cannot be allowed on the unit. The treatment team does not need to agree to this request; the nurse can approve it as long as the items do not pose a safety risk.

Rationale 4: Nurses must grant ethnic requests as long as the request does not pose a safety risk to the patient or others. To allow an ethnic request without seeking further information about safety could jeopardize patient safety. There is no need for the patient to sign a release of responsibility to avoid litigation; if items pose a safety risk, they cannot be allowed on the unit. The treatment team does not need to agree to this request; the nurse can approve it as long as the items do not pose a safety risk.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-4

Question 6

Type: MCSA

The public health nurse notices that several patients in the hypertension clinic have poorly controlled hypertension, even though they have been prescribed appropriate antihypertensive drugs. Which question will best enable the nurse to assess these patients?

1. Does your religion allow the use of high blood pressure medication?

2. Do you think your high blood pressure is a problem?

3. Can you afford the high blood pressure medication?

4. Does your culture use herbs to treat high blood pressure?

Correct Answer: 3

Rationale 1: Once treatment is rendered, the cost of prescription drugs may be far too high for patients on limited incomes. The use of herbs may be important in the patients culture, but the cost of the medication is more likely the problem. To ask a patient if they think hypertension is a problem should not be necessary; the nurse could eliminate this by appropriate medication education when the medication is prescribed for the patient. Religious beliefs could result in the patient not taking the medication, but the cost of the medication is more likely the problem.

Rationale 2: Once treatment is rendered, the cost of prescription drugs may be far too high for patients on limited incomes. The use of herbs may be important in the patients culture, but the cost of the medication is more likely the problem. To ask a patient if they think hypertension is a problem should not be necessary; the nurse could eliminate this by appropriate medication education when the medication is prescribed for the patient. Religious beliefs could result in the patient not taking the medication, but the cost of the medication is more likely the problem.

Rationale 3: Once treatment is rendered, the cost of prescription drugs may be far too high for patients on limited incomes. The use of herbs may be important in the patients culture, but the cost of the medication is more likely the problem. To ask a patient if they think hypertension is a problem should not be necessary; the nurse could eliminate this by appropriate medication education when the medication is prescribed for the patient. Religious beliefs could result in the patient not taking the medication, but the cost of the medication is more likely the problem.

Rationale 4: Once treatment is rendered, the cost of prescription drugs may be far too high for patients on limited incomes. The use of herbs may be important in the patients culture, but the cost of the medication is more likely the problem. To ask a patient if they think hypertension is a problem should not be necessary; the nurse could eliminate this by appropriate medication education when the medication is prescribed for the patient. Religious beliefs could result in the patient not taking the medication, but the cost of the medication is more likely the problem.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9-6

Question 7

Type: MCSA

The nurse is providing group education about warfarin (Coumadin) to minority patients who have experienced strokes (brain attacks). The nurse determines that learning has occurred when the patients make which statement?

1. We may need to have more frequent blood tests.

2. We may need to have less frequent blood tests.

3. We may need more medication than other ethnic groups.

4. We may need less medication than other ethnic groups.

Correct Answer: 4

Rationale 1: Asian and African American patients are poor metabolizers of warfarin (Coumadin), so they will often require lower dosages. There is no need for Asian and African American patients to have more frequent blood tests than Caucasian patients. Asian and African American patients are poor metabolizers of warfarin (Coumadin), so they will often require lower, not higher, dosages. There is no need for Asian and African American patients to have less frequent blood tests than Caucasian patients.

Rationale 2: Asian and African American patients are poor metabolizers of warfarin (Coumadin), so they will often require lower dosages. There is no need for Asian and African American patients to have more frequent blood tests than Caucasian patients. Asian and African American patients are poor metabolizers of warfarin (Coumadin), so they will often require lower, not higher, dosages. There is no need for Asian and African American patients to have less frequent blood tests than Caucasian patients.

