Question 1

A woman from an Arab culture is in labor and delivery. Her husband insists he must stay with her and will not allow her to receive any analgesia. Which action by the nurse is the most appropriate?&#10;A) Inform the husband that he must sign a release of responsibility to avoid future litigation against the hospital.&#10;B) Allow this request, and be available in the event the request changes.&#10;C) Inform the husband that it is his wife's choice whether to receive analgesia.&#10;D) Allow the request, but inform the husband that the primary health care provider will make the final decision regarding analgesia.&#10;

Accepted Answer

Rationale 1: When cultural differences are allowed and supported, clients are not as likely to initiate litigation.
Rationale 2: Nurses must allow and support cultural differences. The husband's decisions must be respected as long as the client's safety is not jeopardized.
Rationale 3: In some cultures, the husband, not the wife, makes the choices for health care.
Rationale 4: In some cultures, the husband, not the primary health care provider, makes the health care decisions.

Question 2

A male client comes to the emergency department with chest pain. Upon assessment the nurse notes that his blood pressure is 210/100 mmHg. The client's wife says to the nurse, "He has not been taking his blood pressure medication, and the cost is covered under our drug plan." What should the nurse's plan of action include?

A) Plan to assess the client for any cultural concerns about the medication.
B) Plan to teach the client the importance of taking his medication.
C) Plan to assess the client for sexual side effects such as erection difficulty.
D) Plan to design a teaching plan about medication that includes the client's wife.

Plan to assess the client for sexual side effects such as erection difficulty.

Accepted Answer

Rationale 1: Assessment of cultural beliefs is important, but with this particular medication, assessment of side effects is initially more important.
Rationale 2: It is premature to teach the importance of medication to the client without first assessing the reason for non adherence.
Rationale 3: A common side effect of antihypertensive medication in males is sexual difficulty, such as erection problems.
Rationale 4: While this may be advisable, it is not the most important action of the nurse at this time.

Question 3

Which of the following client assessment reveals a psychosocial history that may affect the client's outcome?&#10;A) Older first nation adult who has had a stroke that lives in a remote northern community.&#10;B) Middle-aged client with alcoholism living on the street.&#10;C)S even-year-old with asthma in a foster care home&#10;D) Sixteen-year-old requesting birth control without parental consent&#10;E) Recently divorced mother of three children with breast cancer&#10;

Accepted Answer

Rationale 1: This client may not have access to health care in order to monitor effects of medications.
Rationale 2: A client with alcoholism living on the street may need additional care to ensure that treatment outcome is successful.
Rationale 3: Residing in foster care should not have a negative impact on outcome.
Rationale 4: Many teens seek contraception without their parents' consent. This should not have a negative impact on outcome.
Rationale 5: This client may be the family's sole provider and may face financial barriers to compliance with pharmacotherapy.

Question 4

The nurse in the emergency department is caring for several clients from diverse cultures. Which statements show the nurse's ability to provide culturally competent care?&#10;A) &#34;Can you tell me why you are afraid to take the medication. Do you have any questions I can answer to alleviate your fear?&#34;&#10;B) &#34;I really don't understand why you won't consider an abortion. Your admission papers say you are an atheist.&#34;&#10;C) &#34;I'm not quite sure why the health care provider is giving you these prescriptions. You didn't get them filled the last time you were here.&#34;&#10;D) &#34;I understand your religion prohibits blood transfusions. Would you consider non-blood alternatives?&#34;&#10;E) &#34;I just want to make sure you and your spouse understand all risks as you consider the options.&#34;

Accepted Answer

Rationale 1: This statement may encourage the client to open up to the nurse about fears.
Rationale 2: This is a judgmental and insensitive comment. A culturally competent nurse is sensitive to the client's spiritual beliefs or lack thereof.
Rationale 3: This statement does not consider social factors that may contribute to non-adherence.
Rationale 4: This statement shows the nurse is respectful of religious beliefs and open to offering alternative treatment.
Rationale 5: This statement shows the nurse is accepting of clients' beliefs.

Question 5

Which of the following clients of the nurse may be at risk for less than optimal outcomes to pharmacotherapeutics?&#10;A) The client who lives in a remote northern community of 300 people.&#10;B) The college educated client who lives in a large urban community..&#10;C) The elderly recently widowed woman who is functionally illiterate.&#10;D) The young family who attends religious services regularly.&#10;E) The elderly male on a limited income

Accepted Answer

Rationale 1 Limited access to health care provider or facility may create significant obstacles to obtaining health care for a condition.
Rationale 2. There are no environmental or community concerns regarding this client.
Rationale 3. The nurse must be aware that these clients may not be able to read drug labels, understand written treatment instructions, or read brochures describing their disease or pharmacotherapy.
Rationale 4. When serious illness occurs clients may find comfort in and support from religious rituals and artifacts.
Rationale 5. Any individual on a limited income may not be able to afford prescription medications ordered for them, this may cause them not to seek treatment for health concerns.

Question 6

A client is prescribed a chemotherapeutic drug for treatment of leukemia and asks the nurse why a drug that can also cause cancer is being used to treat cancer. Which response by the nurse is the most appropriate?

