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Pharmacology Connections to Nursing Practice 1st Edition by Michael Patrick Adams – Test Bank 

 

Adams: Pharmacology: Connections to Nursing Practice, 1e

Chapter 3

Principles of Drug Administration

 

Learning Outcomes

  1. Outline a plan for improving patient adherence to the medication regimen.
  2. Describe how the storage of drugs can affect their effectiveness.
  3. Describe the components of a legal prescription and the abbreviations associated with drug orders.
  4. Relate the importance of dosing schedules to successful pharmacotherapeutic outcomes.
  5. Compare and contrast the three systems of measurement used in pharmacology.
  6. Explain the importance of properly documenting medication administration.
  7. Compare and contrast enteral, topical, and parenteral drug administration.

 

 

Learning Outcome 1 Outline a plan for improving patient adherence to the medication regimen.

 

 

  1. The client informs the nurse that her husband recently died, and she wishes to dispose of his unused pain medications, which include Percocet (oxycodone and acetaminophen) tablets. The nurse advises her to:
  1. Return them to the pharmacy.
  2. Flush them down the toilet.
  3. Throw them away in the trash.
  4. Save them in case she needs them herself at a later date.

Answer: 2

Rationale:

  1. Medications that no longer are used or have expired should be disposed of properly. It would not be necessary to return them to the pharmacy.
  2. The FDA advises that narcotics, such as Percocet, should be flushed down the toilet.
  3. Throwing them away in the trash is not safe, as they could be used by someone else.
  4. They might not be safe for her to take at a later date.

Cognitive Level: Application

Client Need: Safe, Effective Care Environment

Nursing Process: Implementation

Learning Outcome: 3-1

 

 

 

  1. The nurse is reviewing clients’ prescriptions prior to discharge. Which comment by the client would best indicate the client might be non-adherent to medication administration?
  1. “I know I should finish the entire prescription even if I feel better.”
  2. “I usually take this medication at bedtime, even though the label says to take it in the morning.”
  3. “I know my insurance policy will cover all of these prescriptions.”
  4. “I keep a written reminder in my kitchen and my bathroom to take all these pills at the right time.”

Answer: 2

Rationale:

  1. The client should take the entire prescription; this reflects the client’s intent to be adherent.
  2. There are many factors that can influence the client’s adherence to pharmacotherapy. One factor is self-adjustment of doses and schedules, indicated by the client’s statement regarding taking the medication at a time other than when prescribed. The nurse needs to explore why the client makes that change, and if drug therapeutics will be affected by the time change.
  3. Other factors influencing non-adherence include stopping the medication when the client feels better, lack of finances, and forgetting to take medications. The client indicates insurance is sufficient, so lack of finance will not be a problem.
  4. Other factors influencing non-adherence include stopping the medication when the client feels better, lack of finances, and forgetting to take medications. Keeping written reminders is a good way to help the client remember.

Cognitive Level: Application

Client Need: Safe, Effective Care Environment

Nursing Process: Evaluation

Learning Outcome: 3-1

 

Learning Outcome 2 Describe how the storage of drugs can affect their effectiveness.

 

  1. A client seen by the home health nurse keeps her medication stored in a medicine cabinet in her bathroom, explaining “I know they are safe from my grandchildren.” The nurse should respond:
  1. “Storing them in the bathroom exposes them to high humidity, which can enhance deterioration.”
  2. “As long as the lids are on tightly, they will be protected from the light and humidity, and are safe.”
  3. “It would be better to store them on your kitchen counter, where you can see them and will be reminded to take them.”
  4. “They should be safe there, and you can remember to take them when you brush your teeth each day.”

Answer: 1

Rationale:

  1. It is not recommended to store medications in the bathroom, as they are exposed to high humidity, which can cause deterioration of the pills.
  2. Even though the lids might be on tightly, the medications still are subject to humidity in the bathroom.
  3. Storing the medications on the kitchen counter makes them more visible but exposes them to light, which can also contribute to deterioration of some medications, and they would not be as safe.
  4. It is not recommended to store medications in the bathroom, as they are exposed to high humidity, which can cause deterioration of the pills.

Cognitive Level: Application

Client Need: Safe, Effective Care Environment

Nursing Process: Implementation

Learning Outcome: 3-2

 

 

  1. A client with a history of angina has been given a prescription for nitroglycerin sublingual tablets. The nurse instructs the client to have some medication available whenever away from home, and suggests the following:
  1. “Keep an extra bottle in your glove compartment.”
  2. “Wrap a few tablets in tin foil and keep them on your person.”
  3. “Carry an extra labeled bottle in your pocket or purse.”
  4. “Place a few pills in your wallet so you will always have them handy.”

Answer: 3

Rationale:

  1. Storing the pills in the glove compartment would expose them to extremes in temperatures, and they would not always be available to the client.
  2. Wrapping the pills in tin foil is not safe, as they are not marked.
  3. It would be most advisable to have a labeled bottle, so there is no question regarding identification and dose of tablet, and so they would be protected from light.
  4. Carrying the medications in a wallet is not as safe as carrying a marked prescription.

Cognitive Level: Comprehension

Client Need: Safe, Effective Care Environment

Nursing Process: Implementation

Learning Outcome: 3-2

 

 

Learning Outcome 3 Describe the components of a legal prescription and the abbreviations associated with drug orders.

 

 

  1. After checking the following newly written prescription on a client’s chart—Aspirin, 81 mg p.o. q.d., starting today—the nurse should take which action?
  1. Transcribe the order as written onto the medication administration record (MAR).
  2. Check with the pharmacist to verify that the client is not allergic to aspirin.
  3. Request that the pharmacist send a dose immediately to begin therapy.
  4. Contact the primary care provider to verify the abbreviation q.d.

Answer: 4

Rationale:

  1. The Institute for Safe Medical Practices recommends the abbreviation “q.d.” can lead to medication errors, and should be avoided. The words “daily” or “every day” should be used instead, and so the nurse needs to verify the abbreviation before transcribing it to the MAR.
  2. It would not be necessary to check with the pharmacist for allergies; the nurse can check the client’s chart or ask the client.
  3. The dose was not ordered STAT, and so it does not have to be sent immediately.
  4. The Institute for Safe Medical Practices recommends the abbreviation “q.d.” can lead to medication errors and should be avoided. The words “daily” or “every day” should be used instead and so the nurse needs to verify the abbreviation before transcribing it to the MAR.

Cognitive Level: Analysis

Client Need: Safe, Effective Care Environment

Nursing Process: Implementation

Learning Outcome: 3-3

 

 

  1. When transcribing an order for levothyroxine (Synthroid), the nurse recognizes the following is correct:
  1. Synthroid .125 mc
  2. Synthroid .1250 mg
  3. Synthroid 0.125 mg
  4. Synthroid 0.1250 mg

Answer: 3

Rationale:

  1. The correct notation contains a leading zero before the decimal point. Omitting the leading zero can contribute to incorrect dosing. Adding a zero after the dose is also incorrect.
  2. The correct notation contains a leading zero before the decimal point. Omitting the leading zero can contribute to incorrect dosing. Adding a zero after the dose is also incorrect.
  3. The correct notation contains a leading zero before the decimal point. Omitting the leading zero can contribute to incorrect dosing. Adding a zero after the dose is also incorrect.
  4. The correct notation contains a leading zero before the decimal point. Omitting the leading zero can contribute to incorrect dosing. Adding a zero after the dose is also incorrect.

Cognitive Level: Knowledge

Client Need: Safe, Effective Care Environment

Nursing Process: Assessment

Learning Outcome: 3-3

 

 

  1. The nurse is having difficulty reading an order written by the physician. Before transcribing the order, the nurse should take which action?
  1. Verify interpretation of the order with a colleague.
  2. Ask another physician on the unit to interpret the order.
  3. Contact the physician to clarify the order.
  4. Ask the client what plan of treatment was discussed with the physician.

Answer: 3

Rationale:

  1. Verifying an order with another colleague could lead to errors if the colleague incorrectly interprets what is written.
  2. Another physician or care provider cannot be held responsible for what another physician has written, and should not be consulted.
  3. The nurse must contact the person responsible for writing the order to properly verify exactly what was written.
  4. Asking the client what was discussed does not guarantee the order will be correctly verified.