Rationale 3: Asian and African American patients are poor metabolizers of warfarin (Coumadin), so they will often require lower dosages. There is no need for Asian and African American patients to have more frequent blood tests than Caucasian patients. Asian and African American patients are poor metabolizers of warfarin (Coumadin), so they will often require lower, not higher, dosages. There is no need for Asian and African American patients to have less frequent blood tests than Caucasian patients.

Rationale 4: Asian and African American patients are poor metabolizers of warfarin (Coumadin), so they will often require lower dosages. There is no need for Asian and African American patients to have more frequent blood tests than Caucasian patients. Asian and African American patients are poor metabolizers of warfarin (Coumadin), so they will often require lower, not higher, dosages. There is no need for Asian and African American patients to have less frequent blood tests than Caucasian patients.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 9-7

Question 8

Type: MCMA

The nurse is conducting a holistic assessment of a patient with alcoholism. What are the important questions to ask?

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

Standard Text: Select all that apply.

1. How is drinking alcohol viewed by your culture?

2. Have you ever attended Alcoholic Anonymous meetings?

3. Did you see your parents drinking alcohol when you were growing up?

4. Have you been in alcohol rehabilitation before now?

5. What blood relatives of yours are addicted to alcohol?

Correct Answer: 1,3,5

Rationale 1: Biological, environmental, and cultural questions are valid questions to ask during a holistic assessment. Participation in a rehabilitation program refers to treatment, and does not have relevance to a holistic assessment. Participation in Alcoholics Anonymous refers to treatment, and does not have relevance to a holistic assessment.

Rationale 2: Biological, environmental, and cultural questions are valid questions to ask during a holistic assessment. Participation in a rehabilitation program refers to treatment, and does not have relevance to a holistic assessment. Participation in Alcoholics Anonymous refers to treatment, and does not have relevance to a holistic assessment.

Rationale 3: Biological, environmental, and cultural questions are valid questions to ask during a holistic assessment. Participation in a rehabilitation program refers to treatment, and does not have relevance to a holistic assessment. Participation in Alcoholics Anonymous refers to treatment, and does not have relevance to a holistic assessment.

Rationale 4: Biological, environmental, and cultural questions are valid questions to ask during a holistic assessment. Participation in a rehabilitation program refers to treatment, and does not have relevance to a holistic assessment. Participation in Alcoholics Anonymous refers to treatment, and does not have relevance to a holistic assessment.

Rationale 5: Biological, environmental, and cultural questions are valid questions to ask during a holistic assessment. Participation in a rehabilitation program refers to treatment, and does not have relevance to a holistic assessment. Participation in Alcoholics Anonymous refers to treatment, and does not have relevance to a holistic assessment.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9-1

Question 9

Type: MCSA

The patient is an American Indian admitted to the hospital for chemotherapy. At any given time, five family members are in the patients room, which is private. The nurse tells the patient that according to hospital policy; only two visitors at a time are allowed. What does the best analysis by the nurse manager reveal about the nurses action?

1. The nurse should have assessed the patients preferences about how many family members she wanted to be present.

2. The nurse should have called the physician and obtained an order for additional family members to be present.

3. This was the correct action; the nurse was following protocol by informing the patient about hospital policy.

4. The nurse should have allowed the patient to have as many family members as she wanted to be present.

Correct Answer: 1

Rationale 1: The nurse should have assessed the patients preference about how many visitors she wanted in her room before so strictly interpreting the hospital rules. Many hospital rules, such as how many visitors are allowed, are flexible and do not have to be strictly interpreted; this patient is in a private room. The nurse must be realistic with regard to the number of family visitors the patient wants present; five family members is acceptable; twenty would be too many. This situation could be resolved by the nurse, there is no need for a physicians order at this point.

Rationale 2: The nurse should have assessed the patients preference about how many visitors she wanted in her room before so strictly interpreting the hospital rules. Many hospital rules, such as how many visitors are allowed, are flexible and do not have to be strictly interpreted; this patient is in a private room. The nurse must be realistic with regard to the number of family visitors the patient wants present; five family members is acceptable; twenty would be too many. This situation could be resolved by the nurse, there is no need for a physicians order at this point.