A) "The incidence of carcinogenic effects is really quite small, and you shouldn't be concerned about it."
B) "Since you are receiving such potent drugs, they have to warn of you of every possible side effect."
C) "The risk for causing another cancer is there, but sometimes the benefit of the treatment outweighs the risks."
D) "The carcinogenic effects often do not show up for a few decades, and we want to cure this leukemia now."

Accepted Answer

Rationale 1: The incidence of carcinogenic drugs differs among drugs and is not always predictable.
Rationale 2: This response does not address the client's concers.
Rationale 3: The benefits of treatment sometimes do outweigh the risks; this provides an honest answer to the client.
Rationale 4: Although carcinogenic effects often do not show up for 20 or more years, this is not the best explanation.

Question 7

A nurse is admitting a client with diabetic mellitus. The client will be started on a new oral antihyperglycemic drug to manage blood glucose levels. Which information would be critical for the nurse to assess?

A) Medical history
B) Current lab results
C) Number of previous hospitalizations
D) Use of dietary supplements
E) Side effects of all medications the client is taking

Accepted Answer

Rationale 1: Medical history may reveal conditions that contraindicate the use of certain drugs.
Rationale 2: Current lab results may reveal important information about the health of organs, such as the kidneys and liver, which would be important to metabolism and excretion of drugs.
Rationale 3: Number of hospitalizations is not relevant to this admission..
Rationale 4: Some dietary supplements can interact with drugs.
Rationale 5: While this is good information, it is not relevant to this situation.

Question 8

A nurse teaching a prenatal class is reinforcing precautions concerning the use of medications during pregnancy. The nurse determines the class understands when the students make which comments?&#10;A) &#34;There are some medications I cannot take because I am pregnant and they could hurt my baby.&#34;&#10;B) &#34;I need to check with my doctor before I take any medication because some drugs can hurt my baby.&#34;&#10;C) &#34;I should consider all drugs to be harmful to my baby unless my doctor tells me it is okay.&#34;&#10;D) &#34;I have to be very careful to let all my health providers know that I am pregnant before they prescribe medications for me.&#34;&#10;E) &#34;Once into my second trimester, I won't need to worry about taking over-the-counter medications because the baby will be more fully-developed.&#34;&#10;

Accepted Answer

Rationale 1: Encouraging proper nutrition will not prevent drug-induced kidney problems.
Rationale 2: It is important to monitor lab tests for any indication that a nephrotoxic drug is having an adverse effect on the kidneys.
Rationale 3: It is important to recognize drugs that affect the kidneys, monitor lab values, and adjust doses if needed.
Rationale 4: Identifying present kidney impairment will allow the provider to adjust any nephrotoxic drug doses, which will minimize the strain on the kidney.
Rationale 5: Encouraging proper hydration will help to protect the kidneys by improving excretion of drugs.

Question 9

The nurse is caring for a client who has been admitted for uncontrolled hypertension and is being started on a second antihypertensive drug. The client asks the nurse why the health care provider ordered another drug instead of increasing the dose of the first drug. The nurse's response is based on which principles?

A) A second drug from the same class is added to prevent the dose of the first drug from being increased.
B) Adding a second drug may allow both drugs to be used at a lower dose.
C) The effect of two drugs from different classes may have a greater effect than two drugs from the same class.
D) Adding the second drug will result in an antagonist effect and result in an increase the effects.
E) Adding a second drug rather than increasing the dose of the first may decrease incidence of adverse effects.

Accepted Answer

Rationale 1: Keeping both doses low and taking advantage of an additive effect reduces the potential for adverse effects.
Rationale 2: Keeping both doses low and taking advantage of an additive effect reduces the potential for adverse effects.
Rationale 3: The two drugs will affect different receptor site to achieve the same goal, resulting in a greater response but at lower doses.
Rationale 4: Adding a second drug that has an antagonistic effect will result in canceling out the therapeutic effects of the first drug.
Rationale 5: Adding a second drug within the same class or from another class will allow lower dosing, which will decrease the potential for adverse effects.

Question 10

A nurse educator explaining drug allergies to students includes which statements in the teaching?&#10;A) &#34;Drug allergies occur with very small amounts of drug.&#34;&#10;B) &#34;The symptoms of drug allergies are unrelated to the pharmacologic actions of the drug.&#34;&#10;C) &#34;Drug allergies require a previous exposure to the drug.&#34;&#10;D) &#34;The symptoms of a drug allergy are produced by an underactive response by the body's defences.&#34;&#10;E) &#34;The severity of the allergic response is directly related to the dose of the drug.&#34;&#10;

Accepted Answer

Rationale 1: Drug allergies can occur with very small amounts of drug.
Rationale 2: The symptoms of drug allergies are unrelated to the pharmacologic actions of the drug and are attributed to the response of the body's defenses.
Rationale 3: Drug allergies require a previous exposure to the drug or a similar drug.
Rationale 4: The symptoms of a drug allergy are produced by a hyper-response of the body's defenses.
Rationale 5: The severity of the allergic response is unrelated to the dose of the drug.

Deck 3: Individual, Psychosocial, and Cultural Influences on Drug Responses