Cognitive Level: Comprehensive

Client Need: Safe, Effective Care Environment

Nursing Process: Implementation

Learning Outcome: 3-3

 

 

Learning Outcome 4 Relate the importance of dosing schedules to successful pharmacotherapeutic outcomes.

 

  1. At 3:00 p.m., a client phones into the clinic and informs the nurse he has forgotten to take the 10:00 a.m. dose of a medication, and that another dose is due at 4:00 p.m. The nurse informs the client to:
  1. Take a double dose of the medication at 4:00 p.m.
  2. Take the missed dose now and take the 4:00 p.m. dose at 8:00 p.m.
  3. Omit the 10:00 a.m. dose and take the 4:00 p.m. dose as ordered.
  4. Omit today’s doses and resume taking them as ordered tomorrow.

Answer: 3

Rationale:

  1. It would be unsafe to take a double dose of the medication.
  2. It would not be necessary to adjust doses and change times of administration.
  3. When a client realizes he has missed a dose of medication, but it is very close to when the next dose is due, skipping the missed dose and resuming the medication as scheduled are recommended.
  4. Too many doses would be missed if the client waits until the next day to resume taking the medication.

Cognitive Level: Application

Client Need: Safe, Effective Care Environment

Nursing Process: Implementation

Learning Outcome: 3-4

 

 

  1. A client is to receive a dose of furosemide (Lasix) 40 mg IV stat. The nurse plans to administer the medication:
  1.  Immediately.
  2. As required by the client’s condition.
  3. When the next scheduled dose of medications is due.
  4. When the next delivery of medications from the pharmacy is made.

Answer: 1

Rationale:

  1. The word stat is used when a medication needs to be given immediately, usually due to an emergency situation or life-threatening condition.
  2. A “p.r.n.” or pro re nata order is given as required by a client’s condition or request, such as pain medications.
  3. Giving the dose with the next scheduled time for drugs could cause a serious delay in treatment.
  4. Waiting for a delivery of drugs from the pharmacy can also cause a serious delay; stat doses of drug are often procured from a stock supply on the floor, or a special delivery must be sent from the pharmacy.

Cognitive Level: Comprehension

Client Need: Safe, Effective Care Environment

Nursing Process: planning

Learning Outcome: 3-4

 

 

  1. A client has an order for acetaminophen (Tylenol) 625 mg p.o. every four hours p.r.n. The client received a dose at 1000, and is requesting another dose at 1230. The nurse should take which action?
  2. Administer 625 mg of acetaminophen.
  3. Administer half of the 625mg dose of acetaminophen
  4. Inform the client it is too early for another dose of acetaminophen.
  5. Administer 625 mg of acetaminophen and explain that another dose cannot be given for six hours.

Answer: 3

Rationale:

  1. It would be unsafe to give the 625 mg of acetaminophen at 1230.
  2. 325 mg of acetaminophen cannot be given, since this amount was not ordered.
  3. A drug ordered p.r.n. is administered as needed by the client, but also must adhere to the time limits given. The client should not receive another dose until 1400.
  4. An adjustment in the time of administration cannot be made by the nurse.

Cognitive Level: Application

Client Need: Safe, Effective Care Environment

Nursing Process: Implementation

Learning Outcome: 3-4

 

 

Learning Outcome 5 Compare and contrast the three systems of measurement used in pharmacology.

 

  1. The nurse is administering a medication the client has brought from home. The label indicates the dose is one teaspoon. The nurse prepares:
  1. 1 ml.
  2. 5 ml.
  3. 10 ml.
  4. 15 ml.

Answer: 2

Rationale:

  1. The conversion of household to metric is one teaspoon equals 5 ml.
  2. The conversion of household to metric is one teaspoon equals 5 ml.
  3. The conversion of household to metric is one teaspoon equals 5 ml.
  4. The conversion of household to metric is one teaspoon equals 5 ml.

Cognitive Level: Knowledge

Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

Nursing Process: Implementation

Learning Outcome: 3-5

 

 

  1. The nurse is preparing to administer 1.5 ounces of milk of magnesia to a client. The nurse prepares:
  1. 15 ml.
  2. 30 ml.
  3. 45 ml.
  4. 60 ml.

Answer: 3

Rationale

  1. The conversion of household measurements to metric is one ounce equals 30 ml; 1.5 ounces equals 45 ml.
  2. The conversion of household measurements to metric is one ounce equals 30 ml; 1.5 ounces equals 45 ml.
  3. The conversion of household measurements to metric is one ounce equals 30 ml; 1.5 ounces equals 45 ml.
  4. The conversion of household measurements to metric is one ounce equals 30 ml; 1.5 ounces equals 45 ml.

Cognitive Level: Comprehension

Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

Nursing Process: Implementation

Learning Outcome: 3-5

 

  1. A client has an order for acetaminophen grains X for temperature above 39 degrees centigrade. The medication is supplied in milligrams. The nurse prepares which dose?
  2. 250 mg
  3. 300 mg
  4. 500 mg
  5. 600 mg

Answer: 4

Rationale:

  1. One grain is equivalent to 60 mg; 10 grains x 60 mg = 600 mg.
  2. One grain is equivalent to 60 mg; 10 grains x 60 mg = 600 mg.
  3. One grain is equivalent to 60 mg; 10 grains x 60 mg = 600 mg.
  4. One grain is equivalent to 60 mg; 10 grains x 60 mg = 600 mg.

Cognitive Level: Comprehension

Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

Nursing Process: Implementation

Learning Outcome: 3-5

 

Learning Outcome 6 Explain the importance of properly documenting medication administration.

 

 

  1. The nurse prepares a unit dose of acetaminophen (Tylenol) for a client who reported having a headache. When the nurse goes to administer the medication, the client states the headache “is not so bad” and declines the medication. The nurse should take which action?
  1. Document the medication on the medication administration record (MAR), since it has been recorded as being removed from stock.
  2. Return the medication to stock and record the client’s comments on the chart.
  3. Document the client’s refusal, and save the medication for possible later use.
  4. Flush the medication down the toilet, since it can no longer be used.

Answer: 2

Rationale:

  1. It should not be recorded in the MAR, since it was not administered to the client.
  2. Since the medication is unit dose, it can be returned to stock, and the client’s comments and refusal of the medication should be recorded.
  3.  It is not safe to save the medication for later use; it is best to return it to stock.
  4. As long as the medication has not been removed from the unit dose packaging, it can be returned to stock, and does not need to be wasted.

Cognitive Level: Comprehension

Client Need: Safe, Effective Care Environment

Nursing Process: Implementation

Learning Outcome: 3-6

 

  1. The nurse should intervene when a nursing student is observed doing which of the following?
  1. Documenting a medication in the medication administration record (MAR) just prior to administering it
  2. Checking the client’s identification bracelet and asking for a birth date prior to administering medications
  3. Documenting a client’s refusal to take a prescribed medication
  4. Documenting administration of a medication five minutes after it has been administered

Answer: 1

Rationale:

  1. Medications should not be documented before they are given; the client might refuse the medication or be unable to take it, and this practice can lead to many errors.
  2. The client’s identification and birth date should be verified prior to giving medications.
  3.  A client’s refusal to take mediations should be documented.
  4. Medications should be documented as soon after administering them as possible.

Cognitive Level: Application

Client Need: Safe, Effective Care Environment

Nursing Process: Implementation

Learning Outcome: 3-6

 

 

Learning Outcome 7 Compare and contrast enteral, topical, and parenteral drug administration.

 

  1. When administering sublingual nitroglycerin to a client, the nurse places the tablet:
  1. On top of the tongue.
  2. Between the gum and cheek.
  3. Under the tongue.
  4. Along the cheek at the back of the mouth.

Answer: 3

Rationale:

  1. Lozenges or troches are placed on top of the tongue.
  2. Buccal tablets are placed between the gum and cheek.
  3. Sublingual tablets are placed under the tongue.
  4. No specific medication is placed at the back of the mouth.