Rationale 3: The nurse should have assessed the patients preference about how many visitors she wanted in her room before so strictly interpreting the hospital rules. Many hospital rules, such as how many visitors are allowed, are flexible and do not have to be strictly interpreted; this patient is in a private room. The nurse must be realistic with regard to the number of family visitors the patient wants present; five family members is acceptable; twenty would be too many. This situation could be resolved by the nurse, there is no need for a physicians order at this point.

Rationale 4: The nurse should have assessed the patients preference about how many visitors she wanted in her room before so strictly interpreting the hospital rules. Many hospital rules, such as how many visitors are allowed, are flexible and do not have to be strictly interpreted; this patient is in a private room. The nurse must be realistic with regard to the number of family visitors the patient wants present; five family members is acceptable; twenty would be too many. This situation could be resolved by the nurse, there is no need for a physicians order at this point.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 9-6

Question 10

Type: MCSA

The physician has prescribed a chemotherapeutic drug for the patient with cancer. This drug commonly causes loss of hair. The patient asks the nurse, Will all of my hair fall out? What is the most therapeutic response by the nurse?

1. We are not really sure; applying an ice bag to your head may help.

2. Dont worry, we can recommend an excellent wig company if need be.

3. Yes, that is one of the expected side effects of this medication.

4. It might. Have you discussed this with your physician?

Correct Answer: 3

Rationale 1: The nurse must always be forthright in explaining drug actions and potential side effects; minimizing potential adverse effects can result in a distrust of the nurse. Ice bags can minimize hair loss with some patients, but the nurse is not honestly answering the patients question. Telling a patient not to worry is one of the most non-therapeutic responses a nurse can make. In this case, the nurse, not the physician, is responsible for answering the patients questions.

Rationale 2: The nurse must always be forthright in explaining drug actions and potential side effects; minimizing potential adverse effects can result in a distrust of the nurse. Ice bags can minimize hair loss with some patients, but the nurse is not honestly answering the patients question. Telling a patient not to worry is one of the most non-therapeutic responses a nurse can make. In this case, the nurse, not the physician, is responsible for answering the patients questions.

Rationale 3: The nurse must always be forthright in explaining drug actions and potential side effects; minimizing potential adverse effects can result in a distrust of the nurse. Ice bags can minimize hair loss with some patients, but the nurse is not honestly answering the patients question. Telling a patient not to worry is one of the most non-therapeutic responses a nurse can make. In this case, the nurse, not the physician, is responsible for answering the patients questions.

Rationale 4: The nurse must always be forthright in explaining drug actions and potential side effects; minimizing potential adverse effects can result in a distrust of the nurse. Ice bags can minimize hair loss with some patients, but the nurse is not honestly answering the patients question. Telling a patient not to worry is one of the most non-therapeutic responses a nurse can make. In this case, the nurse, not the physician, is responsible for answering the patients questions.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-3

Question 11

Type: MCSA

The patient is admitted to the hospital following an abortion, and she is septic. The physician orders antibiotics that the patient refuses stating, I dont deserve them. The nurse providing care has anti-abortion beliefs. What is the best response by the nurse?

1. I think you need to do what is best for you.

2. You have a serious infection and really need the drug.

3. Do you think you should be punished because you had an abortion?

4. Ill call your physician and let him know about your decision.

Correct Answer: 2

Rationale 1: Telling the patient she needs the drug is providing the best care possible; this must be done even though the nurses beliefs are different from the patients beliefs. Telling the patient she needs to do what is best is inappropriate; the nurse knows she needs the drug. Calling the physician is inappropriate; the nurse knows the patient needs the drug. Asking the patient if she thinks she should be punished is inappropriate; she is septic and needs the medication.

