Deck 10: Psychosocial and Cultural Influences on Pharmacotherapy

Question 1

The public health nurse notices that several clients 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 clients?

A) "Does your religion allow the use of high blood pressure medication?"
B) "Can you afford the high blood pressure medication?"
C) "Do you think your high blood pressure is a problem?"
D) "Does your culture use herbs to treat high blood pressure?"

Answer 1

"Can you afford the high blood pressure medication?"

Question 2

The client is an Aboriginal elder admitted to the hospital for chemotherapy. At any given time, five family members are in the client's room, which is private. The nurse tells the client 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 nurse's action?

A) The nurse should have assessed the client's preferences about how many family members she wanted to be present.
B) The nurse should have allowed the client to have as many family members as she wanted to be present.
C) The nurse should have called the physician and obtained an order for additional family members to be present.
D) This was the correct action; the nurse was following protocol by informing the client about hospital policy.

Answer 2

The nurse should have assessed the client's preferences about how many family members she wanted to be present.

Question 3

The nurse is conducting a holistic assessment of a client with alcoholism. What are the important questions to ask? Select all that apply.

A) "Have you been in alcohol rehabilitation before now?"
B) "What blood relatives of yours are addicted to alcohol?"
C) "Did you see your parents drinking alcohol when you were growing up?"
D) "How is drinking alcohol viewed by your culture?"
E) "Have you ever attended Alcoholic Anonymous meetings?"

Answer 3

"What blood relatives of yours are addicted to alcohol?"
"Did you see your parents drinking alcohol when you were growing up?"
"How is drinking alcohol viewed by your culture?"

Question 4

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

A) The wealthy client who can afford the best medical care available.
B) The client who is also seeing a psychiatrist for treatment of depression.
C) The client with a support group of cancer survivors.
D) The client who is a former physician.

Question 5

The client is diagnosed with cancer. The physician has recommended chemotherapy, which would likely save the client's life. The client 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?

A) With the client's permission, plan to involve a hospital minister to discuss the client's perspective about cancer.
B) With the client's permission, plan to meet with family members to discuss the client's perspective about cancer.
C) With the client's permission, plan to bring the case before the hospital's board of ethics.
D) With the client's permission, plan to contact the client's minister to discuss the client's perspective about cancer.

Question 6

The nurse is doing a holistic assessment on a client prior to the initiation of antihypertensive medication. What will the best assessment include? Select all that apply.

A) level of education
B) belief in a higher power
C) blood pressure
D) mood
E) the cause of the hypertension

Question 7

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

A) "Don't worry, we can recommend an excellent wig company if need be."
B) "We are not really sure; applying an ice bag to your head may help."
C) "It might. Have you discussed this with your physician?"
D) "Yes, that is one of the expected side effects of this medication."

Question 8

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

A) With the client's permission, plan to discuss his diet with whomever prepares meals for his family.
B) Plan to ask the physician for a consult by dietary services so a dietician can teach the client about low fat diets.
C) With the client's permission, plan to ask an East Indian nurse to speak to him about a low fat diet.
D) Plan to give the client information specific to East Indian-low fat diets.

Question 9

A client comes to the emergency department with chest pain; his blood pressure is 210/100 mm/Hg. The client's wife says to the nurse "He has not been taking his blood pressure medication, and we can afford it." What will the best plan of the nurse include?

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

Question 10

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

A) "Why didn't you take your medicine as we talked about?"
B) "Do I have to inform your physician about your noncompliance?"
C) "Are you able to read and comprehend the printed information?"
D) "Don't you understand how important it is to take the medicine?"

Question 11

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

A) "We may need less medication than other ethnic groups."
B) "We may need to have less frequent blood tests."
C) "We may need to have more frequent blood tests."
D) "We may need more medication than other ethnic groups."

Question 12

The client is admitted to the hospital following an abortion, and she is septic. The physician orders antibiotics that the client refuses stating, "I don't deserve them." The nurse providing care has anti -abortion beliefs. What is the best response by the nurse?

A) "Do you think you should be punished because you had an abortion?"
B) "I think you need to do what is best for you."
C) "I'll call your physician and let him know about your decision."
D) "You have a serious infection and really need the drug."

Question 13

The African -American client has panic attacks, is suicidal, and is on an inpatient psychiatric unit. The psychiatrist orders sertraline (Zoloft) and clonazepam (pms -Clonazepam). The client 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?

A) Allow the request after the client signs a release of responsibility to avoid litigation.
B) Allow the request after all members of the treatment team agree to it.
C) Allow the request without seeking further information from the client.
D) Allow the request as long as the herbs and objects do not pose a safety risk for the client or other clients.

Question 14

The adolescent Aborginal 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 nurse's evaluation?

A) The adolescent really does not need an additional dose of methylphenidate (Ritalin) at school.
B) The adolescent is embarrassed about having to take medicine at school; it is a social stigma.
C) The adolescent is fearful that this drug may be a "gateway drug" and he will abuse other substances.
D) The adolescent has developed alternative coping mechanisms to increase his focus during classes.

Question 15

The client is from an Arab culture and is in labour 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?

A) Inform the husband that it is his wife's choice whether or not to receive analgesia.
B) Allow this request, and be available in the event the request changes.
C) Inform the husband that he must sign a release of responsibility to avoid future litigation against the hospital.
D) Allow the request, but inform the husband that the physician will make the final decision about analgesia.