Cognitive Level: Knowledge

Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

Nursing Process: Implementation

Learning Outcome: 3-7

 

 

  1. The nurse is preparing to administer an intramuscular injection (IM) into the dorsogluteal site. The nurse plans to insert the needle at which angle?
  1. 30 degrees
  2. 45 degrees
  3. 75 degrees
  4. 90 degrees

Answer: 4

Rationale:

  1. Intradermal injections may be given at 30 degrees.
  2. Subcutaneous injections are given at a 45 degree angle.
  3. IM injections are generally administered at a 90-degree angle, unless the client is extremely thin or emaciated and adjustment of angle is warranted.
  4. IM injections are generally administered at a 90-degree angle, unless the client is extremely thin or emaciated and adjustment of angle is warranted.

Cognitive Level: Knowledge

Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

Nursing Process: Implementation

Learning Outcome: 3-7

 

 

  1. When administering an intramuscular injection into the deltoid muscle, the nurse recalls that the volume in the syringe should not exceed:
  2. 0.5 ml.
  3. 1 ml.
  4. 2 ml.
  5. 3 ml.

Answer: 2

Rationale:

  1. The deltoid muscle is a small muscle, and volume should not exceed 1 ml. Volumes of 2 and 3 ml are considered excessive.
  2. The deltoid muscle is a small muscle, and volume should not exceed 1 ml. Volumes of 2 and 3 ml are considered excessive.
  3. The deltoid muscle is a small muscle, and volume should not exceed 1 ml. Volumes of 2 and 3 ml are considered excessive.
  4. The deltoid muscle is a small muscle, and volume should not exceed 1 ml. Volumes of 2 and 3 ml are considered excessive.

Cognitive Level: Knowledge

Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

Nursing Process: Implementation

Learning Outcome: 3-7

 

 

Adams: Pharmacology: Connections to Nursing Practice

Chapter 17

Cholinergic Agonists

 

Learning Outcome 1 Identify the physiologic responses that occur when a drug activates cholinergic receptors.

 

  1. Stimulation of the cholinergic receptors can cause which of the following conditions?
  1. Constipation
  2. Vomiting
  3. Muscle strength
  4. Muscle weakness

Answer: 3

Rationale:

  1. Stimulation of cholinergic receptors causes the intestinal walls to contract and increase peristalsis.
  2. Stimulation of cholinergic receptors increases peristalsis.
  3. Stimulation of cholinergic receptors increases muscle contractibility.
  4. Stimulation of cholinergic receptors increases, not decreases, muscle tone.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome 17-1

 

 

  1. Cholinergic drugs are most often indicated in which situation?
  1. Inhibiting muscular contractions in the bladder
  2. Preventing excess salivation and sweating
  3. Lowering intraocular pressure in patients with glaucoma
  4. Treating a patient with bradycardia

Answer: 3

Rationale:

  1. Cholinergic drugs would have the opposite effect in the bladder.
  2. Cholinergic drugs would likely cause these symptoms as side effects.
  3. Cholinergic drugs are most often indicated to lower intraocular pressure in patients with glaucoma.
  4. Cholinergic drugs would likely worsen bradycardia, and must be used with caution in patients with CAD.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome 17-1

 

 

  1. The most significant difference between neostigmine versus physostigmine is that physostigmine:
  2. Cannot counteract neuromuscular blocking effect.
  3. Is less effective for treating overdoses of muscarinic-blocking drugs.
  4. Has no adverse effects.
  5. Does not cross the blood-brain barrier.

Answer: 4

Rationale:

  1. It is more likely that neostigmine will not be able to counteract neuromuscular blocking effect.
  2. Neostigmine is less effective for treating overdoese of muscarinic-blocking drugs than physostigmine.
  3. The two have similar adverse effects
  4. Physostigmine does not cross the blood-brain barrier.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome 17-1

 

Learning Outcome 2 Compare and contrast the mechanisms of action for direct- and indirect-acting cholinergic agonists.

 

  1. A side effect to expect from an anticholinergic agent, like atropine, does not include:
  2. Dilated pupils.
  3. Urinary retention.
  4. Dry mouth.

Answer: 4

Rationale:

  1. Anticholinergic agents could cause dilated pupils as a sympathetic nervous system effect.
  2. Anticholinergic agents could cause urinary retention as a sympathetic nervous system effect.
  3. Anticholinergic agents could cause dry mouth as a sympathetic nervous system effect.
  4. Diarrhea is not a side effect of anticholinergic agents.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome 17-2

 

 

  1. A client has received a dose of atropine in the preoperative area. On the way to the operating room, the client complains of a sudden feeling of warmth. The client’s skin is flushed, warm, and dry. The nurse’s actions should include:
  2. Notifying the surgeon of the client’s vital signs.
  3. Assessing the vital signs and advising the OR that surgery must be delayed for one hour.
  4. Assessing the client’s mental status and vital signs. If normal, document finding and proceed to operating room.
  5. Explaining the side effects of atropine to the client.

Answer: 3

Rationale:

  1. Notifying the surgeon of the client’s vital signs would only be necessary if the client’s vital signs were abnormal. The symptoms described are common for the medication given.
  2. Delaying the surgery would be inappropriate given the timing and half-life of atropine.
  3. Assess the client’s mental status and vital signs. If normal, document the finding and

proceed to operating room and report the finding to the surgeon and anesthesiologist.

  1. Explaining the side effects of atropine to the client is appropriate, but not the most appropriate, as documentation of the vital signs would be more critical.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome 17-2

 

 

  1. The nurse recognizes that neuromuscular blocking agents do not alter perceptions of pain during medical procedures. Prior to receiving the medication, the nurse asks the client to communicate pain by blinking. Is this method of communication appropriate given the medication’s action?
  2. Yes, during the procedure only
  3. Yes, for the first 24 hours postoperatively
  4. Yes, for 72 hours postoperatively
  5. No, the medication would prohibit this type of communication.

Answer: 4

Rationale:

  1. A client who has received a neuromuscular blocking agent cannot communicate.
  2. A client who has received a neuromuscular blocking agent cannot communicate.
  3. A client who has received a neuromuscular blocking agent cannot communicate.
  4. The action of a neuromuscular blocking agent would prohibit communication. Treatment of pain and anxiety is a standard of care during use of neuromuscular blocking agents.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome 17-2

 

Learning Outcome 3 Differentiate among the following types of cholinergic drugs: direct muscarinic agonists, indirect muscarinic agonists, and nicotinic agonists.

 

  1. Clients who receive which of the following medications can be expected to have neuromuscular pain the first postoperative day?
  2. Succinylcholine (Anectine)
  3. Atracurium (Tracrium)
  4. Pancuronium
  5. Tubocurarine

Answer: 1

Rationale:

  1. Succinylcholine can cause pain for 2–3 days postoperatively secondary to muscle contraction.
  2. Neuromuscular pain is not a side effect of atracurium.
  3. Neuromuscular pain not a side effect of pancuronium.
  4. Neuromuscular pain not a side effect of tubocurarine.

Cognitive Level: Implementation

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome 17-3

 

 

  1. Why would physostigmine be preferred over neostigmine to reverse muscarinic toxicity?
  2. Pharmacodynamics
  3. Pharmacokinetics
  4. No adverse effects
  5. Cost efficiency

Answer: 2

Rationale:

  1. Neostigmine cannot cross the blood-brain barrier.
  2. Because of the effects at the blood-brain barrier
  3. Neostigmine can still cause adverse effects without therapeutic response.
  4. Both drugs are generic and widely available.

Cognitive Level: Knowledge

Client Need: Physiological Assessment

Nursing Process: Assessment

Learning Outcome 17-3

 

Learning Outcome 4 Differentiate between the pharmacotherapy of cholinergic crisis and myasthenic crisis.

 

  1. Identify a way to differentiate between a cholinergic crisis and a myasthenic crisis from among the following:
  2. Ask the patient about his family and occupational history.
  3. Administer edrophonium and monitor the client’s response.
  4. Assess serum levels of the cholinesterase inhibitor.
  5. Assess the neuromuscular status of the client.