Rationale 2: Telling the patient she needs the drug is providing the best care possible; this must be done even though the nurses beliefs are different from the patients beliefs. Telling the patient she needs to do what is best is inappropriate; the nurse knows she needs the drug. Calling the physician is inappropriate; the nurse knows the patient needs the drug. Asking the patient if she thinks she should be punished is inappropriate; she is septic and needs the medication.

Rationale 3: Telling the patient she needs the drug is providing the best care possible; this must be done even though the nurses beliefs are different from the patients beliefs. Telling the patient she needs to do what is best is inappropriate; the nurse knows she needs the drug. Calling the physician is inappropriate; the nurse knows the patient needs the drug. Asking the patient if she thinks she should be punished is inappropriate; she is septic and needs the medication.

Rationale 4: Telling the patient she needs the drug is providing the best care possible; this must be done even though the nurses beliefs are different from the patients beliefs. Telling the patient she needs to do what is best is inappropriate; the nurse knows she needs the drug. Calling the physician is inappropriate; the nurse knows the patient needs the drug. Asking the patient if she thinks she should be punished is inappropriate; she is septic and needs the medication.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-3

Question 12

Type: MCSA

The African American patient had a myocardial infarction and is receiving atorvastatin (Lipitor). The nurse caring for the patient is Caucasian. The nurse assesses the patients diet to be very high in fat. What is the best plan by the nurse to improve the patients diet and reduce the risk for additional medications?

1. With the patients permission, plan to ask an African American nurse to speak to him about a low-fat diet.

2. With the patients permission, plan to discuss his diet with whomever prepares meals for his family.

3. Plan to give the patient information specific to African Americans about low-fat diets.

4. Plan to ask the physician for a consult by dietary services so a dietician can teach the patient about low-fat diets.

Correct Answer: 2

Rationale 1: Every culture has culture-specific diets; the nurse must include the person in the family who does the meal preparation if a different diet is to be successful. Asking the patient about having an African American nurse speak to him is racist and implies that a Caucasian nurse cannot understand the dietary needs of an African American patient. At this point, a consult by dietary services is premature. Providing information is a good idea, but the nurse must also teach the patient.

Rationale 2: Every culture has culture-specific diets; the nurse must include the person in the family who does the meal preparation if a different diet is to be successful. Asking the patient about having an African American nurse speak to him is racist and implies that a Caucasian nurse cannot understand the dietary needs of an African American patient. At this point, a consult by dietary services is premature. Providing information is a good idea, but the nurse must also teach the patient.

Rationale 3: Every culture has culture-specific diets; the nurse must include the person in the family who does the meal preparation if a different diet is to be successful. Asking the patient about having an African American nurse speak to him is racist and implies that a Caucasian nurse cannot understand the dietary needs of an African American patient. At this point, a consult by dietary services is premature. Providing information is a good idea, but the nurse must also teach the patient.

Rationale 4: Every culture has culture-specific diets; the nurse must include the person in the family who does the meal preparation if a different diet is to be successful. Asking the patient about having an African American nurse speak to him is racist and implies that a Caucasian nurse cannot understand the dietary needs of an African American patient. At this point, a consult by dietary services is premature. Providing information is a good idea, but the nurse must also teach the patient.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 9-5

Question 13

Type: MCSA

The patient is receiving a beta-blocker medication. The nurse has done medication education and provided the patient with printed information to take home. During the next appointment, the nurse notes that the patient is not taking the medication properly. What is a therapeutic assessment question to ask this patient?

1. Do I have to inform your physician about your noncompliance?

2. Why didnt you take your medicine as we talked about?

3. Are you able to read and comprehend the printed information?

4. Dont you understand how important it is to take the medicine?

Correct Answer: 3

Rationale 1: Up to 48% of English-speaking patients do not have functional literacy, a basic ability to read, understand, and act on health information. The nurse should ask the patient about the ability to read and understand printed information. Asking why questions put the patient on the defensive, and the nurse might not receive the most accurate answer. Being confrontational with a dont you understand question is as demeaning as asking a why question. It is inappropriate to involve the physician before the nurse assesses the reason for noncompliance; and this question is threatening.

Rationale 2: Up to 48% of English-speaking patients do not have functional literacy, a basic ability to read, understand, and act on health information. The nurse should ask the patient about the ability to read and understand printed information. Asking why questions put the patient on the defensive, and the nurse might not receive the most accurate answer. Being confrontational with a dont you understand question is as demeaning as asking a why question. It is inappropriate to involve the physician before the nurse assesses the reason for noncompliance; and this question is threatening.

Rationale 3: Up to 48% of English-speaking patients do not have functional literacy, a basic ability to read, understand, and act on health information. The nurse should ask the patient about the ability to read and understand printed information. Asking why questions put the patient on the defensive, and the nurse might not receive the most accurate answer. Being confrontational with a dont you understand question is as demeaning as asking a why question. It is inappropriate to involve the physician before the nurse assesses the reason for noncompliance; and this question is threatening.

Rationale 4: Up to 48% of English-speaking patients do not have functional literacy, a basic ability to read, understand, and act on health information. The nurse should ask the patient about the ability to read and understand printed information. Asking why questions put the patient on the defensive, and the nurse might not receive the most accurate answer. Being confrontational with a dont you understand question is as demeaning as asking a why question. It is inappropriate to involve the physician before the nurse assesses the reason for noncompliance; and this question is threatening.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9-6

Question 14

Type: MCSA

All of the patients have cancer and are receiving chemotherapy. Which patient does the nurse evaluate as having the highest probability for a remission?

1. The patient with a support group of cancer survivors

2. The patient who is also seeing a psychiatrist for treatment of depression

3. The wealthy patient who can afford the best medical care available

4. The patient who is a former physician

Correct Answer: 1

Rationale 1: Positive attitudes and high expectations toward therapeutic outcomes in the patient may influence the success of pharmacotherapy. The support group of cancer survivors would provide the best support, and the highest probability for a positive outcome. A wealthy patient can afford the best medical care, but this patient would not have as high a probability for remission as the patient with a support group. A former physician may have a sound knowledge base about cancer, but this patient would not have as high a probability for remission as the patient with a support group. Treatment for depression might help the outcome, but this patient would not have as high a probability for remission as the patient with a support group.

Rationale 2: Positive attitudes and high expectations toward therapeutic outcomes in the patient may influence the success of pharmacotherapy. The support group of cancer survivors would provide the best support, and the highest probability for a positive outcome. A wealthy patient can afford the best medical care, but this patient would not have as high a probability for remission as the patient with a support group. A former physician may have a sound knowledge base about cancer, but this patient would not have as high a probability for remission as the patient with a support group. Treatment for depression might help the outcome, but this patient would not have as high a probability for remission as the patient with a support group.

Rationale 3: Positive attitudes and high expectations toward therapeutic outcomes in the patient may influence the success of pharmacotherapy. The support group of cancer survivors would provide the best support, and the highest probability for a positive outcome. A wealthy patient can afford the best medical care, but this patient would not have as high a probability for remission as the patient with a support group. A former physician may have a sound knowledge base about cancer, but this patient would not have as high a probability for remission as the patient with a support group. Treatment for depression might help the outcome, but this patient would not have as high a probability for remission as the patient with a support group.

Rationale 4: Positive attitudes and high expectations toward therapeutic outcomes in the patient may influence the success of pharmacotherapy. The support group of cancer survivors would provide the best support, and the highest probability for a positive outcome. A wealthy patient can afford the best medical care, but this patient would not have as high a probability for remission as the patient with a support group. A former physician may have a sound knowledge base about cancer, but this patient would not have as high a probability for remission as the patient with a support group. Treatment for depression might help the outcome, but this patient would not have as high a probability for remission as the patient with a support group.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 9-3

Question 15

Type: MCSA

Which of the following best describes spirituality?