Answer: 2

Rationale:

  1. Asking the patient about their family and occupational history is helpful, but not diagnostic.
  2. This is diagnostic test for myasthenic crisis.
  3. Assessing serum levels of the cholinesterase inhibitor does not correlate with physical symptoms.
  4. Assessing the neuromuscular status of the patient will not differentiate between the two conditions.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome 17-4

 

  1. A client with myasthenia gravis is receiving therapy with neostigmine. The client telephones to report severe abdominal pain for the last four hours. The nurse’s most appropriate response would be:
  2. “This is a common side effect, and should resolve when you have a bowel movement.”
  3. “You are probably constipated. Take a laxative and return to the office in the morning.”
  4. “Increase your evening dose of medication. This should resolve your pain.”
  5. “You need to be evaluated immediately for a bowel obstruction.”

Answer: 4

Rationale:

  1. Neostigmine can cause some constipation, but should not cause severe abdominal pain.
  2. Advising the client to take a laxative and return to the office in the morning could cause a perforated bowel if the client’s bowel were obstructed.
  3. Increasing the evening dose of medication could worsen the obstruction.
  4. Advise the client to be evaluated immediately for a bowel obstruction.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome 17-4

 

 

  1. Cholinesterase inhibitors can:
  2. Prevent transmission at muscarinic, ganglionic, and neuromuscular junctions.
  3. Intensify transmission at neuromuscular junctions only.
  4. Intensify transmission at muscarinic, ganglionic, and neuromuscular junctions.
  5. Prevent transmission at neuromuscular junctions only.

Answer: 1

Rationale:

  1. They can act on all three sites.
  2. They prevent transmission at all sites.
  3. They break apart the neurotransmitter acetylcholine, which is vital for the transmission of nerve impulses.
  4. Cholinesterase inhibitors are used to reduce the action of cholinesterase, thereby making more acetylcholine available to nerve cells in the brain.

Cognitive Level: Knowledge

Client Need: Physiological Assessment

Nursing Process: Assessment

Learning Outcome 17-4

 

 

 

 

 

 

 

Learning Outcome 5 Describe the pharmacotherapy of myasthenia gravis.

 

  1. While assessing a patient before administering neostigmine for myasthenia gravis management, the nurse documents that the patient has increased muscle strength compared with the last assessment over an hour ago. Your interpretation of this data should be:
  2. The patient’s dose should be increased.
  3. The medication appears to be effective.
  4. The next dose of the medication should not be given.
  5. Toxicity from the medication is imminent.

Answer: 2

Rationale:

  1. The patient has already gained some strength from the previous dose.
  2. This is the expected outcome.
  3. There is no mention that the patient is hypereflexive.
  4. There is no indication that the patient is hypereflexive.

Cognitive Level: Evaluation

Client Need: Physiological Assessment

Nursing Process: Assessment

Learning Outcome 17-5

 

 

  1. A patient who is suspected to have myasthenia gravis is given a small dose of postoperative medication. The patient subsequently develops increased muscle weakness. Which medication should the nurse anticipate administering immediately?
  2. A cholinesterase inhibitor
  3. A dopamine agonist
  4. A sympathetic stimulant
  5. A calcium channel blocker

Answer: 1

Rationale:

  1. This would increase muscle strength.
  2. This would relax the peripheral muscles.
  3. A parasympathetic stimulant would be needed.
  4. This would relax cardiac contractility.

Cognitive Level: Knowledge

Client Need: Physiological Assessment

Nursing Process: Assessment

Learning Outcome 17-5

 

 

  1. A patient entering the hospital for a prostatectomy questions whether he should take his normal medications for myasthenia gravis prior to coming to the hospital. In particular, he needs to know when to take his ambenonium (Mytelase). You:
  2. Advise him to take his medication as scheduled.
  3. Advise him to hold the medication.
  4. Ask if he is able to empty his bladder prior to taking his medication.
  5. Consult with the urologist performing the case.

Answer: 1

Rationale:

  1. The patient should take his medication, so muscle strength and contractibility during the surgery won’t be compromised.
  2. This would inhibit the bladder’s emptying during the surgery.
  3. Even if he can empty the bladder now, he might not be able to without his medication after anesthesia is given.
  4. This can be handled by good nursing evaluation.

Cognitive Level: Application

Client Need: Physiological Assessment

Nursing Process: Assessment

Learning Outcome 17-5

 

Learning Outcome 6 Identify the prototype and representative drugs, and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

 

  1. In the postoperative client, the nurse recognizes that bethanecol (Urecholine) might be given to treat:
  1. Urinary atony.
  2. Ischemic colitis.
  3. Postoperative hypotension.
  4. Respiratory atelectasis.

Answer: 1

Rationale:

  1. Bethanecol (Urecholine) might be given to treat a urinary atony in a postoperative patient.
  2. Urecholine should not be given in any case suspicious for GI obstruction or ischemia.
  3. Urecholine could cause worsening of the hypotension secondary to bradycardia.
  4. Urecholine could cause worsening secondary to respiratory depression.

Cognitive Level: Application

Client Need: Physiological Assessment

Nursing Process: Assessment

Learning Outcome 17-6

 

 

  1. Common side effects of bethanecol include:
  1. Hypertension.
  2. Constipation.
  3. Tachycardia.
  4. Abdominal cramping.

Answer: 4

Rationale:

  1. More commonly, bethanecol would cause hypotension.
  2. Bethanecol might cause diarrhea and abdominal cramping.
  3. Bethanecol might cause bradycardia.
  4. Abdominal cramping is a common side effect of bethanecol.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome 17-6

 

 

  1. Common side effects from anticholinergic drugs include all of the following, except:
  1. Diarrhea.
  2. Dilated pupils.
  3. Blurred vision.
  4. Dry mouth.

Answer: 1

Rationale:

  1. Anticholinergic drugs would more commonly cause constipation.
  2. Dilated pupils are expected as a side effect of anticholinergic drugs.
  3. Blurred vision is expected as a side effect of anticholinergic drugs.
  4. Dry mouth is expected as a side effect of anticholinergic drugs.

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome 17-6

 

Learning Outcome 7 Apply the nursing process to care for patients receiving drug therapy with cholinergic agonists.

 

  1. Caution should be used in administering cholinergic drugs to patients with a history of:
  1. Glaucoma.
  2. Benign prostatic hypertrophy.
  3. Leg cramps.
  4. Heartburn.

Answer: 2

Rationale:

  1. Would improve glaucoma symptoms by constriction.
  2. Cholinergic drugs might increase bladder tone, which would cause the patient to have difficulty with urination.
  3. Leg cramps are not a common adverse effect.
  4. The nurse should use caution when administering a cholinergic drug to a patient with a GI obstruction, but not one with heartburn.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome 17-7

 

 

  1. A priority nursing diagnosis in the patient receiving anticholinergic drugs would be:
  1. Impaired Gas Exchange related to respiratory secretions.
  2. Injury Risk related to CNS changes related to medications.
  3. Urinary Retention related to loss of bladder tone.
  4. Knowledge Deficit related to new medications.

Answer: 1

Rationale:

  1. Impaired gas exchange related to respiratory secretions is the most critical priority.
  2. Injury risk related to CNS changes related to medications is also present, but less critical than impaired gas exchange.
  3. Urinary retention related to loss of bladder tone is present, but not an immediate priority.
  4. Knowledge deficit related to new medications is present, but not an immediate priority.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Diagnosis

Learning Outcome 17-7

 

 

  1. A migrant worker presents to the Emergency Department with signs of an acute, recent organophosphate poisoning exposure. Which treatment plan should the nurse expect?
  2. Give neostigmine as the antidote.
  3. Keep the patient relaxed and quiet; administer no medications.
  4. Treat the symptoms with echothiophate.
  5. Administer a stat dose of pralidoxime as an immediate antidote.

Answer: 4

Rationale:

  1. Neostigmine is not an antidote; it would have the opposite effect.
  2. Organophosphate poisoning requires immediate life-saving interventions.
  3. Echothiophate is not an antidote: it would have the opposite effect.
  4. Administer a stat dose of pralidoxime or atropine as an immediate antidote.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome 17-7

 

Adams: Pharmacology: Connections to Nursing Practice

Chapter 36

Drugs for Hypertension

 

Learning Outcome 1 Explain how hypertension is classified.