1. The capacity to love

2. Objective viewpoints

3. Logical thinking

4. Critical deliberation

Correct Answer: 1

Rationale 1: Spirituality is described as the capacity to love.

Rationale 2: Objective viewpoints do not capture the capacity to love.

Rationale 3: Logical thinking does not always include the capacity to love.

Rationale 4: Critical deliberation does not include the capacity to love or spirituality.

Global Rationale:

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9-3

Question 16

Type: MCSA

Which of the following best indicates an ethnic characteristic that can affect pharmacotherapy?

1. Genetic differences

2. Diet

3. Health beliefs

4. Alternative therapies

Correct Answer: 1

Rationale 1: Ethnicity relates to biology and genetics. Diet, alternative therapies, and health beliefs are cultural characteristics.

Rationale 2: Ethnicity relates to biology and genetics. Diet, alternative therapies, and health beliefs are cultural characteristics.

Rationale 3: Ethnicity relates to biology and genetics. Diet, alternative therapies, and health beliefs are cultural characteristics.

Rationale 4: Ethnicity relates to biology and genetics. Diet, alternative therapies, and health beliefs are cultural characteristics.

Global Rationale:

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9-4

Question 17

Type: MCSA

Which group of people would be most likely to use spices for maintaining the balance of hot and cold?

1. Hispanic

2. European

3. Native American

4. African American

Correct Answer: 1

Rationale 1: Those from the Hispanic culture will most likely use spices for maintaining the balance of hot and cold.

Rationale 2: Those from the European culture will not likely use spices for balancing hot and cold.

Rationale 3: Those from the Native American culture will not likely use spices for balancing hot and cold.

Rationale 4: Those from the African American culture will not likely use spices for balancing hot and cold.

Global Rationale:

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9-5

Question 18

Type: MCSA

Which statement regarding human DNA sequences is accurate?

1. Only 2% of human DNA is different among the different ethnicities.

2. Due to enzyme polymorphism, Hispanics are less likely to metabolize codeine to morphine.

3. Even though human genetic differences are small, significant differences can be seen with drug metabolism.

4. Asian Americans are the ethnic group known to be slow acetylators.

Correct Answer: 3

Rationale 1: Human DNA differences of only 0.2% can produce significant differences in the way drugs are handled within the body. Asian Americans are less likely to metabolize codeine to morphine, and Caucasians are known to be slow acetylators.

Rationale 2: Human DNA differences of only 0.2% can produce significant differences in the way drugs are handled within the body. Asian Americans are less likely to metabolize codeine to morphine, and Caucasians are known to be slow acetylators.

Rationale 3: Human DNA differences of only 0.2% can produce significant differences in the way drugs are handled within the body. Asian Americans are less likely to metabolize codeine to morphine, and Caucasians are known to be slow acetylators.

Rationale 4: Human DNA differences of only 0.2% can produce significant differences in the way drugs are handled within the body. Asian Americans are less likely to metabolize codeine to morphine, and Caucasians are known to be slow acetylators.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9-7

Question 19

Type: MCSA

Which statement is accurate regarding gender and pharmacology?

1. Women tend to seek medical care earlier than men do.

2. Currently, it is not considered sexual discrimination for health plans to exclude covering oral contraceptives.

3. Since the 1980s, the FDA has mandated that research studies include both male and female subjects.

4. Studies indicate that men and women suffer from Alzheimers disease in equal numbers.

Correct Answer: 1

Rationale 1: Women are quicker to seek medical care than are men. Studies indicate that more women than men suffer from Alzheimers disease. In 1993, the FDA mandated that research studies include both male and female subjects. In 2001, a federal court ruling deemed exclusion of oral contraceptives sexual discrimination.

Rationale 2: Women are quicker to seek medical care than are men. Studies indicate that more women than men suffer from Alzheimers disease. In 1993, the FDA mandated that research studies include both male and female subjects. In 2001, a federal court ruling deemed exclusion of oral contraceptives sexual discrimination.

Rationale 3: Women are quicker to seek medical care than are men. Studies indicate that more women than men suffer from Alzheimers disease. In 1993, the FDA mandated that research studies include both male and female subjects. In 2001, a federal court ruling deemed exclusion of oral contraceptives sexual discrimination.

Rationale 4: Women are quicker to seek medical care than are men. Studies indicate that more women than men suffer from Alzheimers disease. In 1993, the FDA mandated that research studies include both male and female subjects. In 2001, a federal court ruling deemed exclusion of oral contraceptives sexual discrimination.

Global Rationale:

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 9-8

Question 20

Type: MCMA

The nurse is assessing several patients. For which patient does assessment reveal a psychosocial history that may affect the patients outcome?

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

Standard Text: Select all that apply.

1. Older adult who recently suffered a stroke, has an unsteady gait, and lives in a two-story home

2. Middle-aged patient with Down syndrome living in a group home

3. Recently divorced mother of three children with breast cancer

4. Sixteen-year-old requesting birth control without parental consent

5. Seven-year-old with asthma in a foster care home

Correct Answer: 1,2,3

Rationale 1: This patient may not be able to return to a home that requires climbing stairs.

Rationale 2: A patient with Down syndrome needs additional care to ensure that treatment outcome is successful.

Rationale 3: This patient may be the familys sole provider and may have financial concerns.

Rationale 4: Many teens seek contraception without their parents consent. This should not have a negative impact on outcome.

Rationale 5: Residing in foster care should not have a negative impact on outcome.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9-3

Question 21

Type: MCMA

The nurse in charge of a clinical study welcomes the participants in an open forum. One patient is surprised that there are men and women from several ethnic groups. The nurse tells the group that in the past, ethnic variables were largely unknown or ignored for what reasons?

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

Standard Text: Select all that apply.

1. Clinical trials failed to include ethnically diverse subjects.

2. Clinical trials comprised mostly Caucasian males.

3. Little attention was focused on identifying the different effects drugs had on various ethnic groups.

4. Research proved there were no differences among ethnic groups.

5. The large majority of clinical trials included Caucasian females.

Correct Answer: 1,2,3

Rationale 1: There was a lack of ethnic diversity in early clinical trials.

Rationale 2: Until recently, clinical trials comprised mostly Caucasian males.

Rationale 3: Little attention was focused on identifying the differences in pharmacologic effects in diverse ethnic groups.

Rationale 4: There was insufficient research to show differences because little attention was focused on these differences.

Rationale 5: The large majority of clinical trials excluded females.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-3

Question 22

Type: MCMA

The nurse in the emergency department is caring for several patients from diverse cultures. Which statement shows the nurses ability to provide culturally competent care?

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

Standard Text: Select all that apply.

1. I understand your religion prohibits blood transfusions. Would you consider nonblood alternatives?

2. I just want to make sure you and your spouse understand the risks as you consider the options.

3. I dont really understand why you are afraid to take the medication. Do you have any questions I can answer to alleviate your fear?

4. I really dont understand why you wont consider an abortion. Your admission papers say you are an atheist.

5. Im not quite sure why the health care provider is giving you these prescriptions. You didnt get them filled the last time you were here.

Correct Answer: 1,2,3

Rationale 1: This statement shows the nurse is respectful of religious beliefs and open to offering alternative treatment.

Rationale 2: This statement shows the nurse is accepting of patients beliefs.

Rationale 3: This statement may encourage the patient to open up to the nurse about fears.

Rationale 4: This is a judgmental and insensitive comment. A culturally competent nurse is sensitive to the patients spiritual beliefs or lack thereof.

Rationale 5: This statement does not consider social factors that may contribute to nonadherence.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9-5

Question 23

Type: MCMA

A home health nurses patient caseload is ethnically diverse. Which interventions show understanding of cultural variables?

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

Standard Text: Select all that apply.