 

  1. The client has a blood pressure reading of 126/84 mm/Hg. She asks the nurse if she has high blood pressure. What is the best response by the nurse?
  2. “Your blood pressure is normal.”
  3. “Your blood pressure is high-normal.”
  4. “You have prehypertension.”
  5. “You have stage I hypertension.”

Answer: 3

Rationale:

  1. Normal blood pressure is < 120/80.
  2. High-normal is an older classification that is no longer in use.
  3. According to JNC-7, prehypertension includes individuals with systolic readings of 120–130 mm/Hg or diastolic readings of 80–89 mm/Hg.
  4. Stage I hypertension is systolic 140–159 or diastolic 90–99.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 36-1

 

  1. The nurse is counseling a client with prehypertension. Which is the most appropriate statement by the nurse?
  2. “You must begin medication.”
  3. “Let’s discuss your lifestyle.”
  4. “Prehypertension will progress to hypertension.”
  5. “Prehypertension isn’t really serious.”

Answer: 2

Rationale:

  1. Prehypertension is initially treated with lifestyle modifications.
  2. Prehypertension should be initially treated by modification in lifestyle.
  3. Many individuals can treat prehypertension with lifestyle modifications, and will never progress to hypertension.
  4. Prehypertension is always serious, and requires lifestyle modifications.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 36-1

 

  1. A client’s blood pressure is 158/94. The blood pressure was elevated at the last visit two weeks ago. The nurse anticipates that the physician will:
  2. Send the client home, because the blood pressure is normal.
  3. Have the client return for a third blood pressure check.
  4. Diagnose the client with hypertension.
  5. Order further tests.

Answer: 4

Rationale:

  1. The client’s blood pressure is classified as stage I hypertension.
  2. Diagnosis of hypertension is usually made after two separate high readings.
  3. This answer is OK, but further testing should be done to rule out secondary causes.
  4. Further testing is indicated to rule out secondary hypertension and evaluate target end-organ damage.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome: 36-1

 

Learning Outcome 2 Summarize the long-term consequences of untreated hypertension.

 

  1. The client recently was diagnosed with hypertension with a sustained blood pressure of 144/90 mm/Hg. The client is concerned about effects on the body. What effects of hypertension on the body will the nurse include in her education of this client? Select all that apply.
  2. Heart failure
  3. Blindness
  4. Liver failure
  5. Stroke
  6. Kidney damage

Answer: 1, 2, 4, 5

Rationale:

  1. By increasing the work of the heart, hypertension can lead to heart failure.
  2. By damaging the retinal arteries, hypertension can lead to blindness.
  3. Liver failure is not caused by systemic hypertension.
  4. Hypertension increases the risk of both hemorrhagic and thrombotic stroke by weakening arteries and promoting atherosclerosis.
  5. Hypertension damages the arteries of the glomerulus, leading to kidney disease.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 36-2

 

  1. The physician asks you to monitor a client with stage II hypertension for signs of kidney damage. Which of the following would indicate kidney damage?
  2. Urine output of 60 ml/hr
  3. Estimated glomerular filtration rate of 105
  4. Proteinuria
  5. Dysuria

Answer: 3

Rationale:

  1. Urine output of 30 ml/hour is considered normal.
  2. GFR of 105 is considered normal.
  3. Proteinuria is a very common sign of kidney damage due to hypertension.
  4. Dysuria is not a sign of kidney damage.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome: 36-2

 

 

Learning Outcome 3 Compare and contrast the roles of non-pharmacologic and pharmacologic methods in the management of hypertension.

 

  1. The client has been recently diagnosed with hypertension. Assessment data includes:

Weight: 200 pounds

Height: 5’ 4”

Diet: mostly starches

Alcohol intake: three beers/week

Stressors: Works 60 hours/week.

In planning care with this client, what is the priority outcome?

  1. Client will balance diet according to the food pyramid.
  2. Client will decrease stress by limiting work to 40 hours/week.
  3. Client will eliminate alcohol from the diet.
  4. Client will achieve and maintain optimum weight.

Answer: 4

Rationale:

  1. A balanced diet is important, but not the priority outcome.
  2. Decreasing stress is important, but not the priority outcome.
  3. Eliminating alcohol is important, but not the priority outcome.
  4. Achieving and maintaining optimum weight is of greatest importance when a client has hypertension. For obese clients, a 10–20-pound weight loss can produce a measurable change in blood pressure.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome: 36-3

 

 

  1. The nurse is teaching the client about lifestyle modifications to help manage the client’s hypertension. The nurse determines that teaching has been effective when the client makes which statement?
  2. ”I need to get started on my medications right away.”
  3. “I won’t be able to run the marathon anymore.”
  4. “My father had hypertension, did nothing, and lived to be 90 years old.”
  5. “I know I need to give up my cigarettes and alcohol.”

Answer: 4

Rationale:

  1. Implementing lifestyle modifications might eliminate the need for pharmacotherapy, so the client might not have to take medication right away.
  2. Increasing physical activity is an important lifestyle modification for controlling hypertension.
  3. The fact that the client’s father had hypertension and lived to be 90 years old does not mean that the client will have the same experience; the client is in denial.
  4. Limiting intake of alcohol, and discontinuing tobacco products, are important non-pharmacological methods for controlling hypertension.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Evaluation

Learning Outcome: 36-3

 

  1. The nurse is teaching the client about lifestyle modifications to help manage the client’s hypertension. The nurse determines that teaching has been effective when the client makes which statement?
  2. “As long as I take my medications, I don’t need to make any lifestyle changes.”
  3. “Lifestyle changes always get blood pressure down to normal levels.”
  4. “I will probably need to change my lifestyle and take medications.”
  5. “Lifestyle changes are just a way to make you feel like you’re doing something.”

Answer: 3

Rationale:

  1. Most hypertensive clients require multiple drugs. Lifestyle changes can reduce the number of drugs and the dose required to control blood pressure. In some clients, lifestyle changes alone can control blood pressure.
  2. While lifestyle changes are an important part of hypertension treatment, many clients will also require pharmacologic therapy.
  3. Most clients with hypertension do best with a combination of drug therapy and lifestyle changes.
  4. Lifestyle changes are an important part of hypertension treatment. Weight loss and dietary changes both have shown to yield substantial blood pressure changes.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Evaluation

Learning Outcome: 36-3

 

Learning Outcome 4 Describe general principles guiding the pharmacotherapy of hypertension.

 

  1. A client does not want to take hypertension medication, and asks why it is needed, as the client feels fine. The nurse should reply:
  2. “If the hypertension is severe, symptoms could arise.”
  3. “You’re right, there is no need for these medications.”
  4. “The medications can prevent complications from hypertension.”
  5. “The medications can prevent worsening of the hypertension.”

Answer: 3

Rationale:

  1. While the statement is correct, it is the not the primary goal of hypertension treatment.
  2. Hypertension should always be treated.
  3. The primary goal of hypertension is to prevent complications of hypertension, such as stroke and blindness.
  4. While the statement is true, it is not the primary goal of hypertension treatment.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Evaluation

Learning Outcome: 36-4

 

  1. The nurse is caring for a client with a new diagnosis of hypertension and no other conditions. The nurse should anticipate that the first medication prescribed will most likely be:
  2. A thiazide-type diuretic.
  3. A beta blocker.
  4. An ACE inhibitor.
  5. A calcium channel blocker.

Answer: 1

Rationale:

  1. JNC VI recommends a thiazide-type diuretic as the first drug of choice for clients without other underlying factors.
  2. Beta blockers are recommended first-line drugs for patients with hypertension and heart disease.
  3. ACE inhibitors are recommended first-line drugs for patients with diabetes.
  4. Calcium channel blockers are not normally recommended as first-line drugs for hypertension alone.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome: 36-4

 

 

Learning Outcome 5 Identify drug classes used in the primary and alternate management of hypertension.

 

  1. A client with hypertension recently was diagnosed with diabetes. The client asks why the physician has prescribed an ACE inhibitor. The nurse responds:
  2. “It protects the heart.”
  3. “It protects the kidney.”
  4. “It protects the eye.”
  5. “It protects the nerves.”