1. Discussing cultural preferences for herbs and spices and possible alternatives when drug interactions are possible

2. Assessing the patients response to acupuncture for pain

3. Discussing the patients beliefs regarding treatment

4. Notifying the health care provider of the patients intentions to consult with a medicine man for spiritual guidance

5. Removing the patients collection of herbs to decrease the risk of an adverse effect when taken with Western medicine

Correct Answer: 1,2,3

Rationale 1: It is important to assess the cultural use of herbs and spices and determine if there may be any interactions with prescribed medications.

Rationale 2: The nurse can assess the patients response to acupuncture and interpret the effects on prescribed treatment with respect for the patients culture.

Rationale 3: Cultures view health and wellness in different ways. An understanding of the patients cultural beliefs allows the nurse to provide better support and guidance.

Rationale 4: As long as the medicine man does not prescribe any herbs, the nurse does not have to discuss this with the provider.

Rationale 5: The nurse need not remove the herbs but rather should discuss possible adverse effects when the herbs are mixed with prescribed medications.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-5

Question 24

Type: MCMA

A patient asks the nurse why a medication prescribed by the provider didnt do anything at all. Which statement by the nurse accurately describes how genetics influence drug action?

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

Standard Text: Select all that apply.

1. Genetic differences can result in significant differences in how each patients body handles the same medication.

2. Genetic differences can cause mutations in enzymes, changing the way they function. This can alter how the body metabolizes and excretes drugs.

3. Because of genetic differences, medication may accumulate to toxic levels in one patient while in another patient may be inactivated before it can have a therapeutic effect.

4. Genetic differences can be expressed as an alteration in the structure of an enzyme, which can cause a defective receptor and an allergic response to drugs.

5. Genetic differences in patients who are biracial result in an allergic response to medications.

Correct Answer: 1,2,3

Rationale 1: 99.8% of human DNA sequences are identical. The remaining 0.2% can account for significant differences in peoples ability to handle medications.

Rationale 2: The structure of an enzyme is closely related to its function. A mutation can cause a change in the structure of the enzyme, resulting in a change in its function.

Rationale 3: When enzymes are functionally changed by genetics, metabolism and excretion can be altered, resulting in the drug either accumulating or being inactivated.

Rationale 4: Small changes in the structure of a protein may result in a defective receptor that will not accept the drug and the drug not having any therapeutic effect.

Rationale 5: Genetic differences can result in mutations of enzymes or proteins, which may result in changes in function. Being of a certain race may predispose a patient to mutations and, therefore, uncommon responses to medication, but this does not mean the patient will have an allergic response to medications.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9-6

Question 25

Type: MCMA

A nurse administering medications to a variety of patients on a medical-surgical floor recognizes that which patients may need additional education about medication adherence?

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

Standard Text: Select all that apply.

1. Fifty-year-old recently remarried male taking antihypertensive medication

2. Thirty-four-year-old female with family history of blood clots taking an estrogen oral contraceptive

3. Sixty-eight-year-old male recently started on antidepressants known to cause gynecomastia

4. Twenty-eight-year-old female started on acne medication known to cause male-patterned hair growth

5. Seventy-eight-year-old male taking estrogen as therapy for prostate cancer

Correct Answer: 1,2,4

Rationale 1: Antihypertensive medications can cause impotence. This patient will need additional education about this possible side effect.

Rationale 2: Estrogen can cause an increased risk for thrombolytic events, especially in patients who have a positive family history.

Rationale 3: Men at this age usually already have some degree of enlargement of breast tissue due to decreasing testosterone and would not necessarily need additional education to prevent medication nonadherence.

Rationale 4: Some acne medications cause increased hair growth in a male pattern, such as on the face. While controlling acne is a goal, the patient may not want the extra hair growth.

Rationale 5: Although estrogen therapy can result in breast enlargement, men at this age usually already have some degree of breast enlargement due to decreased testosterone levels.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 9-7

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

Copyright 2014 by Pearson Education, Inc.

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