Answer: 2

Rationale:

  1. ACE inhibitors can protect the heart from hypertension, but so can other drug classes.
  2. ACE inhibitors protect the kidney in clients with diabetes. By treating the client with an ACE inhibitor, the physician is dealing with the hypertension and diabetes at the same time.
  3. Any anti-hypertensive will protect the eye from hypertension.
  4. Nerves are typically damaged by hypertension, and ACE inhibitors do not protect the nerves.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 36-5

 

  1. A client is newly diagnosed with hypertension and diabetes. Which of the following drug classes is likely to be prescribed? Select all that apply.
  2. Thiazide diuretic
  3. ACE inhibitor
  4. Angiotensin receptor blocker
  5. Calcium channel blocker
  6. Beta blocker

Answer: 2, 3

Rationale:

  1. Thiazide diuretics treat hypertension, but do not help diabetes.
  2. ACE inhibitors and ARBs both protect the kidney in clients with diabetes. JNC VI recommends that clients with other compelling factors be given an antihypertensive that also treats the “other” factor.
  3. ACE Inhibitors and ARBs both protect the kidney in clients with diabetes. JNC VI recommends that clients with other compelling factors be given an antihypertensive that also treats the “other” factor
  4. Calcium channel blockers treat hypertension, but do not help diabetes.
  5. Beta blockers treat hypertension, but do not help diabetes, and can mask signs of hypoglycemia.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome: 36-5

 

  1. A client with a history of heart disease has been diagnosed with hypertension. Which of the following drug classes is likely to be prescribed?
  2. Thiazide diuretic
  3. ACE inhibitor
  4. Angiotensin receptor blocker
  5. Calcium channel blocker
  6. Beta blocker

Answer: 5

Rationale:

  1. Thiazide diuretics protect the heart from hypertension, but do not specifically help protect the heart from heart disease.
  2. ACE inhibitors can protect the heart from heart disease, but not to the extent that beta blockers can.
  3. Angiotensin receptor blockers can protect the heart from heart disease, but not to the extent beta blockers can.
  4. Calcium channel blockers protect the heart from hypertension, but do not specifically help protect the heart from heart disease.
  5. Beta blockers are typically given to clients with heart disease to protect the heart. JNC VI recommends that clients with other compelling factors be given an anti-hypertensive that also treats the “other” factor.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 36-5

 

 

Learning Outcome 6 Describe the pharmacological management of hypertensive emergencies.

 

  1. A client is treated in the Emergency Department for hypertensive emergency. The nurse anticipates treatment with which of the following drugs?
  2. Metoprolol
  3. Lisinopril
  4. Nitroprusside
  5. Clonidine

Answer: 3

Rationale:

  1. Metoprolol is not used for hypertensive emergencies.
  2. Lisinopril is not used for hypertensive emergencies.
  3. Nitroprusside is a direct vasodilator, and is typically used to lower blood pressure immediately during hypertensive emergencies.
  4. Clonidine is not used for hypertensive emergencies.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 36-6

 

  1. A client presents with a blood pressure of 210/124. The nurse recognizes that this is:
  2. Prehypertension.
  3. Stage I hypertension.
  4. Stage II hypertension.
  5. Hypertensive crisis.

Answer: 4

Rationale:

  1. Prehypertension is blood pressures 120/80–139/89.
  2. Stage I hypertension is blood pressures 140/90–159/99.
  3. Stage II hypertension is blood pressures greater than 160/100.
  4. Hypertensive emergencies are characterized by diastolic readings greater than 120 mm/Hg.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 36-6

 

  1. The client comes to the Emergency Department with a blood pressure of 200/120 mm/Hg. The physician orders hydralazine (Apresoline) IV. What will the nurse’s priority assessment include?
  2. Hypotension and tachycardia
  3. Hypotension and bradycardia
  4. Hypotension and hyperthermia
  5. Hypotension and tachypnea

Answer: 1

Rationale:

  1. Direct vasodilators produce reflex tachycardia, a compensatory response to the sudden decrease in blood pressure caused by the drug.
  2. Direct vasodilators produce hypotension and tachycardia, not bradycardia.
  3. Direct vasodilators do not affect body temperature.
  4. Direct vasodilators do not affect respiratory rate.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome: 36-6

 

 

Learning Outcome 7 For each of the classes shown in the chapter outline, identify the prototype and representative drugs, and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects.

 

  1. The client is receiving doxazosin (Cardura) for hypertension. He asks the nurse how the medication works. What is the nurse’s best response?
  2. “It works by causing your kidneys to excrete more urine.”
  3. “It works by making your blood vessels expand.”
  4. “It works by making your heart work more efficiently.”
  5. “It works by decreasing the release of your stress hormones.”

Answer: 2

Rationale:

  1. Excreting more urine is an effect of diuretic medications.
  2. Doxazosin (Cardura) is selective for blocking alpha-1 receptors in vascular smooth muscle, which results in dilation of arteries and veins.
  3. Increasing the efficiency of the heart is not an effect of doxazosin (Cardura).
  4. Decreasing the release of stress hormones is not an effect of doxazosin (Cardura).

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 36-7

 

  1. The nurse completed medication education with the client who receives hydrochlorothiazide (Hydrodiuril). The nurse determines that teaching has been effective when the client makes which statement?
  2. “I need to avoid salt substitutes and potassium-rich foods.”
  3. “If I develop a cough, I should call my doctor.”
  4. “I take my medication early in the morning.”
  5. “I really need to avoid grapefruit juice when I take this medication.”

Answer: 3

Rationale:

  1. Hydrochlorothiazide (Hydrodiuril) is a potassium-excreting diuretic, and potassium supplementation is often necessary.
  2. Development of a cough occurs with ACE inhibitors, not with diuretics.
  3. Taking hydrochlorothiazide (Hydrodiuril) early in the day will help prevent nocturia.
  4. Grapefruit juice inhibits the metabolism of the calcium channel blockers.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Evaluation

Learning Outcome: 36-7

 

  1. What is a priority nursing intervention for a client who has just begun antihypertensive treatment with enalapril (Vasotec)?
  2. Review the client’s lab results for hypokalemia.
  3. Take the client’s blood pressure.
  4. Order a sodium-restricted diet for the client.
  5. Monitor the client for headaches.

Answer: 2

Rationale:

  1. Enalapril (Vasotec) is more likely to cause hyperkalemia, not hypokalemia.
  2. Enalapril (Vasotec) might produce a first-dose phenomenon resulting in profound hypotension, which could result in syncope.
  3. Enalapril (Vasotec) does not affect sodium levels.
  4. Although headache is a side effect, it is not as big a priority as is profound hypotension.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 36-7

 

 

Learning Outcome 8 Use the nursing process to care for clients receiving anti-hypertensive drugs.

 

  1. The client comes to the Emergency Department with a blood pressure of 200/120 mm/Hg. The physician orders hydralazine (Apresoline) IV. What will the nurse’s priority assessment include?
  2. Hypotension and tachycardia
  3. Hypotension and bradycardia
  4. Hypotension and hyperthermia
  5. Hypotension and tachypnea

Answer: 1

Rationale:

  1. Direct vasodilators produce reflex tachycardia, a compensatory response to the sudden decrease in blood pressure caused by the drug.
  2. Direct vasodilators produce hypotension and tachycardia, not bradycardia.
  3. Direct vasodilators do not affect body temperature.
  4. Direct vasodilators do not affect respiratory rate.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome: 36-8

 

 

  1. The client with hypertension has experienced heart failure. The nurse notes that the client is receiving nifedipine (Procardia). What is a priority assessment for the nurse?
  2. Auscultate breath sounds for crackles.
  3. Review recent lab results for hypokalemia.
  4. Assess level of orientation.
  5. Assess urinary output.

Answer: 1

Rationale:

  1. Some calcium channel blockers can reduce myocardial contractility and can worsen heart failure. Crackles in the lungs can indicate pulmonary edema, which could indicate heart failure.
  2. Calcium channel blockers do not cause hypokalemia.
  3. Level of orientation could be decreased with heart failure, but it is not a priority assessment at this time.
  4. Urinary output could be decreased with heart failure, but it is not a priority assessment at this time.

Cognitive Level: Assessment

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 36-8

 

  1. The client has a nighttime cough related to taking enalapril (Vasotec). What is the best nursing intervention to promote rest in this client?
  2. Contact the physician for an order for a cough suppressant medication.
  3. Have the client sleep on two or three pillows at night.
  4. Have the client sit up at an 80-degree angle in a comfortable chair at night.
  5. Contact the physician for an order for a sedative-hypnotic medication.

Answer: 2

Rationale:

  1. An ACE-induced cough will not be relieved by cough medication.
  2. The client should sleep with her head elevated if a cough becomes troublesome when she is in a supine position.
  3. Sitting up at an 80-degree angle would be effective, but would be too uncomfortable for the client.
  4. A sedative-hypnotic medication would put the client to sleep, but do nothing to address the client’s cough.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 36-8

 

 

  1. The nurse is taking the initial history of a client admitted to the hospital for hypertension. The physician has ordered a beta-adrenergic blocker. Which statement by the client does the nurse recognize as most significant?
  2. “When I have a migraine headache, I need to have the room darkened.”
  3. “My father died of a heart attack when he was 48 years old.”
  4. “I don’t handle stress well; I have a lot of diarrhea.”
  5. “I have always had problems with my asthma.”

Answer: 4

Rationale:

  1. Beta-adrenergic blockers do not affect migraine headaches.
  2. Having a father who died of a heart attack when he was young is significant, but has no correlation to this client and the use of beta-adrenergic blockers.
  3. There is no correlation between increased stress, diarrhea, and beta-adrenergic blockers.
  4. With increased doses, beta-adrenergic blockers can slow the heart rate and cause bronchoconstriction. They should be used with caution in clients with asthma.

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome: 36-8

 

 

Adams: Pharmacology: Connections to Nursing Practice

Chapter 63

Enteral and Parenteral Nutrition

 

 

LEARNING OUTCOME 1 Compare and contrast the enteral and parenteral methods of nutrition.

 

  1. The nurse knows that parenteral nutrition will be used to meet the nutritional needs of a client:
  2. With HIV–AIDS.
  3. Receiving radiation therapy to the neck.
  4. In a comatose state.
  5. With a non-functioning GI tract.

 

Answer: 4

Rationale:

  1. A client with HIV–AIDS is a candidate for enteral nutrition.
  2. A client receiving radiation therapy to the neck is a candidate for enteral nutrition.
  3. A client in a comatose state is a candidate for enteral nutrition.
  4. A client with a non-functioning GI tract is not a candidate for enteral nutrition, but is a candidate for parenteral nutrition.

 

 

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome 63-1

 

  1. A nurse is providing information about nutritional support to a client, and explains that to benefit from enteral nutrition:
  2. Specialized nutrient formulas cannot be needed.
  3. It must be administered as a continuous infusion.
  4. The GI tract must be functional.
  5. The gag and swallow reflexes must be intact.

 

Answer: 3

Rationale:

  1. Enteral nutrition includes specialized nutrient formulas designed for patients with specific conditions such as renal, pulmonary, or hepatic diseases.
  2. Enteral nutrition can be delivered as intermittent or continuous infusion, or as a

bolus feeding.

  1. For the client to be able to receive enteral nutrition, the GI tract must be functional.
  2. A feeding tube can be used if the gag and swallow reflexes are not intact.

 

Cognitive Level: Application

Client Need: Physiologic Integrity

Nursing Process: Implementation

Learning Outcome 63-1

 

LEARNING OUTCOME 2

 

Distinguish among oligomeric, polymeric, modular, and specialized formulas for enteral nutrition.

 

  1. A nurse is instructing a client recovering from a severe burn injury about the importance of enteral nutrition. Which statement by the nurse is most accurate regarding this client’s need for nutritional support?

 

  1. “This product contains protein to support cell growth, and to maintain and repair body tissues.”
  2. “This product is designed for impaired hepatic function.”
  3. “This product is less likely to affect glucose levels.”
  4. “This product will maintain adequate hydration.”

Answer: 1

Rationale:

  1. Clients recovering from burn injuries have increased protein needs associated

with repair of body tissues.

  1. A client with a burn injury is more likely to experience renal impairment rather

than hepatic impairment.

  1. A product less likely to affect glucose levels is appropriate for clients who

have diabetes.

  1. Generally, enteral formulas do not provide adequate water in solution to maintain hydration, and additional free water is needed

 

Cognitive Level: Application

Client Need: Physiologic Integrity

Nursing Process: Implementation

Learning Outcome 63-2

 

  1. The nurse recognizes the best enteral formula for clients with digestive disorders is a:

 

  1. Specialized formula.
  2. Modular formula.
  3. Oligomeric formula.
  4. Polymeric formula.

 

Answer: 3

Rationale:

  1. Specialized formulas are designed for clients with renal failure, hepatic failure, pulmonary conditions, or enzyme deficiencies.
  2. Modular formulas contain a protein, carbohydrate, or lipid.
  3. Oligomeric formulas are easily absorbed into the body, requiring little digestion, and are most appropriate for clients with digestive disorders.
  4. Polymeric formulas require a fully functioning GI tract.

 

Cognitive Level: Application

Nursing Process: Implementation

Client Need: Physiological Integrity

Learning Outcome 63-2

 

 

LEARNING OUTCOME 3

 

Identify possible complications and adverse effects of enteral nutrition administration.

 

  1. In a client receiving enteral nutrition, which intervention is the nurse most likely to implement to reduce risk of aspiration?
  2. Add fiber to the formula.
  3. Elevate the head of bed to 30 degrees.
  4. Administer an anti-diarrheal agent.
  5. Administer the formula at room temperature.

 

Answer: 2

Rationale:

  1. Fiber is added to reduce diarrhea.
  2. Risk for aspiration is increased when a client is supine. Elevating the head of bed to 30 degrees during continuous feeding, and 30 minutes after a feeding, will decrease risk for aspiration.
  3. An anti-diarrheal agent is administered to manage diarrhea.
  4. Administering the formula at room temperature helps to decrease nausea and vomiting.

 

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome 63-3

 

  1. Damage to the nasal mucosa is associated with:
  1. Use of large-bore feeding tubes.
  2. Secure feeding tube placement.
  3. Alternating nares for feeding tube placement.
  4. Flushing the feeding tube before and after medication administration.

 

Answer: 3

Rationale:

 

  1. Extended use of large-bore nasal feeding tubes is associated with damage to the nasal mucosa.
  2. Securing a nasal feeding tube in the center position of the nare minimizes friction and decreases damage to the nasal mucosa.
  3. Alternating nares for feeding tube placement reduces damage to the nasal mucosa.
  4. Flushing the feeding tube before and after medication administration prevents clogging of the feeding tube. It is not associated with damage to the nasal mucosa.

 

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome 63-3

 

LEARNING OUTCOME 4

 

Identify and describe the major drug interactions that can occur when enteral nutrition formulas are given.

 

  1. A nurse is preparing to administer medications to a client receiving enteral nutrition. Which of the following medications should not be administered via a PEG tube?
  2. An elixir for oral administration
  3. A suspension for oral administration
  4. An enteric-coated pill for oral administration
  5. A reconstituted powder for oral administration

 

Answer: 3

Rationale:

  1. An elixir is a liquid form of medication, and can be administered via a PEG

tube.

  1. A suspension is a liquid form of medication, and can be administered via a PEG tube.
  2. An enteric-coated pill should not be crushed and administered via the PEG tube. A more appropriate drug or route should be determined.
  3. A reconstituted powder can be administered via a PEG tube.

 

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome 63-4

 

  1. A nurse is caring for a client who is prescribed phenytoin (Dilantin). To most effectively administer this agent, the nurse will:
  2. Check the client’s phenytoin (Dilantin) level before administering the dose.
  3. Dilute the liquid form of phenytoin (Dilantin) with 100 cc of water.
  4. Hold the enteral feeding two hours before and two hours after giving phenytoin

(Dilantin).

  1. Request an alternate form and route to administer the phenytoin (Dilantin).

 

Answer: 3

Rationale:

  1. It is appropriate to check a drug level prior to administering a drug. However,

the drug level will not affect procedures associated with drug administration.

  1. It is more common to dilute drugs with 30 cc of water. In addition, flushing

before and after administering the drug is recommended.

  1. When phenytoin is administered with an enteral feeding, it binds with proteins

in the enteral formula, which can result in subtherapeutic levels of the drug.

To avoid this, it is recommended that the feeding be held two hours before and two hours after administering the drug.

  1. Phenytoin (Dilantin) can be administered via a feeding tube, making it

unnecessary to request an alternate form and route.

 

Cognitive Level: Knowledge

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome 63-4

 

LEARNING OUTCOME 5

 

Implement nursing management for the care of patients receiving enteral feedings.

 

  1. The nurse anticipates that the plan for a client with insufficient weight gain will include:
  1. Increasing the delivery rate of the enteral formula.
  2. Providing free water to dilute a hypertonic formula.
  3. Decreasing the protein content of the formula.
  4. Change to a bolus feeding schedule.

 

Answer: 1

Rationale:

  1. Increasing the delivery rate will provide additional calories.
  2. Free water is used to dilute hypertonic solution, but it will not increase caloric intake.
  3. Decreasing the protein content of the formula will reduce its nutritional value. Typically, a restricted protein formula is used in clients with impaired renal function.
  4. Bolus feeding is a delivery method. To increase caloric intake, the amount of formula or type of formula will need to be modified.

 

Cognitive Level: Application

Client Need: Physiologic Integrity

Nursing Process: Planning

Learning Outcome 63-5

 

  1. To evaluate stabilization of the nutritional status in a client receiving enteral nutrition, the nurse will:
  2. Monitor daily weights.
  3. Monitor vital signs.
  4. Assess oral intake.
  5. Measure abdominal girth.

 

Answer: 1

Rationale:

  1. Daily weights will indicate if the client is losing, maintaining, or increasing

body weight.

  1. Vital signs can be used to evaluate the presence of infection and fluid volume

status.

  1. Generally, enteral nutrition is employed when oral intake is inadequate, and while oral intake can be monitored, it is not the most reliable parameter to evaluate this client’s nutritional status.
  2. 4. Abdominal girth is measured to evaluate abdominal distention.

 

Cognitive Level: Application

Client Need: Physiologic Integrity

Nursing Process: Evaluation

Learning Outcome 63-5

 

 

LEARNING OUTCOME 6

 

Discuss parenteral protein-sparing nutrition, peripheral vein parenteral nutrition, and central hyperalimentation, and the indications for the use of each.

 

  1. Prior to administering a hypertonic total parenteral nutrition solution, the nurse verifies that the client has:
  2. A central venous access device.
  3. An insulin coverage scale.
  4. Serum electrolyte imbalances.
  5. Robust peripheral veins.

Answer: 1

Rationale:

  1. A central venous access device, with confirmed placement, is required to infuse a hypertonic TPN solution.
  2. It is not necessary to have orders for insulin coverage prior to initiating TPN; however, it is important to monitor glucose levels.
  3. Electrolyte imbalances should be corrected prior to initiating therapy; however, the client does not have to have an electrolyte imbalance to receive TPN.
  4. Peripheral TPN is associated with a risk of phlebitis, so robust veins are required if it is to be administered. Peripheral TPN has a lower osmolality than does TPN administered via a central vein.

 

Cognitive Level: Application

Client Need: Physiologic Integrity

Nursing Process: Implementation

Learning Outcome 63-6

 

 

LEARNING OUTCOME 7

 

Describe the components of total parenteral nutrition solutions, and the function of each element in attaining the body’s daily requirements.

 

  1. The nurse knows that a fat emulsion is added to a parenteral nutrition solution to decrease:
  2. Triglyceride levels.
  3. Glucose levels.
  4. Amino acid levels.
  5. Albumin levels.

Answer: 2

Rationale:

  1. Hyperlipidemia is a side effect associated with fat emulsions.
  2. Fat emulsions are added to parenteral nutrition to decrease glucose levels by adding an additional source of energy.
  3. Protein is associated with amino acids.
  4. Albumin is a protein.

 

 

Cognitive Level: Knowledge

Client Need: Physiologic Integrity

Nursing Process: Implementation

Learning Outcome 63-7

 

 

  1. The nurse knows that amino acids, a component of total parenteral nutrition, are needed by the body to: (Select all that apply.)
  2. Serve as a primary source of calories.
  3. Promote production of proteins.
  4. Act as metabolic cofactors for enzymes.
  5. Conserve lean body mass.
  6. Promote wound healing.

 

Answer: 2, 4, 5

Rationale

  1. Carbohydrates and lipids are primary sources of calories in TPN.
  2. Amino acids promote production of proteins.
  3. Trace minerals are metabolic cofactors for enzymes.
  4. Adequate levels of amino acids will conserve lean body mass.
  5. Adequate levels of amino acids promote wound healing.

 

Cognitive Level: Application

Client Need: Physiologic Integrity

Nursing Process: Implementation

Learning Outcome 63-7

 

 

LEARNING OUTCOME 8

 

Describe possible complications of parenteral nutrition therapy.

 

  1. The nurse is assessing a client for complications associated with parenteral nutrition therapy. The nurse checks for crackles (rales) and weight gain to identify a(n):
  2. Air embolism.
  3. Fluid overload.

 

Answer: 4

Rationale:

  1. A pneumothorax is associated with sharp chest pain and decreased breath

sounds.

  1. Infection is associated with fever, increased WBC, and positive blood

cultures.

  1. Air embolism is associated with shortness of breath, chest pain, and cyanosis.
  2. Fluid overload is associated with dyspnea, distended neck veins, crackles (rales), and weight gain.

 

Cognitive Level: Application

Client Need: Physiologic Integrity

Nursing Process: Assessment

Learning Outcome 63-8

 

  1. To decrease the risk of infection associated with the introduction of bacteria from the TPN solution, the nurse will:
  2. Assess temperature daily.
  3. Use a 0.22 micron inline filter.
  4. Inspect the IV insertion site for redness.
  5. Change the dressing every three days

Answer: 2

Rationale:

  1. Assessing for a change in temperature can indicate infection, but it will not

reduce risk of infection.

  1. A 0.22 micron inline filter is used to reduce introduction of bacteria from the TPN solution.
  2. Redness at the IV site can indicate a local site infection.
  3. Changing the dressing will not decrease the bacterial content of the TPN solution.

 

Cognitive Level: Application

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome 63-8

 

 

LEARNING OUTCOME 9

 

Implement nursing management for the care of patients receiving total parenteral nutrition.

 

  1. A client receiving parenteral nutrition has an increased pulse, and pale, cool, clammy skin. Which of the following interventions will the nurse perform?
  2. Stop the parenteral nutrition infusion.
  3. Check blood glucose levels.
  4. Increase the parenteral nutrition infusion rate.
  5. Administer insulin coverage.

 

Answer: 2

Rationale:

  1. Parenteral nutrition should not be discontinued abruptly, because it can result in hypoglycemia.
  2. Blood glucose levels should be checked because the signs exhibited by the client are associated with hypoglycemia or excess insulin.
  3. Parenteral nutrition infusion rates are based on the nutrition goal to be achieved within an established timeframe. Increasing the infusion rate is not indicated.
  4. The signs exhibited by the client are associated with hypoglycemia, so insulin should not be administered to the client.

 

 

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome 63-9

 

  1. A nurse is caring for a client receiving parenteral nutrition therapy. In a stable patient, which of the following laboratory values will be monitored daily by the nurse?
  2. BUN
  3. Electrolytes
  4. Glucose
  5. Triglycerides

 

Answer: 3

Rationale:

  1. In a stable patient, BUN is monitored weekly.
  2. In a stable patient, electrolytes are monitored 1–2 times a week.
  3. In a stable patient, glucose is monitored daily.
  4. In a stable patient, triglycerides are monitored weekly.

 

Cognitive Level: Knowledge

Client Need: Safe, Effective Care Environment

Nursing Process: Assessment

Learning Outcome 63-9